bluuebunny/crossref_metadata_2025 huggingface dataset:
Feature comparison residuals for foreign fibre classification model
Authors: Wei Wei , Zhou Xue , Huang Zhen , Su Zhiwei
Published: April 2024

Various types of foreign fibres may be mixed in the planting, transportation, and production processes of cotton, which not only cause equipment to be out of control, but also leads to a decrease in the quality of cotton textile products and economic losses. The machine vision based detection method for cotton foreign fibres is widely used. Based on existing related research, we construct a classification dataset for cotton foreign fibres in practical scenarios, named the CF2113‐10 dataset. The authors design a basic foreign fibre classification network called CottonNet that balances performance and efficiency. The classification accuracy on the validation set reached 94.2%. In order to enhance the high‐level feature extraction ability, this paper improves the feature fusion method of residual networks and proposes CottonNet‐Res, which improves the classification accuracy to 95.1%. Finally, a classification model based on feature difference fitting, CottonNet‐Fusion, is proposed to address the classification problem of foreign fibre images sampled in complex environments. The classification accuracy of foreign fibre images sampled in ordinary scenes has improved to 97.4%, while the images sampled in complex environments maintain an accuracy of 90.3%.
Design and validation of a novel semiconductor area optimised 3300 V SiC half bridge for MMC
Authors: Bergmann Lukas , Bakran Mark‐M.
Published: April 2024

This article presents the design and experimental validation of a novel semiconductor area optimised 3300 V half bridge with Silicon Carbide (SiC) MOSFETs for HVDC converters. Based on a loss simulation, the problem statement is provided. On this results, a mathematical derivation for the optimised semiconductor area design is executed. After this step, a system loss simulation shows the performance in efficiency and specific output power. Finally, a proof of concept was provided by a scaled hardware test setup to characterise the dynamic behaviour of the novel SiC half bridge design compared to the conventional SiC half bridge.
Optimal PV‐storage capacity planning for rail transit self‐consistent energy systems considering extreme weather conditions
Authors: Guo Siyu , Cai Liuyang , Wu Haiyi , Song Guanghui , Lin Li , Chen Yanbo
Published: April 2024

With the rapid development of electrified rail transportation, the traction load demand of rail transportation has increased sharply, and its operational security under extreme conditions has been highlighted. Given the above background, this paper proposes a planning method for the optimal photovoltaic (PV)‐storage capacity of rail transit self‐consistent energy systems considering the impact of extreme weather. First, the basic structure of a rail transit self‐consistent energy system is presented. Second, considering a power transmission system with line trip‐off under extreme weather conditions, a traction load reduction model is established to obtain the maximum power exchange capability between the power transmission network and rail substations. Subsequently, an optimal planning model for a hybrid energy storage system (HESS) is proposed to minimize the total HESS investment and rail transit system operation costs. Finally, the model is linearized as mixed‐integer linear programming and solved using Gurobi and the Yalmip toolbox. The simulation results verify the effectiveness of the proposed optimal PV‐storage capacity planning for rail transit self‐consistent energy systems.
First ALMA observations of the HD 105211 debris disc: A warm dust component close to a gigayear-old star
Authors: Yang Qiancheng , Liu Qiong , Kennedy Grant M. , Wyatt Mark C. , Dodson-Robinson Sarah , Akeson Rachel , Liao Nenghui
Published: April 2024

Context. Most debris discs consist of a gas-poor, cold dust belt located tens to hundreds of astronomical units away from the host star. Many cold dust belts exhibit distinct structures attributed to the dynamic interaction of planetary systems. Moreover, in a few systems, additional warm components can be found closer to the central star, resembling the asteroid belt or zodiacal dust in our Solar System.

Aims. In this work, we investigate the structure of the disc surrounding the nearby F2V star HD 105211 (η Cru, HIP 59072), which has a warm excess (seen with Spitzer/MIPS at 24 μm) and a potential asymmetry in the cold belt (seen in the Herschel/PACS images).

Methods. We applied the CASA pipeline to obtain the ALMA 1.3 mm continuum images of HD105211. Then we constructed the spectral energy distribution (SED) of the system and performed Markov chain Monte Carlo (MCMC) simulations to fit a model to the ALMA visibility data. To characterise the disc asymmetry, we analysed the ALMA images of two individual observation blocks (OB1, conducted on 2017 March 28, and OB2, conducted on 2018 May 9) and compared them to the previous Herschel images.

Results. Our modelling reveals that the disc around HD105211 is a narrow ring (23.6±4.6 au) with low eccentricity (e ≤ 0.03) positioned at a distance of 133.7±1.6 au from the central star, which differs from the broad disc (100 ± 20 au) starting at an inner edge of 87 ± 2.5 au, inferred from the Herschel images. We found that both observation blocks show excess emission at the stellar position (>3σ), while OB1 shows an offset between the star and the phase centre (~0.3″), and OB2 shows brightness clumps (~2σ). We used a two-temperature model to fit the infrared SED and used the ALMA detection to constrain the warm component to a nearly pure blackbody model.

Conclusions. The relatively low ratio of actual radius to blackbody radius of the HD 105211 debris disc indicates that this system is depleted in small grains, which could indicate that it is dynamically cold. The excess emission from the stellar position suggests that there should be a warm millimetre-sized dust component close to the star, for which we suggest two possible origins: in situ asteroid belt or comet delivery.
The effect of unequal load values on reinforced concrete deep beams
Authors: Abdulrazzaq Nawras T. , Abdul-Razzaq Khattab S.
Published: April 2024

One of the most important problems facing the behavior and strength of deep beams is the asymmetry of the load in terms of magnitude despite its presence in the center of the beam span. It is known that the compression paths (struts) that transfer the load from the support points to the load points are usually symmetrical in deep beams when the 2-point load is central and equal, but in the current research work these struts are asymmetrical as a result of the inequality of load. This led to the strut with the higher load failing before that with the lower load. Therefore, the deep beam fails early. Twelve deep beam specimens were analyzed using SAP2000 software, which is based on the finite element method. Unequal 2-point loads of 33%-67%, 25%-75%, and 12.5%-87.5% were adopted. This case was studied using different values of concrete's compressive strength of 20, 30, and 40 MPa. Accordingly, the load capacity, midspan deflection, positive moments, and shear stresses decreased by about 24-13%, 22-8%, 11-10%, and 15-13.5%, respectively.
m-rnc rings
Authors: Mahmood Ali Sh. , Mohammed Ibraheem Zubaida
Published: April 2024

In this article, an element w of an associative ring R is called m-regular nil clean or m-rnc if expressed as w = am + b where am is m-regular element and b is a nilpotent element. R is named m-regular nil clean ring or m-rnc ring. If all the elements of a ring R are m-rnc, some characteristics and basic properties of m-rnc rings are presented in this work.
Ancient Textual Restoration Using Deep Neural Networks
Authors: Abbas Ali Alkhazraji Ali , Khudair Baheeja , Mahdi Naser Alzubaidi Asia
Published: April 2024

Ancient text restoration represents a critical area in computer science because it reflects an imagination about human life in early eras. Deep leaning plays a crucial role in AI last few years, specifically Generative Adversarial Networks (GANs), to regenerate and acclimatize old manuscripts that have suffered from the time effects, degradation, or deterioration. This work used Codex Sinaiticus dataset that preprocessed by encoding the dataset after that number and special character have been removed, new line symbol has been removed, tokenization process has been used to separate each word as an instance. Class target has been generated by removing character making it as a target and replacing it with special character. Using produces Generative Adversarial Networks (GANs), which consist of generator and discriminator inside in one learning framework. The generator part responsible for generating the missing text while the discriminator evaluates the generated text. But using an iteratively procedure these networks together collaboratively to provide a very sensitive reconstruction operations with the same format of ancient manuscripts, inscriptions and documents. Three prediction models used as proposed techniques for retrieving missing ancient texts are LSTM, RNN, and GAN and the results was validation accuracy 86%,92% and 98% respectively.
A Multimodal Biometric System for Iris and Face Traits Based on Hybrid Approaches and Score Level Fusion
Authors: Najah Kadhim Ola , Hasan Abdulameer Mohammed , Mahdi Hadi Al-Mayali Yahya
Published: April 2024

The increasing need for information security on a worldwide scale has led to the widespread adoption of appropriate rules. Multimodal biometric systems have become an effective way to increase recognition precision, strengthen security guarantees, and reduce the drawbacks of unimodal biometric systems. These systems combine several biometric characteristics and sources by using fusion methods. Through score-level fusion, this work integrates facial and iris recognition techniques to present a multimodal biometric recognition methodology. The Histogram of Oriented Gradients (HOG) descriptor is used in the facial recognition system to extract facial characteristics, while the deep Wavelet Scattering Transform Network (WSTN) is applied in the iris recognition system to extract iris features. Then, for customized recognition classification, the feature vectors from every facial and iris recognition system are fed into a multiclass logistic regression. These systems provide scores, which are then combined via score-level fusion to maximize the efficiency of the human recognition process. The realistic multimodal database known as (MULB) is used to assess the suggested system's performance. The suggested technique exhibits improved performance across several measures, such as precision, recall, accuracy, equal error rate, false acceptance rate, and false rejection rate, as demonstrated by the experimental findings. The face and iris biometric systems have individual accuracy rates of 96.45% and 95.31% respectively. The equal error rates for the face and iris are 1.79% and 2.36% respectively. Simultaneously, the proposed multimodal biometric system attains a markedly enhanced accuracy rate of 100% and an equal error rate as little as 0.26%.
Model for Effective Rice Disease Recognition Based on Deep Learning Techniques
Authors: Bachay Firas Muneam , AL_Dujaili Mohammed Jawad , Al-Fatlawi Ahmed
Published: April 2024

Iraq’s primary crop, crucial for both domestic consumption and exports, is rice. The prevalence of rice infections poses a significant challenge to farmers, impacting crop yield and resulting in substantial losses. Human identification of diseases relies on expertise, making early diagnosis crucial for sustaining rice plant health. To address the limited number of rice leaf images in the database, our approach incorporates augmentation and dilation rate. Integrating drone technology and machine learning algorithms offers a promising solution to efficiently diagnose rice leaf diseases. However, existing methods face challenges such as picture backgrounds, insufficient field image data, and symptom variations. This work introduces a robust methodology, leveraging a specialized Convolutional Neural Network (CNN) model for rice leaf photos, effectively enhancing disease classification accuracy. The proposed approach successfully identifies and diagnoses three distinct classes: leaf smut, brown spot, and bacterial leaf blight.
Analysing the Performance of OFDM-SPM With and Without channel Coding to Enhance the Spectral Efficiency and BER
Authors: Naji Fadel Amneen , Hayder Hashim Issraa , Ali Aldhalemi Bannen , Jawad Kadhim Mohammed
Published: April 2024

A modulation technique has recently developed known as “OFDM with Subcarrier Power Modulation (OFDM-SPM)”. This technique utilizes two types of modulation. The first one called power modulation, where the power level of each subcarrier changes depending on the bit stream while transmit uses another type of conventional modulation such as a QPSK. The results shows that the adoption of OFDM with SPM improve the throughput, save the power, reduce the complexity, and so on. On the negative side, it shows degradation in the “Bit Error Rate” (BER) performance. In this paper, the convolutional code is the proposed to improve the BER while paired with the vitribi hard decision decoder which is considered easy to implement of the hardware and costs. the suggested methods will be discussed in the terms of throughput and BER with the three power reallocation policies ) PRPs).
A Review Study of the Optimized Cluster Head Placement of Transmit-Only Nodes in Wireless Sensor Networks
Authors: Hatash Reham , Al-Ibadi Mohanad , Al Hilli Ahmed , Ramadhan Ali J. , TaeiZadeh Ali
Published: April 2024

Wireless sensor networks (WSNs) with transmit-only (TO) nodes are gaining increased popularity, in particular, in applications requiring heavy deployment of sensor nodes in harsh and inaccessible environments. The data collected by the members of the WSN is relayed to a nearby base station (BS) via a cluster-head (CH). Since the nodes are usually battery-limited, it is important to optimize the location of the CH in the sensing environment to prolong the lifetime of the entire network. In this paper, we describe this problem using a general energy model and review the main articles that discuss the energy optimization problem in WSNs and summarize their important results, in addition to the basic working principles of the different widely used energy-optimization algorithms.
Review on rehabilitation of rc deep beams using external bonded frp and nsm technique
Authors: Naji Al-Husseiny Murtada , Hussein Kamonna Hayder
Published: April 2024

Due to a variety of reasons, including increased service loads, environmental impacts, construction errors, and mechanical impediments, the strengthening process was becoming necessary for many concrete buildings worldwide. The strengthening process is carried out in several ways, the most common of which are the Near-Surface mounted (NSM) technique and the External Bonded Reinforcement (EBR) technique. The main object of the strengthening process is to increase the strength and durability of reinforced concrete structures and reducing early failure. This research discussed the most important papers that dealt with strengthening deep beams due to their exposure to heat or extreme loads using two techniques (NSM) and (EBR). Several results were reached through experimental testing of the specimens of each research, especially the most important of them: First, making openings, when necessary, away from the loading path because the opening in the loading path reduces the capacity of the beam. Secondly, resorting to using the mechanical method when installing the fiber-reinforced polymer externally, as it greatly reduces the tearing and collapse of the sheets. Third, the number of layers must be less than three when using (GFRP) sheets in the strengthening process, as violating this will cause a decrease in the final capacity of the beam. Fourth, resorting to inclined schemes when strengthening deep beams or repairing them with various materials made of carbon fiber-reinforced polymer (FRP). Finally, it is possible to use (CFRP) bars with (NSM) technology, as this option can be relied upon to rehabilitate damaged structures.
A novel approach to social content recommendation using deep self-organizing maps and hierarchical clustering
Authors: Yousif Hawas Abbas , Adel Al-Shaher Mohamed
Published: April 2024

Social media platforms generate a large amount of content users create, which requires methods for suggesting relevant content. In current empirical research introduces an approach to improving social content recommendations using the Deep Self Organizing Map (DSOM) algorithm and hierarchical clustering. The study uses a database that includes user posts, comments, likes, shared content, and user profiles. The DSOM algorithm analyzes and organizes the data, while hierarchical clustering enhances performance. By utilizing the insights gathered from this social content database, we can significantly improve the accuracy and relevance of recommendations. This improvement will ultimately increase user engagement and satisfaction on social media platforms. The findings of this research have implications for recommendation systems on social media platforms and strategies related to promoting content and analyzing user behavior.
Properties of Energy-Like Statistics Under Squared Euclidean Distance and Exponential Gamma Distributions
Authors: Jebur Ali Ahmed , Ali Naji Abeer , Hussein Abd Zaid Baneen , Hataf Fazaa Kawthar , Ramadhan Ali J.
Published: April 2024

This study investigates distance-based statistical parameters and squared Euclidean distance for samples from exponential and gamma distributions. Statistical tests can be used as two-sample tests to determine the homogeneity between the distributions of two data sets, whether they are circular or linear. This study uses standard squared Euclidean distance linear data to calculate the properties of the proposed statistical tests, including one-dimensional and two-dimensional or higher assumptions.
Proposed new permutation method to secure data in cloud computing
Authors: Hussein Nage Noor , Abbas Hattab Anwar
Published: April 2024

The idea of cloud computing makes it possible to create a shared pool of reconfigurable computing resources (such servers, networks, storage, apps, and services) that can be released and deployed quickly with no administrative effort or communication with service providers. When data is stored in a remote data center, maintaining data security is essential. This can be achieved by encryption. Through the process of encryption, data is changed so that unauthorized users cannot read it.The proposed system uses a new encryption technique that is based on the mathematical properties of the data. The proposed system is more secure than traditional encryption techniques because it utilizes the mathematical properties of the data. It is also more efficient because it doesn't require as much computation as traditional encryption techniques, meaning that less computation is needed.
Use of Factor Scores in Multiple Regression Model for Predicting Customer Satisfaction in Online Shopping
Authors: Ramadhan Ali J. , Krishna Priya S. R. , Naranammal N. , Gautam Rajani , Mishra Pradeep , Ray Soumik , Abotaleb Mostafa , Alkattan Hussein , Albadran Zainalabideen
Published: April 2024

Online shopping can be done from our convenient places like home, office, etc., and the product will be delivered to the respective places. There are many factors influencing online shopping. The purpose of this study is to develop a statistical model that is used to determine the factors that influence online shopping. In this study, using factor analysis five main factors have been obtained from 15 variables that influence online shopping. These five factors have significant effects on satisfaction of customers and accounted up to 56% of total variation. Using the factor scores as independent variables, multiple regression model has been developed for predicting customers satisfaction in online shopping. Customer satisfaction has been used as dependent variable in the regression model. The five main factors that contribute online shopping are: preference of consumers towards online shopping, the risk involved in purchasing products through online, time effectiveness in online shopping, difficulties faced during online shopping and getting products from trustworthy websites.
Adomian decomposition method for solving nonlinear fractional delay differential equations
Authors: Gatea Ali Abdulsada
Published: April 2024

In this survey, presented numerical method said Adomian decomposition method (ADM) for settling nonlinear fractional delay differential equations (NFDDEs) .In this status use the fractional derivative with the Riemann-Liouville fractional (RLF) derivative and submitted the solution of some applications by numerically method. These results appear that the suggestion technique is very effective and simple to implement.
Variable selection in Poisson regression model based on chaotic meta-heuristic search algorithm
Authors: Alangood Heyaa Nadhim Ahmed , Algamal Zakariya Yahya , Khaleel Mundher Abdullah
Published: April 2024

By determining the most significant variables that are connected to the response variable, Increasing prediction accuracy and processing speed can be achieved through the process of variable selection. Regression modeling has drawn a lot of interest from several scientific domains. One of the most effective nature-inspired algorithms that has been suggested recently and can be used effectively for variable selection is the Firefly algorithm. The chaotic firefly algorithm is presented in this work to carry out the Poisson regression model's variable selection. A simulation study is carried out to assess how well the suggested strategy performs in terms of variable selection criteria and prediction accuracy. Its effectiveness is also contrasted with alternative approaches. The outcomes demonstrated the effectiveness of our suggested strategies, which beat other widely used approaches.
The effective role of temperature in improving the electrical conductivity and thermopower of n-PbTe films
Authors: Otajonov Salim , Khalilov Mukhammadmuso , Kochkorova Gulnara , Tishabayeva Irodaxon , Тeshaboyev Muhiddinjon , Tashlanova Nigora
Published: April 2024

This paper discusses the effective role of temperature in improving the electrical conductivity and thermoelectric power of n-PbTe films obtained by high-temperature evaporation. It has been established that an increase in the substrate temperature to 350-370 0С leads to an increase in thermopower and electrical conductivity due to an increase in the diffusion process, leading to an increase in blocks. It is found that the thermoelectric parameters strongly depend on the film thickness.
Technology for the formation and application of simulation modeling in the educational process
Authors: Suyumov Jurabek , Lutfillayev Makhmud , Yuldosheva Dilfuza , Xasanova Maxinur , Polvonov Alimirzo
Published: April 2024

The article discusses the technology of formation and application of simulation modeling in the educational process. It is based on the fact that the formation of computer skills is considered an important task when using computers in teaching subjects, developing strategies for finding solutions to both educational and practical problems, and predicting the process of educational problems. The pedagogical experiment was based on the qualimetric method, during which quantitative and qualitative indicators of student learning were determined.
Numerical simulation of the flow in a flat suddenly expanding channel based on a two-fluid turbulence model
Authors: Madaliev Erkin , Madaliev Murodil , Akramov Axror , Umurqulov Shahzod , Qurbonova Sarvinoz
Published: April 2024

The article presents the results of a numerical study of the flow structure in a flat channel in the zone of its sudden expansion in the form of a ledge. The calculations are based on the numerical solution of a system of non-stationary equations using a new two-fluid turbulence model. The results of the profiles of longitudinal velocity and turbulent stress in different sections of the channel before and after the ledge, as well as the change in the coefficient of friction for the lower wall of the channel depending on the distance after the ledge are obtained. For the difference approximation of the initial equations, the control volume method was used, and the relationship between velocities and pressure was found using the SIMPLEC procedure. In this case, the viscous terms were approximated by the central difference, and for convective terms, a second-order scheme of accuracy against the flow was used. To confirm the correctness of the numerical results, a comparison was made with experimental data from the NASA database for the Reynolds number Re=36000. And the influence of the calculated grid in the results of the study was also investigated.
Oscillatory flow of rheological complex fluid in a flat channel
Authors: Navruzov Kuralboy , Sharipova Shokhista
Published: April 2024

The article examines the oscillatory flow of rheological complex fluids in a flat channel, in which the rheological complex fluid was obtained based on the Maxwell model, and its mixture is described based on the Newtonian fluid model. Both mixtures of fluids are represented as a homogeneous model of a two-component liquid. In this case, differential equations of motion of homogeneous liquid mixtures are given. Based on this equation, the problem of oscillatory flows of rheological complex fluids in a flat channel is solved analytically. When solving, formulas are given for determining the longitudinal velocity. Using the obtained formulas, graphs of the longitudinal velocity distribution over the cross section of the channel are determined depending on the change in the oscillation frequency parameter, and with their help, appropriate conclusions are drawn.
Towards 2-μm comb light source based on multiple four-wave mixing in a dual-frequency Brillouin fiber laser
Authors: Deroh Moise , Xu Gang , Lucas Erwan , Beugnot Jean-Charles , Maillotte Hervé , Sylvestre Thibaut , Kibler Bertrand
Published: April 2024

In this study, we report the generation of multi-wavelength light sources through enhanced four-wave-mixing processes using a straightforward and adaptable dual-frequency Brillouin fiber laser. This passive optical and nonreciprocal cavity is first tested and analyzed with long fiber lengths up to 1 km in the 1.55 μm telecommunication C band and then in the 2-μm waveband. In the latter case, we demonstrate that our fiber cavity enables efficient multiple four-wave mixings, in the continuous-wave regime, which are commonly inaccessible in long silica-fibers due to increased losses. We also report on the tunable repetition rate from tens of GHz to hundreds of GHz, by simply changing the frequency spacing between the two continuous-wave pumps. The coherence limitations of our all-fiber system are discussed, along with the impact of the dispersion regime of the nonlinear fiber that forms the cavity.
Influence of structural parameters of descaling nozzle on jet behavior
Authors: Yang Bowen , Liu Guangqiang , Zhang Guoxin , Liu Kun , Han Peng
Published: April 2024

Compared to alternative descaling methods, the high-pressure water descaling technology offers cheaper costs and higher descaling rate, which has obvious advantages. As a key component, the descaling nozzle will have a direct impact on the descaling effect. Based on the detailed study of the traditional U-shaped and V-shaped grooving methods, this paper discovered a conical curve grooving method where the grooving curve shape factor lies between those of the two aforementioned methods, and established a full-scale model of the descaling nozzle. For the conical groove nozzle, numerical Computational Fluid Dynamics (CFD) simulations were performed using the shape factor of the groove curve between 0 and 1 and the throat diameter between 2.1 and 2.4 mm. It has been determined that a descaling nozzle with the shape factor between 0.75 and 0.9 has superior dynamic performance, and that when the throat diameter is between 2.3 and 2.4 mm, the nozzle has a higher outlet average velocity and a reasonable outlet flow rate. In conclusion, the dimensionless functional relationship between taper shape factor, throat diameter, nozzle outlet average velocity, effective descaling width and area is established in order to provide certain theoretical support for various production requirements of nozzles.
Turkish Cashier Problem with time windows and its solution by matheuristic algorithms
Authors: Bassaleh Ahmad , Duman Ekrem
Published: April 2024

Turkish Cashier Problem (TCP) is a new application area of the traveling salesman problem that was introduced to the literature recently. In this problem, the cashier can use public transportation or take a taxi where the cashier must visit multiple customer locations while minimizing the total transportation cost. In this study, we introduce a more realistic version of this problem where time has been integrated. This aspect is achieved by imposing time intervals within which the cashier must visit the customers. We name this problem as the TCP with time windows (TCPwTW). We develop several matheuristic algorithms to solve the TCPwTW: a modified version of the Simplify and Conquer (SAC) algorithm that was suggested for the TCP, simulated annealing (SA), original and modified versions of the migrating birds optimization (MBO) algorithm coupled with mathematical programming. We also tried to find the exact optimum using a Solver where for complex problems, only lower bounds were found. Numerical experimentation reveals that while for problems with loose time intervals, an exact solver can be considered. Once the time intervals tighten up, the best solutions can be obtained using matheuristics involving SA and MBO.
Akutes Koronarsyndrom mit instabiler Präsentation – Herz-Kreislauf-Stillstand und kardiogener Schock
Authors: Roßberg Michelle , Thiele Holger , Pöss Janine
Published: April 2024

Patienten mit einem akuten Koronarsyndrom (ACS) können sich mit einem Herz-Kreislauf-Stillstand und/oder einem kardiogenen Schock präsentieren. Die im August 2023 erschienene ACS-Leitlinie der Europäischen Gesellschaft für Kardiologie (ESC) widmet dem Management dieser instabilen Patientengruppen ein eigenes Kapitel. Patienten mit kardiogenem Schock infolge eines ACS sollen einer sofortigen invasiven Koronarangiografie unterzogen werden; bei erfolgreich Wiederbelebten ist nur dann eine schnellstmögliche Koronardiagnostik zu forcieren, wenn im EKG ST-Strecken-Hebungen persistieren oder bei kardiogenem Schock. Der Nutzen mechanischer Kreislaufunterstützungssysteme ist vor dem Hintergrund der neutralen bzw. uneinheitlichen Ergebnisse randomisierter Studien umstritten; sie sollten ausgewählten Patientengruppen vorbehalten werden. Nach Herz-Kreislauf-Stillstand wird eine Fiebervermeidung empfohlen, während der Benefit einer Hypothermie auf das Outcome unklar und Gegenstand
weiterer laufender Multicenterstudien ist.
Antithrombotische Therapie des akuten Koronarsyndroms – akut und Langzeit
Authors: Wassmann Sven
Published: April 2024

Die antithrombotische Therapie ist eine wichtige Komponente der Behandlung von
Patienten mit akutem Koronarsyndrom (ACS). Während die Antikoagulation meist nur in der
Akutphase benötigt wird, kommt dem Einsatz antithrombozytärer Substanzen eine große
Bedeutung in der Akut-, Erhaltungs- und Langzeittherapie des ACS zu. Aktuell ist eine
duale antithrombozytäre Therapie (DAPT) mit ASS und einem potenten P2Y12-Inhibitor für
12 Monate Standardtherapie. Da das insbesondere in der initialen Phase nach ACS erhöhte
ischämische Risiko im Verlauf abnimmt, das Blutungsrisiko aber kumulativ erhöht bleibt,
wurden DAPT-verkürzende und DAPT-deeskalierende antithrombozytäre Therapiekonzepte bei
ACS-Patienten in einer Vielzahl von Studien und Metaanalysen untersucht. Die aktuelle
ESC-Leitlinie zum akuten Koronarsyndrom von 2023 hat die neuen Therapiekonzepte und
umfangreichen Studiendaten zur antithrombotischen Therapie nach ACS aufgenommen und
gewertet und gibt Therapieempfehlungen im Sinne von Standard- und alternativen
Strategien. Therapieentscheidungen zur antithrombotischen Therapie nach ACS sollten
individuell in Abhängigkeit des ischämischen Risikos und Blutungsrisikos getroffen und
ggf. im zeitlichen Verlauf angepasst werden.
Handlungsempfehlungen von Trans*-Klientinnen zur Beziehungsgestaltung in der stimmtherapeutischen Arbeit
Authors: Stang Philipp , Probst Verena
Published: April 2024

Anhand einer qualitativen Querschnittsstudie wurden Trans*-Menschen zu ihren Empfehlungen hinsichtlich der Beziehungsgestaltung in der stimmtherapeutischen Arbeit mit einem teilstrukturierten Interview befragt. Mit Hilfe einer inhaltsanalytischen Auswertung konnten wesentliche Komponenten herausgearbeitet werden. Es entstand eine Handlungsempfehlung für die stimmtherapeutische Intervention.
Initiale Behandlung des akuten Koronarsyndroms: prähospitale Logistik und Notfalltherapie
Authors: Giannitsis Evangelos , Preusch Michael , Frey Norbert
Published: April 2024

Die prähospitale Phase vom medizinischem Erstkontakt, d. h. Phase des ACS, bis zur
Einlieferung ins geeignete Krankenhaus ist von großer Bedeutung, da in dieser Zeit eine
Triage des Patienten stattfindet und Entscheidungen getroffen werden zur optimalen
Verbringung des Patienten. In Deutschland steht dafür flächendeckend eine Bandbreite
etablierter Versorgungseinheiten wie Chest Pain Units und primäre PCI-Zentren sowie
„Cardiac Arrest Center“ zur Verfügung, sodass Zeitverluste bis zu einer primären
Revaskularisierung oder definitiven Diagnose oder Differenzialdiagnose minimiert werden
können. Neben der Überwachung der Vitalparameter und des EKGs kann eine Analgesie,
Antikoagulation und ggf. antithrombozytäre Therapie bereits vor Krankenhausaufnahme
initiiert werden.
Akutes Koronarsyndrom – Selektion invasive Strategie und Reperfusion
Authors: Zeymer Uwe , Zahn Ralf
Published: April 2024

Bei Patienten mit akutem Koronarsyndrom tragen 2 Parameter wesentlich zur
Entscheidungsfindung zur sofortigen invasiven Strategie bei: das EKG und die
hämodynamische Situation bei Aufnahme. Bei ST-Strecken-Hebungen und/oder kardiogenem
Schock ist eine sofortige invasive Strategie mit Reperfusion indiziert.

Bei Patienten ohne ST-Strecken-Hebungen sollte eine frühe Risikostratifizierung inkl.
serieller Troponinbestimmungen stattfinden. Bei hämodynamisch und rhythmologisch
stabilen Patienten mit Nicht-ST-Strecken-Hebungsinfarkt (NSTEMI) wird eine invasive
Diagnostik innerhalb von 24 Stunden nach Aufnahme empfohlen, während Patienten ohne
Troponindynamik oder sonstige Risikofaktoren elektiv mittels Kardio-CT,
Koronarangiografie oder nicht invasiver Ischämiediagnostik abgeklärt werden können. Auch
nach prähospitaler Reanimation ist nur beim ST-Strecken-Hebungsinfarkt (STEMI) und/oder
kardiogenem Schock eine sofortige invasive Diagnostik indiziert. Die
Reperfusionstherapie beim STEMI sollte routinemäßig mit perkutaner Koronarintervention
(PCI) stattfinden, nur bei sehr langen Verzögerungen (> 2 Stunden nach
Diagnosestellung) zur PCI kann eine Fibrinolyse erfolgen, die aber immer von einer
invasiven Diagnostik gefolgt werden sollte. Beim Vorliegen einer Mehrgefäß-KHK (KHK:
koronare Herzerkrankung) ist in aller Regel eine vollständige Revaskularisierung
anzustreben, wobei dies bei hämodynamisch stabilen Patienten ein- oder zweizeitig
erfolgen kann.
Spontane Koronararteriendissektion
Authors: Fengler Karl , Thiele Holger
Published: April 2024

Die spontane Koronararteriendissektion (SCAD) ist eine seltenere, dennoch wichtige Ursache des akuten Koronarsyndroms, bei der es zu verzögertem Fluss im Gefäß durch die Bildung eines Hämatoms in der Wand der Koronararterie kommen kann. Anders als bei der atherosklerotischen koronaren Herzkrankheit ist die SCAD vor allem bei Frauen im mittleren Lebensalter prävalent. Die aktuellen Leitlinien der European Society of Cardiology (ESC) empfehlen für die allermeisten Fälle ein konservatives Vorgehen mit einer medikamentösen Therapie, die der des allgemeinen akuten Koronarsyndroms entspricht. Bei einer hohen Rate an Spontanheilungen unter dieser Therapie ist die Prognose insgesamt durch eine niedrige Letalität gekennzeichnet.
Erfolgreich erweitertes Therapieangebot – Neurofeedback
Authors: Dankert Ann-Christin , Sieverling Frauke
Published: April 2024

Auf der Suche nach einem neuen Therapieangebot für ihre Praxis stießen die Ergotherapeutinnen Ann-Christin Dankert und Frauke Sieverling auf das Infra-Low Frequency Neurofeedback. Bereits nach kurzer Zeit konnten sie mit Klient*innen mit psychischen und kognitiven Einschränkungen erste Erfolge feiern. Wie sie die Methode umsetzen, beschreiben sie im Artikel.
Für einen gesunden Lebensstil – Programm: Overcoming MS
Authors: Gerasch Leonie
Published: April 2024

Obwohl Multiple Sklerose nicht heilbar ist, zeigen wissenschaftliche Erkenntnisse, dass der richtige Lebensstil Symptome reduzieren und das Fortschreiten der Erkrankung verlangsamen oder verhindern kann. Die Wohltätigkeitsorganisation „Overcoming MS“ stellt ein Lifestyle-Programm zur Verfügung, das Betroffenen dabei hilft, ein selbstbestimmtes und erfülltes Leben zu führen.
Soziale Determinanten für die psychische Gesundheit von Geflüchteten
in Deutschland – Der Einfluss postmigratorischer sozialer Isolation und
Ressourcen auf Psychopathologie und Inanspruchnahmeverhalten
Authors: Schaffrath Jonas , Schmitz-Buhl Mario , Gün Ali Kemal , Gouzoulis-Mayfrank Euphrosyne
Published: April 2024

Die psychische Gesundheit von Geflüchteten wird durch vielfältige prä-, peri- und
postmigratorische Faktoren beeinflusst. Unklar bleibt bislang weitestgehend, wie
soziale Determinanten die Inanspruchnahme psychiatrisch-psychotherapeutischer
Behandlung beeinflussen. In einer Fragebogenerhebung wurden 189 Geflüchtete aus
einer klinischen Stichprobe in psychotherapeutisch-psychiatrischer Behandlung
und einer Stichprobe ohne Behandlung verglichen. Hierbei wurde mittels
CHAID-Algorithmus der Einfluss sozialer Determinanten auf Psychopathologie und
Inanspruchnahmeverhalten untersucht. In der psychisch stark belasteten
Gesamtstichprobe (54% PTBS- bzw. 41,4% Depressions-Symptomatik) waren die
Patient*innen in allen psychometrischen Skalen (HTQ, SCL-K9, PHQ-9) sowie
hinsichtlich traumatischer Erlebnisse schwerer betroffen als die
Nicht-Patient*innen und sie konnten weniger auf Ressourcen wie ein soziales Netz
oder Aufenthaltstitel zurückgreifen. Stärkster Prädiktor für eine
psychotherapeutisch-psychiatrische Behandlung war soziale Isolation im
Wohnumfeld. Bei Patient*innen war fehlende Arbeitserlaubnis stärkster Prädiktor
einer Depressionssymptomatik. Die Ergebnisse weisen auf die Bedeutung
postmigratorischer sozialer Faktoren für die psychische Gesundheit geflüchteter
Menschen hin. Stabile soziale Beziehungen könnten zusammen mit formellen
Faktoren wie Arbeitserlaubnis und Aufenthaltstitel dazu beitragen, psychische
Belastung und Behandlungsbedürftigkeit zu senken.
Stigmata entkräften – Queere Menschen in der Psychiatrie
Authors: Biechele Ulli
Published: April 2024

Weil sie sehr häufig Diskriminierung und Gewalt, Stigmatisierung und Ausgrenzung erfahren, haben queere Menschen ein höheres Risiko für psychische Erkrankungen. Was ihnen dabei hilft und was sie sich von Mitarbeitenden in der Psychiatrie wünschen, sind unter anderem Offenheit und Respekt.
Auf dem Weg zu kulturellen Skripten von Traumafolgen
Authors: Maercker Andreas , Bachem Rahel , Mutuyimana Celestin , Eberle David
Published: April 2024

Hintergrund Für die Beschreibung von depressionsartigen psychischen
Beschwerden in verschiedenen kulturellen Weltregionen hat sich das Konzept der
kulturellen Skripte als sehr nützlich erwiesen. Der Beitrag stellt erstmals das
Galaxienmodell und dessen Umsetzung in der Modellvorstellung der kulturellen
Skripte theoretisch vor und verbindet diese mit der kulturpsychologischen
Werteforschung. Mit einer neuen, umfangreichen Serie von Forschungsprojekten
sollen posttrauma-bezogene psychische Beschwerden in verschiedenen Weltregionen
untersucht werden.

Methoden Die Arbeit in zwei Ländern/Regionen begann mit Fokusgruppen, in
denen Elemente kultureller Skripte durch traumatisierte Klienten und/oder von
(therapeutischen) Experten zusammengetragen werden. Dazu wurde ein
theoriegeleiteter Rahmen möglicher post-traumatischer Skriptelemente vorgegeben.
In der Schweiz wurden Fokusgruppen mit Patient:innen und mit Expert:innen
durchgeführt. In Ruanda und drei ostafrikanischen Ländern wurden Fokusgruppen
mit Genozid-Überlebenden und anderen Traumaopfern durchgeführt. Die Auswertung
fand semi-quantitativ statt.

Ergebnisse Als Skriptelemente wurden in der Schweiz ca. 50 Symptome und
Veränderungen genannt (z. B. Trotzdem funktionieren müssen). Als Skriptelement
in Ostafrika wurden ca. 100 Symptome und Veränderungen genannt (z. B. Verlust
der Menschenwürde). Erste temporale Zusammenhänge (d. h. starke Skripts) wurden
für die Schweizer Skripts gefunden (z. B. Selbstentwertung – Drang zu
funktionieren). In der Ostafrikanischen Studie wurden zudem den
Skriptgruppierungen zugrundeliegende kulturelle Wertorientierungen erhoben
(z. B. Ansehen in der Gemeinschaft).

Diskussion Die hier vorgestellten illustrativen Ergebnisse belegen das
Galaxienmodell und die Eignung des kulturellen Skriptkonzepts für die
Traumafolgen-Erfassung. Es zeigen sich Unterschiede und Übereinstimmungen in den
beiden bisher untersuchten Weltregionen. Weitere Schritte an den beiden
Studien-Sites werden die temporalen Zusammenhänge und die Beziehungen zu
Wertorientierungen sein. An den anderen Untersuchungssites werden die Studien in
den Folgejahren gestartet.
Accurate and safe diagnosis and treatment of neoplastic biliary lesions using a novel 9F and 11F digital single-operator cholangioscope
Authors: Robles-Medranda Carlos , Alcivar-Vasquez Juan , Raijman Isaac , Kahaleh Michel , Puga-Tejada Miguel , Del Valle Raquel , Alvarado Haydee , Cifuentes-Gordillo Carlos , Binmoeller Kenneth F. , Baptista Alberto Jose , Barreto-Perez Jonathan , Rodriguez Jorge , Egas-Izquierdo Maria , Cunto Domenica , Calle-Loffredo Daniel , Lukashok Hannah , Baquerizo-Burgos Jorge , Tabacelia Daniela
Published: April 2024

Background and study aims Digital single-operator cholangioscopy (DSOC) allows the diagnosis of biliary duct disorders and treatment for complicated stones. However, these technologies have limitations such as the size of the probe and working channel, excessive cost, and low image resolution. Recently, a novel DSOC system (eyeMAX, Micro-Tech, Nanjing, China) was developed to address these limitations. We aimed to evaluate the usefulness and safety of a novel 9F and 11F DSOC system in terms of neoplastic diagnostic accuracy based on visual examination, ability to evaluate tumor extension and to achieve complete biliary stone clearance, and procedure-related adverse events (AEs).

Patients and methods Data from ≥ 18-year-old patients who underwent DSOC from July 2021 to April 2022 were retrospectively recovered and divided into a diagnostic and a therapeutic cohort.

Results A total of 80 patients were included. In the diagnostic cohort (n = 49/80), neovascularity was identified in 26 of 49 patients (46.9%). Biopsy was performed in 65.3% patients with adequate tissue sample obtained in 96.8% of cases. Biopsy confirmed neoplasia in 23 of 32 cases. DSOC visual impression achieved 91.6% sensitivity and 87.5% specificity in diagnosing neoplasms. In the therapeutic cohort (n = 43/80), 26 of 43 patients required lithotripsy alone. Total stone removal was achieved in 71% patients in the first session. Neither early nor late AEs were documented in either the diagnostic or therapeutic cohort.

Conclusions The novel DSOC device has excellent diagnostic accuracy in distinguishing neoplastic biliary lesions as well as therapeutic benefits in the context of total stone removal, with no documented AEs.
A Brief Historical Perspective on Pulmonary Embolism
Authors: Morgan Clinton T. , Saha Sibu P.
Published: April 2024

Pulmonary embolism is a major cause of mortality worldwide. In this historical perspective, we aim to provide an overview of the rich medical history surrounding pulmonary embolism. We highlight Virchow's first steps toward understanding the pathophysiology in the 1800s. We see how those insights inspired early attempts at intervention such as surgical pulmonary embolectomy and caval ligation. Those early interventions were refined and ultimately led to the development of inferior vena cava filters, the earliest clinical applications of anticoagulation, and even apparently disparate medical advances such as the successful development of cardiopulmonary bypass. We also see how the diagnosis of pulmonary embolism has evolved from rudimentary monitoring of vitals and symptoms to the development of evermore sophisticated tests such as contrast tomography angiography and echocardiography. Finally, we discuss current approaches to diagnosis, classification, and myriad treatments including anticoagulation, thrombolysis, catheter-directed interventions, surgical embolectomy, and extracorporeal membrane oxygenation guided by Pulmonary Embolism Response Teams.
A Usability Survey of a Quality Improvement Data Visualization Tool among Medical Intensive Care Unit Nurses
Authors: Williams Abigail M. , Davis Claire L. , Bjoring Margot , Blackstone Kris , Barros Andrew J. , Enfield Kyle B.
Published: April 2024

Background Cognitive overload is prevalent among intensive care unit (ICU) clinicians. Data visualization may decrease cognitive load by assisting with data interpretation and task prioritization. We developed the Bundle Board to display real-time data from the electronic medical record (EMR), highlighting opportunities for action in standardized ICU patient care. This study evaluates the practical usability of this data visualization tool among nurses in the ICU.

Methods The tool is offered as an application separate from the EMR and was available in the medical ICU for 8 months before we surveyed unit nursing staff. To evaluate usability of the tool, we adapted the Health-Information Technology Usability Scale and included an option to provide open-ended feedback. Survey data were analyzed using quantitative and qualitative methods.

Results ICU nurses were invited to participate through email and verbal announcements. Of the potential participants, 38% (N = 47) responded. The survey demonstrated that the tool was perceived as usable. For each subscale, mean scores were as follows: Perceived Ease of Use 4.40, Impact 4.14, User Control 4.07, and Perceived Usefulness 3.61. There were no significant differences between core and contracted nurses or after stratifying by duration of Bundle Board use. Fifteen respondents completed the optional free-text portion of the survey. Qualitative analysis revealed six subthemes focusing on perceived impacts on quality and safety, cognitive burden and workload, and emotional impact of the Bundle Board.

Conclusion The Bundle Board demonstrated good usability among ICU nurses, who provided substantive feedback for its improvement. These observations may be generalizable to other comparable interventions. Iterative feedback from end users is vital to developing and implementing a digital health intervention. Our study provides a framework for performing a usability analysis within a specific clinician population and environment.