bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of simple additive weighting algorithm in decision support system
Authors: Sihombing Volvo , Siregar Victor Marudut Mulia , Tampubolon Wahyu Simon , Jannah Maya , Risdalina  , Hakim Abdul
Published: February 2021

The research focused on the problems of buying a second-hand Toyota vehicle. The ability to make fast, precise and accurate decisions will be the key to success in today’s global competition. The number of factors that need to be considered when a purchaser wants to buy a second-hand car also leads the purchaser to make the wrong choice when selecting a second-hand car to buy. This problem is solved by developing a support system that helps consumers make choices about purchasing second-hand cars. This Decision Support System is generated using the Simple Additive Weighting (SAW) method. From this research it can be concluded that the SAW method is very appropriate to use as a decision support tool where three best second-hand car alternatives are obtained consisting of Toyota Fortuner with a preference value of 101, Toyota Rush car with a preference value of 90.4, and the Toyota Kijang Innova with a preference value of 88.6.
Forward chaining and fuzzy logic tsukamoto methods for decision
Authors: Saefudin Yusuf , Triayudi Agung , Sholihati Ira Diana
Published: February 2021

Sales recognition at PT. X is important. This will determine the monthly business growth rate. The main factor determining sales recognition is the delivery of goods on time in the current month. In this regard, a well process of allocating goods is needed. This study focuses on goods allocation recommendations to maximize sales recognition. The expert system was built using forward chaining and fuzzy logic Tsukamoto methods. The main principles of Supply Chain Management are also added to the algorithm in order to achieve maximum recommendation results. The end result is “High” and “Standard” recommendations for the allocation of goods based on available data. Recommendation “High” is worth ∼ 3.9M or the equivalent of ∼ 10.4% of the total potential available. However, the real actions taken are still based on decisions from related parties.
Smart traffic light control system using image processing
Authors: Meng Belinda Chong Chiew , Damanhuri Nor Salwa , Othman Nor Azlan
Published: February 2021

Traffic congestion has become a serious issue due to the growing number of vehicles in Malaysia. Traffic light control system is widely used to control the flow of road junction. Currently, most of the traffic light system used pre-time and count down timers to control traffic flow. Due to the fixed-time setting, often the system unable to handle unexpected heavy traffic flows and cause traffic jam. Thus, there is a need of adaptive traffic signals which are able to do real time monitoring to control traffic light signal based on traffic density. This study proposed an adaptive traffic light control system that uses image processing and image matching technique in controlling the traffic in an effective manner by taking images of each lane at a junction. The density of traffic in the images at each junction are compared. Results show that more time are allocated for the vehicles on the densest road to pass compared to other less dense road. Edge operation detector is used to detect the density of traffic at each lane. In this study, a comparison study was carried out by applying five different edge detectors namely Roberts, Sobel, Log, Canny and active contour. Among these detectors, Canny edge operation detector has found to be the best as it could extract actual edges with average time of 0.453 second.
Decision support system for selection technique using MOORA method
Authors: Siregar Victor Marudut Mulia , Tampubolon Mega Romauly , Parapat Eka Pratiwi Septania , Malau Eve Ida , Hutagalung Debora Silvia
Published: February 2021

This study aims to solve the problem of selecting the best students as recipients of the Academic Achievement Improvement scholarship at Sekolah Tinggi Akuntansi dan Manajemen Indonesia (STAMI). The scholarship data processing process carried out by STAMI is currently still using a manual process and only uses the GPA criteria only in determining scholarship recipients. This problem is resolved using a Decision Support System with the Multi-Objective Optimization based on Ratio Analysis (MOORA) method. The criteria used in this Decision Support System consist of: parents’ income, parents’ dependents, semester, and GPA. Alternative data used in this study consisted of 7 alternative STAMI students. The best ranking results from selecting the best students to obtain scholarships using the MOORA method are students with the STAMI_Student02 alternative with a ranking value of 0.2345.
Integration of GIS for Mapping Distributed Online Learning
Authors: Ohliati Jenny , Sukmandhani Arief Agus , Yossy Emny Harna
Published: February 2021

This study was carried out to overcome one of the main obstacles encountered, namely the lack of information on the location of student residences in private universities that provide online learning system. Quantum GIS can display the distribution of students in all regions of Indonesia. The method used in this study is the descriptive analysis method. The results of this study are presented in the form of a distribution map of online learning students across Indonesia, which shows information about student data based on a regional boundary map.
Data mining techniques with machine learning algorithm to predict patients of heart disease
Authors: Mulyawan  , Bahtiar Agus , Dwilestari Githera , Basysyar Fadhil Muhammad , Suarna Nana
Published: February 2021

Data mining is a way of searching for information from large amounts of data for the purposes of various applications. Several techniques in data mining can be used for association, classification, clustering, prediction, and sequential modeling. Machine learning is used in medical science to help medical teams find out the condition of patients with heart disease. A lot of machine learning still has limited predictive capabilities, and is incompatible. This study uses different machine learning techniques, namely PSO-based SVM, Neural Network, Decision Tree, Naïve Bayes and SVM to assist in building, understanding and interpreting different models of heart disease diagnosis. The use of the pso-based svm algorithm in the prediction of heart disease shows a 100% greatest accuracy than the Decision Tree, only 88.68% and Naïve Bayes of 82.15%, Neural Network with an accuracy of. 95.71%, SVM with an accuracy of 99.71%. The results of this study are expected to be beneficial for the world of health and for researchers who use machine learning techniques.
Genre e-sport gaming tournament classification using machine learning technique based on decision tree, Naïve Bayes, and random forest algorithm
Authors: Dikananda Arif Rinaldi , Ali Irfan , Fathurrohman  , Ade Rinaldi Rizki , Iin
Published: February 2021

The development of the game industry in this global era no longer presents entertaining games but also provides competitive games. With the recent competitive game, it can be categorized into a sport called e-Sport. Various game developers have also created e-Sport facilities and created a tournament to advance the industry. The increasing number of tournaments that are held in the field of sports from various types of games, it requires a classification for the types of games that are actively holding tournaments from the last few years. The classification used is Naive Bayes, decision tree and random forest algorithm. Naïve Bayes has become one of the algorithms for data. Naïve Bayes is a classification system based on the theorem of Bayes. Naïve Bayes is a classification system based on the theorem of Bayes. It’s also recognized that the Naïve Bayes Classifier is greater than certain other classification methods. As first, the main aspect of Naïve Bayes is a very good (naive) presumption of freedom from any situation or case. It’s also recognized that the Naïve Bayes Classifier is greater than certain other classification methods. As first, the main aspect of Naïve Bayes is a very good (naive) presumption of freedom from any situation or case. Decision trees are also well machine learning algorithms used to solve complex classification problems. Decision Tree is a classification method for data mining that aims to predict the behavior of the database. The result from this research is Random forest accuration 60%.
Competency test clustering through the application of Principal Component Analysis (PCA) and the K-Means algorithm
Authors: Dana Raditya Danar , Soilihudin Dodi , Silalahi Ryan Hamonangan , Kurnia D.A , Hayati Umi
Published: February 2021

The implementation of the Competency Test at the LSP institution in higher education is an effort to ensure that students have abilities in certain fields according to predetermined competency standards. Education providers are required to always strive to improve the quality and quality of education with the aim that the student’s academic performance will always improve. From the results of observations made in the research location, it was found a problem with the high number of failures in the implementation of the competency test. This study aims to conduct cluster analysis of the data from the implementation of competency tests using Machine Learning techniques through the application of Principal Component Analysis (PCA) and K-Means Algorithm, through several stages in the form of data collection, data cleaning, data transformation, data modeling and experimentation. This study resulted in grouping the results of competency tests which were divided into 3 clusters, namely cluster 1 as much as 38%, cluster 2 as much as 32% and cluster 3 as much as 30%.
Comparative study of tyre ash and palm kernel oil cake as back-filling agents for effective grounding
Authors: Kulor Frank , Dzah Christian , Markus Elisha D. , Apprey Michael W. , Kagbetor Patrick
Published: February 2021

A simple method for analyzing electrical earthing system is presented. The idea behind this research is to furnish the general public particularly in Ghana to understand the effectiveness of using low resistive materials to provide low resistance values for their earthing frameworks to protect lives and guarantee hardware security. Right now, proficiency of materials accessible for free, to be specific, Palm Kernel Oil Cake (PKOC) and Tyre ash, as conductive inlay material for decreasing earth terminal resistance was assessed. Earth mat 20-cm length and 10cm breath were covered with each refilling material with their exhibition contrasted with reference to the earth mat additionally covered at a similar location with raw sand, specifically, sandy gravel at a specific area in Ghana. The outcomes show that tyre ash gives a steady earth resistance in both dry and wet climate conditions and improves it significantly as compared to PKOC. The main purpose of evaluating these two local materials as a backfilling agent is to reduce the earth resistivity which in this study was achieved successfully after 3 months of monitoring.
Implementation of Traveling salesman problem Algorithm for Scheduling and Shortest Distance Optimization
Authors: Ginting Novita Br , Inawan Erik , Afrianto Yuggo , Muliawati Fithri
Published: February 2021

PD Mitra Makmur Perkasa is a company that distributes bottled drinking water. The decline in service levels in the timeliness of delivery is one of the problems experienced by the company. Based on the analysis conducted, the cause is due to irregular and unsystematic scheduling. To overcome this problem, we need a system that can manage systematic scheduling and provide optimal mileage recommendations to streamline delivery times and maximize the number of deliveries. These papers aim to build a web-based information system for scheduling the delivery of bottled drinking water using the waterfall system development method and the heuristic TSP (travelling salesman problem) method. TSP used to determine travel routes and produce recommendations for the shortest distance to be traversed and to maximize the amount of drinking water that can be delivered optimally. The results TSP method can be applied to a web-based scheduling information system for the delivery of bottled drinking water. It will have an impact on increasing service and maintaining, as well as increasing the number of customers. The resulting testing with the structural and functional BlackBox test results declared appropriate and functional.
Design and implementation of automatic autoclave temperature and pressure data recording system
Authors: Safitri Meilia , Pranaditya Afif , Handoko Brama , Anggoro Sotya
Published: February 2021

Sterilization data history is needed to maintain and examine an autoclave performance to minimize the risk of sterilization failure. This study aimed to develop a sterilization data recording system for an autoclave with external data storage using an SD card. The TFT LCD is used as the user interface to make it easier for users to monitor temperature and pressure during the sterilization process. The MAX 31865 temperature sensor and the MPX 5700 AP pressure sensor are used to monitor the temperature and pressure in real-time during the sterilization process. The entire sterilization process of the developed system is controlled using The ATMega 2560 microcontroller. Three testings have been carried out to determine the designed temperature, and the pressure data recording system has been a success, Temperature data recording, Pressure data recording, and Process data recording. Based on the conducting test results, the designed recording system gives an excellent performance to record the temperature, pressure level, and data sterilization process with a success rate of 100%.
The Effect of the use of Gypsum Waste as a Filler Substitution on Stone Matrix Asphalt Coarse
Authors: Alpius Kezia Sri Wahyuni Soean , Mangontan Robert
Published: February 2021

This research is intended to test the use of gypsum waste as a cement filler substitution in a mixture of coarse stone matrix asphalt (SMA). The methodology in this research is to conduct a series of tests for the characteristics of coarse, fine, and filler aggregates, then design the composition of the coarse Stone Matrix Asphalt (SMA) mixture as well as Marshall immersion testing to obtain the remaining Marshall Stability. The results of research conducted at the Road and Asphalt Laboratory of the Faculty of Engineering, Department of Civil, Indonesian Christian University, Paulus Makassar, through the Marshall immersion test obtained a mixture of rough Stone Matrix Asphalt (SMA) with the proportion of gypsum waste as cement filler substitution, namely 100%: 0%, 75%: 25%, 50%: 50%, 25%: 75%, 0%: 100% meets the requirements issued by the Directorate General of Highways of the Ministry of Public Works of the Republic of Indonesia, General Specifications 2018. Test results for Marshall Immersion mixture of Stone Matrix Asphalt (SMA) coarse in all proportions of gypsum waste to obtain Marshall Stability Time meet the limit requirements, namely ≥ 90% so that the mixture is resistant to immersion in water.
The effect of square submerged breakwater on wave transmission in the coastal area
Authors: Bungin Erni Rante
Published: February 2021

A transmission wave is a transmission wave that passes through an obstacle where its parameter can be expressed as the ratio of the transmitted wave height (Ht) to the incident wave height (Hi). Waves can occur due to wind, tides, artificial disturbances such as ship movements and earthquakes. To reduce wave energy coming from the high seas, a breakwater can be installed. The breakwater is a building that functions to break the waves of sea water, thereby reducing the energy in sea water waves. The aim of this research is to understand the wave transmission with an asymmetrical sinking structure with a square shape which is varied with respect to the length of the model. This research was conducted with a sinking square-shaped breakwater model. The results of this study indicate that the size of the transmission coefficient is influenced by the length of the model and the water depth of the sinking breakwater model. The longer the model arrangement installed, the greater the transmission coefficient, as if the water depth increases, the transmission coefficient will also increase.
Identification of Construction Failures Due to Landslide Using Resistivity Methods on Kayulangi - Tarengge Km 531 + 600 Road
Authors: Apriyani Ika , Salle Lasty Dinulfy Kaimuddin
Published: February 2021

Landslides are one of the natural indication of equilibrium their morphological forms, mass transfer in landslide countermeasures. Various research methods can be carried out both in general and detail. causes of landslides. The purpose of conducting the research is to identify the behavior of landslides in terms of soil / rock layers and groundwater availability with the aim of identifying potential indication of construction failure. Based on the results of the research, the landslide on the north side of KM 531 + 600 based on the results of the field identification shows that the landslide material is in the form of sandy clay with the type of landslide is creeping with a maximum landslide depth of 3m and a slope length of 30m. Recommended treatment is the construction of a retaining wall with a distance of at least 3m from the shoulder of the road combined with the arrangement of surface water flow drainage on slopes. The retaining wall is equipped with a pipe to drain groundwater with a pipe diameter of at least 2 inches and a maximum space between the pipes of 1m, and on the KM 531 + 600 drainage channel it is necessary to carry out construction rehabilitation and equipped with a sediment pond and channel construction designed to reduce flow speed Surface water.
Heart Rate Variability (HRV) during anger emotion stimulation: features for affective
Authors: Rumpa Lantana Dioren , Toding Apriana , Jefriyanto Wilson , Sapulette Rossa O.
Published: February 2021

Recent studies have revealed the relationship between human Emotion and health. Researchers are trying to find the best features to distinguish human Emotion through its psychophysiology signals in the Affective Computing study. Humans have six basic emotions, such as Anger, Sadness, Happy, Surprise, Fear, and Disgust. Emotions affect human ANS (Autonomous Nervous System). The heart is one of the human inner organs affected by the ANS (working under ANS). Heart rate is one of the Psychophysiological signals that changed depends on human Emotion. This study tried to analyze the difference between human heart rate during Anger and Normal Emotion Stimulation. Video Stimuli were used to Evoke Emotion. 15 Participant’s heartbeats were recorded using an ECG sensor from E-Health Sensor Platform v2.0. We used HRV (Heart Rate Variability) MeanRR feature as a comparison. Some studies said that experiencing long-term Anger Emotions can cause serious illness to the human body. There are some differences in the MeanRR feature between ANGER State and NORMAL State. The findings of this investigation complement those of earlier studies about HRVi. This research supports the idea that HRV can be used as a feature to detect human affect state.
Transportation model as distance measurement location from Perumnas Antang to Makassar City
Authors: Elizabeth
Published: February 2021

The generation of transportation for residents of Perumnas Antang to the market location occurs as a result of transportation actors carrying out movements or activities at the same time to the market location to meet their food and clothing needs. The purpose of this study is to analyze the characteristics of the transportation modes of the Perumnas Antang population to the market location and to model the movement of the Perumnas Antang population to the market location. This research was conducted at the location of Perumnas Antang on Street Antang Raya, Manggala Village, Manggala District, Makassar. The sample in this study was taken from the Perumnas Antang location. Data collection methods are carried out in interviews and questionnaires. The data were analyzed using multiple linear regression analysis methods. The results of this study indicate that the generation at Perumnas Antang to the market location is influenced by travel time, distance traveled, the mode used, age, and type of work.
The potential for flooding in Koro Bakara watershed area, East Luwu due to the land conversion
Authors: Fitrian Eltrit Bima , Boro Wona Grace
Published: February 2021

Changes in land use in protected forest areas to pepper plantations are one of the serious problems that occur around the Koro Bakara watershed in East Luwu. This study aims to determine (1) irregularities in land use in the Koro Bakara watershed at East Luwu, (2) The level of flood vulnerability in the Bakara East Luwu watershed as a result of land use mismatch. This research was carried out in the East Luwu Koro Bakara watershed area with a total watershed area of 14,010 ha, administratively located in the Sorowako area, Towuti District, East Luwu Regency. The method used was the SWAT Method (Soil and Water Assessment Tool) by using ArcSwat software. This research is included in non-experimental research, namely by using direct observation in the field. Input data in the SWAT Model are slopes, land cover, climate, and soil types. The research shows that the total area of forest area that is in accordance with the pattern of space is only 15.92% for protected forest areas and 6.04% for limited production forest areas. In the Koro Bakara watershed based on the results of the wetness index analysis, there were 71.24% of the watershed area included in the category of no potential, 1.03% of the watershed area included in the category of medium potential, 27.72% of the watershed included in the category of high potential flooding.
Embracing industrial revolution 4.0 in universities
Authors: Halili Siti Hajar , Sulaiman Shukri , Sulaiman Hamidah , Razak Rafiza
Published: February 2021

Embracing education 4.0 in universities in the Malaysian perspective has been limited to date and still considered at the early stages of implementation. This paper aims to analyze the literature highlighting the important elements of education 4.0 in universities as a means to position them strategically for the future. This is to provide new insight into the exploration of the idea in education through the perspective of how universities could embrace education 4.0 in the future. Since industrial revolution 4.0 (IR4.0) brings a huge impact on education, this paper helps universities policymakers to embrace their works on developing industrial revolution 4.0 education transformation and put more initiatives for the positive learning experience. This literature analysis reviews the following relevant areas: academic program 4.0, technological advancement 4.0 in teaching and learning, and 21st-century pedagogy. Hence, this study is significant in serving as a guideline to academicians and policymakers in embracing the IR4.0 in higher education. This paper may have some direct implications towards the industrial 4.0 (IR4.0) movements in Malaysia which able to help the ministry to extend their works on developing IR 4.0 education transformation in line with Malaysia Education Blueprint 2013-2025.
Prevalence of microvascular angina among patients with stable symptoms in the absence of obstructive coronary artery disease: a systematic review
Authors: Aribas Elif , Roeters van Lennep Jeanine E , Elias-Smale Suzette E , Piek Jan J , Roos Maurits , Ahmadizar Fariba , Arshi Banafsheh , Duncker Dirk J , Appelman Yolande , Kavousi Maryam
Published: February 2021

Our purpose was to perform a systematic review to assess the prevalence of microvascular angina (MVA) among patients with stable symptoms in the absence of obstructive coronary artery disease (CAD). We performed a systematic review of the literature to group the prevalence of MVA, based on diagnostic pathways and modalities. We defined MVA using three definitions: (i) suspected MVA using non-invasive ischaemia tests; proportion of patients with non-obstructive CAD among patients with symptoms and a positive non-invasive ischaemia test result, (ii) suspected MVA using specific modalities for MVA; proportion of patients with evidence of impaired microvascular function among patients with symptoms and non-obstructive CAD, and (iii) definitive MVA; proportion of patients with positive ischaemia test results among patients with an objectified impaired microvascular dysfunction. We further examined the ratio of women-to-men for the different groups. Of the 4547 abstracts, 20 studies reported data on MVA prevalence. The median prevalence was 43% for suspected MVA using non-invasive ischaemia test, 28% for suspected MVA using specific modalities for MVA, and 30% for definitive MVA. Overall, more women were included in the studies reporting sex-specific data. The women-to-men ratio for included participants was 1.29. However, the average women-to-men ratio for the MVA cases was 2.50. In patients with stable symptoms of ischaemia in the absence of CAD, the prevalences of suspected and definitive MVA are substantial. The results of this study should warrant cardiologists to support, promote and facilitate the comprehensive evaluation of the coronary microcirculation for all patients with symptoms and non-obstructive CAD.
Native and prosthetic graft infections of the thoracic aorta: surgical management
Authors: Rustum Saad , Beckmann Erik , Martens Andreas , Krüger Heike , Arar Morsi , Kaufeld Tim , Haverich Axel , Shrestha Malakh Lal
Published: February 2021

OBJECTIVES

Infection of the native aorta or after previous open or endovascular repair of the thoracic aorta is associated with high risks for morbidity and mortality. We analysed the outcome after surgical management of a native mycotic aneurysm or of prosthetic graft infection of the descending aorta.

METHODS

From June 2000 to May 2019, a total of 39 patients underwent surgery in our centre for infection of the native descending aorta (n = 19 [49%], group A) or a prosthetic descending aorta [n = 20 (51%), group B]. In the 20 patients in group B, a total of 8 patients had prior open aortic repair with a prosthesis and 12 patients had a previous endovascular graft repair.

RESULTS

The cohort patients had a mean age of 57 ± 14; 62% were men (n = 24). The most common symptoms at the time of presentation included fever, thoracic or abdominal pain and active bleeding. Emergency surgery was performed in 11 patients (28%); 3 patients had emergency endovascular stent grafts implanted during thoracic endovascular aortic repair for aortic rupture before further open repair. The 30-day mortality was 42% in group A and 35% in group B. The 90-day mortality was 47% in group A and 45% in group B. Pathogens could be identified in approximately half of the patients (46%). The most commonly identified pathogens were Staphylococcus aureus in 6 patients (15%) and Staphylococcus epidermidis in 4 patients (10%). Survival of the entire group (including patients with both native and prosthetic graft infections) was 44 ± 8%, 39 ± 8% and 39 ± 8% at 1, 2 and 3 years after surgery. The percentage of patients who survived the initial perioperative period was 81 ± 9%, 71 ± 9% and 71 ± 10% at 1, 2 and 3 years after surgery.

CONCLUSIONS

Patients with infection of the descending aorta, either native or prosthetic, are associated with both high morbidity and mortality. However, patients who survive the initial perioperative period have an acceptable long-term prognosis. In emergency situations, thoracic endovascular aortic repair may help to stabilize patients and serve as bridge to open repair.
Diversity of Cronobacter genus isolated between 1970 and 2019 on the American continent and genotyped using multi-locus sequence typing
Authors: Costa Paula Vasconcelos , Vasconcellos Luiza , Forsythe Stephen James , Brandão Marcelo Luiz Lima
Published: February 2021

This study aimed to evaluate the Cronobacter spp. strains isolated on the American continent and characterized using multi-locus sequence typing (MLST) available in the PubMLST database and current literature. From 465 Cronobacter spp. strains, the majority (n = 267, 57.4%) was from North America, mainly from USA (n = 234) and 198 (42.6%) were from South America, mainly from Brazil (n = 196). A total of 232 (49.9%) were isolated from foods, 102 (21.9%) from environmental, 87 (18.7%) from clinical, 27 (5.8%) from PIF, one from water (0.2%) and 16 (3.5%) from unknown sources. A total of five species were represented: Cronobacter sakazakii (374, 80.4%), Cronobacter malonaticus (41, 8.8%), Cronobacter dublinensis (29, 6.2%), Cronobacter turicensis (16, 3.5%) and Cronobacter muytjensii (5, 1.1%). The strains with complete MLST profile (n = 345) were assigned to 98 STs, a ratio of 3.5 strain by ST found and the calculated Simpson`s index was 0.93. The strains showed a high diversity and after eBURST analysis, 30 STs (n = 189) formed 12 single and/or double-locus variant clonal complexes (CC). A total of 38 STs (38.7%) were associated with clinical cases of infection, including well established C. sakazakii CC 1, 4, 8 and 83; C. malonaticus ST60, 307, 394 and 440; and C. sakazakii ST 12 and 494.
An interrupted time series analysis of the lockdown policies in India: a national-level analysis of COVID-19 incidence
Authors: Thayer Winter M , Hasan Md Zabir , Sankhla Prithvi , Gupta Shivam
Published: February 2021

India implemented a national mandatory lockdown policy (Lockdown 1.0) on 24 March 2020 in response to Coronavirus Disease 2019 (COVID-19). The policy was revised in three subsequent stages (Lockdown 2.0–4.0 between 15 April to 18 May 2020), and restrictions were lifted (Unlockdown 1.0) on 1 June 2020. This study evaluated the effect of lockdown policy on the COVID-19 incidence rate at the national level to inform policy response for this and future pandemics. We conducted an interrupted time series analysis with a segmented regression model using publicly available data on daily reported new COVID-19 cases between 2 March 2020 and 1 September 2020. National-level data from Google Community Mobility Reports during this timeframe were also used in model development and robustness checks. Results showed an 8% [95% confidence interval (CI) = 6–9%] reduction in the change in incidence rate per day after Lockdown 1.0 compared to prior to the Lockdown order, with an additional reduction of 3% (95% CI = 2–3%) after Lockdown 4.0, suggesting an 11% (95% CI = 9–12%) reduction in the change in COVID-19 incidence after Lockdown 4.0 compared to the period before Lockdown 1.0. Uptake of the lockdown policy is indicated by decreased mobility and attenuation of the increasing incidence of COVID-19. The increasing rate of incident case reports in India was attenuated after the lockdown policy was implemented compared to before, and this reduction was maintained after the restrictions were eased, suggesting that the policy helped to ‘flatten the curve’ and buy additional time for pandemic preparedness, response and recovery.
Protective effect of flavonoids from Passiflora edulis Sims on diabetic complications in rats
Authors: Salles Bruno César Correa , Leme Krissia Caroline , da Silva Marcelo Aparecido , da Rocha Cláudia Quintino , Tangerina Marcelo M P , Vilegas Wagner , Figueiredo Sônia A , Duarte Stella Maris da Silveira , Rodrigues Maria Rita , de Araújo Paula Fernanda Borges
Published: February 2021

Objectives

This study was carried out to evaluate the effects of flavonoids present in leaves of Passiflora edulis fruit on complications induced by diabetes in rats.

Methods

The extract of P. edulis leaf was obtained by 70% ethanol maceration. From the dry extract, the fractions were obtained by consecutive liquid–liquid partition with hexane, ethyl acetate and n-butanol. The content of isoorientin of ethyl acetate and n-butanol fractions was determined by ultra-performance liquid chromatography coupled with electrospray and triple quadrupole ionization (TQD) analysis in tandem mass spectrometry (UPLC–ESI-Tq-MS). Only Fr-BuOH was used to treat diabetic or not Wistar rats. Biochemical parameters, platelet aggregation and production of reactive species were evaluated.

Key findings

The UPLC–ESI-Tq-MS analysis revealed the presence of several flavonoids, among which we identified five possible flavonoids c-heterosides (luteolin-7-O-pyranosyl-3-O-glucoside, apigenin-6-8-di-C-glycoside, apigenin-6-C-arabinoside-8-C-glycoside, isoorientin, isovitexin). The diabetic rats (treated intraperitoneally with alloxan, 150 mg/kg) treated with Fr-BuOH (20 mg/kg/day for 90 days) presented improvement in blood glucose, serum levels of fructosamine, lipid profile and urea. Furthermore, the Fr-BuOH reduced both platelet aggregation and the production of oxidant species in diabetic animals.

Conclusions

These results suggested that flavonoid C-glycosides present in the Fr-BuOH may be beneficial for the diabetic state, preventing complications induced by diabetes.
First Report of SARS-CoV-2 B.1.1.251 lineage in Brazil
Authors: dos Santos Cliomar Alves , Bezerra Gabriela Vasconcelos Brito , de Azevedo Marinho Aline Rafaelle Rocha Almeida , Sena Ludmila Oliveira Carvalho , Alves Juliana Cardoso , de Souza Mercia Simone Feitosa , de Oliveira Góes Marco Aurélio , Teixeira Daniela Cabral Pizzi , Silva Paola Cristina Resende , de Siqueira Marilda Agudo Mendonça Teixeira , Martins-Filho Paulo Ricardo
Published: February 2021

On 29 January 2021, we identified a new circulating lineage of Severe acute respiratory syndrome coronavirus 2 in Brazil, located in Sergipe state, Northeast region. The B.1.1.251 lineage was identified in a 32-old-man with headache, sore throat and coryza. Further studies are needed to evaluate the transmissibility and virulence of this emergent coronavirus lineage in Brazil.
Enhancement of lithium in red clump stars by the additional energy loss induced by new physics
Authors: Mori Kanji , Kusakabe Motohiko , Balantekin A Baha , Kajino Toshitaka , Famiano Michael A
Published: February 2021

Since 7Li is easily destroyed in low temperatures, the surface lithium abundance decreases as stars evolve. This is supported by the lithium depletion observed in the atmosphere of most red giants. However, recent studies show that almost all of red clump stars have high lithium abundances A(Li) > −0.9, which are not predicted by the standard theory of the low-mass stellar evolution. In order to reconcile the discrepancy between the observations and the model, we consider additional energy loss channels that may come from physics beyond the Standard Model. A(Li) slightly increases near the tip of the red giant branch even in the standard model with thermohaline mixing because of the 7Be production by the Cameron–Fowler mechanism, but the resultant 7Li abundance is much lower than the observed values. We find that the production of 7Be becomes more active if there are additional energy loss channels, because themohaline mixing becomes more efficient and a heavier helium core is formed.
A Systematic Review of Phenylephrine Versus Noradrenaline for the Management of Hypotension Associated With Neuraxial Anesthesia in Women Undergoing Cesarean Section
Authors: Heesen M. , Hilber N. , Rijs K. , Rossaint R. , Girard T. , Mercier F.J. , Klimek M.
Published: February 2021

(Anaesthesia. 2020;75:800–808)

Up to 60% of women who receive spinal anesthesia during cesarean delivery experience hypotension. Phenylephrine has become the vasopressor of choice but is associated with maternal reflex bradycardia. Noradrenaline is an alternative vasopressor and is associated less with bradycardia. Noradrenaline has weak β-adrenergic activity and some studies have suggested noradrenaline is associated with fetal acidosis. This review aimed to identify randomized controlled trials comparing the use of noradrenaline and phenylephrine in women receiving spinal anesthesia for cesarean delivery.
An Ultrasound Assessment of Gastric Emptying Following Tea With Milk in Pregnancy: A Randomized Controlled Trial
Authors: Irwin R. , Gyawali I. , Kennedy B. , Garry N. , Milne S. , Tan T.
Published: February 2021

(Eur J Anaesthesiol. 2020;37:303–308)

Fasting guidelines from the American Society of Anesthesiologists (ASA) and European Society of Anaesthesiologists (ESA) recommend that clear fluids, including tea without milk, can be ingested up to 2 hours before general or regional anesthesia. Milk is considered to have the same gastric emptying time as solid food and requires a fasting period [nil per os (NPO) time] of 6 hours. While both guidelines suggest that a small amount of milk may be added to clear fluids without impacting NPO times, there is little evidence to support this guidance. The aim of this study was to compare gastric emptying of tea with milk versus water in pregnant women.
Chronic Hypertension in Pregnancy
Authors: Battarbee A.N. , Sinkey R.G. , Harper L.M. , Oparil S. , Tita A.T.N.
Published: February 2021

(Am J Obstet Gynecol. 2020;222:532–541)

New guidelines for the management of chronic hypertension have been published in the last 3 years by the American College of Obstetricians and Gynecologists (ACOG), The American College of Cardiology (ACC), The American Heart Association (AHA), and the International Society for the Study of Hypertension in Pregnancy (ISSHP). The authors compiled this work to review the evidence supporting these new guidelines and to provide critiques on areas that need further research.
Labor and Delivery Visitor Policies During the COVID-19 Pandemic: Balancing Risks and Benefits
Authors: Arora K.S. , Mauch J.T. , Gibson K.S.
Published: February 2021

(JAMA. 2020;323:2468–2469)

During a global pandemic, the responsibility of a physician shifts to prioritizing community health rather than maximizing the best interests of individual patients. As such, policies limiting patient visitors have been implemented in virtually all clinical settings in order to curb infectious exposures. Many labor and delivery units have instituted a policy limiting patients to one prescreened and afebrile adult visitor. At the beginning of the pandemic, many hospitals in the New York City Area were more stringent and many prohibited all visitors to delivery and postpartum units. However, the New York Department of Health issued guidelines and the governor of New York issued an executive order that reaffirmed the right of pregnant women to have an accompanying support person present during labor, delivery, and the immediate postpartum period.
Antenatal Corticosteroids: Too Much of a Good Thing?
Authors: DeMauro S.B.
Published: February 2021

The use of antenatal corticosteroids to accelerate fetal lung maturation and prevent neonatal mortality in preterm infants has been considered a notable advancement in perinatal care, though there are questions regarding the safety of this therapy in various populations. One study found an association between antenatal corticosteroids and increased neonatal mortality in women at risk for preterm birth in low- and middle-income countries. When there is a risk for late preterm delivery (34 to 36 wk gestation), large trials have shown lower rates of respiratory distress syndrome but no benefit in mortality rates.
Baseline Parameters for Rotational Thromboelastometry in Healthy Laboring Women: A Prospective Observational Study
Authors: Lee J. , Eley V.A. , Wyssusek K.H. , Kimble R.M.N. , Way M. , Coonan E. , Cohen J. , Rowell J. , van Zunderta A.A.
Published: February 2021

(BJOG. 2020;127:820–827)

The point-of-care test used for determining whole blood coagulation data, known as rotational thromboelastometry (ROTEM), is used in hepatic and cardiac surgery, obstetrics, and trauma. Normal ROTEM ranges for clotting time and maximum clot firmness in pregnant, term women in labor have not been previously studied. The primary aim of this study was to establish baseline ROTEM parameters for healthy term laboring women. Furthermore, a secondary aim was to compare these results to previous studies’ reference ranges and the manufacturer’s ranges for the nonobstetric population.
Sphenopalatine Ganglion Block for the Treatment of Postdural Puncture Headache: A Randomized, Blinded, Clinical Trial
Authors: Jespersen M.S. , Jaeger P. , Ægidius K.L. , Fabritius M.L. , Duch P. , Rye I. , Afshari A. , Meyhoff C.S.
Published: February 2021

(Br J Anaesth. 2020;124:739–747)

The epidural blood patch (EBP) has ∼75% success rate in the management of postdural puncture headache (PDPH). EBP is an invasive, painful, and resource-demanding treatment associated with a number of complications. There is evidence to suggest a topical sphenopalatine ganglion block (SPG) could be as effective as EBP at managing PDPH. This randomized blinded study aimed to investigate the effects of SPG block on pain scores and rescue procedures compared with placebo on adult patients with PDPH, fulfilling the criteria for EBP.
Safety and Efficacy of Sildenafil Citrate to Reduce Operative Birth for Intrapartum Fetal Compromise at Term: A Phase 2 Randomized Controlled Trial
Authors: Turner J. , Dunn L. , Tarnow-Mordi W. , Flatley C. , Flenady V. , Kumar S.
Published: February 2021

(Am J Obstet Gynecol. 2020;222:401–414)

Intrapartum fetal compromise, or fetal distress, is a major cause of perinatal death and hypoxic-ischemic encephalopathy in low- to middle-income countries, and causes 1 in 5 cases of cerebral palsy in high-income countries. The only proven interventions for intrapartum fetal compromise are emergency cesarean delivery or emergency delivery by instrumental vaginal birth, both of which carry significant risks. Sildenafil citrate increases fetal and uteroplacental blood flow and is an effective treatment for adult and newborn pulmonary hypertension. This study evaluated the efficacy and safety of sildenafil citrate in reducing the rate of emergency cesarean delivery or instrumental vaginal birth for intrapartum fetal distress.
Hemodynamic Changes in Women With Symptoms of Supine Hypotensive Syndrome
Authors: Humphries A. , Mirjalili S.A. , Tarr G.P. , Thompson G.M.D. , Stone P.
Published: February 2021

(Acta Obstet Gynecol Scand. 2020;99:631–636)

Supine hypotensive syndrome (SHS), while lacking a clear universal definition, is sometimes defined as a drop in systolic blood pressure from 15 to 30 mm Hg or an increase in heart rate of 20 bpm when in the supine position. Inadequate collateral venous circulation has been thought to explain the etiology of SHS but this has not been well-studied. This study aimed to measure blood flow in women with symptoms of SHS, in both the supine and left lateral positions with particular attention to the azygos vein, and compare these to measurements in asymptomatic women.
Classification System and Case Definitions for SARS-CoV-2 Infection in Pregnant Women, Fetuses, and Neonates
Authors: Shah P.S. , Diambomba Y. , Acharya G. , Morris S.K. , Bitnun A.
Published: February 2021

(Acta Obstet Gynecol Scand. 2020;99:565–568)

The vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from mother-to-fetus has been highly debated, and there are varied recommendations for testing and classifying parturients suspected of COVID-19 infection. Newborns with a coronavirus disease 2019 (COVID-19) infection may also pose danger to health care workers, particularly because some may not exhibit symptoms at birth. This paper examined the classification of pregnant women and neonates suspected or confirmed to have COVID-19 at the onset of labor and delivery.
Comparative Efficacy of Epidural Clonidine Versus Epidural Fentanyl for Treating Breakthrough Pain During Labor: A Randomized Double-blind Clinical Trial
Authors: Lee A. , Landau R. , Lavin T. , Goodman S. , Menon P. , Smiley R.
Published: February 2021

(Int J Obstet Anesth. 2020;42:26–33)

Opioids are a common epidural adjuvant for top-up boluses with local anesthetic for labor analgesia. There has been increased interest in nonopioid options in recent years as opioid-use disorder has become more prevalent. Clonidine, a lipophilic α2-adrenergic agonist, has been used for initiation and maintenance of labor analgesia in patients with opioid tolerance but has not been studied as an adjuvant for breakthrough pain in labor. This study aimed to compare clonidine and bupivacaine to fentanyl and bupivacaine in terms of efficacy for breakthrough labor pain, hypothesizing that clonidine would be superior to fentanyl.
Prophylactic Intrathecal Morphine and Prevention of Postdural Puncture Headache: A Randomized Double-blind Trial
Authors: Peralta F.M. , Wong C.A. , Higgins N. , Toledo P. , Jones M.J. , McCarthy R.J.
Published: February 2021

(Anesthesiology. 2020;132:1045–1052)

Postdural puncture headache (PDPH) occurs in 50% to 80% of patients who experience an unintentional dural puncture (UDP). PDPH can cause maternal morbidity and lengthen maternal hospital stay. There is no established method of preventing PDPH after UDP. One trial found epidural morphine reduced PDPH rate from 48% with placebo to 12%. There is concern that epidural morphine with a large dural tear could put patients at higher risk of respiratory depression. The use of an intrathecal catheter after UDP is common in many obstetric care centers. This study evaluated the effects of intrathecal morphine after UDP on the incidence and severity of PDPH in obstetric patients.
Intrathecal Morphine Versus Intrathecal Hydromorphone for Analgesia After Cesarean Delivery: A Randomized Clinical Trial
Authors: Sharpe E.E. , Molitor R.J. , Arendt K.W. , Torbenson V.E. , Olsen D.A. , Johnson R.L. , Schroeder D.R. , Jacob A.K. , Niesen A.D. , Sviggum H.P.
Published: February 2021

(Anesthesiology. 2020;132:1382–1391)

The effectiveness of intrathecal morphine for postcesarean analgesia is widely established, and is used throughout the United States and across the world. However, drug shortages have affected the supply of preservative-free morphine throughout the United States, leading to the exploration of alternative analgesic options. This study aimed to compare both the effectiveness and side effects of intrathecal morphine when compared with intrathecal hydromorphone. The authors hypothesized that equipotent doses would yield a superior result for intrathecal morphine following a 24-hour period.
Sampling Design in Nursing Research
Authors: Curtis Alexa Colgrove , Keeler Courtney
Published: February 2021

Editor's note: This is the third article in a series on clinical research by nurses. The series is designed to give nurses the knowledge and skills they need to participate in research, step by step. Each column will present the concepts that underpin evidence-based practice—from research design to data interpretation. The articles will be accompanied by a podcast offering more insight and context from the author.
U.S. Representative Cori Bush
Authors: McSpedon Corinne
Published: February 2021

Missouri sends its first nurse to Congress.
Sex Gap in Outcomes After Myocardial Infarction
Authors: Rosenberg Karen
Published: February 2021

According to this study:

Women are at higher risk than men for developing heart failure after a myocardial infarction (MI).

Women who have an ST-segment elevation MI have a higher risk of death.
Parents' English Proficiency Linked to Adverse Events in Hospitalized Children
Authors: Rosenberg Karen
Published: February 2021

According to this study:

Hospitalized children whose parents express limited comfort with English are twice as likely to experience harm—including preventable harm—due to medical care.

Targeted strategies are needed to improve communication and safety for these children.
Preserving Integrity and Staying Power as a Nurse in a Pandemic
Authors: Rushton Cynda Hylton
Published: February 2021

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog is a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.