bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional Competitiveness and National Economic Growth
Authors: Samosir Omas Bulan , Rajagukguk Wilson
Published: September 2017

Indonesia is a country with a notable economic inequality both across its provinces and districts. This inequality can be attributed to the disparities in access to development. In this paper, the effects of regional competitiveness and economic reforms on economic growth is studied. Regional competitiveness factors include infrastructure pillar, health and education pillar, and labor market efficiency pillar. The data come from the Indonesia Database for Policy and Economic Research (INDO-DAPOER) of the World Bank for the year 2010. The results of the study show that the percentage of households with electricity, the percentage of births attended by skilled health worker, the net enrollment ratio for primary education, the number of people employed, and the total grants statistically and significantly influence regional economic growth positively. Indonesia is to reduce inequality in regional competitiveness and improve the total grants distribution in order to promote regional economic growth equality in the country.
Conceptual Graphs Based Approach for Subjective Answers Evaluation
Authors: Jain Goonjan , Lobiyal D.K.
Published: September 2017

Automated evaluation systems for objective type tests already exist. However, it is challenging to make an automated evaluation system for subjective type tests. Therefore, focus of this paper is on evaluation of simple text based subjective answers using Natural Language Processing techniques. A student's answer is evaluated by comparing it with a model answer of the question. Model answers cannot exactly match with the students' answers due to variability in writing. Therefore, researchers create conceptual graphs for both student as well as model answer and compute similarity between these graphs using techniques of graph similarity measures. Based on the similarity, marks are assigned to an answer. Lastly, in this manuscript authors compare the results obtained by human graders and the proposed system using Pearson correlation coefficient. Also, comparison has been drawn between the results of proposed system with other existing evaluation systems. The experimental evaluation of the proposed system shows promising results.
Implementing Genetic Algorithms to Assist Oil and Gas Pipeline Integrity Assessment and Intelligent Risk Optimization
Authors: Calzada-Orihuela Gustavo , Urquiza-Beltrán Gustavo , Ascencio Jorge A , Reyes-Salgado Gerardo
Published: September 2017

Oil and gas industry, worldwide, needs to monitor, control and assess the elements that are involved in the general oil transportation and production processes. However, these processes are not risk free. The project proposes an intelligent support system that provides optimized projections for effective risk management. The project focuses on the development of a set of Genetic Algorithms (GAs), a branch of AI systems that assists to optimize the usage and distribution of resources. GAs will reduce the latent risks and potential dangers as much as possible. The main purpose is to minimize the risk levels in a pipeline segment based on their condition and by detecting optimal variable configurations: their Risk of Failure (RoF), Probability of Failure (PoF), Consequence of Failure (CoF), and their sub elements (threats and impacts). The heuristic results generated by this set of GAs show a significant reduction on the risk assessment measures, by finding “optimized” configurations of these variables.
A Fuzzy DEMATEL Analysis of Cultural Variables in Traffic Rules Violation
Authors: Mavi Reza Kiani , Zarbakhshnia Navid , Khazraei Armin
Published: September 2017

Traffic rules violation stems from numerous causes such as the lack of appropriate traffic rules training, non-institutionalization of respect to the rights of others especially pedestrians, and more importantly self-preference. There is a need for accidents prevention and deeper analysis of the multi-attributes which lead to unwanted accidents and lethal crashes resulting in death. Most of these elements are cultural variables. In this study, the cultural variables affecting traffic rules violation are investigated. From among many cultural variables, 6 most important factors were examined. For this aim, 10 traffic officers who have more than 10 years' experience and 10 citizens with master's degree and at least 6 years driving experience, participated in this research. For determining the cause and effect relations between them, fuzzy DEMATEL is applied. Findings show that unawareness of traffic rules has the greatest importance because it is the premier causal factor from one hand and on the other hand, it has the maximum relation with the other cultural variables.
Real-Time Monitoring of Intercity Passenger Flows Based on Big Data
Authors: Li Zheng , Wang Yan , Chen Qin
Published: September 2017

Managing population mobility is a key to urban growth and sustainable development. This study uses administrative and business data from a number of trustworthy and publicly-available websites for public transport to access passenger flows in a real-time manner. A case study is used to illustrate the application, with intercity passenger flows by public transport mode (rail or air), by rail service type and by time. Moreover, a model is developed for monitoring the implications of population movements, which can be a decision support tool for governments and policy makers to manage population mobility. The big-data approach to accessing public transport passenger movement has the following characteristics: (1) low cost, (2) a population scale, (3) instantaneous data collection/update, and (4) high quality.
A Web-based Tool for Business Process Improvement
Authors: Martins Paula Ventura , Zacarias Marielba
Published: September 2017

Current business process modeling methodologies offer little guidance regarding how to discover and maintain business process models aligned with their actual execution. The authors argue that business processes should emerge and evolve collaboratively within an organization. Considering this limitation, this paper presents an overview of some Web-based tools and explores their main functionalities. This study highlights the need of a bi-directional form of communication, between operational and process actors. The paper contributes with a new business process and practice authoring tool based on authors' vision for business process improvement.
Facile Synthesis of Chitosan Modified Fe3O4 Magnetic Nanoparticles for Azo Dye Amido Black 10B Adsorption
Authors: Jia Wan Xin , Lu Dong Tao , Shuang Shao Min , Yang Jun , Dong Chuan
Published: September 2017

Magnetic chitosan nanoparticles (Fe3O4-CS MNPs) were synthesized by an improved one-pot hydrothermal method and applied for azo dye amido black 10B adsorption. The Fe3O4-CS MNPs were characterized by SEM, TEM, DLS, XRD, FTIR, TGA and VSM. The adsorptive behavior of amido black 10B on Fe3O4-CS MNPs was investigated using the UV-vis specteophotometric technique and the affecting parameters including solution pH, contact time, amido black 10B concentration and Fe3O4-CS MNPs amount were examined. The adsorption process followed the pseudo-second-order kinetic model. The adsorption equilibrium data fitted well with the Freundlich isotherm model with the saturated adsorption capacity of 124.8 mg/g at pH=2.0. The desorption experiment could be carried out using NaOH with the recovery of 91.78%. After five cycles, adsorption efficiency still reached 83.24%. The results showed that Fe3O4-CS MNPs possessed a simple synthesis route and excellent reusability, which have potential application in the adsorption of azo dye in environmental effluents.
Toxicity Evaluation, HET-CAM Irritation, and Anti-Irritant Potential of Rice Bran Wax Policosanol Nanoemulsion
Authors: Ishaka Aminu , Ismail Maznah , Imam Mustapha Umar , Mahmud Rozi , Sani Ismaila Muhammad , Zakaria Zuki Abu Bakar
Published: September 2017

Policosanol, a mixture of long-chain alcohols found in animal and plant waxes, has several biological effects. However, it has a bioavailability of less than 10%. One of the ways of improving bioavailability is by nanoemulsion formulation. We developed rice bran wax policosanol nanoemulsion (npol) using high-pressure homogenization. Even though earlier toxicological studies did not show policosanol-related toxicity, it is an essential part of the development of the therapeutic formulation to evaluate its toxicity status. In this study, in vitro, in vivo toxicity, and irritation and anti-irritation potential of the npol were evaluated. 3T3-L1 cells and Sprague Dawley rats were treated with npol in the in vitro and acute oral toxicity tests; while the Hen’s Egg Test Chorio-Allantoic membrane (HET-CAM) was used to test for its irritation and anti-irritation potential. npol at 2mg/mL showed lower toxicity to 3T3-L1 cells by MTT assay compared to the same concentration of policosanol after 24 (60 and 50% viabilities), 48 (62 and 58% viabilities), and 72 (110 and 89% viabilities) hours, respectively. npol was non-irritant and has slightly anti-irritant potential based on the HET-CAM test. There was also no significant toxicity to a limit test dose of 40 ml/Kg body weight of npol (containing 2000 mg/Kg body weight of policosanol) in acute oral toxicity test on Sprague-Dawly rats. The results suggest that policosanol nanoemulsion is a safe formulation devoid of toxicity and irritation potential.
Pattern of occurrence and treatment outcome of second primary malignancies: A single center experience
Authors: Chaudhary Prekshi , Gupta Sweety , Leekha Nitin , Tandon Ruchir , Nandy Malay , De Sudarsan
Published: September 2017

Background: The incidence of cancer survivors is increasing, but these individuals, unfortunately, face the risk of second primary malignancies (SPMs). This increasing incidence can be credited to increased survival rates of cancer patients, environmental factors, host factors, and genetic predispositions. Hence, vigilance on the part of the patient as well as clinician for the development of new signs and symptoms is mandatory. Aims: Retrospective analysis of the pattern of incidence and clinical outcome of patients diagnosed with SPM and to review the literature. Settings and Design: A hospital-based retrospective collection of prospective data of patients diagnosed with SPM. Materials and Methods: Thirty-six patients with histopathologically proven SPM from January 2009 to July 2015 were included in this study. Factors such as age, sex, site, stage, histology, treatment received, and outcome were recorded. Statistical Analysis Used: Basic statistical tools have been used for analyzing the data. Results and Conclusions: The likelihood of occurrence of second malignancy, either synchronous or metachronous, should always be kept in mind while evaluating a cancer patient. Appearance of new signs and symptoms during the initial evaluation as well as during follow-up should raise a suspicion, and both patient and oncologist should have a low threshold for further assessment. Early diagnosis and treatment will reduce morbidity and mortality and lead to better survival outcome.
Activation of phosphoinositide 3-kinase/Akt/mechanistic target of rapamycin pathway and response to everolimus in endocrine receptor‑positive metastatic breast cancer – A retrospective pilot analysis and viewpoint
Authors: Bajpai Jyoti , Ramaswamy Anant , Chandrasekharan Arun , Mishra Surya , Shet Tanuja , Gupta Sudeep , Badwe R. A.
Published: September 2017

Introduction: Biomarkers predictive of response to mechanistic target of rapamycin (mTOR) inhibitor, everolimus, in endocrine receptor (ER)-positive metastatic breast cancer (MBC) are a work in progress. We evaluated the feasibility of directly measuring mTOR activity and phosphatase and tensin homolog (PTEN) expression and correlating their expression with response and survival. Materials and Methods: MBC patients who received everolimus with endocrine therapy (ET) after progression on an aromatase inhibitor and had adequate tissue preservation for estimation of mTOR activity and PTEN expression were selected for analysis from a prospectively maintained database. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan–Meier method, and correlation between mTOR activity and PTEN expression with survival was done by log-rank test. Results: Thirteen ER-positive MBC patients were available for analysis. PTEN expression was lost in 11/13 (84.6%) patients and retained in 2/13 patients (15.4%). mTOR activity was absent in four patients (30.7%), weak in six patients (46.1%), and moderate in 3 patients (23.2%). Median PFS for the entire population was 2.5 months while median OS was not reached. Patients with an absent mTOR activity showed a longer PFS (5 vs. 1.5 vs. 2 months) than those with weak and moderate activity, respectively (P = 0.043). There was no correlation between loss of PTEN expression and PFS. Conclusions: Measurement of direct mTOR activity in patients with MBC receiving everolimus/ET combination appears feasible. Absent mTOR activity may predict for longer PFS with everolimus-ET combination and requires further study.
Breast cancer risk factor evaluation in a Western Himalayan state: A case–control study and comparison with the Western World
Authors: Thakur Purnima , Seam Rajeev Kumar , Gupta Manoj K. , Gupta Manish , Sharma Mukesh , Fotedar Vikas
Published: September 2017

Context: Breast cancer incidence is increasing rapidly in India. The lifestyle, built, genetic makeup, reproductive and breastfeeding patterns are quite different in Indian females when compared to the Western population. Generalizing the Western data to the population residing in the Himalayan region would breed inaccuracies. Aim: The aim of our study was to identify risk factors in our own population in a Western Himalayan state of Himachal Pradesh, India. Subjects and Methods: A case–control study with 377 cases of invasive breast cancer and 346 hospital-based controls was conducted for 1 year. The data were collected by interviewing the individuals during their visit to hospital using a questionnaire. The data were analyzed using standard statistical techniques using SPSS version 17 software. Results: Factors found to have strong association with invasive breast cancer on multivariate analysis are late age at first childbirth >30 years, which is the strongest risk factor associated, late age of menopause > 50 years, high socioeconomic class, and age of female above 50 years. Conclusion: In our females, age >50 years, late age of menopause (>50 years), late age at first childbirth (>30 years), and high socioeconomic status were found to be major risk factors associated with breast cancer. Several factors implicated in the Western data were not found to be significant in our study. We need to identify such aspects in reproductive and breastfeeding patterns of women and spread awareness regarding the same.
Experiences of two different modalities in the management of choroidal melanoma in the Asian Indian population
Authors: Meeralakshmi Prajna , Shah Parag K. , Narendran Venkatapathy
Published: September 2017

Background: Choroidal malignant melanoma is a rare intraocular cancer in Asian Indian population. There is a paucity of data from our population comparing iodine 125 (I-125) brachytherapy and enucleation. Aim: This study aims to compare two groups of choroidal melanoma patients treated with either I-125 brachytherapy or enucleation in the Asian Indian population. Objectives: To evaluate the long-term morbidity and mortality rates in choroidal melanoma patients treated with either I-125 brachytherapy or enucleation. Methods: It is a retrospective study involving forty four eyes, diagnosed with choroidal melanoma from May 2008 to February 2015. All were evaluated preoperatively for metastasis. Twenty-two underwent globe salvaging I-125 brachytherapy surgery whereas remaining 22 underwent globe destructive primary enucleation procedure. Results: At a mean follow-up 39 months, 2 of 22 cases (9%) died in the brachytherapy group. One was secondary to metastasis in the liver while the other case died of a natural cause. In the enucleation group also, there were two deaths (9%) secondary to metastasis. The metastasis free survival was 95% in the brachytherapy group and 91% in the enucleation group, which was not statistically significant (P = 0.3577). Kaplan–Meier survival at 3 years and 5 years was 95% and 89% for brachytherapy group and 94% and 89% for enucleation group. Conclusion: This study found no difference in the long-term survival of choroidal melanoma patients treated with either brachytherapy or enucleation in the Asian Indian eyes.
Unraveling the spectrum of KIT mutations in gastrointestinal stromal tumors: An Indian Tertiary Cancer Center Experience
Authors: Pai Trupti , Bal Munita , Shetty Omshree , Gurav Mamta , Ostwal Vikas , Ramaswamy Anant , Ramadwar Mukta , Desai Sangeeta
Published: September 2017

Background: Primary mutations in the KIT gene are the driving force for gastrointestinal stromal tumors (GIST) tumorigenesis. Predictive role of KIT mutation status aids oncologists in patient management. There is a paucity of comprehensive data on the frequency of mutations in the KIT gene in GIST affecting Indian patients. The aims of this study were to determine the frequency and spectrum of molecular alterations affecting the KIT gene and assess their association with clinicopathologic features in a cohort of patients of GIST. Materials and Methods: Morphological and immunohistochemically confirmed GIST cases (n = 114) accessioned from August 2014-June 2015 were analyzed for mutations in KIT exons 9, 11, 13, and 17 and subjected to Sanger sequencing onto the ABI 3500 Genetic Analyzer. The sequences were analyzed using sequence analysis software: SeqScape® and Chromas Lite. Results: KIT mutations were seen in 70% of cases and the majority of KIT mutations involved exon 11 (57%), followed by exon 9 (10%), exon 13 (3%), and exon 17 (1%). Most common exon 11 mutations were in-frame deletions (61.4%) followed by substitution mutations (19.3%). Exon 9 mutations showed identical duplication of Ala-Tyr at codons 502–503. Simultaneous mutations affecting exon 11 and 13 were discovered. Novel variations, namely, p.Q556E (c.1666C>G), p.Q556dup (c.1666_1668dupCAG), p.K558_V559delinsS (c.1672_1677delAAGGTTinsAGT), p.Y503_F504insTY (c.1509_1510insACCTAT), and p.K642R (c.1925A>G) involving exons 11, 9, and 13, respectively, were observed. Interpretation and Conclusions: First study with complete analysis of all 4 exons of KIT (exons 9, 11, 13, and 17) in Indian GIST patients. Along with well-described KIT mutations, several rare double mutations as well as novel alterations were reported in this series.
Life-Threatening Upper Gastrointestinal Bleeding Secondary to Aortoenteric Fistula
Authors: Islam Tasbirul , Hines George , Katz Douglas S. , Purtil William , Castiller Francis
Published: September 2017

We present a patient with gastrointestinal bleeding secondary to an aortoduodenal fistula. The patient had undergone an open surgical repair of an abdominal aortic aneurysm five years prior to admission.
Analysis of Respiratory Sounds: State of the Art
Authors: Reichert Sandra , Gass Raymond , Brandt Christian , Andrès Emmanuel
Published: September 2017

Objective

This paper describes state of the art, scientific publications and ongoing research related to the methods of analysis of respiratory sounds.

Methods and material

Review of the current medical and technological literature using Pubmed and personal experience.

Results

The study includes a description of the various techniques that are being used to collect auscultation sounds, a physical description of known pathologic sounds for which automatic detection tools were developed. Modern tools are based on artificial intelligence and on technics such as artificial neural networks, fuzzy systems, and genetic algorithms…

Conclusion

The next step will consist in finding new markers so as to increase the efficiency of decision aid algorithms and tools.
Neuroimmune Interaction in Inflammatory Diseases
Authors: Otmishi Peyman , Gordon Joshiah , El-Oshar Seraj , Li Huafeng , Guardiola Juan , Saad Mohamed , Proctor Mary , Yu Jerry
Published: September 2017

The inflammatory response is modulated through interactions among the nervous, endocrine, and immune systems. Intercommunication between immune cells and the autonomic nervous system is a growing area of interest. Spatial and temporal information about inflammatory processes is relayed to the central nervous system (CNS) where neuroimmune modulation serves to control the extent and intensity of the inflammation. Over the past few decades, research has revealed various routes by which the nervous system and the immune system communicate. The CNS regulates the immune system via hormonal and neuronal pathways, including the sympathetic and parasympathetic nerves. The immune system signals the CNS through cytokines that act both centrally and peripherally. This review aims to introduce the concept of neuroimmune interaction and discuss its potential clinical application, in an attempt to broaden the awareness of this rapidly evolving area and open up new avenues that may aid in the treatment of inflammatory diseases.
Eosinophilic Lung Disease
Authors: Mann Bhupinder
Published: September 2017

Eosinophilic lung diseases represent a group of disorders in which lung infiltrates seen on a chest radiograph, may or may not be accompanied by peripheral blood eosinophilia. The causes are varied, and range from drug ingestion, parasite or fungal infection, or else, may be idiopathic. The clinical manifestation of these disorders may be mild or severe, depending on the underlying condition. A full history and examination, along with radiological imaging, bronchoscopy, and serological tests are useful in reaching a diagnosis. Treatment with corticosteroids usually results in a good clinical outcome, if the diagnosis is suspected and made early. Early treatment with high dose corticosteroids may be life saving in some patients, whilst other patients require prolonged and sometimes recurrent courses of corticosteroids, due to the chronic relapsing nature of their condition.
Effects of Seal Oil on Meal-Induced Symptoms and Gastric Accommodation in Patients with Subjective Food Hypersensitivity: A Pilot Study
Authors: Gregersen Kine , Lind Ragna A. , Bjørkkjaer Tormod , Frøyland Livar , Berstad Arnold , Lied Gulen Arslan
Published: September 2017

Background

Food hypersensitivity is a prevalent condition with poorly characterized underlying mechanisms. In the present pilot study we investigated effects of seal oil and soy oil on meal-induced symptoms and gastric accommodation in patients with subjective food hypersensitivity (FH). Single dose experiment: On three consecutive days, 10 mL of seal oil, soy oil, or saline were randomly administered into the duodenum of 10 patients with subjective FH and 10 healthy volunteers through a nasoduodenal feeding tube 10-20 minutes before the ingestion of a test meal. Short-term treatment study: 24 patients with subjective FH were randomly allocated to 10 days’ treatment with either 10 mL of seal or soy oil, self-administrated through an indwelling nasoduodenal feeding tube, 3 times daily. In both experiments meal-induced abdominal symptoms and gastric accommodation were measured by visual analogue scales and external ultrasound respectively.

Results

Symptoms and gastric accommodation were not significantly influenced by single doses of seal or soy oil. When given daily for 10 days, seal oil, but not soy oil, reduced total symptom scores significantly ( P = 0.03). The symptomatic improvement was not associated with improvements in gastric accommodation.

Conclusion

Daily administration of seal oil may benefit patients with subjective FH. The beneficial effect of seal oil in patients with subjective FH can not be ascribed to improved gastric accommodation.
Fulminant Hepatic Failure Caused by Diffuse Liver Metastases following Gastrointestinal Stromal Tumor Resection
Authors: Zeina Abdel-Rauf , Nachtigal Alicia , Vlodavsky Eugene , Naschitz Jochanan E.
Published: September 2017

Metastatic tumors to the liver resulting in fulminant hepatic failure are a rare occurrence and have not been previously described in patients with gastrointestinal stromal tumor (GIST). A 70 year-old man was referred to hospital with postprandial discomfort. On examination a 19.5 cm large epithelioid GIST of the stomach was diagnosed. The mass exhibited unfavorable prognostic features: mitotic index 18/50 high-power fields, large primary tumor size and male sex. Complete tumor resection with negative margins was achieved and metastases were not detected. The patient presented six months later with jaundice, asterixis and elevated liver enzymes. Computerized tomography showed multiple liver hypodense lesions representing metastases. Treatment with imatinib mesylate was of no avail and the patient died 3 days later as the result of hepatic failure. Massive liver metastases can, even though rarely, be responsible for fulminant hepatic failure. Clinical and radiological follow-up are crucial in patients with GIST even after surgical resection.
Article Commentary: The Role of Adjuvant Therapy in Gastrointestinal stromal Tumor after Operative Treatment
Authors: Lok Ka-Ho
Published: September 2017

The treatment for localized advance gastrointestinal stromal tumor (GIST) is far from ideal. Up to 50% of patient developed post-operative recurrence and died within 5 years. Recently, imatinib was found to significantly improve recurrence-free survival in post-operative patients. The role of adjuvant therapy in high risk GIST patients is discussed.
Surgery is Indicated for Persistent Enterocutaneous Fistulizing Crohn's Disease
Authors: Baars Judith E. , Kuipers Ernst J. , Van Dekken Herman , Van Der Woude C. Janneke
Published: September 2017

We describe a patient with Crohn's disease who presented with a persistent enterocutaneous fistula. Colonoscopy showed no abnormalities in the terminal ileum and cecum. The patient was treated with corticosteroids and azathioprine for Crohn's disease. The fistula responded partially to therapy. Surgery was performed and revealed a well-differentiated adenocarcinoma, originating from the fistulous tract. In persistent enterocutaneous fistulae surgery is indicated and could keep us from shocking surprises.
Indications and Outcome of Endoscopic Papillectomy of the Major and Minor Papilla—a Prospective 5-year Study
Authors: Will Uwe , Gottschalk Peter , Bosseckert Hans , Meyer Frank
Published: September 2017

Endoscopic papillectomy is a promising and challenging endoscopic intervention. The aim of this study was i) to classify the differential indication, and ii) to study the outcome in papillectomy of suspicious tumor lesions of the papilla of Vater (papilla).

Methods

Thirty nine patients were enrolled (22 males/17 females; range of age, 21-88 years) who underwent endoscopic papillectomy because of a polypoid tumor at the papilla revealed by previous endoscopic ultrasonography (EUS) over a time period of 5 years. Follow-up EUS and histologic investigation were performed within 28 days(d).

Results

I) All tumors were detectable using EUS (range of tumor size, 1-4.5 cm). II) Indications, histologic diagnoses and their distribution were as follows: Group(Gr.)1 ( n = 21): Adenoma ( n = 18), uT1 carcinoma(Ca) of high risk patients ( n = 3) with R0 resection ( n = 17) vs. R1 ( n = 4; all reapproached using argon beamer). On the 28th postinterventional d, all subjects were free of tumor. Recurrent tumor growth was found in 3 cases after 6, 18 and 26 months respectively (range of endoscopic follow up [ n = 14], 3-60 months). Three patients (free of tumor) died from other causes after 3, 8 and 18 months, respectively. Gr. 2 ( n = 8): Contradiction between EUS (infiltrating tumor growth) and histologic finding (adenoma or unspecific inflammation); histological findings were: Adenomyomatosis of the papilla ( n = 5), infiltrating Ca of the papilla or peripapillary region ( n = 3). Gr. 3 ( n = 4): Neuroendocrine tumors of the major ( n = 2) or minor papilla ( n = 2): 2 benign, 1 Ca and 1 carcinoid tumor. Gr. 4 ( n = 6): Non-introducible catheter through the minor papilla in case of suspected pancreas divisum ( n = 2) or through the major papilla ( n = 1) after previous gastric resection (Billroth II) or because of Ca of the papilla with no successful attempts to drain the bile duct ( n = 3): Catheter insertion was achieved after papillectomy ( n = 3) or partial tumor resection ( n = 3). III) Complications: 8 of 39 patients (20.5%) developed postinterventional pancreatitis (severe course, n = 1); in 7 cases, bleeding occurred, no perforation was seen. The rate of recurrent tumor growth after R0 resection was 17.6% (3 of 17 subjects).

In

papillectomy is feasible in the case of i) polypoid tumor of the papilla, ii) infiltrating tumor growth revealed by EUS and negative histologic investigation (optional: plus deep biopsy), and iii) tumor lesion, through which catheter can not be placed to get access to the pancreatobiliary system.

In

endoscopic papillectomy fulfills diagnostic as well as therapeutic requirements and can be recommended as minimally invasive but appropriate method for well-defined indications of papillary tumor lesions.
Underlying—Disease Risk for Antispasmodic Premedication in Older Patients Undergoing Investigations of the Gastrointestinal Tract
Authors: Saito Noboru , Seshimo Akiyoshi , Kameoka Shingo
Published: September 2017

Purpose

Improve risk management of patients undergoing investigations of the gastrointestinal (GI) tract, in regard to underlying diseases and choice of premedication. According to a nationwide survey in Japan, 74% of the deaths associated with premedication were patients aged 60 years or over.

Methods

Subjects were 418 patients undergoing investigations of the GI tract (367 endoscopy, 51 barium contrast radiography) between October 2001 and January 2004. Age distribution peaked in the 65-69 years group, and 40% of subjects were aged 65 years and over. Using a questionnaire, each subject was interviewed prior to the investigation to determine contraindications for anticholinergic agents or glucagon preparations. To confirm the risk associated with antispasmodic agents in elderly subjects, the group was subdivided into those aged under 65 years and those aged 65 and over, and compared.

Results

Anticholinergic agents were contraindicated in more than 50% of subjects aged 65 years and over, and glucagon was contraindicated in 11% of subjects aged 65 years and over. The proportion of elderly subjects in whom antispasmodic agents, including anticholinergics and glucagon, were contraindicated was significantly greater than for subjects aged under 65 years.

Conclusions

Using a written questionnaire at the time of obtaining informed consent facilitates the identification of underlying diseases and selection of appropriate premedication.
Telesurgery of Microscopic Micromanipulator System “NeuRobot” in Neurosurgery: Interhospital Preliminary Study
Authors: Goto Tetsuya , Miyahara Takahiro , Toyoda Kazutaka , Okamoto Jun , Kakizawa Yukinari , Koyama Jun-Ichi , Fujie Masakatsu G. , Hongo Kazuhiro
Published: September 2017

Object

Robotic surgery can be applied as a novel technology. Our master-slave microscopic-micromanipulator system (NeuRobot), which has a rigid endoscope and three robot-arms, has been developed to perform neurosurgical procedures, and employed successfully in some clinical cases. Although the master and slave parts of NeuRobot are directly connected by wire, it is possible to separate each part and to apply it to telesurgery with some modifications. To evaluate feasibility of NeuRobot in telesurgery, some basic experiments were performed.

Methods

The quality of telemedicine network system between Shinshu University and one of the affiliated hospitals, which was completely separated from other public network systems, was investigated. The communication delay was calculated from the transmitting and the receiving records in the computers set in each hospital. The relationship between the change in communication delay from the master part to the slave part of NeuRobot (0, 100, 300, 500 and 700 ms) respectively and feasibility of NeuRobot was investigated. The task performance time in each time changing group was compared. Feasibility of NeuRobot in telesurgical usage was evaluated. The master part and the slave part of NeuRobot placed in each hospital were connected through private network system. Interhospitally connected NeuRobot was compared with directly connected one in terms of task performance time.

Results

Less than 1 ms was required for corresponding the data in a steady transmitting state. Within 2 seconds after connection, relative time delay (maximum 40 ms) and packet loss were sometimes observed. The mean task performance time was significantly longer in over 500 ms delayed group compared with directly connected NeuRobot. There was no significant difference in the task performance time between directly connected NeuRobot and interhospitally connected NeuRobot.

Conclusion

Our results proved that telesurgical usage of NeuRobot was feasible. Telesurgical usage of telecontrolled manipulator system is recommended for application in a private network system in order to reduce technical and ethical problems. Some technical innovations will bring breakthrough to the telemedicine field.
A methodology coupling geophysical and borehole measurements to estimate the permeability of a site that will infiltrate treated wastewater
Authors: Bisone S. , Clement R. , Forquet N.
Published: September 2017

When water cannot be discharged to superficial water body or the discharge volume needs to be limited, treated wastewater downstream a treatment plant can be infiltrated. Operational and environmental challenges emerge from this practice: how to size infiltration facilities and what will be the impact of the treated wastewater on groundwater quality? Preliminary studies are recommended for soil-based constructed wetlands and compulsory when permanent infiltration is needed. Unfortunately there is no guideline on how to deal with spatial heterogeneity of soil properties. They can greatly influence water pathway in the soil and the quantities of treated wastewater that can infiltrate. The aim of this article is to introduce a methodology that associates geophysical measurements and more localized ones in order to better described the near-surface with a particular focus on field saturated hydraulic conductivity. Starting from the fastest and coarsest method, the suggested hierarchical process allows optimizing the sampling strategies for longer and more accurate measurements. Therefore, such a methodology, while increasing the quality of results, may also reduce the time and cost of preliminary studies. Two applications are presented demonstrating the advantages of associating several methods. They also underline the input of using geophysical methods on soil that have been largely modified by human activity.

Lorsqu'il n'existe pas d'autre exutoire possible ou que l'on souhaite réduire les volumes déversés vers le milieu récepteur superficiel, l'eau usée traitée à la sortie des stations d'épuration est infiltrée à proximité. Cette pratique fait émerger des questionnements d'ordre opérationnel et environnemental : comment dimensionner un ouvrage d'infiltration et quels sont les impacts éventuels sur le milieu récepteur souterrain ? Des études préalables sont recommandées pour les zones de rejet végétalisées et obligatoires dans le cas des zones d'infiltration mais aucun document ne précise comment prendre en compte l'hétérogénéité spatiale des propriétés du sol. Ces dernières pouvant fortement influencer le cheminement de l'eau vers la nappe ainsi que les quantités susceptibles d'être infiltrées. Le présent article introduit une méthodologie couplant des mesures géophysiques spatialisées et des mesures ponctuelles afin de décrire au mieux la configuration de la proche surface, notamment sa conductivité hydraulique au champ. Le processus hiérarchique proposé permet, en allant de la mesure la plus rapide et la moins précise, à la mesure la plus longue et la plus précise, d'optimiser les plans d'échantillonnage et ainsi réduire le temps et le coût de l'étude. Deux exemples d'application de la méthodologie sont présentés mettant particulièrement en évidence la complémentarité des outils et l'apport de la géophysique notamment sur des milieux fortement remaniés par l'homme.
Redesign of computerized decision support to improve antimicrobial prescribing
Authors: Del Gigante Jessica , Moran Maria , Sandaradura Indy , Li Ling , Richardson Katrina L. , Sandhu Anmol , Lehnbom Elin C. , Westbrook Johanna I. , Day Richard O. , Baysari Melissa T.
Published: September 2017

Objective: To determine the impact of the introduction of new pre-written orders for antimicrobials in a computerized provider order entry (CPOE) system on 1) accuracy of documented indications for antimicrobials in the CPOE system, 2) appropriateness of antimicrobial prescribing, and 3) compliance with the hospital’s antimicrobial policy. Prescriber opinions of the new decision support were also explored to determine why the redesign was effective or ineffective in altering prescribing practices.

Methods: The study comprised two parts: a controlled pre-post study and qualitative interviews. The intervention involved the redesign of pre-written orders for half the antimicrobials so that approved indications were incorporated into pre-written orders. 555 antimicrobials prescribed before (September – October, 2013) and 534 antimicrobials prescribed after (March – April, 2015) the intervention on all general wards of a hospital were audited by study pharmacists. Eleven prescribers participated in semi-structured interviews.

Results: Redesign of computerized decision support did not result in more appropriate or compliant antimicrobial prescribing, nor did it improve accuracy of indication documentation in the CPOE system (Intervention antimicrobials: appropriateness 49% vs. 50%; compliance 44% vs. 42%; accuracy 58% vs. 38%; all p>0.05). Via our interviews with prescribers we identified five main reasons for this, primarily that indications entered into the CPOE system were not monitored or followed-up, and that the antimicrobial approval process did not align well with prescriber workflow.

Conclusion: Redesign of pre-written orders to incorporate appropriate indications did not improve antimicrobial prescribing. Workarounds are likely when compliance with hospital policy creates additional work for prescribers or when system usability is poor. Implementation of IT, in the absence of support or follow-up, is unlikely to achieve all anticipated benefits.

Citation: Baysari MT, Del Gigante J, Moran M, Sandaradura I, Li L, Richardson KL, Sandhu A, Lehnbom EC, Westbrook JI, Day RO. Redesign of computerized decision support to improve antimicrobial prescribing. Appl Clin Inform 2017; 8: 949–963 https://doi.org/10.4338/ACI2017042017040069
Direct molecular-level characterization of different heterogeneous freezing modes on mica – Part 1
Authors: Abdelmonem Ahmed
Published: September 2017

Abstract. The mechanisms behind heterogeneous ice nucleation are of fundamental importance to the prediction of the occurrence and properties of many cloud types, which influence climate and precipitation. Aerosol particles act as cloud condensation and freezing nuclei. The surface–water interaction of an ice nucleation particle plays a major, not well explored, role in its ice nucleation ability. This paper presents a real-time molecular-level comparison of different freezing modes on the surface of an atmospherically relevant mineral surface (mica) under varying supersaturation conditions using second-harmonic generation spectroscopy. Two sub-deposition nucleation modes were identified (one- and two-stage freezing). The nonlinear signal at the water–mica interface was found to drop following the formation of a thin film on the surface regardless of (1) the formed phase (liquid or ice) and (2) the freezing path (one or two step), indicating similar molecular structuring. The results also revealed a transient phase of ice at water–mica interfaces during freezing, which has a lifetime of around 1 min. Such information will have a significant impact on climate change, weather modification, and the tracing of water in hydrosphere studies.
Gasoline aromatics: a critical determinant of urban secondary organic aerosol formation
Authors: Peng Jianfei , Hu Min , Du Zhuofei , Wang Yinhui , Zheng Jing , Zhang Wenbin , Yang Yudong , Qin Yanhong , Zheng Rong , Xiao Yao , Wu Yusheng , Lu Sihua , Wu Zhijun , Guo Song , Mao Hongjun , Shuai Shijin
Published: September 2017

Abstract. Gasoline vehicle exhaust is an important contributor to secondary organic aerosol (SOA) formation in urban atmosphere. Fuel composition has a potentially considerable impact on gasoline SOA production, but the link between fuel components and SOA production is still poorly understood. Here, we present chamber experiments to investigate the impacts of gasoline aromatic content on SOA production through chamber oxidation approach. A significant amplification factor of 3–6 for SOA productions from gasoline exhausts is observed as gasoline aromatic content rose from 29 to 37 %. Considerably higher emission of aromatic volatile organic compounds (VOCs) using high-aromatic fuel plays an essential role in the enhancement of SOA production, while semi-volatile organic compounds (e.g., gas-phase PAHs) may also contribute to the higher SOA production. Our findings indicate that gasoline aromatics significantly influence ambient PM2. 5 concentration in urban areas and emphasize that more stringent regulation of gasoline aromatic content will lead to considerable benefits for urban air quality.
The influence of idealized surface heterogeneity on virtual turbulent flux measurements
Authors: De Roo Frederik , Mauder Matthias
Published: September 2017

Abstract. The imbalance of the surface energy budget in eddy-covariance measurements is still an unsolved problem. A possible cause is the presence of land surface heterogeneity. The influence of surface heterogeneities on the atmospheric boundary layer has been intensively investigated since two decades. Previous studies found that heterogeneities of the boundary-layer scale or larger are most effective in influencing the boundary layer turbulence. Subsequent large-eddy simulations showed that also the turbulent fluxes are influenced by large-scale organized structures in the boundary layer. However, the precise influence of the surface characteristics on the energy imbalance of measurements in the surface layer and its partitioning is still unknown. To investigate the influence of surface variables on all the components of the flux budget under convective conditions, we set up a systematic parameter study by means of large-eddy simulation. For the study we use a virtual control volume approach, which allows the determination of advection by the mean flow, flux-divergence and storage terms of the energy budget at the virtual measurement site, in addition to the standard turbulent flux. We focus on the heterogeneity of the surface fluxes and keep the topography flat. The surface fluxes vary locally in intensity and these patches have different length scales. Intensity and length scales can vary for the two horizontal dimensions but follow an idealized chessboard pattern. Our main focus lies on heterogeneities of length scales of the kilometer scale, and length scales of one order of magnitude smaller. For heterogeneities of these two types, we investigate the average response of the fluxes at a number of virtual towers, when varying the heterogeneity length within the length scale and when varying the contrast between the different patches. For each simulation, virtual measurement towers were positioned at functionally different positions (e.g. downdraft region, updraft region, at border between domains, etc.). Furthermore, we seek correlators for the energy balance ratio and the energy residual in the simulations. Besides the expected correlation with measurable atmospheric quantities such as the friction velocity, boundary-layer depth and temperature and moisture gradients, we have also found an unexpected correlation with the temperature difference between sonic temperature and surface temperature.
Simultaneous assimilation of ozone profiles from multiple UV-VIS satellite instruments
Authors: van Peet Jacob , van der A Ronald , Kelder Hennie , Levelt Pieternel
Published: September 2017

Abstract. A three-dimensional global ozone distribution has been derived from assimilation of ozone profiles that were observed by satellite. By simultaneous assimilation of ozone profiles retrieved from the nadir looking satellite instruments Global Ozone Monitoring Experiment 2 (GOME-2) and Ozone Monitoring Instrument (OMI), which measure the atmosphere at different times of the day, the quality of the derived atmospheric ozone field has been improved. The assimilation is using an extended Kalman filter in which chemical transport model TM5 has been used for the forecast. The combined assimilation of both GOME-2 and OMI improves upon the assimilation results of a single sensor. The new assimilation system has been demonstrated by processing 4 years of data from 2008 to 2011. Validation of the assimilation output by comparison with sondes show that biases vary between −5 % and +10 % between the surface and 100 hPa. The biases for the combined assimilation vary between −3 % and +3 % in the region between 100 and 10 hPa where GOME-2 and OMI are most sensitive. This is a strong improvement compared to direct retrievals of ozone profiles from satellite observations.
Investigating biomass burning aerosol morphology using a laser imaging nephelometer
Authors: Manfred Katherine M. , Washenfelder Rebecca A. , Wagner Nicholas L. , Adler Gabriela , Erdesz Frank , Womack Caroline C. , Lamb Kara D. , Schwarz Joshua P. , Franchin Alessandro , Selimovic Vanessa , Yokelson Robert J. , Murphy Daniel M.
Published: September 2017

Abstract. Particle morphology is an important parameter affecting aerosol optical properties that are relevant to climate and air quality, yet it is poorly constrained due to sparse in situ measurements. Biomass burning is a large source of aerosol that generates particles with different morphologies. Quantifying the optical contributions of non-spherical aerosol populations is critical for accurate radiative transfer models, and for correctly interpreting remote sensing data. We deployed a laser imaging nephelometer at the Missoula Fire Sciences Laboratory to sample biomass burning aerosol from controlled fires during the FIREX intensive laboratory study. The laser imaging nephelometer measures the unpolarized scattering phase function of an aerosol ensemble using diode lasers at 375 nm and 405 nm. Scattered light from the bulk aerosol in the instrument is imaged onto a CCD using a wide-angle field-of-view lens, which allows for measurements at 4–175° scattering angle with ~ 0.5° angular resolution. Along with a suite of other instruments, the laser imaging nephelometer sampled fresh smoke emissions both directly and after removal of volatile components with a thermodenuder at 250 °C. The total integrated aerosol scattering signal agreed with both a cavity ring-down photoacoustic spectrometer system and a traditional integrating nephelometer within instrumental uncertainties. We compare the measured scattering phase functions at 405 nm to theoretical models for spherical (Mie) and fractal (Rayleigh-Debye-Gans) particle morphologies based on the size distribution reported by an optical particle counter. Results from representative fires demonstrate that particle morphology can vary dramatically for different fuel types. In some cases, the measured phase function cannot be described using Mie theory. This study demonstrates the capabilities of the laser imaging nephelometer instrument to provide real-time, in situ information about dominant particle morphology, which is vital for understanding remote sensing data and accurately describing the aerosol population in radiative transfer calculations.