bluuebunny/crossref_metadata_2025 huggingface dataset:
The green paving block made from the broken lightweight concrete brick: the preliminary study
Authors: Singthong Y , Nusit K , Subsomboon K
Published: March 2023

Presently, construction the building walls with lightweight concrete blocks in Thailand is very popular; however, lightweight concrete blocks are easily damaged during transportation to the construction sites. The waste generated from damaged lightweight concrete blocks requires proper management with an additional budget. Reusing the broken lightweight concrete block as aggregate for the concrete paving block is one of the waste management alternatives. Therefore, this research aims to evaluate the characteristics of concrete paving block made by broken lightweight blocks. The tests required by the Thai Industrial Standards Institute were followed in the research. The replacement percentages of the broken block by mixture weight equivalent to 0%,10%,20%, and 30% were employed to reduce the virgin-coarse aggregate used for concrete paving block manufacturing. The test results revealed that the compressive strength of the concrete paving block reduced by 0.06 ksc at every 1% of replacing the virgin aggregate by broken lightweight block. Moreover, the water absorption of the concrete paving block increased with the rise in amount of broken lightweight blocks. These might be caused by the porous cement mortar adhered on the broken lightweight blocks. Therefore, the modification of broken lightweight blocks is required prior to employ this waste as the aggregate for concrete paving block mixture.
Building YoloV4 models for identification of rock minerals in thin section
Authors: Pratama B G , Qodri M F , Sugarbo O
Published: March 2023

Rock mineral identification is a costly and time-consuming task using conventional methods of testing physical and chemical properties, especially in the petrographic laboratory. A comprehensive identification model for three rock minerals in sedimentary rocks based on the YoloV4 model is available as a solution. The models predict rock minerals by calculating the pixels and the weights that have been trained previously. First, the YoloV4 models and framework were built. Then, a total of 44 manually labelled thin section images (sedimentary rocks thin section) were used to create the model to detect minerals accurately. The MAP and loss results showed that the parameters of the minerals detection model in PPL are 11% and 1.19, respectively. Meanwhile, The MAP and loss results of XPL are 19% and 1.18, respectively. Finally, Identification of rock minerals using deep learning algorithms is a very promising idea especially the YoloV4 model can build a comprehensive detection of rock samples in thin sections effectively.
Design and documentation as attributes to waste generation at construction sites
Authors: Moeis A A A , Che Ahmad A , Tharim A H A , Othman N
Published: March 2023

Rapid demand of housing and infrastructure development in Malaysia had result in more construction and consequently increase the construction waste. Construction waste takes major impact to the environmental if there is no proper management of construction waste from earliest point of waste generated until waste disposal. Thus, it is important to identify attributes influencing construction waste generated at construction sites. This study aims to determine design and documentation as attributes of construction waste generation. This study was conducted at Putrajaya, Malaysia. Putrajaya was selected because this city is pioneer in urban development in measuring and promoting green development activities in Malaysia. Quantitative study using questionnaire survey was conducted at construction sites in Putrajaya. A total of 21 respondents from the construction sites have returned the survey. Using relative importance index (RII) as the analysis tools, this study determined that the design and documentation are waste generation attributes at construction sites. Findings of this study could assist more comprehensive study in determining the attributes of waste generation at construction sites.
Data stories and dashboard development: a case study of an aviation schedule and delay causes
Authors: Salleh S S , Shukri A S , Othman N I , Saad N S M
Published: March 2023

In this case study, five key processes in modelling a data story of aviation data patterns during COVID-19 have been executed. It started with the collection of secondary data from relevant sources. Data inspection, transformation, and preparation activities, including data cleaning, filtering, and sampling, are all included in this work. Iterative exploratory data analysis (EDA) has been conducted to determine the pattern of each independent attribute, followed by an assessment after the data story is modelled and integrated on a dashboard. The questionnaire has been distributed and the visuals were assessed by giving respondents a few tasks to interpret stories based on their comprehension. The result shows that the data stories have been interpreted in a similar narrative by all the respondents. The overall mean score is 4.71, and this significantly shows that the respondents agree and strongly agree that the visual objects help in communicating patterns and stories. The overall process gives researchers experience and guidelines for future work. Overall, the objectives of the study have been met. Nevertheless, it gives researchers a lot of experience in interpreting data, cleansing and transformation, analysis, modelling the visualisation by selecting suitable charts, and integrating the objects together into a dashboard.
Effect of milling time variation on TiTaVWCr HEA powder as nuclear material on microstructure and mechanical properties by a mechanical alloying method
Authors: Sutrisna  , Prasetiyo A B , Kartikasari R , Aziz I
Published: March 2023

TiTaVWCr HEA alloy is a refractory material that is often used as nuclear material. This research uses powder material and milling using the mechanical alloy method. This research aimed to determine the microstructure and mechanical properties of the TiTaVWCr HEA alloy milling process for 4 h, 8 h, 16 h, and 24 h. Tests were carried out using XRD spectra and Secondary Electron Microstructure-Energy Dispersive Spectroscopy (SEM-EDS) to determine the characteristics of the material and its microstructure. The results showed that the HEA model with low milling (4 h and 8 h) microstructure distribution was not uniform, and there was agglomeration in certain areas. After milling was increased to 16 hours, the distribution of elements became uniform, but oxides appeared on Ti became in the formation of Ti-O. The hardness value shows that the longer the milling time, the higher the hardness. This phenomenon is related to the increase in grain dimension, and dislocation density.
Efficiency enhancement of dye-sensitized solar cell with PVdF-HFP:MPII:NaI quasi-solid-state electrolyte
Authors: Zakaria P N M , Saaid F I , Raffi A A M , Noor I S M , Woo H J , Tan W
Published: March 2023

Quasi-solid-state polymer electrolyte (QSSPE) based on poly(vinylidene fluoride-co-hexafluoropropylene) (PVdF-HFP) was prepared using sodium iodide (NaI) salt, 1-methyl-3-propylimidazolium iodide (MPII) ionic liquid, propylene carbonate (PC) and 1,2-dimethoxyethane (DME) plasticizers. This paper discusses the effects of using a binary mixture of large (MPII) and small (NaI) cation alkaline salts on enhancing the performance of DSSCs with gel polymer electrolytes. The amount of NaI was varied while the other components were kept constant to study the dependence of dye-sensitized solar cell (DSSC) performance on NaI amount. The incorporation of NaI in PVdF-HFP-MPII-PC-DME has enhanced the efficiency of DSSC. DSSC with 0.6 M MPII and 0.4 M NaI showed the highest efficiency of 4.16 % and short circuit current density (J
sc) of 13.63 mAcm−2. Additionally, the roles of TBP and GuSCN as co-additives in the electrolytes were also discussed in this paper. The presence of 4-tert-butylpyridine (TBP) and guanidine thiocyanate (GuSCN) further enhanced the efficiency from 4.16 to 6.95 %.
Investigation of mechanical, microstructure, and corrosion properties of duplex stainless steel joint for natural gas processing facilities
Authors: Pamuji D S , Hakim M L , Sutrisna  , Novianto
Published: March 2023

Duplex stainless steel is an exotic material known for its excellent corrosion resistance and mechanical properties due to the presence of a two-phase structure that is quite balanced between ferrite and austenite, making it one of the top choices for the oil and gas industry. In this paper, we will discuss the process and investigation of the welding results of the A/SA 790 UNS 31803 duplex pipe joint which is connected using the gas tungsten arc welding (GTAW) process for gas purification process applications. The welding process and qualification is based on the ASME BPVC Sec code. IX was then tested to obtain information on the characteristics of the mechanical properties, microstructure, and corrosion resistance of the resulting joints. Heat input in the welding process is a crucial factor that determines the equilibrium of the ferrite and austenite phases which then correlates with the mechanical properties and corrosion resistance of the joint. Based on the microstructural analysis, there was a decrease in the ferrite phase in the weld metal, but it was still within the required limits. Furthermore, the results of the mechanical properties test showed that the tensile strength of the joint was greater than the tensile strength of the base metal and no open discontinuity was observed in the bending test. The corrosion test showed no signs of pitting corrosion with a weight loss value of 1.7 g/m2.
Numerical analysis of the influence iron type on Von Mises Stress and safety parameters for compost processing machine frame construction
Authors: Prasetiyo A B , Sekarjati K A , Sutrisna
Published: March 2023

The installation of other engine parts, such as the engine, transmission, shaft, blade, and cover, includes the engine frame. The engine frame must be developed and constructed with the strength to support other components. The building of the waste processing machine frame with variants of square tube type and angle bar type will be analyzed in this study, with a focus on the analysis of von Mises’s stress and safety aspects. Using Solidworks software, finite element analysis is the research methodology used. The examination of the waste processing machine’s frame modelling using square tubes and angular bars yielded maximum von Mises stress values of 3.77e+7 N/m2 and 3.162e+4 N/m2, respectively. The maximum deformation values for the square tube iron and angular bar used in the modelling analysis of the waste processing machine frame are 2,499e+1mm and 9,725e+1mm, respectively . and 8.5 and 1 is the required minimum safety factor value for modelling the frame of a waste processing machine made of square tube iron. The safety factor value of 2-3 is the primary criterion for a suitable design. It is safe and advised to utilize the waste processing machine frame made of square tube iron for this purpose.
Lithium Extraction Method from Geothermal Brine to Find Suitable Method for Geothermal Fields in Indonesia: A Review
Authors: Suud Esty Mustika , Suryantini  , Mubarok Muhammad Zaki
Published: March 2023

Lithium has become an essential metal for modern industries. Specifically, the growth of battery-based electric vehicles will demand much more lithium shortly. Many studies have been conducted to find the sources of lithium; one of them is geothermal brine. Indonesia has enormous geothermal resources; some fields have lithium content that can potentially be extracted. Various methods in the extraction process of lithium from the geothermal brine have been developed, both on laboratory and pilot projects. Conventionally, solar evaporation has been used to concentrate lithium from brine, but it takes a long time and depends on the weather. Thus, a more rapid and selective process is desired to fulfill the market demand and avoid weather constraints. This paper reviews the lithium extraction from the geothermal brine by direct extraction methods using solvent extraction, adsorption and ion exchange, membrane, and electrodialysis. The study is based on a desktop study and aims to summarize the knowledge, method, technology, and techniques of lithium extraction from geothermal brine that has already been used and to find out which extraction method is suitable for the Indonesian geothermal field. Multiple-stages solvent extraction from geothermal brine well X in Dieng performed by the authors demonstrated a lithium extraction efficiency of 94% and indicated an opportunity to be further investigated to extract lithium from the Dieng geothermal brine.
Assessing capacity to deploy direct air capture technology at the country level – an expert and information entropy comparative analysis
Authors: Izikowitz David , Li Jia , Wang Eryu , Zheng Biao , Zhang Yuquan W
Published: March 2023

An ever-dwindling carbon budget, resulting in temperature rise of 1.5 °C above pre-industrial levels projected between 2030–2035, has generated a necessity to explore climate mitigation technologies such as direct air capture (DAC). DAC typically involves the use of materials and energy to capture CO2 directly from the atmosphere. However, DAC technologies remain a long way from the necessary level of development and scale needed to move the needle on carbon removal and mitigating against climate change. This study conducts a country-level analysis using an expert elicitation and an information entropy method, with a weighted group of variables identified from existing literature as necessary to develop and deploy low-temperature, electrochemical and high-temperature DAC technologies. Here we show that: (1) adopting the expert survey variable weighting, USA, Canada, China and Australia are best positioned to deploy the various DAC technologies; (2) the information entropy approach offers a broadly similar result with traditionally developed nations being best positioned, in addition to land rich countries, to deploy DAC technologies; (3) a comparatively developed policy and financing environment, as well as low carbon energy supply would raise a country’s DAC capacity; (4) developing countries such as China have significant potential to deploy DAC, owing to a well-rounded position across variables. These results produce wide-ranging policy implications for efforts to deploy climate mitigation technologies through the development of a multilateral, coordinated mitigation and carbon dioxide removal deployment strategy.
Discovery and genome-guided mapping of REN12 from Vitis amurensis, conferring strong, rapid resistance to grapevine powdery mildew
Authors: Sapkota Surya , Zou Cheng , Ledbetter Craig , Underhill Anna , Sun Qi , Gadoury David , Cadle-Davidson Lance
Published: March 2023

Powdery mildew resistance genes restrict infection attempts at different stages of pathogenesis. Here, a strong and rapid powdery mildew resistance phenotype was discovered from Vitis amurensis ‘PI 588631’ that rapidly stopped over 97% of Erysiphe necator conidia, before or immediately after emergence of a secondary hypha from appressoria. This resistance was effective across multiple years of vineyard evaluation on leaves, stems, rachises, and fruit and against a diverse array of E. necator laboratory isolates. Using core genome rhAmpSeq markers, resistance mapped to a single dominant locus (here named REN12) on chromosome 13 near 22.8–27.0 Mb, irrespective of tissue type, explaining up to 86.9% of the phenotypic variation observed on leaves. Shotgun sequencing of recombinant vines using skim-seq technology enabled the locus to be further resolved to a 780 kb region, from 25.15 to 25.93 Mb. RNASeq analysis indicated the allele-specific expression of four resistance genes (NLRs) from the resistant parent. REN12 is one of the strongest powdery mildew resistance loci in grapevine yet documented, and the rhAmpSeq sequences presented here can be directly used for marker-assisted selection or converted to other genotyping platforms. While no virulent isolates were identified among the genetically diverse isolates and wild populations of E. necator tested here, NLR loci like REN12 are often race-specific. Thus, stacking of multiple resistance genes and minimal use of fungicides should enhance the durability of resistance and could enable a 90% reduction in fungicides in low-rainfall climates where few other pathogens attack the foliage or fruit.
CaREM1.4 interacts with CaRIN4 to regulate Ralstonia solanacearum tolerance by triggering cell death in pepper
Authors: Zhang Yanqin , Guo Shuangyuan , Zhang Feng , Gan Pengfei , Li Min , Wang Cong , Li Huankun , Gao Gang , Wang Xiaojie , Kang Zhensheng , Zhang Xinmei
Published: March 2023

Remorins, plant-specific proteins, have a significant role in conferring on plants the ability to adapt to adverse environments. However, the precise function of remorins in resistance to biological stress remains largely unknown. Eighteen CaREM genes were identified in pepper genome sequences based on the C-terminal conserved domain that is specific to remorin proteins in this research. Phylogenetic relations, chromosomal localization, motif, gene structures, and promoter regions of these remorins were analyzed and a remorin gene, CaREM1.4, was cloned for further study. The transcription of CaREM1.4 in pepper was induced by infection with Ralstonia solanacearum. Knocking down CaREM1.4 in pepper using virus-induced gene silencing (VIGS) technologies reduced the resistance of pepper plants to R. solanacearum and downregulated the expression of immunity-associated genes. Conversely, transient overexpression of CaREM1.4 in pepper and Nicotiana benthamiana plants triggered hypersensitive response-mediated cell death and upregulated expression of defense-related genes. In addition, CaRIN4-12, which interacted with CaREM1.4 at the plasma membrane and cell nucleus, was knocked down with VIGS, decreasing the susceptibility of Capsicum annuum to R. solanacearum. Furthermore, CaREM1.4 reduced ROS production by interacting with CaRIN4-12 upon co-injection in pepper. Taken together, our findings suggest that CaREM1.4 may function as a positive regulator of the hypersensitive response, and it interacts with CaRIN4-12, which negatively regulates plant immune responses of pepper to R. solanacearum. Our study provides new evidence for comprehending the molecular regulatory network of plant cell death.
CATALYST: challenging antibiotic allergy status
Authors: Brayson Joseph , Barrett Scott , Baqir Wasim , Campbell David , Oswald Tamsin , Ellis Simon , Premchand Nikhil
Published: March 2023

Objectives

To develop a transferable process, CATALYST (challenging antibiotic allergystatus), to assess and challenge penicillin allergy status of inpatients within an NHS Foundation Hospital.

Methods

A multidisciplinary team (MDT) steering group reviewed existing literature and protocols enabling penicillin allergy assessment, challenge and de-labelling. Using this, they identified five key steps forming the basis of CATALYST: clinical assessment of the nature of allergy; inclusion/exclusion criteria; consent; direct oral penicillin challenge; and removal of allergy label. A pharmacist-led pilot was conducted to assess the process, during which a continuous PDSA (plan-do-study-act) cycle was observed. This included formally auditing endpoint data such as accuracy of allergy status in medical records post-intervention.

Results

CATALYST was successfully developed with key resources produced to support clinicians. It was piloted in 304 patients, with 172 patients excluded and 132 successful allergy challenges. There was one incident of an adverse event (acute kidney injury) in the 132 successful patients, which occurred as a delayed reaction following 22 days of penicillin therapy. Only 64% of permanent records (held by GP) were appropriately updated when audited at the end of the pilot.

Conclusions

CATALYST is a transferable process to facilitate safe assessment, challenge and removal of spurious penicillin allergy labels. Handover between care sectors forms a key element of allergy removal to ensure all records are updated and work is needed to ensure this process is done effectively.
Evaluation of a new rapid immunochromatographic assay for the detection of GES-producing Gram-negative bacteria
Authors: Gonzalez Camille , Volland Hervé , Oueslati Saoussen , Niol Léa , Legrand Camille , Francius Laura , Chalin Arnaud , Vogel Anaïs , Simon Stéphanie , Naas Thierry
Published: March 2023

Background

As carbapenemase-producing Enterobacterales are increasingly reported worldwide, their rapid detection is crucial to reduce their spread and prevent infections and outbreaks. Lateral flow immunoassays (LFIAs) have become major tools for the detection of carbapenemases. However, as for most commercially available assays, only the five main carbapenemases are targeted.

Objectives

Here, we have developed and evaluated an LFIA prototype for the rapid and reliable detection of the increasingly identified GES-type β-lactamases.

Methods

The GES LFIA was validated on 103 well-characterized Gram-negative isolates expressing various β-lactamases grown on Mueller–Hinton (MH) agar, chromogenic, and chromogenic/selective media.

Results

The limit of detection of the assay was 106 cfu per test with bacteria grown on MH agar plates. GES LFIA accurately detected GES-type β-lactamases irrespective of the culture media and the bacterial host. The GES LFIA was not able to distinguish between GES-ESBLs and GES-carbapenemases. Because GES enzymes are still rare, their detection as an ESBL or a carbapenemase remains important, especially because extensive use of carbapenems to treat ESBL infections may select for GES variants capable of hydrolysing carbapenems.

Conclusions

The GES LFIA is efficient, rapid and easy to implement in the routine workflow of a clinical microbiology laboratory for the confirmation of GES-type β-lactamases. Combining it with immunochromatographic assays targeting the five main carbapenemases (KPC, NDM, VIM, IMP and OXA-48) would improve the overall sensitivity for the most frequently encountered carbapenemases and ESBLs, especially in non-fermenters.
Recurrent spontaneousEscherichia colimeningitis in an adult: a case report
Authors: Amulele Anne V , Ong’ayo Gerald , Arara Alfred M , Machanja Edwin W , Etyang Anthony , Aliyan Nadia A , Wareham David W , Berkley James A , Gordon Nicola C
Published: March 2023

Objectives

The aim of this study was to characterize an unusual case of spontaneous, community-acquired Escherichia coli meningitis in an adult presenting to a general hospital in Kenya, where initial clinical recovery was followed by reinfection with an MDR, hospital-acquired strain.

Patient and methods

An adult presented to a hospital in Kenya with meningitis symptoms. E. coli was cultured from CSF. Treatment with ceftriaxone was successful; however, the patient relapsed a few days later. E. coli was cultured from CSF and blood during the reinfection episode, though the patient died during admission. We sequenced the isolates using Illumina MiSeq and performed antimicrobial susceptibility testing, fitness and virulence assays on the bacteria.

Results

The E. coli isolates from the two episodes were found to be distinct: the initial strain was ST88, serotype O8 H17 while the subsequent episode was caused by an ST167, serotype O101 H5 MDR strain. The ST88 strain was susceptible to all drugs except ampicillin and amoxicillin/clavulanate while the ST167 strain was MDR, including to all β-lactam drugs due to the presence of the carbapenemase gene blaNDM-5. The hospital-acquired ST167 strain was also resistant to newer drugs such as cefiderocol and eravacycline, which are currently not available locally, and had overall lower fitness and virulence in vitro compared with the initial infecting strain.

Conclusions

Though less fit and virulent in vitro, the MDR strain was fatal, suggesting that host factors, rather than bacterial virulence, may have been of greater importance in this patient’s outcome.
Non-stationary spatio-temporal point process modeling for high-resolution COVID-19 data
Authors: Dong Zheng , Zhu Shixiang , Xie Yao , Mateu Jorge , Rodríguez-Cortés Francisco J
Published: March 2023

Most COVID-19 studies commonly report figures of the overall infection at a state- or county-level. This aggregation tends to miss out on fine details of virus propagation. In this paper, we analyze a high-resolution COVID-19 dataset in Cali, Colombia, that records the precise time and location of every confirmed case. We develop a non-stationary spatio-temporal point process equipped with a neural network-based kernel to capture the heterogeneous correlations among COVID-19 cases. The kernel is carefully crafted to enhance expressiveness while maintaining model interpretability. We also incorporate some exogenous influences imposed by city landmarks. Our approach outperforms the state-of-the-art in forecasting new COVID-19 cases with the capability to offer vital insights into the spatio-temporal interaction between individuals concerning the disease spread in a metropolis.
Thrombolysis of bowel obstruction? A thought-provoking presentation of a common surgical pathology
Authors: Raythatha Jineel H , Tucker Bradley , Lester Geoffrey , Eather Samuel , Lambert Ben
Published: March 2023

We present a unique case of bowel obstruction with a hiatus hernia causing atypical chest pain with dynamic ST-segment elevation in a regional Australian emergency department. The ST elevation only resolved after nasogastric decompression of the bowel obstruction. Early thrombolysis of presumed myocardial infarction led to upper gastrointestinal tract bleeding that could have been avoided with timely diagnosis. An extensive review of literature, in addition to our case report, suggests bowel obstruction is a differential diagnosis for patients who have inferior pattern ST elevation but normal troponin presenting with atypical chest pain, nausea, vomiting and previous abdominal surgery.
Unique challenges of risk-reducing surgery for hereditary diffuse gastric cancer syndrome: a narrative review
Authors: Gallanis Amber F. , Davis Jeremy L.
Published: March 2023

The common use of genetic testing has reinvigorated discussions surrounding enhanced cancer surveillance, chemoprevention, and preventive surgery strategies due to increasing recognition of pathogenic germline genetic variants. Prophylactic surgery for hereditary cancer syndromes can significantly reduce the risk of developing cancer. Hereditary diffuse gastric cancer (HDGC), characterized by high penetrance and an autosomal dominant inheritance pattern, is causally linked to germline mutations in the CDH1tumor suppressor gene. Risk-reducing total gastrectomy is currently recommended in patients with pathogenic and likely pathogenic CDH1 variants; however, the physical and psychosocial sequelae of complete stomach removal are substantial and need to be investigated further. In this review, we address the risks and benefits of prophylactic total gastrectomy for HDGC in the context of prophylactic surgery for other highly penetrant cancer syndromes.
Metalloproteinase-9 on the Ocular Surface of Patients With Implanted Boston Type 1 Keratoprosthesis
Authors: Arteaga Andrea C. , Weiss Margaret C. , Perez Raiza , Cortina María Soledad
Published: March 2023

Purpose:

The aim of this study was to characterize the presence of ocular surface inflammation, using matrix metalloproteinase-9 (MMP-9) as a marker, on the ocular surface of eyes with implanted Boston keratoprosthesis type 1 (KPro).

Methods:

Patients with implanted KPro at a single tertiary center were recruited to assess ocular inflammation. MMP-9 was measured using the InflammaDry test in both eyes of each patient. The non-KPro eye served as the control. Rate of positivity of MMP-9 was compared between groups. Possible associations between ocular surface inflammation and the development of postoperative complications were evaluated using univariate statistical analysis.

Results:

Fifty eyes from 25 patients were included. The mean age was 50 years. Noninflammatory indications for KPro were predominant among patients. Eighty-eight percent of KPro eyes had a positive test for MMP-9 while only 25% of control eyes were positive (P < 001). The most common complications were retroprosthetic membrane, epithelial defects, and sterile corneal melt. The presence of a strong positive result was associated with a higher frequency of complications (80% of eyes) compared with a faint positive test (54%) and a negative test (33%).

Conclusions:

The KPro device seems to increase MMP-9 levels on the ocular surface. High MMP-9 levels may be associated with higher risk of complications. MMP-9 testing can be useful to assess subclinical ocular surface inflammation with a potential role in the postoperative care of patients with KPro.
Prenatal Antidepressant Exposure and the Risk of Attention-Deficit/Hyperactivity Disorder in Childhood: Accounting for Misclassification of Exposure
Authors: Esen Buket Öztürk , Ehrenstein Vera , Nørgaard Mette , Sørensen Henrik Toft , Pedersen Lars
Published: March 2023

Background:

Many studies of prenatal antidepressant exposure and the risk of attention-deficit/hyperactivity disorder (ADHD) have done little to reduce bias from exposure misclassification. We assessed the prenatal antidepressant–ADHD effect by incorporating information on repeatedly redeemed prescriptions and redemptions of drug classes commonly used in pregnancy in the analyses to reduce bias from exposure misclassification.

Methods:

Using population-based registries, we conducted a nationwide cohort study of all children born in Denmark from 1997 to 2017. In a former-user analysis, we compared children prenatally exposed, defined by a redeemed prescription by the mother during pregnancy, to a comparison cohort consisting of prenatally unexposed children whose mothers had redeemed a prescription before pregnancy. We incorporated information on repeatedly redeemed prescriptions and redemptions of drug classes commonly used in pregnancy in the analyses to reduce bias from exposure misclassification. We used incidence rate ratios (IRRs) and incidence rate differences (IRDs) as effect measures.

Results:

The cohort included 1,253,362 children, among whom 24,937 were prenatally exposed to antidepressants. The comparison cohort consisted of 25,698 children. During follow-up, 1,183 exposed children and 1,291 children in the comparison cohort developed ADHD yielding an IRR of 1.05 (95% confidence interval [CI] = 0.96, 1.15) and an IRD of 0.28 (95% CI = −0.20, 0.80) pr. 1,000 person-years. IRRs from analyses attempting to reduce exposure misclassification varied from 1.03 to 1.07.

Conclusions:

Our results were not consistent with the hypothesized effect of prenatal antidepressant exposure on the risk of ADHD. Attempts to reduce exposure misclassification did not alter this finding.
Survey of ESCRS members' attitudes toward operating room waste
Authors: Chang David F. , Elferink Sjoerd , Nuijts Rudy M.M.A
Published: March 2023

In a survey of ESCRS member cataract surgeons, 92% felt that operating room waste is excessive and should be reduced; 99% were concerned about global warming and climate change. Most respondents cited restrictions on reuse by manufacturers and regulatory bodies as major drivers of this waste. There was a strong desire to have more reusable options for instruments, devices, and supplies. In comparable percentages with an earlier survey of North American cataract surgeons using the identical questionnaire, there was a strong willingness to reuse many surgical supplies, as well as topical and intraocular medications. This was true even though ESCRS members were much more likely to practice in hospitals (68% vs 35%). The similarities of these results to the North American survey suggest that these attitudes toward sustainability are in fact global and universal. The strong concordance between the 2 surveys suggests that global collaboration is both possible and necessary.
Acute central corneal haze and thinning with atypical keratitis presentation
Authors: Moshirfar Majid , Ward Matthew , Khan Saima A. , Kim Gene , Zhu Dagny , Afshari Natalie , Karimian Farid , Vaidya Neel S. , Majmudar Parag
Published: March 2023

A 24-year-old woman presented with a 7-day history of blurry vision, redness, and extreme pain in her right eye. She had no pertinent medical or ocular history and did not use spectacles or contacts. Uncorrected distance visual acuity (UDVA) was 20/40 in the right eye and could not be improved with refraction. Slitlamp examination revealed a 1.5 × 1.5 mm central epithelial defect with surrounding white blood cell recruitment. Confocal microscopy (Figure 1

JOURNAL/jcrs/04.03/02158034-202304000-00020/figure1/v/2023-08-19T002652Z/r/image-tiff

) was performed, and she was treated with chlorhexidine 0.02% drops every hour in the right eye. 2 weeks later, the cornea had completely re-epithelialized; however, persistent corneal haze, decreased visual acuity, and corneal thinning and flattening was noted. Pachymetry was 484 µm in the right eye and UDVA was 20/40 (Supplemental Figure 1, available at http://links.lww.com/JRS/A836). In the following 2 weeks, UDVA improved to 20/25. 6 months after the initial presentation, UDVA was unchanged and faint central corneal haze was noted on examination (Figure 2

JOURNAL/jcrs/04.03/02158034-202304000-00020/figure2/v/2023-08-19T002652Z/r/image-tiff

). Of interest, her family history is significant for her younger 16-year-old brother with 3 prior episodes of a similar type of keratitis/keratopathy over the course of 2 years in both eyes with similar central paracentral corneal haze, thinning, and flattening and similar confocal findings (Figure 3

JOURNAL/jcrs/04.03/02158034-202304000-00020/figure3/v/2023-08-19T002652Z/r/image-tiff

). He also was unresponsive to topical antibiotics and antivirals except topical chlorhexidine. Her brother has been our patient for the last several years prior to her first visit to our clinic.

What is your diagnosis? What medical diagnostic tests, if any, would you recommend? Is this an infectious or simply an inflammatory response? Is there any genetic or familial predisposition?
Development and Psychometric Testing of the Clinical Reasoning Scale Among Nursing Students Enrolled in Three Types of Programs in Taiwan
Authors: HUANG Hui-Man , HUANG Chu-Yu , LIN Kuan-Chia , YU Chia-Hui , CHENG Su-Fen
Published: March 2023

Background

There is no instrument currently available to assess the essential nursing competency of clinical reasoning (CR).

Purpose

The purpose of this study was to develop and test the psychometric properties of CR assessment instrument appropriate for use with nursing students across different types of programs.

Methods

H. M. Huang et al.'s (2018) Framework of Competencies of Clinical Reasoning for Nursing Students was used to guide this study. Two rounds of Delphi study and confirmatory factor analysis (CFA) were conducted to test content and construct validity. Internal consistency was tested for reliability.

Results

The four-domain, 16-item Likert-scale Clinical Reasoning Scale (CRS) was developed. One thousand five hundred four nursing students currently enrolled in three different types of nursing programs completed the CRS. The content validity index was .85–1.0, the CFA indicated goodness of fit, and the Cronbach's α score range was .78–.89.

Conclusion

The CRS is a valid and reliable tool for assessing CR in nursing students in different types of nursing program.
A Feasibility Evaluation of the Need-Centered Watch–Assess–Need Intervention–Think Education and Training Program for Behavioral and Psychological Symptoms of Dementia
Authors: YANG Yueh-Ying , YANG Ya-Ping , CHEN Kuei-Min , WANG Chi-Jane , CHANG Su-Hsien , WANG Jing-Jy
Published: March 2023

Background

Despite the high prevalence of dementia among residents living in long-term care facilities in Taiwan, most care providers in these facilities have not received adequate training to deal with the behavioral and psychological symptoms of dementia (BPSD). An original care and management model for BPSD has been developed, and model-based recommendations for an education and training program have been made. However, empirical testing has not yet been conducted to determine the efficacy of this program.

Purpose

This study was designed to evaluate the feasibility of using the Watch–Assess–Need intervention–Think (WANT) education and training program for BPSD in long-term care settings.

Methods

A mixed-method design was used. Twenty care providers and 20 corresponding care receivers (residents with dementia) from a nursing home in southern Taiwan were enrolled. Data were collected using a variety of measurement tools, including the Cohen-Mansfield Agitation Inventory, Cornell Scale for Depression in Dementia, Attitude towards Dementia Care Scale, and Dementia Behavior Disturbance Self-efficacy Scale. Qualitative data, including care-provider perspectives on the efficacy of the WANT education and training program, were also collected. Repeated measures were conducted on the results of quantitative data analysis, whereas content analysis was performed on the results of qualitative data analysis.

Results

Findings indicate that the program relieves agitated behavior (p = .01), alleviates depression in those with dementia (p < .001), and enhances care-provider attitudes toward dementia care (p = .01). However, no significant improvement was found in self-efficacy among the care providers (p = .11). In terms of qualitative outcomes, care providers indicated they perceived improved self-efficacy in managing BPSD, improved ability to view problems from a more need-centered perspective, improved attitudes toward dementia and patients' BPSD, and decreased care burden and stress.

Conclusions/Implications for Practice

The study found the WANT education and training program to be feasible in clinical practice. Because of this program's simple and easy-to-remember characteristics, it is recommended that it be vigorously promoted to care providers in both long-term institutional and home care settings to help them effectively address the BPSD.
Rectus sheath block versus local anesthetic infiltration in pediatric laparoscopic inguinal hernia repair: a randomized controlled trial
Authors: Chen Liang , Liu Shuangmei , Cao Yanyan , Yan Lei , Shen Yang
Published: March 2023

Background:

Rectus sheath block (RSB) and local anesthetic infiltration (LAI) are used for postoperative analgesia in pediatric laparoscopic inguinal hernia repair. However, whether the analgesic effect of RSB is superior to LAI remains unclear. The authors hypothesized that RSB would reduce opioid consumption in patients.

Methods:

Patients aged 3–14 years scheduled for laparoscopic inguinal hernia repair were randomly allocated to the RSB, local anesthetic infiltration high concentration (LAIHC), local anesthetic infiltration low concentration (LAILC), or control groups. Preoperatively, they received 0.4 ml/kg of 0.25% ropivacaine (RSB), 0.4 ml/kg of 0.25% ropivacaine (LAILC), or 0.2 ml/kg of 0.5% ropivacaine(LAIHC), and 0.2 ml/kg of normal saline (control). The primary outcome was equivalent morphine consumption.

Results:

The authors analyzed 136 patients (RSB, 33; LAIHC, 34; LAILC, 35; control, 34). Intraoperative morphine equivalent consumption was lower in the RSB group [0.115 (0.107−0.123)] than in the LAIHC [0.144 (0.137−0.151)], LAILC [0.141 (0.134−0.149)], and control [0.160 (0.151−0.170)] groups (P<0.001). In the post-anesthesia care unit, morphine equivalent consumption differed between the RSB [0.018 (0.010–0.027)], LAIHC [0.038 (0.028–0.049)], LAILC [0.056 (0.044–0.067)], and control [0.074 (0.063−0.084)] groups (P<0.001). The rescue morphine equivalent consumption did not differ significantly between the RSB [0.015 (0.007–0.023)] and LAIHC [0.019 (0.010–0.029)] groups, which were lower than that in the control group [0.037 (0.029–0.045)] (P=0.001).

Conclusions:

RSB can provide effective analgesia for pediatric laparoscopic inguinal hernia repair, with better effectiveness than that of LAI at the same dose.
Hybrid-Flexible Classroom Design in the Physical Therapist Classroom
Authors: Jordon Max K , Tudini Frank , Liuzzo Derek
Published: March 2023

Introduction.

Doctor of Physical Therapy (DPT) education has traditionally been delivered in a face-to-face format. However, alternative educational models are on the rise with the proliferation of hybrid programs. Although hybrid education may benefit students in unique ways, many students prefer the personal interaction afforded by a face-to-face format. An alternative model, Hybrid-Flexible (HyFlex), allows students to have the benefits of a hybrid education while allowing for face-to-face interactions. Therefore, the purpose of this study was to describe the application of an alternative educational method—HyFlex—in the DPT classroom.

Review of Literature.

In a HyFlex model, students can choose to attend each class period in person, synchronously online, or asynchronously. Although previous research has found that hybrid programs have equivalent performance compared with traditional style, there is a paucity of published research on the effectiveness of HyFlex in the DPT classroom.

Subjects.

Thirty-six students (n = 26 female students) enrolled in a first-year DPT kinesiology course participated in this study.

Methods.

Students chose which method of engagement they preferred, and attendance choice was recorded. Students were categorized into synchronous engagement, partial asynchronous engagement, or asynchronous engagement groups. Quantitatively, grades for quizzes, tests, and the final examination were recorded and compared across the groups. Qualitatively, the students filled out a survey asking about their experience, and answers were assessed using a qualitative descriptive approach.

Results.

Quantitative data analysis revealed no differences between the groups in academic performance. Qualitative data revealed that students felt the HyFlex model allowed for better organization, flexibility, and reduced stress. However, there were concerns about the social impact, academic loss, decreased motivation, and technological issues.

Discussion and Conclusion.

This study describes how a HyFlex model can be implemented in a DPT classroom that allows for greater flexibility and reports of improved stress reduction with no academic loss.
Preclinical Studies on Pulsatile Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review
Authors: Kanagarajan Dhayananth , Heinsar Silver , Gandini Lucia , Suen Jacky Y. , Dau Van Thanh , Pauls Jo , Fraser John F.
Published: March 2023

Refractory cardiogenic shock is increasingly being treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO), without definitive proof of improved clinical outcomes. Recently, pulsatile V-A ECMO has been developed to address some of the shortcomings of contemporary continuous-flow devices. To describe current pulsatile V-A ECMO studies, we conducted a systematic review of all preclinical studies in this area. We adhered to PRISMA and Cochrane guidelines for conducting systematic reviews. The literature search was performed using Science Direct, Web of Science, Scopus, and PubMed databases. All preclinical experimental studies investigating pulsatile V-A ECMO and published before July 26, 2022 were included. We extracted data relating to the 1) ECMO circuits, 2) pulsatile blood flow conditions, 3) key study outcomes, and 4) other relevant experimental conditions. Forty-five manuscripts of pulsatile V-A ECMO were included in this review detailing 26 in vitro, two in silico, and 17 in vivo experiments. Hemodynamic energy production was the most investigated outcome (69%). A total of 53% of studies used a diagonal pump to achieve pulsatile flow. Most literature on pulsatile V-A ECMO focuses on hemodynamic energy production, whereas its potential clinical effects such as favorable heart and brain function, end-organ microcirculation, and decreased inflammation remain inconclusive and limited.
Catch-Up Growth in Infants and Young Children With Faltering Growth: Expert Opinion to Guide General Clinicians
Authors: Cooke Richard , Goulet Olivier , Huysentruyt Koen , Joosten Koen , Khadilkar Anuradha Vaman , Mao Meng , Meyer Rosan , Prentice Andrew M. , Singhal Atul
Published: March 2023

Faltering growth (FG) is a problem regularly seen by clinicians in infants and young children (<2 years of age). It can occur due to non-disease-related and disease-related causes and is associated with a wide range of adverse outcomes, including shorter-term effects such as impaired immune responses and increased length of hospital stay, and longer-term consequences, including an impact on schooling and cognitive achievements, short stature, and socioeconomic outcomes. It is essential to detect FG, address underlying causes and support catch-up growth where this is indicated. However, anecdotal reports suggest misplaced fear of promoting accelerated (too rapid) growth may deter some clinicians from adequately addressing FG.

An invited international group of experts in pediatric nutrition and growth reviewed the available evidence and guidelines on FG resulting from disease-related and non-disease-related effects on nutritional status in healthy term and small for gestational age infants and children up to the age of 2 years in low-, middle-, and high-income countries. Using a modified Delphi process, we developed practical consensus recommendations to provide clarity and practical recommendations for general clinicians on how FG should be defined in different young child populations at risk, how FG should be assessed and managed, and the role of catch-up growth after a period of FG. We also suggested areas where further research is needed to answer remaining questions on this important issue.
Evaluation and treatment of postoperative periprosthetic humeral fragility fractures
Authors: Kobayashi Evangeline F. , Namdari Surena , Schenker Mara , Athwal George S. , Ahn Jaimo
Published: March 2023

Postoperative periprosthetic humeral shaft fractures represent a growing and difficult complication to treat given the aging patient population and associated bone loss. Determining the best treatment option is multifactorial, including patient characteristics, fracture pattern, remaining bone stock, and implant stability. Possible treatment options include nonoperative management with bracing or surgical intervention. Nonoperative treatment has been shown to have higher nonunion rates, thus should only be selected for a specific patient population with minimally displaced fractures or those that are unfit for surgery. Surgical management is recommended with prosthetic loosening, fracture nonunion, or failure of nonoperative treatment. Surgical options include open reduction and internal fixation, revision arthroplasty, or hybrid fixation. Careful evaluation, decision making, and planning is required in the treatment of these fractures.