bluuebunny/crossref_metadata_2025 huggingface dataset:
Ballast-Supported Foundation Designs for DIY Low-Cost Open-Source Solar Photovoltaic Racking Systems
Authors: Vandewetering Nicholas , Jamil Uzair , Pearce Joshua M.
Published: January 2024

Although solar photovoltaic (PV) system costs have declined, capital cost remains a barrier to widespread adoption. Do-it-yourself (DIY) system designs can decrease costs by about 50% by reducing labor costs, but if not attached to a building structure demand ground penetration for conventional footings. This is not technically and economically feasible at all sites. To overcome these challenges, this study details systems designed to eliminate drilling holes and pouring concrete. Two different designs for both fixed tilt and variable tilt PV racking are investigated to assess their structural integrity, constructability, and economic cost when fabricated with a ballast-supported foundation. The ballast-supported foundations are analyzed for eight such systems by proposing two separate ballast designs: one for single line of post systems, and one for double line of post systems built on a 4-kW basis. The results of the analysis found that both designs are slightly more expensive than typical in-ground concrete systems by 25%, but the overall DIY systems costs remain economically advantageous. Sensitivity analyses are conducted to show how modifications to the dimensions including clearances and distances between gabions influence the weight of the system and thus change the economic value of the design, so users can trade dimensional freedom for cost-savings, and vice versa. Overall, all the wood-based PV racking system designs provide users with cost-effective and easy DIY alternatives to conventional metal racking, and the novel ballast systems presented provide more versatility for PV systems installations.
The California Coast and Living Shorelines - A Critical Look
Authors: Griggs Gary B
Published: January 2024

California and most other coastlines around the world are being impacted by both long-term sea-level rise and short-term extreme events. Because of California’s long and intensively developed coastline, it is an important area for evaluating responses to these challenges. The predominant historic approach to coastal erosion in California and globally has been the construction of hard coastal armoring such as seawalls and rock revetments. The concept of living shorelines – defined as using natural elements like plants, sand or rocks to stabilize the coastline – has been widely proposed as a soft or green response to coastal erosion and flooding. These approaches have very limited application in high-energy environments, however, such as California’s 1,100-mile-long outer coast and are not realistic solutions for protection from wave attack at high tides or long-term sea-level rise. Each of the state’s coastal communities need to identify their most vulnerable areas, develop adaptation plans, and plan eventual relocation strategies in response to an accelerating sea-level rise.
Mem U Zin as a Bridge to Kurdish Language Problems
Authors: Gocgen Ahmet
Published: January 2024

"Mem u Zin" holds a paramount status in Kurdish literature, celebrated for its profound exploration of love. Authored by the esteemed Kurdish poet and writer Ahmet Khani in the 17th century, this epic masterpiece represents the pinnacle of literary achievement within the Kurdish cultural milieu. By conducting a concise analysis of "Mem u Zin," our aim was to shed light on the underlying factors that contribute to the perceived separation of Kurdish society from perfection. We provided a comprehensive view of the linguistic obstacles encountered by the Kurds in this exploration.
Business Transformation Towards Circular Economy: A Systematic Literature Review and Prospects for Future Research
Authors: Hashemi Farahmand Sayedhadi , Rahimiaghdas Niloufar
Published: January 2024

The growing global interest in Circular Economy (CE) adoption by organizations has received considerable attention in academic literature. This review delves into the multifaceted aspects of CE transformation, assessing barriers, drivers, and potential research directions. It encompasses three main clusters: frameworks and definitions, barriers and drivers, and industry-specific research. Existing studies significantly contribute by unveiling strategies, frameworks, and innovative ap-proaches aiding CE transition. However, there's a notable focus on identifying barriers hindering CE implementation, revealing a critical need for effective solutions. Moreover, the review highlights the lack of CE frameworks in the service sector and insufficient awareness among Small and Me-dium Enterprises, necessitating deeper exploration. Despite the potential of digital technologies like Industry 4.0 in expediting CE transformation, comprehensive implementation strategies remain lacking. Noteworthy frameworks, such as circular business models and two-stage transformation models, offer practical pathways for CE adoption. Dynamic capabilities emerge as a crucial yet underexplored factor facilitating CE transition. Future research should delve into country-specific contexts, integrate digital technologies into industries, and explore the relationship between dy-namic capabilities and CE transformation, especially within small and medium-sized enterprises. While progress has been made in understanding CE principles' adoption, this review highlights research gaps that require attention for global sustainability and widespread CE practice imple-mentation.
Faktor-Faktor yang Memengaruhi Sikap Afektif Petani pada Indeks Pertanaman (IP) Padi 400 di Kecamatan Ngemplak Kabupaten Boyolali
Authors: Sari Prisca Puspita , Suminah Suminah , Permatasari Putri
Published: January 2024

The Rice Cropping Index 400 (IP Padi 400) is one of the government’s initiatives to boost the production of rice commodities. The goal of the IP Padi 400 is to maximize the cropping index while optimizing the spatial and temporal patterns of rice cultivation. The aims of this study are to (1) know the variables influencing farmers’ affective attitudes toward the IP Padi 400 and (2) determine the effect of factors that influence affective attitudes on the farmers’ affective attitudes toward the IP Padi 400 in Ngemplak Sub-district, Boyolali Regency. This study used quantitative methods. A sample consisting of 47 participants was gathered by the census method. The analysis used multiple linear regression. The results of this study are: (1) non-formal education variables have a low influence; however, government support from the Ministry of Agriculture of Indonesia and agricultural extensions have a very significant influence and (2) non-formal education variables, government support, and agricultural extensions have significant influence on the formation of farmers’ attitudes toward the IP Padi 400.
Motivasi Petani dalam Budidaya Tanaman Pepaya (Carica papaya L.) di Kecamatan Mojosongo Kabupaten Boyolali
Authors: Pratiwi Rahmah Indri , Suminah Suminah , Widiyanti Emi
Published: January 2024

Papaya is one of the horticultural crops that can be developed in current cultivation because it takes advantage of Indonesia’s tropical climate and is traditionally easily cultivated by farmers. Improper post-harvest handling resulted in a low selling price of papaya in the market. This condition caused farmers to experience losses and their numbers continue to decline because they chose to stop cultivating papaya. Even though the condition of papaya farmers continues to decline, some still persist in cultivating papaya. This is closely related to the motivation of farmers. This study aims to (1) examine the motivation level of farmers in cultivating papaya, (2) examine the factors that influence farmers’ motivation in cultivating papaya, (3) examine the influence between the factors that influence the motivation of farmers in cultivating papaya plants in Mojosongo Sub-district, Boyolali Regency. The research method used is a quantitative method. The research location was chosen purposively (intentionally) to be in Mojosongo Sub-district, Boyolali Regency. The sampling method used proportional random sampling and obtained 70 respondents. Data analysis applies multiple linear regression analysis. The results of the study prove that: (1) the motivation of farmers in cultivating papaya belongs to the high category; (2) the income variable is in the very high category, land area is in the medium category, the number of family is in the medium category; (3) the variables of land area and number of family have a significant effect on farmer motivation while income has no effect.
Dinamika Kelompok Wanita Tani Mbanar Melalui Program Integrated Farming di Desa Kragan Kecamatan Gondangrejo Kabupaten Karanganyar
Authors: Samudro Muhammad Lanang , Setyowati Retno
Published: January 2024

The Women Farmer Group is a community group that seeks training from stakeholders to promote economic growth. This research was necessary due to the Mbanar Women Farmer Group needed to gain the experience and knowledge to manage an integrated agricultural program. This research examines the dynamics of the Mbanar Women Farmer Group. Descriptive qualitative research is used at Gondangrejo Sub-district, Karanganyar Regency. This research uses purposive and snowball sampling for informant selection. The data utilized are primary and secondary from interviews, documentation and observation. Research shows that Mbanar Women Farmers Group dynamics involve group components, such as 1) The group goals in the category have not been achieved, 2) The group structure is in the good category, 3) The group task function is in a suitable category, 4) The development and coaching of the group is in the appropriate category, 5) Group cohesiveness in the good category, 6) Group pressure in the not appropriate category, 7) Group effectiveness in the adequate category, 8) Group atmosphere in the good category, and 9) Hidden intentions in forming groups in the appropriate category.
External Rotation Strength After TSA in Osteoarthritic Shoulders with Eccentric Deformity Is Not Impacted by Posterior Rotator Cuff Deficiency
Authors: Coats-Thomas Margaret S. , Marra Guido , Ludvig Daniel , Garg Ankur , Perreault Eric J. , Seitz Amee L.
Published: January 2024

Background:

Patients with persistent glenohumeral osteoarthritis symptoms despite nonoperative management may pursue anatomic total shoulder arthroplasty (TSA). TSA revision rates are higher in patients with preoperative eccentric (asymmetric posterior erosion) compared with concentric (symmetric) glenoid deformity. If posterior rotator cuff deficiency demonstrated preoperatively in patients with eccentric deformity persists after TSA, it may manifest as relative weakness in external compared with internal rotation secondary to deficient activity of the shoulder external rotator muscles. Persistent posterior rotator cuff deficiency is hypothesized to contribute to TSA failures. However, it remains unknown whether rotational strength is impaired after TSA in patients with eccentric deformity. Our goal was to determine if patients with eccentric deformity exhibit relative external rotation weakness that may be explained by posterior rotator cuff deficiency after TSA.

Methods:

Patients who were >1 year after TSA for primary glenohumeral osteoarthritis and had had preoperative eccentric or concentric deformity were prospectively recruited. Torque was measured and electromyography was performed during maximal isometric contractions in 26 three-dimensional direction combinations. Relative strength in opposing directions (strength balance) and muscle activity of 6 shoulder rotators were compared between groups.

Results:

The internal (+) and external (−) rotation component of strength balance did not differ in patients with eccentric (mean internal-external rotation component of strength balance: −7.6% ± 7.4%) compared with concentric deformity (−10.3% ± 6.8%) (mean difference: 2.7% [95% confidence interval (CI), −1.3% to 6.7%]; p = 0.59), suggesting no relative external rotation weakness. Infraspinatus activity was reduced in patients with eccentric (43.9% ± 10.4% of maximum voluntary contraction [MVC]) compared with concentric (51.3% ± 10.4% of MVC) deformity (mean difference: −7.4% [95% CI, −13.4% to −1.4%] of MVC; p = 0.04).

Conclusions:

A relative external rotation strength deficit following TSA was not found, despite evidence of reduced infraspinatus activity, in the eccentric-deformity group. Reduced infraspinatus activity suggests that posterior rotator cuff deficiencies may persist following TSA in patients with eccentric deformities. Longitudinal study is necessary to evaluate muscle imbalance as a contributor to higher TSA failure rates.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Clinical and Patient-Reported Outcomes After Total Wrist Arthroplasty and Total Wrist Fusion
Authors: Clementson Martin , Larsson Sara , Abramo Antonio , Brogren Elisabeth
Published: January 2024

Background:

The functional benefits of total wrist arthroplasty (TWA) over total wrist fusion (TWF) are unknown. The purpose of this prospective cohort study was to compare TWA and TWF with respect to functional outcomes and activity limitations at up to 2 years postoperatively.

Methods:

Between 2015 and 2020, we enrolled all adult patients undergoing TWA or TWF for the management of symptomatic end-stage wrist arthritis at 1 hand surgery department. The primary outcome was the Patient-Rated Wrist Evaluation (PRWE). The secondary outcomes were the visual analog scale (VAS) for pain at rest, on motion, and on loading; grip strength; Disabilities of the Arm, Shoulder and Hand (DASH); and range of motion. Patients completed questionnaires and were examined by the same physiotherapist at baseline and at 3, 6, 12, and 24 months postoperatively. Mixed-model analyses adjusting for age, diagnosis, the preoperative value of the dependent variable, and time since surgery were performed to compare differences in PRWE scores, VAS pain scores, and grip strength between TWA and TWF.

Results:

Of the 51 patients who had been included at baseline, 47 (18 in the TWA group and 29 in the TWF group) responded to questionnaires and underwent examinations at up to 2 years postoperatively. At baseline, the 2 groups did not differ in terms of age, sex, diagnosis (inflammatory or noninflammatory arthritis), PRWE score, VAS pain score, grip strength, DASH score, or range of motion. No differences between the groups were found for the PRWE (β, −0.1; 95% confidence interval [CI], −14 to 13; p = 0.99), VAS pain at rest (β, −3.3; 95% CI, −15 to 9; p = 0.58), VAS pain on loading (β, −5.3; 95% CI, −22 to 11; p = 0.52), or grip strength (β, −0.02; 95% CI, −0.18 to 0.14; p = 0.80) on the adjusted mixed-model analyses.

Conclusions:

Among patients with symptomatic end-stage wrist arthritis, those who underwent TWA did not demonstrate short-term outcomes, including patient-reported disability, pain, and grip strength, superior to those of patients who underwent TWF. These findings call into question the widespread use of TWA.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Radiologic Assessment of Interbody Fusion
Authors: Duits Anneli A.A. , van Urk Paul R. , Lehr A. Mechteld , Nutzinger Don , Reijnders Maarten R.L. , Weinans Harrie , Foppen Wouter , Oner F. Cuhmur , van Gaalen Steven M. , Kruyt Moyo C.
Published: January 2024

Background:

Lumbar interbody fusion (IF) is a common procedure to fuse the anterior spine. However, a lack of consensus on image-based fusion assessment limits the validity and comparison of IF studies. This systematic review aims to (1) report on IF assessment strategies and definitions and (2) summarize available literature on the diagnostic reliability and accuracy of these assessments.

Methods:

Two searches were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Search 1 identified studies on adult lumbar IF that provided a detailed description of image-based fusion assessment. Search 2 analyzed studies on the reliability of specific fusion criteria/classifications and the accuracy assessed with surgical exploration.

Results:

A total of 442 studies were included for search 1 and 8 studies for search 2. Fusion assessment throughout the literature was highly variable. Eighteen definitions and more than 250 unique fusion assessment methods were identified. The criteria that showed most consistent use were continuity of bony bridging, radiolucency around the cage, and angular motion <5°. However, reliability and accuracy studies were scarce.

Conclusion:

This review highlights the challenges in reaching consensus on IF assessment. The variability in IF assessment is very high, which limits the translatability of studies. Accuracy studies are needed to guide innovations of assessment. Future IF assessment strategies should focus on the standardization of computed tomography–based continuity of bony bridging. Knowledge from preclinical and imaging studies can add valuable information to this ongoing discussion.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Survey of Intubation of COVID-19 Patients in the Critical Care Units to Assess Adherence to Guidelines and Critical Events Encountered
Authors:   Assistant professor, Department of Anesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad 500082, India, kar Akhya kumar , Sundar Ayya Syama ,   Associate Professor, Department of Anesthesiology and Intensive Care, Nizam’s Institute of Medical Sciences, Hyderabad 500082, India.
Published: January 2024

Background: The Coronavirus disease (COVID-19) pandemic affected the health care personnel with the worse outcome as compared to the general population.Anaesthesiologists,being the first responders in critical care units (ICU) for aerosol-generating procedures like endotracheal intubation are at higher risk of getting infected with the virus.The updated SARS guideline (Severe Acute Respiratory Syndrome) of the 2003 epidemic in Toronto, Canada, is quite instructive for endotracheal intubation. This study was intended with the primary objective to find out the adherence of guidelines among the anaesthesiologists while doing endotracheal intubation and the secondary objective is to assess the incidence of other critical events. Methods: This survey was conducted in a tertiary care centre among the anaesthesiologists about their first COVID-19 patient intubation,based on a 40-point questionnaire about adherence of guidelines and critical event encountered. All the responses collected in google form which was further evaluated with the help of SPSS-17. Results: Total of 112 patients intubated in the ICU, out of which 62% were emergency intubation, aerosol boxes used while intubation in 20% cases. Hand hygiene before the procedure was not followed in 25% and no gowns used while doing the procedure was recorded in 34% respondents. Clamping ET tube and use of hydrophobic filter was missed in 15% and 22% cases. The surroundings contaminated in 51% of respondents. Hypoxia, hypotension, arrhythmia, hypertension, cardiac arrest and aspiration during intubation was observed in 58%, 62%, 29%, 21%, 22%, 11% cases respectively. Conclusion: With the anaesthesiologists getting adapted to the new norms of intubation in COVID days, the adherence to guidelines is suboptimal, and the complication rate was high during the first intubation attempts.
A Comparative Study of Intrathecal Low dose Isobaric and Hyperbaric Levobupivacaine in Ambulatory Perianal Surgeries: A Prospective, Double Blind Study
Authors:   Assistant Professor, Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002, India., Nagaraja Swathi , Nethra SS ,   Professor, Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002, India., Sanket Bhargavi ,   Assistant Professor, Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002, India., Chikkanarasimha Mamatha ,   Senior Resident, Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002, India., Vani NV ,   Senior Resident, Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka 560002, India.
Published: January 2024

Background: Perianal surgeries can be conveniently performed under saddle block . We intended to compare intrathecal low dose isobaric and hyperbaric levobupivacaine and study their efficacy in perianal surgeries under saddle block on ambulatory basis. Methods: In this prospective, randomised controlled, double blind trial involving 20 patients in each group were randomised into two groups, Group I and Group H. Group I received 1ml of 0.5% levobupivacaine(5 mg) + 0.16 ml of Normal Saline ( total volume-1.16 ml) and Group H : 1 ml of 0.5% levobupivacaine (5 mg) + 0.16 ml of 50% dextrose (total volume-1.16 ml). Duration for ambulation being the primary criteria, we also noted maximum cephalic spread, time to reach maximum height of sensory blockade, 2 segment regression, duration of motor and sensory blockade, time for voiding and time for rescue analgesia . Appropriate statistical tests were used for final analysis. P value less than 0.05 was considered statistically significant. Results: There were no significant differences between the two groups in terms of the maximum height of sensory blockade and 2 segment regression that was achieved and request for first rescue analgesic. Duration of motor blockade, time to full recovery of sensory block and first voiding were all statistically significantly shorter in group H than group I. Conclusions: We conclude that hyperbaric levobupivacaine is superior to isobaric form while being closer to ideal choice of anaesthetic agent on ambulatory basis required for perianal anaesthesia while both the concentrations are similar in their safety profile.
Anaesthetic Challenges in a Child Presenting with A Large Epiglottic Cyst for Excision
Authors:   Junior Consultant, Department of Anaesthesiology, Rangadore Memorial Hospital, Bangalore, Karnataka 560085, India., K G Kavya , Lengade Puspha ,   Senior Consultant, Department of Anaesthesiology, Rangadore Memorial Hospital, Bangalore, Karnataka 560085, India., B S Manjunath ,   Senior Consultant, Department of Anaesthesiology, Rangadore Memorial Hospital, Bangalore, Karnataka 560085, India.
Published: January 2024

Laryngeal cysts are relatively rare benign lesions that represent approximately 5% of benign laryngeal lesions.1 Though benign, they can present with severe respiratory obstruction. We present one such rare case in a child aged 6yrs presenting with a large epiglottic cyst highlighting the anaesthetic challenges related to management of the airway in this age group. Fiberoptic intubation was planned in our case keeping all the necessary equipments in case of airway crisis.
Comparative Study of Magnesium Sulphate and Lignocaine Viscous Gargle in Prevention of Postoperative Sore Throat – A Experimental Study
Authors:   Associate Professor, Department of Anaesthesiology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu 603319, India., Sathappan Kumaresan , Barathi K Vino ,   Assistant Professor, Department of Anaesthesiology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu 603319, India., Chandran Prasath ,   Professor and Head, Department of Anaesthesiology, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Tamil Nadu 603319, India.
Published: January 2024

Background: Postoperative sore throat (POST) is a common occurrence following endotracheal intubation in general anaesthesia Pharmacological agents like local anaesthestics, corticosteroids, ketamine, magnesium sulphate(MgSO4) are tried for attenuating POST. In this study, we compared efficacy of magnesium sulphate with lignocaine gargle on attenuating incidence and severity of POST. Methods: In this randomized double blind controlled study, total 60 adult patients were randomly allocated to two equal groups, Group M (n~30) and group L(n~30). In group M patients received Magnesium sulphate 20mg/kg, dissolved in 20 ml of 5% dextrose solution. In group L patients received 20ml of 2% lignocaine viscous solution. Patients were allowed to gargle slowly for 30 s, 15 min before induction of anesthesia with the solution as per allotment of the group. In post operative period patients were assessed for POST in a four-point scale (0- 3) at 0, 1, 2, 4, 8, 12, and 24 hrs.). Heart rates (HR), SpO2, mean arterial pressure (MAP), were recorded. Results: Incidence of POST in group M recorded lower than group L, and they are 26% vs. 56%, 16% vs. 46%, 10% vs. 40%, 6.6% vs. 33% 3% vs. 20% at 0,1,2,4,8 hrs respectively. Severity of POST was lower in Group M compared to Group L at 0,1,2,4 and 8 hrs. Hemodynamic variables were comparable and statistically insignificant. Conclusion: We suggest the use of MgSO4 gargle before induction of GA as an effective measure to decrease the incidence & severity of POST compared to lignocaine gargle.
Comparative Study of Ondansetron versus Low Dose Ketamine in Prevention of Intra Operative Hypotension and Shivering in Patients Undergoing Subarachnoid Block
Authors:   Senior Resident, Department of Anaesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh 517425, India., K.A Aslam , Sekhar.T Chandra ,   Assistant Professor, Department of Anaesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh 517425, India., Raghunath Rajay ,   Consultant, Department of Anaesthesiology, Rajiv Gandhi Speciality Hospital, Agatti Lakshadweep 682553, India., Rameswra Reddy K. ,   Post Graduate, Department of Anaesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh 517425, India., P Janakiraman. ,   Biostatistician, Department of Community Medicine, Department of Anaesthesiology, PES Institute of Medical Sciences and Research, Kuppam, Andhra Pradesh 517425, India.
Published: January 2024

ontext: Subarachnoid block (SAB) is a safe anesthestic technique commonly practiced worldwide. It is associated with hypotension (33%), bradycardia (13%), and shivering due to hypovolemia, sympathetic blockade, and Bezold- zarisch reflex. Hypotension is managed with vasopressors and crystalloids, while drugs and physical methods are useful to control shivering. Aims: The study aims to evaluate the efficacy of ondansetron versus low dose ketamine to prevent hypotension and shivering during SAB. Settings and Design: A prospective, randomized comparative study. Methods: The studywas conducted on 120 patients undergoing elective lower abdominal surgeries under SAB. Patients were randomly allocated into two groups of 60 each. Group K received 0.25 mg/kg ketamine, while Group O received 4 mg of ondansetron as a slow intravenous infusion (IV) 5 min before SAB. Mean arterial pressure (MAP) and Heart rate (HR) were studied at 2 min intervals for the first ten minutes and once in 5 minutes for the next thirty minutes. Shivering scores were measured at 5 min interval for 40 min. Statistical Analysis: Mean Arterial pressure and heart rate were compared and analyzed using unpaired t-tests. Shivering was compared using contingency tests. Results: A decrease in HR is significantly lower in group K than in group O after 2 min (p < 0.001), 8 min (p < 0.001), 15 min (p < 0.0031), 25 min (p < 0.0115) and 40 min (p < 0.0037) of SAB. MAP was increased at 2 min time interval in the Ketamine group comparative with the Ondansetron group with a p-value <0.05 showing a high statistical significance. Group K had grade I (p < 0.001) shivering in 70% (42) of the patients compared with 36.7% (22) of patients in group O. Conclusion: Administration of IV ondansetron and ketamine prevents SAB induced hypotension and shivering effectively.
A Comparative Evaluation of the Effect of Preoperative Ketamine and Tramadol Nebulisation on Post Operative Sore Throat after Endotracheal Intubation
Authors:   Ex resident, Department of Anesthesiology & Critical Care, Government Medical College and Hospitals, Kota, Rajsthan 324005, India., ... Arvind , Somvanshi Mukesh ,   Senior professor, Department of Anesthesiology & Critical Care, Government Medical College and Hospitals, Kota, Rajsthan 324005, India., Tripathi Archana ,   Senior professor, Department of Anesthesiology & Critical Care, Government Medical College and Hospitals, Kota, Rajsthan 324005, India., Elavarasi M Nikitha ,   PG Resident, Department of Anesthesiology & Critical Care, Government Medical College and Hospitals, Kota, Rajsthan 324005, India.
Published: January 2024

Background: Postoperative sore throat (POST) is a common complaint during postoperative period after tracheal intubation. We evaluated and compared the effects of preoperative ketamine or tramadol nebulization on POST in patients undergoing general anaesthesia with tracheal intubation. Methods: Sixty patients, aged 18-60 years of ASA status 1 & 2 scheduled for elective surgery lasting upto 2 hours under general anaesthesia with endotracheal intubation were randomly divided into two groups; Group K: patients received Ketamine 50 mg (1 ml) with normal saline (4 ml) nebulisation, Group T: patients received Tramadol 50 mg (1 ml) with normal saline (4 ml) nebulization 30 min before induction. Incidence of postoperative sore throat and its intensity, nausea vomiting, sedation and any side effects of drugs were recorded. Result: No significant difference was observed in the incidence of postoperative sore throat between the ketamine group and tramadol group patients. Severity of POST was higher in group T as compared to group K but it was statistically insignificant. Nausea, vomiting and sedation incidence was comparable in both groups. Conclusion: Preoperative nebulisation with ketamine is clinically more effective than tramadol nebulization in prevention of postoperative sore throat.
Segmental Thoracic Spinal for Modified Radical Mastectomy in Carcinoma of Breast
Authors:   Post graduate, Department of Anesthesiology, Mamata Medical College, Khammam, Telangana, Andhra Pradesh 507002, India., Kapu Bindu , Yugandhar K ,   Associate professor, Department of Anesthesiology, Mamata Medical College, Khammam, Telangana, Andhra Pradesh 507002, India., kumar S Kiran ,   Professor, Department of Anesthesiology, Mamata Medical College, Khammam, Telangana, Andhra Pradesh 507002, India.
Published: January 2024

Segmental Thoracic spinal anesthesia for modified Radical Mastectomy in patients with compromised Pulmonary Function Test provides good hemodynamic stability, and adequate intraoperative and postoperative analgesia, with patient satisfaction. Here, we present a 60 years old patient with carcinoma of the breast posted for Modified Radical Mastectomy under Segmental Thoracic Spinal Anaesthesia.
Pregnancy and Antiphospholipid Antibody Syndrome
Authors:   Postgraduate Student, Department of Anesthesiology, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka, India., B Aswin , T Sumanth ,   Assistant Professor,  Department of Anesthesiology, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka, India., Madhusudhana Ravi ,   Professor & HOD, Department of Anesthesiology, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka, India.
Published: January 2024

Introduction: ALPA is an autoimmune hypercoagulable state caused by antiphospholipid antibodies. It is characterized by thrombotic episodes in arteries, veins and pregnancy related complications like still birth, preterm delivery, miscarriage and severe preeclampsia. We report a case of APLA syndrome due to its rarity. Case Report: A 28 year old woman with a history of two previous abortions and positive serology for APLAs with 9 months gestation came to our hospital for safe confinement. She was diagnosed as primary APLA syndrome in view of bad obstetric history and positive lupus anticoagulant. She is a known hypothyroidism. She was on Injection Enoxaparin 0.6 ml OD for 1 year which was changed to unfractionated heparin 14000 units OD subcutaneously after admitting to our hospital. In view of bad obstetric history, an elective caesarean section was planned. Unfractionated heparin was stopped 24 hours before surgery. Preoperative investigations revealed a normal APTT, PT, INR. Spinal anesthesia given in L3–L4 inter-spinal space with 25G needle after preloading with 500 ml crystalloids and a sensory block up to T6 was attained. She delivered a single live male child with APGAR score 9. Injection Oxytocin 15 units was given intraoperatively. The further perioperative course was uneventful. She was restarted on Injection Enoxaparin 0.6ml OD for 6 weeks.
Dyslipidemia at 12-14 Weeks of Gestation for Predicting Development of Preeclampsia: A Cohort Study
Authors:   Resident, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra 411043, India, Agarwal Neha , Nimbargi Vandana ,   Professor, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra 411043, India.
Published: January 2024

Introduction: Pregnancy is an insulin resistant condition which allows physiologicaldyslipidemia to occur. This physiological dyslipidemia is essential for allowing fetal growth. However, when dyslipidemia crosses the physiological range, it predisposes the woman to preeclampsia development. Epigenetic reprogramming of the cells in the growing fetus increases the cardiovascular and metabolic complications in the adulthood. Material and methods: 330 antenatal patients were included in the study after matching inclusion and exclusion criteria. Lipid values were tested at 12-14 weeks of gestation and the women were followed up till delivery. Preeclampsia development was noted in women having deranged lipid values. Results: Of 330 antenatal patients enrolled in the study, 104 patients developed preeclampsia. All preeclampsia patients had hyperlipidemia in the 1st trimester. Conclusion: Early, cost-effective detection methods, management and timely delivery by outweighing risks of prematurity in baby and multiorgan failure,eclampsia and ultimately maternal mortality attributed to preeclampsia.
Clinical Efficacy of Modified Pregnancy Unique Quantification of Emesis (PUQE Score) in Managemenet of Emesis of Pregnancy
Authors:   Resident, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra 411043, India., Bharambe Rupali , Kakade Aniket ,   Professor, Department of Obstetrics and Gynecology, Bharati Vidyapeeth Deemed to be University, Pune, Maharashtra 411043, India.
Published: January 2024

Clinical Efficacy of modified Pregnancy Unique Quantification of Emesis (PUQE score) in managemenet of emesis of pregnancy. Aims: To study PUQE score in ANC patients till 12 weeks, attending OPD or emergency department. To triage the patient as mild, moderate and severe case and to treat them accordingly. Settings and Design: Study was conducted in the Department of Obstetrics and Gynaecology in a tertiary care hospital. An Observational analytical study. The study included all the women with emesis in pregnancy from 1st September 2019 to 30th September 2021 matching the inclusion and exclusion criteria Study included all the women having emesis in pregnancy attending antenatal OPD and Emergency Medical Department, till 12 weeks.
Stress Associated with In Vitro Fertilization (IVF) in Women
Authors:   Psychologist, Department of Psychology, Fariya Counseling and Hypnotherapy Centre, Kerala 683514, India., J B Aswathy
Published: January 2024

Millions of people around the world affect infertility in their reproductive age. Infertility has a major impact on the couples’ families and communities in which they live. Around 10% to 15% of couples are infertile in a general population. IVF is one of the option when we think to cure the infertility to those couple in which either of them has been diagnosed with problem of having a baby. In vitro fertilization IVF is one of the most promised types of assisted reproductive technology (ART). The latest report, from 2018, shows that 50% of women ages 35 gone through IVF procedures and resulted in a live birth of baby. 3.9% of the egg transfers done women ages 42 and older and it resulted in a live birth. If a woman is under childlessness, she was experiencing years of the stress from the beginning onwards from where the couple is incapable of having a baby. At that time, she gets to know that she needs to undergo in vitro fertilization, feeling of stress will magnify. IVF is a series of intense medical procedure so when a women passes through the treatment if she felt emotional stress is which is not unusual. Success rate of IVF treatment varies depending on several factors, so if unfortunately the treatment fails it will definitely cause a dramatic emotional distress in the couple especially in case of females. The objective of our study is to analysis the stress of women when she preparing for, during the procedure and after the treatment. In short it is concluded that before during and after the procedure of IVF women generally faces stress in its various degrees. In wide spectrum, marital, social, physical, emotional, financial, and religious status causes stress in women.
A Rare Case of Chorioangioma / Non Immune Fetal Hydrops
Authors:   Professor & HOD, Department of Obstretrics and Gynecology, Vinayaka Missions Medical College, Karaikal 609609, Pondicherry, India., K Geetha , Anna Louis Lisa ,   Post Graduate, Department of Obstretrics and Gynecology, Vinayaka Missions Medical College, Karaikal 609609, Pondicherry, India.
Published: January 2024

Chorioangioma is a placental hemangioma is a common, non-trophoblastic benign vascular placental tumour of primitive chorionic mesenchyme. The size of the tumour is important. Smaller tumours are clinically insignificant. Giant chorioangioma more than 4 cm has higher risk of maternal and foetal complications. Early diagnosis is done by imaging techniques. Placental lesions detected on sonography necessitate close surveillance of these pregnancies because of the poor outcome ofpregnancy. We present a 32-year primigravida with placental chorioangioma who went in spontaneous labour and delivered a male baby. The baby was referred to higher centre for further evaluation and revealed mild cardiomegaly. The histopathological examination of placenta helped in the diagnosis of placental chorioangioma.
The Use of Hedge Phrases in Histopathology Reports by Filipino Pathologists and Clinicians’ Interpretation of Them
Authors: Macasaet Paolo , Villanueva III Emilio
Published: January 2024

Introduction. When communicating uncertainty in histopathology reports, pathologists often use hedge phrases (HPs) to qualify their diagnoses, assuming that clinicians understand their meaning. However, Western studies have shown that these phrases have remarkable variations in intended and perceived certainty, which may impact the next steps of patient care.
Objectives. For seven commonly used HPs, we aimed to determine: how frequently these are used and encountered in histopathology reports in the Philippine setting; if there are differences in certainty among the phrases as well as between the intended and perceived certainty by pathologists and clinicians, respectively; the frequency of seeking clarification for each phrase, the preferred mode of communication, and the frequency that the next steps of patient management are taken for each phrase.
Methodology. Through snowball sampling, 57 pathologists and 111 clinicians from different geographic regions in the Philippines were recruited for an online survey. For each HP, participants reported the frequency of use of or encounter, rated percentage certainty, and answered questions regarding frequency of clarification, next step of management, and preferred mode of communication. Differences between intended and perceived certainty were determined by the Mann-Whitney U test. Differences in certainty among HPs were determined by the Kruskal-Wallis H test with the post-hoc Dunn test.
Results. The phrases “consistent with” and “diagnostic of” were the most and least frequent HPs, respectively. Certainty was perceived to be lower than intended for the phrase “cannot rule out” and for when no HP is used. Differences in certainty were found among most of the HPs. “Diagnostic of” and “consistent with” showed high certainty, “compatible with” and “favor” showed moderate certainty, “suggestive of” and “suspicious for” showed fair certainty, and “cannot rule out” had low certainty.
Conclusion. The variability of intended and perceived certainty for different HPs may warrant standardization of usage in reporting to prevent potential miscommunication and misinterpretation.
Experimental Study on Permeability and Gas Production Characteristics of Montmorillonite Hydrate Sediments Considering the Effective Stress and Gas Slippage Effect
Authors: Wu Zhaoran , Gu Qingkai , Wang Lei , Li Guijing , Shi Cheng , He Yufa , Li Qingping , Li Yanghui
Published: January 2024

Gas permeability in hydrate reservoirs is the decisive parameter in determining the gas production efficiency and gas production of hydrate. In the South China Sea (SCS), the gas flow in tight natural gas hydrate (NGH) silty clay reservoirs is significantly affected by the gas slippage effect and the effective stress (ES) of overlying rock. To improve the effectiveness of hydrate exploitation, it is necessary to understand the influence of gas slippage in hydrate reservoirs on the permeability evolution law. For this paper, the gas permeability characteristics and methane production of hydrate montmorillonite sediments were studied at different pore pressures and ESs. Experimental data revealed that the gas permeability of montmorillonite samples before methane hydrate (MH) formation is seriously affected by the Klinkenberg effect. The gas permeability of montmorillonite sediments before hydrate formation is generally smaller than that after hydrate formation, and the gas slippage effect in the sediments after hydrate formation is weaker than that before hydrate formation. With the change in ES, the intrinsic permeability of sediment has a power law relationship with the simple ES. The ES law coefficient n was determined using the response surface method to eliminate the influence of gas slip on gas permeability. As pore pressure decreases and MH decomposes, montmorillonite swelling seriously affects gas permeability. However, the gas slippage effect has a good compensation effect on the permeability of montmorillonite sediments after MH decomposition under low pore pressure. The multistage depressurization-producing process of MH in montmorillonite sediments is mainly 3 MPa depressurization-producing stage and 2 MPa depressurization-producing stage. In this paper, the influence mechanism of gas slippage effect of hydrate reservoir is studied, which is conducive to improving the prediction accuracy of gas content in the process of hydrate exploitation and exploring the best pressure reduction method to increase the gas production of hydrate in the process of exploitation.
Temporally distributed parent body accretion in the C reservoir of the solar system
Authors: Neumann Wladimir , Ma Ning , Bouvier Audrey , Trieloff Mario
Published: January 2024

Accretion processes in protoplanetary disks produce a diversity of small bodies that played a crucial role in potentially multiple reshuffling events throughout the solar system and in both early and late accretion of planets. Application of thermo-chronometers to meteorites provides precise dating of the formation age of various mineralogical components. Nucleosynthetic isotopic anomalies that indicate a dichotomy between non-carbonaceous (NC) and carbonaceous (C) meteorites and precise parent body chronology can be combined with planetesimal thermal evolution models to constrain the timescale of accretion and dynamical processes in the early solar system. Achondrite parent bodies are considered to have accreted early and mostly in the NC region. By contrast, late accretion in the C region produced mostly undifferentiated parent bodies, such as the parent body of CR chondrites that formed as late as 4 Ma after solar system formation. However, presence of more evolved CR-related meteorites suggests also an earlier accretion timing. We present modeling evidence for a temporally distributed accretion of parent bodies of CR-related meteorite groups that originate from a C reservoir and range from aqueously altered chondrites to highly equilibrated chondrites and partially differentiated primitive achondrites. The parent body formation times derived range from < 1 Ma to ≈ 4 Ma after solar system formation, with ≈ 3.7 Ma, ≈ 1.5−2.75 Ma, < 0.6 Ma, and < 0.7 Ma for CR1-3, Flensburg, NWA 6704, and NWA 011. This implies that accretion processes in the C reservoir started as early as in the NC reservoir and produced differentiated parent bodies with carbonaceous compositions in addition to undifferentiated C chondrite parent bodies. The accretion times correlate inversely with the degree of the meteorites’ alteration, metamorphism, or differentiation. The accretion times for the CI/CM, Ryugu, and Tafassites parent bodies of ≈ 3.75 Ma, ≈ 1 − 3 Ma, and 1.1 Ma, respectively, fit well into this correlation in agreement with the thermal and alteration conditions suggested by the meteorites.
Effect of high-dose N-acetylcysteine on exacerbations and lung function in patients with mild-to-moderate chronic obstructive pulmonary disease: a multicentre, double-blind, randomised, placebo-controlled trial
Authors: Ran Pixin , Zhou Yumin , Wu Fan , Shi Zhe , Cao Jie , Tian Jia , Yao Weimin , Wei Liping , Li Fenglei , Cai Shan , Shen Yao , Wang Zanfeng , Zhang Huilan , Chen Yanfang , Fu Yingyun , He Zhiyi , Chang Chun , Jiang Yongliang , Chen Shujing , Yang Changli , Yu Shuqing , Tian Heshen , Chen Qijian , Zhao Ziwen , Ying Yinghua , Zhou Yong , Liu Shengming , Deng Zhishan , Huang Peiyu , Zhang Yunzhen , Luo Xiangwen , Zhao Haiyan , Gui Jianping , Lai Weiguang , Hu Guoping , Liu Cong , Su Ling , Liu Zhiguang , Huang Jianhui , Zhao Dongxing , Zhong Nanshan
Published: January 2024

Evidence for the treatment of patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) is limited. The efficacy of N-acetylcysteine (an antioxidant and mucolytic agent) for patients with mild-to-moderate COPD is uncertain. In this multicentre, randomised, double-blind, placebo-controlled trial, we randomly assigned 968 patients with mild-to-moderate COPD to treatment with N-acetylcysteine (600mg, twice daily) or matched placebo for two years. Eligible participants were 40–80 years of age and had mild-to-moderate COPD (forced expiratory volume in 1 second [FEV1] to forced vital capacity ratio < 0.70 and an FEV1 ≥ 50% predicted value after bronchodilator use). The coprimary outcomes were the annual rate of total exacerbations and the between-group difference in the change from baseline to 24 months in FEV1 before bronchodilator use. COPD exacerbation was defined as the appearance or worsening of at least two major symptoms (cough, expectoration, purulent sputum, wheezing, or dyspnoea) persisting for at least 48 hours. Assessment of exacerbations was conducted every three months, and lung function was performed annually after enrolment. The differences between the N-acetylcysteine group and the placebo group in the annual rate of total exacerbations were not significant (0.65 vs. 0.72 per patient-year; relative risk [RR], 0.90; 95% confidence interval [CI], 0.80–1.02; P = 0.10). There was no significant difference in FEV1 before bronchodilator use at 24 months. Long-term treatment with high-dose N-acetylcysteine did not significantly reduce the annual rate of total exacerbations and did not improve lung function in patients with mild-to-moderate COPD. Chinese Clinical Trial Registration: ChiCTR-IIR-17012604.