bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of the dynamics and patterns of paddy field use – A case study
Authors: Salim Sneha , Sathidevi C.
Published: July 2023

Any emerging economy that relies heavily on agriculture must go through the process of agricultural development in order to hasten economic progress. Agriculture is a crucial primary sector. The focus of agricultural development schemes has shifted to productivity increase as growth from expansion has reached a plateau. The present study asses the donation of area, yield and their commerce to growth in product of rice as well as the composite periodic growth rate in area, product and yield of rice in Kerala. Kerala’s husbandry has undergone substantial structural changes, including a fall in its share of the state’s GDP and commercialization of agriculture. In the state, both the net sown area and the gross cropped area have decreased over time. Kerala is now in a state of food insecurity as a result of the changes in land use patterns, which have resulted in a major conversion of paddylands for the development of cash crops and for non-agricultural purposes. The study comes to the conclusion that Kerala’s food insecurity, rapid exposure of husbandry, and confederated conditioning are all results of the absence of an effective land application strategy. The most recent SPSS and XLSTAT versions were used to produce the results in this study. The researcher contends that paddy agriculture as a whole has to be improved.
A Novelty of Several Optimization Criteria Hybrid Energy Storage System and Power Management in EV Applications
Authors: Sankarananth S. , Santhosh Kumar G. , Kavitha G.
Published: July 2023

The power management capabilities of hybrid energy storage systems offer several advantages for EVs, including improved performance, longer battery life, and reduced cost. HES technologies which combine Li-ion cells with ultra-capacitors (UC), are developing as just a possible alternative to the constraints of conventional ESS for conserving electricity. Lithium-ion batteries have a limited cycle life, meaning that they gradually degrade with each charge-discharge cycle. This can reduce the overall lifetime of the ESS and require more frequent replacements, adding to the cost and environmental impact of EVs. To circumvent those constraints, mixed battery packs combining battery technology as well as superconductors are being developed. To improve the design and control of hybrid energy storage systems for electric vehicles (EVs), a bi-level multi-objective framework has been proposed. A Bi-level multi-objective design and control framework, incorporating NSGA-II and fuzzy logic control, to obtain an optimal sized hybrid energy storage system and corresponding power management strategy. This dynamic and multi-objective architecture may achieve optimum solution hybrids battery bank as well as a matching significant power scheme one at a moment through integrating non-dominated sorting genetic and fuzzy logic control methods. To evaluate the effectiveness of the proposed bi-level multi-objective framework, Pareto optimal solutions of different hybrid energy storage systems are obtained. This approach can lead to significant improvements in the performance and efficiency of hybrid energy storage systems, making them more suitable for EVs and other applications that require high-performance energy storage solutions.

Index Terms—Batteries, ultra capacitors, recursive imprecise input, non – linear and non optimisation, and e – mobility
Short term solar irradiation forecasting using Deep neural network with decomposition methods and optimized by grid search algorithm
Authors: Kumar Srivastava Rijul , Gupta Anuj
Published: July 2023

Due to the variable nature of solar energy, it is necessary to manage a bilateral contract negotiation between suppliers and customers. Therefore, to fulfil this condition, this paper proposed an ensemble approach to forecast the solar irradiation. The signal processing techniques Variational Mode Decomposition (VMD) and Discrete Wavelet Transform (DWT) used with deep neural network to forecast the solar irradiation. The hyperparameters of deep learning model are optimized using grid search optimization with in a suitable tolerable search range. The data of three years (2012-14) is used; where data of year 2012-2013 is used to train model and testing is done on data of year 2014 for New Delhi location. Among all developed models, Bi-LSTM-VMD-Grid Search performance is better in terms of RMSE (5.456W/m2), MAPE (0.948%) and R2(0.924%), Because Bi-LSTM process the information twice and faster than other algorithms and VMD refine the quality of input data better as comparison to DWT. The result of proposed model is compared with existing techniques that predicted the solar irradiation and the forecasted results are more efficient and reliable.
Design of a PV-Fed Drive System with a Single-Phase Induction Motor for Irrigation Application
Authors: Nhantumbo Eleyde , Bojang Dawda , Verma Monika , Kulkarni Ashish
Published: July 2023

This paper presents the design, implementation, and perfor-mance evaluation of a photovoltaic (PV)-fed drive system with a single-phase induction motor for irrigation applications. The study focuses on a built hardware setup and strategy to achieve objectives, the setup is consist-ing of two 100 W solar panels, a 10 A charge controller, a 12 V battery, a 700 W DC to AC inverter, a step-up transformer 12 V DC to 230 V, and a single-phase pump coupled with a motor of 0.5 HP (0.37 kW). The paper discusses the design considerations, system configuration, control strategy, and the efficiency of the PV-fed motor for irrigation purposes. The findings demonstrate the feasibility and effectiveness of using solar energy to power irrigation systems, showcasing the potential for sustainable and energy-ef-ficient agricultural practices.
A study of hybrid fibre reinforced concrete with E-plastic waste
Authors: Rajendra Prasath C. , Dhanalakshmi A. , Vivek D. , Sugunan Diana Alice , Clara D. , Hari Preeta C.
Published: July 2023

Electronic waste, also known as electronic and electrical equipment waste, poses significant pollution issues for people and the environment. It's essential to think about new, efficient waste management methods, particularly those that emphasise recycling. Glass fibre and polypropylene fibre have the benefit of being lightweight, lowering the overall cost of building and promoting construction efficiency. The effectiveness of hybrid fibre-reinforced concrete using E plastic waste as coarse aggregate was investigated in the current study. The concept behind the research study is to replace 0% to 30% of the concrete's coarse aggregates with E-waste and 1% glass and 1% polypropylene fibres (each by weight of concrete). The results demonstrated that E-plastic aggregate may be successfully used in fibre-reinforced concrete, up to 20% of the weight of the coarse aggregate with hybrid fibre, leading to resource and waste depletion.
Role of Artificial Intelligence in Construction Project Management
Authors: Korke Pavankumar , Gobinath R. , Shewale Manisha , Khartode Bhagyashree
Published: July 2023

The construction business currently contributes 13% of the world's Gross Domestic Product (GDP), and it is anticipated that by the year 2030, its value would have increased by 85%, reaching $15.5 billion globally. China, the United States of America, and India are the three countries that are most responsible for the demand in the building business. Keeping subcontractors, contractors, designers, clients, and other parties routinely supplied with vast amounts of information has been one of the most challenging difficulties in the construction industry. The application of Information Technology (IT) has significantly contributed to the integration of disparate pieces of information within the context of widely dispersed construction projects. The construction sector, including the full construction value chain, is presently going through a period of transformation. The amount of money that is being invested into Artificial Intelligence (AI) is rising at a rate that is almost impossible to keep up with. Because of this, there is the potential to enhance the productivity of human work by forty percent and double the annual rates of economic growth by the year 2035. This research presents a discussion of the numerous methodologies that have been researched by the researchers along with a review of the artificial intelligence that is used in the construction industry, specifically Construction Project Management. Additionally, this research offers a review of the artificial intelligence that is utilized in the construction business.
Technologies of Invention for Sustainable Development of Construction and Architecture
Authors: Korotich Andre , Fomin Nikita , Mironova Lyudmila
Published: July 2023

The article presents the original author's approach to the methodologies of invention in the field of construction and architecture and with consideration of specific examples of solving inventive tasks for various typological groups of architectural and construction objects. The "direct" and "reverse" ways of creating relevant inventive solutions for key sectors of the national economy in the context of aggravation of interstate competition in various fields of intellectual activity are considered. The conclusion is made about the need to develop the two considered topical counter methodologies in order to form other principal alternative ways of the innovation platform.
Identification of Sustainability factors of Self-Compacting Geopolymer Concrete for precast construction using SEM
Authors: Sawant Rohan , Joshi Deepa A. , Menon Radhika , Wadhwa L.K.
Published: July 2023

Today's cement concrete industry is a major polluter. Cement, used as a binder in cement concrete, is made by high-temperature combustion, which raises atmospheric CO2 levels and contributes to climate change and natural resource depletion. As raw supplies diminish, several governments begin to levy carbon taxes. Numerous research have been undertaken to produce an innovative and ecologically advantageous construction material known as Geopolymer concrete (GC) in order to minimise and eliminate greenhouse gas emissions. In order to connect coarse aggregates (CA), fine aggregates (FA), and other materials in GC and improve concrete quality while using fewer natural resources, it is essential to replace cement with a byproduct substance rich in silicon and aluminium, such as red mud, fly ash (FA), rice husk ash (RHA), silica fume (SF), ground granulated blast furnace slag (GGBS), and others, activated by a high alkaline solution (AS). In this study were surveyed online and precast self-compacting geopolymer concrete's sustainability was examined. The data underwent factor analysis. Principal component analysis is used to extract factors. According to the research, there are 9 key variables to consider: Reduction in Carbon Footprint, Utilization of Waste Materials, Environmentally Friendly, Reduce Water usage during production, Low Maintenance, Augmentation of Mechanical Properties of Concrete, Natural Materials, Cost Effective, Reduction in Energy consumption during production. These are the nine primary sustainability criteria of Self-Compacting Geopolymer Concrete for Precast Construction.
Treatment of Leachate by Phytoremediation technique using Marigold and Colocasia Plants
Authors: Nerlekar Tanaya , Bhange Purshottam , Belge Supriya , Bankar Yash , Waghale Sakshi
Published: July 2023

Treatment of leachate is an important aspect in solid waste management and treatment system. A sustainable and economical method called phytoremediation makes use of plants to remove, degrade, or stabilize contaminants from polluted wastewater. In this work, the phytoextraction of zinc and copper from landfill leachate by Marigold and Colocasia plant is carried out. The efficiency of Marigold and Colocasia in the treatment of leachate is examined in this study. The findings demonstrated that plants greatly lowered the level of heavy metals in the landfill leachate. Marigold and Colocasia plants have a removal effectiveness of more than 95% for zinc in landfill leachate, with copper having the highest value at 44%. Both the chemical and biological oxygen demands (COD and BOD) are reduced by 87% and 67%, respectively. The average removal of pollutants is found to be 64%, 95% and 33% for total hardness, turbidity and pH for Marigold plant and 65%, 98% and 29% for total hardness, turbidity and pH for Colocasia plant.
Fastai and Convolutional Neural Network Based Land Cover Classification
Authors: Surana Priya , Phulpagar Bhagwan , Patil Pramod
Published: July 2023

The primary objective of this research is to create a Deep Learning model that can accurately classify satellite images into predefined categories. To accomplish this goal, we developed an effective approach for satellite image classification that utilizes deep learning and the convolutional neural network (CNN) for feature extraction. We trained our model using a labeled dataset of satellite images provided by Planet Labs, which specializes in detecting various types of land covers. By utilizing the CNN algorithm, we were able to automatically extract features from satellite data with relatively minimal processing compared to other image classification algorithms. To develop our model, we employed the Fastai library, which enables us to quickly and effortlessly achieve state-of-the-art results in image classification tasks.
Does the Type of Cardioplegia Solution Affect Intraoperative Glucose Levels? A Propensity-Matched Analysis
Authors: Mongero Linda B. , Tesdahl Eric A. , Stammers Alfred H. , Stasko Andrew J. , Weinstein Samuel
Published: July 2023

Myocardial protection during cardiac surgery is a multifaceted process that is structured to limit injury and preserve function. Evolving techniques use solutions with varying constituents that enter the systemic circulation and alter intrinsic systemic concentrations. This study compared two distinct cardioplegia solutions on affecting intraoperative glucose levels. Data were abstracted from a multi-institutional perfusion registry, including a total of 1,188 propensity-matched cases performed from January through October 2016, at 17 cardiac surgical centers across the United States in which both del Nido and 4:1 cardioplegia were used during the study period. Covariate data included insulin administration, crystalloid cardioplegia volume, diabetes history, glucose at operating room entry, and nine additional variables. Primary and secondary endpoints were the highest intraoperative glucose level and maximum glucose in excess of 180 mg/dL. Mixed-effects multivariable linear and logistic regression models were used to assess the primary and secondary endpoints, respectively, allowing for statistical control of center and surgeon effects. Greater median crystalloid cardioplegia volume was given in the del Nido group (n = 594) 1,040 mL [interquartile range (IQR) = {800, 1,339}] compared with the 4:1 group (n = 594) 466 mL [IQR = {360, 660}] in the 4:1 group (p < .001) despite these groups being statistically indistinguishable in terms of bypass and cross-clamp times as well as seven other patient covariates. More patients required intraoperative insulin drip in the 4:1 group compared with del Nido (65.7% vs. 56.2%, p < .001). Multivariable linear mixed-effects analysis yielded an estimated maximum intraoperative glucose for the del Nido group of 177.8 mg/dL compared with that of the 4:1 group, 183.5 mg/dL—a statistically significant reduction of 5.7 mg/dL (p = .03). Multivariable logistic mixed-effects analysis showed a statistically nonsignificant reduction in the likelihood of crossing the 180 mg/dL threshold for del Nido compared with 4:1 (odds ratio [OR] = .79, p = .214). After controlling for known confounding variables, intraoperative maximum glucose levels for the del Nido group were 5.7 mg/dL lower than that of the 4:1 group; there was limited evidence suggesting a difference between methods in the likelihood of exceeding the threshold of 180 mg/dL intraoperatively. Further research is warranted to examine the differential effects of cardioplegia solution on intraoperative glucose levels.
High-Frequency Percussive Ventilation Facilitates Weaning from Extracorporeal Membrane Oxygenation in Adults
Authors: Gulkarov Iosif , Schiffenhaus James , Wong Ivan , Afzal Ashwad , Khusid Felix , Worku Berhane
Published: July 2023

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an invaluable rescue therapy for patients suffering from cardiopulmonary arrest, but it is not without its drawbacks. There are cases where patients recover their cardiac function, yet they fail to wean to mechanical conventional ventilation (MCV). The use of high-frequency percussive ventilation (HFPV) has been described in patients with acute respiratory failure (RF) who fail MCV. We describe our experience with five patients who underwent VA-ECMO for cardiopulmonary arrest who were successfully weaned from VA-ECMO with HFPV after failure to wean with MCV. Weaning trials of HFPV a day before decannulation or at the time of separation from VA-ECMO were conducted. Primary endpoint data collected include pre- and post-HFPV partial pressures of oxygen (PaO2) and PaO2/FIO2 (P/F) ratios measured at 2 and 24 hours after institution of HFPV. Additional periprocedural data points were collected including length of time on ECMO, hospital stay, and survival to discharge. Four of five patients were placed on VA-ECMO subsequent to percutaneous coronary intervention. One patient had cardiac arrest secondary to RF. Mean PaO2 (44 ± 15.9 mmHg vs. 354 ± 149 mmHg, p < .01) and mean P/F ratio (44 ± 15.9 vs. 354 ± 149, p < .01) increased dramatically at 2 hours after the initiation of HFPV. The improvement in mean PaO2 and P/F ratio was durable at 24 hours whether or not the patient was returned to MCV (n = 3) or remained on HFPV (n = 2) (44 ± 15.9 mmHg vs. 131 ± 68.7 mmHg, p = .036 and 44 ± 15.9 vs. 169 ± 69.9, p < .01, respectively). Survival to discharge was 80%. The data presented suggest that HFPV may be used as a strategy to shorten time on ECMO, thereby reducing the negative effects of the ECMO circuit and improving its cost efficacy.
Incidence of Cerebral Microemboli in Single-Dose vs. Multidose Cardioplegia in Adult Cardiac Surgery
Authors: Mukdad Laith , Toppen William , Sanaiha Yas , Mantha Aditya , Bland Stephanie , Shemin Richard , Benharash Peyman
Published: July 2023

Cerebral microemboli have been associated with neurocognitive deficits after cardiac operations using cardiopulmonary bypass (CPB). Interventions by the perfusionist and alterations in blood flow account for a large proportion of previously unexplained microemboli. This study compared the incidence of microemboli during cardiac operations using conventional (multidose) and del Nido (single-dose) cardioplegia delivery. Transcranial Doppler ultrasonography was used to detect microemboli in bilateral middle cerebral arteries of 30 adult patients undergoing cardiac operations using CPB and aortic clamping. Multidose conventional blood cardioplegia (CBC) was used in 15 patients and single-dose del Nido cardioplegia (DNC) in 15. Manual count of microemboli during cross-clamp and during administration of cardioplegia was performed. Baseline preoperative characteristics were similar between groups. There were no differences in the ascending aortic atheroma grade (1.4 ± .4 CBC vs. 1.6 ± .7 DNC,p= .44), bypass times (141 ± 36 minutes CBC vs. 151 ± 33 minutes DNC,p= .64), and cross-clamp times (118 ± 32 minutes CBC vs. 119 ± 45 minutes DNC,p= .95). The use of multidose CBC was associated with a seven-fold increase in the number of microemboli per minute of bypass (1.65 ± 1 vs. .24 ± .18 emboli/min DNC,p= .0004). In this prospective pilot study, we found that the use of single-dose cardioplegia strategy led to fewer cerebral microemboli when compared with the traditional multidose approach. Our findings warrant further investigation of various cardioplegia strategies and neurologic outcomes in larger cohorts.
Bivalirudin Anticoagulation Dosing Protocol for Extracorporeal Membrane Oxygenation: A Retrospective Review
Authors: Netley Jared , Roy James , Greenlee Joseph , Hart Shaun , Todt Michael , Statz Bryan
Published: July 2023

Anticoagulation with unfractionated heparin during extracorporeal membrane oxygenation (ECMO) is common, but alternative agents are being evaluated for safety and efficacy. The objective of this analysis was to assess if a comprehensive bivalirudin dosing and monitoring protocol effectively guides dose adjustments and monitoring of bivalirudin in patients during ECMO. Our analysis included 11 patients who received bivalirudin during ECMO therapy and had dosing managed using our hospital derived protocol. Patients treated over a 1-year period were included in this retrospective analysis. Clinical characteristics and changes in activated partial thromboplastin time (aPTT) were evaluated from medical records to determine the efficacy of the dosing protocol. ECMO was initiated for acute respiratory distress syndrome in eight (72.7%) patients and for cardiac arrest in three (27.3%) patients. A total of 178 protocol guided dose adjustments were made during the study. Among the dose adjustments, 56 (31.5%) attained the protocol predicted aPTT level change, 96 (53.9%) of the measured aPTT changes were less than predicted, and 26 (14.6%) of the measured aPTT changes were more than predicted. On average, patients were within their defined therapeutic aPTT target range 66.3% of the time. All patients reached their designated aPTT target range within the first 24 hours of therapy. Significant bleeding was documented in eight (72.7%) patients. No clinically evident thromboembolic events were identified in vivo while cannulated. This analysis suggests that bivalirudin can be managed using a dosing protocol to provide anticoagulation therapy to patients during ECMO and can provide foundational guidance for dose adjustment and monitoring for other institutions.
Bloodless Heart Surgery for an 11-kg Infant of the Jehovah’s Witness Faith Undergoing Second Repair for Complete Atrioventricular Canal
Authors: Plancher Gary , Datt Bharat , Nguyen Moui , Munro Hamish , DeCampli William M. , Pourmoghadam Kamal
Published: July 2023

Bloodless pediatric cardiac surgery is the intent of most surgical centers especially in the Jehovah’s Witness population where it is a desire not to administer blood products because of religious belief. It is a tremendous feat, considering that most pediatric cardiovascular prime volumes are more than 20% of the patient’s estimated blood volume (EBV). We report on our bloodless strategy for a 2-year old Jehovah’s Witness with trisomy 21 and complete atrioventricular canal repair, who underwent atrial septal defect and ventricular septal defect patch closure, pulmonary artery debanding, and pulmonary arterioplasty. We modified our circuit to reduce our prime volume to approximately 10% of the EBV and removed 200 mL of the patient’s blood before surgery as acute normovolemic hemodilution. We did not alter our institutional standards for transfusion of blood and blood products. The post cardiopulmonary bypass (CPB) hematocrit was 30%. We conclude that bloodless CPB surgery can be performed safely in Jehovah’s Witness patients with a carefully planned interdisciplinary approach.
Asanguinous Del Nido Cardioplegia for an Aortic Valve Replacement Patient with Cold Agglutinins
Authors: Rosenbloom Michael , Hancock Michael , Weinstock Perry , Paterek Allyson , Highbloom Richard , Bowen Frank , Patel Kinjal
Published: July 2023

A patient with known cold agglutinins requiring an aortic valve replacement was referred for surgery. Asanguinous, Del Nido cardioplegia was used for myocardial protection. Warm induction followed by cold infusion prevented any agglutination and eliminated the need for subsequent cardioplegia doses. Following the cross-clamp period, the heart returned to normal sinus rhythm without need for defibrillation. Postoperative ejection fraction and systolic function were normal.
Complete Myocardial Function Recovery with ECMO in a Woman Presenting with Cardiogenic Shock during Peripartum Period
Authors: Das Mukund , Rathi Anil , Afzal Ashwad , Ramasubbu Kumudha
Published: July 2023

Peripartum cardiomyopathy is a potentially life-threatening cause of heart failure (HF) that affects women toward the end of pregnancy or in months after delivery. Treatment is similar to the treatment for HF with reduced ejection fraction (EF). Most women make full myocardial function recovery within 6 months on conventional HF therapy. In rare instances, catastrophic presentations may occur with hemodynamic instability requiring the use of mechanical support. Because of the small patient population, limited information is available regarding the recovery of myocardial function in women who received mechanical support. We present a case of a woman in her peripartum period who presented with cardiogenic shock and made complete myocardial function recovery after 4 days of extracorporeal membrane oxygenation (ECMO). Our patient’s EF at the time of catastrophe was 5–10%, which improved to 60% on day 4 on ECMO.
An Ethanol-Free Autologous Thrombin System
Authors: Matuska Andrea M. , Klimovich Marina K. , Chapman John R.
Published: July 2023

Thrombin is a coagulation protein of central importance to hemostasis and wound healing that can be sourced from human blood, bovine blood, and engineered cell lines. Only autologous thrombin lacks the risks of transmitting emergent pathogens or eliciting an immunogenic response. Previous commercial autologous thrombin devices require the use of high concentrations of ethanol to achieve thrombin stability, introducing cytotoxicity risks. A new point of care device for preparing an ethanol-free autologous thrombin serum was investigated. The ethanol-free autologous serum (AS) was prepared using the Thrombinator™System (Arthrex, Inc., Naples, FL). A total of 120 devices were tested with the blood of 30 healthy donors to determine the reliability and flexibility of the procedure. AS was prepared from both whole blood (WB) and platelet-poor plasma (PPP). Study endpoints were thrombin activity determined using a coagulation analyzer and formation of cohesive bone graft composites objectively measured using a durometer. The average thrombin activity produced by this system from 24 donors was 20.6 ± 2.7 IU/mL for WB and 13.4 ± 3.8 IU/mL for PPP which correlated to clot times of 3.9 and 5.9 seconds, respectively. The device tolerated use of varying volumes of blood to prepare AS. In addition, the system was able to generate four successive and comparable AS productions. When combined with platelet-rich plasma and bone graft material, cohesive scaffolds were always formed. A new device and method for preparing single donor, ethanol-free, AS with thrombin activity was demonstrated.
Flow Awareness as a New Safety Device for Cardiopulmonary Bypass
Authors: Brolhorst Jacki , Peterson Brittney , Holt David W.
Published: July 2023

Safety devices such as bubble detectors and level detectors have been in use for more than 40 years and initially reduced the risks associated with gaseous emboli during cardiopulmonary bypass; however, the risks have not been eliminated. This research explored a new safety device designed to further reduce these risks: Flow Awareness Technology. This device visually alerts the perfusionist when the ratio of venous return does not equal the amount of arterial flow. To determine the efficacy of this device, 33 participants with no perfusion background were randomly assigned to Group A (flow awareness only), Group B (level detector only), or Group C (control). These participants were instructed to turn off the arterial pump when they noticed that the fluid in the venous reservoir had begun to drop or if their assigned safety device was triggered. The venous line was fully occluded at times unknown to the participants. These times coincided with before, during, or after times that the participants were expected to paper-chart known values. Each participant’s amount of fluid lost (in milliliters) from the reservoir and reaction time (in seconds) to shut off the arterial roller pump were measured. Group A lost an average of 80.8 mL, Group B lost an average of 173.6 mL, and Group C lost an average of 140.3 mL. Average measured time for each group is as follows: Group A took 2.16 seconds, Group B took 4.31 seconds, and Group C took 4.09 seconds to shut off the arterial pump. Statistics support the hypothesis that Flow Awareness Technology significantly reduces the reaction time to an adverse event such as a sudden occlusion of the venous line, thus reducing the amount of fluid lost during such an event.
Bivalirudin Anticoagulation for an Infant with Hyperbilirubinemia and Elevated Plasma-Free Hemoglobin on ECMO
Authors: Ezetendu Chidiebere , Jarden Angela , Hamzah Mohammed , Stewart Robert
Published: July 2023

Heparin has been used for decades as an anticoagulant in patients on mechanical circulatory support, which includes extracorporeal membrane oxygenation (ECMO) and ventricular assist devices. Bivalirudin is a direct thrombin inhibitor that can be used as an alternative anticoagulant in neonates and infants demonstrating inaccurate heparin monitoring. We report a case of a 2-month-old male child who was placed on ECMO for severe acute respiratory distress syndrome. His ECMO course was complicated by severe hemolysis and hyperbilirubinemia, which precluded accurate monitoring of heparin activity. Bivalirudin was successfully used for anticoagulation in this patient.
Establishing a Ventilator–Heart Lung Machine Communication Bridge to Mitigate Errors when Weaning from Bypass
Authors: Rance Geoffrey , Arney David , Srey Rithy , Goldman Julian M. , Zenati Marco A.
Published: July 2023

If a perfusionist weans a patient off the heart lung machine (HLM) and the anesthesiologist has not re-started the ventilator, the patient will become hypoxic. The objective of this project was to create a redundant safety system of verbal and electronic communication to prevent failure to ventilate errors after cardiopulmonary bypass. This objective could be realized by building an electronic communication bridge directly between the HLM and ventilator. A software application was created to retrieve and interpret data from the pump and ventilator and trigger a programmed smart alarm. The software is able to interpret data from the pump and ventilator. When both are off simultaneously (defined as a pump flow of 0 L/min with a respiratory rate of 0 breaths/min), the application will raies an alarm. Communication between a pump and ventilator is possible, enabling the deployment of a safety system that could exist in the operating room (OR) as a standalone alarm. A device dataset can be used to optimize clinical performance of the alarm. The application could also be integrated into smart checklists and computer-assisted OR process models that are currently in development.
Non-Invasive Tissue Oximetry—An Integral Puzzle Piece
Authors: Vranken Nousjka P. A. , Weerwind Patrick W.
Published: July 2023

Non-invasive tissue oximetry is a monitoring method for continuous assessment of tissue oxygenation, which may aid in detection of hemodynamic instability and otherwise unnoticed hypoxia. Numerous studies focused on using non-invasive tissue oximetry intraoperatively, proposing its predictive value in relation to clinical outcome. Tissue oximetry may be part of standard monitoring practice for brain monitoring during cardiac surgery in many clinical centers; however, the monitoring method can be deployed in numerous clinical settings. This succinct overview aims to determine the role of non-invasive tissue oximetry in current clinical practice.
Dermabond as a Novel Solution for Needle-Hole Repair in Arterial Cannula while on Extracorporeal Membrane Oxygenation Therapy
Authors: Reisenauer Janani S. , Neal James R. , Joyce David L.
Published: July 2023

The annual incidence of extracorporeal membrane oxygenation (ECMO) for adult patients is increasing. Indications may vary from acute lung injury, ECMO-assisted cardiopulmonary resuscitation, to cardiac failure with an inability to wean from cardiopulmonary bypass. Complications may happen to the ECMO circuit, including cannula leaks from holes, cracks, or other damage, during the support period. Here, we present a novel solution for repairing a bleeding structural leak in the side of an arterial cannula. Dermabond was used to seal a small leak in the cannula likely caused by an earlier accidental needle puncture. Dermabond was applied to the area of damage, then allowed to cure, and wrapped with Ioban for increased stability. The patient was weaned from ECMO 2 days later without any complications from the repair of the cannula. The cannula was unable to be exchanged because of the small thoracotomy used to gain access for cannulation, so a repair was attempted. Moving the cannula to the femoral vessel was ruled out because of continued hypoxia and fear of creating a mixing cloud. Although less invasive incisions are becoming more common in cardiac surgery, these incisions for ECMO may be problematic if issues related to cannulas arise.
Aquapheresis (AQ) in Tandem with Extracorporeal Membrane Oxygenation (ECMO) in Pediatric Patients
Authors: Constantinescu Alex R. , Adler Jason L. , Watkins Eileen , Negroni-Balasquide Xamayta L. , Laufenberg De’Ann , Scholl Frank G. , Lavandosky Gerald J.
Published: July 2023

Children with cardiopulmonary failure requiring extracorporeal membrane oxygenation (ECMO) are at risk for fluid overload (FO) despite the normal estimated glomerular filtration rate (eGFR). It has been shown that survival in the intensive care unit (ICU) is inversely proportional to FO. Therefore, fluid removal, or prevention of FO, in these critical cases has the potential to improve survival. Aquapheresis (AQ), a procedure used for fluid removal, with success in patients with heart failure has also been used in children with acute oliguric kidney injury (AKI), to prevent and treat FO. The purpose of this article was to describe the use of Aquadex FlexFlow®for AQ in pediatric patients on ECMO, as a means to provide a simplified and safe form of fluid removal with minimal impact on ECMO therapy. The principal variables collected include patients’ demographics, urine output, serum creatinine, withdrawal and infusion pressures, ultrafiltration (UF) rates, and ECMO flow ranges, along with length of stay in pediatric ICU and survival. Patient survival was 100% with preserved eGFR. The ECMO flows were not affected by AQ. Urine output decreased somewhat during therapy, with little AQ machine pressure variations. Range of UF tolerated without hemodynamic abnormalities was 1.24–6.2 mL/kg/h, allowing the patients to maintain their pre-AQ body weight, while receiving intravenous (IV) nutrition and medications. This article describes the use of AQ in tandem with ECMO in a user-friendly and safe way to provide UF in children requiring cardiopulmonary support, with minimal flow and hemodynamic disturbance.
Does Standardizing Extracorporeal Circuit Design for Cardiopulmonary Bypass Affect Outcomes? Results from a National Perfusion Registry
Authors: Stammers Alfred H. , Mongero Linda B. , Tesdahl Eric A. , Coley Thomas
Published: July 2023

Standardization of clinical practice is an effective means of reducing unwanted variation and improving safety. There are numerous extracorporeal circuit (ECC) designs in clinical practice which both complicates the conduct of cardiopulmonary bypass (CPB) and increases costs, especially in situations where clinicians may conduct perfusion at more than one center. The current study was undertaken to determine the effect of standardizing ECCs by incorporating new generation devices as part of a pack enhancement project (PEP). Standardization of ECCs in cardiac centers within a national perfusion provider was undertaken to incorporate new generation oxygenators to reduce variation and improve safety among clinicians. The PEP was carried out in adult centers performing cardiac surgery across America. Data were analyzed for 12 months before the change and compared with those of an equal time thereafter. The outcome measures were ECC prime volume, hematocrit (HCT) drift, and transfusion of intraoperative red blood cells (RBCs). The transition time frame took just less than 12 months and included soliciting input from end-users, pack redesign, and education and implementation. Before the PEP, 91 hospitals used 47 different ECC configurations, which was reduced by 83.0% to eight packs. Regression analysis comparing outcomes between PEP and non-PEP patients showed statistically significant but subtle changes. The net prime volume increased slightly in the PEP group (733–750 mL,p< .001), whereas RBC transfusions did not vary, and the PEP group had a small reduction in nadir HCT (28.0 vs. 27.5,p< .001) and HCT drift (−9.6 vs. −10.25,p< .001). A concurrent analysis of 50,135 patients not in the PEP conducted over the same time period showed no change in RBC transfusions. Although small changes in the net prime volume and transfusion rates were seen with the standardization of ECCs, the primary benefit of this initiative was the increased familiarity and continuity of circuit design across sites.
Use of Augmented Reality to Assist Teaching for Future Perfusionists in Extracorporeal Technology
Authors: Yamada Yasuharu , Nakamura Taro , Yamada Masako , Maruyama Junko , Maruyama Kazuo , Azuma Eiichi
Published: July 2023

The aim of this study was to foster the better perfusion education when providing extracorporeal circulation (ECC) technology for future perfusionists. For this purpose, we have developed an augmented reality (AR) program for ECC students. Currently, the cost of equipment and its simulator is high. Furthermore, it is desirable for ECC students to practice at any time. AR describes user experiences that add 2D (plane detection) or 3D elements to the live view from a device’s camera in a way that makes those elements appear to inhabit the real world. We can use these technologies to create AR experiences using the back camera of a smartphone or tablet. We can also build our own instrument with custom visualization and data analysis. Although AR technology may not be new, its potential in ECC student education is just beginning to be explored. Unlike other computing technologies, AR interfaces offer seamless interaction between the real and virtual worlds, a tangible interface metaphor, and a means for transitioning between real and virtual worlds. Here, we have shown our experiences of cost-effective AR technology for future perfusionists.
Gestão das áreas florestais comunitárias/baldios em Portugal
Authors: Skulska Iryna , Pacheco Renata , Colaço Maria Conceição , Sequeira Ana Catarina , Rego Francisco C. , Acácio Vanda
Published: July 2023

Os terrenos comunitários portugueses - baldios, têm uma história centenária. Desde os seus primórdios, as populações rurais locais usaram estes terrenos para garantir a sua subsistência, o que implicou uma alteração progressiva da paisagem através da utilização de florestas, campos agrícolas, e pastagens. Assim, foram-se desenvolvendo as vertentes económicas e sociais locais que no presente caracterizam os baldios. Estes territórios passaram por diversos regimes de gestão e governança e a sua maior parte foi arborizada no século passado. Atualmente, são estruturas, em que os proprietários, i.e., compartes, estão organizados em assembleias onde todos os compartes têm assento, e podem optar por diferentes formas de gestão dos baldios. Num contexto de desafios e de necessidade de informação sobre a situação atual dos terrenos baldios, realizou-se um simpósio sobre a gestão das áreas florestais comunitárias/baldios, no âmbito do 9° Congresso Florestal Nacional que decorreu na Madeira em 2022. Este artigo reúne as principais visões acerca do tema apresentadas no evento, e lista possíveis passos para melhorar a governança e valorização dos baldios portugueses.
Was wirklich wirkt – Chancen und Grenzen der persönlichen Erfahrung
Authors: Kiesele Julian
Published: July 2023

Oft liefern aktuelle Studienlage und persönliche Erfahrung völlig unterschiedliche Schlussfolgerungen – ein bekanntes Dilemma. Um diesen Spagat zu schaffen, ist es hilfreich zu wissen, was eine wirksame Therapie ausmacht und was sie von einer (vermeintlich) unwirksamen Therapie unterscheidet. Dabei spielen Kontext-faktoren, die bei Patient*innen einen scheinbar positiven Therapieeffekt herbeiführen, ebenso eine Rolle wie kognitive Verzerrungen bei Behandelnden, die das Gefühl der Wirksamkeit beeinflussen.
Finanzielle Beeinflussung medizinischer Entscheidungen in Deutschland – Eine Übersichtsarbeit zu Ursachen und Forschungsstand von ökonomischen Einflüssen in der stationären Versorgung
Authors: Lückmann Sara Lena , Böhme Grit , Krüger Felix , Hiemer Sonja , Al-Ali Haifa-Kathrin , Wuppermann Amelie
Published: July 2023

Der verstärkte finanzielle Druck im deutschen Gesundheitswesen kann auch medizinische Entscheidungen beeinflussen. Diese selektive Literaturrecherche stellt den aktuellen Forschungsstand zu finanzieller Beeinflussung der stationären Versorgung in Deutschland dar. Durch den aktuell bestehenden wirtschaftlichen Druck im Gesundheitswesen fühlen sich Ärzte zunehmend auch bei Indikationsstellung und Behandlungsentscheidungen finanziellen Zwängen unterworfen. Es gibt Evidenz für finanziell initiiertes Upcoding und Mengenausweitungen. Zum Ausmaß, zu Risikogruppen und zum Einfluss auf die Qualität der Versorgung ist wenig bekannt. Gut erforscht ist die Auswirkung des finanziellen Drucks auf die Arbeitszufriedenheit, den empfundenen Stress und die Gesundheit der behandelnden Ärzte. Die aktuelle Diskussion zur Ökonomisierung ärztlichen Handelns ist wichtig, vor allem zu Fehlanreizen und Arbeitszufriedenheit. Zu Patientenwohlgefährdungen ist wenig bekannt.
Diagnostik, Therapie und psychosoziale Aspekte bei late-onset Morbus
Pompe
Authors: Hahn Philipp , Siefen Rainer-Georg , Benz Korbinian , Jackowski Jochen , Köhler Cornelia , Lücke Thomas
Published: July 2023

Morbus Pompe ist eine schwerwiegende lysosomale Stoffwechselerkrankung, die sich
von frühester Kindheit bis ins Erwachsenenalter klinisch manifestieren
kann. Ihre Diagnose wird durch ein breites Symptomspektrum erschwert. Eine
frühe Diagnose mittels Enzymaktivitätsbestimmung aus Trockenblut
und humangenetischer Sicherung ist insbesondere seit Einführung der
Enzymersatztherapie (in Deutschland 2006) entscheidend für das
Behandlungsergebnis und die Lebensqualität der Patienten. Bei unklaren
muskulären Erkrankungen ist daher auch ein M. Pompe in Erwägung
zu ziehen. Dieser Artikel gibt einen Überblick über die
Erkrankung und konzentriert sich auf die Diagnostik ihres
spätmanifestierenden Typs, der sowohl im Kindes- und Jugendalter als
auch im Erwachsenenalter auftreten kann. Die relevantesten Aspekte der
interdisziplinären Versorgung Betroffener werden dargestellt.
Darüber hinaus beleuchtet er die psychosozialen Belastungen bei Kindern
mit M. Pompe und ihren Familien, welche von psychischen Störungen bis
hin zu sozialem Rückzug reichen können und gibt Hinweise zum
Umgang mit Eltern betroffener Kinder.
Expertise nutzen – Rückbildungskurse in physiotherapeutischen Praxen
Authors: Zippel Claus , Werse Louisa , Schütte Janosch
Published: July 2023

Physiotherapeut*innen sollten beim Thema Rückbildung keine falsche Bescheidenheit zeigen, oder sich gar in den Schatten von Hebammen stellen. Eine Umfrage zeigt, dass die Frauen ein aktives Übungsprogramm und anatomische Kenntnisse schätzen. Achten Kursanbieter auf Rahmenbedingungen wie etwa Kurszeiten, können sie möglicherweise noch mehr Mütter für ihr Angebot gewinnen.
Nahtlosverfahren 4.0 – Eine hybride Intervention zur
Kliniknachsorge bei alkoholbezogenen Störungen
Authors: Lukas Christian Aljoscha , Hacker Daniel
Published: July 2023

Alkoholbezogene Störungen sind eine der häufigsten psychischen
Störungen und sind mit großem individuellem Leid sowie hohen
Kosten für die Gesellschaft verbunden. Die stationäre Therapie
stellt eine wesentliche und gut evaluierte Behandlungsform bei alkoholbezogenen
Störungen dar. Bezüglich der Verstetigung stationär
erzielter Therapieerfolge durch eine Nachsorge herrscht in Deutschland jedoch
aktuell eine Mangelsituation zu Lasten der Betroffenen. Hybride
E-Health-Interventionen besitzen das Potential, als ergänzende
Komponente in der poststationären Versorgung signifikante
Therapieeffekte zu erzielen. Derartige menschlich gestützte
Interventionen sind ort- und zeitunabhängig nutzbar,
kostengünstig zu reproduzieren und sprechen durch ihren hohen
Anonymitätsgrad Betroffene jenseits des konventionellen Suchtsystems an.
mentalis Appstinence ist eine hybride Nachsorgeintervention
für alkoholbezogene Störungen im poststationären
Setting. Bereits in einer Feasibility Studie wurde demonstriert, dass eine hohe
Adhärenz sowie eine Reduktion dysfunktionaler Einstellungen, des
Suchtverlangens und Risikokonsums erreicht werden kann. Weiterhin weisen erste
Daten aus der Versorgungspraxis darauf hin, dass Appstinence die
Überführungsrate in Anschlussmaßnahmen steigert sowie
die Rehospitalisierungsrate reduziert wird. Zusätzlich erfolgt aktuell
die Evaluation in einer randomisierten kontrollierten Studie. Folglich kann die
Integration solch hybrider E-Health-Interventionen einen wichtigen Baustein
für die Verbesserung des poststationären Suchthilfesystems
bedeuten.
Endovascular Treatment of Brain Arteriovenous Malformations in Pediatric Patients: A Single Center Experience and Review of the Literature
Authors: Borges de Almeida Gonçalo , Pamplona Jaime , Baptista Mariana , Carvalho Rui , Conceição Carla , Lopes da Silva Rita , Sagarribay Amets , Reis João , Fragata Isabel
Published: July 2023

Background Brain arteriovenous malformations (bAVMs) are abnormal vascular connections with direct arteriovenous shunts, generally symptomatic in the adult life. However, a small number of bAVMs may manifest in pediatric patients, with higher bleeding risk and mortality rates when compared to adults. The purpose of this study is to review our experience with endovascular treatment of bAVMs in pediatric patients.

Methods This is a retrospective analysis of all bAVMs in pediatric patients (0–18 years) who underwent diagnostic digital subtraction angiography (DSA) at our institution from January 2010 to June 2021.

Results Twenty-six patients met the inclusion criteria, of which 12 underwent endovascular treatment. Treated patients had a mean age of 10.25 years and 58% were females. Complete angiographic exclusion was achieved in five (42%) patients with endovascular treatment. Five patients with residual bAVM after embolization needed adjuvant therapy with surgery (n = 3) or stereotactic radiosurgery (SRS; n = 2). Two patients are still undergoing embolization sessions. Procedure-related complications occurred in two patients (17%) and included small vessel perforation and an occipital ischemic stroke. Two patients showed bAVM recurrence on follow-up (17%) and subsequently underwent SRS (n = 1) or surgery (n = 1), both resulting in complete bAVM exclusion. All patients had a modified Rankin scale (mRS) score of 0 to 2 on follow-up.

Conclusion Our experience supports the effectiveness and safety of endovascular treatment of bAVM in selected pediatric patients. A multidisciplinary approach combining surgery and SRS is warranted to achieve higher complete bAVM obliteration rates. Long-term follow-up is important as these lesions may show recurrence over time, especially in the pediatric population.