bluuebunny/crossref_metadata_2025 huggingface dataset:
Green Synthesis Using Klebsiella pneumoniae as well as its Execution onto Textiles for Microbe Resistance
Authors: Singh Pankaj Kumar , Goyal Monika
Published: December 2020

Microorganisms like bacteria and yeast and their use in the combination of nanoparticles is a basically a recent phenomenon. These microorganisms lessen the toxicity by decreasing the ions of metal or through the creation of complexes which are insoluble along with the metal’s ions (as metal sulfides) as colloidal elements. The present study focuses on bio-synthesis of silver nanoparticles by the bacterium Klebsiella pneumoniae. The reduction of AgNO3to Ag nanoparticles was due to the extracellular production of the enzyme nitrate reductase by the K. pneumoniae into the medium. The particles were characterized by SEM. The biosynthesized Ag nanoparticles were padded on the fabrics of cotton by cure method of dry pad. The preliminary antimicrobial activity was performed by disc diffusion method against Escherichia coli and Staphylococcus aureus. The antimicrobial property of the treated fabrics were confirmed qualitatively and quantitatively by parallel streak (AATCC- 147) and challenge test (AATCC -100) respectively. SEM results revealed the form of the nano particles were in range of 50 - 60 nm. An area of inhibition of 7 mm as well as 5 mm were found against S.aureus and E.coli respectively by disc diffusion test. Parallel streak method also confirmed the anjinicrobial activity. The results of the challenge test revealed the fabrics treated with biosynthesized nanoparticles depicted 100% minimum point in comparision with S.aureus and 99% reduction against E.coli.
Nanotechnological Nano Noses
Authors: Singh Pradeep Kumar , Goyal Monika , Yadav Rajat
Published: December 2020

Nano-biosensors surely have their place in the modern universe of the nanotechnologies. The most recent age of electronic noses is nano biosensor clusters dependent on the electrical properties of olfactory receptors from well-evolved creatures, which are proteins arranged in the olfactory epithelium inside the nasal pits. The e-noses accompany various likely applications in sanitation and quality control (poisonous mixes, corruption, immaculateness), beauty care products, assurance of the earth (air and water quality, contaminants, smoke investigation), on-line observing of modern or natural procedures (aging, maturation), security controls (location of risky or harmful substances, explosives, drugs), as a guide while scanning for covered casualties, clinical diagnostics (diabetes, schizophrenia, malignant growth, and so on.), and so forth. These e-noses have been utilized for quite a long time in the research centers of numerous associations. Notwithstanding, as of not long ago they have been unreasonable for use in reality. E-noses have needed versatility, taken too long to even think about producing valuable outcomes, and have just had the option to break down lab arranged examples. The Nano-Nose will upset the electronic nose industry with its minimized size and down to earth pertinence. The lightweight gadget is handheld and can identify and measure analytes quickly. The Nano-Nose is likewise one of a kind in its capacity to break down gushing air instead of just lab controlled air tests, enhancing its true ease of use.
Taguchi Optimization and Flame Hardening Experimental Investigation on Eglin Steel
Authors: Marichamy S , Dhinakaran V , Stalin B , Ravichandran M , Balasubramanian M , Anand Chairman C
Published: December 2020

Flame hardening was one of the surfaces hardening methods to improve the substance behaviors. It was a rapid and economical method to harden the selected surface of the material. It is suitable for all types of steels, particularly wear resistant steel. The hardening of the material was achieved through heating the material and then followed by quenching process. Eglin steel was one of the wear resistant steel which was considered for the experimental work. After the surface of flame hardening of it, Brinell hardness was found through the input factors such as surface temperature, standoff distance (SOD) and quenching time. The Taguchi optimization was used to analyze the effect of flame hardening factors and it has provided the optimal solutions. The involvement factor was studied through the variance test.
Wire Arc Additive Manufacturing Perspectives and Recent Developments
Authors: Dhinakaran V , Stalin B , Ravichandran M , Balasubramanian M , Anand Chairman C , Pritima D
Published: December 2020

The outstanding performance of producing complex three dimensional moulded components, which could be difficult or impossible to accomplish through traditional production processes. Additive processing in recent years has revolutionised the processing paradigm. Due to the high deposition speeds, which are substantially higher than powdered techniques, the wire and arc additive manufacturing (WAAM) is distinct among various additive manufacturing techniques that are suitable for producing large metal components. WAAM’s efficiency is growing rapidly, and thus substantial study is ongoing. This research work will include an overview of the greatest advances in WAAM, outlining the innovations and variants in processes to monitor the microstructure, mechanical properties and defect production in the as-built components along with the most important technological materials used, and the variants of WAAM.
Estimation of Tensile and Compression Properties of 2D Woven Jute and Kevlar Hybrid Laminate
Authors: Raja N D , Kumar K V A
Published: December 2020

In this study, the mechanical properties of a 2D woven novel hybrid laminate containing jute in the warp direction and Kevlar in the weft direction as reinforcement material is compared with four different weaving patterns. The hybrid laminates were tested for its tensile strength, elongation percentage and compressive strength. The results show that under the condition of identical composition of the matrix element, similarity in the thickness of the laminates and same stacking sequences, the weaving patterns exhibit profound influence on the tensile and compressive properties. The plain weaving pattern exhibited lowest tensile strength and compressive strength while the highest values for the two properties was observed from the hybrid laminate having twill weave pattern.
Vibration Analysis of Cutting Tool insert in Turning of 42CrMo4 alloy steel
Authors: Ramesh Kannan C , Manivannan S , Vairamuthu J , Velmurugan P , Manohar N Janaki , Stalin B
Published: December 2020

This investigation, vibration analysis of cutting tool in turning of 42CrMo4 alloy steel using CNMG120408SMRH13A insert. Tool vibration is the important phenomenon which affects the life of the cutting tool, machining quality and behaviour of the metal cutting process. In metal cutting, tool vibration is the significant factor affecting the surface quality of machined surfaces. In this experimental work, control this vibration should be arrested by external force. In the proposed system damper method has used to control the tool vibration. It will be predicted by comparing the parameters of cutting speed, feed, depth of cut, material removal rate and surface roughness of turning operation. The generated vibration is measured. The machining performance has derived by the analytical method and experimentally.
Investigation of cryogenic soaking period on flank wear in turning using Response Surface Methodology
Authors: Ramesh Kannan C , Manivannan S , Vairamuthu J , Tilahun Samuel , Vijayakumar M D , Stalin B
Published: December 2020

In this investigation, the effects of cryogenic soaking time on cutting insert were investigated. Cryogenic treatments were carried out at -196°C for various soaking times of 12, 24, and 48hours followed by tempering at 200°C for 2hours. The Scan Electron Microscope image and X-Ray Diffraction pattern analysis validate the structure of η-carbide on the surfaces of the inserts. The hardness result revealed that the deep cryogenic treatment improved the surface rigidity of the inserts. The speed, feed rate and depth of cut are preferred as input parameters of the experiment. The out response of the tool wear is measured the flank wear of the inserts. As a result, increase in soaking time of deep cryogenic treatment imports superior tool wear resistance of the inserts.
Understanding of Non-Value-Added Overtime in Manufacturing Operations
Authors: Abdul Rasib A H , Musazali M
Published: December 2020

The manufacturing industry plays a crucial role in the production process to meet the demands of the market and to raise the standard of living recently. Nevertheless, one of the most common issues associated with the industry is unnecessary overtime. Overtime has produced a variety of negative consequences on production output. This paper aims to identify the various causes of unnecessary overtime, and the causes have been categorised through the seven wastes of lean manufacturing. This paper also focuses on unnecessary overtime occurred in industries. The method used in this paper is by reviewing the relevant literature from conference papers and journal publications, including the International Journal of Scientific and Technology Research, Journal of Advanced Manufacturing Technology, and International Journal of Engineering and Technology, amongst many others. Finally, the critical components of NAO have been finalised according to the necessaryscopes of operation, which considered as factors which are pre-production, in-production, and post-production. Based on the final critical components, there were two critical sub-factors in pre-production components, six critical sub-factors in-production elements, and five critical sub-factors post-production components.
Effect of Melt Temperature and Holding Time on Mechanical Properties of Polypropylene Composites Bottom Ash Reinforced
Authors: Made Kastiawan I , Nyoman Sutantra I , Sutikno
Published: December 2020

In this study, observing the effect of variations in melt temperature and holding time on the mechanical properties of polypropylene composite materials with coal bottom ash reinforcement has been done. This composite used a particle size of 200-250 mesh with a composition of 10%, and a polypropylene matrix of 90% by weight. Melting temperatures had a variation of 170°C, 180°C and 190°C, and holding times had a change of 0, 30 and 60 minutes. Bottom ash was washed with fresh water (room temperature) and warm water (80°C) until clean from impurities. The next process, bottom ash was drained at room temperature for 24 hours and dried at a temperature of 120°C for 3 hours. The test results showed the value of composite increases to 24.4% for tensile and 123% for flexure strength from the pure matrix strength. These properties were essential information for alternative engineering material research.
Wear experimentation on Tantalum carbide-based Niobium MMC
Authors: Arravind R , Vairamuthu J , Stalin B , Shanmugam S , Balaji R , Dhinakaran V
Published: December 2020

The niobium and its alloys have been used for automobile, marine, and aerospace due to its superior properties such as a lightweight ratio, strength, corrosion resistance, thermal and electrical conductivity. The present work was used to improve the substance properties such as hardness and wear. Tantalum Carbide (TaC) reinforced niobium metal matrix composite (MMC) was produced through the stir casting route. The specific wear rate was determined through a pin on disc tribometer with respect to the input actors such as sliding velocity, load, and temperature. Taguchi optimization was applied to found the optimal parameters. The variance analysis was used to found the influential factor in the wear rate.
Development of Low cost 6 Dot Unicode Braille printer for aiding visually impaired persons
Authors: Mohamed Ismail A , Yuvaraj K , Vigneswaran S , Nagarajan P
Published: December 2020

Numbers of Visually impaired persons are suffering a lot for communicating their thoughts. Braille literacy is not affordable to all since the printers are expensive which costs roughly one Lakhs. This work aims to develop a braille embosser for the affordable price which embosses the A4 size sheet with braille code. Arduino Uno controller is employed to control the angular position of the stepper motor. The input is given as text format to the serial monitor of the arduino IDE. The input texts are converted into Unicode in order to get the corresponding braille code. With the help of stepper motors code is printed on the paper. Keywords: Braille Printer, Arduino UNO, Braille code, Stepper motors, affordable cost.
Performance and Emission Characterization of Adjustable Cylinder Head Type Variable Compression Ratio in Two-Stroke SI Engine
Authors: Gowtham R , Hakeem Meeran Bathusha A , Sankara Ganapathy R , Mohanraj K , Venkatasubramanian N
Published: December 2020

A lot of technologies have been introduced to retain the petrol engines which exhibit a lot of drawbacks based on emissions and knocking. Variable compression ratio (VCR) technology is applied in the line of SI engines for a long period to give back the standards. This paper is going to analyze and experiment on a commercially available type of VCR technologies. The investigation can provide a great method of varying the compression ratio that is put forth, practically analyzed, and previewed with a change from the previous paper and taken to an account to restrict the compression ratio of +/-1.5. In this analysis, we use the same technology as commercially used two-stroke engines but the clearance volume is changed and introduces a metallic bung on the burning chamber. We have performed the test by varying the compression ratios to more or less than two from the original compression ratio. At lesser weight conditions, a low compression ratio is maintained throughout the experiment to boost up the turbocharger to get a better amount of volumetric efficiency without any trouble. The engine is tested at various compression ratios for the performance study and emissions from the power source at various load conditions. While adopting this method in commercial, we can achieve a potentially higher fuel economy, more power, lower emission compared to other available technologies in ongoing research.
Modelling of Robotic Single Peg-In-Hole Assembly Using ADAMS/MATLAB Co-simulation
Authors: Nagarajan P , Vigneshwaran S , Yuvaraj K , Mohammed Ismail A , Raghavendra Prabhu S
Published: December 2020

A virtual assembly model of robotic single peg-in-hole assembly environment is developed to determine contact force using ADAMS/MATLAB Co-simulation in this work. The existing dynamic models of the insertion process are incapable of replicating the real assembly scenarios due to its complicated mathematical expressions and handling variety of dynamic parameters. In order to address this problem, a co-simulation model is proposed to study the dynamic behaviour of a planar robot in executing an assembly process. Initially, the physical robotic assembly environment with 3-R planar manipulator is built in Solid Works and it is imported to ADAMS environment for the analysis. A Cartesian trajectory for the end-effector is given as input for executing the assembly process. Since simulation in ADAMS is executed with joint values, inverse kinematic calculations of the manipulator are employed in MATLAB environment to convert the given Cartesian descriptions into their corresponding joint descriptions. Further, the joint values are properly exchanged between these different software environments using co-simulation model to simulate the intended assembly process. Besides, the contact forces at peg end are analysed under defined lateral error condition.
Predicting the Emissive Characteristics of an IC Engine Using DNN
Authors: Pravin M C , Mukilan M , Vishnu Prakash G , Nithish P , Monish Kanna B , Logesh E
Published: December 2020

Biodiesel is the new form of automotive fuel that the world is now concerning and several researches are going on for the production of an efficient form of Bio-Diesel because of the fact that Diesel and Petrol are going to be exhaustible in nearly 60 years. In order to produce an efficient fuel, it is inevitable to calculate the emission characteristics concerning the fuel. This project deals with the efficient and intelligent way of analyzing and calculating the engine emission characteristics of Bio-diesel operated IC engines. A Machine Learning based model using TensorFlow library has been developed using python programming for the calculation of emission characteristics such as Carbon-monoxide (CO) and Carbon-dioxide (CO2) of an IC engine upon injection of Bio-diesel as fuel in different proportions. These investigations and data-sets are considered for a four stroke internal combustion engine. In this Machine Learning model TensorFlow library has been used for the better visualization of the results and error rectification. The results of the developed TensorFlow model are then compared with an existing Fuzzy model for the same application. The results predicted by this model clearly are in good correlation with the actual values which depicts that this method is effective and the total error of the developed model was found to be ±0.02 which is comparatively lower than that of the existing Fuzzy model. Concludingly, the Machine learning model using TensorFlow was found to be the best model for the calculation of engine emission characteristics of Bio-diesel operated IC engines as it offers more visualization tools and better predictive analysis.
Detection of Soft Sensor Fault Using EKF Algorithm for Two Tank Interacting System
Authors: Sneha K. , Vaishnavi P. , Ganesh M. , Jagadeesh C. , Hariharan A.
Published: December 2020

This paper deals with the identification of fault acting in the highly non-linear two-tank interacting system. This two-tank interacting system is reported with a sensor fault that is acting on the system which makes the system to be highly unstable. For detecting the fault, the estimation algorithm is used. Here the Extended Kalman Filter algorithm is used for identifying the sensor fault acting in the system. In the EKF algorithm residual is generated that indicates the presence of the fault. The residual that is generated gives the difference between the actual and the predicted measurement. This residual generation shows the magnitude of fault that is present in the system and also the nature of the fault that is acting in the system. This EKF based detection of fault indicates the occurrence of fault at the instant of time.
Intelligent and Stable Next Generation HetNets with Self-aggregated Framework
Authors: Sethi Anita , Bisht Manoj
Published: December 2020

The malfunctioning of critical infrastructure causes high-quality deterioration, financial effect and loss of life in a town in the present scenario. It is essential to check the cost-effectiveness and reliability of the quality of critical infrastructures in the pandemic situation. Sensitive monitoring of an infrastructure is costly but necessary, in which fault identification and corrective action are needed at service levels to avoid cascading failures with minimal communication latency. With enhanced expense, resource, and process performance, the growing population in smart cities demanded a high living standard, rigorously straining energy, city services, and infrastructure. Intelligent houses, intelligent transport and smart buildings linked with intelligent networks are three pillars of the smart city initiative. In this paper, an improved framework for enhanced Quality of Service with higher performance in a 5G network is presented. A detailed description of reconfigurable intelligent Smart networks and reconfiguration analysis at various layers are also discussed. SDN and NFV, with the help of an intelligent SDN controller, provide the context for managing a multi-objective heterogeneous network. For self-optimization and self-healing, multiple clustering heuristics are useful for managing these networks at the various locations of smart projects.
A prototype of Fixed Wing UAV for delivery of Medical Supplies
Authors: Pavithran R , Lalith V , Naveen C , Sabari S P , Ajay Kumar MST , Hariprasad V
Published: December 2020

A prototype Unmanned Aerial Vehicle (UAV) is designed for the purpose of last mile delivery to supply medicines and vaccines. This work aims to ascertain that UAVs can be employed to decrease transportation times, increased power efficiency, and improved safety for transportation of necessary products. The prototype model is design to deliver 1 kg maximum payload up to 5 km with an endurance time of 30 minutes. The model is fabricated with a wing span of 1.5 m, Aspect ratio 7, and contains NACA 6 series airfoil shape as its cross section. During the transportation of payload, it has to fly beyond the line of sight which requires an autonomous Pixhawk flight controller installed in the model. Autonomous module aids in the safe flight avoiding the obstacles during the operation. To comply with government regulations for flying the model cruises at an altitude of 350 feet. After reaching the desired GPS destination, the payload is delivered to the target customer via parachute. However the model requires a runway length of 200 m for its takeoff and landing operation.
Simulation of Tic-Tac-Toe Game using LabVIEW
Authors: Deepa R , Janani M , Singh Ankita
Published: December 2020

Tic-Tac-Toe game is a two player game, in which a circle (O) or a cross (X) will fill the square block with three rows and three columns. There will be switching between the players in the game where each player will be provided a chance to make their move. If one of the two players have marked the same markers horizontally, vertically or diagonally then that particular player would awarded points. LabVIEW is the platform in which the above game is simulated. Tic Tac Toe is a two-player game which can be played using the LabView software. In this program the select function is used for the player to select the marker and the view feature in the program is to place the marker selected by the player in the desired position of that player. After each player makes their move the software will update and scan while it continues for the conditions of the game. Overall, this tic-tac-toe operates with the features of the programme and can be used without security problems.
Monitoring and Control of Cooler Tank Level Measurement In Gas Cleaning Plant (GCP)
Authors: Rajalakshmi P , Ponni Bala M , Aravind C , Suji Prasad S J
Published: December 2020

The Cooler Tank Level plays a major role in Gas Cleaning Plants (GCP) and it is a very important parameter to be measured and controlled. If the tank level is not maintained in nominal range, the dust particles will accumulate on the Cooler Tank and affect the process. The production of copper metal at Vedanta, Thoothukudi include Blending of various grades of copper concentrates, Smelting and Refining. Sulphur dioxide is generated from during the smelting of copper and is converted to Sulphuric acid as a byproduct. This process involves three steps such as cleaning of sulphur dioxide gas from Furnace, Catalytic conversion of S02 to SO3 and amalgamation of SO3 with sulphuric acid. The conversion process is exothermic, reversible and adiabatic reaction and hence if the temperature increases it destroys the formation of sulphur trioxide. Hence in order to achieve high conversion efficiency, the converter gases need to be cooled. The SO2 gas from smelter contains metallic dust, fume, acid mist, water vapour and other impurities like halides which will contaminate the product. Therefore the gases are to be cooled and cleaned in Gas Cleaning Plant (GCP). Cooler tank used to remove water vapour from the gas and dust settle at the bottom of cooler. Cooler tank level needs to be maintained in order to avoid overflow of water into scrubber which will block the inlet gas. The level of cooler tank is to be continuously monitored and controlled to achieve the optimum results. The limitations of using Differential Pressure Transmitter for level measurement are overcome by ultrasonic based level sensor and automated using Distributed Control System and Human Machine Interface (HMI).
A Review on Influencing Welding Parameters of Super Alloys
Authors: Raja S , Saranya R , SaiYaswanth V , SachinAdithya A , Rohith Kumar M B
Published: December 2020

Manufacturing industries play a vibrant role in economic development and significant growth of a country. Among all different industries, sheet metal industry is irreplaceable in our routine life. Sheet metal applications include in automobiles, aircrafts, computer panels, building roofs etc. Various manufacturing process of sheet metal industry consists of shearing, bending, welding and deep drawing. Welding is one of the vital process in engineering business. Welding is the best operative method of joining similar and dissimilar components together. Choice of influencing process parameters is very much critical in welding for the purpose of obtaining good quality weldments with preferred mechanical properties and enhanced serviceability. This is impossible with single welding method that yields the optimum weld in all conditions. The choice of welding process depends upon the service environment, time, cost, and deposition rate. Superalloy is an alloy having greater mechanical strength and high corrosion resistance in high temperature applications. Superalloys are of, Nickel, Cobalt and Iron built possessing the crystal structure of Face Centered Cubic (FCC) austenitic. Typical examples of super alloys include Inconel, Hastelloy, Waspaloy, Rene alloys, Incoloy. Among these, Hastelloy is a nickel based superalloy containing the major proportion as Nickel 57%, Chromium 15.5% and Molybdenum 16% with the remaining in smaller proportions. Hastelloys are employed by the chemical industries for their Corrosion-Resistant property. The characteristics of Hastelloy include high resistance to localized corrosion in welding and fabrication. Hastelloy are of different grades optimised for specific purpose. Hastelloy alloys of “C-type” alloys are the most versatile. Hastelloy C276 alloy is a nickel alloy engaged in petro chemical and related industries possessing corrosive chemicals. Hastelloy C276 is ductile in nature, suitable for welding, forming and has high resistance to corrosion. Hastelloy C276 alloy is welded by the fusion welding process. The low quantity of carbon existence prevents carbide precipitation to keep resistance to inter granular attack in thermally affected zones. Every industry requires to attain a good quality of weld with great productivity and low processing cost with commanding weld joint.
Predict the Tensile Strength of Friction Welded Steel/ASS304L Dissimilar Joints
Authors: Rajendran C , Suryaprakash E , Sivasankar V , Suryaprakash P , Rohith K
Published: December 2020

Due to their availability and unique features, mild steel and ASS 304 L were used for various applications such as shipbuilding, boiler, aircraft, and automotive industries. This alloy is welded by using method of fusion welding. In addition, the strength of welded joints has touched 60 percent of the strength of base materials. However, it is difficult to maintain quality weld when dissimilar steel is joined. Therefore, the choice of electrode, filler wire and other process parameters like current, voltage, shielding gas, etc. requires proper attention. Solid state joining process, friction welding (FW) process is an ideal process to get sound joint. Three major FW parameters such as rotational speed, friction force, and forging force have been used in this work to optimize FW parameters to maximize strength using statistical methodology such as variance analysis and experimental design methodology. From the results, the joint is welded at a rotational speed of 1000 rpm, forging pressure of 30 MPa and friction pressure of 30 MPa.
Impact of Baffle on Liquid Structure Connection in Fuel Tank Sloshing
Authors: Rohini D , Abinaya R , Lokesharun D , Karthik K , Sovishnuchringth V , Sivaprakash P
Published: December 2020

The current age has a desire to do explore in sloshing because of its intriguing applications with regards to different fields, for example, estimation of surface profile, DIC [Digital Image Correlation] and so on. The specialists have accomplished effective statures in sloshing strategy, yet answer for sloshing is a major test. This is a direct result of its exceptionally nonlinear component. This undertaking is managed the examination of sloshing elements in airplane fuel tank and the impact presenting confounds. This undertaking is managed the examination of sloshing elements in airplane fuel tank and the impact presenting confounds. This additionally provides data for assurance in the powerful area of confounds through the extent of the tank to refine execution also limit disposition of the vehicle. This correlation is finished using outcomes from computational examination of both 2D and 3D.
Numerical and experimental investigation of fully-coupled and uncoupled finite element model for electromagnetic forming of Aluminium Alloy Al 3014
Authors: Khan Z , Khan M , Jaffery S H I , Younas M , Khan A
Published: December 2020

Electromagnetic forming is a high-velocity forming process in which repulsive forces between conducting coil and workpiece are generated by mutual inductance, thus, creating opposite magnetic fields and Lorentz forces on conducting bodies. In such processes, the formability can be enhanced owing to the high-speed deformation of the material. This paper presents a fully-coupled numerical model and experimental study of the deformation behaviour of aluminium alloy (AL3014) using closed die magnetic pulse forming. The current density, magnetic flux density and Lorentz force of 1mm thick sheet were estimated numerically. The effect of deforming sheet on magnetic flux and induction was considered. As a result of which the percentage error in sheet deformation reduced from 10% for the existing uncoupled model to 5% for the fully coupled proposed model.
Teaching Epidemiology Online (Pandemic Edition)
Authors: Banack Hailey R , Lesko Catherine R , Whitcomb Brian C , Kobayashi Lindsay C
Published: December 2020

In response to the threat posed by the coronavirus disease 2019 (COVID-19) pandemic, many universities are encouraging or requiring online instruction. Teaching an epidemiology course online is different in many respects from teaching in person. In this article, we review specific approaches and strategies related to teaching epidemiology online during the pandemic and beyond, including a discussion of options for course format, grading and assessment approaches, pandemic-related contingencies, and the use of technology. Throughout this article we present practical, epidemiology-specific teaching examples. Moreover, we also examine 1) how the lessons learned about the practice of epidemiology during the pandemic can be integrated into the didactic content of epidemiology training programs and 2) whether epidemiologic pedagogy and teaching strategies should change in the long term, beyond the COVID-19 pandemic. The pandemic has served to heighten our awareness of concerns related to student health and safety, as well as issues of accessibility, equity, and inclusion. Our goal is to present a practical overview connecting pandemic-era online teaching with thoughts about the future of epidemiologic instruction.
The ERA-EDTA Registry Annual Report 2018: a summary
Authors: Kramer Anneke , Boenink Rianne , Stel Vianda S , Santiuste de Pablos Carmen , Tomović Filip , Golan Eliezer , Kerschbaum Julia , Seyahi Nurhan , Ioanou Kyriakos , Beltrán Palma , Zurriaga Oscar , Magaz Ángela , Slon Roblero María F , Gjorgjievski Nikola , Garneata Liliana , Arribas Federico , Galvão Ana A , Bell Samira , Ots-Rosenberg Mai , Muñoz-Terol José M , Winzeler Rebecca , Hommel Kristine , Åsberg Anders , Spustova Viera , Palencia García María Ángeles , Vazelov Evgueniy , Finne Patrik , ten Dam Marc A G J , Lopot František , Trujillo-Alemán Sara , Lassalle Mathilde , Kolesnyk Mykola O , Santhakumaran Shalini , Idrizi Alma , Andrusev Anton , Comas Farnés Jordi , Komissarov Kirill , Resić Halima , Palsson Runolfur , Kuzema Viktorija , Garcia Bazaga Maria Angeles , Ziginskiene Edita , Stendahl Maria , Bonthuis Marjolein , Massy Ziad A , Jager Kitty J
Published: December 2020

Background

The European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) Registry collects data on kidney replacement therapy (KRT) via national and regional renal registries in Europe and countries bordering the Mediterranean Sea. This article summarizes the 2018 ERA-EDTA Registry Annual Report, and describes the epidemiology of KRT for kidney failure in 34 countries.

Methods

Individual patient data on patients undergoing KRT in 2018 were provided by 34 national or regional renal registries and aggregated data by 17 registries. The incidence and prevalence of KRT, the kidney transplantation activity and the survival probabilities of these patients were calculated.

Results

In 2018, the ERA-EDTA Registry covered a general population of 636 million people. Overall, the incidence of KRT for kidney failure was 129 per million population (p.m.p.), 62% of patients were men, 51% were ≥65 years of age and 20% had diabetes mellitus as cause of kidney failure. Treatment modality at the onset of KRT was haemodialysis (HD) for 84%, peritoneal dialysis (PD) for 11% and pre-emptive kidney transplantation for 5% of patients. On 31 December 2018, the prevalence of KRT was 897 p.m.p., with 57% of patients on HD, 5% on PD and 38% living with a kidney transplant. The transplant rate in 2018 was 35 p.m.p.: 68% received a kidney from a deceased donor, 30% from a living donor and for 2% the donor source was unknown. For patients commencing dialysis during 2009–13, the unadjusted 5-year survival probability was 42.6%. For patients receiving a kidney transplant within this period, the unadjusted 5-year survival probability was 86.6% for recipients of deceased donor grafts and 93.9% for recipients of living donor grafts.
Estimated Impacts of Emerald Ash Borer on Ash Timber Supply in Texas, USA
Authors: VanderSchaaf Curtis L , McConnell T Eric , Tanger Shaun M
Published: December 2020

We estimated annual timber growth, removals, and mortalities under various scenarios of the spread of emerald ash borer (Agrilus planipennis Fairmaire; EAB) within Texas. Future annual ash EAB-induced mortalities were simulated to follow either a normal or beta distribution over 25, 50, or 75 years, with five percent of the original inventory remaining at the conclusion of each projection. Discounted present values of future ash growth, harvests, mortalities, salvage, and beginning and ending annual inventories were calculated, and economic impacts to timber receipts were determined from average real prices. The present net effects of timber product output, mortalities, and salvage resulted in benefits ranging from lows of (delivered/stumpage) $37.6/$12.8 million over 25 years when assuming a normal distribution to highs of $247.8/$97.2 million over 75 years under a beta distribution. Salvage intensity exceeded mortality accumulation by a factor of at least 2.00. Regardless of length chosen, mortality that skewed toward later years led to lower discounted volumes and less value lost to EAB. Results were sensitive to discount rate selection (constant, increasing, distributional) with the constant and increasing rates having the most similar results. Longer time horizons led to far smaller losses of overall economic returns allowing more typical harvest management despite EAB.
Spontaneous trans-anal evisceration of small bowel: a case report
Authors: Lasheen Omar
Published: December 2020

Trans-anal evisceration of small bowel is a rare surgical presentation. The first case ever reported was in 1827. The exact mechanism of how this develops remains poorly understood.

A 70-year-old lady presented with multiple small bowel loops eviscerated through the anus. Abdominal exploration was done. The bowel was carefully reduced. There was a longitudinal defect on the anterior wall of the rectum at the recto-sigmoid junction and a large mesenteric defect and thrombosed mesenteric vessels compromising blood supply to part of the bowel. Resection of 50 cm of ileum, jejunostomy and a mucous fistula were performed.

Several preexisting pathologies such as rectal prolapse can result in thinning out of the wall of the rectum. That combined with increased intra-abdominal pressure can explain trans-anal evisceration of the bowel. This condition is managed by surgical intervention. The operation will depend on the extent of viability, contamination and patient’s general condition.
Expectant management of traumatic intussusception
Authors: Swift Kate , Kulendran Krish
Published: December 2020

Mesenteric injuries and traumatic intussusception are rare surgical presentations following blunt trauma, with potentially life-threatening complications. Diagnosis relies on high clinical suspicion and judicious use of imaging in trauma. Literature suggests that these presentations should always be managed operatively for diagnostic clarity, manual reduction of intussusception and, if indicated, resection of involvement segment. However, in the setting of a stable patient with a reassuring examination, this may not be necessary. This case presents the successful expectant management of a traumatic mesenteric haematoma acting as a pathologic lead point for small bowel intussusception.
Improved Antibiotic Prescribing Practices for Respiratory Infections Through Use of Computerized Order Sets and Educational Sessions in Pediatric Clinics
Authors: Zahlanie Yorgo , Mang Norman S , Lin Kevin , Hynan Linda S , Prokesch Bonnie C
Published: December 2020

Background

Computerized clinical decision support systems (CDSS) have shown promising effectiveness in improving outpatient antibiotic prescribing.

Methods

We developed an intervention in the form of EPIC (Verona, WI, USA) order sets comprised of outpatient treatment pathways for 3 pediatric bacterial acute respiratory infections (ARIs) coupled with educational sessions. Four pediatric clinics were randomized into intervention and control arms over pre- and postimplementation study periods. In the intervention clinics, education was provided in between the 2 study periods and EPIC order sets became available at the beginning of the postimplementation period. The primary end point was the percentage of first-line antibiotic prescribing, and the secondary end points included antibiotic duration and antibiotic prescription modification within 14 days.

Results

A total of 2690 antibiotic prescriptions were included. During the pre-implementation phase, there was no difference in first-line antibiotic prescribing (74.9% vs 77.7%; P = .211) or antibiotic duration (9.69 ± 0.96 days vs 9.63 ± 1.07 days; P > .999) between the study arms. Following implementation, the intervention clinics had a higher percentage of first-line antibiotic prescribing (83.1% vs 77.7%; P = .024) and shorter antibiotic duration (9.28 ± 1.56 days vs 9.79 ± 0.75 days; P < .001) compared with the control clinics. The percentage of modified antibiotics was small in all clinics (1.1%–1.6%) and did not differ before and after the intervention (for all statistical comparisons, P ≤ .354).

Conclusions

A computerized CDSS involving treatment pathways in the form of order sets coupled with educational sessions was associated with a higher percentage of first-line antibiotic prescribing and shorter antibiotic duration for the outpatient treatment of pediatric bacterial ARIs.
Propensity-Matched Cost of Clostridioides difficile Infection Overdiagnosis
Authors: Madden Gregory R , Smith David C , Poulter Melinda D , Sifri Costi D
Published: December 2020

Background

Clostridioides difficile is the leading health care–associated pathogen, but clinicians lack a test that can reliably differentiate colonization from infection. Health care costs attributed to C. difficile are substantial, but the economic burden associated with C. difficile false positives is poorly understood.

Methods

A propensity score matching model for cost per hospitalization was developed to estimate the costs of both true infection and false positives. Predictors of C. difficile positivity used to estimate the propensity score were age, Charlson comorbidity index, white cell count, and creatinine. We used polymerase chain reaction (PCR) cycle threshold to identify and compare 3 groups: (1) true infection, (2) C. difficile colonization, and (3) C. difficile negative.

Results

A positive test was associated with $3018 higher unadjusted hospital cost. Among the 3 comparisons made with propensity-matched negative controls (all positives [+$179; P = .934], true positives [–$1892; P = .100], and colonized positives), only colonization was associated with significantly increased (+$3418; P = .012) cost. Differences in lengths of stay (all positives 0 days, P = .126; true 0 days, P = .919; colonized 1 day, P = .019) appeared to underly cost differences.

Conclusions

In the first C. difficile cost analysis to utilize PCR cycle threshold to differentiate colonization, we found high propensity-matched hospital costs associated with colonized but not true positives. This unexpected finding may be due to misdiagnosis of non–C. difficile diarrhea or unadjusted factors associated with colonization.
Low but Increasing Prevalence of Reduced Beta-lactam Susceptibility Among Invasive Group B Streptococcal Isolates, US Population-Based Surveillance, 1998–2018
Authors: Kobayashi Miwako , McGee Lesley , Chochua Sopio , Apostol Mirasol , Alden Nisha B , Farley Monica M , Harrison Lee H , Lynfield Ruth , Vagnone Paula Snippes , Smelser Chad , Muse Alison , Thomas Ann R , Deng Li , Metcalf Benjamin J , Beall Bernard W , Schrag Stephanie J
Published: December 2020

Background

Invasive group B Streptococcus (iGBS) isolates with mutations in the pbp2x gene that encodes penicillin binding protein 2x can have reduced beta-lactam susceptibility (RBLS) when susceptible by Clinical and Laboratory Standards Institute (CLSI) criteria. We assessed the emergence and characteristics of RBLS strains in US iGBS isolates.

Methods

We analyzed iGBS isolates from 8 multistate population-based surveillance sites from 1998 to 2018. During 1998–2014, phenotypic antimicrobial susceptibility was determined by broth microdilution; criteria for 6 antibiotics were used to identify RBLS, followed by whole-genome sequencing (WGS). WGS for all isolates was added in 2015; we used phenotypic and genotypic results of >2000 isolates to validate phenotypic RBLS criteria and genotypic predictions. Since 2016, WGS has been used to screen for RBLS with broth microdilution confirmation of predicted RBLS isolates.

Results

Of 28 269 iGBS isolates, 28 (0.1%) were nonsusceptible by CLSI criteria; 137 (0.5%) met RBLS criteria. RBLS isolates were detected in all Active Bacterial Core surveillance sites. The RBLS proportion increased, especially since 2013 (odds ratio, 1.17; 95% CI, 1.03–1.32); the proportion that were nonsusceptible remained stable.

Conclusions

The RBSL proportion was low but increasing among US iGBS isolates. Ongoing monitoring is needed to detect emerging threats to prevention and treatment of GBS infections.
Portable Magnetic Resonance Imaging for ICU Patients
Authors: Turpin Justin , Unadkat Prashin , Thomas Justin , Kleiner Nick , Khazanehdari Shahab , Wanchoo Sheshali , Samuel Kenia , Moclair Betsy O. , Black Karen , Dehdashti Amir R. , Narayan Raj K. , Temes Richard , Schulder Michael
Published: December 2020

Objectives:

Patients in ICUs often require neuroimaging to rule out a wide variety of intracranial problems. CT may be available in the ICU itself, but MRI has greater sensitivity for many conditions that affect the brain. However, transporting patients who are on ventilators and other life-sustaining devices is a labor-intensive process and involves placing the patient at risk for adverse events. This is a report of portable MRI in a clinical setting.

Design:

This is a prospective, nonrandomized, observational study at one institution, utilizing a 0.064-T, self-shielding, portable MRI in ventilated patients in an ICU setting.

Setting:

Academic medical center.

Patients:

Nineteen patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Patients selected for imaging had any of the following: 1) unexplained encephalopathy or coma, 2) seizures, 3) focal neurologic deficit, or 4) abnormal head CT. Imaging was performed in each patient’s ICU room with a portable, self-shielding, 0.064-T MRI.

Interventions:

None.

Measurements and Main Results:

Among 19 patients, 20 MRI scans in seven ICUs were acquired between April 13, 2020, and April 23, 2020. No adverse events to patients or staff from MRI acquisition were reported. In 12 patients, abnormal findings were seen, which included increased fluid attenuated inversion recovery signal (n = 12), hemorrhage (n = 3), and diffusion-weighted imaging positivity (n =3). Imaging led to changes in clinical management in five patients.

Conclusions:

In this case series of patients, use of portable MRI has been found to be safe, feasible, and led to changes in clinical management based on imaging results. However, future studies comparing results with other imaging modalities are required to understand fully the extent of its clinical utility.
Impact of Sarcopenia, BMI, and Inflammatory Biomarkers on Survival in Advanced Hepatocellular Carcinoma Treated With Anti-PD-1 Antibody
Authors: Akce Mehmet , Liu Yuan , Zakka Katerina , Martini Dylan J. , Draper Amber , Alese Olatunji B. , Shaib Walid L. , Wu Christina , Wedd Joel P. , Sellers Marty T. , Bilen Mehmet A. , El-Rayes Bassel F.
Published: December 2020

Background:

Sarcopenia and inflammation are independently associated with worse survival in cancer patients. This study aims to determine the impact of sarcopenia, body mass index (BMI), and inflammatory biomarkers on survival in advanced hepatocellular carcinoma (HCC) patients treated with anti-PD-1 antibody-based immunotherapy.

Methods:

A retrospective review of advanced HCC patients treated with immunotherapy at Winship Cancer Institute between 2015 and 2019 was performed. Baseline computed tomography and magnetic resonance images were collected at mid-L3 level, assessed for skeletal muscle density using SliceOmatic (TomoVision, version 5.0) and converted to skeletal muscle index (SMI) by dividing it by height (m2). Sex-specific sarcopenia was defined by the median value of SMI. The optimal cut for continuous inflammation biomarker was determined by bias-adjusted log-rank test. Overall survival (OS) was set as primary outcome and Cox proportional hazard model was used for association with survival.

Results:

A total of 57 patients were included; 77.2% male, 52.6% Caucasian, 58.5% Eastern Cooperative Oncology Group performance status 0-1, 80.7% Child Pugh A. Treatment was second line and beyond in 71.9% of patients. The median follow-up time was 6 months. Sarcopenia cut-off for males and females was SMI of 43 and 39, respectively. 49.1% of patients had sarcopenia. Median OS was 5 versus 14.3 months in sarcopenic versus nonsarcopenic patients (Log-rank P=0.054). Median OS was 5 and 17.5 months in patients with BMI <25 and BMI ≥25, respectively (Log-rank P=0.034). Median OS was 3.6 and 14.3 months for patients with neutrophil-to-lymphocyte ratio (NLR) ≥5.15 versus NLR <5.15 (Log-rank P<0.001). In multivariable Cox regression model, higher baseline NLR was associated with worse OS (hazard ratio [HR]: 4.17, 95% confidence interval [CI]: 1.52-11.39, P=0.005). Sex-specific sarcopenia showed a trend of worse OS (HR: 1.71, 95% CI: 0.73-4.00, P=0.215) but was not statistically significant. BMI<25 was associated with worse OS (HR: 2.28, 95% CI: 0.92-5.65, P=0.076). In the association with progression free survival, neither baseline BMI nor sex-specific sarcopenia showed statistical significance.

Conclusion:

After controlling for baseline Child Pugh score and NLR, sex-specific sarcopenia does not predict OS. Baseline BMI and NLR together may predict OS in advanced HCC patients treated with anti-PD-1 antibody.