bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of using repellent products for infants
Authors:   Scientific Research Disinfectology Institute of Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, Vinogradova Arina Igorevna
Published: March 2021

Flying blood-sucking insects widely distributed on the territory of the Russian Federation. Mosquitoes pose a high epidemiological hazard being vectors of many infectious diseases, for example, West Nile fever. Children are one the most vulnerable category of population when attacked by flying blood-sucking insects. Toxicity and hazard of repellent products in different formulations based on 10 % ethyl butylacetylaminopropionate were studied. In connection with the need of the population to protect their children from mosquito bites, it is relevant to evaluate repellent products intended for use on children under one year old. The harmful effects were revealed in the study of the skin-resorptive action of repellent products in doses exceeding the consumption rate by 30 and 50 times, manifested by a change in the state of the nervous system, liver function and a decrease in red blood parameters.
Contactless technologies in the system of antiepidemic measures as a method of control of socially significant infection agents
Authors:   State Research Center of Applied Microbiology and Biotechnology of Rospotrebnadzor, Potapov Vasiliy Dmitrievich , Tyurin Evgeniy Aleksandrovich ,   State Research Center of Applied Microbiology and Biotechnology of Rospotrebnadzor, Kuzin Viktor Vladimirovich ,   State Research Center of Applied Microbiology and Biotechnology of Rospotrebnadzor, Kolupaeva Nadezhda Vyacheslavovna ,   State Research Center of Applied Microbiology and Biotechnology of Rospotrebnadzor, Ganina Elena Anatolevna ,   State Research Center of Applied Microbiology and Biotechnology of Rospotrebnadzor, Grishchenko Natalya Semenovna ,   State Research Center of Applied Microbiology and Biotechnology of Rospotrebnadzor, Rudnitskaya Tatyana Ivanovna ,   State Research Center of Applied Microbiology and Biotechnology of Rospotrebnadzor
Published: March 2021

Efficiency of application in aerosol form of various disinfectant materials with respect to various types of hospital-acquired infection agents, comparison of efficiency of traditional methods of wiping and irrigation, method of aerosol treatment with disinfectants of different groups of active substances with UV treatment for evaluation of possible spheres of application of each technology was studied.
Análisis de las características Corriente-Voltaje (I-V) en Barreras Schottky de Silicio (p)-Oro
Authors: Ortiz-Vázquez Jonathan , Ortiz-Simón José Luis , Vázquez-Méndez Gerardo , Gustavo Emilio Gustavo Emilio
Published: March 2021

The bandwidth, low cost, great storage capacity and performance are characteristics of the random Access Memories (RAM).Some kinds of RAM include ferro-random access memory (FRAM) and magnetoresistive random access memory (MRAM), the latter being of great interest to the scientific community since storage is achieved via magnetic orientation rather than electric orientation. In this paper, we analyze the effect of the application of an external magnetic field on the current-voltage (I-V) characteristics of Schottky barriers made of silicon-gold, to show the effects of magnetoresistance in dispositive semiconductors suited for use as memory storage.
El tiple, "instrumento musical acompañante"
Authors:   , Urrego Arias Hugo Alonso
Published: March 2021

El objetivo de esta investigación es analizar y reconstruir, a partir de un recorrido por fuentes principalmente visuales que marcan la aparición y el despliegue de un instrumento musical colombiano llamado tiple, la tensión entre memoria popular e historia oficial en el proceso de formación estatal nacional en Colombia entre 1886 y 1910. Son diversos los escenarios que aquí son descritos desde la historia gráfica de Colombia entre los siglos XIX y XX. Dicho ejercicio descriptivo hace visibles numerosas manifestaciones, desarrollos y conflictos que contribuyeron silenciosa pero inobjetable a la constitución de “lo nacional” como imaginario de un país sumido en complejas diferencias y contradicciones. El abordaje de fuentes primarias referidas al tiple colombiano en representaciones iconográficas, pictóricas y fotográficas de época es luego cruzado con otras documentos literarios, políticos o escritos en la prensa del momento, proponiendo con esto una lectura que confronte y obligue a la revisión algunas teorías y textos sobre la ideología de formación de un Estado nación colombiano en general, y sobre la aparición, desarrollo y cambio técnico y morfológico del tiple en Especial. La iconografía presentada permite observar no solamente los usos del instrumento y los contextos en los cuales sonaba, sino también el modo como los tipos, costumbres y escenarios para su puesta en escena reflejaban la tensión constante entre lo oral popular y lo oficial escrito, obligando a establecer pares coyunturales no muy tenidos en cuenta en la historiografía colombiana, como el desplazamiento del campo a la ciudad, la ambigüedad ideológica común a los partidos liberal y conservador, la resistencia del artesanado y su posterior y obligado paso a integrar la creciente masa obrera de principios de siglo XX en el país, empujados por un proceso de reproductibilidad técnica que afectaría sin excepción el intercambio económico y las variables artísticas y culturales populares de intercambio entre la población. Dado el caso, y aunque no sea un asunto que toque directamente con la historia ‘reciente’, el esfuerzo puesto en esta investigación ahonda en la relación entre historia y memoria y en las posibilidades que esta tiene cuando es aplicada a procesos de largo aliento, específicamente a la constitución del relato oficial de la nación colombiana, potenciándolo desde un lugar poco visitado, el de la memoria popular.
Hydrodynamic Processes of the Irtysh River Mouth Areas
Authors:   Tkachev B.P.
Published: March 2021

Issues concerning the Irtysh River and the Ob River interaction and the backwater processes during the Irtysh River mouth areas depressions formation (their origin is still disputable) have been discussed. The backwaters hydro/climatic and geo/morphologic factors have been analyzed; a hydrodynamic hypothesis to explain river moth areas backwaters has been suggested.
Implementation of the State Policy in the Field of Water Resources Use and Protection in the Trans-Baikal Region in the Post-Soviet Period
Authors:   Zaslonovsky V.N., Sokolov A.V., Rudenko I.I., Bosov M.A.
Published: March 2021

Approaches and concrete results of realization of a state policy in the field of use and protection of water resources at the regional level with of the Trans-Baikal region during the Post-Soviet period as a study case are presented (since the late 90s to the present).
Specific Features of the Northern Europe River Channel Systems Management (the Vistula and the Severnaya Dvina as examples)
Authors:   Chalov S.R., Habel M., Golovlev P.P., Shacen D., Letnikova V.N., Chalova A.S., Zavadskiy A.S.
Published: March 2021

Historic transformation of the two major rivers of the Northern Europe, namely the Vistula (Poland) and the Severnaya Dvina (Russian Federation) has been considered. These rivers channel regime anthropogenic factors that determine distinctions in bed transformations characteristic forms, distribution of the bed morphological/dynamic types, and deposition runoffs have been compared. Special features of channel deformations within the city boundaries have been analyzed with Velikiy Ustyug on the Severnaya Dvina and Torun on the Vistula as examples. The role of anthropogenic bed transformation in the hazardous hydrological phenomena formation has been analyzed.
Methodical Approaches to Determination of the Runoff Acceptable Irretrievable Withdrawal from Underexplored and Unexplored Rivers and Small Rivers
Authors:   Dubinina V.G., Nikitina O.I., Markov M.L.
Published: March 2021

If the permissible impact of economic and other activities on a water body is exceeded, an irreversible degradation of the ecosystem may occur. Irretrievable water withdrawal is deemed significant human impact on water bodies. The establishment of a critical water limit for the ecosystem’s functioning and organisms’ reproduction is based on the water withdrawal limits’ assessment. The article suggests methodological approaches to defining acceptable irreversible withdrawal of surface water runoff for underexplored and unexplored rivers. It also includes a review of special features of water withdrawal from small rivers.
Development of an Information System for Flooding Zones Building on the Basis of Known Levels of Water in a Waterway
Authors:   Makeyev A.V., Malyshev I.I.
Published: March 2021

An information system of the flooding zones building on the basis of known water levels in a waterway is presented. Desktop- and Web-versions of the developed system are described. The principle of creation of hydrological correct DEM of a flood plain of the Irtysh River and the territory adjoining to it near Khanty-Mansiysk as one of bases for the zones of flooding building is described.
SHOPEE APPLICATION BRAND AWARENESS IN AFFECTING THE PURCHASE DESIRE
Authors: Azizan Norreena Amira , Abdul Hamid Zauridah
Published: March 2021

Shopee is a leading e-commerce platform in Southeast Asia and Taiwan (Haryani Ngah, 2017). It is a platform that provides online buying and selling services that facilitate interaction between sellers and buyers. In addition, Shopee provides secure payment support and strong logistics options. According to Keller (2013), brand awareness is by enhancing brand habits through repeated exposure, i.e. in general it is effective for brand recognition and brand remembering. This means the more consumers have the experience of seeing the brand, listening, or thinking about it, the more likely consumers are to list the brand in their mind. According to Wu, Yeh, and Hsiao (2011), purchase intentions indicate the possibility that consumers will plan or are willing to buy certain products or services in the future. An increase in purchasing intentions reflects an increase in purchasing opportunities. This paper will discuss the findings of a study on Shopee brand awareness and the intention to purchase. There are two specific objectives namely the first; to identify the relationship between remembering the Shopee brand and the intention to purchase at Shopee, and second; to identify the relationship between Shopee brand recognition and intention to purchase at Shopee. This study uses quantitative methods. Questionnaires are distributed online to university students throughout Malaysia. A total of 152 respondents answered the questionnaire. The results of this study found that brand awareness that is able to remember and identify the Shopee brand has a relationship with the intention to buy at Shopee.
SIZE, AGE AND LEVERAGE OF NIGERIA QUOTED OIL AND GAS CORPORATIONS
Authors: Yahaya Onipe Adabenege , Tijjani Bilyaminu
Published: March 2021

Firm size and age influence firm-level leverage. The extent of such influence on the oil and gas industry is not known in Nigeria. There are very few empirical studies that interrogate the effects of firm size and listing age on leverage in Nigeria. This study examines the impacts of firm size and listing age on firm-level financial leverage of listed oil and gas companies in Nigeria. It was non-experimental research and correlational in nature. Data were extracted from annuals and accounts of 8 firms over a period of 13 years (2007-2019) and subjected to descriptive statistics (number of observations, mean, standard deviations, mean, minimum and maximum means) and inferential statistics (multiple regression analysis). The findings show that firm size has a negative and significant impact on firm-level financial leverage. Firm age has a positive and significant effect on firm-level leverage. In this paper, we contribute to the literature by examining the presence and direction of firm size and listing age to financial leverage user data from listed oil and gas firms in Nigeria. Our study is the first to address the adverse implications of Modeling with firm size and listing age on firm-level financial leverage.
Al-Wakalah and Customers’ Preferences toward It
Authors: Annuar Hairul Azlan
Published: March 2021

The agency system has been the main distribution channel for insurers. However, Syarikat Takaful Malaysia Berhad (STMB) does not implement it, while Takaful Nasional Sendirian Berhad (TNSB) does. This has a lot to do with juristic opinions (ikhtilaf) on whether a takaful company (mudarib) can use part of the participants’ capital (rabb al-mal) to pay for management expenses. An exploratory survey was undertaken to ascertain the respondents’ perception on the importance of agents. My study showed that customers prefer the agency system (al-wakalah) and that this system can generate greater benefits (manfa`at) to both parties.
Theoretical background of estimation methodology for intellectual property objects investment attractiveness
Authors: Reva O. M. , Borsuk S. P. , Zasanska S. V. , Yarotskyi S. V.
Published: March 2021

Technology transfer efficiency directly depends on the rate of intellectual property objects attractiveness. These objects involved in this process are selected by the technology user. Investment attractiveness of these objects is the only one that possess emergence property. It allows to compare different objects via same criteria. Theoretical groundings of investment attractiveness integral estimate are developed in this proceeding. The methodology is based on system analysis and decision-making theory. Namely it includes single-step decision-making task with vector efficiency index. Intellectual property objects estimation with indexes is taking into account. It is proven that experts’ individual preferences systems on the defined set of criteria determine experts’ “tastes”. They are considered as pattern masks for correspondent proper conclusion. Statistically agreed group preferences system demonstrates experts’ generalized opinion and should be used as a base for final conclusion about efficiency of intellectual property estimation indexes significance. Expression rate of these indexes has qualitative linguistic type. It is the same as for their ranks in the preferences systems. Thus they might be subjected to defuzzification procedure by significance coefficients application. This task is simply completed with priority arrangement method implementation. Multiplicative approach to the partial efficiency significance estimates aggregation is described. It provides integral estimate that characterizes single efficiency index and allows further indexes aggregation into single parameter. It determines attractiveness of intellectual property object and supports avoidance of mistakes of I and II type. Integral innovative intellectual property object attractiveness estimates are subjected to the normal distribution law. As an example the criteria of fuzzification implementation for multiple estimates are developed. This provides qualitative-quantitative research of considered objects.
Evaluation of the economic impact of electricity prices change (Azerbaijan case)
Authors: Mammadov Fariz
Published: March 2021

This paper has examined the impact of electricity tariff changes to other economic sectors, as well as to potential changes of price levels in the overall economy. In this regard, the authors have applied the Inter-Industry Balance Model and its modification, i.e. Equilibrium Price Multiplier Model. The authors have also empirically built the inter-industry balance and equilibrium price models for the case of Azerbaijan’s economy, and conducted analysis and assessments for this case. The inter-industry balance tables of production and distribution of products and services, officially published by the State Statistical Committee of the Republic of Azerbaijan, were taken as the primary database for this study. It should be noted that the inter-industry balance model for Azerbaijan was built based on 96 sectors of the economy. The model was used to assess the economic impact of electricity price changes in the national economy. Finally, simulations relevant to 10, 20 and 30 percent increase of electricity prices were conducted and potential impacts to Azerbaijan’s economy were assessed. The obtained results were analyzed and summarized.
Forecasting research on priority directions to achieve sdg № 14 “Conservation and rational use of oceans, seafoods and seafood”
Authors: Pisarenko T. V. , Kvasha T. K. , Paladchenko O. F. , Molchanova I. V.
Published: March 2021

The article is devoted to the results of forecasting research to identify priority areas of research and technology in the field of marine conservation to achieve the Sustainable Development Goal (SDG) No. 14 “Conservation and sustainable use of oceans, seas and marine resources for sustainable development”. The research was performed in terms of national objectives of this goal in the following stages: 1) survey of experts from scientific organizations and institutions of higher education on research and technology that can offer domestic science, and which are necessary for the implementation of the tasks of SDG No. 14; 2) survey of expert practitioners on the research and technologies proposed at the first stage, which are needed by the real sector; 3) determining the competitiveness of the proposed research/technology based on bibliometric/ patent analysis. The generalized estimation of all offered directions of scientific researches and technologies on these stages and their clustering according to the received estimation is carried out. According to the results of the work of 13 proposals on the national tasks of the SDG No. 14 priority technologies are identified: integrated assessment of the ecological status of natural ecosystems of the sea on the basis of field research and methods of remote sensing of the earth; express water toxicity indicator; ecological management of coastal-marine waters of estuaries and estuaries in the conditions of development of nature protection activity; adapted for Ukraine international methods for determining the number of fish and estimating the total allowable catches in the Black and Azov Seas; new approaches to managing the use of aquatic biological resources of the Black and Azov Seas aimed at sustainable use of resources.
Scientometric and patent researchof technological directions in the field of protection and restoration of land ecosystems using “Web of science” and “Derwent innovation” platforms
Authors: Berezniak N. V. , Shabranska N. I.
Published: March 2021

The results of scientometric and patent research aime date stablishing the most promising technological trends for making forecasts for 2021–2030 are described. The study is focused on the achievement of Ukraine’s Sustainable Development Goal 15 “Protection and restoration of terrestrial ecosystems”. There search was conducted using the international platforms “Web of Science” (WoS) and “Derwent Innovation”. The period under study is 2011–2019. The results of a scientometric analysis of world and domestic publication activity, as well as the dynamics of citations for a selected array of publications are presented. The publication activity of the countries of the world and Ukraine, as well as of world and domestic companies, institutions, higher educational institutions, carrying out scientific and technical activities, has been established. The analysis of the dynamics of citations and determination of the growth rate of the number of citations (2019/2015, %) by key words / technological areas, which belong to the global technological trends in the field of protection and restoration of terrestrial ecosystems, were carried out. The top-10 technological are as that are the most promising for predictive research have been identified. The results of the analysis of the dynamics and rates of patenting in the world and in Ukraine in this area are presented. The analysis was carried out on the basis of the codes of the International Patent Classification using the international data base “Derwent Innovation”. The patent activity of the main countries of the world and Ukraine, as well as leading world and domestic patent holders, has been established. The patent research was carried out on keywords / technology areas that relate to global technology trends in the named area. The analysis of the dynamics and rates of patenting (2019/2015, %) was carried out. A selection of technological areas with a high rate of patent activity and placement of landscape maps on blue and green zones was carried out. To conduct predictive studies, the most promising, promising and mid-promising technological directions in the field of protection and restoration of terrestrial ecosystems have been identified.
Trabalhando tópicos da geometria com o auxílio do Geoplano: uma experiência com alunos do sexto ano do Ensino Fundamental
Authors: Freire Fernando Oliveira , Oliveira Marcelo Nascimento de Morais , Cavalcante Maria da Paz , Cavalcante Neto Valentim Alves
Published: March 2021

O ensino de Matemática vem passando por mudanças significativas. Métodos tradicionais, antes aceitos, baseados na mera transmissão acrítica de conteúdos por meio de exercícios repetitivos e memorização de fórmulas, vêm sendo questionados em virtude de sua baixa contribuição para o desenvolvimento da aprendizagem do educando. Nessa esteira, o presente artigo tem como objetivo abordar o Geoplano como recurso didático no estudo de tópicos da geometria e analisar a desenvoltura dos alunos de uma turma de 6° ano do Ensino Fundamental na aprendizagem dessa temática com o auxílio desse recurso. Na realização desse estudo de natureza qualitativa, utilizou-se da pesquisa-ação colaborativa considerando uma experiência vivenciada em uma turma participante. Os resultados revelam que houve avanços nos níveis de aprendizagem dos alunos no que se refere aos conceitos geométricos estudados. Constatou-se, ainda, o envolvimento dos educandos nas aulas, sendo possível perceber as potencialidades de aplicação do Geoplano como um recurso didático, principalmente no ensino de figuras planas, áreas, perímetro, semelhanças das figuras planas, ponto, reta e plano.
Vapor–liquid–solid growth of silicon nanowires from surface nanoholes formed with metal-assisted chemical etching
Authors: Uesugi Akio , Horita Taiju , Sugano Koji , Isono Yoshitada
Published: March 2021

The influence of shallow surface nanoholes on the growth direction of silicon nanowires (SiNWs) with the vapor–liquid–solid (VLS) process was studied in order to realize a single-step way to promote integration of high-density SiNWs along a specific direction. Shallow surface nanoholes were formed by the short-time metal-assisted chemical etching (MACE) process with catalytic Au nanoparticles of 60 nm also used for the VLS process, in order to shape nanoholes with a similar diameter to the nanoparticles. With an increase in MACE processing time to 5 min, the ratio of perpendicularly grown SiNWs to the SiNWs that appeared on the (111) silicon surface significantly increased in the initial growth phase, reaching higher than 80%. This ratio was more than 3 times higher than without the MACE process. On the other hand, the excess processing time brought about a decrease of the SiNWs detected. This result indicated that the formation of surface nanoholes with an appropriate depth could be an effective way of controlling SiNW growth direction.
Impact of Ketamine on Pain Management in
Cesarean Section: A Systematic Review and
Meta-Analysis
Authors: Xu Zifeng
Published: March 2021

Background: The pain control effect of ketamine versus control in women during cesarean
operation is not well determined.
Objectives: The present meta-analysis aimed to evaluate the clinical efficacy of ketamine versus
control in cesarean section anesthesia for reducing the postoperative pain and analgesia.
Study Design: We used meta-analysis to address this concern.
Setting: Meta-analysis-based study.
Methods: The databases PubMed, Embase, and the Cochrane Library were systematically
searched to identify the relevant randomized controlled trials (RCTs) of ketamine versus
control in controlling pain after cesarean section from inception to August 2018. Based on
the Cochrane Handbook, the combined analysis was performed using Revman 5.3 software.
Results: A total of 20 RCTs with 1,737 patients who underwent cesarean section were
included. Meta-analysis showed that the pain score in the ketamine group was less than that of
the control group (mean difference [MD], –1.10; 95% confidence interval [CI], –1.61, –0.59; P <
0.0001). Application of ketamine during cesarean section also resulted in decreased consumption
of morphine when compared with the control group (MD, –6.11 mg; 95% CI, –9.93, –2.29; P =
0.002). In addition, the first time required for analgesia was significantly longer in the ketamine
group than that of the control group (MD, 72.48 minutes; 95% CI, 50.85, 94.11; P < 0.00001).
Limitations: Limited patients were included with moderate strength.
Conclusions: Ketamine supplementation during cesarean section reduces pain and morphine
consumption and prolongs the postoperative analgesia.
Key words: Ketamine, cesarean section, randomized controlled trials, meta-analysis
Comparisons of Monopolar Lesion Volumes with
Hypertonic Saline Solution in Radiofrequency
Ablation: A Randomized, Double-Blind, Ex Vivo
Study
Authors: Paul Christopher
Published: March 2021

Background: Chronic degeneration of the zygapophyseal joints in the cervical or lumbar spine
are common causes of axial back pain. Radiofrequency (RF) ablation is a treatment modality in
the denervation of facet joint–related pain. Although multiple factors have been theorized to
contribute to the size of the optimal RF lesion, the addition of hypertonic saline solution has been
posited to create larger RF lesion sizes.
Objectives: This study compares lesion of 20-gauge RF monopolar probe using 2% lidocaine,
0.9% normal saline solution, and 3% saline solution administered through the RF needle prior to
ablation, with subsequent lesion sizes recorded.
Study Design: Randomized, double-blinded, ex vivo study using clinically relevant conditions.
Setting: Procedural laboratory in an academic institution.
Methods: RF ablation lesions were reproduced in room temperature (21°C ± 2°C) chicken breast
specimens with 20-gauge monopolar RF probes inserted. RF was applied for 90 seconds at 80°C
after injection of 1 mL of either 2% lidocaine, 2% lidocaine and 0.9% normal saline solution in a
1:1 ratio, or 2% lidocaine and 3% saline solution in a 1:1 ratio. Tissues were dissected, measured,
and ellipsoid volumes of burn calculated. Homogeneity of variances was assessed via the Bartlett’s
test, and heteroskedasticity with the studentized Breusch-Pagan test. One-way analysis of variance
(ANOVA) (α of 0.05) was used to evaluate statistical significance between volume means across
groups. When the null hypothesis of no difference in burn volume between samples could not be
rejected, a predefined equivalence volume of ± 0.05 cm3
was used with Welch’s 2 one-sided t-tests
(TOST) with a Bonferroni adjusted α of 0.0167 to evaluate for null acceptance.
Results: The mean lesion volume for monopolar RF with 1 mL 2% lidocaine was 0.16 cm3
.
Monopolar RF with 1 mL 2% lidocaine + 0.9% normal saline solution had a mean lesion volume of
0.15 cm3
, and treatment with 1 mL 2% lidocaine + 3% saline solution measured 0.17 cm3
. ANOVA
failed to reject the null, and TOST accepted as equivalent all 3 comparisons.
Limitations: In vivo anatomy and physiology of a human organism was not used for this study.
Samples were not warmed to physiologic temperature. Randomization resulted in slightly unequal
sample sizes, although all groups were of sufficient size that the central limit theorem should apply.
Conclusions: Three commonly used solutions were found to have equivalent lesion sizes from
monopolar probe RF ablation.
Key words: Radiofrequency, ablation, lesion shape, lesion size, monopolar RF, hypertonic saline
solution
Demographic Factors Associated with
Patient-Reported Outcome Measures in Pain
Management
Authors: Gulur Padma
Published: March 2021

Background: Pain control is strongly correlated with the Hospital Consumer Assessment of
Healthcare Providers and Systems (HCAHPS) quality-of-care domains and overall hospital experience.
Prior research implicates several factors in the variability of patients’ pain management satisfaction
scores, including but not limited to racial diversity, ethnic diversity, gender, socioeconomic status,
and other cultural factors.
Objective: In this study, we examined responses to the HCAHPS survey in order to assess factors
associated with patient-reported experiences of pain management.
Study Design: The study design involved a retrospective analysis of patient survey responses.
Setting: The research took place at a university-affiliated tertiary hospital.
Methods: The study was conducted in a university-affiliated tertiary hospital. Records for adult
patients discharged between October 2015 and June 2017 were included. We obtained all patient
responses to the HCAHPS pain management questions. We then performed a systematic statistical
analysis to evaluate interactions between demographic factor variables and responses to the
HCAHPS pain management questions.
Results: Between October 2015 and June 2017, 107,287 patients were discharged from
the hospital. Of these, 13,026 of the respondents answered at least one of the HCAHPS pain
management questions.
Among HCAHPS pain-domain respondents, “Hispanic” and “Black or African American”
respondents are more likely to report successful Pain Control when compared to “Not Hispanic”
and “Caucasian/White,” respectively (odds ratios [ORs] 1.60, 1.22). Additionally, among women,
“Black or African American” respondents are more likely to report positive Staff Helpfulness than
“Caucasian/White” respondents (OR 1.38).
However, we also identified corresponding associations among HCAHPS pain-question responding
and patient race/ethnicity: “Hispanic” and “Black/African American” patients were each less likely
to respond to the HCAHPS pain questions (ORs 2.03, 2.74).
Limitations: The primary limitation to this study was nonresponse bias; nevertheless, this is likely
to be similar to bias experienced at other institutions. Additionally, this is a single institution study;
however, given that the institution has a very large catchment area, we believe the results could
be generalized to other settings.
Conclusion: Response rates and responses to HCAHPS pain questions vary by race/ethnicity
and sex. It appears likely that Hispanic and Black/African American patients underreport negative
experiences. As HCAHPS surveys are used to inform decision-making within the US health care
system, demographic biases in the survey data could lead to biases in care and resource allocation.
Key words: Pain, HCAHPS, patient reported outcome measures, patient satisfaction, ethnicity,
race
Analgesic Efficacy and Adverse Effects of
Meperidine in Managing Postoperative or
Labor Pain: A Narrative Review of Randomized
Controlled Trials
Authors: Cheung Chi Wai
Published: March 2021

Background: Meperidine, a synthetic opioid, has a rapid onset and short duration of action.
Mounting evidence has challenged meperidine’s analgesic benefits, and concerns have been raised
about its safety profile. Despite recommendations to restrict the prescription of meperidine, the
drug remains frequently used.
Objectives: The aim of this study was to evaluate the evidence regarding the efficacy and safety
of meperidine for acute postoperative and labor pain.
Study Design: This was a narrative review of the analgesic efficacy and side effects of meperidine
compared to other analgesic drugs for acute postoperative and labor pain in adults.
Setting: Randomized controlled trials that compared the analgesic efficacy and side effect profile
of meperidine versus another analgesic drug in adult patients were evaluated.
Methods: A systemized search of randomized controlled trials studying meperidine for acute
postoperative or labor pain in the adult patient population from PubMed, Medline, and EMBASE was
performed. Included studies reported on different routes of meperidine administration including
intramuscular, intravenous, and patient-controlled analgesia in various surgical procedures such
as abdominal surgery, Cesarean section, gynecological surgery, orthopedic surgery, cardiothoracic
surgery, as well as for labor analgesia. Meperidine’s analgesic efficacy and safety profile were
compared to other opioids (morphine, tramadol, fentanyl, buprenorphine, nalbuphine, and
pentazocine), nonsteroidal anti-inflammatory drugs (ketorolac, diclofenac, and indomethacin),
dipyrone, ketamine, and bupivacaine.
Results: A total of 62 randomized controlled trials published between 1972 and 2018 were
reviewed. Meperidine had a similar or inferior analgesic efficacy compared to other analgesics for
acute postoperative or labor pain. Meperidine was associated with more sedation and respiratory
depression.
Limitations: The sample sizes of many clinical studies were small, and therefore probably
insufficiently powered to detect differences in uncommon side effects, such as central nervous
system toxicity. In addition, some of the included clinical studies were old.
Conclusion: Considering the availability of other effective analgesics with potentially fewer side
effects, the use of meperidine for acute postoperative or labor pain should not be recommended.
Key words: Acute postoperative pain, adverse effects, labor analgesia, meperidine, pethidine
Evidence for the Efficacy of Scrambler Therapy
for Cancer Pain: A Systematic Review
Authors: Bhatnagar Sushma
Published: March 2021

Background: Certain types of cancer pain have remained hard to control even by highly skilled
pain experts. Uncontrolled cancer pain can have severe effects on quality of life, physical functioning,
and leads to psychological distress. From this perspective, nonpharmacologic modalities of
treatment are important. Neuromodulatory techniques, such as transcutaneous electrical nerve
stimulation and scrambler therapy (ST), have gained popularity in recent times. ST is a relatively
new therapy that has been used for the management of cancer pain resistant to pharmacologic
management. Several studies have shown that ST is an effective therapy for this type of pain.
Objectives: The aim of this study was to detect possible gaps in the literature regarding the
efficacy of ST for cancer pain and formulate recommendations for research through a systematic
review of the literature.
Study Design: A systematic review of the literature was performed following the recommendations
of the PRISMA Statement.
Methods: PubMed and EMBASE were searched for studies that met the inclusion criteria using a
predetermined search strategy. Reference list of retrieved studies and Google Scholar were used to
verify that no relevant studies had been omitted. Data were extracted from the studies with a data
extraction sheet. A qualitative analyses of the extracted data was undertaken.
Results: Twenty-seven studies were retrieved. Ten were articles that were categorized as literature
reviews, including 7 general literature reviews not following a specific review methodology, 1
editorial, and 2 systematic reviews. Seventeen were original studies, including 2 single-arm trials, 1
randomized controlled trial, 4 pilot trials, 4 case reports, 2 retrospective studies, and 4 prospective
studies. By and large, the available literature supports the use of ST as an effective therapy for the
management of refractory cancer pain. However, the level of evidence for its application to cancer
pain is not particularly strong, and improvement in pain with ST may even be owing to a placebo
effect.
Limitations: This study was not a meta-review. Because of the limited number of clinical trials on
ST in cancer pain, such a meta-review could not meaningfully be performed.
Conclusions: Methodologically sound, large randomized control trials are needed in this area.
However at this stage, ST may be considered a good option for cancer patients suffering from pain
that does not respond to pharmacologic treatment.
Key words: Scrambler therapy, cancer, cancer pain, neuropathic pain, Calmare therapy, evidence,
noninvasive pain treatment, chronic pain
Open Lumbar Microdiscectomy and Posterolateral
Endoscopic Lumbar Discectomy for Antero- and
Retrospondylolisthesis
Authors: Yun Dong-Ju
Published: March 2021

Background: Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic
lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc
in degenerative spondylolisthesis. Few studies have investigated the outcomes of open lumbar
microdiscectomy (OLM) and PLELD for antero- and retrospondylolisthesis with mild slippage and
instability.
Objectives: We aimed to evaluate the outcomes of OLM and PLELD for antero- and
retrospondylolisthesis with mild slippage and instability.
Study Design: This study used a retrospective design.
Setting: Research was conducted in a hospital and outpatient surgical center.
Methods: This study enrolled 84 patients aged 20 to 60 years with low-grade degenerative
spondylolisthesis who underwent OLM or PLELD for antero- or retrospondylolisthesis at our
hospital between March 2007 and August 2014 and who were followed up for at least 3 years.
Telephone survey and chart review, with a particular focus on pre- and postoperative radiographic
parameters, were conducted. Additionally, patients were invited to undergo reexamination to
update their clinical and radiological data.
Results: Telephone surveys and clinical/imaging evaluation were conducted on the OLM and PLELD
groups at a mean of 71.44 and 74.69 months, respectively. Out of 43 patients who underwent
OLM, 34 responded to the telephone survey, 17 of whom then underwent reexamination. Among
41 patients who underwent PLELD, 32 responded to the telephone survey, 19 of whom then
underwent reexamination. Based on telephone surveys and patient charts, reoperation at the same
vertebral level was confirmed in 8 patients (23.5%) who underwent OLM and one patient (4.4%)
who underwent PLELD, with a significantly higher rate of reoperation in the OLM group (P = .028).
Vertebral disc height decreased more after OLM than after PLELD. Compared to PLELD, OLM was
associated with significantly worse rates of iatrogenic endplate damage, endplate defect scores,
and alterations in subchondral bone signal intensity. However, the final clinical outcomes did not
differ between OLM and PLELD.
Limitations: The limitations of this study include its relatively small sample size and the possibility
of bias owing to nonrandomized patient selection.
Conclusions: In patients with spondylolisthesis who have a herniated lumbar disc as mild
slippage with instability, PLELD may be a good treatment option to reduce recurrence rates and
mitigate disc degeneration.
IRB approval number: 2016-12-WSH-011
Key words: Anterospondylolisthesis, disc degeneration, endplate, herniated lumbar disc, open
lumbar discectomy, percutaneous endoscopic lumbar discectomy, posterolateral endoscopic
lumbar discectomy, retrospondylolisthesis, slippage
Lidocaine Versus Bupivacaine in the Treatment
of Headache with Intranasal Sphenopalatine
Nerve Block
Authors: Kirkpatrick Daniel L
Published: March 2021

Background: Intranasal sphenopalatine ganglion (SPG) block has been shown to be an effective
treatment for headaches. Multiple therapeutic agents have been studied, although the wide
availability and low cost of lidocaine and bupivacaine have made them attractive treatment
options. To the authors knowledge, no study has yet demonstrated superiority of one anesthetic
over the other.
Objective: To determine the efficacy of lidocaine versus bupivacaine when performing intranasal
sphenopalatine ganglion (SPG) block for the treatment of headaches.
Study Design: Retrospective cohort study.
Setting: A single tertiary care academic institution
Methods: This retrospective study identified patients who underwent SPG block at a single
institution from January 1, 2014 to December 20, 2017. Patients were included if they were
treated with either lidocaine or bupivacaine and had both pre- and post-procedure pain scores
recorded on a 0-10 scale. Patients were excluded if they were less than 18 years of age.
Results: 386 total procedures were performed. 303 (78.5%) were lidocaine delivered via the
SphenoCath device, and 83 (21.5%) were bupivacaine delivered via the Tx360 device. 90.2% of
treatments (n = 348) decreased the patient’s pain level. Of the treatments performed with lidocaine,
89.1% (n = 270) resulted in improvement of the patient’s pain level with a mean decrease in pain
level of 3.1 (SD ± 2.3). Of the treatments performed with bupivacaine, 94.0% (n = 78) resulted in
improvement of the patient’s pain level, with a mean decrease in pain level of 3.0 (SD ± 1.9). No
statistically significant difference was found between the 2 anesthetics.
Limitations: The retrospective study design may introduce selection bias. Both lidocaine and
bupivacaine were administered by different devices (Sphenocath and Tx360 respectively) which
may account for differences in initial treatment success. There were differences in the size of the
two groups, which may also introduce error.
Conclusions: This study demonstrates similar efficacy of SPG block performed with lidocaine or
bupivacaine. While no difference was found, the particular advantages and disadvantages of the
intranasal delivery device may influence physician choice.
Key words: Sphenopalatine ganglion nerve block, lidocaine, bupivacaine, sphenocath, Tx360,
pain intervetnio, headache, miimally invasive therapy
Options: A Prospective, Open-Label Study of HighDose Spinal Cord Stimulation in Patients with
Chronic Back and Leg Pain
Authors: Benyamin Ramsin
Published: March 2021

Background: Therapeutic approaches to spinal cord stimulation (SCS) continue to evolve and
improve patient outcomes in patients receiving SCS therapy secondary to failed back surgery
syndrome.
Objectives: The aim of this study was to evaluate pain relief and other patient outcomes of SCS
using selected high-dose programming parameters.
Study Design: This was a prospective cohort study.
Setting: This study took place at 11 centers in North America.
Methods: Forty-four SCS-naive patients underwent trialing, starting with 1,000 Hz frequency, 90
µs pulse width followed by 300 Hz frequency, 800 µs pulse width, if pain relief was inadequate.
Patients with 50% or greater pain relief were eligible for permanent implantation. Patient’s pain
rating, global impression of change, health-related quality of life, functional disability, satisfaction/
recommendation, stimulation perception, device programming, and adverse events were assessed
at 3 months postimplant.
Results: There were significant improvements from baseline in mean Numeric Rating Scale (NRS11) pain scores for overall pain (7.5 to 3.8; P < 0.01), back pain (7.2 to 3.4; P < 0.01), leg pain
(7.2 to 3.1; P < 0.01), Oswestry Disability Index (ODI) score (51.5 to 32.1; P < 0.01), and European
Quality of Life–Five Dimensions, version 5L score (EQ-5D-5L) (0.58 to 0.74; P < 0.01). Twentyeight of 32 patients (88%) had significant, favorable improvement in Patient Global Impression of
Change (PGIC). Eighty-four percent of patients were “satisfied,” and 78.1% would “definitely”
recommend SCS. Eighteen patients (56%) used 1,000 Hz frequency and 90 µs pulse width
exclusively; these patients experienced mean NRS-11 overall pain score improvement of 4.7 points.
Device-, therapy-, or procedure-related adverse events were experienced in 19 patients (40%,
19 of 48), and all events resolved without reoperation and were similar to those observed with
traditional SCS systems.
Limitations: There was no active or sham comparator group, and therefore the reported effects
may not be solely attributable to therapy effects and may be related to other, nonspecific effects
of SCS.
Conclusions: Improvements in pain relief, PGIC, EQ-5D-5L, ODI, and patient satisfaction were all
clinically relevant and statistically significant. Future studies are needed to understand how these
high-dose parameters perform versus a standard comparator.
Key words: Spinal cord stimulation, high-frequency electrical stimulation, failed back surgery
syndrome, neurostimulation, prospective, nonrandomized study
Continuation of Buprenorphine to Facilitate
Postoperative Pain Management for Patients on
Buprenorphine Opioid Agonist Therapy
Authors: Mehta Disha
Published: March 2021

Background: Acute pain management in patients on buprenorphine opioid agonist therapy
(BOAT) can be challenging. It is unclear whether BOAT should be continued or interrupted for
optimization of postoperative pain control.
Objectives: To determine an evidence-based approach for pain management in patients on
BOAT in the perioperative setting, particularly whether BOAT should be continued or interrupted
with or without bridging to another mu opioid agonist and to identify benefits and harms of either
perioperative strategy.
Study Design: Systematic literature review with qualitative data synthesis.
Setting: Hospital, perioperative.
Methods: The study protocol was registered on PROSPERO (Registration number 9030276355).
Medline via OVID, EMBASE, CINAHL, and the Cochrane CENTRAL register of trials were searched
for prospective or retrospective observational or controlled studies, case series, and case reports
that described perioperative or acute pain care for patients on BOAT. References of narrative and
systematic reviews addressing acute pain management in patients on BOAT and references of
included articles were hand-searched to identify additional original articles for inclusion. The full
text of publications were reviewed for final inclusion, and data were extracted using a standardized
data extraction form. Results were summarized qualitatively. Primary outcomes were postoperative
pain intensity and total opioid use and identification of benefits and harms of perioperative
strategies.
Results: Eighteen publications presenting data on the perioperative management of patients on
BOAT were identified: 10 case reports, 5 case series, and 3 retrospective cohort studies. Eleven
articles reported continuation of BOAT, 2 concerned bridging BOAT, and 4 articles described
stopping BOAT without planned bridging. In one retrospective cohort study, BOAT was continued
in half and interrupted in half of patients. Patients on BOAT may have pain that is more difficult
to treat than those who are not on OAT. There is no clear evidence that one particular strategy
provides superior postoperative pain control, but interruption of BOAT may result in harm,
including failure to return to baseline BOAT doses, continuing non-BOAT opioid use, or relapse of
opioid use disorder.
Limitations: There were a limited number of articles relevant to the study question consisting of
case reports and retrospective observational studies. Some omitted relevant details. No prospective
studies were found.
Conclusions: There is no clear benefit to bridging or stopping BOAT but failure to restart it may
pose concerns for relapse. We recommend continuing BOAT in the perioperative period when
possible and incorporating an interdisciplinary approach with multimodal analgesia.
Key words: Opioid use disorder, opiate substitution treatment, buprenorphine, buprenorphinenaloxone, buprenorphine opioid agonist therapy, postoperative pain, acute pain, multimodal
analgesia