bluuebunny/crossref_metadata_2025 huggingface dataset:
Practical implementation of research on the introduction of on-board meters-indicators for monitoring the technical condition of tractors
Authors: Kostomakhin M. , Kostomakhin N. , Petrishchev N. , Tseiko L.
Published: March 2023

Reducing the excess costs of the consumer due to timely maintenance and increasing the efficiency of detecting deviations in technical condition to improve operational reliability is an important task in improving the efficiency of using energy-saturated tractors of domestic production. In order to promptly provide initial information on the degree of use and the current state of resource-determining parts and assemblies, as well as to increase the controllability and adaptability to diagnosis, indicator counters integrated into the design of tractors are used. Diagnostics and information collection allows us to prevent failures and minimize costs under the conditions of branded service, as well as to monitor the current state of equipment that is under warranty or under lease. In the production of energy-saturated tractors most of the main components and aggregates in the JSC "St. Petersburg Tractor Plant" transmissions are made independently, with the exception of bearings and friction discs. Therefore, in order to increase the operational reliability of the tractor as a whole the proposals for the development of indicator counters were carried out primarily to increase the controllability and adaptability to the diagnosis of power transmissions, as the most relevant for minimizing the costs of the manufacturer, leasing company, and end user. Producing plants, research teams and individual laboratories are engaged in research to solve problems of increasing the resource of agricultural machines and tractors. However, the main indicators of the reliability of agricultural machinery increase with low dynamics, and the cost of maintaining machines increases sharply in the post-warranty period of operation [1-3].
Mathematical model of fluid flow along a straight through filled with a distributed flow from above
Authors: Tazetdinov Rustem , Tibrin Gennady , Deniskin Yuri , Lapteva Svetlana
Published: March 2023

In a one-dimensional approximation and in the absence of friction forces, a mathematical model has been developed for the steady flow of an incompressible fluid along a straight line, for example, a drainage gutter, into which a distributed flow flows from above. The boundary condition missing for solving the system of equations of momentum and continuity is determined using the principle of minimum potential energy. For a rectangular chute, equations are obtained that allow one to calculate the distributions of the layer thickness and fluid velocity along the length of the chute with a plug at one end and without a plug, slope and without slope to the horizon, depending on the intensity of the incoming flow, the size of the chute, and the density of the liquid. This model, by means of a simple recalculation, can also be extended to the flow in a trough of a different cross-sectional profile. The results of the study can be applied to the calculation of external drainage systems.
Retracted Article: Experimental studies on soil compaction using BOMAG BW 226 BVC-5 vibratory roller
Authors: Breskich Vera
Published: March 2023

The Guest Editor(s) and the authors have retracted this article.
Due to an unintentional oversight, the authors failed to disclose a conflict of interest that might have affected interpretations of the work and recommendations by the peer reviewers.
The Publisher approved to the retraction.
Kinetics of isothermal growth of Ulvöspinel (Fe3-xTixO4) in Ti-bearing blast furnace slag with Fe2O3 powder additive
Authors: Li Youyu , Yan Baijun
Published: March 2023

Based on chemical composition and mineral composition of Ti-bearing BF slag, Fe2O3 is introduced to the Ti-bearing BF slag, a magnetic Ulvöspinel phase is formed after roasting, then enriched by magnetic separation. The effects of Fe2O3 dosage, holding temperature and holding time on the grain size and crystal area of Ulvöspinel in titanium bearing blast furnace slag were investigated by SEM-EDS analyses. The occurrence of Ca, Si, Fe, Ti and other elements in roasted slag were studied by EDS. The grain size and crystallization area of Ulvöspinel (>30 µm) in roasted slag under different conditions were counted by image plus pro 6.0 software. The growth kinetics of Ulvöspinel in isothermal process was described by Johnson-Mehl-Avrami-Kologoromov (JMAK) model, the apparent activation energy of Ulvöspinel growth was obtained. The results show that the mixed roasted slag of Ti-bearing BF slag and Fe2O3 is mainly composed of Ulvöspinel phase and calcium-silicon phase; Titanium mainly occurs in Ulvöspinel Fe3-xTixO4 (0 < x < 1), and only trace titanium exists in the calcium silicate phase; The growth of Ulvöspinel phase mainly includes two processes: crystal nucleus growth and Ostwald coarsening; The temperature of about 1073 K is favorable for the growth of Ulvöspinel. If the temperature is too high, low undercooling (ΔT = 1693–Tk) may lead to the slow the nucleation rate, and when the temperature is below 1073 K, the high viscosity slag leads to the slow dissolution of molten Ulvöspinel grains; when mass ratio 25% Fe2O3 to Ti-bearing BF slag, as holding time prolonging, the size and crystal area of Ulvöspinel (>30 µm) gradually increases, and the average size and area fraction of Ulvöspinel (>30 µm) is 56.67 µm and 78.79% after 120 min. After that, the growth of Ulvöspinel almost stopped. The growth process of Ulvöspinel can be described by JMAK equation, and its apparent activation energy is 550.39 kJ. mol−1.
Fenestrated Anterior Communicating Artery Complex Mimicking an Unruptured Aneurysm: Diagnostic Pitfall
Authors: Tsukada Atsushi , Yanaka Kiyoyuki , Takeda Hayato , Onuma Kuniyuki , Takada Maya , Nakamura Kazuhiro , Ishikawa Eiichi
Published: March 2023

Anatomical variations often occur in the anterior communicating artery (AComA) complex, and a careful preoperative evaluation is required before repair of this lesion. We report a case of a fenestrated AComA complex mimicking an unruptured cerebral aneurysm. A 49-year-old woman was referred to our hospital under suspicion of unruptured aneurysms of the AComA and the left middle cerebral artery on magnetic resonance angiography (MRA). Additional three-dimensional computed tomographic angiography (CTA) showed the lesion arising from the AComA complex with a maximum diameter of 4.2 mm. Intraoperative findings showed that the putative aneurysm was actually a fenestrated AComA complex as the blood vessels that formed the AComA complex were dilated and meandering. After the operation, MRA and CTA three-dimensional images were reviewed again but we could still not diagnose the lesion as a fenestrated AComA complex rather than an aneurysm. However, in the MRA source image, a secant line in the lesion was the only finding suggestive of a fenestration. The AComA complex is often associated with various vascular malformations, and it is essential to consider this association in the preoperative evaluation. The interpretation of source images may be helpful for accurate diagnosis and surgical planning.
Low-Grade Astrocytoma Causing Dural and Calvarial Destruction
Authors: Belfquih Hatim , Slioui Badr , Azami Mohamed Amine , Akhaddar Ali
Published: March 2023

Most of the literature on intra-axial lesions causing calvarial and dural destruction comes from case reports for glioblastoma, lymphoma, metastasis, and aggressive meningioma. Destruction of dura and calvaria by low-grade gliomas is extremely uncommon; cases reported so far have been mostly oligodendrogliomas. This article describes the unusual case of a 23-year-old male patient with a left-sided intra and extracranial tumor involving the frontal lobe, destroying the overlying dura and calvaria, who underwent maximal safe resection. Histopathology showed the tumor to be a low-grade astrocytoma. The calvarial thinning or remodeling caused by low-grade gliomas is thought to result from their chronic mass effect, by displacing the overlying layer of cerebrospinal fluid and transmitting brain pulsations directly to the inner table of the skull. Pressure thinning of the inner table of the skull may be caused by Pacchionian granulations close to the midline. Although this is extremely uncommon, magnetic resonance imaging may include low-grade astrocytoma in the differential diagnosis in such cases.
Complementarity between quantum coherence and mixedness: a majorization approach
Authors: Alvarez Yanet , Losada Marcelo , Portesi Mariela , Bosyk Gustavo M
Published: March 2023

Quantum coherence is a relevant resource for various quantum information processing tasks, but it is fragile since it is generally affected by environmental noise. This is reflected in the loss of purity of the system, which in turn limits the amount of quantum coherence of it. As a consequence, a complementarity relation between coherence and mixedness arises. Previous works characterize this complementarity through inequalities between the ℓ
1-norm of coherence and linear entropy, and between the relative entropy of coherence and von Neumann entropy. However, coherence–mixedness complementarity is expected to be a general feature of quantum systems, regardless of the measures used. Here, an alternative approach to coherence–mixedness complementarity, based on majorization theory, is proposed. Vectorial quantifiers of coherence and mixedness, namely the coherence vector and the spectrum, respectively, are used, instead of scalar measures. A majorization relation for the tensor product of both vectorial quantifiers is obtained, capturing general aspects of the trade-off between coherence and mixedness. The optimal bound for qubit systems and numerical bounds for qutrit systems are analyzed. Finally, coherence–mixedness complementarity relations are derived for a family of symmetric, concave and additive functions. These results provide a deeper insight into the relation between quantum coherence and mixedness.
II International scientific and practical conference “Improving energy efficiency, environmental safety and sustainable development in agriculture” (EESTE-II-2022)
Authors: Sadullozoda Shahriyor , Gibadullin Arthur
Published: March 2023

Within the framework of the presented material, the results of the conducted II International scientific and practical conference “Improving energy efficiency, environmental safety and sustainable development in agriculture” (EESTE-II-2022).

List of Acknowledgments, International Program Committee are available in this pdf.
Analyzing the method of increasing the energy efficiency for a direct-flow generator unit based on an educational laboratory stand
Authors: Kuskarbekova S I , Khrutskaya A D , Fedorenko E N , Karimov I F , Zulkarnaev D U
Published: March 2023

The article investigates the modes of gas flow through the flue of a steam direct-flow generator unit using a laboratory stand formed from a cylindrical coil. The criterion for determining the gas flow regime is a dimensionless quantity called the Reynolds number. The speeds and temperatures of the airflow were determined experimentally. Based on these results, the Reynolds number was calculated and the flow modes at each measurement point were determined, as well as the dependence of the Reynolds number on temperature and velocity was obtained, the experiment was analyzed. The reason for further study of aerodynamic processes in a ramjet steam generator is substantiated.
Ensuring the environmental friendliness of internal combustion engines of agricultural machines in conditions of limited air exchange
Authors: Sotnikova E V , Yu Kalpina N
Published: March 2023

The method of protection of personnel working in greenhouses, greenhouses and premises for maintenance and repair of agricultural machinery from exposure to exhaust gases in accordance with the “environmental concept”, according to which the negative impact must be reduced before the products of spent gases will enter the air of the working area of the service personnel and the driver of the machine. The problem was solved with the help of evaporative humidification of the air-fuel mixture due to its simplicity and effectiveness, confirmed during tests on a tractor.
Comprehensive assessment of varieties of garden roses in the conditions of the Udmurt Republic
Authors: Ardasheva O A , Cheremnykh E N , Lekontseva T G , Zorin D A
Published: March 2023

The article presents the results of the introduction study of varieties of garden roses in the central part of the Udmurt Republic. A comprehensive assessment of varieties of garden roses was carried out on the collection plot of roses of the Department of Introduction and Acclimatization of Plants of the Udmurt Federal Research Center of the Ural Branch of the Russian Academy of Sciences, founded in 2018 from 26 varieties of different garden groups (climbing, hybrid tea, scrubs, floribunda, Musk rose hybrids) . In the Udmurt Republic, at present, the assortment of roses for flower decoration of settlements is very scarce and is mainly represented by obsolete varieties, which is also an important aspect in the relevance of these studies. The varieties studied by us were grown in compliance with generally accepted agrotechnical measures. Phenomenological observations were carried out, taking into account the winter hardiness of varieties, taking into account susceptibility to diseases and pests, as well as an analysis of decorative features, which were evaluated on a 100-point scale. The assessment of winter hardiness of varieties was carried out in the spring, in the phase of mass bud break. Summary indicators of characteristics for these traits were used to determine the group of prospects. A comprehensive assessment of varieties of garden roses has identified promising varieties for industrial floriculture (Patte da Velours, Reine Sammut, Leonardo da Vinci, Trende Babylon Eyes, Fancy Babylon Eyes), recommended for landscaping in the conditions of the Udmurt Republic. These varieties are characterized by high decorative qualities, abundant and long flowering, high winter hardiness, relatively low susceptibility to diseases and pests. A promising group of rose varieties can be recommended for private horticulture, as well as using these varieties in urban landscaping using a high level of agricultural technology and special structures for shelter in the winter.
Levels of physiological activity of antioxidant enzymes in potatoes (S. tuberosum L.) when infected PVS virus
Authors: Kirgizova I V , Kalashnikova E A , Turpanova R M , Gadzhimuradova A M , Silaev D V
Published: March 2023

This article presents the results of changes in the activity of potato antioxidant enzymes during infection with the PVS virus. As a result of the research, it was found that the formation of callus to obtain microclones is more efficient when using leaf explants, compared with stem explants in all studied varieties. The article presents that varieties with different susceptibility have different enzymatic activity, which can serve as a marker trait when ranking potatoes in breeding. Interestingly, in potato microclones, the activity of POX, CAT and SOD upon infection was significantly higher compared to the control. At the same time, the greatest differences in the physiological response were noted in the activity of POX in a microclone obtained from a potato variety resistant to viruses, and, on the contrary, a decrease in activity was noted in a microclone from a susceptible variety. However, microclones of the susceptible variety showed higher CAT activity than other genotypes. The highest SOD activity was noted in microclones of resistant potato varieties compared to other genotypes. Our data show that the virus can cause changes in the spectrum of antioxidant enzymes, which was characterized by the appearance of additional isoforms in microclones of Khozyayushka and Alena cultivars, which indicated the formation of more stable protection in these accessions.
System of Criteria and Standards for Renovation Felling in the North-Taiga Forest Region of the European Part of the Russian Federation
Authors: Surina E A , Minin N S , Makarov S S
Published: March 2023

The main goal was to test a set of silvicultural measures that would ensure the natural regeneration of larch in areas of mature and overmature plantations with a different proportion of larch in the composition. The objects were laid in the 121st quarter of the Yemtsovsky educational and experimental forestry of the Northern Arctic Federal University (NArFU) in the Arkhangelsk region, in overmature plantations of the green moss group of forest types, the share of larch in which is from 2 to 5 units in the composition. The predominant forest types were pine forests, blueberry larch forests. The average age of larch is more than 160 years; the undergrowth of this species under the canopy was completely absent. Spruce predominates in the undergrowth, its quantity varies from 2.0 to 4.0 thousand pieces/ha. Renewal of mature and overmature plantations was successful due to spruce and pine undergrowth, but there was a settlement on all strips and deciduous species. On all lanes, the birch already has a height of 2-2.5 meters and is a strong competitor in the growth of spruce and pine, which can completely nullify the further productive development and growth of coniferous undergrowth, and especially larch. It is required to carry out care in young stands in order to form the desired target composition of conifers and the optimal density of the future young plantation. The results can be taken into account when developing a strategy for forest management and forest management, making management decisions, planning and designing activities. The obtained results of the research are the scientific basis for improving the structure of the forests of the European North, increasing their productivity, biospheric role and profitability of the forest sector of the economy.
Analysis of soybean varieties maturation using multispectral data
Authors: Polukhin A A , Kurbanov R K , Tsench Yu S , Zakharova N I , Litvinov M A
Published: March 2023

Aerial photography using unmanned aerial vehicles and a multispectral camera is used to monitor the condition of soybean crops, predict their development and phenotyping. This research focused on evaluation of soybean varieties in the initial ripening period using multispectral data from an unmanned aerial vehicle. The quadrocopter Matrice 200 v2 and the MicaSense Altum multispectral camera were used to collect multispectral data. The article analyzes ten soybean varieties according to five vegetation indices (NDVI, NDRE, ClGreen, GNDVI, MCARI) and five spectral channels with wavelengths from 475 nm to 842 nm. Using the Student’s t-test, significant differences between soybean varieties and the standard soybean variety for the Orel region were revealed. Recommendations have been formed for the assessment of soybean varieties by the maturation rate using multispectral aerial photography: it is recommended to use the vegetation index GNDVI, as well as a spectral channel with a wavelength of 475 nm.
Possibilities of using official data in spatio-temporal modeling of main electrical networks
Authors: Karpachevsky A M , Titov G S
Published: March 2023

The article investigates the accuracy of spatio-temporal modeling of main electrical networks based on open data published in schemes and programs for the development of regions. As a rule, these documents give the date of commissioning / reconstruction of the entire line, which it is at a given point in time, however, in reality, modern lines consist in most cases of a set of segments from different years of construction. Failure to take into account the segmentation of the network leads to errors in the attribution of temporal data, which in turn can lead to errors in planning the development of the network. The paper compares the data of non-segmented and segmented networks and illustrates the distribution of the error in dating.
Automated information processing systems in environmental monitoring
Authors: Bulekova A A , Sungatkyzy S , Akkereeva E K , Sharafieva Zh R , Nurtaeva M
Published: March 2023

The article shows examples of using the algorithm for calculating emissions into the atmosphere during production activities in the process of laboratory tests for designing maximum allowable emissions and assessing the impact of possible activities on the environment. The calculation algorithm is based on the use of the ERA PC software package in the laboratory process, designed to calculate pollutants in all components of the environment. This software package allows you to make calculations for many parameters automatically, which simplifies the work of environmental designers. The use of this software package can be used in the training of specialists in the field of environmental monitoring.
Methods of growing high grain yields in Northern Kazakhstan during the years of virgin lands development (the case of the Zarechny state farm)
Authors: Mazhitova Zh S , Khassenova Zh O , Alimbaev T A , Utebayeva A D
Published: March 2023

This article examines the development of virgin and fallow lands in Kazakhstan in the 1950s. Since the climate in the Kazakh steppes was sharply continental, arid, and the soils unsuitable for farming, the cultivation of grain crops was associated with huge risks and difficulties. Everywhere in those years a great number of state farms were established in Kazakhstan, which had to develop not only vast areas in extraordinary conditions and terms, but also apply innovative for that time and for that area methods of cultivation of high yields of grain crops. Analysis of the materials showed that, despite the difficult natural and climatic conditions, lack of agricultural machinery and labour, the virgin lands cultivators harvested high yields by applying the method of layer-by-layer tillage. The authors concluded that in the course of land use state farm specialists tried to maintain the quality characteristics of the soil.
A rational way of sorting municipal solid waste
Authors: Lemeshko M A , Bashnyak S E , Karelin A E , Stuzhenko N I , Bondareva A S
Published: March 2023

The article provides a brief overview of the most popular and promising methods of sorting municipal solid waste, attention is paid to automated systems for recognizing garbage objects during sorting, and in particular, their high cost with relatively low efficiency. The problem of using high-cost systems for recognizing waste objects by the payback factor with a low content of useful components in the total mass of garbage has been identified. A method of an automated garbage sorting system is proposed and described, in which a person is used as a system for recognizing garbage objects. This method significantly reduces the cost of electron-optical and tactile detectors that recognize garbage objects, while not requiring a huge database to compare 3-d images. At the same time, the recognition accuracy increases significantly, and the cost of the process of recognizing garbage objects on the conveyor is significantly reduced, which in general ensures a quick payback of the garbage sorting system. It is proposed that such a system be used as an intermediate stage in the improvement of image recognition systems for sorting garbage objects.. The approach of using the human ability to recognize as a more economical method to recognize waste objects when sorting them in robotic systems is proposed. At the same time, comfortable working conditions are provided for a person, a sorter operator, who recognizes and encodes each sorting object remotely from garbage using video cameras and a high-resolution monitor. A variant of such a sorting system using mechanotronics is described.
Comparative characteristics of spectrophotometric methods for determining the in vitro antioxidant activity of plant extracts
Authors: Popov A D , Chupakhina N U , Skrypnik L N , Larina V V , Babich O O
Published: March 2023

The article discusses the possibilities of comparing the results of determining the total antioxidant activity (AOA) using three spectrophotometric methods: DPPH, ABTS, and FRAP. The obtained values were compared and revealed a high correlation for all pairs of comparisons as well as a close precision of the AOA content in plant extracts, regardless of the extractant or method of determination. The reliable AOA content in the regional flora was determined and varied in a very wide range from 1.44±0.12 to 1094.02±14.53 µmol TE/g DW plant material, with methanol extracts having the highest AOA concentration. Among 14 species of medicinal and protected plants of the Kaliningrad region, Alnus glutinosa L., Filipendula ulmaria L. и Calluna vulgaris L., а наименьшей Valeriana officinalis L. и Sedum acre L. had the highest AOA.
Controlled expansion of shell-shaped Bose–Einstein condensates
Authors: Boegel Patrick , Wolf Alexander , Meister Matthias , Efremov Maxim A
Published: March 2023

Motivated by the recent experimental realization of ultracold quantum gases in shell topology, we propose a straightforward implementation of matter-wave lensing techniques for shell-shaped Bose–Einstein condensates. This approach allows to significantly extend the free evolution time of the condensate shell after release from the trap and enables the study of novel quantum many-body effects on curved geometries. With both analytical and numerical methods we derive optimal parameters for realistic schemes to conserve the shell shape of the condensate for times up to hundreds of milliseconds.
Brain dysconnectivity with heart failure
Authors: Mueller Karsten , Thiel Friederike , Taskin Birol , Beutner Frank , Teren Andrej , Dubovoy Vladimir K , Möller Harald E , Villringer Arno , Schroeter Matthias L
Published: March 2023

Structural brain damage associated with heart failure is well described; however, little is known about associated changes in various specific brain functions that bear immediate clinical relevance. A satisfactory pathophysiological link between heart failure and decline in cognitive function is still missing. In the present study, we aim to detect functional correlates of heart failure in terms of alterations in functional brain connectivity (quantified by functional magnetic resonance imaging) related to cognitive performance assessed by neuropsychological testing. Eighty patients were post hoc grouped into subjects with and without coronary artery disease. The coronary artery disease patients were further grouped as presenting with or without heart failure according to the guidelines of the European Society of Cardiology. On the basis of resting-state functional magnetic resonance imaging, brain connectivity was investigated using network centrality as well as seed-based correlation. Statistical analysis aimed at specifying centrality group differences and potential correlations between centrality and heart failure-related measures including left ventricular ejection fraction and serum concentrations of N-terminal fragment of the pro-hormone brain-type natriuretic peptide. The resulting correlation maps were then analysed using a flexible factorial model with the factors ‘heart failure’ and ‘cognitive performance’. Our core findings are: (i) A statistically significant network centrality decrease was found to be associated with heart failure primarily in the precuneus, i.e. we show a positive correlation between centrality and left ventricular ejection fraction as well as a negative correlation between centrality and N-terminal fragment of the pro-hormone brain-type natriuretic peptide. (ii) Seed-based correlation analysis showed a significant interaction between heart failure and cognitive performance related to a significant decrease of precuneus connectivity to other brain regions. We obtained these results by different analysis approaches indicating the robustness of the findings we report here. Our results suggest that the precuneus is a brain region involved in connectivity decline in patients with heart failure, possibly primarily or already at an early stage. Current models of Alzheimer’s disease—having pathophysiological risk factors in common with cerebrovascular disorders—also consider reduced precuneus connectivity as a marker of brain degeneration. Consequently, we propose that heart failure and Alzheimer’s disease exhibit partly overlapping pathophysiological paths or have common endpoints associated with a more or less severe decrease in brain connectivity. This is further supported by specific functional connectivity alterations between the precuneus and widely distributed cortical regions, particularly in patients showing reduced cognitive performance.
Impact of binary blends of biodiesels on fuel quality, engine performance and emission characteristics
Authors: Gupta Sandeep , Sharma Mahendra Pal
Published: March 2023

The incessant pressure of energy requirements by the growing global populace has led to the exploration of unconventional methods to produce renewable and sustainable fuels. Among these, biodiesel is most suited to the present needs of eco-friendly standards to keep the atmosphere free from residual emissions. Various fuel-modification methods were developed over a couple of decades to make biodiesel suitable for diesel engines. In the present research, Jatropha curcas biodiesel and waste-cooking-oil (WCO) biodiesel were used to craft a unique binary blend to obtain desirable fuel properties and operational suitability for the diesel engine. The blend with 80% WCO biodiesel and 20% J. curcas biodiesel, which had the most suitable fuel properties, was tested on a four-stroke single-cylinder vertical diesel engine. The emissions and operational parameters were analysed and compared with diesel. The results of the study indicated that engine emissions for binary blend, carbon monoxide and unburnt hydrocarbon emissions were highly reduced, and carbon dioxide and nitrogen oxide (NOx) emissions increased relative to diesel. At full load, NOx emission was found to be 51.32% higher than that from diesel and 3.8% lower than that from WCO biodiesel. Engine performance showed that for the binary blend, at full load, the brake-specific fuel consumption was 396.82 g/kWh, which was 15.26% higher, and the brake thermal efficiency was 22.7%, which was 2.74% lower than regular diesel fuel. The present study suggests that the binary blend of J. curcas biodiesel and WCO biodiesel can be a promising approach towards advancements in the fuel properties of biodiesels.
Impact of C-reactive protein levels on lipoprotein(a)-associated aortic stenosis incidence and progression
Authors: Girard Arnaud , Gaillard Emilie , Puri Rishi , Capoulade Romain , Chan Kwan L , Paulin Audrey , Manikpurage Hasanga D , Dumesnil Jean , Tam James W , Teo Koon K , Couture Christian , Wareham Nicholas J , Clavel Marie-Annick , Stroes Erik S G , Mathieu Patrick , Thériault Sébastien , Tsimikas Sotirios , Pibarot Philippe , Boekholdt S Matthijs , Arsenault Benoit J
Published: March 2023

Aims

Elevated lipoprotein(a) [Lp(a)] levels are associated with the risk of coronary artery disease (CAD) and calcific aortic valve stenosis (CAVS). Observational studies revealed that Lp(a) and C-reactive protein (CRP) levels, a biomarker of systemic inflammation, may jointly predict CAD risk. Whether Lp(a) and CRP levels also jointly predict CAVS incidence and progression is unknown.

Methods and results

We investigated the association of Lp(a) with CAVS according to CRP levels in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk study (n = 18 226, 406 incident cases) and the UK Biobank (n = 438 260, 4582 incident cases), as well as in the ASTRONOMER study (n = 220), which assessed the haemodynamic progression rate of pre-existing mild-to-moderate aortic stenosis. In EPIC-Norfolk, in comparison to individuals with low Lp(a) levels (<50 mg/dL) and low CRP levels (<2.0 mg/L), those with elevated Lp(a) (>50 mg/dL) and low CRP levels (<2.0 mg/L) and those with elevated Lp(a) (>50 mg/dL) and elevated CRP levels (>2.0 mg/L) had a higher CAVS risk [hazard ratio (HR) = 1.86 (95% confidence intervals, 1.30–2.67) and 2.08 (1.44–2.99), respectively]. A comparable predictive value of Lp(a) in patients with vs. without elevated CRP levels was also noted in the UK Biobank. In ASTRONOMER, CAVS progression was comparable in patients with elevated Lp(a) levels with or without elevated CRP levels.

Conclusion

Lp(a) predicts the incidence and possibly progression of CAVS regardless of plasma CRP levels. Lowering Lp(a) levels may warrant further investigation in the prevention and treatment of CAVS, regardless of systemic inflammation.
Use of Artificial Intelligence for Digital Breast Tomosynthesis Screening: A Preliminary Real-world Experience
Authors: Letter Haley , Peratikos Meridith , Toledano Alicia , Hoffmeister Jeffrey , Nishikawa Robert , Conant Emily , Shisler Julie , Maimone Santo , Diaz de Villegas Hector
Published: March 2023

Objective

The purpose of this study is to assess the “real-world” impact of an artificial intelligence (AI) tool designed to detect breast cancer in digital breast tomosynthesis (DBT) screening exams following 12 months of utilization in a subspecialized academic breast center.

Methods

Following IRB approval, mammography audit reports, as specified in the BI-RADS atlas, were retrospectively generated for five radiologists reading at three locations during a 12-month time frame. One location had the AI tool (iCAD ProFound AI v2.0), and the other two locations did not. The co-primary endpoints were cancer detection rate (CDR) and abnormal interpretation rate (AIR). Secondary endpoints included positive predictive values (PPVs) for cancer among screenings with abnormal interpretations (PPV1) and for biopsies performed (PPV3). Odds ratios (OR) with two-sided 95% confidence intervals (CIs) summarized the impact of AI across radiologists using generalized estimating equations.

Results

Nonsignificant differences were observed in CDR, AIR, and PPVs. The CDR was 7.3 with AI and 5.9 without AI (OR 1.3, 95% CI: 0.9–1.7). The AIR was 11.7% with AI and 11.8% without AI (OR 1.0, 95% CI: 0.8–1.3). The PPV1 was 6.2% with AI and 5.0% without AI (OR 1.3, 95% CI: 0.97–1.7). The PPV3 was 33.3% with AI and 32.0% without AI (OR 1.1, 95% CI: 0.8–1.5).

Conclusion

Although we are unable to show statistically significant changes in CDR and AIR outcomes in the two groups, the results are consistent with prior reader studies. There is a nonsignificant trend toward improvement in CDR with AI, without significant increases in AIR.
Racial and ethnic disparities in the enrolment of medicare medication therapy management programs
Authors: Garuccio Joseph , Tsang Chi Chun Steve , Wan Jim Y , Shih Ya Chen Tina , Chisholm-Burns Marie A , Dagogo-Jack Samuel , Cushman William C , Dong Xiaobei , Browning Jamie A , Zeng Rose , Wang Junling
Published: March 2023

Objectives

Racial/ethnic disparities have been found in prior literature examining enrolment in Medicare medication therapy management programs. However, those studies were based on various eligibility scenarios because enrolment data were unavailable. This study tested for potential disparities in enrolment using actual MTM enrolment data.

Methods

Medicare Parts A&B claims, Medication Therapy Management Data Files, and the Area Health Resources File from 2013 to 2014 and 2016 to 2017 were analysed in this retrospective analysis. An adjusted logistic regression compared odds of enrolment between racial/ethnic minorities and non-Hispanic Whites (Whites) in the total sample and subpopulations with diabetes, hypertension, or hyperlipidaemia. Trends in disparities were analysed by including interaction terms in regressions between dummy variables for race/ethnic minority groups and period 2016-2017.

Key Findings

Disparities in MTM enrolment were detected between Blacks and Whites with diabetes in 2013-2014 (Odds Ratio = 0.78, 95% Confidence Interval = 0.75-0.81). This disparity improved from 2013-2014 to 2016-2017 for Blacks (Odds Ratio=1.08, 95% Confidence Interval = 1.04-1.11) but persisted in 2016-2017 (Odds Ratio = 0.84, 95% Confidence Interval = 0.81-0.87). A disparity was identified between Blacks and Whites with hypertension in 2013-2014 (Odds Ratio = 0.92, 95% Confidence Interval = 0.89-0.95) but not in 2016-2017. Enrolment for all groups, however, declined between periods. For example, in the total sample, the odds of enrolment declined from 2013-2014 to 2016-2017 by 22% (Odds Ratio=0.78, 95% Confidence Interval=0.75-0.81).

Conclusions

Racial disparities in MTM enrolment were found between Blacks and Whites among Medicare beneficiaries with diabetes in both periods and among individuals with hypertension in 2013-2014. As overall enrolment fell between periods, concerns about program enrolment remain.
We Are in a Different Place
Authors: Mitchell Julie , Kuntz Joanne
Published: March 2023

Patients present to the emergency department with serious, critical illnesses, and decisions will need to be made in order to choose not only what can be done but what should be done based on the patients’ understanding of their illness, goals, and values. A goals-of-care discussion is a patient-centered approach to complex medical decision-making, with focus on identifying individual values and developing plans for future care based on these values. These discussions provide opportunity for shared decision-making in establishing goals in the context of serious illness and near the end of life. In general, it is important to include information regarding the current disease state, prognosis, and treatment options available. Focusing on the “big picture” is important. If patients can describe how they want to live during their remaining time, healthcare providers can help identify what medical treatments will best achieve this. Key components of a goals-of-care conversation include preparation, assessing the understanding of illness, sharing of information regarding prognosis and trajectory, assessing the goals of care based on a shared understanding of the illness, and determining next steps.
“Read the Papers, Please”
Authors: Fomovska Alina M. , Isaacs Eric
Published: March 2023

This chapter discusses the application of advance directives for patients presenting to the emergency department, as well as the navigation of conversations about existing advance directives with the patient’s family and/or surrogate. The interpretation of the advance directives, when at odds with the wishes expressed by surrogate or family, may be a significant source of moral distress for providers. It is important to consider that these documents are not sufficiently nuanced to address the breadth of end-of-life situations, and surrogate decision maker involvement is a crucial part of interpreting advance directives. The patient’s disease trajectory plays an important role in application of the advance directive. When no advance directive exists, in emergency situations, with limited clinical information and significant time pressures, a time-limited trial may represent an appropriate course of treatment.
Make It Stop
Authors: Aberger Kate
Published: March 2023

Nausea and vomiting are less common but very distressing symptoms in patients with serious illness. Nausea is a subjective experience that portends the feeling that vomiting is imminent. Vomiting is a physical event with forceful expulsion of gastrointestinal contents. Nausea and vomiting may occur concurrently or independently—patients may have the sensation of nausea without vomiting or both. While nausea and vomiting are more common in patients with advanced cancer, this symptom is observed in all patients with serious illness. Effective management of nausea and vomiting requires careful assessment regarding the possible etiologies to include an appreciation of psychological, spiritual, and social factors that may exacerbate these symptoms. A focus on both pharmacological and nonpharmacological management strategies is required for effective management. Fundamental knowledge of the emetogenic pathway that delineates the key central regulatory receptors supports judicious use of pharmacological interventions.
The psychotherapeutic component of psychedelic medicine
Authors: Higbed Laurie , Sessa Ben
Published: March 2023

Psychedelic compounds offer a unique type of mental health treatment. This chapter considers how psychedelics can be explored as an alternative to the typical maintenance medication for the treatment of symptoms, through using psychedelic medicines in a controlled clinical setting as an adjunct to psychotherapy. In combination with psychotherapy, the psychedelic experience provides the opportunity to access and explore the root cause of individuals’ difficulties. The ability of psychedelic-assisted psychotherapy to embrace an individualized formulation-driven rather than a reductionist diagnostic-focused understanding of mental distress is discussed, with this therapeutic approach offering a holistic biopsychosocial intervention. Whilst therapeutic modalities of psychedelic-assisted psychotherapy may vary, this chapter details the key therapeutic phases of preparation, psychedelic drug–assisted experiential sessions, and post-drug integration to explore how psychedelics benefit therapy for a range of mental health problems.
Artificial Doctoring
Authors: Ho Anita
Published: March 2023

This chapter explores how the expanding availability and marketing of direct-to-consumer (DTC) artificial intelligence (AI) health applications affect potential users’ autonomy. Section 1 introduces the common claim that these products can democratize health information and promote users’ autonomy. Section 2 provides a brief overview of various purposes and categories of DTC AI health applications, illustrated with examples of platforms currently on the market. Utilizing the concept of relational autonomy, Section 3 explores how these technologies affect (prospective) users’ self-governance, self-determination, and self-authorization. It examines how the broader social phenomenon of self-quantification via indefinite tracking changes our practical identities and may ironically reinforce medical dominance that can further reduce (prospective) patients’ power. Drawing on lessons learned from other DTC health products such as genetic tests, this section warns of the possibility that DTC AI health monitoring may alienate and marginalize people’s embodied experience in ways that compromise their self-identity rather than promoting self-knowledge.
A Digital Pill to Swallow
Authors: Ho Anita
Published: March 2023

This chapter spotlights artificial intelligence (AI) monitoring algorithms that have been specifically developed to identify and predict medication adherence at the individual patient level. It explores how these emerging technologies may disempower patients in ways that compromise their relational autonomy. Section 1 defines key components of medication adherence and presents the scope of the multidimensional concerns around suboptimal adherence. Section 2 provides examples of how AI has been proposed to identify and predict medication adherence. It focuses on examples in mental health care and opioid for chronic non-malignant pain management to illustrate how AI medication adherence monitoring as a proposed practice is designed to address clinicians’ distrust of patients and bypass patient testimonies. Section 3 explores how medication adherence monitoring expands medical authority and dismisses patients’ subjective experiences and concerns in ways that violate their relational self-governance, self-determination, and self-authorization.
Psychological Models of Suicide
Authors: Barzilay Shira , Lawrence Olivia C.
Published: March 2023

Given the complex nature of suicidal phenomena, theoretical frameworks for understanding suicidal processes and behavior are critical for assessing imminent suicide risk and developing effective interventions. This chapter provides a historical perspective on the evolution of various theoretical approaches to understanding the psychological processes that make suicide possible. Specifically, the chapter describes three generations of the most influential models of suicidal behavior. First-generation models, such as Shneidman’s psychache theory, were developed out of clinicians’ individual experiences, consensus opinion, and clinical judgment. Second-generation models hypothesize that suicide risk is determined largely by long-term biological, clinical, and demographic risk factors. Third-generation models of suicidal behavior, such as Rudd’s fluid vulnerability model, emphasize the critical role of dynamic risk factors, which fluctuate in duration and intensity and are operational in conferring imminent suicide risk. The chapter provides insight into each of the frameworks’ strengths and limitations, as well as their clinical implications for predicting suicide.
Vascular Pressures
Authors: Prabhakar Amit , Raslan Adnan
Published: March 2023

All clinicians participating in the delivery of anesthetic care need to have a solid fundamental understanding of vascular pressure measurements. Vascular pressure measurements serve as the foundation for the majority of hemodynamic monitoring in the clinical setting. Examples of clinically relevant vascular pressures include arterial blood pressure, central venous pressure (CVP), pulmonary pressures, and left ventricular end-diastolic pressure (LVEDP). Measurements can be obtained by either noninvasive or invasive methods. Pressure fluctuations can result in systemic malperfusion and subsequently result in end-organ damage. This chapter reviews the pertinent elements of how each measurement is obtained and also details the clinical significance of each parameter.
Cardiac Output
Authors: Nwozuzu Adambeke , Crimi Ettore
Published: March 2023

Cardiac output is the amount of blood ejected from the ventricles with each cardiac cycle. The pulmonary artery catheter has been the mainstay in assessing cardiac output for decades. Its routine use carries potential risks of right ventricular perforation, pulmonary artery rupture, and/or embolization. Echocardiography, esophageal Doppler, transpulmonary thermodilution, and pulse wave analysis are alternative methods to assess cardiac output. To properly assess the cardiac output in surgical and critically ill patients, it is of great importance to become familiar with the chosen technique and its pitfalls. Nevertheless, estimating the cardiac output in patients is important for anesthesiologists and intensivists in order to ensure adequate oxygen delivery and tissue perfusion.
Coagulation Monitors
Authors: Giordano Christopher , Tom Williams Gabriella
Published: March 2023

A timely and accurate assessment of hemostasis is critical for establishing a safe anesthetic plan and implementing appropriate interventional therapy. Historically, hemostasis has been elucidated by intrinsic and extrinsic pathways, which represent cascading independent enzymes that culminate in coagulation. The construct of this cascade is the foundation of our initial understanding of coagulation processes based on in vitro laboratory metrics such as prothrombin time (PT) and partial thromboplastin time (PTT). The introduction of the cell-based model provides a unique explanation of the coagulation process in vivo by emphasizing the critical role of cell surfaces in facilitating localized clot production through initiation, amplification, and propagation. An appreciation of these two paradigms offers a framework for conceptualizing coagulation monitoring and individualized therapeutic management. PT and the international normalized ratio (INR) are used for evaluation of warfarin therapy, while PTT and activated clotting time (ACT) assess heparin activity. Viscoelastic testing, a method of evaluating clot dynamics of whole blood, further assesses abnormalities in clot formation and dissolution. Thromboelastography (TEG), rotational thromboelastometry (ROTEM), and sonic estimation of elasticity via resonance (SEER) provide a quantitative and qualitative perspective that guides specific blood component therapy.