bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring extreme value analysis of rainfall for some nuclear power plant sites in India
Authors: Gandhre Nikhilesh , Dauji Saha
Published: July 2023

Extreme rainfall is an important consideration for safety of nuclear installations. Literature reported estimation of the same for Indian nuclear power plant sites using Gumbel and Frechet distributions, fitted by least square (graphical) method (LSM). In these reports, the goodness-of-fit was examined graphically by plots on probability papers. In this study, the data for six nuclear sites collected from literature were analysed. For this purpose, in addition to Gumbel and Frechet, other distributions were included and the parameters of the distributions were evaluated using Lieblein technique and maximum likelihood estimation, as well as LSM. The goodness-of-fit was evaluated using the quantitative tool: Anderson-Darling test; and qualitative tools: probability plot and quantile plot – which are suitable for evaluating goodness-of-fit of extreme value distributions. Maximum daily rainfall for return periods of 50, 100 and 1000 years were reported from the fitted distributions. Comparison with the respective values (50 and 100 year return period) from literature demonstrated that the extreme rainfall reported for these sites were quite accurate with maximum variation within ten per cent.
Selection of Materials in Construction Industry with Multi-Criteria Decision Making Models
Authors: Lam Weng Hoe , Liew Kah Fai , Lam Weng Siew
Published: July 2023

Construction companies play a central role in the development of a country. The construction products stimulate the growth of private physical structures and public infrastructure for many productive activities such as utilities, commerce, and services. A good material selection is an essential part that needs to be studied in order to come out with a product that is of high quality and safe to be used. As a result, materials selection in the field of construction has also become an interesting topic for many researchers. Based on the previous literature, several multiple criteria decision making (MCDM) models are proposed to choose the best materials for a particular application in recent years. With multiple decision criteria, material selection is treated as an MCDM problem. According to past studies, the researchers have emphasized the integration of MCDM models to tackle complicated decision making problems. MCDM model is a good tool and has been widely proposed in various fields as MCDM models are capable to tackle the decision making problems that are taking multiple decision criteria into consideration. The intended purpose of this paper aims to provide a literature review on the material selection in the field of construction with MCDM models.
Managing Human-Elephant Cohabitation: Strategies for Mitigating Conflict and Encouraging Coexistence
Authors: Pratap Chandran Benin , D’Souza Aren , Athulya Velt V.H. , Princess I Lydia , Ashwini Velt V.H. , Joice Praisy
Published: July 2023

Human-elephant cohabitation is becoming increasingly common in many parts of the world, particularly in areas where human populations are expanding into traditional elephant habitats. While this coexistence can have benefits for both humans and elephants, it can also lead to conflict and negative outcomes for both parties. This paper explores strategies for managing human-elephant co-habitation, with a focus on mitigating conflict and encouraging coexistence. The paper first examines the factors that contribute to conflict between humans and elephants, including competition for resources, property damage, and human safety concerns. It then reviews current approaches to mitigating conflicts, such as elephant-proof fencing, crop protection methods, and elephant relocation programs. Next, this work explores strategies for encouraging coexistence between humans and elephants. These include approaches such as ecotourism, community-based conservation programs, and education and outreach initiatives. The paper also discusses the importance of engaging local communities in the development and implementation of coexistence strategies. Finally, the pa-per presents case studies from around the world that highlight successful strategies for managing human-elephant cohabitation. These case studies demonstrate the effectiveness of a variety of approaches and underscore the importance of a holistic, community-based approach to managing human-elephant coexistence. Overall, this paper provides insights and recommendations for policymakers, conservation practitioners, and others seeking to promote peaceful coexistence between humans and elephants in areas of shared habitat.
A case study of the improvement of an old building’s shallow foundation resting on sandy clay soil using cement slurry grouting technique
Authors: Van Duc Bui , Duc Tho Pham , Duc Chieu Nguyen , Yubonchit Somjai
Published: July 2023

The need to rebuild and upgrade old structures has grown in recent years, particularly in large urban areas. These renovation and upgrade activities frequently affect the structural load of the building, eventually increasing the loads acting on the foundation. This paper illustrates a case study in which the cement grouting method was used to improve the load-carrying capability of an old structure's foundation. The influence of various key variables of the cement grouting method, such as the diameter, length, and angle of inclination of the mortar pile, was also assessed using the finite element (FE) method, Plaxis 2D. Finally, the optimum parameters for the strengthening method used in the study building were chosen based on the FE analysis results of the improvement of the bearing capacity of the foundation using the cement slurry grouting method.
Conceptual framework of green supply chain management strategy selection in the Indonesian construction industry
Authors: Adi Wijaya Padantya , Armyn Machfudiyanto Rossy
Published: July 2023

The construction industry is one of the industries that have high environmental risks. The construction supply chain process is the main concern due to environmental damage. The lack of green practices implementation in the Indonesian construction industry causes energy consumption and gas emissions to continue to raise every year which will negatively impact the environment. Green supply chain management (GSCM) is a concept that integrates the environmental aspect of traditional supply chain processes and can provide benefits not only on environmental performance but also on economic and organizational performance. This study aims to identify relevant GSCM practices to implement in the Indonesian construction industry and develop a conceptual framework based on ANP for green supply chain management strategy selection. This study uses the Delphi method and ANP which involves professionals and practitioners in construction. The findings show there are seven green design practices, seven green purchasing practices, nine green construction practices, four internal environmental management practices, and two green operation and maintenance practices that are relevant in the Indonesian construction industry, and also a conceptual framework for strategy selection of green supply chain management in construction.
Stabilizing black cotton soil using iron ore waste
Authors: Kumar P. Ashween , Raffi V. Abdul , Preethi M. , Sastri M.V.S.S.
Published: July 2023

Using discarded iron ore powder to settle subgrade soil will improve the characteristics of black cotton soil. The soil's engineering properties are analysed using various tests, such as specific gravity, grain size analysis, Atterberg's limits, compaction properties, and unconfined compressive strength. These tests examine the classification of the soil, the optimum moisture content (OMC), the maximum dry density (MDD), the strength of the soil, and other variables. The black cotton soil (BCS) was taken from Ghatkesar Mandal in the Malkalgiri-Medchal region, while the iron ore was procured from a small-scale local enterprise. For this, a clay soil sample with a medium degree of plasticity was combined with iron ore powder in concentrations ranging from 0% to 20% with a 5% increment. The data obtained demonstrated a steady rise in specific gravity with the addition of scrap iron ore and raised from 2.54 to 2.81 when it comes to unconfined compressive strength. Adding more iron ore increased the UCS to stabilize the soil from 149.31kPa to 232.22kPa. The OMC increased from 16% to 12.5%, MDD from 1.86gm/cc to 1.98gm/cc and Plasticity Index from 42.8% to 28.08%. For all mixes, the soil is well-graded. The results demonstrate that iron ore waste can successfully stabilize the soil.
Evaluating types of soil suitable for construction using radial basis function fuzzy neural network
Authors: Shanthi S. Anita , Keerthana N.
Published: July 2023

This paper deals with radial basis fuzzy neural network using bipolar picture fuzzy soft sets. Firstly a bipolar picture fuzzy decision matrix is constructed. A bipolar picture fuzzy Gaussian membership function is defined. Next degree values are calculated and used for finding the entropy. These entropy values help in determining the weights of bipolar picture fuzzy sets. Output is obtained by multiplication of weight values and BPFS Gaussian membership values. By using this method, the soil suitable for construction of buildings is found.
Analysis of various feedstocks’s used for biogas generation
Authors: Pote Xma R. , Malekar Vaishali , Iyer Shrikant , Sharma Kavita , Kharate Sanjukta , Balbudhe Ishwar
Published: July 2023

Worldwide, there is increasing awareness that the use of alternative energy technology is one of the best means to accomplish development of sustainable energy. One of the method is to convert the compounds which are full of organic biodegradable material into useful material. This involves a basic but complex conversion process known as anaerobic digestion. The production of Biogas can be done by organic waste material like forest dry leaves, flowers, fruits, materials from animals such as cowdung, poultry waste, materials which are bi products of dairy and food industries. The vegetable waste in finely shredded form from our kitchen can also be used for biogas. Initially the process was very much time consuming as the technical parameters related to biogas production were not known. It has been observed that the generation of biogas can be controlled by monitoring various parameters related to design of biogas plant, internal parameters related to digestion process and also use of different feedstock’s. This paper highlights the use of different feedstock materials for biogas generation.
Retrofitting of Reinforced Concrete Beams Using Carbon Fiber Reinforced Polymer
Authors: Patil Vanishri. A. , Wadalkar Shruti , Kale Vinayak
Published: July 2023

The retrofitting of existing reinforced concrete beams using Carbon Fiber Reinforced Polymer (CFRP) has gained significant attention as a viable solution to enhance the structural performance and extend the service life of deteriorated or under-designed structures. This study investigates the effects of CFRP retrofitting on the compressive strength of reinforced concrete beams at different curing durations. Nine beams specimens were prepared and subjected to Flextural strength testing after 7 days, 14 days, and 28 days of curing. The obtained results demonstrate a progressive increase in flextural strength over the curing period, indicating the effectiveness of the CFRP retrofitting technique in enhancing the load-bearing capacity of the beams. The study contributes to the understanding of the benefits and potential applications of CFRP retrofitting in the field of structural rehabilitation
Clinical Evaluation of Measuring the ACT during Elective Cardiac Surgery with Two Different Devices
Authors: Falter Florian , Razzaq Nabeel , John Martin , Fassl Jens , Maurer Markus , Ewing Sean , Hofmeyr Ross
Published: July 2023

Unfractionated heparin is the mainstay of anticoagulation during cardiac surgery on cardiopulmonary bypass (CPB) due to its low cost, quick onset, and ease of reversal. Since over 30 years, the activated clotting time (ACT) has been used to assess the level of heparin activity both before and after CPB. We compared two different methods of measuring the ACT: i-STAT, which uses amperometric detection of thrombin cleavage, and Hemochron Jr, which is based on detecting viscoelastic changes in blood. We included 402 patients from three institutions (Papworth Hospital, Cambridge, UK; Groote Schuur, Cape Town, South Africa; University Hospital Basel, Basel, Switzerland) undergoing elective cardiac surgery on CPB in our study. We analyzed duplicate samples on both devices at all standard measuring points during the procedure. The correlation coefficient between two Hemochron and two i-STAT devices was .9165 and .9857, respectively. The within-subject coefficient of variation (WSCV) ranged from 8.2 to 13.6% for the Hemochron and from 4.1 to 9.1% for the i-STAT. We found that the number of occasions where one of the duplicate readings was >1,000 seconds while the other was below or close to the clinically significant threshold of 400 seconds were higher for the Hemochron. We found the i-STAT to systematically return higher measurements. We conclude that the i-STAT provides a more reliable test for heparin activity and assesses safe anticoagulation during cardiac surgery on pump. The fact the that the i-STAT reads higher than the Hemochron leads to the recommendation to validate the methods against each other before changing devices.
Malposition of the Extracorporeal Membrane Oxygenation Venous Cannula in an Accessory Hepatic Vein
Authors: Winiszewski Hadrien , Perrotti Andrea , Chocron Sidney , Capellier Gilles , Piton Gaël
Published: July 2023

We report a case of a refractory cardiogenic shock secondary to myocardial infarction in a 70-year-old patient requiring femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO). At initial transesophageal echocardiography, the venous cannula tip was seen in the inferior vena cava (IVC), but not in right atrium. On day 8, ultrasonic examination identified that the end of the venous cannula was in the hepatic vein (HV). Despite such malposition, no disturbance in extracorporeal membrane oxygenation (ECMO) venous return was observed. Moving or replacing the cannula was considered a high-risk maneuver potentially resulting in hepatic laceration with hemoperitoneum. Because of adequate venous drainage, allowing sufficient blood flow, venous cannula repositioning was delayed until day 10, when a ventricular defect was repaired and ECMO was weaned off. At the time of VA-ECMO implantation, the venous cannula has to be positioned in the right atrium using real time echo monitoring. Visualization of the guide wire in the IVC but not in the right atrium is insufficient to ensure appropriate venous cannula positioning. Indeed, either accidental catheterization or cannula migration into the HV is possible during ECMO. Health care professionals dealing with ECMO have to be aware of this possible malposition, to correct it and prevent insufficient venous drainage or traumatic complications.
Is Conventional Bypass for Coronary Artery Bypass Graft Surgery a Misnomer?
Authors: Likosky Donald S. , Baker Robert A. , Newland Richard F. , Paugh Theron A. , Dickinson Timothy A. , Fitzgerald David , Goldberg Joshua B. , Mellas Nicholas B. , Merry Alan F. , Myles Paul S. , Paone Gaetano , Shann Kenneth G. , Ottens Jane , Willcox Timothy W. ,   for The International Consortium for Evidence-Based Perfusion, the PERForm Registry, the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR), and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative
Published: July 2023

Although recent trials comparing on vs. off-pump revascularization techniques describe cardiopulmonary bypass (CPB) as “conventional,” inadequate description and evaluation of how CPB is managed often exist in the peer-reviewed literature. We identify and subsequently describe regional and center-level differences in the techniques and equipment used for conducting CPB in the setting of coronary artery bypass grafting (CABG) surgery. We accessed prospectively collected data among isolated CABG procedures submitted to either the Australian and New Zealand Collaborative Perfusion Registry (ANZCPR) or Perfusion Measures and outcomes (PERForm) Registry between January 1, 2014, and December 31, 2015. Variation in equipment and management practices reflecting key areas of CPB is described across 47 centers (ANZCPR: 9; PERForm: 38). We report average usage (categorical data) or median values (continuous data) at the center-level, along with the minimum and maximum across centers. Three thousand five hundred sixty-two patients were identified in the ANZCPR and 8,450 in PERForm. Substantial variation in equipment usage and CPB management practices existed (within and across registries). Open venous reservoirs were commonly used across both registries (nearly 100%), as were “all-but-cannula” biopassive surface coatings (>90%), whereas roller pumps were more commonly used in ANZCPR (ANZCPR: 85% vs. PERForm: 64%). ANZCPR participants had 640 mL absolute higher net prime volumes, attributed in part to higher total prime volume (1,462 mL vs. 1,217 mL) and lower adoption of retrograde autologous priming (20% vs. 81%). ANZCPR participants had higher nadir hematocrit on CPB (27 vs. 25). Minimal absolute differences existed in exposure to high arterial outflow temperatures (36.6°C vs. 37.0°C). We report substantial center and registry differences in both the type of equipment used and CPB management strategies. These findings suggest that the term “conventional bypass” may not adequately reflect real-world experiences. Instead of using this term, authors should provide key details of the CPB practices used in their patients.
The Safe Addition of Nitric Oxide into the Sweep Gas of the Extracorporeal Circuit during Cardiopulmonary Bypass and Extracorporeal Life Support
Authors: Bennett Martin , Thuys Clarke , Augustin Simon , Schultz Brad , Bottrell Steve , Horton Alison , Bednarz Andrzej , Horton Steve
Published: July 2023

Low cardiac output syndrome and the systemic inflammatory response are consequences of the cardiac surgical perioperative course. The mechanisms responsible are multifactorial, but recent studies have shown that nitric oxide (NO) may be a key component in mitigating some of these processes. Following on from literature reports detailing the use of inhaled NO added to the gas phase of the extracorporeal circuit, we set about developing a technique to perform this addition safely and efficiently. In the setting of cardiopulmonary bypass, the technique was validated in a randomized prospective trial looking at 198 children. The benefits observed in this trial then stimulated the incorporation of NO into all extracorporeal life support (ECLS) circuits. This required additional hardware modifications all of which were able to be performed safely. Initial results from the first series of ECLS patients using NO also appear promising.
Effects of ECMO Simulations and Protocols on Patient Safety
Authors: Thomas Fedelyne , Chung Sunyoung , Holt David W.
Published: July 2023

The use of extracorporeal membrane oxygenation (ECMO) has greatly increased over the years; however, the survival rate is only above 56%. There has been a drastic increase in ECMO centers and cases. ECMO has become a popular therapy route for patients with respiratory and cardiac complications; however, patient safety is a major concern. Perfusion and non-perfusion students from the University of Nebraska Medical Center were recruited to participate in three simulation trials. The trials consisted of five different tasks that are required for managing or preventing catastrophic events on ECMO. Students were evaluated for the time it took to complete each task, number of errors made, and protocol referencing. The data indicated that there was a decrease in time for the 1st vs. 2nd trial (p= .02) for perfusion students and a decrease from the 1st to 3rd trial (p= .001) for the circuit set-up simulation. There was a decrease in priming time from the 1st to 3rd trial (p= .02) and for the pump change (p= .0098) for the perfusion students as well. The non-perfusion students had a significant decrease in time for the circuit set-up in the 1st vs. 2nd (p= .004) and 1st vs. 3rd trial (p= .002). There was a decrease in time for priming (.004), pump change (p= .002), tubing change (p= .0098), and errors during the tubing change (p= .02) in the non-perfusion students. Both groups felt more confident after the simulations and the non-perfusion students specifically felt like they were more familiar with the purpose of ECMO after the simulation. ECMO simulations and protocols may improve patient safety by strengthening the skills needed for rapid management, fewer errors, and higher levels of confidence during the management of ECMO and catastrophic events.
Improved Estimation of Total Blood Volume Can Provide a Reliable Prediction of Dilutional Hematocrit and Oxygen Delivery during Cardiopulmonary Bypass
Authors: Lee Min-Ho , Gisnarian Carl J. , Shann Kenneth G.
Published: July 2023

Optimal oxygen delivery during cardiopulmonary bypass (CPB) for open heart surgery is crucial to protect organ function, improve outcomes, and reduce hospital stay. Effective preparation for optimal oxygen delivery during CPB is dependent on a reliable estimation of total blood volume (TBV) to accurately predict dilutional hematocrit (Hct) and calculate indexed oxygen delivery (iDO2). Unreliable estimation of TBV is a major reason for inaccurate prediction of dilutional Hct and iDO2. We performed a retrospective study of 113 patients who underwent cardiac surgery to compare the accuracy of predicted versus measured Hct and iDO2. We used four conventional methods of TBV estimation: 1) weight based A; 70 mL/kg for all patients, 2) weight based B; 70 mL/kg for males and 65 mL/kg for females, 3) Allen’s formula, and 4) Nadler’s formula. We found that TBV estimated by Allen’s formula predicted dilutional Hct better than the other three. However, all four methods overestimate TBV when Hct is low and underestimate when Hct is high, suggesting that TBV is dependent on Hct in addition to body size and gender. Our analysis indicates that two individuals with the same body size and gender can have different TBV depending on Hct. We revised Allen’s formula by adding a component that adjusts TBV depending on Hct to provide a more accurate prediction of dilutional Hct and iDO2.
Pre-Health Professional Perceptions: Should a Formal Stress Relief Program Be Implemented in the Workplace?
Authors: Mosca Matthew S. , Grossman Lauren
Published: July 2023

Stress, depression, and burnout are a burden on employees and the health care system. These adverse mental states are interlinked, with burnout being a medical condition resulting from the unsuccessful management of chronic stress. The purpose of this study was to gain a better understanding of pre-health student self-care mechanisms, stress coping strategies, and preferences for on-the-job stress relief. This was a convenience sample survey of three pre-health programs with a total of 60 subject responses. The primary endpoint was whether the pre-health students felt they wanted a formal stress relief program to be implemented at work in their future career. Secondary outcomes included stress coping strategies, self-care mechanisms, and barriers to good work–life balance. On a 5-point Likert scale (5 being very important), the mean score for a formal stress relief program was 3.6 ± 1.2, with 60% of the students selecting a score ≥4. Students scored “break rooms/relaxation rooms,” “time with family and/or friends,” and “being on-call too often” the highest in terms of perceived importance for stress coping, self-care, and as a barrier to work–life balance, respectively. Health care employers should consider implementing a formal stress relief program on-site with consideration for specific pre-health student stress coping and self-care strategies. This type of program has the potential to reduce employee stress and the negative consequences on the employee and health care system.
Lachyoga – wenn das Lachen komisch wird
Authors: Schlich Melanie
Published: July 2023

Lachen tut gut. Jeder weiß es, die meisten tun es aber viel zu selten – vor allem in Phasen, die von Depressionen, Ängsten oder Zwängen geprägt sind. Wie Lachyoga als pflegetherapeutisches Gruppenangebot etabliert werden kann und welche Effekte sich damit erzielen lassen, erfahren Sie im Interventionskoffer.
Belastungsfaktoren erkennen und vorbeugen
Authors: Momberger Michael
Published: July 2023

Der Pflegeberuf – insbesondere in der Psychiatrie – ist herausfordernd. Pflegekräfte müssen viele fachliche Kompetenzen mitbringen, um ihre Tätigkeiten ausführen zu können. Gleichzeitig herrschen Zeitdruck und Personalnot, hinzu kommt das Gewalt- und Aggressionspotenzial mancher Patient*innen. Was kann getan werden, damit Pflegende trotz der Belastungsfaktoren gesund bleiben?
Wenn kleine Seelen leiden
Authors: Dißmann Steffen
Published: July 2023

Depressionen im Kindes- und Jugendalter bleiben oft unerkannt, sind vielen unbekannt oder werden häufig falsch benannt. Unser Autor richtet den Fokus auf frühe Warnzeichen und zeigt altersabhängige Unterschiede in den Symptomkomplexen auf.
Strukturelle, prozedurale und personelle Voraussetzungen für eine sektorenübergreifende Erbringung endoskopischer gastroenterologischer Leistungen
Authors: Leifeld Ludger , Denzer Ulrike , Frieling Thomas , Jakobs Ralf , Faiss Siegbert , Lenzen Henrike , Lynen Petra , Mayerle Julia , Ockenga Johann , Tappe Ulrich , Terjung Birgit , Wedemeyer Heiner , Albert Jörg ,   für die DGVS
Published: July 2023

Die Gastroenterologie hat entscheidende Fortschritte in diagnostischen und interventionellen endoskopischen Verfahren gemacht, die eine Verbesserung in der Behandlung von vielen Patienten eröffnet. So werden zunehmend organerhaltende Behandlungen ermöglicht, die invasivere organresezierende chirurgische Verfahren ersetzen. Dabei ist das Ausmaß an Komplexität und an Risiken zwischen den verschiedenen endoskopischen Prozeduren sehr unterschiedlich. Vielfach werden heute einfachere endoskopische Prozeduren ambulant angeboten. Weiteres Potenzial einer sektorenübergreifenden Leistungserbringung besteht bei komplexen endoskopischen Eingriffen, die aber besondere strukturelle, prozedurale und personelle Voraussetzungen bedingen, um qualitätsgesichert die Behandlung zu erbringen, eine post-interventionelle Überwachung zu ermöglichen und ggf. Maßnahmen für eine Sicherung des Behandlungserfolgs zu ergreifen. Wir fassen die wesentlichen Voraussetzungen und Grenzen für eine sektorenübergreifende Durchführung endoskopischer Prozeduren in der Gastroenterologie zusammen.
Fall für Drei – Rehabilitation nach Mehrfachamputation
Authors: Breier Susanne , Schröter Johannes , Bayer Stephanie , Trinius Doreen , Bosch Stefanie
Published: July 2023

Nach einem Unfall kam der 33-jährige Leon ins Krankenhaus und wurde an der Schulter operiert. Zu diesem Zeitpunkt ahnt noch niemand, dass ihm aufgrund einer Sepsis wenige Woche später alle vier Extremitäten amputiert werden müssen. Eine Orthopädietechnikerin, eine Physio- und eine Ergotherapeutin berichten, wie sie den Patienten in der Reha begleitet haben.
Clinical Implications of Discrepancy between One-Stage Clotting and Chromogenic Factor IX Activity in Hemophilia B
Authors: Schmidt David E. , Truedsson Åsa , Strålfors Annelie , Hojbjerg Johanne Andersen , Soutari Nida , Holmström Margareta , Ranta Susanna , Letelier Anna , Bowyer Annette , Ljung Rolf , Antovic Jovan , Bruzelius Maria
Published: July 2023

Background Discrepancy in factor IX activity (FIX:C) between one-stage assay (OSA) and chromogenic substrate assay (CSA) in patients with hemophilia B (PwHB) introduces challenges for clinical management.

Aim To study the differences in FIX:C using OSA and CSA in moderate and mild hemophilia B (HB), their impact on classification of severity, and correlation with genotype.

Methods Single-center study including 21 genotyped and clinically characterized PwHB. FIX:C by OSA was measured using ActinFSL (Siemens) and CSA by Biophen (Hyphen). In addition, in vitro experiments with wild-type FIX were performed. Reproducibility of CSA was assessed between three European coagulation laboratories.

Results FIX:C by CSA was consistently lower than by OSA, with 10/17 PwHB having a more severe hemophilia type by CSA. OSA displayed a more accurate description of the clinical bleeding severity, compared with CSA. A twofold difference between OSA:CSA FIX:C was present in 12/17 PwHB; all patients had genetic missense variants in the FIX serine protease domain. Discrepancy was also observed with diluted normal plasma, most significant for values below 0.10 IU/mL. Assessment of samples with low FIX:C showed excellent reproducibility of the CSA results between the laboratories.

Conclusion FIX:C was consistently higher by OSA compared with the CSA. Assessing FIX:C by CSA alone would have led to diagnosis of a more severe hemophilia type in a significant proportion of patients. Our study suggests using both OSA and CSA FIX:C together with genotyping to classify HB severity and provide essential information for clinical management.
When Aryne Chemistry Meets Organosulfur Compounds
Authors: Tan Jiajing , Feng Xiaoying , Fan Rong , Zhuang Zhe , Guo Yifeng
Published: July 2023

Organosulfur compounds are ubiquitous in agrochemicals, active pharmaceutical ingredients, natural products, catalysts, and functional materials. The efficient assembly of sulfur-containing skeletons through S(IV) intermediates has emerged as an actively explored direction in organic synthesis. In the past 7 years, our research group has been devoted to developing aryne-induced, sulfonium-zwitterion-based synthetic methodologies. In this account, we systematically overview our recent efforts on this topic, including sigmatropic rearrangements, ring opening of cyclic sulfides, and selective S-arylation of thio-oxindoles. These distinct protocols feature mild conditions and avoid the use of transition metals, allowing facile access to structurally diverse organosulfur compounds. The working hypothesis for our reaction design and key historical precedents are also critically discussed. Our goal is to achieve selectivity control and diversity-oriented synthesis, further advancing sulfonium zwitterion chemistry in the direction of precision synthesis.

1 Introduction

2 Sigmatropic Rearrangement

3 Ring Opening of Cyclic Sulfides

4 Selective Arylation of Thio-oxindoles

5 Conclusion
Response Assessment of Treated Hepatocellular Carcinoma
Authors: Choudhari Amitkumar J. , Kulkarni Suyash , Shetty Nitin Sudhakar , Gala Kunal , Chandra Daksh , Baheti Akshay D.
Published: July 2023

Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality worldwide, including in India. The incidence of HCC has been rising due to lifestyle diseases such as obesity, diabetes, non-alcoholic fatty liver disease (NAFLD), and alcoholic liver disease (ALD), as well as viral hepatitis infections. Various locoregional therapies (LRTs) are used to treat HCC, including thermal ablation, transarterial therapies, stereotactic body radiotherapy (SBRT), and transarterial radioembolization (TARE). Traditional response evaluation criteria like WHO and RECIST, which rely on size-based measurements, may not accurately assess treatment response to LRTs. To address this limitation, modified response evaluation criteria for solid tumors (mRECIST) and the LI-RADS treatment response algorithm (LR-TRA) have been developed. mRECIST assesses patient-level response, while LR-TRA provides lesion-level response assessment specifically for HCC treated with LRTs. This article discusses the imaging protocols for diagnosing HCC and the imaging appearances of treated lesions after different LRTs. It explains the criteria for categorizing treatment response, such as LR-TR viable, LR-TR non-viable, and LR-TR equivocal. It also highlights the challenges and future directions in response assessment, including the incorporation of ancillary findings, the assessment of patients receiving a combination of locoregional and systemic therapies, and the potential use of biomarkers like serum AFP, AFP-L3, and PIVKA-II. In conclusion, locoregional therapies have expanded the treatment options for HCC, and accurate response assessment is crucial for optimizing patient management. mRECIST and LR-TRA provide valuable tools for evaluating treatment response, and future updates are expected to address specific challenges and incorporate newer approaches like iRECIST and quantitative imaging assessment. Additionally, the use of biomarkers may complement imaging-based response assessment in the future.
mHealth and eHealth Applications for a Medicalized Quarantine Hotel during the COVID-19 Pandemic
Authors: Lin Shu-Chuan , Yeh Hui-Tzu , Lee Yu-Hsia , Hsu Suh-Meei
Published: July 2023

Background In Taiwan, the number of confirmed cases of coronavirus disease 2019 (COVID-19) has risen significantly in May 2021. The second wave of the epidemic occurred in May 2022. mHealth (mobile health, social media communities) and eHealth (electronic health, Hospital Information System) can play an important role in this pandemic by minimizing the spread of the virus, leveraging health care providers' time, and alleviating the challenges of medical education.

Objectives This study aimed to describe the process of using mHealth and eHealth to build a medicalized quarantine hotel (MQH) and understand the physical and mental impact of COVID-19 on patients admitted to the MQH.

Methods In this retrospective observational study, data from 357 patients who stayed at the MQH were collected and their psychological symptoms were assessed using an online Brief Symptom Rating Scale (BSRS). Descriptive statistics, independent sample t-test, univariate analysis of variance, and multiple linear regression analysis were performed.

Results The patients' mean age was 35.5  ±   17.6 years, and 52.1% (n  =  186) of them were males. Altogether, 25.2% (n  =  90) of the patients had virtual visits. The average duration of the hotel stay was 6.8  ±   1.4 days, and five patients (0.01%) were transferred to the hospital. The three most common symptoms reported were cough (39%), followed by the sore throat (22.8%), and stuffy/runny nose (18.9%). Most patients achieved a total BSRS score of 0 to 5 points (3,569/91.0%), with trouble falling asleep (0.65  ±   0.65), feeling tense or high-strung (0.31  ±   0.66), and feeling down or depressed (0.27  ±   0.62) scoring highest. The BSRS score was the highest on the first day. The sex of the patients was significantly related to the BSRS score (p  <  0.001).

Conclusion mHealth and eHealth can be used to further monitor an individual's physiological and psychological states. Early intervention measures are needed to improve health care quality.
Management of Brachial Plexus Birth Injury: The SickKids Experience
Authors: Cawthorn Thomas R. , Hopyan Sevan , Clarke Howard M. , Davidge Kristen M.
Published: July 2023

This article describes the approach utilized by the multidisciplinary team at Sick Kids Hospital to evaluate and treat patients with brachial plexus birth injury (BPBI). This approach has been informed by more than 30 years of experience treating over 1,800 patients with BPBI and continues to evolve over time. The objective of this article is to provide readers with a practical overview of the Sick Kids approach to the management of infants with BPBI.
Cardiovascular Risk Factors in Premature Ovarian Insufficiency using Hormonal Therapy
Authors: Rezende Gabriela Pravatta , Dassie Thamyse , Gomes Daniela Angerame Yela , Benetti-Pinto Cristina Laguna
Published: July 2023

Objective Premature ovarian insufficiency (POI) is characterized by early hypoestrogenism. An increased risk of cardiovascular (CV) disease is a long-term consequence of POI. A challenge of hormone therapy (HT) is to reduce the CV risk.

Methods Cross-sectional study with lipid profile analysis (total cholesterol, LDL-C, HDL-C, VLDL-C and triglycerides), blood glucose levels and arterial blood pressure of women with POI using HT, compared with age and BMI-matched women with normal ovarian function (controls).

Results The mean age and BMI of 102 POI patients using HT and 102 controls were 37.2 ± 6.0 and 37.3 ± 5.9 years, respectively; 27.0 ± 5.2 and 27.1 ± 5.4 kg/m2. There wasn't difference between groups in arterial systolic and diastolic blood pressure, blood glucose levels, total cholesterol, LDL-C, VLDL-C and triglycerides. HDL-C levels were significantly higher in the POI group (56.3 ± 14.6 and 52 ± 13.9mg/dL; p = 0.03). Arterial hypertension was the most prevalent chronic disease (12% in the POI group, 19% in the control group, p = ns), followed by dyslipidemia (6 and 5%, in POI and control women).

Conclusion Women with POI using HT have blood pressure levels, lipid and glycemic profile and prevalence of hypertension and dyslipidemia similar to women of the same age and BMI with preserved gonadal function, in addition to better HDL levels.
IL-10 Polymorphism and Breast Cancer Risk in Georgian Women: A Case–Control Study
Authors: Ahmadi Saba , Surmava Sandro , Kvaratskhelia Eka , Abzianidze Elene , Kankava Ketevani
Published: July 2023

Background Interleukin-10 (IL-10) is a cytokine with a vast variety of functions, but its role in cancer development and progression is not yet clear. It is involved in two of the hallmarks of cancer: vascularization and immune modulation. IL-10 inhibits angiogenesis and hence is antitumorigenic. But it also can suppress the immune system and be tumorigenic.

Objective Evaluating the role of IL-10 (-1082 A/G) gene promoter single-nucleotide polymorphism (SNP) in breast cancer susceptibility and progression in Georgian women.

Methods A case–control study was performed on a total of 128 women, with 64 of them being histologically confirmed to have breast cancer and 64 healthy controls. SNP genotyping was performed with TaqMan assay with real-time polymerase chain reaction. And pathology report, containing proliferative activity and breast cancer hormonal status, was obtained after surgery of the case individuals. Statistical analysis was done to investigate the significance of data obtained from genotyping and histology reports.

Results Statistical analysis revealed that the difference in frequency of genotypes was not statistically significant between cases and controls (chi-square = 0.5812, p = 0.7478). The comparison of proliferative activity of cases with AA genotypes and AG/GG genotypes showed no statistical difference (t = 0.2575, p = 0.7980). Although when put into a plot (box and whiskers), patients with AG/GG genotype have outliers with very high proliferative activity.

Conclusion This study shows that -1082 A/G SNP in the promoter region of the IL-10 gene is not associated with breast cancer risk in Georgian women.
Ophthalmic Education: The Top 100 Cited Articles in Ophthalmology Journals
Authors: Khan Asher , Rangu Neal , Thanitcul Chanon , Riaz Kamran M. , Woreta Fasika A.
Published: July 2023

Purpose To identify the top 100 (T100) cited articles on ophthalmic education and examine trends and areas of focus in ophthalmic education.

Methods A literature search was conducted for articles published between 2011 and 2021 related to ophthalmic education within ophthalmology journals using the ISI Web of Science Core Collection database. The search was performed in June 2022 and was conducted using the search phrase ([educat* OR teach* OR instruct* OR train* OR “medical student*” OR residen* OR fellow* OR undergrad* OR postgrad* OR “faculty” OR “attending”] AND *ophthalm*). Results were analyzed using VOSviewer v.1.6.18 and statistical analysis was performed using Microsoft Excel.

Results The majority of articles were published in the Journal of Cataract & Refractive Surgery (19%), followed by Ophthalmology (12%), and Eye (12%). Articles were most often published in the year 2013 (15%), followed by 2014 (12%) and 2012 (12%). Articles most commonly originated from English-speaking countries, including the United States (43%), England (14%), Canada (8%), and India (8%). Topics most often examined in ophthalmic education were resident education (51%), medical school education (21%), and surgical training (21%). The most common study types were cohort studies (22%), case series (21%), and prospective trials (16%). There were 16 institutions that produced more than one article in the T100 articles list.

Conclusion The T100 articles on ophthalmic education were primarily U.S. based and focused on resident education, surgical training, and medical school ophthalmic curriculum. Further research into ophthalmic education is warranted to establish evidence-based curricula guidelines.
Surgical treatment of temporal lobe epilepsy: comparative results of selective amygdalohippocampectomy versus anterior temporal lobectomy from a referral center in Brazil
Authors: Almeida Laryssa Crystinne Azevedo , Lobato Vanessa Alves , Santos Maria do Carmo Vasconcelos , Moraes Aline Curcio de , Costa Bruno Silva
Published: July 2023

Background Temporal lobe epilepsy (TLE) is a high prevalence neurological disorder. Surgery has emerged as a promising treatment.

Objective The objective of this work is to compare the surgical results of anterior temporal lobectomy (ATL) versus selective amygdalohippocampectomy (SAH) in a cohort of 132 patients.

Methods We performed a retrospective study of 146 patients operated for TLE from 2008 to 2019. Initially, 13 patients were excluded from the study due to insufficient medical record data or follow-up loss. One patient was excluded from the analysis of the results due to death in the first postoperative week. We used the ILAE scale to classify seizure control after surgery. In patients with left hippocampal sclerosis, SAH was performed and in right temporal lobe epilepsy, ATL was the approach of choice.

Results The mean follow-up time after surgery was 57.2 months (12–137). In our data analysis, we found that the group of patients undergoing ATL had a higher prevalence of being completely seizure-free (ILAE I) (57.1% versus 31%) and a higher rate of satisfactory seizure control (88.6% versus 69.3%) p = 0,006, when compared with patients undergoing SAH.

Conclusion The literature is still controversial about seizure control concerning the technique used due to the lack of a robust methodology. Our data analysis identified the superiority of ATL over SAH in seizure outcomes. ATL may be the best option for adequately controlling seizures with minimal additional morbidity in countries with a cost limitation for extended propaedeutics.
Molecular Evaluation of Joubert Syndrome and Hearing Impairment in a Patient with Ataxic Cerebral Palsy
Authors: Sreedevi N. , Swapna N. , Maruthy Santosh , Jayakumar T. , Sylvester Charles
Published: July 2023

Joubert syndrome (JBTS) is a rare autosomal recessive or X-linked congenital brain malformation with strong genetic heterogeneity. Other neurological features of JBTS include hypotonia, ataxia, developmental delay, and cognitive impairment. Hearing loss with JBTS has been reported in the literature. We present the case of a 3.5-year-old boy born to a healthy consanguineous South Indian couple who was presented with ataxic cerebral palsy (CP) and hearing impairment; medical reports confirmed typical brain malformations of JBTS. Hearing impairment was screened by audiological assessment, which confirmed the presence of severe-profound hearing loss with outer hair cell dysfunction. Whole-exome sequencing (WES) was performed to know the molecular aspects of the condition and to detect any novel mutations. The homozygous mutation AHI1 c.2023G > A associated with JBTS type 3 and GJB2 c.71G > A mutation associated with hearing impairment were identified. Sanger sequencing was performed to validate the result and it identified heterozygous AHI1 c.2023G > A and GJB2 c.71G > A in the patient's parents. This study confirms the diagnosis of JBTS by WES helps identify the genetic causes of hereditary disorders that accelerate genetic evaluation and counseling for at-risk families.
Outcomes of Pediatric Endoscopic Pilonidal Sinus Treatment: A Systematic Review
Authors: Mentessidou Anastasia , Mirilas Petros , Maravilla Veniza , Malakounides Georgina
Published: July 2023

Treatment of pilonidal sinus disease with conventional excision techniques is associated with recurrence up to 20 to 30% (primary closure) or with prolonged healing that might last months (closure by secondary intention). Endoscopic pilonidal sinus treatment (EPSiT) is gaining increasing popularity. This systematic review aims to summarize and evaluate the reported outcomes of pediatric EPSiT (PEPSiT) to date. Systematic search was performed for all studies on PEPSiT in patients younger than 18 years, pertaining to demographics, technique, and outcomes. Fisher's test was used to assess the associations between success/recurrence rates and different approaches (fistuloscope vs. cystoscope, different wound care protocols). A total of 320 patients (9 studies, 2018–2022) with a weighted mean age of 15.7 years and follow-up duration of 13.5 months were included. PEPSiT was successful in 290 patients (90.9%) with weighted mean time to healing of 4.1 weeks. Recurrence was reported in 29 patients (9.1%) with weighted mean time to recurrence of 4.6 months. Outcomes were not significantly altered by the use of fistuloscope versus pediatric cystoscope (p = 1.0), or with perioperative laser epilation (p = 0.06), or postoperative regular shaving, depilatory creams, light pulse, or laser (p = 0.31). The weighted mean operative time was 38 minutes and hospital stay was 16 hours. Summary of available evidence confirms that PEPSiT is safe and effective. Added to its noninvasiveness, PEPSiT's pooled outcomes appear superior to those of numerous conventional techniques. Comparison with conventional techniques, particularly off-midline flap and semi-closure procedures, is, however, lacking. The superiority of PEPSiT needs to be confirmed in future comparative studies, including cost–benefit analysis.
Fetoscopic Laser Ablation of Type II Vasa Previa: A Cost Benefit Analysis
Authors: Monson Martha A. , Chmait Ramen H. , Einerson Brett
Published: July 2023

Objective We aimed to compare costs of two strategies for third-trimester type II vasa previa management: (1) fetoscopic laser ablation surgery (FLS) referral and (2) standard management (SM).

Study Design A decision analytic model and cost-benefit analysis from a health care perspective were performed. The population included patients with type II vasa previa at approximately 32 weeks. SM entailed 32-week antepartum admission and cesarean at approximately 35 weeks. FLS referral included consultation and possible laser surgery at 32 weeks for willing/eligible candidates. Successful laser surgery allowed the possibility of term vaginal delivery. Outcomes included antepartum admission, preterm birth, cesarean, neonatal transfusion, and death. Sensitivity analyses were performed.

Results In base case analysis, FLS referral was cost saving compared with SM (total cost per patient $65,717.10 vs. 71,628.16). FLS referrals yielded fewer antepartum admissions, cesareans, premature births, neonatal transfusions, and deaths. Eligible referred patients choosing FLS incurred a total cost of $41,702.46, a >40% decrease compared with SM. FLS referral was cost saving in all one-way sensitivity analyses except when antepartum admission costs were low. In threshold analyses, FLS referral was cost saving unless laser surgery cost was >$39,892 (2.75x expected cost), antepartum admission cost for monitoring of vasa previa or ruptured membranes was <$7,455, <11% patients were eligible for laser surgery, and when <12% of eligible patients chose laser surgery. In two-way sensitivity analysis, FLS referral was cost saving except at very high laser surgery costs and extremely low antepartum admission costs.

Conclusion Referral for FLS for type II vasa previa was cost saving and improved outcomes compared with SM, despite upfront costs, fetoscopy-related risks, and many patients being ineligible or not opting for surgery after referral.

Key Points