bluuebunny/crossref_metadata_2025 huggingface dataset:
Automated traffic sign and light pole detection in mobile LiDAR scanning data
Authors: Javanmardi Mohammadreza , Song Ziqi , Qi Xiaojun
Published: December 2018

Detection of traffic signs and light poles using light detection and ranging (LiDAR) data has demonstrated a valid contribution to road safety improvements. In this study, the authors propose a fast and reliable method, which can identify various traffic signs and light poles in mobile LiDAR data. Specifically, they first use the surface reconstruction algorithm to extract the normal vectors of the points as one of the characteristic features and apply k ‐means on the characteristic features of the points to automatically segment the data into road or non‐road points. They then employ sliding cuboids to search for high‐elevated objects that are located near the borders and on top of the road points. They further employ the random sample consensus algorithm to remove outliers and keep the points that fall on the perpendicular planes to the road trajectory. Finally, they introduce a modified seeded region growing algorithm to remove noisy points and incorporate the shape information to reject the false objects. A set of extensive experiments have been carried out on the datasets that are captured by Utah Department of Transportation from I‐15 highway. The results demonstrate the robustness of the proposed method in detecting almost all traffic signs and light poles.
Modular control with carrier auto‐interleaving and capacitor‐voltage balancing for MMCs
Authors: Seleme Seleme Isaac , Grégoire Luc‐André , Cousineau Marc , Ladoux Philippe
Published: December 2018

In this study, a new control method dedicated to modular multilevel converters (MMCs) is proposed. The approach is based on local communication between the individual controls of each submodule (SM). The local values of the capacitor voltages and the carrier‐phase angles are shared between immediate neighbours achieving balancing of their capacitor voltages, and an automatic interleaving of the pulse‐width modulation (PWM) signals. Using an inter‐cell communication strategy, the number of required data exchanges with a centralised controller is greatly reduced. This method works for any number of SMs present in the converter and provides an integrated dynamic reconfiguration capability to enable or disable SMs during operation, without any additional consideration for the control‐algorithm's implementation. Such a capability is not offered by classical MMC control methods using either PWM or nearest‐level control strategies. Higher stability, robustness and larger bandwidth of the proposed method are first demonstrated through real‐time simulation. The auto‐interleaving of the PWM carriers and the capacitor‐voltage balancing, provide fast responses and adequate accuracy. Experimental results are provided using a 600 V/3 kW/18 cells single‐phase MMC demonstrator confirming the simulation results, and the advantages of this SM control strategy.
Centralised model‐predictive decoupled active–reactive power control for three‐level neutral point clamped photovoltaic inverter with preference selective index‐based objective prioritisation
Authors: Bonala Anil Kumar , Sandepudi Srinivasa Rao
Published: December 2018

This study presents a single‐stage grid‐tied three‐level neutral point clamped photovoltaic inverter with a centralised model‐predictive decoupled active–reactive power control. The proposed centralised model predictive control (CMPC) incorporates the constraints of maximum power extraction, dc‐link capacitor voltage balancing and active–reactive power tracking in a single objective function. The dc‐link voltage of the inverter is regulated to its reference for extracting the maximum power. In order to eliminate the impact of reactive power exchange on floating dc‐link voltage regulation, a decoupled active–reactive power control is used in the CMPC. Furthermore, a preference selective index‐based dynamic weighting factor selection approach is introduced to maintain the relative importance between the power tracking and dc‐link capacitor voltage balancing. The proposed control approach eliminates the outer dc‐link voltage control loop and also, the empirical approach required for the selection of weighting factors. As a result, it ensures an optimal control action in each sampling period to improve the steady‐state and dynamic tracking performance of the control objectives. The proposed control approach is experimentally verified by using a 1.2 kW laboratory‐scale prototype and the results are presented to demonstrate its effectiveness compared to the classical proportional–integral‐based model predictive control.
Optimal battery sizing considering degradation for renewable energy integration
Authors: de la Torre Sebastián , González‐González José M. , Aguado José A. , Martín Sebastián
Published: December 2018

The problem of sizing an electrochemical energy storage system for renewable energy integration is a complex task. There are several system input parameters that must be taken into account for a correct design. Among them, the ageing characteristic of the technology, the service that the system provides, i.e. the power profile that the system faces and the desired C‐rate are considered. A simple solution for this problem is not available in the literature. This study presents a simple yet robust optimisation‐based model for renewable energy integration. The model explicitly takes into account the intrinsic battery ageing process. The authors propose a formulation for the optimisation problem that can be written in terms of just one continuous variable, namely, the amount of energy that the battery is able to store (battery size); using the proposed procedure, solving the problem obtained is a relatively straightforward task. Results are first discussed using an illustrative example and later extended to two real case studies.
Enhanced control and parameter analysis for virtual synchronous generators without PLL
Authors: Zhang Bo , Zhang Xueyuan , Song Zijun , Yan Xiangwu
Published: December 2018

Currently, virtual synchronous generator (VSG) technology is proposed to be a solution to stability controlling of micro‐source inverter. However, the deviation from phase locked loop (PLL) influences the reference frequency calculating which is important to the VSG control system. This paper focuses on the virtual inertia controller in the VSG control system, an enhanced controller is achieved for avoiding the effect of PLL on the VSG dynamics. For analysing dynamic characteristics of the enhanced VSG control system, the linearised small‐signal model of VSG in isolated operation is well established, including electrical system, enhanced virtual inertia controller, voltage and current controller, virtual impedance, and droop controller. By small‐signal stability analysis, the influence rules of the main parameters (load, line, virtual inertia and proportional‐Integral gain) on VSG system impacts are provided, which helps identifying possible feedback signals for controller design to improve the system stability. Results obtained from time‐domain small‐signal model are compared with those from the electrical simulation to verify its accuracy.
Simulation analysis of intermittent arc grounding fault applying with improved cybernetic arc model
Authors: Li Shurong , Xue Yongduan , Feng Guang , Xu Bingyin
Published: December 2018

Intermittent arc grounding fault frequently occurs in non‐solidly earthed networks. Establishing an accurate arc model is the basis for analysis of fault characteristics. First of all, an improved cybernetic arc model is introduced in this study, which can effectively demonstrate arcing process through controlling the arc length, and which is applied to simulation analysis of intermittent arc grounding fault. Then, a novel method is proposed to identify when the arc would extinguish or restrike. Arc extinction is determined by comparing the stable ignition voltage and air withstand voltage, while arc reignition is dependent on the competition between recovery voltage and air withstand voltage. Finally, a typical simulation model of 10 kV distribution network is built via PSCAD, and impacts of arc model parameters on fault characteristics are analysed. Comparison between simulation results and field data indicates that the arc model can accurately describe arc characteristics and that the intermittent arc grounding overvoltage generated by the suggested method is consistent with the actual case. In the Petersen coil grounded system, arc reignition times turns to be fewer, intermittent arc duration shorter and the overvoltage amplitude lower than those in the isolated neutral system.
Development of magnetic‐wedge linear adjustable reactor
Authors: Guan Ruiyang , Wei Xinlao , Chen Qingguo
Published: December 2018

Adjustable reactor is an important VAR compensator for AC system, so it has practical significance to do researches on this device. This paper proposed a method of adjusting inductance value based on a controlled magnetic‐wedge, which could change the air‐gap in the magnetic path by adjusting the depth it inserted. The reactor based on this method was named as magnetic‐wedge linear adjustable reactor. Its working principle and inductance's mathematical models were analysed in detail. ANSYS was used to simulate reactor's magnetic field in order to verify the analysis previously. A prototype was made and its inductance's adjustment curve was measured. Results showed that: the inductance's adjustment curve was a piecewise function. When the magnetic‐wedge was in positive section, the relationship between inductance and depth of magnetic‐wedge inserted was a linear function. If the magnetic‐wedge was totally inserted, the air‐gap was minimum while inductance was maximum. If the magnetic‐wedge was totally pulled out, the air‐gap was maximum while inductance was minimum. When the magnetic‐wedge was in negative section, the relationship between inductance and magnetic‐wedge's position was a double‐exponential function, the nearer magnetic‐wedge's position was, the more sensitively the inductance changed. Magnetic‐wedge could control magnetic flux path and restrain air‐gap edge effect.
Fault location in AC transmission lines with back‐to‐back MMC‐HVDC using ConvNets
Authors: Zhu Beier , Wang Haozong , Shi Shenxing , Dong Xinzhou
Published: December 2018

The back‐to‐back modular multi‐level converter–high‐voltage DC (MMC‐HVDC) system is gaining popularity in the field of enhancing power transmission capacity but poses challenges to fault diagnosis. A novel method for the fault location for such a system based on convolutional networks (ConvNets) is presented. The proposed method uses voltages and currents of only one terminal of transmission lines. Compared with existing methods, the proposed method automatically learns features from a dataset of voltage and currents signals. The fault location is then achieved by linear regression with an L 1 penalty using the features extracted by ConvNets. Additionally, the fault location network is trained jointly with fault‐type information to improve performance. The feasibility of the proposed method has been verified on a 220 kV back‐to‐back MMC‐HVDC transmission system for various fault locations and under different fault conditions using power systems computer‐aided design (PSCAD)/electro magnetic transient design and control (EMTDC). Results show that the proposed method can locate faults using one cycle data with high accuracy.
Improving breakdown performance for SOI LDMOS with sidewall field plate
Authors: Tang Pan‐pan , Wang Ying , Bao Meng‐tian , Luo Xin , Cao Fei , Yu Cheng‐hao
Published: December 2018

In this work, a silicon‐on‐insulator (SOI) lateral diffused MOSFET (LDMOS) incorporated with sidewall field plate (SEP) is presented and investigated using three‐dimensional numeric simulation. A new additional electric field peak is formed, due to the compound field plate established along the n‐drift region. The lateral surface electric field can be modulated, which enhances the breakdown voltage. Meanwhile, the doping concentration of n‐drift region is increased, which decreases the specific on‐resistance. Compared with the superjunction LDMOS, a 23.7% increase in the breakdown voltage and a 21.7% decrease in the specific on‐resistance are obtained in the SFP‐LDMOS device.
Arylpyridines: A Review from Selective Synthesis to Atropisomerism
Authors: Czarnocki Zbigniew , Pomarański Piotr
Published: December 2018

Multiply arylated heterocycles are interesting structures with highly useful functions and fascinating optoelectronic and biological properties. Pyridines are an important class of compounds, playing a role in various fields of chemistry. When the pyridine ring is connected to other aromatic systems, novel stereochemical outcomes may arise. This work summarizes different methodologies applied for the synthesis of substituted arylpyridine derivatives and summarizes stereochemical phenomena resulting from atropisomerism present in certain arylated pyridines.

1 Introduction

2 Arylpyridines Containing meta- and para-Substituted Phenyl Groups

2.1 Arylpyridine Derivatives as Amphetamine Analogues Markers

2.2 Site-Selective Synthesis of Arylpyridines

3 Atropisomerism in Arylpyridines Containing ortho-Substituted Phenyl Groups

3.1 Synthesis of Arylpyridines Containing ortho-Substituted Phenyl Groups

3.2 Other Methods for the Preparation of Arylated Pyridines

4 Fully Substituted Pyridine Derivatives

4.1 Site-Selective Synthesis of Fully Arylated Pyridines

4.3 Atropisomerism in Densely Substituted Arylpyridines Containing ortho-Substituted Phenyl Groups

5 Enantioselective Synthesis of Arylpyridine Derivatives

6 Conclusion
Cardiovascular and Metabolic Risk in Women in the First Year Postpartum: Allostatic Load as a Function of Race, Ethnicity, and Poverty Status
Authors: Shalowitz Madeleine U. , Schetter Christine Dunkel , Hillemeier Marianne M. , Chinchilli Vernon M. , Adam Emma K. , Hobel Calvin J. , Ramey Sharon Landesman , Vance Maxine Reed , O'Campo Patricia , Thorp John M. , Seeman Teresa E. , Raju Tonse N. K. ,   Eunice Kennedy Shriver National Institute of Child Human Development Community Child Health Network
Published: December 2018

Objective Allostatic load (AL) represents multisystem physiological “wear-and-tear” reflecting emerging chronic disease risk. We assessed AL during the first year postpartum in a diverse community sample with known health disparities.

Study Design The Eunice Kennedy Shriver National Institute for Child Health and Human Development Community Child Health Network enrolled 2,448 predominantly low-income African-American, Latina, and White women immediately after delivery of liveborn infants at ≥20 weeks' gestation, following them over time with interviews, clinical measures, and biomarkers. AL at 6 and 12 months postpartum was measured by body mass index, waist:hip ratio, blood pressure, pulse, hemoglobin A1c, high-sensitive C-reactive protein, total cholesterol and high-density lipoprotein, and diurnal cortisol slope.

Results Adverse AL health-risk profiles were significantly more prevalent among African-American women compared with non-Hispanic Whites, with Latinas intermediate. Breastfeeding was protective, particularly for White women. Complications of pregnancy were associated with higher AL, and disparities persisted or worsened through the first year postpartum.

Conclusion Adverse AL profiles occurred in a substantial proportion of postpartum women, and disparities did not improve from birth to 1 year. Breastfeeding was protective for the mother.
Association of Antenatal Depression with Clinical Subtypes of Preterm Birth
Authors: Venkatesh Kartik , Ferguson Kelly , Smith Nicole , Cantonwine David , McElrath Thomas
Published: December 2018

Objective To estimate the association between antenatal depression and spontaneous preterm birth (SPTB) relative to medically indicated preterm birth (MPTB).

Study Design This was a secondary analysis of a nested case–control study of preterm birth (PTB). The exposure was a clinical diagnosis of antenatal depression. The outcome was PTB at <37 weeks classified as SPTB (spontaneous labor, preterm premature rupture of membranes, placental abruption, and cervical shortening); and MPTB (preeclampsia and intrauterine growth restriction). Multinomial logistic regression models compared women without PTB versus MPTB and SPTB, adjusting for age, race, parity, tobacco use, insurance status, and prepregnancy body mass index, and history of PTB for SPTB.

Results Among 443 pregnant women, 15.6% had an SPTB and 8.6% had an MPTB, and 16% were diagnosed with antenatal depression. Women with an SPTB were three times more likely to have antenatal depression compared with women without an SPTB (adjusted odds ratio [AOR]: 2.81; 95% confidence interval [CI]: 1.40–5.63). No significant association was identified between antenatal depression and MPTB (AOR: 1.77; 95% CI: 0.67–4.62). The association between antenatal depression and SPTB did not change after adjusting the aforementioned model for a history of PTB and antidepressant use.

Conclusion Antenatal depression may differentially affect the risk of PTB through an increase in the odds of SPTB. These results have implications for future studies on prevention and treatment options for depression and PTB.
Therapeutic Hypothermia in Brazil: A MultiProfessional National Survey
Authors: Variane G. F. , Cunha L. M. , Pinto P. , Brandao P. , Mascaretti R. S. , Magalhães Mauricio , Sant'Anna Guilherme M.
Published: December 2018

Objective To determine the rate of therapeutic hypothermia (TH) use, current practices, and long-term follow-up.

Study Design Prospective cross-sectional national survey with 19 questions related to the assessment of hypoxic–ischemic encephalopathy (HIE) and TH practices. An online questionnaire was made available to health care professionals working in neonatal care in Brazil.

Results A total of 1,092 professionals replied, of which 681 (62%) reported using TH in their units. Of these, 624 (92%) provided TH practices details: 136 (20%) did not use any neurologic score or amplitude-integrated electroencephalogram (aEEG) to assess encephalopathy and 81(13%) did not answer this question. Any specific training for encephalopathy assessment was provided to only 81/407 (19%) professionals. Infants with mild HIE are cooled according to 184 (29%) of the respondents. Significant variations in practice were noticed concerning time of initiation and cooling methods, site of temperature measurements and monitoring, and access to aEEG, electroencephalogram (EEG), and neurology consultation. Only 19% could perform a brain magnetic resonance imaging (MRI), and 31% reported having a well-established follow-up program for these infants.

Conclusion TH has been implemented in Brazil but with significant heterogeneity for most aspects of hypothermia practices, which may affect safety or efficacy of the therapy. A step forward toward quality improvement is important.
Accuracy of Prenatal Diagnosis of Congenital Cardiac Malformations
Authors: Pinheiro Diesa Oliveira , Varisco Bruna Boff , Silva Marcelo Brandão da , Duarte Rafaela Silva , Deliberali Graciele Dequi , Maia Carlos Roberto , Jiménez Mirela Foresti , El Beitune Patrícia
Published: December 2018

Objective To evaluate the accuracy of the diagnosis of fetal heart diseases obtained through ultrasound examinations performed during the prenatal period compared with the postnatal evaluation.

Methods A retrospective cohort study with 96 pregnant women who were attended at the Echocardiography Service and whose deliveries occurred at the Complexo Hospitalar Santa Casa de Porto Alegre, in the state of Rio Grande do Sul, Brazil. Risk factor assessment plus sensitivity and specificity analysis were used, comparing the accuracy of the screening for congenital heart disease by means of obstetrical ultrasound and morphological evaluation and fetal echocardiography, considering p < 0.05 as significant. The present study was approved by the Research Ethics Committee of the Institution.

Results The analysis of risk factors shows that 31.3% of the fetuses with congenital heart disease could be identified by anamnesis. The antepartum echocardiography demonstrated a sensitivity of 97.7%, a specificity of 88.9%, and accuracy of 93% in the diagnosis of congenital heart disease. A sensitivity of 29.3% was found for the obstetric ultrasound, of 54.3% for the morphological ultrasound, and of 97.7% for the fetal echocardiography. The fetal echocardiography detected fetal heart disease in 67.7% of the cases, the morphological ultrasound in 16.7%, and the obstetric ultrasound in 11.5% of the cases.

Conclusion There is a high proportion of congenital heart disease in pregnancies with no risk factors for this outcome. Faced with the disappointing results of obstetric ultrasound for the detection of congenital heart diseases and the current unfeasibility of universal screening of congenital heart diseases through fetal echocardiography, the importance of the fetal morphological ultrasound and its performance by qualified professionals is reinforced for a more appropriate management of these pregnancies.
Effect of Narcotic Analgesics on the Ultrastructure of the Eyeball (Experimental Study)
Authors: Pidvalna Uliana , Kost Andriy , Mateshuk-Vatseba Lesya
Published: December 2018

Background The use of opioids among people of the young and working age has sharply increased in recent years simultaneously with the outbreak observed in the general population.

Objective To determine the trigger mechanism of the destructive effect of narcotic analgesics on the ultrastructural level of the vascular tunic of the eyeball. Methods: This experimental study was performed on 26 male rats aged 3.0 months and body weight 160–180 g with daily intramuscular injection of Nalbuphine hydrochloride during 4 weeks. The material for the study was represented by ultramicroscopic sections of the vascular tunic of the eyeball.

Results In comparison with the control group there was observed swelling of the cytoplasm and the nuclei of endotheliocytes, considerably narrowed lumens of the capillaries. Plasmolemma of endotheliocytes forms protrusions into the lumen of endotheliocytes forming microvilli. Changes of destructive nature took place in the elements of the smooth endoplasmic reticulum and mitochondrial complex. Signs that are characteristic of sclerosis were found in the surrounding connective tissue complex. In particular, lesions of endothelium and basement membrane of the elements of hemomicrocirculatory bloodstream, epithelium of the ciliary processes, cellular and non-cellular elements of the iris and the uvea proper have studied.

Conclusion The databased on the experimental model allow extrapolation the results obtained to humans. It is confirmed that the development of angiopathy is the trigger mechanism of the destructive effect of narcotic analgesics.
3‐min whole body cryotherapy/cryostimulation after training in the evening improves sleep quality in physically active men
Authors: Douzi Wafa , Dupuy Olivier , Tanneau Maxence , Boucard Geoffroy , Bouzigon Romain , Dugué Benoit
Published: December 2018

Exercise training during evening may disturb sleep patterns and hinder recovery process. The present study aimed to examine the effect of whole body cryotherapy (WBC) exposure after training in the evening on sleep quality and night heart rate variability (HRV). A total of 22 physically active men were randomized to undergo either WBC (3‐min at −40°C, wind speed of 2.3 m s−1) or passive recovery (control) following an evening training consisting of 25 min of continuous running at 65% of the maximal aerobic speed (MAS) followed by intermittent running at 85% of the MAS. Each night following the training, the number of movements and HRV during sleeping time were recorded. The next morning, subjective sleep quality and perceived pain were assessed using Spiegel questionnaire and a visual analogue scale, respectively. The number of movements during the night following WBC was significantly reduced (p < 0.05) compared with the control condition. Subjective sleep quality following WBC was significantly better than the control group (p < 0.05). During the estimated slow‐wave sleep (SWS), the high frequency power (HF) was higher in the WBC group than the control group (p < 0.05), and the low frequency power (LF) and the LF/HF ratio were lower than the control group (p < 0.05). Pain was significantly reduced following WBC compared to the control (p < 0.01). In conclusion, the use of 3‐min WBC after training in the evening improves subjective and objective sleep quality in physically active subjects, which may be due to greater pain relief and improved parasympathetic nervous activity during the SWS period.
Directionally compensated mechanical work provided by the shoulder leads to similar racket velocities during open and square stance forehand groundstrokes in tennis*
Authors: Kawamoto Yuta , Iino Yoichi , Yoshioka Shinsuke , Fukashiro Senshi
Published: December 2018

The differences between the racket‐arm acceleration mechanisms during open and square stance forehand groundstrokes in tennis were examined by quantifying the mechanical work done on the racket arm. We studied 13 advanced tennis players as they performed these strokes at maximum effort and calculated the work using inverse dynamics. The racket head speed was similar between the open and square stances. In the open stance, the lack of weight shifting towards the hitting direction resulted in a lower velocity for the shoulder joint centre in the hitting direction than in the square stance, and less work was done by the shoulder joint force in the hitting direction in the open stance than in the square stance (0.30 ± 0.11 J·kg‐1 vs. 0.38 ± 0.16 J·kg‐1; p = 0.005). However, in the open stance, the torso rotated more towards the hitting direction and had more upward acceleration, which resulted in more work done by the sideways and upward shoulder joint forces than in the square stance (sideways: 0.07 ± 0.09 J·kg‐1 vs. 0.05 ± 0.09 J·kg‐1, p = 0.046; upward: 0.08 ± 0.09 J·kg‐1 vs. 0.04 ± 0.07 J·kg‐1, p = 0.002). Thus, the greater work done by the sideways and upward shoulder joint forces compensated for the lesser work done by the shoulder joint force in the hitting direction in the open stance. In both stances, mainly the horizontal flexion torque and internal rotation torque at the shoulder increased the energy of the racket arm.
Mothers, Peers, and Gender-Role Identity
Authors: Olivetti Claudia , Patacchini Eleonora , Zenou Yves
Published: December 2018

We study whether a woman’s labor supply as a young adult is shaped by the work behavior of her adolescent peers’ mothers. Using detailed information on a sample of U.S. teenagers who are followed over time, we find that labor force participation of high school peers’ mothers affects adult women’s labor force participation, above and beyond the effect of their own mothers. The analysis suggests that women who were exposed to a larger number of working mothers during adolescence are less likely to feel that work interferes with family responsibilities. This perception, in turn, is important for whether they work when they have children.
Localization of Muscle Edema and Changes on Muscle Contractility After Dry Needling of Latent Trigger Points in the Gastrocnemius Muscle
Authors: Baraja-Vegas Luis , Martín-Rodríguez Saúl , Piqueras-Sanchiz Francisco , Faundez-Aguilera José , Bautista Iker J , Barrios Carlos , Garcia-Escudero Maria , Fernández-de-las-Peñas César
Published: December 2018

In this article, we aimed to describe what happens in skeletal muscle after dry needling intervention using magnetic resonance imaging (to show if there is edema) and tensiomyography (to measure contractile properties). At the same time, we describe the relationship between pain, edema, and contractility. Our results suggest that in asymptomatic patients, the application of dry needling over latent trigger points produce intra-muscular edema, an increase in muscle stiffness and an improved muscle contraction time.
CE: Original Research: Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses: An Exploration of the Use of Protective Gloves and Gowns
Authors: Lawson Christina C. , Johnson Candice Y. , Nassan Feiby L. , Connor Thomas H. , Boiano James M. , Rocheleau Carissa M. , Chavarro Jorge E. , Rich-Edwards Janet W.
Published: December 2018

Background: Many antineoplastic (chemotherapeutic) drugs are known or probable human carcinogens, and many have been shown to be reproductive toxicants in cancer patients. Evidence from occupational exposure studies suggests that health care workers who have long-term, low-level occupational exposure to antineoplastic drugs have an increased risk of adverse reproductive outcomes. It's recommended that, at minimum, nurses who handle or administer such drugs should wear double gloves and a nonabsorbent gown to protect themselves. But it's unclear to what extent nurses do.

Purpose: This study assessed glove and gown use by female pregnant and nonpregnant nurses who administer antineoplastic drugs in the United States and Canada.

Methods: We used data collected from more than 40,000 nurses participating in the Nurses’ Health Study 3. The use of gloves and gowns and administration of antineoplastic drugs within the past month (among nonpregnant nurses) or within the first 20 weeks of pregnancy (among pregnant nurses) were self-reported via questionnaire.

Results: Administration of antineoplastic drugs at any time during their career was reported by 36% of nonpregnant nurses, including 27% who reported administering these drugs within the past month. Seven percent of pregnant nurses reported administering antineoplastic drugs during the first 20 weeks of pregnancy. Twelve percent of nonpregnant nurses and 9% of pregnant nurses indicated that they never wore gloves when administering antineoplastic drugs, and 42% of nonpregnant nurses and 38% of pregnant nurses reported never using a gown. The percentage of nonpregnant nurses who reported not wearing gloves varied by type of administration: 32% of those who administered antineoplastic drugs only as crushed pills never wore gloves, compared with 5% of those who administered such drugs only via infusion.

Conclusion: Despite longstanding recommendations for the safe handling of antineoplastic and other hazardous drugs, many nurses—including those who are pregnant—reported not wearing protective gloves and gowns, which are considered the minimum protective equipment when administering such drugs. These findings underscore the need for further education and training to ensure that both employers and nurses understand the risks involved and know which precautionary measures will minimize such exposures.
Association of Facility Type With Procedural-Related Morbidities and Adverse Events Among Patients Undergoing Induced Abortions
Authors: Roberts Sarah C. M. , Upadhyay Ushma D. , Liu Guodong , Kerns Jennifer L. , Ba Djibril , Beam Nancy , Leslie Douglas L.
Published: December 2018

(Abstracted from JAMA 2018;319:2497–2506)

Despite the ruling in June 2016 by the US Supreme Court that the Texas law requiring abortion facilities to meet ambulatory surgery center (ASC) standards is unconstitutional, 13 states still have laws requiring abortions to be provided in these centers. Supporters of these laws have argued that ASC requirements make abortion safer.
Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement
Authors: Curry Susan J. , Krist Alex H. , Owens Douglas K. , Barry Michael J. , Caughey Aaron B. , Davidson Karina W. , Doubeni Chyke A. , Epling John W. , Kemper Alex R. , Kubik Martha , Landefeld C. Seth , Mangione Carol M. , Phipps Maureen G. , Silverstein Michael , Simon Melissa A. , Tseng Chien-Wen , Wong John B.
Published: December 2018

(Abstracted from JAMA 2018;320:674–686)

The number of deaths from cervical cancer in the United States has decreased substantially since the 1960s and especially during the last 2 decades because of the implementation of widespread cervical cancer screening. Most cases of this cancer occur in women who have not been adequately screened.
Periconception Glycemic Control in Women With Type 1 Diabetes and Risk of Major Birth Defects: Population-Based Cohort Study in Sweden
Authors: Ludvigsson Jonas F. , Neovius Martin , Söderling Jonas , Gudbjörnsdottir Soffia , Svensson Ann-Marie , Franzén Stefan , Stephansson Olof , Pasternak Björn
Published: December 2018

(Abstracted from BMJ 2018;362:k2638)

Poor glycemic control has been linked to both immediate (eg, ketoacidosis) and long-term (eg, mortality and cardiovascular disease) complications in people with type 1 diabetes. The risk of pregnancy-related complications is of particular relevance to women with type 1 diabetes.
Prenatal Biochemical Screening and Long Term Risk of Maternal Cardiovascular Disease: Population Based Cohort Study
Authors: Ray Joel G. , Huang Tianhua , Meschino Wendy S. , Cohen Eyal , Park Alison L.
Published: December 2018

(Abstracted from BMJ 2018;362:k2739)

Placental vascular disease is thought to arise within the temporary interface of the trophoblast and endometrial decidua, resulting in adverse outcomes for mother and fetus, including preeclampsia, placental abruption, poor fetal growth, and preterm birth. Some risk factors for placental vascular disease, including for preeclampsia, are the same as those for cardiovascular disease.
Association Among Depression, Symptom Experience, and Quality of Life in Polycystic Ovary Syndrome
Authors: Greenwood Eleni A. , Pasch Lauri A. , Cedars Marcelle I. , Legro Richard S. , Huddleston Heather G.
Published: December 2018

(Abstracted from Am J Obstet Gynecol 2018;219:279.e1–279.e7)

Polycystic ovary syndrome (PCOS) affects up to 15% of reproductive-age women. Symptoms of PCOS include hirsutism, obesity, menstrual disturbances, and infertility; these impair health-related quality of life among women with the syndrome.
Cardiac Autonomic Effects of Secondhand Exposure to Nicotine from Electronic Cigarettes
Authors: Lee Mi-Sun , Rees Vaughan W. , Koutrakis Petros , Wolfson Jack M. , Son Youn-Suk , Lawrence Joy , Christiani David C.
Published: December 2018

Background:

The rapid increase in prevalence of e-cigarette (EC) use may lead to widespread exposure to secondhand emissions among nonsmokers, but evidence on the potential cardiovascular health risks is limited. We aimed to investigate the effect of short-term secondhand exposure to nicotine from e-cigarette (EC) emissions on cardiac autonomic function using heart rate variability (HRV).

Methods:

A randomized, repeated measures crossover study of healthy nonsmoking volunteers was conducted. Standard deviation of NN intervals (SDNN), average of the standard deviation of NN intervals (ASDNN), root mean square of successive differences (rMSSD), and heart rate–corrected QT interval (QTc) were calculated during 1 hour of EC exposure session.

Results:

Nicotine from EC emissions was associated with a 7.8% decrease in SDNN (95% CI [confidence interval]: −11.2%, −4.3%), 7.7% decrease in ASDNN (95% CI: −11.0%, −4.2%), and 3.8 milliseconds decrease in QTc (95% CI: −5.8, −1.9). Compared with a short exposure time period (<15 minutes), greater nicotine associated with reductions in ASDNN (P
for interaction = 0.076) with longer exposure time periods. For QTc, greater nicotine associated with reductions were found during 15- to 30-minute exposure time period (P
for interaction = 0.04).

Conclusion:

We present the first evidence of cardiac autonomic effects of short-term secondhand exposure to nicotine from EC emissions among healthy nonsmokers. Further comprehensive research on EC exposure extending to more subjects and flavor compounds is warranted.
Plastic Surgery Faces the Web: Analysis of the Popular Social Media for Plastic Surgeons
Authors: Ben Naftali Yeela , Duek Ori Samuel , Rafaeli Sheizaf , Ullmann Yehuda
Published: December 2018

Background:

The use of social media is growing tremendously along with its impact on the practice of plastic surgery, for better or for worse. Patients are increasingly using social media to obtain information about either the procedure or the surgeon.

Objectives:

The aims of this study were to examine social media posting regarding plastic surgery and to analyze successful online communication methods of the plastic surgeons with the public.

Methods:

A prospective analysis of 3 popular, global social media networks was performed, using the English language key phrases “plastic surgery” and “#plastic_surgery.” Three hundred posts related to plastic surgery published on Instagram, YouTube, and Facebook in November 2017 were assessed by the following parameters: author identity, subject (self-promotion, educational, commercial, and personal posts), “social media currency” (likes, shares, comments, and views), and if special effects (videos, photos, etc.) or viral subjects such as reality stars or shaming were utilized.

Results:

Sixty-three percentage of the posts on Instagram originated with plastic surgeons, compared with 18% on Facebook and only 13% on YouTube (P < 0.01); together, the plastic surgeons’ posts comprise 31% of the total posts, whereas 49% of posts published by commercial companies (P < 0.01). Most of the posts on Instagram were self-promotional (83%), in comparison to Facebook (29%) or YouTube (6%); P < 0.01. YouTube posts are more personal in nature compared with Instagram and Facebook [39%, 7%, 9%, respectively (P < 0.01)]. Educational content in the posts accounts for only 16% of them, P < 0.01. Shaming is seen in 21% of the posts, especially in Facebook (39%), and mainly related to famous public figures (25%); P < 0.05. Celebrity endorsed posts received more attention in every aspect of social media currency (likes, comments, shares, and views). The use of images of women attracts attention and is widely used in social media posts of plastic surgery (68%). Posts that chose to include videos (22%) are generously rewarded. Online shaming also attracts attention, mostly found in Facebook (39%), and mainly of a public figure (25%). The 10 most powerful attention drawing motives were jokes, attractive female plastic surgeons, celebrities, personal stories, provocative surgeries, videos or photos of surgeries, sex, shaming, and patient education.

Conclusion:

Social media have become an important tool for self-promotion and a means to providing better customer service. This trend applies to the plastic surgeon as well. The study’s main insights were to use Instagram, personal stories, educational post, videos and other unique inputs, and involve celebrities in the posts. In general, it would be wise to invest and understand these communication platforms, as they have become the path to dominate the field.
The Suture Tab Technique: Securing Implant Position in Prepectoral Breast Reconstruction
Authors: Janhofer David E. , Economides James M. , Song David H.
Published: December 2018

Human acellular dermal matrix (ADM) can augment prepectoral prosthetic-based direct-to-implant breast reconstruction by providing an additional soft-tissue layer between breast implant and skin, as well as to reinforce the inframammary fold and breast pocket. Utilizing ADM in this way has helped reduce rates of implant rippling, capsular contracture, and implant extrusion. Difficulty in securing ADM-wrapped implants has caused many surgeons to improvise techniques for secure implantation. Here, we describe a simple technique for creating suture tabs within the ADM for efficient fixation of the ADM-implant construct to the chest wall.
Preoperative Computed Tomography Angiography in Autologous Breast Reconstruction—Incidence and Impact of Incidentalomas
Authors: Tevlin Ruth , Borrelli Mimi R. , Nguyen Dung , Momeni Arash
Published: December 2018

Background:

Incidentalomas are lesions found coincidentally during examination, imaging, or surgical procedures. Preoperative computed tomography angiography (CTA) before abdominal flap harvest for breast reconstruction can lead to identification of incidentalomas leading to the need for further investigations. The aim of this study was to examine the prevalence of incidental findings on preoperative CTA and to determine their impact on management.

Methods:

A retrospective chart review was performed at a single tertiary institution. CTA reports were analyzed for the presence of incidental findings and details of follow-up were studied. Logistic regression was used to identify factors associated with incidental findings.

Results:

One hundred eighteen patients with a mean age of 49 years were included in the study. The majority of patients underwent bilateral reconstruction (65%, n = 77) in the immediate setting (70%, n = 83). Fifty-six percentage had an incidental finding on CTA, with hepatic (20%), renal (14%), and osseous (11%) abnormalities being most common. Additional imaging including ultrasound, CT, and magnetic resonance imaging were recommended in 19 cases (16%). Additional consultations were sought for 3 patients before reconstruction (with suspicion of bone metastases, an intraabdominal mass, and suspicion of colonic malignancy, respectively). No significant surgical delay secondary to CT findings was noted.

Conclusions:

Incidentalomas following preoperative CTA of the abdomen/pelvis are common (56%). However, unlike previous reports, we did not observe a change in reconstructive plan following incidentaloma discovery. We recommend that all patients are counseled pre-CTA regarding the possibilities of incidentaloma detection and need for additional imaging.
Comparison of Tri-folded and Scroll-based Graft Viability in Preloaded Descemet Membrane Endothelial Keratoplasty
Authors: Barnes Kali , Chiang Eric , Chen Conan , Lohmeier John , Christy Jason , Chaurasia Akash , Rosen Allison , Vora Parth , Cai Stephanie , Subramanya Anshul , Durr Nicholas , Allen Robert , Eghrari Allen Omid
Published: December 2018

Purpose:

To compare corneal endothelial damage associated with 2 techniques for preloaded Descemet membrane endothelial keratoplasty (DMEK): a tri-folded graft stored in a plastic cartridge designed for DMEK and a scrolled graft stored in a modified Jones Tube, at the time of preparation and after shipping.

Methods:

DMEK grafts were prepared at the Rocky Mountain Lions Eye Bank. The grafts were either tri-folded and loaded in a plastic cartridge or scrolled and loaded into a modified Jones Tube. In each group, the grafts were then either immediately removed from the cartridges or shipped for 48 hours. The grafts were then stained with Calcein AM and imaged using a fluorescent microscope. Endothelial cell loss (ECL) was determined using trainable segmentation in Fiji by 2 graders. At each time point, rates of ECL loss were compared across the 2 groups. To explore the role of donor characteristics, a multivariable regression model was produced to account for method (tri-folding vs. scroll), donor age, donor gender, death-to-preservation time, death-to-preparation time, and shipping.

Results:

A total of 40 grafts were prepared, processed, imaged, and analyzed. No significant difference in cell loss was seen between groups at either time point alone. In the multivariate model, no significant increase in cell loss was associated with either tri-folding (3.7% less ECL; P = 0.051) or shipping (4.3% less ECL; P = 0.049).

Conclusions:

All techniques used resulted in clinically acceptable levels of ECL. Tri-folded tissue in a plastic cartridge did not result in ECL inferior to a scroll when prepared either immediately or preloaded for 48 hours.
Overestimation of an Outbreak of Enterobacter cloacae in a Neonatal Intensive Care Unit in Germany, 2015
Authors: Steffen Gyde , Pietsch Michael , Kaase Martin , Gatermann Sören , Werner Guido , Fuchs Stephan , Pfeifer Yvonne , Schmitt Wolfgang , Adam Henning , Eckmanns Tim , Haller Sebastian
Published: December 2018

Background:

In August 2015, 17 neonates withEnterobacter cloacae (E. cloacae) colonization were identified in a neonatal intensive care unit (NICU) in Germany. Two developed severe brain abscesses. Despite temporary NICU closure in September, another infant withE. cloacaecolonization was detected in October 2015.

Methods:

We defined potential cases as inpatients treated in the NICU or any pediatric/maternity ward in 2015 withE. cloacaein any specimen before molecular typing. Cases were at first confirmed by arbitrarily-primed-polymerase-chain-reaction and later by XbaI-macrorestriction/pulsed-field gel electrophoresis and next-generation-sequencing. Enhanced barrier precautions and cohorting were implemented for all potential cases and microbiologic screening was extended from NICU to all pediatric/maternity wards.

Results:

Of 41 potential cases (occurring between 08/04/2015 and 15/11/2015 in 4 wards), the isolates of 23 shared identical arbitrarily-primed-polymerase-chain-reaction patterns; 3 without plausible epidemiologic link. Pulsed-field gel electrophoresis analyses verified only 10 cases (all in the NICU); next-generation-sequencing analysis confirmed these results. In addition 6 cases without isolates available for genotyping were closely linked in place and time.

Conclusions:

Forty-one suspected patients were cohorted and the NICU was temporarily closed. Further analyses revealed that only 16 cases belonged to the outbreak. Only close interdisciplinary collaboration and highly discriminatory genotyping methods allowed to clearly differentiate between cases and noncases in thisE. cloacaeoutbreak.
Orbital Floor and Rim Reconstruction With a Titanium Orbital Implant and Acellular Dermis
Authors: Scofield-Kaplan Stacy M. , Patel Sagar Y. , Mancini Ronald
Published: December 2018

Reconstruction of the orbital rim and floor following tumor excision is traditionally performed with bone grafts, vascularized grafts, or free flaps. The authors describe a case of an osteosarcoma of the maxillary sinus and a second case of an ossifying fibroma of the orbital floor, both of which required reconstruction of the orbital floor and rim. In both of these cases, reconstruction of the orbital floor and rim was performed with a titanium implant whose anterior portion was bent inferiorly to recreate the orbital rim. Acellular dermis was sutured over the anterior portion of the orbital implant to act as a barrier between the implant and the overlying eyelid tissues.