bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of additive usage on motorcycle CO and CO2 emission
Authors: Wardoyo Arinto Y.P. , Johan  , Noor A.E. , Alwansyah Mohammad Hisyam , Adi Eko T. P. , Budianto Arif
Published: February 2022

A fuel additive has been believed to raise engine performance by increasing fuel efficiency. However, a study about the influence of fuel additives on CO and CO2 emission has not been clearly understood yet. In this study, we investigate the influence of fuel additives on CO and CO2 motorcycle emission. Ten different additives: Bio additives and synthetic additives mixed with gasoline with RON of 90 used to operate a standard 100 cc motor engine. The additive concentration was determined by using the factory recommended dose. The engine was activated for 100 seconds during the smoke collection procedure. The smoke was collected into a measurement chamber with a dimension of (20 × 30 × 20) cm3. The CO and CO2 concentrations were measured by using Q-Trak Indoor Air Quality Monitor 7575. The remaining fuel was drained after the measurement to calculate the consumed one. In the result, the bio-additive produced CO2 of (0.44 × 103 - 2.76 × 103) ppm and synthetic additive of (0.12 × 103 - 1.48 × 103) ppm. On the other hand, the bio additive produced CO of (0.12 × 103-1.11 × 103) ppm while the synthetic produces (0.12 × 103-1.11 × 103) ppm. The bio and synthetic additive CO2 emission factors were calculated of (0.28–8.01) ppm/ml fuel and (0.88-13.17) ppm/ml. For CO, the emission factor was obtained of (0.48–8.93) ppm/ml and 0.29 ppm/ml -4.08 ppm/ml for bio and synthetic additive, respectively. In conclusion, using bio-additives produced more CO2 and CO emissions on the motorcycle.
Influence of thickness on heat treatment from 300 to 1100 K of aluminum thin film
Authors: Susila Anggara Budi , Handoko Erfan , Budi Esmar , Budi Agus Setyo
Published: February 2022

We investigated the influence of Aluminum thin film thickness during heat treatment. The films with thickness of 5 nm, 10 nm and 15 nm were heated from room temperature up to above melting point with same heating rate. Molecular Dynamics (MD) simulation is employed to study the behaviour of the thin film where the atoms were followed based on its trajectories. Thin film thickness gives significance contribution to the mechanism of the melting. Smaller thickness suffered strong pressure oscillation while the thin film temperature is increases. Local crystal structure confirmed the transformation of the system from crystalline state to melting state.
Conversion of Salam leaves (Syzygium polyanthum (Wight) Walp.) bio-kitchen waste as functional activated carbon for sustainable supercapacitor electrodes
Authors: Windasari  , Taslim Rika
Published: February 2022

Porous carbon based on bio/organic waste is a very popular raw material used in high-level applications due to its advantages of high porosity, high electrical conductivity, suitable pore structure, and good stability. In this study, bio-kitchen waste is used as a precursor to obtaining high functional activated carbon which is applied to electrochemical energy storage applications. This kitchen waste is focused on Salam leaves (Syzygium polyanthum (Wight) Walp.). Precursors are converted to porous carbon through a simple technique and a green approach without the addition of synthetic materials. In addition, activated carbon is designed in a new form of monolith without a binder. The material properties were thoroughly investigated through monolith dimension reduction and X-ray diffraction. The dimensions of the monolith are reviewed based on mass, thickness, and diameter. The activated carbon obtained shows porosity and amorphous properties which are useful in supporting its electrochemical natures. Furthermore, the electrochemical properties of carbon electrodes were reviewed using standard cyclic voltammetry and galvanostatic charge-discharge methods in a two-electrode system. In addition, a 1M H2SO4 aqueous electrolyte was selected to enhance the supercapacitor cell performance and it exhibit high specific capacitance of 145 F g−1. Based on these results, it is surprising that bio-kitchen waste has great potential as a high-carbon material for high-level applications.
Effects of heat treatment on the microstructure of the ODS (oxide dispersion strengthened) steel Fe-9Cr-0.5Y2O3
Authors: Bandriyana B , Sugeng B , Salam R , Hairani D , Sujatno A , Shabrina N
Published: February 2022

Synthesis of a ferritic ODS steel Fe-9Cr-0.5Y2O3 was carried out to develop as a candidate for nuclear fuel cladding material. The ODS steel was fabricated by powder metallurgy method with mechanical alloying, compaction and plasma sintering process. Effects of heat treatment on microstructure was investigated to enhance the mechanical properties. The heat treatment was carried out by annealing and tempering processes at temperatures of 900°C and 670°C with reference to the Fe-Cr phase diagram. Characterization was carried out using SEM-EDX and XRD test for microstructural analysis and Vickers hardness measurement. It is revealed that the heat treatment process will change the grain size and phase that affected the hardness of material.
Synthesis of ferritic ODS steel with different electric current in arc plasma sintering method
Authors: Shabrina Nanda , Sugeng Bambang , Salam Rohmad , Sujatno Agus , Haerani Diene Noor , Bandriyana B
Published: February 2022

Ferritic ODS (Oxide Dispersion Strengthened) steel has been synthesis by Arc Plasma Sintering method with different electric current from milled powder in Fe-14Cr-0.5Y2O3 wt% composition. Ferritic milled powder was carried out using high-energy milling with various BPR (Ball to Powder Ratio) and milling duration. The samples’ crystallite size-strain, phase, and composition were analyzed by XRD (X-Ray Diffraction) with Rietveld methods. The microstructures and micro-hardness were investigated by Optical microscopy, SEM-EDS (Scanning Electron Microscopy-Energy Dispersion Scanning), and Vickers microhardness. The different electric currents of Arc plasma sintering affect the microstructure and mechanic properties of the samples. The results observed ferrite formation. Some void and aggregation were also observed in the samples. However, the microhardness increases by increasing the electric current. On the other hand, the main phase Fe-Cr was also observed in the samples, while the crystallite size-strain also changed by changing the electric current.
Complete ensemble empirical mode decomposition with adaptive noise integrating feedforward neural network for tourist arrival forecasting
Authors: Herawati S , Negara YDP , Latif M
Published: February 2022

The tourism sector has an important role in helping the income of a region, especially for economic development and opportunities to expand employment. However, the trend tourist arrival to these tourist attractions has decreased since the COVID-19 pandemic. The government enforces a new normal policy to reopen tourist attractions by implementing health protocols. Local governments and tourism managers need forecasting of tourist arrivals to help plan the tourism sector in the future and anticipate an increase in tourist arrival. Most tourist arrivals are influenced by several factors, such as : seasonality, politics, disasters, crises, and other important events. One method to accommodate these factors is using Ensemble Empirical Mode Decomposition (EEMD). However, EEMD still produces a mixing mode during decomposition. Complete Ensemble Mode Decomposition with Adaptive Noise (CEEMDAN) is proposed to overcome the weaknesses of EEMD. This research integrates CEEMDAN with Feedforward Neural Network (FNN) in generating forecasts. The experiment results show that the integration of CEEMDAN and FNN can produce good forecasting accuracy.
Investigation Cogging Torque of PMM with rotor and Stator optimization for renewable energy application
Authors: Sirait Patia Welly , Siregar Marsul , Nur Tajuddin , Panjaitan Lanny
Published: February 2022

This paper proposes the cogging torque reduction by using the optimization of the slotting method on the stator and the cutting edge of the rotor side magnet of the Permanent Magnet Machiene (PMM), of the Synchrounous Generator (PMSG). Here, the effect on the cross-sectional area of the magnetic poles and the additional width of the slot opening will lead to an improvement in the reduction of cogging torque for the investigated of the machine. The proposed machine has 6 poles and 18 slots with a fixed slot opening widths on the stator and modified magnetic poles on the rotor. The software used to investigate and analyze the saturation of the induced cores in the stator and rotor of machine is the magnetic finite element method (FEMM 4.2). The most cost-effective method to minimize the presence of cogging torque of any PMSG is to conduct the modification of the rotor where the magnets are located and modify the stator structure despite the complexity and cost of manufacturing the stator. Here, the cutting of magnetic edge structure using a simple cutting method is implemented. This is a different method from that already widely implemented for cutting the edge of the magnet surface. The simulation results show that the PMSG cogging torque by cutting the magnetic edge and adding a dummy slot can significantly minimize the cogging torque. It is found that the cogging torque reduction is 99.47 percent. This condition as the low cogging torque and low PMG speed can be used for reference design and PMSG construction for renewable energy plants such as in geothermal power plants.
Synthesis and structural characteristic of Nd3+/Er3+ co-doped Lithium Fluorophosphate (LFP) glasses
Authors: Rajagukguk Juniastel , Hariono  , Panggabean Jonny H , Rajagukguk Donna H , Sarumaha Chayani , Kaewkhao Jakrapong
Published: February 2022

Transparent fluorophosphate glass containing face center cubic LiF crystals doped with Nd3+/Er3+ were succesfully characterized by melt-quenching method. The sample composition following chemical formula (65-x)P2O5-20LiF-14CaF-1Nd2O3-xEr2O3 (x = 0.0; 0.5; 1.0; 1.5 and 2.0 mol%). The density parameter was calculated using Archimedes method in distilled water and this value used to calculating of molar volume. Several physical properties of Nd3+/Er3+ co-doped LFP glasses were calculated and correlated with structural properties. The X-ray diffraction (XRD) spectrum used to verify the glasses structure. The further structural characteristic was investigated using FTIR. Based on the investigation is discovered that the prepared co-doped glasses shows amorf and high transparency.
Requirement analysis for human factor engineering on SMR-NuScale design
Authors: Maerani R , Suryono T J , Santoso S
Published: February 2022

Human Factors Engineering (HFE) is an important element of control room facility design and Man Machine Interface (MMI) design whose principles must be applied systematically to ensure the safe operation of power reactors. In the design of the NuScale Small Modular Reactor (SMR), the United States-Nuclear Regulatory Commission (US-NRC) as an international regulatory body has published Design-Specific Review Standards (DSRS) for Nuclear SMR design which are specific for NuScale. There is no specific discussion related to HFE in the document. However, in order to develop the NuScale design in In Indonesia, we can learn from Oregon State University, the first Nuscale developer, regarding the requirements when those are compared to the large nuclear reactors. Therefore, reviewing the NuScale SMR design needs to be carried out starting with the conducting a requirement traceability analysis by tracing the guidelines from the regulatory body and knowing the recommended guideline in developing the HFE design, especially for the specific SMR/NuScale. It is hoped that by understanding the process of verifying these requirements documents, Indonesia will be able to apply the HFE for the NuScale reactor by meeting the criteria required by BAPETEN and be able to prepare the validation method so that the design can obtain a license.
Pneumonia identification based on lung texture analysis using modified k-nearest neighbour
Authors: Kana Saputra S , Taufik Insan , Hidayat Mhd , Dharma Dinda Farahdilla
Published: February 2022

Covid-19 is a virus that was first discovered in China, which has the impact of mild and severe respiratory infections such as pneumonia. Pneumonia is inflammation and consolidation of lung tissue due to infectious agents. Generally pneumonia has a high mortality rate, as do Covid-19 patients. For now, it is very difficult to distinguish between Pneumonia and Covid-19, due to the high similarity of X-Ray image results. The high similarity has an impact on the difficulty of difference between Pneumonia and Covid-19 patients. This research aims to be able to different Pneumonia and Covid-19 patients based on texture analysis of the Gray Level Co-Occurrence Matrix using Modified k-Nearest Neighbour as a classifier. The calculations used in the Gray Level Co-Occurrence Matrix method are Contrast, Correlation, Energy, and Homogeneity which will be input for the Modified k-Nearest Neighbour classifier. The results showed that the highest accuracy is when the value of K = 3 using Manhattan Distance and 80%:20% data percentage, which is 87.5%. For the values of K = 7 and K = 9 there is no change in accuracy, so it can be concluded that the value of K that affects accuracy only occurs at the values of K = 3 and K = 5. Then, the higher the K value, the lower the resulting accuracy.
Testing and development of plastic optical fiber as humidity and temperature sensor
Authors: Waluyo B D , Sari R D , Januariyansah S
Published: February 2022

This experiment has developed and tested a plastic fiber optic-based temperature and humidity sensor (FOTHS). In the FOTHS test, the leading equipment is needed, such as a single model plastic optical fiber, a test chamber, a time-domain reflectometer (OTDR), a computer for data acquisition, and silicone oil used as a substitute for the 3 cm long optical fiber cladding layer. Silicone oil is used as a sensor material because it has a high sensitivity to changes in temperature and humidity. Optical fiber testing is carried out in a light-tight test chamber by changing the temperature and humidity. Changes in light intensity with changes in temperature and humidity are measured by OTDR, with information in voltage changes. At a constant temperature and variable humidity, information was obtained that the light intensity increased linearly at 45 °C with an increase in voltage of 0.0057 volt/1% RH. At constant humidity and variable temperature, information was obtained that the light intensity will decrease linearly at 20% RH with a voltage drop of 0.0171 volt/1 °C. Changes in voltage to variations in temperature and moisture make plastic optical fiber a temperature and humidity sensor.
Development of interactive learning media in computer network using augmented reality technology
Authors: Hutahaean Harvei Desmon , Muhammad Aulia Rahman S , Mendoza Muhammad Dominique
Published: February 2022

Technological development affect on aspects of education that impact on learning activities. In computer networks learning, there is still rarely media use which has an impact on students’ understanding of how to install computer networks. Current mobile phones have many features that can be used to play games, watch videos, listen to music, personal assistant, find information, GPS, and many more. One of the interesting technologies that can be developed on mobile phones is Augmented Reality. Augmented Reality (AR) is a technology that combines two-dimensional or three-dimensional virtual objects into a real three-dimensional environment and then projects these virtual objects in real time. This research discusses the development of learning media Augmented reality of computer network installation. The purpose of this research is to develop augmented reality learning media and build media that makes it easier for students to understand the process of installing computer networks that becomes an alternative as a learning media. The method used is Research and Development (R&D).
The utilization of biomass waste as charcoal briquette to reduce waste disposal
Authors: Gunawan Safri , Nursanni Banu , Suprapto  , Januariyansah Sapitri
Published: February 2022

This study focuses on the potential of biomass to be developed becomes charcoal briquette. Based on data from the Central Bureau of Statistics (North Sumatra Province), the planted area and total coconut production of North Sumatra Province in 2019 were 110,345 hectares and 99,132 tons. The objective of this research is to obtain the properties of charcoal briquettes by varying the composition and pressure. The variations of the briquette moulding pressure are 80 and 100 Bar with composition variations of 1:10 and 1:15, respectively. The experimental tests were carried out to obtain Young’s modulus and wt% of briquette. The results showed that the value of tensile strength and wt% of briquette depends on the moulding pressure and duration of drying. The conclusion of this study shows that coconut shell and durian skin waste are very likely to be used as a renewable alternative fuel energy source as briquette.
Seismicity and influence of coulomb stress on the risk of earthquakes in South Sulawesi
Authors: Suharna A , Eko Hadi Sujiono , Palloan Pariabti
Published: February 2022

This study aims to analyze the distribution of earthquake events, analyze seismicity based on the parameters of b value, analyze changes in Coulomb stress and analyze the risk of earthquake events in South Sulawesi based on seismicity levels and changes in Coulomb stress in the range of 1991-2021. The data used in this study is data on earthquake events in 1991-2021 obtained from the IRIS and ISC catalogues. Data from the IRIS catalogue is mapped using ArcGIS software to see the distribution of the next earthquake spread processed by using MATLAB-based ZMapp 7 software to obtain the value of seismicity parameter (b value). Data from the ISC catalogue is mapped using Google Earth software to see the spread of earthquakes and then processed using MATLAB-based Coulomb 3.1 software to obtain analysis of stress Coulomb changes. Based on the results of the analysis obtained a value of b between 0.9-1.5 shows the value of b obtained is relatively low which correlates with a high level of stress. Based on the results of the analysis of changes in Coulomb stress obtained the movement of increased stress towards the red lobe with a value of 0.1 to 1 bar and decreased stress towards the blue lobe with a value of -0.1 to -1 bar. In general, earthquake-prone areas are located in the northern to central parts of South Sulawesi.
Assessment of the reliability of deconvolution procedures for RCF spectroscopy of laser-driven ion beams
Authors: McCallum S. , Milluzzo G. , Borghesi M. , Subiel A. , Romano F.
Published: February 2022

Laser-driven ion beams are defined by a number of unique features, including a large spread in energy. A stack configuration of radiochromic films (RCF) can be utilized to characterize such beams through measurements of their energy spectra. A spectroscopic procedure is reported that allows the proton energy density within each active layer of a radiochromic film (RCF) stack to be retrieved. This is based upon on a deconvolution algorithm developed through Geant4 Monte Carlo simulations to correct the contributions of energy depositions within a given film layer. Through Monte Carlo calculations, the spectrum retrieved from a simulated film stack can be retrieved and compared with a known energy spectrum, providing an examination of the efficacy of this tool. Application of the developed deconvolution procedure thus offers the potential to correctly reconstruct the incident energy spectrum of a laser-driven proton and ion beam from a stack of irradiated RCF.
Adaptive protograph-based BICM-ID relying on the RJ-MCMC algorithm: a reliable and efficient transmission solution for plasma sheath channels
Authors: LIU Yanming , WEI Hailiang , SHI Lei , YAO Bo
Published: February 2022

For reentry communication, owing to the influence of the highly dynamic plasma sheath (PS), the parasitic modulation effect can occur and the received phase shift keying (PSK) signal constellation can be severely rotated, leading to unacceptable demodulation performance degradation. In this work, an adaptive non-coherent bit-interleaved coded modulation with iterative decoding (BICM-ID) system with binary PSK (BPSK) modulation and protograph low-density parity-check under the PS channel is proposed. The proposed protograph-based BICM-ID (P-BICM-ID) system can achieve joint processing of demodulation and decoding, where the soft information is adaptively estimated by reversible-jump Markov chain Monte Carlo (RJ-MCMC) algorithms. Simulation results indicate that compared to existing algorithms, the proposed system can adapt well to the dynamic characteristics of the PS channel and can obtain a 5 dB performance improvement at a bit error rate of 10−6.
New signaling kid on the block: the role of the postmitotic midbody in polarity, stemness, and proliferation
Authors: Farmer Trey
Published: February 2022

To complete cytokinesis, abscission of the proteinaceous and microtubule-rich intercellular bridge needs to occur. The midbody (MB), a structure that forms on the intercellular bridge, is a key regulator of cytokinesis and appears to play a role in downstream signaling after abscission. Initially, it was thought that after abscission was completed, the MB was degraded. However, a new body of evidence has emerged suggesting that one daughter cell or a surrounding non–daughter cell can inherit or internalize the MB, thus leading to changes in cell proliferation and differentiation. In this review, we highlight the role that the MB has after mitosis. We will focus on the rising evidence that the MB plays an important role in establishment of cell polarity, such as apical lumen formation, neurite extension, and ciliation. Additionally, we will discuss the evidence suggesting that MBs can also serve the role of signaling organelles (MBsomes) that lead to cell proliferation, differentiation, and even tumorigenicity.
Wearable devices to monitor recovery after abdominal surgery: scoping review
Authors: Wells Cameron I. , Xu William , Penfold James A. , Keane Celia , Gharibans Armen A. , Bissett Ian P. , O’Grady Greg
Published: February 2022

Background

Wearable devices have been proposed as a novel method for monitoring patients after surgery to track recovery, identify complications early, and improve surgical safety. Previous studies have used a heterogeneous range of devices, methods, and analyses. This review aimed to examine current methods and wearable devices used for monitoring after abdominal surgery and identify knowledge gaps requiring further investigation.

Methods

A scoping review was conducted given the heterogeneous nature of the evidence. MEDLINE, EMBASE, and Scopus databases were systematically searched. Studies of wearable devices for monitoring of adult patients within 30 days after abdominal surgery were eligible for inclusion.

Results

A total of 78 articles from 65 study cohorts, with 5153 patients were included. Thirty-one different wearable devices were used to measure vital signs, physiological measurements, or physical activity. The duration of postoperative wearable device use ranged from 15 h to 3 months after surgery. Studies mostly focused on physical activity metrics (71.8 per cent). Continuous vital sign measurement and physical activity tracking both showed promise for detecting postoperative complications earlier than usual care, but conclusions were limited by poor device precision, adherence, occurrence of false alarms, data transmission problems, and retrospective data analysis. Devices were generally well accepted by patients, with high levels of acceptance, comfort, and safety.

Conclusion

Wearable technology has not yet realized its potential to improve postoperative monitoring. Further work is needed to overcome technical limitations, improve precision, and reduce false alarms. Prospective assessment of efficacy, using an intention-to-treat approach should be the focus of further studies.
FII and Perplexing Presentations: What is the Evidence Base for and against Current Guidelines, and What are the Implications for Social Services?
Authors: Gullon-Scott Fiona , Long Cathie
Published: February 2022

Fabricated or induced illness (FII) and perplexing presentations (PPs) are the terms used by the Royal College of Paediatrics and Child Health (RCPCH) in the UK. FII is presented as if synonymous with Munchausen syndrome by proxy, a rare presentation which is now known in Diagnostic and Statistical Manual of Mental Disorders, 5th Edition as factitious disorder imposed on another (FDIoA). However, FII is not a diagnosis, and the definition is far broader than FDIoA. RCPCH admit that there is a limited evidence base for the prevalence, specificity or sensitivity of FII and the associated ‘alerting signs’, and yet local authorities across the UK have Child Protection Policies developed directly from the RCPCH guidelines. An increasing number of families of children with neurodevelopmental presentations (such as autism), or presentations of complex or less well-known conditions such as Ehlers–Danlos syndrome, are finding themselves being investigated for FII by Social Services, and consequently labelled as potential ‘perpetrators’ of child abuse, on the basis of FII guidelines. The present article discusses the issues relating to FII and PP, how current guidelines are creating implicit and explicit bias against certain kinds of families and the implications for Social Services.
Performance test of medium-temperature chiller with induction air-conditioning system
Authors: Hong Yuhua , Wang Gaoyuan , Wang Zhiyi
Published: February 2022

In this paper, medium-temperature chiller with induction air-conditioning system is introduced. Several onsite measurements were carried out on temperature and relative humidity distribution and energy consumption in summer 2020 in order to study the potential performance when applied in hot summer cold winter zone. The performance test results show that (1) the indoor temperature and humidity both comply with the range of design parameters; (2) the corresponding indoor air dew point temperature is much lower than the supply air temperature of air inductive unit, which implies no condensed water or dew on surface of air inductive unit; (3) the performance of the circulation pump, extensive type air handling unit fan; and medium-temperature chiller has exceeded the requirements of national standards.
The ABC Test: A New Model for Employment Status Determination?
Authors: Davidov Guy , Alon-Shenker Pnina
Published: February 2022

The tests for identifying who is an ‘employee’—the gateway for a multitude of employment rights—have preoccupied generations of labour lawyers. It is relatively rare, however, to see a significant change in the law itself in this area. We are currently witnessing such a rare change in the USA, where a new test called the ‘ABC test’ was adopted in California and is gaining support elsewhere. The new California test starts with a legal presumption of employee status. To rebut the presumption, the hiring party has to demonstrate that all the following conditions are satisfied: no control over the worker, the work is outside the usual course of the employer’s business and the worker is customarily engaged in an independently established business. The goal of this article is examine whether this new test is normatively better than previous tests and should be regarded as a model for legislation in other countries as well. Our assessment is made in light of three benchmarks: whether the new test successfully advances the purpose of labour laws, whether it adopts an optimal balance between selectivity and universalism, and whether it strikes an optimal balance between rules and standards. Our conclusion is generally positive, but at the same time we argue that some modifications are necessary to improve the test and make it a useful model.
How the Body Became Integrated: Cybernetics in the History of the Brain Death Debate
Authors: Scherz Paul
Published: February 2022

Although the term integration is central to the definition of brain death, there is little agreement on what it means. Through a genealogical analysis, this essay argues that there have been two primary ways of understanding integration in regard to organismal wholeness. One stems from neuroscience, focusing on the role of the brain in responding to external stimuli, which was taken up in phenomenological accounts of life. A second, arising out of cybernetics, focuses on the brain’s role in homeostasis. Recent debates over brain death are largely over this cybernetic understanding of integration. However, the phenomenological understanding of organismal wholeness can be seen in arguments by the President’s Council on Bioethics in favor of brain death. This essay argues that the cybernetic understanding of life is problematic and should be discarded. A phenomenological understanding of life can provide a better basis for arguments over definitions of life and death.
Measurement of Potential Over- and Under-policing in Communities
Authors: Atherley Loren T , Hickman Matthew J , Parkin William S , Helfgott Jacqueline B
Published: February 2022

Over- and under-policing of neighbourhoods can undermine public trust and confidence in the police as well as the broader justice process. This study reports on attempts to operationalize and test a spatial indicator of potential over- and under-policing, where over-policing is defined as a level of police presence at a particular location that is greater-than-expected, given the level of public demand for police services, current police enforcement strategy, and community preference regarding police activity. Automated Vehicle Locator data and Computer-aided dispatch logs from the Seattle Police Department, as well as data drawn from community-based surveys, are modelled using a Geographic Information System. The model uses 2-week data windows to provide timely and actionable information that can be rendered for decision makers in a CompStat style accountability and management forum. Such an approach has potential utility for police management, as well as for community engagement and reform efforts aimed at addressing the problem of over-policing.
Unemployment Insurance as a Subsidy to Risky Firms
Authors: Van Doornik Bernardus , Fazio Dimas , Schoenherr David , Skrastins Janis
Published: February 2022

We document that a more generous unemployment insurance (UI) system shifts labor supply from safer to riskier firms and reduces the compensating wage differentials that risky firms need to pay. Consequently, a more generous UI system increases risky firms’ value and fosters entrepreneurship by reducing new firms’ labor costs. Exploiting a UI reform in Brazil that affects only part of the workforce allows us to compare labor supply for workers with different degrees of UI protection within the same firm, sharpening the identification of the results. Altogether, our results suggest that UI provides a transfer system from safe to risky firms.
Immune Modulatory Effects of Nonsteroidal Anti-inflammatory Drugs in the Perioperative Period and Their Consequence on Postoperative Outcome
Authors: Bosch Dirk J. , Nieuwenhuijs-Moeke Gertrude J. , van Meurs Matijs , Abdulahad Wayel H. , Struys Michel M. R. F.
Published: February 2022

Nonsteroidal anti-inflammatory drugs are among the most commonly administered drugs in the perioperative period due to their prominent role in pain management. However, they potentially have perioperative consequences due to immune-modulating effects through the inhibition of prostanoid synthesis, thereby affecting the levels of various cytokines. These effects may have a direct impact on the postoperative outcome of patients since the immune system aims to restore homeostasis and plays an indispensable role in regeneration and repair. By affecting the immune response, consequences can be expected on various organ systems. This narrative review aims to highlight these potential immune system–related consequences, which include systemic inflammatory response syndrome, acute respiratory distress syndrome, immediate and persistent postoperative pain, effects on oncological and neurologic outcome, and wound, anastomotic, and bone healing.
Observation Versus Cast Treatment of Toddler’s Fractures
Authors: Fox Joseph , Enriquez Brianna , Bompadre Viviana , Carlin Kristen , Dales Mark
Published: February 2022

Background:

Nondisplaced metaphyseal fractures of the distal tibia, or toddler’s fractures, are one of the most common pediatric injuries. Healing typically occurs quickly without sequelae. Treatment ranges from long leg cast immobilization to observation. This study compares short-term clinical and radiographic outcomes of toddler’s fractures treated with long leg casting versus observation.

Methods:

Patients with toddler’s fractures were offered enrollment and randomization at diagnosis. Because many families opposed randomization, a preference arm was added after one year. All subjects were analyzed as a prospective cohort. Radiographs were obtained at diagnosis and 4 weeks. A modified Oxford Ankle Foot Questionnaire for Children (OAFQ-C) and family satisfaction survey were collected at diagnosis, 4 and 8 weeks. Scores were analyzed using mixed effect models. Family satisfaction surveys were compared using a Wilcoxon rank sum test.

Results:

Forty-four subjects participated in the study, 34 (77%) in the preference arm and 10 (23%) in the randomized cohort. The median patient age was comparable between the cast and the observation groups, 2.0 versus 1.8 years, respectively. Significant improvement in OAFQ-C scores was observed in both groups over 8 weeks (P<0.01). Patients in the observation group had a higher initial play score than the cast group (P=0.03). The observation group trended toward higher physical scores at all time points (P=0.11). There was no significant difference in emotional scores between groups (P=0.77). No displacement was observed in any patient. Casted patients had significantly more minor complications with 4 patients requiring cast change or removal compared with 0 in the observed group (P=0.01). At 8 weeks, 80% of parents in the cast group were likely or very likely to choose the same treatment compared with 95.6% in the observation group. Family satisfaction scores did not differ between groups (P=0.18). They demonstrated differences in perceived normal walking at 4 weeks, with 50% of casted patients walking normally compared with 92% of observed patients. Over 90% of patients in both groups were reportedly walking normally at week 8.

Conclusion:

Observation of toddler’s fractures results in equivalent clinical and radiographic outcomes, high family satisfaction and fewer complications compared with treatment with a long leg cast.

Level of Evidence:

Level II.
Incidence of Deep Vein Thrombosis in Cerebral Palsy Following an Orthopaedic Surgical Event
Authors: Sees Julieanne P. , Maguire Kathleen , Prestowitz Sky , Rogers Kenneth J. , Miller Freeman
Published: February 2022

Purpose:

The purpose of this study was to identify the incidence of venous thromboembolism (VTE) and characterize the demographics, comorbidities, and risk factors for patients with cerebral palsy (CP) having orthopaedic surgery.

Methods:

All patients diagnosed with CP who underwent an orthopaedic surgical procedure at one institution between 2008 and 2017 were identified. Diagnosis codes and associated patient events were recovered from the electronic medical record. Each VTE event was reviewed to ascertain an actual VTE episode related to a surgical event.

Results:

The review included 2583 orthopaedic surgical events in 1371 patients. Of the initial 88 cases identified, 28 cases had a deep thrombosis documented. Six cases of VTE occurred within 3 months following the surgical event. Three of these cases had thigh thrombosis, and 2 patients had upper arm thrombosis, and 1 patient had a superior vena cava thrombosis. On further workup, 5 of these 6 patients were identified as having a congenital hypercoagulable condition.

Conclusions:

VTE is a relatively rare occurrence after orthopaedic surgery in pediatric patients with CP, but when it occurs, a full hematologic workup for a congenital hypercoagulable condition is indicated. Based on the low incidence of thigh thrombosis, routine pharmacological or intermittent mechanical calf compression is not recommended. A careful clinical and family history should be performed to identify patients with possible genetic hypercoagulable conditions who would merit prophylaxis.

Level of Evidence:

Level IV.
Femoral Lengthening in Children: A Comparison of Motorized Intramedullary Nailing Versus External Fixation Techniques
Authors: Tillotson Laura O. , Maddock Connor L. , Hanley Jacqueline , Arseneau Gillian M. , Bradley Catharine S. , Kelley Simon P.
Published: February 2022

Background:

Femoral lengthening is associated with high complication rates often related to the type of surgical device used to perform the lengthening. The advent of intramedullary lengthening devices has promised a reduction in complications when compared with external fixation systems. The purpose of this study was to compare the clinical outcomes of femoral lengthening in children using a motorized intramedullary nail (Precice) versus an external fixation system (Taylor Spatial Frame—TSF; or Monolateral Rail System—MRS) at a single institution, single surgeon practice.

Methods:

This study is a retrospective comparison of pediatric patients who had previously undergone femoral lengthening (±deformity correction). Patients ages 8 to 18 years of age were included and grouped based on whether they had undergone Precice nailing or external fixation (TSF or MRS) between 2010 and 2019.

Results:

Twenty-seven patients (32 femurs) were included. Thirteen patients (15 femurs) had undergone Precice nailing and 14 patients (17 femurs) had undergone external fixation. The Precice group had significantly fewer problems, obstacles, and complications than the external fixation group, Precice 6.6%, 0%, 0%, respectively, and external fixation 47.1%, 29.4%, 0% respectively (P<0.01). Unplanned return to the operating room occurred in 4 cases, solely in the external fixation group. There were no differences in percentage of goal length achieved, Precice (mean 93.6%, range: 66.7% to 114.3%), external fixation (mean 96%, range: 76.9% to 117.5%) P=0.31 and total length achieved, Precice (mean: 44 mm, range: 20 to 80 mm), external fixation (mean: 46 mm, range: 10 to 70 mm) P=0.72. There was no difference in consolidation index, Precice (24.1 d/cm), external fixation (28.5 d/cm) P=0.36. The Precice group had a significantly shorter length of stay (mean: 2.2 d, range: 1 to 4 d), compared with the external fixation group (mean: 3.7 d, range: 2 to 8), P=0.01.

Conclusions:

Femoral lengthening in children using a motorized intramedullary nail was associated with a markedly reduced rate of complications and shorter length of stay compared with external fixation.

Level of Evidence:

Level III.
The value of sestamibi single-photon emission computed tomography/computed tomography in differentiating and staging renal cell carcinomas: A systematic review
Authors: Deb Abdalla Ali , Agag Ayman , Naushad Naufal , Krishnamoorthy Rajbabu , Serag Hosam
Published: February 2022

Misdiagnosis of benign renal neoplasms can lead to unnecessary surgical resections, which increases the risk of other morbidities and mortality. Therefore, it is crucial to find a diagnostic modality for differentiation between benign and malignant renal masses. In the current study, we summarized published pieces of evidence concerning the use of technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) as a promising diagnostic nuclear imaging modality for the differentiation of renal neoplasms. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for Systematic Reviews and Meta-Analyses. We conducted a systematic electronic database search for suitable studies from inception till February 20, 2020 in 9 databases. The risk of bias was assessed for the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We identified 9373 records after exclusion of 8978 duplicates using EndNote software. Title and abstract screening resulted in 761 records for further full-text screening. Finally, four studies were included with total sample size of 80 patients. The overall risk of bias was low to moderate. The results of all the included studies supported using 99mTc-sestamibi SPECT/CT for the differentiation between benign and malignant renal neoplasms. The use of 99mTc-sestamibi SPECT/CT could be a rapid, less invasive, promising diagnostic modality for histological diagnosis and staging of renal neoplasm, as well as monitoring post-therapy tumor's response. However, more studies with large sample sizes are essential to confirm the reliability and accuracy of this modality for usage.
Extracorporeal membrane oxygenation in coronavirus disease 2019
Authors: Friedrichson Benjamin , Kloka Jan A. , Neef Vanessa , Mutlak Haitham , Old Oliver , Zacharowski Kai , Piekarski Florian
Published: February 2022

BACKGROUND

In the context of the coronavirus disease 2019 (COVID-19) pandemic, many retrospective single-centre or specialised centre reports have shown promising mortality rates with the use of extracorporeal membrane oxygenation (ECMO) therapy. However, the mortality rate of an entire country throughout the COVID-19 pandemic remains unknown.

OBJECTIVES

The primary objective is to determine the hospital mortality in COVID-19 patients receiving venovenous ECMO (VV-ECMO) and veno-arterial ECMO (VA-ECMO) therapy. Secondary objectives are the chronological development of mortality during the pandemic, the analysis of comorbidities, age and complications.

DESIGN

Cohort study.

SETTING

Inpatient data from January 2020 to September 2021 of all hospitals in Germany were analysed.

PARTICIPANTS

All COVID-19-positive patients who received ECMO therapy were analysed according to the appropriate international statistical classification of diseases and related health problem codes (ICDs) and process key codes (OPSs).

MAIN OUTCOME MEASURES

The primary outcome was the hospital mortality.

RESULTS

In total, 4279 COVID-19-positive patients who received ECMO therapy were analysed. Among 404 patients treated with VA-ECMO and 3875 treated with VV-ECMO, the hospital mortality was high: 72% (n = 291) for VA-ECMO and 65.9% (n = 2552) for VV-ECMO. A total of 43.2% (n = 1848) of all patients were older than 60 years with a hospital mortality rate of 72.7% (n = 172) for VA-ECMO and 77.6% (n = 1301) for VV-ECMO. CPR was performed in 44.1% (n = 178) of patients with VA-ECMO and 16.4% (n = 637) of patients with VV-ECMO. The mortality rates widely varied from 48.1 to 84.4% in individual months and worsened from March 2020 (59.2%) to September 2021 (78.4%).

CONCLUSION

In Germany, a large proportion of elderly patients with COVID-19 were treated with ECMO, with an unacceptably high hospital mortality. Considering these data, the unconditional use of ECMO therapy in COVID-19 must be carefully considered and advanced age should be considered as a relative contraindication.
Two-Year Outcomes of the Paul Glaucoma Implant for Treatment of Glaucoma
Authors: Tan Marcus Chun Jin , Choy Heng Yoong Chloe , Koh Teck Chang Victor , Aquino Maria Cecilia , Sng Chelvin Cheryl Agnes , Lim Dawn Ka Ann , Loon Seng Chee , Chew Tec Kuan Paul
Published: February 2022

Purpose:

To determine 2-year efficacy of the PAUL Glaucoma Implant (PGI), a novel glaucoma tube shunt in patients with advanced glaucoma.

Participants:

Patients with glaucoma refractory to maximum medical therapy or previous failed glaucoma surgery.

Methods:

Retrospective review of all patients who had underwent PGI implantation in a single tertiary institution between May 1, 2017 and March 30, 2021.

Main Outcome Measures:

Primary outcome measure was failure defined as intraocular pressure (IOP) >18 mm Hg or <6 mm Hg on 2 consecutive visits after 3 months, reoperation for IOP-related indication, explantation of implant or loss of light perception vision. Complete success was defined as unmedicated IOP ≤18 mm Hg or ≥6 mm Hg in the absence of failure.

Results:

Forty-five eyes in 45 patients were identified, with mean follow-up duration of 24.9±2.0 months. Thirty patients (66.7%) had primary glaucoma and 11 (24.4%) with previous glaucoma surgery. At 2 years following surgery, 8 eyes (17.8%) fulfilled the failure criteria with 32 eyes (71.1%) achieving complete success. Compared with mean medicated preoperative IOP (19.8±6.3 mm Hg), postoperative IOP at 24 months was 13.9±3.7 (P<0.01). Mean number of medications decreased from 3.2±0.8 preoperatively to 0.29±0.65 at 24 months (P<0.01). Significant complications included self-limiting shallow anterior chamber (n=10; 22.2%), hypotony requiring intervention (n=4; 8.9%) and tube occlusion (n=4; 8.9%).

Conclusions:

The PGI was able to achieve sustained IOP reduction with reduction of medications at 2 years postsurgery in patients with advanced glaucoma.
Extracorporeal Life Support Organization Guideline for Transport and Retrieval of Adult and Pediatric Patients with ECMO Support
Authors: Labib Ahmed , August Erin , Agerstrand Cara , Frenckner Bjorn , Laufenberg De’ann , Lavandosky Gerald , Fajardo Christian , Gluck Jason A. , Brodie Daniel
Published: February 2022

Disclaimer:

This guideline for the preparation for and undertaking of transport and retrieval of patients on extracorporeal membrane oxygenation (ECMO) is intended for educational use to build the knowledge of physicians and other health professionals in assessing the conditions and managing the treatment of patients undergoing ECLS / ECMO and describe what are believed to be useful and safe practice for extracorporeal life support (ECLS, ECMO) but these are not necessarily consensus recommendations. The aim of clinical guidelines are to help clinicians to make informed decisions about their patients. However, adherence to a guideline does not guarantee a successful outcome. Ultimately, healthcare professionals must make their own treatment decisions about care on a case-by-case basis, after consultation with their patients, using their clinical judgement, knowledge and expertise. These guidelines do not take the place of physicians’ and other health professionals’ judgment in diagnosing and treatment of particular patients. These guidelines are not intended to and should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment must be made by the physician and other health professionals and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the clinical condition. These guidelines reflect the data at the time the guidelines were prepared; the results of subsequent studies or other information may cause revisions to the recommendations in these guidelines to be prudent to reflect new data, but ELSO is under no obligation to provide updates. In no event will ELSO be liable for any decision made or action taken in reliance upon the information provided through these guidelines.