bluuebunny/crossref_metadata_2025 huggingface dataset:
High - speed power hydraulic actuator of reciprocating motion
Authors: Golubeva Olesya , Pogorelova Alina , Mirniy Viktor
Published: March 2023

As an object of research in this paper, we use a hydro-mechanical system of high-speed technological equipment with reciprocating movement of the output link on the example of a cyclic perforating press hammer with a force of 1600 kN and a speed of up to 75 working strokes of the slider per minute. The theoretical analysis of the operation of a high-speed hydraulic reciprocating drive for a cyclic press made using a pump-accumulator power source containing one hydraulic accumulator showed that increasing its speed is technically possible, but not economically justified. Additional calculations have shown that the loss of working fluid is actually reduced. As a result, the speed of the hydraulic reciprocating drive increases from 127 to 148 and 157 beats per minute, respectively. But at the same time, its efficiency decreases from 21% to 18% and 16%, respectively. In order to increase the speed of the hydraulic reciprocating drive, it is necessary to make fundamental changes to its scheme aimed at increasing the efficiency factor by reducing unproductive energy costs during operation.
Laser heat treatment effect on fatigue of hinged cantilever beams
Authors: Alisin V.
Published: March 2023

The paper considers the effect of laser hardening treatment of steels on the fatigue strength of materials. The statement of efficiency of laser processing for formation of hard surface layer of processed surface which protects from wear is substantiated in relation to a hinge design in agricultural machines placed on a cantilever fastened beam which is a hinge axis. The phenomenon of reduction of fatigue characteristics of structural steels after laser treatment is investigated. Influence of fatigue loading on beam durability is analyzed. On the basis of experimental data analysis, the conclusion is formulated that the surface defects in the form of wells which are formed under the influence of laser pulse play an important role during the pulse laser treatment. Particular attention is paid to the role of residual stresses generated by the thermal effects of the laser. On the basis of this research, it is recommended that laser hardening treatment should be carried out, the pulse energy of which does not lead to surface melting.
Improving the energy efficiency of the boiler house of the city of Syzran, Samara region by introducing equipment with improved technical characteristics
Authors: Rakhaev Vasily , Gavrilova Anna
Published: March 2023

The work is devoted to improving the energy efficiency of the boiler house by introducing more modern equipment with improved technical and economic characteristics. A drawing of this equipment is presented. The heat engineering calculation of the heat exchanger is performed. The problems of concession agreements of heat supply organizations are formulated. The mechanism of interaction of public-private regulation is described. The paper outlines how important it is to have a rational energy saving mechanism. The advantages and disadvantages of concessions are noted. An example of foreign experience in the use of concession agreements is given. This article touches on the topic of reducing energy consumption, including due to the transition to a different type of coolant in the boiler room. Based on the specifics of the object of heat consumption of the boiler house, the most rational heat carrier instead of water vapor is hot water, as can be seen from the above calculations. The principle of operation and the feasibility of using a waterwater heat exchanger are described. In the work, the author transfers the heat exchanger to another type of coolant, as well as to another design of the heat exchanger. The advantages and disadvantages of the equipment are given. The work carried out a constructive heat engineering calculation. An assessment is made of the contribution to the modernization of heat supply systems, due to the effective interaction of heat supply organizations with specialized heat supply companies.
Cooling of an infinite rectangular plate with an adibatically insulated side
Authors: Kanareykin Aleksandr
Published: March 2023

The work is devoted to the issues of non-stationary heat transfer. The article presents a solution for the distribution of the temperature field in an infinite rectangular plate with an adiabatically isolated side. As a result, an analytical expression of the plate temperature distribution is obtained in the form of a series containing trigonometric and exponential functions. The paper also considered special cases when the internal thermal resistance of thermal conductivity is greater and when the external resistance of heat output is less. Special cases were interpreted physically. One of the special cases leads the problem to a problem with boundary conditions of the first kind, when the surface temperature is constant, which indicates the reliability of the results obtained.
The normal distribution application: systolic blood pressure
Authors: Svistova Svetlana , Nikitina Tatiana
Published: March 2023

The present study established that sample data for 50 participants were approximately normally distributed using visual analysis. The distributions categorised by respective levels of gender, smoking condition, and across levels of age group showed approximate normality with varying standard deviations. From our research we conduct that smokers have higher probability of high blood pressure and hypertension, males had a higher systolic blood pressure than females, however, smokers had higher blood pressure than non-smokers.
Features of the structure of metal composite alloy obtained by electric slag remelting with controlled magneto-hydrodynamic action
Authors: Kuzmichev Evgenii N. , Gordienko Pavel S. , Drozdov Evgenii A. , Kirichenko Evgenii A.
Published: March 2023

The results of experimental studies on the use of mineral raw materials containing zirconium oxides without its deep technological processing to create alloys by electroslag remelting are presented. Dependences of the transition of zirconium into remelted low-carbon steel on the magnitude of electromagnetic pulses have been established. It has been experimentally proven that zircon concentrate can be used as an alloying component to obtain alloyed alloys and coatings in electroslag technologies. In this case, the concentrate is used in a comprehensive manner, without additional technological processing.
Rolled metal electron plasma treatment for automotive hardware cold upsetting
Authors: Fillipov Alexey Alesandrovich , Pachurin German Vasilyevich , Mochalina Mariia Vadimovna , Kuzmin Nikolay Alexandrovich , Trunova Irina Gennadievna , Golubeva Olga Vladislavovna
Published: March 2023

One of the most important objectives of the modern car production development is to improve the quality of metal products and parts made from it, increase their efficiency, reliability, service life, bringing these indicators to the level of the world standards, ensuring the competitiveness of domestic products at the foreign market. The structural safety of motor vehicles is largely determined by the operational reliability of the constituent elements. Car fasteners made of high-carbon and alloy wire, including hardware items, are among the critical and widely used parts in mechanical engineering. The most common and progressive method of their manufacture is the cold upsetting from rolled bar material. The bar material surface condition has a significant impact on its quality. Hot rolled products from metallurgical plants are typically delivered to the processing facilities covered with scale and rust. To improve the surface quality of semifinished metallurgical products for rerolling at the stage of wire preparation for drawing, it is subjected to continuous mechanical or chemical cleaning. Traditionally, the technology of surface scale removing by etching is used in production. This method of scale removal provides a high level of cleaning, but there are problems with the disposal of spent acid solutions, reducing the steel ductility. Mechanical methods of scale removal have been widely introduced recently, although the use of mechanical scale removal devices also does not completely solve the problem. The paper considers the possibility of using advanced electron plasma treatment technologies for these purposes and the influence of traditional methods and this scale removing method from the rolled steel surface on the quality of metal preparation for upsetting.
Nonlinear mathematical model of an economic soliton
Authors: Stanislavovich Oleg
Published: March 2023

In modern conditions of economic transformation, the functioning and development of production systems is characterized by instability, nonlinearity and dynamism of the main indicators and parameters. The financial and production system is affected by a large number of market, inflationary, social and other disturbances, which leads to the losses in financial stability, a decrease in production volumes, a decrease in demand for manufactured products, etc. Therefore, it is necessary to have an effective management system and operational decision-making. The relevant direction for solving this problem is the development of a flexible intelligent control system that makes it possible to diagnose quickly the unfavorable state of the financial and production system and activate promptly the mechanisms that return the system to equilibrium. In this case, information becomes the main resource of management, which performs an integrating role and is a necessary component when using all other resources. All this predetermines the use of information technology management. With a high dynamism and instability of the external environment, it becomes necessary to apply the methods and approaches of the new science of management, concentrating its attention on the theory of complex systems and nonlinear dynamics, with the help of which complex control systems can cope effectively with uncertainty and rapid changes. The development and use of modern information technologies for enterprise management are based on the introduction of integrated information processing technology and the creation of mathematical methods and computer modeling tools. In the work of information technologies, management is implemented by creating an integrated intelligent computerized system based on the use of economic and mathematical methods, computer technology and communication means, i.e. implements a fundamentally new management platform, which is based on the integration of management information through a mechanism for generalizing the information database and knowledge.
Cement production efficiency improving
Authors: Orazov Parahat , Nurberdiev Redzhepnur , Khodzhamuradov Kurt
Published: March 2023

The paper considers the issues of increasing the efficiency and environmental safety of cement production by using clinker dust in slurry preparation and replacing a certain part of clinker with mineral additives having pozzolanic activity. On the basis of research work carried out at the production site of the Baherden cement plant (Turkmenistan), the suitability of a Venturi scrubber to capture the dust generated in wet clinker kilns of cement plants has been established. The technological scheme for the use of the sludge generated in the scrubber in the preparation of clinker was developed. Based on the results of analyses of the main indicators of cement prepared with the addition of sludge the possibility of using the collected dust in the production of cement has been established. The optimal solution for three interrelated problems, such as increasing the efficiency of cement production, reducing the amount of harmful gases emitted into the atmosphere, and rational use of natural resources, is to reduce the specific consumption of clinker by compensating a certain part of it with mineral additives with pozzolanic activity.
Application of artificial intelligence and neural network technologies in the construction industry
Authors: Garyaev Nikolay , Garyaev Andrey
Published: March 2023

One of the problems that may arise in the way of successful implementation of energy supply in urban areas is the difficulty of analyzing and interpreting a large amount of digital data received from various sensors. This problem may adversely affect the performance of energy organizations. The purpose of this study is to study modern tools to solve the problem of processing big data using technologies of simulation and artificial intelligence. This study is dedicated to the development of innovative digital models for the balanced distribution of energy consumption in urban areas.
Increase the resource and reduce the life cycle cost locomotive wheelset
Authors: Mayba I. , Valinsky O.
Published: March 2023

The paper presents the results of research on the analysisy of modern technical means and technologies to increase the service life and reduce the cost of the life cycle of a locomotive wheelset. Calculations are performed and the results of technical and economic efficiency of the use of modern innovative comb-smearing devices lubrication (USGL) and plasma hardening devices (SCR) for locomotive wheel pairs, as well as clutch activation devices (UATL), are presented. The practice of operating USGL and UPU devices has shown that the most effective is their joint use with the achievement of a consolidatedого effect on increasing the service life of locomotive wheel bands. Technical and economic calculation of the efficiency of using UATL friction activation devices has shown the economic feasibility of using locomotive coupling activation systems которые обеспечиваю, which provide an increase in the mileage of locomotives between equipment in the conditions of field operation of the locomotive fleet and reduce the cost of building additional points for equipping locomotives with sand.
Comparative legal study defining the bill of lading significance in maritime transport of goods
Authors: Gavrilov Vladimir , Ushakov Ruslan , Khamkhoeva Laura , Kumalagov Nikolay , Littih Inna
Published: March 2023

The given research paper studies the regulatory normative acts of the Russian Federation and foreign states related to the legal meaning of the bill of lading applying the following scientific methods: dialectical method, the comparative legal and historical ones, systematic, formal legal method and special legal interpretation approach. Particular attention is paid to the legal documents of the United States of America and Great Britain as the legal acts of these countries have had the greatest impact on all foreign legislation related to the carriage of goods by sea in general, and the bill of lading, in particular. The authors highlight the points that require a more detailed study as well as other general and different features of the bill of lading in the Russian Federation and in other foreign states legislation. The problematic aspects of the bill of lading caused by the peculiarities of the Russian Federation historical development are also determined in the article. The studied material allows the authors to propose certain amendments to the current legislation of the Russian Federation: to include the legal regulations of the bill of lading into the legislative codified act – the Code of Merchant Shipping of the Russian Federation while at present they are mainly located in by-laws.
Digital management of electricity consumption as a factor of transport company value
Authors: Klavsuts Irina , Shcherbakova Natalia
Published: March 2023

Transport industry enterprises consume a significant amount of electricity, and management impacts on this process with the help of digital technologies will reduce costs and allow to obtain other beneficial effects. The paper points out that the development of transport infrastructure, electric transport and all categories of smart transport increases the dependence of the efficiency of the functioning of transport companies on the consumed volumes and quality of electric energy. The authors considered the effects from using new methods of digital management of resource consumption, which include increasing the stability of the power system, increasing the accuracy of measuring consumed resources, as well as solving the problems of effective planning and resource allocation. The influence of the effects of digital management of electricity consumption is considered from the standpoint of value-based management. The key conditions for the information support of the functioning of control systems is a change in the format and method of information exchange, i.e. the transition from the transmission of analog data to digitized information blocks. The results of the study are to confirm the positive impact of the use of digital technologies in the management of electricity consumption, primarily on reducing operating costs and, as a result, increasing the value of transport companies, as well as highlighting the prospects for their widespread use in transport systems, which may be the subject of future research.
Identification of the similarity of urban mobility country patterns during the period of COVID restrictions: methodology and results
Authors: Petrov Artur , Zakharov Dmitrii
Published: March 2023

The term “Black Swan” by N. Taleb (Taleb, 2007) well illustrates a sudden, negatively manifesting itself in relation to the surrounding world factor. Actively used since 2015, this concept implies a shock impact on economic and production systems, which include transport and logistics systems. COVID-19 and its negative manifestations are a good example of such a 'black swan’. The serious crisis of the world economic system, which began in February-March 2020 and lasted about 450-600 days, was caused by a total restriction of elementary physical contacts between people and any manifestations of their pedestrian and transport mobility associated with it. The widespread lockdowns served this very purpose. However, lockdowns varied across countries in terms of timing, duration, methodological approaches, the strength of restrictions, and control measures. As a result, the mobility of the urban population varied with the influence of the external environment and was not identical in different cities. This paper presents the results of comparative studies of the urban population mobility dynamics in three European cities: two cities of one country – Moscow and St. Petersburg, and another European capital – Amsterdam. At the same time, the goal was to identify the urban mobility country patterns similarity during the period of COVID restrictions. Two tasks were solved: a cross-country comparison of trends in urban population mobility during 2020-2021 and a comparison of trends in population mobility in two cities of the same country.
Who outperforms automobile industry in India? Comparative study on financial performance between tata motors versus M& M LTD
Authors: Maheswari N. Uma , Kumar E. Muthu , Koushik R.
Published: March 2023

Background: The immense growth of automobile industry in India made the people to satisfy their desire in driving the most luxurious vehicle. Every other day, we have been getting news about some new launches, some low-cost cars which are all custom-made in a sophistication such that even the common man can afford the vehicle. The Compound Annual Growth Rate of the Indian automotive industry’s sales between financial year 2009 and 2020 comes around 8%. Purpose: The purpose of this study is to know about the financial performance of leading automobile industry by comparing their financial statements. Objectives: The financial position of TATA motors and M & M Ltd were ascertained with the help of ratios as a parameter. Secondly to analyse the financial performance of both the companies by comparing its financial statements. Methodology: In this research work two automobile companies in India were selected for analysis. The selected automobile companies last five years i.e., from 2018 to 2022 financial position were analysed. This research is based on the secondary data. Different ratios were used to analyse the financial position of TATA motors and M & M Ltd. Findings: By analysing the financial position of the two companies it is clear that the net sales of the M & M Ltd is higher than the Tata Motors. It shows that even though the Tata Motors is performing well in its sales it has to concentrate to reduce its expenses to increase the profit. Likewise in the aspects of earnings per share, return on capital employed ratio, return on net worth ratio, gross profit ratio and net profit ratio the Tata Motors is lesser than the M & M Ltd. After analysing the aspects in this research, it says that M&M Ltd is betterthan Tata Motors from the year 2018 to 2022.
Formation of factors for ensure the effectiveness of the information process of industrial enterprise management
Authors: Altfihat Ali Ata Salman , Kuzubov Alexey , Maksimenko Aleskandr
Published: March 2023

The article has formed a system of indicators for assessing the effectiveness of the information management process in order to determine the possibility and feasibility of its use in the management of an industrial enterprise. Indicators, the calculation of which is based on internal sources of information of an industrial enterprise according to management and financial accounting data, form the basis of the information process for managing the activities of an industrial enterprise. For the analysis, the data were combined with the subject area into indicators of labor, production and financial spheres. In order to improve the process of managing an industrial enterprise, partial indicators of assessing the effectiveness of the information process of managing an industrial enterprise were calculated on the basis of the synthesis of expert assessment methods: by scores and the method of analyzing hierarchies. Based on the results of the study, priority indicators have been identified for calculating the integral indicator of ensuring the effectiveness of the information process of managing an industrial enterprise with ensuring the reliability, content, completeness and relevance of the information process. The factors that ensure the efficiency of the information process of enterprise management are identified, thanks to which it becomes possible to design in advance several approaches to organizing the future activities of an industrial enterprise.
The use of the effective age in the calculation of the cadastral value as a factor in the sustainable development of the region
Authors: Gubanishcheva Maria , Sementsov Nikita
Published: March 2023

In the Russian Federation taxes are calculated based on the cadastral value of immovable property, formed on market information, including information related to the economic characteristics of using of a real estate object. This creates conditions for the rational and efficient use of land plots and capital construction projects (capital construction object). However, it is worth noting that today these conditions are poorly implemented due to biased cost indicators forming the base real estate taxation. The purpose of the study is to test methodological tools for calculating the cadastral value of a capital construction object, taking into account adjusted effective age in the context of sustainable development of the region. When performing repair and restoration work, physical wear is compensated only partially. In this regard, the cost of a constructed building and the cost of a building that was overhauled or reconstructed in the same year are not equivalent to each other. The proposed by the authors corrected effective age allows us to reflect the content of difference between the year of construction and the year of reconstruction or overhaul as a whole. This makes it possible to resolve the issue of using such a pricing factor as a date of overhaul (reconstruction). At the moment, regions do not have a unified position in a practical approach to this issue. To demonstrate the applicability of methodological tools, the assessment of cadastral value was carried out within the framework of the cost approach. The sample used includes 132 objects, residential and non-residential buildings located on the territory of the city of Tomsk, in respect of which reconstruction was carried out. The results showed that the calculation models of physical depreciation of a building based on corrected effective age become more flexible because partial compensation of physical depreciation is taken into account during the renovation. In total, these measures lead to the accuracy increase while calculating the cadastral value.
Combining methods for designing a regional program of the bakery sector development
Authors: Valery Koshelev , Vorozhtsova Ludmila , Aleksanov Dmitriy , Romanyuk Maria , Sukharnikova Maria , Chekmareva Natalia
Published: March 2023

The analysis of investment projects for the construction of bakery enterprises and infrastructure facilities, based on the results of optimization of their placement, allows designing a program for the development of the bakery sector for remote subsidized regions. The program is aimed at ensuring an increase in the competitiveness of local producers and in the physical and economic availability of bakery products for the population. The proposed method of combined application of methods of mathematical modelling andproject analysis has been implemented in one of the remote northern regions of Russia – the Republic of Karelia, where the studied problems were expressed most acutely. The results obtained from the modelling give the opportunity to predict the cash flows of the project for the development of the baking sector of the Republic and evaluate its effectiveness. The results of the analysis show that both the project as a whole and its components are effective and meet the interests of the stakeholders.
Neue Therapieansätze beim Mammakarzinom
Authors: Arnheim Katharina
Published: March 2023

In mehreren Sitzungen wurden auf dem Kongress der European Society of Medical Oncology (ESMO) neue Studiendaten zum therapeutischen Vorgehen beim frühen und metastasierten Brustkrebs vorgestellt.
Pulmonales Sarkom
Authors: Krome Susanne
Published: March 2023

Pulmonale Sarkome machen weniger als 1 % aller Lungentumoren aus. Bei der Diagnose liegt oft ein fortgeschrittenes Stadium, aggressives Wachstum und hoher lokaler Invasionsgrad vor. Die retrospektive Analyse fasst Daten aus 4 nicht randomisierten Studien zusammen, in denen Patienten eine Resektion oder zusätzlich eine adjuvante Chemotherapie erhielten. Die Kombination verlängerte signifikant die Überlebenswahrscheinlichkeit. Der Evidenzgrad war aufgrund der Studiendesigns und der unterschiedlichen medikamentösen Protokolle allerdings gering.
Nichtkleinzelliges Bronchialkarzinom
Authors: Krome Susanne
Published: March 2023

Bei 3–13,8 % der Patienten mit Bronchialkarzinom treten im Krankheitsverlauf thromboembolische Ereignisse (TE) auf, die die Lebensqualität verschlechtern und mit einem kürzeren Überleben assoziiert sind. Bislang war unklar, ob sich das Risiko in Abhängigkeit vom Mutationsstatus unterscheidet und sich eine Therapie mit Tyrosinkinase-Inhibitoren (TKI) auf das Überleben auswirkt. Eine aktuelle retrospektive Studie identifizierte Treibermutationen und bietet eine klinische Basis zur Identifizierung von Risikopatienten, Prävention und Therapie.
CDKN1C-Related Beckwith-Wiedemann Syndrome: First Patient from India
Authors: Arora Veronica , Takkar Aashita , Dubey Sudhisha , Gupta Deepti , Saxena Renu , Verma I.C
Published: March 2023

Beckwith-Wiedemann syndrome (BWS; MIM# 130650) is a well-characterized pediatric overgrowth disorder. In approximately 5% of the cases, it is caused by pathogenic variants in the CDKN1C (cyclin-dependent kinase inhibitor 1C). CDKN1C gene encodes for a protein p57 (KIP2) that acts as an inhibitor of cyclin-dependent kinases (CDK) that are expressed in the G and S-phase of the cell cycle, thus regulating cellular proliferation. Variants in CDKN1C gene lead to loss of inhibitory function of CDK and thus impair the inhibition of growth, resulting in BWS phenotype.

We describe here a 2.5-year-old boy with a maternally inherited variant c.182G > T, p.Trp61Cys in the CDKN1C gene causing BWS. The natural history of the disorder is described along with the gradual change in the facial features. An insight into the genotype–phenotype correlation and disorders to be considered in the differential diagnosis is provided. We describe a common overgrowth syndrome with its rare genetic mechanism and highlight the salient features that help in making a diagnosis and managing patients.
From a Holocaust Survivor’s Initiative to a Ministry of Education Project: Fredka Mazia and the First Israeli Youth Journeys to Poland 1965–1966
Authors: Geva Sharon
Published: March 2023

The first Israeli youth journey to Poland took place in 1965. Fredka Mazia, a Holocaust survivor, initiated, organized, and led the group. Following a positive public response, the Ministry of Education and Culture organized their own journey in 1966. In 1967, after Poland severed relations with Israel, the government suspended further journeys until the 1980s. In time, they have become a tradition and the focus of several research studies; however, these studies largely ignore both the initial journeys of the 1960s and the woman who initiated them. This article describes Mazia’s pioneering role in this project, and the program’s impact on the lives of Israeli youths, perceptions of the Holocaust, and Holocaust commemoration.
Artificial Intelligence Authoring Financial Recommendations: Comparative Australian Evidence
Authors: Neilson Ben
Published: March 2023

This article explores the use of artificial intelligence software to create financial recommendations. It seeks to define the impacts and outline the benefits of using ChatGPT software in the highly regulated Australian financial sector. ChatGPT was asked to create a financial recommendation, which was evaluated against the relevant regulations and the recommendations of existing professionals and market contributors. The data generated was analysed using Qualtrics analysis techniques. The findings suggest that ChatGPT significantly reduces the time required to carry out creation, input, and editing services for simple financial advice recommendations. However, ChatGPT fails to operate effectively with complex financial advice and requires professional guidance to ensure regulatory adherence. In future, it may be possible to develop ChatGPT as a complementary tool to decrease the time and cost required to create financial recommendations.
A Systematic Review of Music Interventions to Support Parent–Child Attachment
Authors: Newman Lalitha J , Stewart Sandra E , Freeman Nerelie C , Thompson Grace
Published: March 2023

Secure attachment in early childhood is important for wellbeing throughout life. Music interventions show promise for supporting early parent–child relationships; however, their effects on attachment security are unclear as few music intervention evaluations have measured attachment outcomes. This systematic literature review aimed to synthesize published empirical literature examining the effects of music interventions on relationship quality between typically developing children aged birth to 5 years old and their parents. The study aimed to: (1) establish whether music interventions were associated with changes in attachment-related outcomes; (2) identify music intervention characteristics likely to support secure attachment; and (3) elucidate processes through which music techniques may have contributed to attachment-related changes. Included interventions focused on the parent–child dyad, involved a substantial music component delivered by a music therapist or an allied health professional, and assessed and/or described relationship outcome/s. A total of 23 studies describing 15 unique interventions met criteria for inclusion and represented approximately 808–815 parent–child dyads. Mothers were the most common caregivers. All interventions demonstrated some effectiveness, including in attachment-related outcomes such as bonding, emotional co-regulation, and parental sensitivity. All interventions involved singing, suggesting it may be especially suitable for supporting parent–child attachment; other music techniques used included instrument playing and movement to music. Findings suggested that music interventions may facilitate attachment-related changes through intervening in psychological processes, including parental sensitivity, reflective functioning, and emotional co-regulation. Future research should develop music interventions aiming specifically to support attachment quality, and music intervention evaluations should use validated attachment assessments and longitudinal study designs.
Just Call 911
Authors: Elie Marie-Carmelle
Published: March 2023

Hospice, a philosophy of end-of-life care that is a funded program in the United States, represents an interdisciplinary model to provide the palliation of physical, emotional, and spiritual symptoms among patients with a terminal diagnosis. In the United States, patients may enroll in this interdisciplinary medical program when the prognosis is estimated by two physicians to be 6 months or less if the disease runs its usual course. Approximately 1.5 million Americans representing 50% of Medicare beneficiaries are enrolled in hospice every year, and approximately 40% receive this care within days or weeks before death or when death is considered imminent, limiting the benefits of hospice to the dying patient and their caregivers. While it is unknown how often patients enrolled in a hospice program of care present to the emergency department, in the experience of most clinicians, they have cared for these patients.
“God Help Us”
Authors: Viera-Ortiz Liliana , Munet-Colón Clariliz
Published: March 2023

Often the emergency clinician has to make fast-paced clinical decisions for patients with severe illness while balancing family beliefs and expectations. Spiritual and cultural concerns that arise at bedside often hinder clinical decisions and must be addressed in order to move forward with patient care. Clinicians may feel uncomfortable and unskilled in discussing spiritual and cultural issues, possibly due to the lack of training, limited time, and unfamiliarity with these issues. Limited access to palliative care, family’s hopes for a miracle, and desire for aggressive measures at the end of life could also promote uncomfortable and difficult conversations. Failure of clinicians to explore the impact of spirituality and culture on how the patient and the family experience serious illness may limit the appropriate care and create conflict. Clinicians should practice cultural humility to have an open and respectful conversation with the family. Acknowledging their beliefs and cultural practices may help create rapport and open communication channels to better explore other treatment options, such as comfort care or hospice.
“Mine, No . . . Mine”
Authors: Brenner Jay M.
Published: March 2023

When patients cannot speak for themselves, clinicians look to surrogates to represent their wishes. Surrogate decision makers may not know the patient’s wishes; in which case, they typically try to think of the patient’s best interests or sometimes their own. Emergency clinicians are offered guidance to navigate these often-complex situations that, if mishandled, can lead to less-than-optimal patient outcomes, contribute to surrogate guilt, and exacerbate provider burnout through the exacerbation of moral distress. These include (1) techniques for negotiating with surrogates in conflict; (2) examination of expressed interest versus best interest decision-making; (3) autonomy versus authenticity; and (4) factors of independence, frailty, and cognition.
Caught in the Middle
Authors: Romero Cynthia S. , Kumar Lekshmi
Published: March 2023

Hospice and palliative care patients and their families often call emergency medical services (EMS) in emergency situations. In addition to providing appropriate care for the situation, EMS must take into account the patient’s care plan, avoiding any treatments that may go against the patient’s wishes. This may require further discussions with the patient, their family, and the hospice or palliative care team. Ready access and availability of critical documentation delineating the patient’s wishes is crucial. EMS must be familiar with their state laws regarding the legality of advance directives and written medical orders and whether these documents can help guide their patient management plan. The initial care provided to those with life-threatening illness by EMS and the decision to transport to a hospital are essential, as these can determine the patient’s management course, including receiving unwanted or invasive procedures. No matter the patient’s goals of care, they should receive prompt treatment of any troublesome and painful symptoms. Patients and their grieving families will require compassion, empathy, and support from EMS, who may need to explain progression of the disease and complications to the patient and their families. Research indicates that EMS providers are seeking more education and training on palliative care because this is currently lacking in most systems. Collaboration with hospice and palliative care networks would be crucial in helping prehospital providers with their decision-making and treatment options through specific palliative care education and guidelines.
Historical overview
Authors: Thompson Chase , Husain Ishrat M.
Published: March 2023

Humans have a long and complicated history with psychedelic compounds. Originally discovered as a component of certain plants and fungi, the psychedelics were widely used by ancient and indigenous peoples for millennia. Contemporary Western society had been largely disconnected from psychedelics but was reintroduced when Albert Hofmann first synthesized D-lysergic acid diethylamide (LSD) in the 1940s, and when American banker Gordon Wasson was introduced to psilocybin by Maria Sabina in the 1950s and spread word of these ‘magic mushrooms’. LSD and psilocybin became objects of scientific and cultural fascination, but their early prominence shifted into abrupt decline in the 1970s because of sweeping international drug laws and regulation. In the 1990s, the psychedelics re-emerged, this time from an era of prohibition. From that point onward, there has been an ongoing renaissance of psychedelic science.
Risks and adverse events associated with the use of psychedelics
Authors: Neill Joanna C. , Shahid Mohammed , Gittins Rosalind , Schlag Anne K. , Tarazi Frank I.
Published: March 2023

Improved understanding of the potential risks and adverse effects of psychedelics is essential before psychedelic-assisted therapy is adopted into mainstream medicine. In spite of numerous recent clinical trials, gaps in knowledge remain. A comprehensive analysis of human receptor pharmacology is required to inform clinical dosing strategies and improve the understanding of drug-drug interactions, specifically relating to psychedelic medicines with currently available antidepressants, antipsychotics, and anticonvulsants. Pharmacovigilance will be essential post-regulatory approval to ensure patient safety and tolerability, and future clinical trials must include a more ethnically diverse population. This is one of the most important and exciting innovations in psychiatry for over half a century. In order to maximize the potential for patient benefit, it is essential that we proceed carefully and conduct all essential safety and risk-benefit evaluations at each stage.
Psychedelics as psychiatric medicines: Current challenges and future prospects
Authors: Castle David , Ledwos Nicole , Nutt David
Published: March 2023

This is an exciting time for psychedelics and related drugs, with a renewed scientific interest in their potential benefits for a range of mental health disorders and addictions. However, much is yet to be discovered about this group of drugs, including precisely how they work in the brain; how their biological effects interact with psychological support to effect therapeutic change; how long their benefits endure; and how safe they are in the longer term. The nature of the psychedelic experience, its necessity in obtaining therapeutic benefit, and how the psychological component can be safely delivered are outstanding issues. There are also questions to be answered regarding how these drugs can be integrated into mainstream service delivery, how they will be made available and funded, and what training will be required of therapists. Finally, gold-standard trial designs, addressing thorny issues such as blinding and placebo response, as well as expectancy bias, need to be agreed and adopted, as we explore efficacy and safety across a growing range of mental health and addictive disorders.
The Narrative-Crisis Model of Suicide
Authors: Galynker Igor
Published: March 2023

The narrative-crisis model of suicide (NCM) is a multistage diathesis-stress model of suicide that integrates empirically validated long- and short-term risk factors to explain the mental processes that lead to suicide. As a preface to a detailed discussion of the NCM, the chapter outlines key differences between trait and state risk factors, as well as between static and dynamic risk factors. The primary focus of the chapter is to expound on the NCM and its theoretical basis: when individuals with heightened baseline vulnerability for suicide (i.e., long-term risks factors) encounter stressful life events, they may develop distorted views of themselves and others, culminating in a perception of their having no future and increasing the likelihood of their developing a suicidal crisis. The NCM’s three components, which are discussed throughout the chapter, are: (1) long-term risk factors, which are relatively stable over time and incur heightened vulnerability for suicide; (2) the suicidal narrative, a subacute suicidal state whereby individuals develop maladaptive views of themselves and the world that result in the perception of an intolerable present and a future that is unimaginable; and (3) suicide crisis syndrome, an acute suicidal state characterized by cognitive and affective dysregulation that signals imminent risk for suicidal behavior. The result of SCS is a suicide attempt, made in a desperate urge to end the intolerable mental pain of SCS. Empirical support for the NCM, as well as the model’s flexibility in explaining several types of suicidal behaviors, are also discussed.
Stressful Life Events
Authors: Lawrence Olivia C. , Goncearenco Inna , Ziafat Kimia
Published: March 2023

Stressful life events are critical precipitants of suicidal thoughts and behaviors and play a central role in triggering the onset of acute suicidal states. This chapter reviews the evidence to date for various types of stressors that have been linked to suicidal thoughts and behaviors. Six broad categories of stressful life events are examined: work and financial hardship, relationship conflict, serious medical illness, serious mental illness, recent substance misuse, Internet and social media use, and the COVID-19 pandemic. While the literature discussed in the chapter largely includes adult samples, stressful life events shown to be uniquely related to suicide in adolescents, such as conflict with parents, ongoing childhood neglect, and bullying, are also examined throughout the text. Case examples are provided throughout the chapter to illustrate the role of stressful life events in conferring increased suicide risk.
Suicide Crisis Syndrome
Authors: Galynker Igor
Published: March 2023

This chapter provides an in-depth review of the suicide crisis syndrome (SCS), an acute pre-suicidal mental state associated with imminent suicidal behavior. The chapter opens with a brief overview of the increasing empirical focus on understanding short-term risk factors for suicide, following an introduction to SCS, the rationale for its development, and its empirical basis. The next sections examine the proposed DSM diagnostic criteria for SCS and the research supporting the validity, reliability, and clinical utility of SCS and its symptomology. The first key symptom of SCS is a frantic hopelessness/entrapment, defined as a persistent or recurring overwhelming feeling of urgency to escape or avoid an unbearable life situation that is perceived to be impossible to escape, avoid, or endure (Criterion A). Additional diagnostic criteria include affective disturbances, loss of cognitive control, hyperarousal, and acute social withdrawal (Criteria B). Structured according to the proposed SCS DSM criteria, the SCS assessment algorithm provided in this chapter does not rely on self-disclosure of suicidal ideation. Additionally, the One-minute Assessment, which targets core symptoms of SCS, is suggested for use in high-volume and high-pressure clinical settings, such as the emergency department. An in-depth analysis of three clinical cases, representing the high risk of imminent suicide, moderate risk of imminent suicide, and low risk of imminent suicide, is included to illustrate the SCS interview assessment algorithm.
Emotional Response to Suicidal Patients in the Assessment of Imminent Suicide Risk
Authors: Imbastaro Benedetta , Lawrence Olivia C. , Goncearenco Inna , Ziafat Kimia
Published: March 2023

Clinicians’ emotional responses to suicidal patients can be a clinically useful source of information when determining a patient’s level of suicide risk. Although clinicians’ emotional responses to suicidal patients have been largely overlooked in research and practice, a growing body of evidence suggests that clinicians exhibit unique patterns of emotional reactions to suicidal patients that are linked to clinician decision-making and prospective suicidal outcomes. This chapter reviews the extant literature on the association between clinicians’ emotional responses in interaction with suicidal patients and patients’ future suicidal behavior. Underlying mechanisms of clinicians’ emotional responses, common defense mechanisms in psychotherapy with suicidal patients, and the meaning of different patterns of clinician emotional responses are discussed and illustrated by clinical cases. Additionally, the use of clinicians’ emotions as diagnostic tools for assessing imminent suicide risk is described. The chapter outlines a self-assessment framework, which includes guidelines for appraising one’s subjective emotional response and incorporating it into formulating a patient’s suicide risk. A practical method for assessing one’s emotional response is provided with relevant clinical cases illustrating its implementation in clinical assessment.
Orthopedic Surgery
Authors: Lazar Alina
Published: March 2023

Orthopedic surgery is frequently performed in children for traumatic fractures, developmental disorders of the skeleton, and bone neoplasms. The main anesthetic considerations are bleeding, sequelae of abnormal neurodevelopment or prematurity, and pain management. Multimodal analgesia, including regional anesthesia, is recommended. When performing neuraxial and peripheral nerve blocks proper patient selection and postoperative monitoring are essential to avoid complications. Scoliosis correction is done via either rod placement or spinal fixation. Bleeding and difficulties with neuromonitoring are of particular concern in patients with neuromuscular scoliosis. Spinal cord injury and severe postoperative pain are other important risks associated with scoliosis surgery. Antifibrinolytics and blood salvage techniques decrease blood loss, while multimodal analgesia, including opioids, adjuvants, and regional anesthesia, ensure adequate postoperative pain management.