bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimizing AAC production hard waste costs: A hybrid IMSD and DfE approach in machine‐building industry
Authors: Aldarrat Hatem , Cogum Billy Özer , Reupke Lorenz
Published: September 2018

The autoclaved aerated concrete (AAC) products life cycle generates environmental impacts (1) from extracting and processing raw materials; (2) during manufacturing, assembly, and distribution; (3) due to their packaging, use, and maintenance; and (4) at the end of their life cycle. AAC machines builders and manufacturing firms were always concerned with meeting regulations that limited or prohibited the pollution and waste that is generated by manufacturing processes. However, nowadays new regulations are also focusing on the material content of the products that are sold in an effort to control the substances that enter the waste stream. In the present research paper some selected AAC machines and equipment's solutions used in minimizing the production hard waste in AAC industries will be presented and investigated by conducting a hybrid Industrial Machines and System Design concept and Design for Environment concept. This preliminary study will illustrate some examples of newly developed WKB Systems GmbH machinery and equipment that is constructed and used as a part of the AAC production processes of the blocks and reinforced panels and other AAC products.
Comparisons of confined and different types of reinforcement on the behavior of masonry shear walls
Authors: Jasiński Radosław
Published: September 2018

This paper presents a comparison of results for shear walls: unreinforced (three walls), confined (six walls), and reinforced with two different types of reinforcements (four walls). Masonry walls made of autoclaved aerated concrete (AAC) had a thickness t = 0.18. Four series of different walls of the same length equal to l = 4.43 m and the height of h = 2.43 m were made and tested. Compressive strength of material masonry units and mortar for thin joints was equal to fb = 4.0 N/mm2 and fm = 6.1 N/mm2. Compressive strength of walls (according to EN 1052‐1:2000) was fc,mv = 2.97 N/mm2 and (fk = 2.48 N/mm2) and elastic modulus was Ecm = 2.040 N/mm2. Walls were tested at the same initial compressive stresses perpendicular to the plane of bed joints σc = 0.1, 0.75, and 1.0 N/mm2. In confined models, two external vertical cores and two horizontal beams were made and reinforced in accordance with the requirements of the European Standard EN‐1996‐1‐1. Steel truss‐type reinforcement and plastic grid placed in each bed joint were used in walls. The obtained values of stresses were compared at the time of cracking and destruction. The morphology of cracking and the mechanism of destruction were analyzed.
Testing boundary conditions determining the drying shrinkage behavior of AAC
Authors: Rzeczkowski Patrick , Lohaus Ludger
Published: September 2018

The German application rules DIN 20000–404:2018‐04 for the use of autoclaved aerated concrete (AAC) according to DIN EN 771–4:2015‐11 state that the total value of the drying shrinkage as stated in DIN EN 680:2006‐03 must not exceed 0.40 mm/m. This value was set to determine the long‐term resistance due to carbonation. Such shrinkage tests, therefore, aim to distinguish critical from noncritical AAC blocks. The shrinkage curves of AACs tested in previous investigations differed from the behavior postulated in DIN EN 680:2006‐03. These deviations during shrinkage can be partly attributed to overlapping mechanisms, such as carbonation. In addition, the standard permits different storage conditions. The samples can be stored in either a room or cabinet with temperature and humidity control. In the present study, the possible testing boundary conditions according to DIN EN 680:2006‐03 are investigated to determine and evaluate the effects resulting from different testing boundary conditions and provide recommendations for performing the test. Furthermore, indications of processes in the material structure running parallel to shrinkage are to be derived. The investigations are accompanied by repeated shrinkage tests and thermogravimetric analyses.
Shaking table test study on a steel frame with autoclaved aerated concrete walls
Authors: Cheng Caiyuan , He Liusheng
Published: September 2018

This paper studies the seismic performance of a steel frame with autoclaved aerated concrete (AAC) walls through full‐scale shaking table tests. In the tested single‐span two‐storey steel frame, two types of AAC walls, AAC panel, and AAC block masonry wall, were adopted. Damage distribution and progress, acceleration and displacement responses, and the effect of window openings and corresponding strengthening methods were investigated. Test results showed that good seismic performance of the model structure was achieved with using both types of AAC walls, the connection used between AAC walls and steel structure was reliable and the reinforcement applied for the wall near window openings was found effective.
Carbonation of autoclaved aerated concrete containing fly ash
Authors: Winkels Bernd , Nebel Holger , Raupach Michael
Published: September 2018

Due to the process of carbonation, the durability of autoclaved aerated concrete (AAC) may be affected. An adequate test method to assess the durability of AAC products in a short period currently does not exist. Hence, the German Institute for Building Technology (DIBt) has defined a limit value for drying shrinkage in order to prevent massive strength decrease of AAC products. In order to understand the deterioration mechanisms more in detail, investigations on the development of the compressive strength and the structural transformation of AAC have been carried out. Specimens taken from two different AAC products on the basis of quartz sand as well as fly ash were stored in different climate conditions. Shrinkage behavior was determined in normal climate (NC) of 20°C and 45% relative humidity. The compressive strength was determined at the beginning and additionally after about 180, 360, and 540 days. Phase analyses by X‐ray diffraction (XRD) were applied to correlate the structural transformation with compressive strength as well as shrinkage behavior in dependence of the silicate‐bearing raw materials.
Seismic performance of AAC masonry infill: From traditional systems to innovative solutions
Authors: Milanesi Riccardo R. , Morandi Paolo , Penna Andrea , Magenes Guido
Published: September 2018

According to many post‐seismic event surveys and research investigations, the seismic response of masonry infills can cause considerable economic and downtime losses and can represent a serious threat to human lives. Although many researchers have developed innovative infill systems and new design criteria, a widely scientifically and practical recognized solution which can be adopted for every masonry type has not been achieved yet. Moreover, the increased use of autoclaved aerated concrete (AAC) masonry infills thanks to its lightness, excellent thermal and acoustic insulation, and the fire resistance highlights the need of enhancing the knowledge about the seismic behavior of such infill material, and the possibility to develop improved systems that optimize the response of the AAC masonry in order to reduce detrimental issues of traditional infills. Within this paper, the experimental cyclic (in‐plane and out‐of‐plane) response of some traditional and enhanced infill solutions are presented together with a numerical simulation of the in‐plane tests on AAC unreinforced masonry infills. Furthermore, the main aspects affecting the seismic response, such as the in‐plane performance, the out‐of‐plane resistance, the local effects on adjacent reinforced concrete (RC) members, are discussed in order to indicate a possible path for future seismic resistant innovative solutions for AAC masonry infills.
Demolition waste and limit values for landfill
Authors: Walther Hartmut B.
Published: September 2018

Introduction

Different building materials have been studied concerning their characteristic properties in the context of the European landfill directive and its implementation in Germany.

Methods

Content analyses were amended by leaching tests and the full set of assignment criteria was always tested. 15 samples of different origins were studied, i.e. 8 samples of brick masonry, 4 samples of concrete, 1 sample of calcium silicate masonry and 2 samples of reinforced Autoclaved Aerated Concrete panels.

Results

All samples comply with the criteria of “inert waste” and “non‐hazardous waste” of the European landfill directive and with disposal site class I (“Deponieklasse I”) of the German landfill directive. Numerous samples do not comply with the criteria of “inert waste”, even if they consist of materials generally accepted to be inert.

Conclusion

The waste material tested never exceeded the criteria of “non‐hazardous waste” disposal site class I. The compliance with the criteria of “inert waste” can only be achieved by testing the individual material, a general assignment does not seem possible.
Improvement of the mixing process and the influence on the AAC properties
Authors: Menzel Christoph
Published: September 2018

The influence of the mixing process is normally not in the focus of the research of autoclaved aerated concrete. However, the homogeneous distribution of the individual raw material components plays a decisive role. Especially in bulk densities of less than 300 kg/m3, it is important to dissolve agglomerates and thus to allow optimal wetting of the solid particles with water. This is advantageous, for example, for the stability of the green cake, since the reactive surface of the binder particles increases and the hydration products therefore crosslink better. Another advantage of an ideal mixing process is the enhancement of the effect of additives used, especially if these are difficult to mix into water. The consequences are improved product properties or potential savings in terms of raw material costs.
Quality control of autoclaved aerated concrete by means of X‐ray diffraction
Authors: Paul Marcus
Published: September 2018

X‐ray diffraction is a very powerful tool for the characterization of crystalline phases in multi‐phase materials. In recent years, this method has been established in numerous industrial branches for quality control in processes where materials consisting of crystalline phases are produced. For instance, cementitious materials exhibit up to 20 different phases of which each is responsible for certain physical and chemical properties of the product. Knowing and understanding the phase assemblage of a material and the effects on its behavior allows the optimization of a product with respect to properties, quality, and production costs. The cement industry is using this knowledge by characterizing the materials along the production chain from raw materials to the final products by means of X‐ray diffraction. Autoclaved aerated concretes (AACs) consist mainly of crystalline and non‐crystalline solids, and for that reason, they have been subject to many crystallographic studies using X‐ray diffraction. Although the phase assemblage is regularly investigated, only little knowledge gained from these studies is transferred to production sites in order to monitor the manufacturing process. The crystallographic phase assemblage of autoclaved aerated concrete could be examined by X‐ray diffraction on a routine basis in order to maintain constant product quality and, thus, even material properties. Another beneficial aspect of this method is that it enables choosing more economic raw materials and optimizing process parameters.
Length change characteristics of autoclaved aerated concrete and other porous media based on pore structure
Authors: Matsui Kunio , Asamoto Shingo , Ogawa Akihiro
Published: September 2018

Autoclaved aerated concrete (AAC) is an important building material and is a typical porous material. In this study, the moisture sorption and length change isotherms of AAC, Vycor glass, and a diatomaceous shale material were measured. Local minimum values of length change were observed at relative humidities (RH) from 60 to 90% during the desorption process in all cases. Significant hysteresis between desorption and adsorption occurred in this RH range. However, the length of each material changed with small moisture loss or gain and no hysteresis was observed at RH from 10 to 50%. The anomalous length change behavior above 60% RH was explained by capillary tension in inkbottle‐shaped pores, whereas the surface energy model was applied to the length change at low RH. The length change characteristics of the materials with different pore structures in our study can be explained by the pore size distribution.
Research of transformation process of barrier layers in antifriction bearing with solid lubricating filler at autoclave simulated operation
Authors: Perevertov Valeriy
Published: September 2018

For the time being, solutions to increase coupling durability are being searched for in a number of aspects: process design; physical and chemical, aimed at creating innovative and improving existing materials; physicometallurgical, aimed to find scientifically justified solutions to composition, structure, and property issues related to materials intended for production of components of friction assembly and methods to impact their near‐surface layers. An in‐depth study of kinetics of structural, phase and diffuse transformations is required in order to solve these problems. Researching the processes that occur when graphite‐based solid lubricants are in use, we will also examine strength and deformation properties of friction pair surface microvolumes. An objective of this paper is to study transformation processes of near‐surface layers in antifriction bearing while using solid‐antifriction lubricating fillers.
A novel cerebellar commissure and other myelinated axons in the Purkinje cell layer of a pond turtle (Trachemys scripta elegans)
Authors: Daly Daniel T. , Ariel Michael
Published: September 2018

Parallel fibers in the molecular layer of the vertebrate cerebellum mediate slow spike conduction in the transverse plane. In contrast, electrophysiological recordings have indicated that rapid spike conduction exists between the lateral regions of the cerebellar cortex of the red‐ear pond turtle (Trachemys scripta). The anatomical basis for this commissure is now examined in that species using neuronal tracing techniques. Fluorescently tagged dextrans and lipophilic carbocyanine dyes placed in one lateral edge of this nonfoliated cortex are transported across the midline of living brains in vitro and along the axonal membranes of fixed tissues, respectively. Surprisingly, the labeled commissural axons traversed the cortex within the Purkinje cell layer, and not in the white matter of the molecular layer or the white matter below the granule cell layer. Unlike thin parallel fibers that exhibit characteristic varicosities, this commissure is composed of smooth axons of large diameter that also extend beyond the cerebellar cortex via the cerebellar peduncles. Double labeling with myelin basic protein antibody demonstrated that these commissural axons are ensheathed with myelin. In contrast to this transverse pathway, an orthogonal myelinated tract was observed along the cerebellar midline. The connections of this transverse commissure with the lateral cerebellum, the vestibular nuclear complex, and the cochlear vestibular ganglia indicate that this commissure plays a role in bilateral vestibular connectivity.
Risk Stratification of Prostate Cancer Using the Combination of Histogram Analysis of Apparent Diffusion Coefficient Across Tumor Diffusion Volume and Clinical Information: A Pilot Study
Authors: Zhang Zhao , Xu Huazhi , Xue Yingnan , Li Jiance , Ye Qiong
Published: September 2018

Background

The effectiveness of quantitative MRI and clinical information in the risk stratification of prostate cancer (PCa) patients was evaluated separately in previous research; however, the differentiation power of combining quantitative MRI and clinical information has yet to be investigated.

Purpose

To investigate the power of combining histogram analysis of apparent diffusion coefficient (ADC) of tumor diffusion volume (tDv) with clinical information for the differentiation of low‐grade (Gleason score [GS] ≤6) and high‐grade (GS ≥7) PCa.

Study Type

Retrospective.

Population

Fifty‐nine PCa patients who underwent preoperative diffusion‐weighted imaging (DWI) (acquired with b = 0, 1000 mm2/s) and followed by radical prostatectomy within 6 months.

Sequences

T2‐weighted, DWI, and ADC images at 3.0T.

Assessment

tDv defined with different ADC thresholds were analyzed for each patient and combined with age and prostate‐specific antigen (PSA) level. Binary logistic regression with backward feature selection was applied to determine the best discrimination and corresponding combination of parameters.

Statistical Tests

Kolmogorov–Smirnov test; independent samples t‐test; Mann–Whitney U‐test; Spearman's rank correlation; receiver operating characteristic (ROC) analysis; binary logistical regression.

Results

PSA and the 10th percentile ADC value of tDv defined with different diffusion thresholds were significantly different between low‐grade and high‐grade PCa groups (P < 0.05 for all). Median ADC of tDv based on a threshold of 1.008 × 10−3 mm2/s exhibited the best performance (AUC = 0.86, 95% confidence interval [CI]: 0.75–0.94), whereas binary logistic regression with backward feature selection achieved 97.20% accuracy with AUC = 0.978 (95% CI: 0.929–0.997).

Data Conclusion

The discriminatory power of a single histogram variable of ADC in tDv was not significantly superior to that of a single clinical parameter. The combination of histogram analysis of ADC of tDv and clinical information using logistic regression might significantly improve the risk stratification of PCa and achieve reasonably high accuracy.

Level of Evidence: 4

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2019;49:556–564.
Clinical epidemiology of infectious disease among patients with chronic kidney disease
Authors: Ishigami Junichi , Matsushita Kunihiro
Published: September 2018

Infectious disease is recognized as an important complication among patients with end-stage renal disease, contributing to excess morbidity and health care costs. However, recent epidemiological studies have revealed that even mild to moderate stages of chronic kidney disease (CKD) substantially increase risk of infection. Regarding underlying mechanisms, evidence suggests various aspects of altered immune response in patients with CKD including impaired function of T cells, B cells and neutrophil. Multiple conditions surrounding CKD, such as older age, diabetes, and cardiovascular disease are important contributors in the increased susceptibility to infection in this population. In addition, several mechanisms impairing immune function have been hypothesized including accumulated uremic toxins, increased oxidative stress, endothelial dysfunction, low-grade inflammation, and mineral and bone disorders. In terms of prevention strategies, influenza and pneumococcal vaccines are most feasible and important. Nevertheless, the extent of vaccine utilization in CKD has not been well documented. In addition, antibody response to vaccination may be reduced in CKD patients, and thus a vaccine delivery strategy (e.g., dose and frequency) may need to be optimized among patients with CKD. Through this review, we demonstrate that infection is a major but underrecognized complication of CKD. As CKD is recognized as a serious public health issue, dedicated research is needed to better characterize the burden of infectious disease associated with CKD, understand the pathophysiology of infection in patients with CKD, and develop effective strategies to prevent infection and its sequela in this high risk population.
Enhanced storage capability by biomass-derived porous carbon for lithium-ion and sodium-ion battery anodes
Authors: Hao Jian , Wang Yanxia , Chi Caixia , Wang Jing , Guo Qingjie , Yang Yu , Li Yao , Liu Xiaoxu , Zhao Jiupeng
Published: September 2018

Efficient electrodes with impressive storage capability and fast ion transfer rate are urgently needed to meet the demand for higher energy/power densities and longer life cycles and large rate powering devices.
Freeze-Out Mergers
Authors: Dalkır Elif , Dalkır Mehmet , Levit Doron
Published: September 2018

Do freeze-out mergers mitigate the free-rider problem of corporate takeovers? We study this question in a tender offer model with finitely many shareholders. Under a freeze-out merger, minority shareholders expect to receive the original offer price whether or not they tender their shares. We show that the ability to freeze out shareholders increases the raider’s expected profit. However, as the number of shareholders gets arbitrarily large, the raider’s expected profit in equilibrium converges to zero for any freeze-out clause with an ownership threshold that is strictly above simple majority. In this sense, freeze-out mergers do not solve the free-rider problem.

Received September 17, 2016; editorial decision June 3, 2018 by Editor Francesca Cornelli.
Cages in ACDF are Associated With a Higher Nonunion Rate Than Allograft
Authors: Pirkle Sean , Kaskovich Samuel , Cook David J. , Ho Alisha , Shi Lewis L. , Lee Michael J.
Published: September 2018

Study Design.

A retrospective database review.

Objective.

The purpose of this study was to analyze the rate of nonunion in patients treated with structural allograft and intervertebral cages in anterior cervical discectomy and fusion (ACDF).

Summary of Background Data.

Existing literature consists primarily of single-center studies with inconsistent findings.

Methods.

We performed a retrospective analysis of 6130 patients registered in the PearlDiver national database through Humana Insurance from 2007 to 2016. All ACDF patients with anterior plating who were active in the database for at least 1 year were included in the study. Patients with a fracture history within 1 year of intervention, past arthrodesis of hand, foot, or ankle, or a planned posterior approach were excluded from the study. Patients were stratified by number of levels treated, tobacco use, and diabetic condition. Nonunion rates of structural allograft and intervertebral cage groups after 1 year were compared using Chi-squared analyses.

Results.

Four thousand sixty-three patients were included in the allograft group, while 2067 were included in the cage group. Overall nonunion rates were significantly higher in the cage group (5.32%) than in allograft group (1.97%) (P < 0.01). When controlling for confounders, increased rates of nonunion were consistently observed in the cage group, achieving statistical significance in 25 of the 26 analyses.

Conclusion.

The increased rate of nonunion associated with intervertebral cages may suggest the superiority of allograft over cages in ACDF.

Level of Evidence: 3
Opioid-free Analgesia for Posterior Spinal Fusion Surgery Using Erector Spinae Plane (ESP) Blocks in a Multimodal Anesthetic Regimen
Authors: Chin Ki Jinn , Lewis Stephen
Published: September 2018

Study Design.

A case report.

Objective.

The aim of this study was to report the use of erector spinae plane (ESP) blocks as part of an opioid-free multimodal anesthetic regimen and its impact on postoperative pain and opioid requirements following spine surgery.

Summary of Background Data.

Posterior spinal fusion surgery is highly painful and usually requires significant amounts of opioids for adequate perioperative analgesia; this is commonly associated with adverse effects, including opioid-induced hyperalgesia, nausea, and ileus. The ESP block is a novel ultrasound-guided regional anesthetic technique involving local anesthetic injection into the musculofascial plane between erector spinae muscle and transverse processes. This safe and simple technique blocks dorsal rami of spinal nerves and can thus provide opioid-sparing analgesia for spine surgery.

Methods.

A 35-year-old woman with a previous T3-pelvis fusion for neuromuscular scoliosis underwent revision surgery involving T2-T8 decompression and fusion. She refused the use of perioperative opioids due to intolerable adverse effects during previous surgeries. Analgesia was provided by preoperative bilateral ESP blocks at T4 with 20 mL 0.25% bupivacaine and epinephrine 5 μg/mL on each side, and intraoperative infusion of ketamine and dexmedetomidine. Oral acetaminophen 1 g 6-hourly was administered postoperatively, together with baclofen 10 mg 8-hourly to treat muscle spasms.

Results.

The patient had adequate analgesia without use of any opioids during her anesthetic or hospital stay.

Conclusion.

A multimodal intraoperative anesthetic regimen incorporating ESP blocks was able to eliminate the need for postoperative opioid analgesia following posterior spinal fusion. surgery. This case report serves as proof-of-concept that this regimen may significantly improve pain trajectories and reduce opioid use in this patient population.

Level of Evidence: 4
Patient Outcomes After the Introduction of Statewide ICU Nurse Staffing Regulations*
Authors: Law Anica C. , Stevens Jennifer P. , Hohmann Samuel , Walkey Allan J.
Published: September 2018

Objectives:

To assess whether Massachusetts legislation directed at ICU nurse staffing was associated with improvements in patient outcomes.

Design:

Retrospective cohort study; difference-in-difference design to compare outcomes in Massachusetts with outcomes of other states (before and after the March 31, 2016, compliance deadline).

Setting:

Administrative claims data collected from medical centers across the United States (Vizient).

Patients:

Adults between 18 and 99 years old who were admitted to ICUs for greater than or equal to 1 day.

Interventions:

Massachusetts General Law c. 111, § 231, which established 1) maximum patient-to-nurse assignments of 2:1 in the ICU and 2) that this determination should be based on a patient acuity tool and by the staff nurses in the unit.

Measurements and Main Results:

Nurse staffing increased similarly in Massachusetts (n = 11 ICUs, Baseline patient-to-nurse ratio 1.38 ± 0.16 to Post-mandate 1.28 ± 0.15; p = 0.006) and other states (n = 88 ICUs, Baseline 1.35 ± 0.19 to Post-mandate 1.31 ± 0.17; p = 0.002; difference-in-difference p = 0.20). Massachusetts ICU nurse staffing regulations were not associated with changes in hospital mortality within Massachusetts (Baseline n = 29,754, standardized mortality ratio 1.20 ± 0.04 to Post-mandate n = 30,058, 1.15 ± 0.04; p = 0.11) or when compared with changes in hospital mortality in other states (Baseline n = 572,952, 1.15 ± 0.01 to Post-mandate n = 567,608, 1.09 ± 0.01; difference-in-difference p = 0.69). Complications (Massachusetts: Baseline 0.68% to Post-mandate 0.67%; other states: Baseline 0.72% to Post-mandate 0.72%; difference-in-difference p = 0.92) and do-not-resuscitate orders (Massachusetts: Baseline 13.5% to Post-mandate 15.4%; other states: Baseline 12.3% to Post-mandate 14.5%; difference-in-difference p = 0.07) also remained unchanged relative to secular trends. Results were similar in interrupted time series analysis, as well as in subgroups of community hospitals and workload intensive patients receiving mechanical ventilation.

Conclusions:

State regulation of patient-to-nurse staffing with the aid of patient complexity scores in intensive care was not associated with either increased nurse staffing or changes in patient outcomes.
SCOTOPIC AND FAST MESOPIC MICROPERIMETRY IN EYES WITH DRUSEN AND RETICULAR PSEUDODRUSEN
Authors: Corvi Federico , Pellegrini Marco , Belotti Maria , Bianchi Carlo , Staurenghi Giovanni
Published: September 2018

Purpose:

To evaluate the feasibility in the clinical practice of a fast and simple mesopic microperimetry examination comparing the retinal sensitivity in eyes with drusen and reticular pseudodrusen by scotopic and mesopic testing.

Methods:

In eyes with only drusen and only reticular pseudodrusen, retinal sensitivity was assessed by mesopic testing and after 35 minutes of dark adaptation by scotopic testing using 2 grids of 6 and 10 stimulus points.

Results:

Fifteen eyes with drusen and 14 eyes with reticular pseudodrusen were enrolled with mean best-corrected visual acuity of 20/20. In mesopic and scotopic examination, we found significant higher retinal sensitivity of eyes with drusen compared with reticular pseudodrusen (P < 0.001). The mean duration of the examination of mesopic testing was less than 2 minutes, significantly reduced compared with scotopic testing (P < 0.01).

Conclusion:

Eyes with reticular pseudodrusen presented a significantly reduced retinal sensitivity than eyes with drusen with scotopic and mesopic testing. The different retinal sensitivity between patients was found despite both group presenting good visual acuity. The retinal sensitivity evaluated by mesopic testing may replace the use of scotopic testing and best-corrected visual acuity examination, saving time and providing useful information in the assessment of macular function to identify patients with risk of disease progression.
Squamous Cell Carcinoma Invading a Transplanted Cornea: Eye- and Vision-Sparing Palladium-103 Plaque Radiation Therapy for a Functionally Monocular Patient
Authors: Semenova Ekaterina , Finger Paul T. , Choi Walter
Published: September 2018

Purpose:

To present a unique approach to eye and vision sparing for a patient with squamous cell carcinoma invading through a penetrating keratoplasty (PK) wound.

Methods:

A 56-year-old functionally monocular man was found to have squamous cell carcinoma with intraocular invasion through a PK wound. Eye- and vision-salvaging palladium-103 plaque radiation was performed. An amniotic membrane graft was used to buffer and thus protect the cornea during the 7-day treatment. Leaded eye glasses were worn during the day to block emitted radiation and allow functional vision during irradiation.

Results:

At 3.5 years status posttreatment, the tumor has regressed, PK has become progressively hazy (within the irradiated zone), and his vision is stable at 20/320. The epicorneal tumor has disappeared, and the intraocular tumor nodules are more highly reflective, but persistent. There has been no intraocular tumor progression, worsening of his glaucoma, or evidence of intraocular radiation vasculopathy.

Conclusions:

Transcorneal intraocular tumor invasion was controlled using palladium-103 ophthalmic plaque radiation therapy applied through the natural and donor cornea. Definitive treatment resulted in local tumor control and preservation of vision.
Interactive effects of conditioned pain modulation and temporal summation of pain—the role of stimulus modality
Authors: Horn-Hofmann Claudia , Kunz Miriam , Madden Melanie , Schnabel Eva-Luisa , Lautenbacher Stefan
Published: September 2018

Conditioned pain modulation (CPM) and temporal summation of pain (TSP) are 2 experimental paradigms capturing endogenous pain modulation, which have repeatedly demonstrated clinical relevance. Conditioned pain modulation describes the inhibition of the pain response to a test stimulus (Ts) when a second noxious stimulus, the conditioning stimulus (CS), is concurrently applied. Temporal summation of pain describes the enhanced pain response to a series of stimuli compared with single stimuli. Temporal summation of pain–limiting effects of CPM are likely but may depend on the stimulus modality of the Ts. This study aimed at investigating these differential effects of stimulus modality. Thirty-five healthy volunteers completed 2 experimental blocks (Ts modality: pressure vs heat) in balanced order. Both blocks consisted of 3 conditions: baseline (no CS), CPM1 (nonpainful CS: 42°C water bath), and CPM2 (painful CS: 46°C water bath). Single stimuli and series of stimuli were alternatingly applied to assess TSP by means of a Numerical Rating Scale. Both TSP and CPM were successfully induced with no difference between the 2 Ts modalities. We also detected a significant interaction between TSP and CPM, with higher pain reduction for a series of Ts compared with single Ts during the painful CS. Interestingly, this interaction was modality-dependent: TSP for heat Ts was completely abolished by CPM, whereas this was not the case for pressure Ts. Our findings suggest different forms of central sensitization induced by TSP using either heat or pressure stimuli, which differ in their susceptibility to CPM. Clinical implications and directions for future research are discussed.
Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties
Authors: Birnie Kathryn A. , Hundert Amos S. , Lalloo Chitra , Nguyen Cynthia , Stinson Jennifer N.
Published: September 2018

In 2006, PAIN published a systematic review of the measurement properties of self-report pain intensity measures in children and adolescents (Stinson JN, Kavanagh T, Yamada J, Gill N, Stevens B. Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. PAIN 2006;125:143–57). Key developments in pediatric pain necessitate an update of this work, most notably growing use of the 11-point numeric rating scale (NRS-11). Our aim was to review the measurement properties of single-item self-report pain intensity measures in children 3 to 18 years old. A secondary aim was to develop evidence-based recommendations for measurement of child and adolescent self-report of acute, postoperative, and chronic pain. Methodological quality and sufficiency of measurement properties for reliability, validity, responsiveness, and interpretability was assessed by at least 2 investigators using COnsensus based Standards for the selection of health Measurement INstruments (COSMIN). Searches identified 60 unique self-report measures, of which 8 (reported in 80 papers) met inclusion criteria. Well-established measures included the NRS-11, Color Analogue Scale (CAS), Faces Pain Scale–Revised (FPS-R; and original FPS), Pieces of Hurt, Oucher—Photographic and Numeric scales, Visual Analogue Scale, and Wong-Baker FACES Pain Rating Scale (FACES). Quality of studies ranged from poor to excellent and generally reported sufficient criterion and construct validity, and responsiveness, with variable reliability. Content and cross-cultural validity were minimally assessed. Based on available evidence, the NRS-11, FPS-R, and CAS were strongly recommended for self-report of acute pain. Only weak recommendations could be made for self-report measures for postoperative and chronic pain. No measures were recommended for children younger than 6 years, identifying a need for further measurement refinement in this age range. Clinical practice and future research implications are discussed.
Integration of Medication-Assisted Treatment Information for Opioid Use Disorders Into a Graduate Nursing Curriculum
Authors: Kameg Brayden , Kaufman Robert , Lindsay Dawn , Mitchell Ann M.
Published: September 2018

Purpose:

The United States is in the midst of an unprecedented public health crisis, with annual morbidity and mortality data related to opioid use consistently increasing and appearing more worrisome. To mitigate such consequences, it is critical that those with opioid use disorders are provided with and have access to evidence-based treatment modalities.

Methods:

The project utilized a course scaffolding approach to integrate a comprehensive substance use framework into an advanced practice nursing curriculum, with an emphasis on medication-assisted treatment as part of an advanced pharmacology course required for licensure.

Results:

Students’ knowledge assessment increased significantly, from an average of 2.82 to 3.78 out of 5 items, t(217) = −10.31, p < .01.

Conclusions:

Educators and academic administrators must be steadfast in their resolve to include substance use, and specifically opioid use, education into all areas and levels of nursing study.
Screening Adults With Substance Use Disorder for Adverse Childhood Experiences
Authors: Chandler Genevieve E. , Kalmakis Karen A. , Murtha Teri
Published: September 2018

Objective:

The purpose of this study was to assess the incidence of adverse childhood experiences (ACEs) and the efficacy and feasibility of a trauma-informed screening for ACEs among individuals in a substance use disorder recovery program.

Method:

Individual interviews, questionnaires, and postinterview survey and reflections were used in this cross-sectional clinical translation project. Descriptive statistics were used to analyze demographics, ACE scores, protective childhood experiences, self-reported diagnoses, and postintervention survey data. Postinterview reflections were reviewed and grouped into common ideas as shared by participants, as well as interesting impressions, insights, and responses to the interviews.

Results:

Thirty clients participated in the interview process. Among the 29 participants who completed the questionnaires, all reported at least one ACE, and 82.8% reported six or more ACEs. In addition, 96.6% reported experiencing more than four protective factors. Twelve (40%) clients were referred for further mental health counseling after the interviews. Notable findings from the interviews were the general lack of awareness of the relationship between ACEs and current substance use disorder among participants. Gaining knowledge about the impact of ACEs on their recovery seemed to provide a sense of relief and a feeling that they were “normal.”

Conclusions:

The trauma-informed care approach is intended to promote mindfulness regarding the effect of ACEs on substance abuse in this population. Screening for ACEs is necessary if effective interventions are to be provided, with the goal of improving client outcomes.
Evaluation of an Opiate Overdose Educational Intervention and Naloxone Prescribing Program in Homeless Adults Who Use Opiates
Authors: Pietrusza Lisa M. , Puskar Kathryn R. , Ren Dianxu , Mitchell Ann M.
Published: September 2018

Opiate overdose deaths are considered an epidemic by the Centers for Disease Control and Prevention. Homeless adults are disproportionately affected by opioid overdoses. The purpose of this project was to implement an opiate overdose training and routine naloxone prescribing program for patients at a Health Care for the Homeless clinic. Education consisted of overdose risk factors, signs of overdose, how to respond to an opiate overdose, and how to administer naloxone. Knowledge was measured with a pretest and a posttest. Intranasal naloxone was prescribed for each person who received the education, and prescription fill rates were tracked 1 week after the clinic visit. Patients had a significant increase in knowledge, and the overall naloxone fill rate was 33%. Fill rates varied by housing, insurance, and other prescription status. Opiate overdose education can effectively be delivered in a homeless medical clinic, although more research is needed regarding barriers to naloxone fill rates.
Pretransplant Sarcopenia in Patients With NASH Cirrhosis Does Not Impact Rehospitalization or Mortality
Authors: Aby Elizabeth S. , Lee Edward , Saggi Satvir S. , Viramontes Matthew R. , Grotts Jonathan F. , Agopian Vatche G. , Busuttil Ronald W. , Saab Sammy
Published: September 2018

Background:

Malnutrition and muscle wasting are common in patients with end-stage liver disease (ESLD), yet go underdiagnosed. Frequently used indices of nutritional status, such as body mass index, are inflated in patients with ESLD due to a fluid overloaded state. Previous work has demonstrated a strong association between psoas muscle area, a surrogate for sarcopenia, and worse survival following liver transplantation; however, the impact of sarcopenia on post liver transplant outcomes in patients with nonalcoholic steatohepatitis (NASH) cirrhosis has not been evaluated.

Goals:

Describe the impact of sarcopenia in patients with NASH cirrhosis on post liver transplantation outcomes, including initial hospital length of stay, rehospitalization, and survival.

Materials and Methods:

A single-center, retrospective analysis was conducted of adult liver transplants performed for NASH cirrhosis between 2002 and 2015. Sarcopenia was defined by psoas area measured at the L3 vertebra from abdominal imaging within 6 months before orthotopic liver transplant (OLT).

Results:

A total of 146 patients were evaluated. The mean Model for End-Stage Liver Disease score at transplant was 34.9±7.4. Sarcopenia was present in 62% of patients and was more likely in female and Hispanic patients. There were no significant differences in length of initial hospitalization following OLT, days hospitalized within the first year post-OLT, survival at 1 year, or overall survival between sarcopenic and nonsarcopenic patients.

Conclusions:

Sarcopenia in patients with NASH cirrhosis and high Model for End-Stage Liver Disease scores is not associated with an increase in mortality or rehospitalization following liver transplantation; however, the study findings were limited by a small sample size.
Association of Vitamin D and Parathyroid Hormone With Barrett’s Esophagus
Authors: Rubenstein Joel H. , McConnell Daniel , Beer David G. , Chak Amitabh , Metko Valbona , Clines Gregory
Published: September 2018

Background:

Esophageal adenocarcinoma has been inversely associated with exposure to ultraviolet radiation. This could be because of vitamin D deficiency or hyperparathyroidism promoting gastroesophageal reflux disease (GERD) and Barrett’s esophagus.

Aim:

The aim of this study is to determine the association between parathyroid hormone (PTH) and vitamin D deficiency with GERD symptoms, erosive esophagitis, and Barrett’s esophagus.

Methods:

We assayed banked serum for PTH and total 25-hydroxy vitamin D from a cross-sectional cohort. Logistic regression was performed to estimate the associations of vitamin D deficiency and hyperparathyroidism with GERD symptoms, erosive esophagitis, and Barrett’s esophagus.

Results:

Sera from 605 men were assayed, including 150 with GERD, 216 with erosive esophagitis, 145 with Barrett’s esophagus, and 174 normal subjects. Contrary to our hypothesis, we found a strong inverse association between Barrett’s esophagus and hyperparathyroidism (odds ratio=0.516; 95% confidence interval=0.265, 1.01), and a trend toward an inverse association with vitamin D deficiency. We found no association between vitamin D deficiency or hyperparathyroidism with GERD symptoms or erosive esophagitis.

Conclusions:

Contrary to our hypothesis, we found an inverse association between serum PTH and Barrett’s esophagus. Validation of the finding and the mechanism of that association deserves further study.
Endoscopic treatment for patients with gastric outlet stricture and biliary obstruction in the absence of endoscopic ultrasound: a retrospective study
Authors: Cai Xiaobo , Zhang Haiyun , Luo Shenzheng , Baiwen Li , Ma Jing , Lu Lungen , Wan Xinjian
Published: September 2018

Background and aim

Endoscopic biliary drainage is difficult in patients with biliary obstruction combined with gastric outlet stricture (GOS). Endoscopic ultrasound is useful for such patients, but needs advanced technique and sophisticated equipment. This study aimed to evaluate the efficacy and safety of conventional endoscopic retrograde cholangiopancreatography (ERCP) in patients with GOS and biliary obstruction without the assistance of endoscopic ultrasound.

Patients and methods

Seventy-four patients with GOS proximal to the ampulla and biliary obstruction, including 27 with benign GOS and 47 with malignant GOS, were retrospectively enrolled. Three conventional methods were used to pass through the stricture and allow the duodenoscope to reach the papilla: adjusting the endoscope, balloon dilation, and metal stent insertion. The uncovered metal stent insertion was applied only in patients with malignant GOS. The primary outcome evaluated was successful biliary drainage.

Results

No serious complications occurred during or after ERCP. The overall success rate of biliary drainage in the patients was 81.1%. The success rate of duodenoscopy insertion by endoscope adjustment, balloon dilation, and stent insertion was 44.6, 68.9, and 71.4%, respectively. Endoscope adjustment was more successful in the patients in the benign group compared with the patients in the malignant group (60.9 vs. 35.7%). Similar findings were obtained for balloon dilation (92.3 vs. 59.4%).

Conclusion

Most GOS, encountered during ERCP, can be safely dealt with using conventional endoscopic approaches in patients with biliary obstruction. However, the efficacy of endoscope adjustment or balloon dilation is better for benign GOS than for malignant GOS.
Effects of antiviral treatment on the risk of hepatocellular cancer in patients with chronic viral hepatitis
Authors: Stournaras Evangelos , Neokosmidis Georgios , Stogiannou Dimitrios , Protopapas Andreas , Tziomalos Konstantinos
Published: September 2018

Hepatocellular carcinoma (HCC) is a major complication of chronic hepatitis B (CHB) and chronic hepatitis C (CHC). Accumulating data suggest that antiviral treatment in both CHB and CHC reduces the incidence of HCC. Evidence is more consistent for interferon-based treatment in both CHB and CHC and for lamivudine in patients with CHB. However, more limited data suggest that other nucleos(t)ide analogues might also reduce the risk of HCC. In contrast, conflicting data have been reported on the effects of direct-acting antivirals on the incidence of HCC.
Skeletal muscle mass depletion in patients with hepatitis C virus infection
Authors: Fukui Aiko , Kawabe Naoto , Hashimoto Senju , Kamei Hiroyuki , Yoshioka Kentaro
Published: September 2018

Objective

The aim was to assess the relationship between muscle mass depletion and chronic hepatitis C virus (HCV) infection.

Patients and methods

We retrospectively evaluated abdominal computed tomography data for 611 patients. The participants included 302 patients with HCV infection and 309 patients with gallstones (as a control). The skeletal muscle mass at the level of the third lumber vertebra (L3) was measured from the computed tomography images and normalized for height to calculate the L3 skeletal muscle index (L3-SMI, cm2/m2). Statistical analysis was carried out separately for each sex, given that L3-SMI differs significantly between men and women.

Results

L3-SMI showed no significant difference between chronic hepatitis patients and gallstone patients in either sex. L3-SMI was significantly lower in male cirrhotic patients than in those with chronic hepatitis (P<0.001). The Child–Pugh score was correlated negatively with L3-SMI in male patients with HCV-related cirrhosis (ρ=0.200, P=0.031). In addition, the BMI in both sexes was associated with L3-SMI in the gallstone and chronic hepatitis group, in the chronic hepatitis and liver cirrhosis group, and in the liver cirrhosis group.

Conclusion

Skeletal muscle mass is not affected by chronic HCV infection in patients without cirrhosis and decreases in accordance with liver disease progression in male patients with chronic HCV infection.
International Nursing: Needs Assessment for Training in Disaster Preparedness for Hospital Nurses
Authors: Noh Jiyoung , Oh Eui Geum , Kim So Sun , Jang Yeon Soo , Chung Hyun Soo , Lee Ogcheol
Published: September 2018

Despite high awareness of the need, opportunities for nurses to gain disaster experience or training are limited. In Korea, most disaster training is done in an undergraduate curriculum where there is very limited practice, and the educational topics are mostly focused on the field aspect of disaster events. The purpose of this study was to determine the need for such training for hospital nurses and to determine appropriate and relevant components of the training contents. A qualitative survey approach using the modified Delphi method was used to collect and analyze the data. The surveys were conducted in 3 rounds. After the results were analyzed from the third-round survey, the authors finalized the contents for a training program to prepare nurses for their roles during disasters. Through a structured needs analysis using a modified Delphi survey, the framework for the content development of disaster training curriculum for hospital nurses was developed.