bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation of Rooftop Rainwater Harvesting Potential using Applications of Google Earth Pro and GIS
Authors:   Assistant Professor, Vardhaman College of Engineering, Hyderabad, India., Hari Durgasrilakshmi
Published: October 2019

In the present scenario of global warming, the availability of drinking water is the main concern. The problem of water shortage tackled in reliable scientific approaches. Rainwater harvesting is one of the best practices in collecting and storing rainwater. This method is cost-effective in the planning and development of rainwater harvesting facilities in water-scarce areas for future needs. In this paper, a case study of Vardhaman College of Engineering, Hyderabad, in Telangana state has taken to estimate the rooftop rainwater harvesting potential. In this study, In this study to digitize the various types of rooftops, Google Earth Pro is used. The overall potential quantity of rainwater harvestable at the institutional level can be assessed by using ArcGIS. Total water demand for the study area is calculated considering the existing population. Rainwater harvesting sites are identified and proposed according to the lowest elevation and drainage direction of the study area. The volume of the storage tank is designed based on daily discharge by assuming the length, breadth and height. The results of this study will demonstrate the Applications of Google Earth Pro and GIS in estimating rainwater harvesting potential to tackle the prevailing water shortage in the study area. Rainwater harvesting provides water at the point of demand, minimizes the stress on existing natural resources and also an eco-friendly solution.
Traditionalism, as a factor in the development of Central Asian society (XIX-early XX centuries.)
Authors:   Tashkent University of Information Technologies named after Muhammad al- Khorazmi / Tashkent, Uzbekistan., N Makhkamova , D. Tashkenbayeva ,   Tashkent University of Information Technologies named after Muhammad al- Khorazmi / Tashkent, Uzbekistan
Published: October 2019

After Uzbekistan gained state independence, one of the priorities of the national historical science was the task of re-creating the true history of the Uzbek people and their statehood at various stages of historical development. In the process of implementing this task, the introduction into scientific circulation and the objective interpretation of a new source material has become important. These include an extensive body of research devoted to a wide range of issues related to the development of the history of Central Asian society in different literature on its periodization. One of the important theoretical questions of our time is the question of the level of enlightenment and cultural development in the Central Asian states in the XIX - early XX centuries. In the European oriental studies of that period, the theory of “underdevelopment and stagnation” of Eastern societies became widespread. This position was dominant in the historical literature not only in the XIX - early XX centuries, but also of the whole subsequent time up to the beginning of the 90s. Proponents of the theory of underdevelopment and backwardness of Eastern society, one of the arguments in its favor said that it was their traditionalism. Probably it was because of ignorance or unwillingness to know more deeply the essence of relationships within this society made a mistake. After all, traditionalism, being a truly specific feature of Eastern society, was the force that preserved its achievements in the sphere of production and culture, spiritual values. Traditionalism was the source of continuity between generations. Thanks to him, architecture, literature, poetry, music, calligraphy, ornamentalism, etc., continued to live, for traditionalism never excluded the creative development of content within the traditional form. And it was precisely because of tradition that the successfully found solution was necessarily passed on to the next generation. Thus, the thesis that treats traditionalism as a factor constraining the development of Eastern society is wrong. It is possible to make an unequivocal conclusion about what to call ignorant a society in which lively trade was conducted, there was a well-organized system of Muslim education, excellent experts in various fields of human activity, for centuries formed traditions both in the industrial and spiritual-moral spheres, means to go to cut with the historical truth.
Development of Analog Behavioural Model of BiMOSFET
Authors:   Student, Amrita Vishwa Vidyapeetham, Coimbatore (Tamil Nadu), India., V Harini. , Acharya Mahesh ,   SO/E, Raja Ramanna Center for advanced Technology, Indore (M.P.), India., Vijayakumari A. ,   Assoc. Professor, Amrita Vishwa Vidyapeetham, Coimbatore (Tamil Nadu), India.
Published: October 2019

Behavioural modelling of a power semiconductor device offers many advantages to an application engineer as it is possible to model the device from the available datasheet without a detailed knowledge of the fabrication process. The development of an analog behavioural model for a BiMOSFET is undertaken here by using the Hammerstein model. The Hammerstein model is developed with static and dynamic block sub-blocks and is designed to respond for varying temperatures.The datasheet values of Ic and Vceare utilized to derive the static linear block,while the dynamic block is modelled as Hammerstein current source.The developed model of the BiMOSFET has been verified for its terminal characteristics through OrCAD simulations and hardware testing. The developed model of BiMOSFETexhibits fast simulation times with reasonable accuracy. The hardware testing is carriedout with BiMOSFET IXBF55N300 by observing its currents and voltages under the variation of gate voltage at constant collector emitter voltage and variation of collector emitter voltage at constant gate voltage.
Inter area Stability Enhancement of Interconnected power system using Second-order Sliding Mode Controller
Authors:   Asst.Professor, Dept.of EEE, GMR Institute of Technology, Rajam, India., Raghutu Ramakrishna , Rao Dr.P.V.Ramana ,   Professor, Dept.of EEE, Acharya Nagarjuna University, Guntur, India.
Published: October 2019

The presence of DFIG (Doubly Fed Induction Generator) affecting the stability of the inter-area interconnected power system due to the lagging response of DFIG under undesirable conditions like faults. This paper addresses a Second-order Sliding Mode controller for DFIG to damp inter-area frequency oscillations of the interconnected power system. The proposed heuristic controller is a sliding mode controller of second-order type and works based on the reactive power capability of DFIG. This novel controller is not affected by system modeling uncertainties and unwanted parameter variations. The proposed controller is designed and implemented on 3-bus interconnected system in MATLAB/Simulink environment and the results obtained compared with the conventional controller under different fault conditions to show the effectiveness. Results demonstrated that the sliding mode controller effectively damping inter-area oscillations compared with a conventional controller.
Swarm Intelligence based efficient routing algorithm for platooning in VANET through Ant Colony Optimization
Authors:   School of Computer Science, University of Petroleum & Energy Studies, Dehradun, India., Singh Gagan Deep , Prateek Dr. Manish ,   School of Computer Science, University of Petroleum & Energy Studies, Dehradun, India.., Sastry G Dr. Hanumat ,   School of Computer Science, University of Petroleum & Energy Studies, Dehradun, India..
Published: October 2019

Today’s era is of smart technology, Computing intelligence and simulations. Many areas are now fully depended on simulation results for implementing real time workflow. Worldwide researchers and many automobile consortium are working to make intelligent Vehicular Ad hoc Network but till yet it is just a theory-based permutation. If we take VANET routing procedures then it is mainly focussing on AODV, DSDV and DSR routing protocols. Similarly, one more area of Swarm Intelligence is also attained attention of industry and researchers. Due the behavior of dynamic movement of vehicle and ants, Ant Colony Optimization is best suited for VANET performance simulations. Much of the work has already done and in progress for routing protocols in VANET but not focused on platooning techniques of vehicle nodes in VANET. In our research idea, we came up with a hypothesis that proposes efficient routing algorithm that made platooning in VANET optimized by minimizing the average delay waiting and stoppage time. In our methodology, we have used OMNET++, SUMO, Veins and Traci for testing of our hypothesis. Parameters that we took into consideration are end-to-end delay as an average, packet data delivery ratio, throughput, data packet size, number of vehicle nodes etc. Swarm Intelligence has proved a way forward in VANET scenarios and simulation for more accurate results. In this paper, we implemented Ant Colony Optimization technique in VANET simulation and proved through results that if it integrates with VANET routing scenarios then result will be at its best.
Generating Cross Domain Models using Generative Adversarial Networks
Authors:   Department of CSE, Dr.M.G.R. Educational and Research Institute,Chennai,Tamil Nadu, India., George Dr.G.Victo Sudha , Arun A.R. Raj Ganesh ,   Department of CSE, Dr.M.G.R. Educational and Research Institute,Chennai,Tamil Nadu, India., Geetha Dr. S. ,   Department of CSE, Dr.M.G.R. Educational and Research Institute,Chennai,Tamil Nadu, India
Published: October 2019

Normally an average human can understand the relationship between different fields and domains easily with limited information exposure. On the other hand even a modern day computer is pretty bad in understanding relationship between different domain
Significant Guidance to Employ the Software to Analyze and Design the Reinforced Concrete Structures: State-of-The-Art
Authors:   Civil Engineering Department, Near East University, Nicosia, North Cyprus, via Mersin 10, Turkey., Sadeghi Kabir , Ghaboun Nivin ,   Civil Engineering Department, Near East University, Nicosia, North 10, Cyprus, via Mersin Turkey
Published: October 2019

Prevailing analysis and design of reinforced concrete (RC) structures is a critical stage in the construction industry to deliver the projects within the estimated construction time period and within the budget. The selection of suitable structural engineering software to perform the analysis and design tasks is not an easy matter of fact, especially with the existence of many specialized software in this domain such as Robot Structural Analysis, MIDAS Gen, SAP 2000, STAAD.PRO, Tekla Structural designer, S-Frame and many others. So a strong comparison between the existing software must be made before taking the final decision of selecting any software. The main goal of this paper is to present overall guidance for selection of the suitable software among the most common software used for the analysis and design of RC structures along with the supported design codes, analysis types and design modules incorporated in each software. The technical specifications, characteristics, application domains, incorporated structural design codes, limitation, technical popularity and capabilities of the existing most common used software were studied and compared. Based on the performed study, eleven software were selected and presented as a useful guideline for the structural engineers in the analysis and design of RC structures. In this paper, a complete guideline including the required technical information for structural engineers to choose the suitable software for analyzing and designing of the RC structures is presented.
Thermo-Mechanical Analysis and Its Effect on Rf Behaviour of A Tapered Cavity of the W-Band Gyrotron Oscillator
Authors:   Department of Electronics Engineering, IIT (BHU) Varanasi, Varanasi, India., Rao V Sivavenkateswara , Thottappan Muthiah ,   Department of Electronics Engineering, IIT (BHU) Varanasi, Varanasi, India., Jain Pradip Kumar ,   Department of Electronics Engineering, National Institute of Technology Patna, Patna, India.
Published: October 2019

Thermo-mechanical analysis of a tapered cylindrical RF interaction cavity of a TE6,2, 95 GHz, 100 kW gyrotron has been carried out to study the effect of ohmic loss generated due to radiated microwave energy. For stable device operation, with the help of design relationships, describing the approach, an optimum thermal system design has been presented and performances got analyzed using a commercial simulation code “COMSOL Multiphysics”. For various cavity thicknesses, and convective heat transfer coefficient values under without fins and with radial fins conditions system performance have been investigated. Taking water as coolant at ~293 K, hydraulic diameter and flow rate range has been determined for the optimum convective heat transfer coefficient values. An optimized simple cooling system thus designed keeps the maximum RF cavity radius deformation (increase) ~ 3.2 μm maintaining the average cavity outer surface temperature of 308 K. Further, using nonlinear time-dependent multimode analysis, a decrease of 48 MHz in resonance and a decrement of 20 in diffractive quality factor of the interaction cavity along with reduction of 2 kW of the device output power have been observed in the case for the deformed cavity from those of the initial cavity gyrotron device, which are found within the tolerance limit of such devices.
Evaluation for Improving Security Management of Service Oriented Architecture At Meraki Digital Indonesia
Authors:   Faculty of Computer Science, Mercu Buana University, Jakarta, Indonesia., Ranggadara Indra
Published: October 2019

Meraki Digital Indonesia wants to evaluate security management on Service Oriented Architecture that has been implemented in this company whether it is in accordance with the standards or not, using the COBIT 5 method. It is expected that the suitability of the maturity level can be carried out in accordance with the security management domain needed to ensure the fulfillment of the basic requirements of organizational information resources, namely the availability of integrity and availability of data or information. As well as using the Analytical Hierarchy Process algorithm to provide recommendations using decision-making in solving problems with explicit logical analysis, there are three principles that underlie AHP thinking, which is compiling hierarchies, the principle of setting priorities, and the principle of logical consistency. Then the evaluation results using COBIT 5, there are 6 security management criteria that are used as a basis for evaluating, among others, strategies & policies, organizations, people, processes, technology and facilities and domains that are used are Plan and Organizes (PO), Acquire and Implement (AI), Deliver and Support (DS), and Monitor and Evaluate (ME). Whereas for recommendations needed by using analytical hierarchy processes, there are three things that need to be improved according to the wishes of stakeholders, namely the need to improve the criteria of technology with a value of 0.132, facilities with a value of 0.137, and people with a value of 0.161 according to the lowest ranking on the tested criteria.
Selection the Best Technique for Solid Waste Management at Misurata City, Libya
Authors:   Civil Engineering Department, Near East University, Nicosia, Cyprus., Gökçekuş Hüseyin , Kassem Youssef ,   Mechanical Engineering Department, Near East University, Nicosia, Cyprus.. Qussai Omari, Mechanical Engineering Department, Near East University, Nicosia, Cyprus.
Published: October 2019

The paper presents a proposal for selecting the appropriate waste treatment method for Misurata, reviewing key criteria for such a decision. Many countries use modern methods of solid waste treatment, which can be transformed from the source of pollution into an economic commodity. Libya continues to suffer from solid waste management processes in terms of aggregation, transport or treatment. This paper deals with an approach in the field of solid waste treatment in terms of the nature of these wastes and their methods of management. It also addresses environmental problems related to the subject of solid waste using different treatment methods. It also reviews some studies on this subject. The study concluded that the environmental standard criteria are the most important when making the decision, followed by the technical criteria. At the level of the proposed technique, the study showed that the anaerobic digestion technique is the most appropriate. For the purpose of selecting the best method for solid waste management, the swing weighting method was developed using Ms-Excel.
Combine Eco-conception Standard and TRIZ Method in Eco- Innovation Applied for Drying Olive Cake.
Authors:   Laboratoire Contrôle et Caractérisation Mécanique des Matériaux et des Structures ENSEM, Université Hassan II Casablanca, MOROCCO., Lajdel Abdellatif , Mazouzi M. ,   Laboratoire Contrôle et Caractérisation Mécanique des Matériaux et des Structures ENSEM, Université Hassan II Casablanca, MOROCCO., Bakasse M. ,   UCD-FSJ-Laboratoire de Chimie Organique, Bioorganique et Environnement FSJ, Université Chouaib Doukkali El Jadida, MOROCCO., Lajdel M. ,   Laboratoire Contrôle et Caractérisation Mécanique des Matériaux et des Structures ENSEM, Université Hassan II Casablanca, MOROCCO.
Published: October 2019

The objective of this research is optimizing a process of recycling residues called olive cake (stones) for renewable energy use and Pomace for animal feed industry use. This study includes a drying and separation of solid residues from pulp and store final product for an expedition to recommended user. Drying will proceed continuously in parallel with the existing production process of olive oil. The existence of technical constraints relating to high humidity and economic limitations related to logistics and energy consumption in order to make the residues usable leads us to consider a study of an integrated economic process to respond to this issue. In the literature there are drying solutions to be able to recover the residues but the cost of this operation remains in most cases a constraint which limits the reuse of vegetable waters. Among the techniques there is a centrifugation, drying by gas dryers and drying by a fluidized bed. With the use of eco-design standard and TRIZ method as combined approach we solve this problem and present an economic system as solution to recover the residues of the olive oil "olive cake" in view of their reuse in the energy supply for the case of the pomace and in industry for pulp. The design include the drying of pomace and pulp before storage for shipment to the recommended uses. This separation will be carried out in continuous mode in parallel with the existing production process. In our thesis we introduce an innovation to solve a problem of drying residues by considering constraints of the cost and the technical feasibility of solution without neglecting the environmental aspect.
Effect of Sand Coating with Solution on Bond Strength of Bamboo
Authors:   Civil, Smt. Kashibai Navale College of Engineering Pune, Maharastra., Kamble Amol Ashok , Subramaniam Dr. Suppiah ,   Civil, Vel Tech, Rangarajan Dr. Sagunthala R&D Institute of Science and Technology, Chennai.
Published: October 2019

In a developing country like India, there is an increasing demand for RCC. The major component of RCC is steel. Steel is an alloy of carbon. In manufacturing processes of steel lots of energy is required. For such energy, lots of natural energy sources are used which can adversely affect the environment. For sustainable development, Bamboo may be a proper replacement for steel. Bamboo is fast growing grass which easily cultivated in any types of land. For replacement of bamboo, the bond between bamboo and concrete must be strong. The bond strength of bamboo and concrete is a major concern in the use of bamboo. The surface of the bamboo is naturally coated and has a smooth surface. Due to smooth surface bond strength is decreasing. For increasing bond strength there must be the proper coating for bamboo. In this paper, a solution is used for coating. For roughness, the surface is coated with sand with a solution. For comparing bond strength of different coated surface pull out the test is carried out. For pull out, test samples with the various coated surfaces are cast and tested after 7, 14 and 28 days. The result shows an increase in bond strength of the coated surface.
Authentication of Communicating Node Key Generation Based on User with Mutual Removal Concepts
Authors:   CSE department, Vel Tech Rangarajan Dr.Sagunthala R&D Institute of Science and Technology , Chennai, India., N.K Manikandan , V Shanmuganathan ,   CSE department, Vel Tech Rangarajan Dr.Sagunthala R&D Institute of Science and Technology , Chennai, India., D Manivannan ,   CSE department, Vel Tech Rangarajan Dr.Sagunthala R&D Institute of Science and Technology , Chennai, India
Published: October 2019

The present conventions for making pair wise mysteries between hubs in a remote system, so these insider facts are secured from a secret agent, yet with constrained system nearness. The main present a fundamental mystery understanding convention for single-bounce systems, where mysteries are developed utilizing traffic traded between the hubs, and we demonstrate that under standard hypothetical suppositions, our convention is data hypothetically secure. Secondly, proposing a secrecy understanding convention for subjective, multi-jump arranges that expand on the fundamental convention yet in addition contains configuration highlights for utilizing extra sources that multi-bounce offers, for mystery. At long last, assess our conventions, and give exploratory proof that it is practical to make a huge number of mystery bits every second, in reasonable remote setups.
Design and Implementation of RNS Filter using Modular-Multipliers
Authors:   Electronics and Communication Engineering, Vr. Siddhartha Engineering College Vijayawada, India., Bhargavi P. , Reddy K. Srinivasa ,   Electronics and Communication Engineering, Vr. Siddhartha Engineering College Vijayawada, India., Prakash M. Durga ,   Electronics and Communication Engineering, Vr. Siddhartha Engineering College Vijayawada, India.
Published: October 2019

In this paper, an efficient RNS based multiply-accumulate (MAC) unit is proposed to implement residue number system (RNS) based finite impulse response filter (FIR). The proposed MAC (PMAC) approach reduces the number of adders in critical path delay. In this work, a FIR filter with PMAC approach is implemented using structural Verilog HDL language. The United Microelectronics Corporation 90 nm technology library has been used for synthesis. The performance metrics such as area, power and delay are obtained using Cadence RTL compiler. The synthesis results shows that RNS filter with PMAC improves clock frequency and reduces delay and area when compared to conventional MAC (CMAC).To compare the performance of the filters power delay product (PDP) is also considered. The PMAC architecture has improved PDP gain by 30.63% when compared to CMAC.
Big Data Architecture for Intelligent Transport Systems
Authors:   School of Computer Science and Engineering(SCOPE) ,VIT University, Vellore, India., B Mounica . , Lavanya Dr. K. ,   School of Computer Science and Engineering(SCOPE) , VIT University, Vellore ,India.
Published: October 2019

Day by day as the volume of data is being generated massively, storing of data and processing of data becomes a ever growing challenge in intelligent transport system (ITS). In intelligent transport system there are different areas to concentrate like smart parking systems, dynamic toll charging, smart traffic management etc. This paper is mainly focused on big data architecture for intelligent transport system for dynamic toll charging, traffic management and traffic analysis related data collection from various sources. The data collected from various sources can be in the form of structured data, semi structured data and unstructured data. Because of verity of data collected, this paper gives an idea about which data model is appropriate depending on data collected for transportation system.
Machine Learning Based Recognition of Crops Diseases By CNN
Authors:   Assistant Professor, CSE Dept, BVRIT HYDERABAD, Naresh Mr. K. , Satish Dr. G. Naga ,   Associate Professor, CSE Dept, BVRIT HYDERABAD, Ram Mr. K. Bhargav ,   Assistant Professor, CSE Dept, BVRIT HYDERABAD, Srinivasulu Dr. Ch. ,   Professor, CSE Dept, BVRIT HYDERABAD
Published: October 2019

Machine learning plays a major role from past years in image detection, spam reorganization, normal speech command, product recommendation and medical diagnosis. Present machine learning algorithms used for the identification of crops, their diseases and also provide remedies to them. In the present paper, we discuss the Crops Diseases and remedies. Agro consultant application deals with crops and its diseases, nutritive deficiency indication and providing remedy using machine learning techniques for automated vision system used at agricultural field. The task of identifying plants is time-consuming even for botanists. Real- time identification of crop diseases, nutritive deficiency symptoms, and providing a remedy is an application that will aid users in spotting plant species through their leaves. The system will allow the user to search the database, browse the list of collected leaf samples, and take pictures of leaves and analyze them. Crop diseases are a major hazard to food security, but their swift naming remains not easy in many parts of the world due to the lack of the necessary communications. Using a public dataset of diseased and healthy plant leaves collected under controlled conditions, we train a deep convolutional neural network to identify crop species, their diseases and also provide remedies for diseased crops, weeds, and damaged pest.
Responses of Building Base Isolated With High Damping Rubber Bearings
Authors:   Thuyloi University, 100000 Ha noi, Vietnam., Dung Nguyen Anh , Nguyen Quang Hung ,   Thuyloi University, 100000 Ha noi, Vietnam.
Published: October 2019

Seismic isolation is one of the most efficient techniques to protect structures against earthquakes. Rubber bearings are suitable for low-rise and medium-rise buildings due to its durability and easy fabrication. This paper presents the hori-zontal response of a six-storey base-isolated building using high damping rubber bearings (HDRB) under two ground motions of earthquakes as types I and II in JRA (2002) by finite element analysis. In this analysis, these bearings are mod-elled by the bilinear hysteretic model which is indicated in JRA and AASHTO. Comparison of horizontal response including base shear force and roof level acceleration between the two cases: base-isolated building and fixed-base building is carried out to evaluate the effectiveness of the use of HDRB on the protection of buildings from earthquakes. The numerical results show that the peak value of roof floor acceleration of the fixed-base building is two times higher than that of the base-isolated building, and the floor accelerations depend on the peak values of ground acceleration. In addition, the step-by-step design procedure for deter-mining the size of HDRBs used for buildings is also presented in this paper.
The Role of Contractor's Experience Factors In The Process of Prequalification for Green Buildings Projects.
Authors:   Department of Civil Engineering, Yıldız Technical University/ Istanbul, Turkey., Najm Ali Abdullah Najm , Gürgün Aslı Pelin ,   Department of Civil Engineering, Yıldız Technical University/ Istanbul, Turkey.
Published: October 2019

Few numbers of articles dealt with the factors that affecting the selection of contractors in green buildings. This study has conducted to identify the Role Of Contractor's Experience Factors In The Process Of Prequalification For Green Buildings Projects. A total of four sub-factors which are (Experience In Delivering Green Building, The Contractor's & Sub-Contractors Experience In Construction Of Intended Product/Project Type, Recommendation Letters From Past Client, Past Health And Safety Performance); Classified as being used widely in the process of contractors’ prequalification in Turkey, and falls according to the opinion of the experts under the factor of Contractor’s Experience. These sub-factors have extracted from a rigorous literature review of a gross 120 articles published in the past 18 years. Then nine extensive interviews have established with engineers and architects who enrolled in Green Building projects, to score the above-mentioned sub-factors relatively on a scale from (1 to 9) to facilitate the utilization of the Analytical Hierarchy Process method (AHP). To avoid any variations in the expert's opinion regarding the priorities Geometric Mean was adopted, and finally, the weight of the sub-factors that used during the process of selection has determined. The results showed that the factors are ranked as the following: (Experience In Delivering Green Building), (The Contractor's & Sub-Contractors Experience In Construction Of Intended Product/Project Type), (Past Health And Safety Performance), (Recommendation Letters From Past Client) Respectively. Furthermore, both of (Experience In Delivering Green Building), and (The Contractor's & Sub-Contractors Experience In Construction Of Intended Product/Project Type) have recognized as dominant factors with a total weight of 58.5%. according to the calculations that based on the evaluations of interviewees.This study aids to minimize the potential risks associated with the decision-making process, which related to the selection of the best contractor. In other words, it helps to award the project to a contractor who can achieve the successful completion of the project, with a preliminary guarantee of attainment for Green Certificate for it through the accumulated experience in this area
Endoscopic Spine Surgery: Distance Patients
Will Travel for Minimally Invasive Spine
Surgery
Authors: Telfeian Albert E.
Published: October 2019

Background: Transforaminal lumbar endoscopic discectomy is a minimally invasive spine
surgery procedure performed principally for the treatment of lumbar herniated discs. Endoscopic
spine surgeons around the world have noted how far patients will travel to undergo this minimally
invasive spine surgery, but the actual distance patients travel has never been investigated.
Objective: We present here our analysis of how far patients will travel for endoscopic spine
surgery by studying the referral patterns of patients to 3 centers in 3 different countries.
Study Design: Retrospective chart review of de-identified patient data was performed to
analyze the distance patients travel for spine surgery.
Methods: Patient demographic data was analyzed for patients undergoing transforaminal
lumbar endoscopic discectomy procedures over the same 8 month period in 2015 at centers in
the United States (U.S.), Netherlands, and Germany.
Results: Travel distances for patients were determined for 327 patients. The average distance
traveled for the U.S. center was 91 miles, the Dutch center was 287 miles, and the German
center was 103 miles. For the U.S. center 16% of patients traveled out of state for surgery and
for the European centers combined, 4% of patients traveled out of the country for surgery.
Limitations: The period of data analyzed was less than one year and the data collected was
analyzed retrospectively.
Conclusions: Quality metrics in health care tend to be focused on how health care is delivered.
Another health care metric that focuses more on what patients desire is presented here: how far
patients will travel for innovative spine care.
Key words: Endoscopic spine surgery, transforaminal, minimally invasive, travel, lumbar disc
herniation
Is Kratom the New ‘Legal High’ on the Block?:
The Case of an Emerging Opioid Receptor
Agonist with Substance Abuse Potential
Authors: Chan ge Chien George C.
Published: October 2019

Kratom is an unscheduled herbal extract that contains alkaloids with opioid receptor agonist
activity. It is currently available in the form of dietary supplements and is used and abused by
chronic pain patients on prescription opioids. Active alkaloids isolated from Kratom such as
mitragynine and 7-hydroxymitragynine are thought to act on mu and delta opioid receptors
as well as alpha 2 adrenergic and 5-HT2A receptors. Animal studies suggest that Kratom
may be more potent than morphine. Consequently, Kratom consumption produces analgesic
and euphoric feelings among users. Some chronic pain patients on opioids take Kratom to
counteract the effects of opioid withdrawal. Although the Food and Drug Administration has
banned its use as a dietary supplement, Kratom continues to be widely available and easily
accessible on the internet at much lower prices than other opioid replacement therapies
like buprenorphine. There are no Federal regulations monitoring the sale and distribution of
this substance. Consumption of Kratom has been associated with hallucination, delusion,
depression, myalgia, chill, nausea/vomiting, respiratory depression, hepatotoxicity, seizure,
coma and death. A search of the pain literature shows past research has not described the
use and potential deleterious effects of this extract. Many pain physicians are not familiar with
Kratom. As providers who take care of high-risk chronic pain patients using prescribed opioids,
knowledge of all current substances with opioid receptor agonists with abuse potential is of
paramount importance. The goal of this article is to introduce Kratom to pain specialists and
identify issues for further studies that will be required to help better understand the clinical and
long-term effects of Kratom use among chronic pain patients.
Key words: Opioid receptor agonist, Kratom, Mitragynine, opioid overdose, chronic pain,
substance abuse :
Vitamin D Supplementation in Patients with
Chronic Low Back Pain: An Open Label, Single
Arm Clinical Trial
Authors: Ghai Babita
Published: October 2019

Background: Vitamin-D deficiency may possibly be related to chronic low back pain (CLBP).
Objective: The study is aimed to assess the impact of vitamin-D supplementation on pain
intensity, functional disability, and vitamin-D levels in patients with CLBP.
Study Design: Single arm open-label study.
Setting: Outpatient pain clinic of a tertiary care hospital.
Methods: Sixty-eight eligible patients (CLBP for ≥ 3 months, pain score ≥ 50 on visual analogue
scale (VAS) and plasma 25-Hydroxyvitamin D3 levels < 30 ng/mL) were enrolled. Patients were
supplemented with 60,000 IU of oral vitamin-D3 given every week for 8 weeks. Efficacy parameters
included pain intensity and functional disability measured by VAS and modified Oswestry disability
questionnaire (MODQ) scores at baseline, 2, 3, and 6 months post-supplementation. Plasma
25(OH) D3 levels were measured at baseline and 8 weeks.
Results: Baseline mean (SD) vitamin-D levels were 12.8 (5.73) ng/mL and increased to 36.07
(12.51) post supplementation (P < 0.01). Forty-five (66%) patients attained normal levels (> 29
ng/mL) post supplementation. Significant reduction in VAS was observed at 2, 3, and 6 months
[61 (19), 45 (19), 36 (18)] as compared to 81 (19) at baseline (P ≤ 0.001 at all-time intervals). A
significant improvement in the functional ability was also observed at 2, 3, and 6 months [36 (12),
31 (13), and 26 (10)] as compared to baseline 45 (16) (P ≤ 0.001 at all-time intervals).
Conclusion: Vitamin-D supplementation in deficient CLBP patients may lead to improvement in
pain intensity and functional ability apart from normalization of the levels. Future controlled clinical
trials are required to confirm the hypothesis.
Key words: Vitamin D, deficiency, screening, low back pain, chronic, supplementation
Anatomy, Pathophysiology and Interventional
Therapies for Chronic Pelvic Pain: A Review
Authors: Hunter Corey W.
Published: October 2019

Background: Chronic pelvic pain (CPP) represents a group of poorly understood disorders that
are often refractory to conventional treatment. Referral to pain management typically occurs later
in the continuum of care; as such, many of the injections and nerve blocks commonly prescribed
for such patients are potentially limited in efficacy. While neuromodulation is conventionally
considered the next algorithmic step in the treatment of chronic pain after injections fail, there
is a common perception that neuromodulation is largely ineffective for CPP conditions. However,
there is evidence that suggests neuromodulation may in fact be a viable treatment option for this
particular patient population when utilized properly.
Objectives: To provide a basic overview of the pathophysiology of CPP and the relevant
neuroanatomy as it pertains to various available treatment options, as well as the techniques and
potential targets for neuromodulation.
Study Design: Literature review.
Setting: Private practice, academic and hospital setting.
Methods: A comprehensive review of the available literature was performed targeting publications
focused on CPP and various techniques for utilizing neuromodulation to treat it.
Results: Neuromodulation is an established treatment modalities, however its usefulness as it
relates to treating CPP has typically been drawn into question. In this literature review, we discuss
the efficacy of various techniques for treating CPP with neuromodulation.
Limitations: Evidence to support the various treatments, while encouraging, is based on small
studies and case series. Large-scale randomized, placebo-controlled clinical trials are warranted
to evaluate the clinical efficacy and safety of the different treatments described, particularly
neuromodulation.
Conclusions: In addition to the percutaneous, injection-based treatments described herein,
neuromodulation remains a plausible option for recalcitrant cases that fail to respond to more
conventional means.
Key words: Chronic pelvic pain, neuromodulation, spinal cord stimulation, CRPS, complex
regional pain syndrome, neuropathic pain.
Fluoroscopic Guided Radiofrequency of Genicular
Nerves for Pain Alleviation in Chronic Knee
Osteoarthritis: A Single-Blind Randomized
Controlled Trial
Authors: Kamel Dr. Emad Z.
Published: October 2019

Background: Nowadays, pain and disability due to chronic knee arthritis is a very common
problem in middle aged people. A lot of modalities for management are available, including
conservative analgesics and up to surgical interventions. Radiofrequency ablation of genicular
nerves is assumed to be an effective less invasive and safe pain alleviation modality.
Objectives: To evaluate the efficacy of fluoroscopic guided radiofrequency neurotomy of the
genicular nerves for alleviation of chronic pain and improvement of function in patients with knee
osteoarthritis.
Study Design: A single-blind randomized controlled trial.
Setting: Pain management unit, and Rheumatology and Rehabilitation clinics of Assiut University
hospitals, Assiut, Egypt.
Methods: This study involved 60 patients with chronic knee osteoarthritis. Radiofrequency
neurotomy of the genicular nerves was done for 30 patients (Group A) while the other 30 patients
(Group C) received conventional analgesics only. The outcome measures included visual analog
scale (VAS), Western Ontario and McMaster Universities Index (WOMAC), and Likert scale for
patient satisfaction in the 2nd week,3rd, and 6th months.
Results: There were significant differences regarding the VAS in the 2nd week, 3rd, and 6th
months between the 2 groups, and a significant difference in total WOMAC index in the 6th
month only. There were significant changes when comparing pretreatment values with the values
during the whole follow-up period with regard to the VAS and total WOMAC index in both groups.
Limitations: No diagnostic block was done prior to radiofrequency. We recommend the use of
such a technique on a larger number of OA patients, with a longer follow-up period.
Conclusion: RF can ameliorate pain and disability in chronic knee osteoarthritis in a safe and
effective manner.
Keywords: Chronic pain, radiofrequency (RF), knee osteoarthritis
Identifying Levorphanol Ingestion Using Urine
Biomarkers in Health Care Patients
Authors: Watson Amber R.
Published: October 2019

Background: Levorphanol is a long-acting opioid analgesic that is an optical isomer of
dextrorphan, a metabolite of the over-the-counter cough suppressant dextromethorphan.
Providers prescribing levorphanol for pain management may need to assess compliance through
urine drug testing, as this agent is subject to abuse. Therefore, it is important to differentiate
between dextromethorphan and levorphanol ingestion.
Objectives: This article is the first to report urine concentrations of levorphanol/dextrorphan
and 3-hydroxymorphinan in human urine and assesses the need for an enantiomeric analysis to
distinguish between dextromethorphan and levorphanol ingestion.
Study Design: Retrospective data review.
Methods: Medication compliance test results were reviewed for 521 urine samples submitted
to Aegis Sciences Corporation between July 2014 and July 2016. Samples were included in this
analysis if dextromethorphan or levorphanol testing was requested by the ordering provider.
Urine samples were hydrolyzed with β-glucuronidase and analyzed using liquid chromatographytandem mass spectrometry (LC-MS/MS). An enantiomeric analysis to distinguish levorphanol from
dextrorphan and (-)-3-hydroxymorphinan (norlevorphanol) from (+)-3-hydroxymorphinan was not
performed.
Results: Nineteen urine samples with levorphanol listed as prescribed had median levorphanol/
dextrorphan and 3-hydroxymorphinan concentrations of 1,881 ng/mL and 141 ng/mL, respectively.
One-quarter of the urine samples with dextromethorphan listed as prescribed did not have any
detectable dextromethorphan or 3-methoxymorphinan.
Limitations: An enantiomeric analysis was not utilized with the LC-MS/MS testing method;
therefore, levorphanol could not be differentiated from dextrorphan, and (-)-3-hydroxymorphinan
could not be differentiated from (+)-3-hydroxymorphinan. The hepatic and renal function for these
patients was unknown; however, both could impact the metabolism, distribution, and excretion
of levorphanol biomarkers in urine. The dextromethorphan and/or levorphanol dose and timing of
last ingestion was also not assessed.
Conclusions: It may be impossible to distinguish between levorphanol and dextromethorphan
ingestion based on urine biomarkers, unless dextromethorphan or 3-methoxymorphinan is present
or an enantiomeric analysis is performed. Therefore, the potential exists for patients prescribed
levorphanol to ingest dextromethorphan and appear compliant with levorphanol therapy. This
should prompt clinicians to consider the parameters of their laboratory’s testing method when
interpreting levorphanol drug test results.
Key words: Levorphanol, dextrorphan, dextromethorphan, 3-hydroxymorphinan, urine testing,
urine concentration, drug testing, medication compliance testing
Effect of Dexmedetomidine Added to Modified
Pectoral Block on Postoperative Pain and Stress
Response in Patient Undergoing Modified
Radical Mastectomy
Authors: El Sherif Fatma A.
Published: October 2019

Background: The most common surgical procedure for breast cancer is the modified radical
mastectomy (MRM), but it is associated with significant postoperative pain. Regional anesthesia
can reduce the stress response associated with surgical trauma.
Objectives: Our aim is to explore the efficacy of 1 µg/kg dexmedetomedine added to an
ultrasound (US)-modified pectoral (Pecs) block on postoperative pain and stress response in
patients undergoing MRM.
Study Design: A randomized, double-blind, prospective study.
Setting: An academic medical center.
Methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I–
II (18–60 years old and weighing 50–90 kg) scheduled for MRM were enrolled and randomly
assigned into 2 groups (30 in each) to receive a preoperative US Pecs block with 30 mL of 0.25%
bupivacaine only (group 1, bupivacaine group [GB]) or 30 mL of 0.25% bupivacaine plus 1 µg/
kg dexmedetomidine (group II, dexmedetomidine group [GD]). The patients were followed-up 48
hours postoperatively for vital signs (heart rate [HR], noninvasive blood pressure [NIBP], respiratory
rate [RR], and oxygen saturation [Sao2]), visual analog scale (VAS) scores, time to first request
of rescue analgesia, total morphine consumption, and side effects. Serum levels of cortisol and
prolactin were assessed at baseline and at 1 and 24 hours postoperatively.
Results: A significant reduction in the intraoperative HR, systolic blood pressure (SBP), and diastolic
blood pressure (DBP) starting at 30 minutes until 120 minutes in the GD group compared to the GB
group (P < 0.05) was observed. The VAS scores showed a statistically significant reduction in the
GD group compared to the GB group, which started immediately up until 12 hours postoperatively
(P < 0.05). There was a delayed time to first request of analgesia in the GD group (25.4 ± 16.4
hrs) compared to the GB group (17 ± 12 hrs) (P = 0.029), and there was a significant decrease of
the total amount of morphine consumption in the GD group (9 + 3.6 mg) compared to the GB
group (12 + 3.6 mg) (P = 0.001). There was a significant reduction in the mean serum cortisol and
prolactin levels at 1 and 24 hours postoperative in the GD patients compared to the GB patients
(P < 0.05).
Limitations: This study was limited by its sample size.
Conclusion: The addition of 1 µg/kg dexmedetomidine to an US-modified Pecs block has superior
analgesia and more attenuation to stress hormone levels without serious side effects, compared to
a regular Pecs block in patients who underwent MRM.
Key words: Postoperative pain, dexmedetomidine, Pecs block, stress response, breast surgery