bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of selected CNC machining parameters on the surface roughness of the 7075 aluminium alloy
Authors: Sobek M , Grabowski L
Published: August 2019

Modern machining operations are characterized by very high precision and high quality of the surface. In order to achieve such surface quality, many factors influencing the tested parameters should be taken consideration. The most important parameter that allows estimating surface quality after machining is the roughness parameter, and more precisely arithmetical mean deviation of the assessed profile - Ra. The paper titled “The impact of selected CNC machining parameters on the surface roughness of the 7075 aluminum alloy” describes the test process, which aims to set parameters of machining that allow obtaining the highest quality of the surface of the processed material. During the research, a number of tests were carried out. The tests were carried out with various machining parameters. During the research cycle, two main parameters were taken into consideration that have an impact on the quality of the surface. The research process assumed a change of the speed and feed parameters. Afterward, a dependence between them and surface quality was assessed. Other parameters such as the cutting direction, the number of tool blades and the depth of cut remained unchanged. All tests were carried out on samples made of 7075 aluminum alloy (PA9, AlAnMgCu1,5). The samples were made using the MAZAK VTC-530C CNC machine. A portable surface roughness measuring device MarSurf PS10 was used for data acquisition. Further testing will also include other parameters. Such an approach will allow gathering a full set of information about proper processing of that particular material. Designed testing process will be also possible to apply to any other material.
Analytical and graphical modelling of the cutting scheme when generating with a pinion cutter
Authors: Bordeanu M , Frumusanu G , Oancea N
Published: August 2019

The teeth generation in the case of the cylindrical gears with involute profile is frequently realized with tools of pinion cutter type, on specialized slotting machine tools. In general, during gear teeth machining, several teeth of the tool are concomitantly in contact with the worked part, each one detaching a separate chip. The process is characterized by important unevenness of these chips cumulated area, depending on the relative position between the pinion cutter and the worked part. This transforms into cutting force and cutting torque unevenness and negatively influences both machine tool operating and tool life. The paper addresses the problem of smoothing the detached chips cumulated area at the consecutive strokes of the tool, along the rolling motion between it and the worked part, in order to obtain a main cutting torque as uniform as possible. In this purpose, the analytical modelling of the tool/worked part contact is realized at first, in the cases of generating both exterior and interior gears with involute straight teeth. Then, because the analytical solution is very laborious, a modelling algorithm is developed in one of the most performant graphical environments, which is CATIA. By implementing the graphical solution, the variation of detached chips cumulated area can be determined and the required variation law of the rolling feed, leading to process smoothing, can also be found. A numerical approached case study, concerning the teeth machining for an exterior gear is also presented.
Considerations on longitudinal dynamic effects of unbraked vehicle in passenger train composition – parametric study
Authors: Cruceanu C , Craciun C
Published: August 2019

The study investigates the trains’ longitudinal dynamic evolutions in certain unusual situations that may be encountered, even rarely, in railway operation. It is about the case of operating passenger trains having in componence a vehicle with isolated braking system. This is a state that, according to regulations, is generally not acceptable, but there are circumstances that can conduct to exceptions. Our purpose is to find out by numerical simulations the influence that certain parameters, such as the number of vehicles of the train, the weight of locomotive and the position of the unbraked vehicle, have on the longitudinal dynamics of passenger trains during braking actions. The numerical simulations were performed for trains in classical composition, meaning a locomotive hauling 3 up to 19 passenger vehicles, thus covering virtually all the current situations encountered in operation. In simulations there were considered all the possible placements of the unbraked vehicle within the train body. The main outcomes, submitted to a comprehensive analyse, are the maximum in-train forces and the position in long of the train of the most affected couplers by longitudinal dynamic compression (buff) and tensile (draft) forces. The time dependency of in-train forces is also discussed.
Preliminary studies on the braking efficiency of an engine working in combined Jake brake and exhaust brake regime
Authors: Manolache-Rusu I C , Glovnea M , Suciu C
Published: August 2019

The improvements brought lately to heavy duty vehicles led to a decrease of their native retarding capacity. This difficulty is commonly compensated by the auxiliary braking systems such as the Jake brake or exhaust brake. The purpose of this study is to evaluate the behaviour of an auxiliary brake system consisting from a combination of an exhaust brake and a Jake brake. For this purpose, a simulation model was developed to evaluate the retarding power of a single-cylinder engine that works at the same time in Jake brake and exhaust brake mode respectively. The present article deals with five study cases, at constant engine speed, for a better comparison of the braking torques obtained for each operation mode of the I.C. engine. Simulations performed on the studied engine in Jake brake mode, provide an increase in braking efficiency, compared to the brake efficiency when it is used in exhaust brake mode. Obtained results show a significant increase in braking capacity for the case of a single cylinder engine, when the two auxiliary braking systems are simultaneously used. The proposed model can be used to optimize braking performance to the any reciprocating engines that presents an engine brake or an exhaust brake system.
Spearman’s rho modification in digital image processing
Authors: Nalepa B , Gwiazda A
Published: August 2019

The article presents an alternative Spearman’s rank correlation pattern as an innovative method in detecting the edges of an image by defining characteristic points of the image. Edge detection methods can be counted as the image processing stage following the implementation of the “initial” image processing, which includes: use of filters such as low-pass or high-pass, wavelet transform, etc. In this article hitherto known edge detection algorithms will be replaced with image ranking method. The first chapter of this work contains an analysis of the current knowledge on the ranking of the image. The operation of the Spearman rho algorithm together with its various configurations and the comparison of the two methods studied are presented in turn. Next, the modification of the Spearman rho pattern is presented along with the justification for the use of such a transformation. The same chapter also presents the effects of the algorithm, comparing it with known image ranking methods. The next stage of works consisted in developing a method for the interpretation of the results obtained. In the last chapter of the work, the obtained test results were summarized and analysed.
Big data analytics with graphical techniques applied on sensors data
Authors: Oroian-Boca M L
Published: August 2019

The term “Big Data” is now a popular way to refer to massive digital information available in both structured and unstructured form integrated from multiple, diverse, dynamic sources of information. Big data can be used to solve a variety of problems with significant cost reduction cost. Analysis and processing of large data sets represent a significant challenge. Massive data sets are collected and studied in numerous domains, from engineering sciences to social networks, biomolecular research, commerce, and security. Extracting valuable information from big data requires innovative approaches that efficiently process large amounts of data as well as handle and, moreover, utilize their big data analytics structure can be used in electronics industry too. In this study, I created a graphic tool in LabVIEW for the analyses of ECG signals for 3 types of subjects, in the same environment take in case the age of each subject and the influence of the environment on the physiological state of each one. The environmental conditions varied and the variations in the human body have been assessed in three situations: studying with music, studying without music and in relaxing state. LabVIEW proved to be an efficient tool to analyse and compare the produced signals in various time spans and also to compare the ECG signals for the investigated subjects.
Heat transfer original studies –Theory and applications
Authors: Raicu A , Barhalescu M , Memet F
Published: August 2019

Thermal stresses, thermal fatigue, materials’ constants variation with the temperature, residual stresses and micro-structure of the parts after the solidification process are heat transfer phenomenon related problems. The calculation instrument of a given age of science and technology has a great influence on the mathematical solutions and the according applications in engineering. The paper presents a synthesis, including the authors’ contributions in the heat transfer problems, which may be regarded in a broader context of the distinct branches of engineering that are the fields of expertise of the authors. The first step is to analyse the theoretical aspects to be mastered in order to wisely apply them in concrete engineering problems. In this way, there are presented the basic equations used by the authors in their analytical studies and the background of the numerical methods used in engineering, i.e. the finite difference method and the finite element method. In the following case studies are presented the influences of the heat transfer in an internal combustion engine related phenomena, the connections with the casting manufacturing process and some interesting aspects regarding the connections between the melt temperature with the residual stresses. To conclude, the distinct fields of expertize of the authors are useful to present the various facets of the heat transfer problem which is one of their long run concerns in research.
Fuzzy modeling of dependability optimization for supporting the production-quality strategies - case study in technical field
Authors: Vilcu A , Verzea I , Pislaru M , Herghiligiu I
Published: August 2019

this work treats dependability from a functional (systemic) standpoint, which implies meeting a function required within an input/output system. This approach is demanded and necessary within technical equipment design stages, and is an integrant part of systems integrity design methodology. Designing the system integrity includes design criteria for reliability, availability, maintainability and safety of any system and equipment. The combination of these four concepts leads to the necessity of a comparative and integrative methodology that should ensure a good systems design, with required integrity values that can be computed easily, analyzed the most complete possible, and with the possibility to be modified accordingly. During the recent years, artificial intelligence techniques have been developed for dependability, that make use of, statistic methods (necessary for the realization of an operation history), deterministic mathematic algorithms (to determine the exact solutions when these can be determined and are required and the time resource is not critical), heuristic artificial intelligence methods (that can provide good quality solutions when time is a critical resource) - neuronal networks, genetic algorithms (to determine predicted or extreme values for system variables), as well as fuzzy methods for systems in which the system variables change within certain values intervals. All these techniques offer a global image of the artificial intelligence modelling (AIM) in designing the reliability, availability, maintainability and safety, in order to offer a continuous design feedback mean during the entire engineering design process. In this work, we shall develop a fuzzy model for a technical process and will compare our results with the results supplied by mathematical, neuronal and genetic models applied to the same system. The qualitative comparison of models will be completed with their quantitative comparison, by analyzing the complexity of algorithms and execution time. The utility of this work consists in the implementation of an inter-disciplinary tool easy to apply to technical systems with measurable dependability variables that can provide during the flow sheet, the values requested from technical and economic standpoint.
A one-degree-of freedom ankle rehabilitation platform
Authors: Doroftei I , Racu C M , Honceriu C , Irimia D
Published: August 2019

The ankle structure holds one of the most important role in the human biomechanics. Due to complexity of everyday activities this joint is the most prone to be injured part of the lower limb. For a complete recovery of the locomotor function, recovery exercises are mandatory. The existent ankle rehabilitation equipments allow only simple rehabilitation exercises, which cannot be used safely without the aid of a therapist. The introduction of robotic physical recovery systems represents a modern alternative to traditional recovery. Actuated devices are advantageous because they allow many types of exercises on same device, and also they accurate measure forces and angular motions. The purpose of this two paper is to propose a simple rehabilitation device, based on a one-degree-of-freedom mechanisms. Some structural, kinematic and designing aspects of this new ankle rehabilitation device are presented.
Considerations of the energy balance of an internal combustion engine and the recovery of heat lost through the cooling water
Authors: Faitar C , Nedelcu A T , Buzbuchi N , Stan L , Dumitrache L M
Published: August 2019

The thermal balance of an engine expresses the distribution of available heat, between the equivalent energy of effective mechanical work and the various losses. From the analysis of the thermal balance, it results if the thermal energy is used efficiently, corresponding to the economic work of the engine, helping to find and remove the causes that lead to the non-economical use of thermal energy. The thermal balance is useful in calculations for the design of the cooling system and the calculation of the exhaust gas recovery system. The heat flow lost through the cooling fluid is determined by measuring the flow of cooling water and also its inlet and outlet temperature. The heat flow lost through the exhaust gases is determined by the difference between the enthalpy of the exhaust gas and the enthalpy of the fresh entry load. The heat flow lost due to incomplete chemical burn is determined by analyzing the exhaust gases and determining the components that contain chemical energy. The parameters necessary for the thermal balance at a certain operating regime are obtained from direct measurements. The paper presents an analysis of thermal balance for ICE in the maritime domain and the possibilities of cooling system recovery for a ship engine of a tanker ship.
The study of the traction behaviour of knitted structures with controlled dimensional stability
Authors: Szabo M , Babanatis-Merce R M , Barbu I , Babanatsas T , Jitaru L
Published: August 2019

This paper proposes a comparative study of the tensile behaviour of the knitwear under linen made of 100% cotton yarn in 1:1 rib with Nm 50/1 and 2:2 rib with Nm 40/1. The rib structures 1:1 are more dimensionally stable than the rib structures 2:2, on both directions, due to the higher number of yarn-yarn contact points and due to the distribution of the rib platinum loop. The studies made on the proposed structures have demonstrated that it can be obtained an almost identical dimensional stability, which fits in the limits ±2, if for the rib structures 2:2 thicker yarns are being used. After knitting and finishing, the structure parameters of the knits are determined and then they are subjected to the tensile strength, and the result after processing the obtained data, it is concluded that the behaviour of the knits at the tensile stresses is comparable to the real situation. The study is carried out on both directions of the knits, in the horizontal direction, of the rows of meshes and in the vertical direction of the strings. The performance-elongation diagrams are represented through graphics and the results obtained are interpreted, the data being used to determine the structure parameters of the knits in order to obtain maximum dimensional stability at wearing.
Considerations upon the performances of the main naval engine and energy efficiency evaluation
Authors: Faitar C , Memet F
Published: August 2019

Nowadays, the essential source of ship propulsion is the diesel low-speed engine, and the power necessity and rate of propeller rotation especially rely upon the ship’s structure and the propeller geometry. Along these lines, in order to arrive at a solution that is as ideal as could be allowed, some broad information is basic for ship diesel engine parameters that impact the propulsion ship system. The performance of any system on board ship is specifically identified with its reliability. So as to get the best out of marine motors, it is critical to screen their performances and take measures to accomplish productive combustion. The paper points the significance of estimating the performances of the propulsion motor utilizing the NHX program. NHX electronic program estimates the pressure inside engine cylinders by the usage of the beat signal from Top Dead Center (T.D.C.) of the number 1 cylinder. Additionally, analyses the after burning period at the combustion stroke of each cylinder. The E.E.O.I. (Energy Efficiency Operational Indicator) is an observing tool for ship management and fleet efficiency. The estimations of the factors have a diminishing trend amid the usage time periods, achieving at least a 30% decrease of the pollutants in the years 2025 contrasted with the values before the implementation of this index. E.E.D.I. index has been considered as the biggest and most dominant sections of the sea business.
Validation of potential flow method for ship resistance prediction
Authors: Pacuraru F
Published: August 2019

Considering the extensive use of numerical methods in naval design, a question about the accuracy numerical tools that could estimate the flow around the ship and which are the limitations of these tools for practical design applications. In this context, experimental test on scaled models play an important role in validation of numerical simulations. This work is dedicated to validation of the method used to calculate the non-linear potential free-surface flow around the ship. Global quantities, as total resistance, wave resistance coefficient, residual resistance coefficient are flow characteristics concentrated in a single value, and their validation provides a criterion for choosing the optimum hull. Validation of physical phenomena is done using the wave profile, the pressure distribution on the body or the free surface topology. Validations were developed by comparing experimental data published for benchmark test cases, results of the resistance test performed in ICEPRONAV towing tank, against the results of numerical calculation performed by the author. Numerical simulations were performed using the XPAN module of the SHIPFLOW program, dedicated to the calculation of non-linear potential free-surface flow. Therefore, in order that the validation to be consistent and not influenced by scale effects, all calculations have been performed for the model scale. For this purpose, numerical studies have been considered for three ship models with different complex geometries. Two of the three hulls, the 60 Series and the DTMB 5415, are benchmark tests, chosen due to a wide range of detailed experimental and numerical results. The other one is case study for which experimental measurements were carried out in the frame of research projects.
Temporal regulation of cell polarity via the interaction of the Ras GTPase Rsr1 and the scaffold protein Bem1
Authors: Miller Kristi E. , Lo Wing-Cheong , Chou Ching-Shan , Park Hay-Oak
Published: August 2019

The Cdc42 guanosine triphosphatase (GTPase) plays a central role in polarity development in species ranging from yeast to humans. In budding yeast, a specific growth site is selected in the G1 phase. Rsr1, a Ras GTPase, interacts with Cdc42 and its associated proteins to promote polarized growth at the proper bud site. Yet how Rsr1 regulates cell polarization is not fully understood. Here, we show that Rsr1-GDP interacts with the scaffold protein Bem1 in early G1, likely hindering the role of Bem1 in Cdc42 polarization and polarized secretion. Consistent with these in vivo observations, mathematical modeling predicts that Bem1 is unable to promote Cdc42 polarization in early G1 in the presence of Rsr1-GDP. We find that a part of the Bem1 Phox homology domain, which overlaps with a region interacting with the exocyst component Exo70, is necessary for the association of Bem1 with Rsr1-GDP. Overexpression of the GDP-locked Rsr1 interferes with Bem1-dependent Exo70 polarization. We thus propose that Rsr1 functions in spatial and temporal regulation of polarity establishment by associating with distinct polarity factors in its GTP- and GDP-bound states.
A Systematic Review of the Literature of Delayed Inflammatory Reactions After Hyaluronic Acid Filler Injection to Estimate the Incidence of Delayed Type Hypersensitivity Reaction
Authors: Chung King Lueh , Convery Cormac , Ejikeme Ifeoma , Ghanem Ali M
Published: August 2019

Background

Hyaluronic acid (HA) dermal filler injection is believed to be a safe procedure. However, with the increase in the number of performed procedures and indications, the number of product-related complications, especially delayed inflammatory reactions, has also increased. Delayed-type hypersensitivity (DTH) reaction is one of these delayed inflammatory reactions, which is preventable by performing a pretreatment skin test.

Objectives

The authors sought to find the incidence of delayed inflammatory reactions and DTH reaction after HA injection and to determine whether a pretreatment skin test is worthwhile to be performed.

Methods

The authors conducted a systematic literature review of all the relevant prospective studies, retrospective studies, and case reports on delayed inflammatory reactions and DTH reaction after HA filler injection.

Results

The incidence of delayed inflammatory reactions calculated from the prospective studies was 1.1% per year, and that of possible DTH reaction was 0.06% per year. Most retrospective studies estimated a percentage of delayed inflammatory reactions of less than 1% in 1 to 5.5 years. The incidence of DTH reaction would be lower than that. Among all the DTH cases reported, only about 5% of them were proven to be genuine DTH reactions.

Conclusions

The incidence of both delayed inflammatory reactions and DTH reaction is low. There is evidence that genuine DTH reactions caused by HA fillers approved by the Food and Drug Administration do exist. This adverse event can be prevented by performing a pretreatment skin test. However, the incidence of DTH reaction is so low that the pretreatment skin test is not mandatory if Food and Drug Administration-approved HA fillers are used.

Level of Evidence: 4
Development of a gender-relevant tobacco cessation intervention for women in Brazil—an intervention mapping approach to planning
Authors: Kienen Nádia , Wiltenburg Thaís Distéfano , Bittencourt Lorna , Scarinci Isabel C
Published: August 2019

The purpose of this article is to describe the development of a theory-based, culturally and gender-relevant Community Health Worker (CWH)-led tobacco cessation intervention for low-income Brazilian women who augments the tobacco cessation program offered through the public health system using Intervention Mapping (IM). We began with the establishment of a network of representatives from different segments of society followed by comprehensive needs assessments. We then established a logical planning process that was guided by a theoretical framework (Social Cognitive Theory) and existing evidence-based tobacco cessation programs, taking into account socio-political context of a universal health care system. Given the gender-relevance of our intervention and the importance of social support in tobacco cessation among women, we chose an intervention that would be delivered within the public health system but augmented by CHWs that would be trained in behavior change by researchers. One of major advantages of utilizing IM was that decisions were made in a transparent and supportive manner with involvement of all stakeholders throughout the process. Despite the fact that this process is very taxing on researchers and the health care system as it takes time, resources and negotiation skills, it builds trust and promotes ownership which can assure sustainability.
Mapping Orientalist Discourses: Using Waltz with Bashir in the Classroom
Authors: Tomé-Alonso Beatriz , Prado Lucía Ferreiro
Published: August 2019

While fiction and non-fiction productions can be used as tools to observe, describe, and analyze the “world-out-there,” within these events-issues centered approaches post-positivists posit films themselves as “cultural artifacts” to be analyzed. This paper proposes a critical analysis of Waltz with Bashir (2008) to be conducted with students in the classroom. This acclaimed animated film by Israeli writer and director Ari Folman depicting the 1982 Lebanon War is a non-obvious but germane example of Said's “Orientalism.” After explaining post-structuralism and post-orientalist stances on subjectivity, power relations, and the political consequences of the narratives we create, we analyze the film by applying an orientalist grid to Waltz with Bashir and raising qualitative questions to foster the student's criticality. We conclude by examining student's reactions to the film and their understanding of “Orientalism.”
Estimation of the net energy and protein requirements for maintenance of male arctic foxes (Alopex lagopus) during the growth period12
Authors: Zhong W , Mu L L , Han F F , Luo G L , Zhang X Y , Liu K Y , Guo X L , Yang H M , Li G Y
Published: August 2019

The maintenance requirements of net energy and net protein were assumed to represent the most accurate and important values totally for the animal’s utilization. The objective of this experiment was to determine the net energy and net protein requirements for maintenance of growing arctic foxes. The experiments was evaluated using regression models estimated from data collected by means of indirect calorimetry, nitrogen balance trials, and digestion and metabolism experiments. Thirty-six growing arctic foxes (3 487 ± 261.7 g) at the age of 85 days were randomly assigned to four groups with 9 animals in each group. Arctic foxes were fed a complete formula diet at four intake levels (100%, or 80%, 60%, and 40% of feed requirements) from 24 July 2017 to 23 September 2017. Arctic foxes in each treatment were kept individually in respiration chambers after 1-d adaptation at day 2 for a 3-d balance trial and then at day 5 followed by a 3-d fasting period. The metabolizable energy intake (MEI), heat production in the fed state (HP), and retained energy (RE) of arctic foxes significantly decreased (P < 0.01) as the feed intake level decreased. Fasting heat production (FHP) of arctic foxes was not influenced by feed intake level (P > 0.05). The metabolizable energy maintenance requirement (MEm) and net energy maintenance requirement (NEm) estimated from the linear relationship between RE and MEI were 230 and 217 kJ/kg of body weight BW0.75/d, respectively. The MEm and NEm estimated by logarithmic regression of HP on MEI were 225 and 209 kJ/kg BW0.75/d, respectively. The net N maintenance requirement (NNm) and net protein maintenance requirement (NPm) estimated from the linear relationship between retained nitrogen (RN) and daily nitrogen intake (NI) were 179.6 mg/kg BW0.75/d and 1.123 g/kg BW0.75/d, respectively. It is concluded that NEm and NPm values obtained fill the net energy and protein requirements shortage, and provide the basic data for establishing the standard of nutrition demand of breeding arctic foxes in China.
Effects of the Age-Related Resistance to Potato virus Y in Potato on the Systemic Spread of the Virus, Incidence of the Potato Tuber Necrotic Ringspot Disease, Tuber Yield, and Translocation Rates Into Progeny Tubers
Authors: Chikh-Ali Mohamad , Tran Lisa T. , Price William J. , Karasev Alexander V.
Published: August 2019

The recombinant strain of potato virus Y (PVY), PVYNTN, is the main cause of the potato tuber necrotic ringspot disease (PTNRD) in susceptible potato cultivars, which reduces the quality of potato tubers, in addition to the yield loss. Control of PVY has been the main challenge in most potato-producing areas. Here, the effects of the age-related resistance (ARR) were investigated in transplants of a potato cultivar Yukon Gold to the infection with PVYNTN strain in greenhouse experiments. Within the first 3 weeks after transplanting into soil (week 1 [W1] to W3), Yukon Gold plants developed ARR that impaired the systemic movement of PVYNTN into upper noninoculated leaves and concomitant translocation into progeny tubers starting from W4 after transplanting. The yield and quality of tubers from PVY-infected plants with the established ARR (W5 to W8) were comparable with the healthy controls, suggesting that late PVY infection would not significantly affect commercial potato production. Plants inoculated early (W1 to W2), before the establishment of the ARR, exhibited a 100% primary systemic infection with PVYNTN and produced fewer tubers of smaller sizes, exhibiting PTNRD; this resulted ≤70% yield reduction compared with plants inoculated later in the season (W5 to W8). This ARR greatly restricted the systemic movement of PVYNTN in the foliage and resulted in very limited translocation rates of the virus into tested progeny tubers: 7.8 and 4.1% in 2017 and 2018, respectively, of all plants inoculated later in the season (W5 to W8). This study suggests that PVYNTN management programs in Yukon Gold seed potato should focus more on the early stages of the potato development before the onset of the ARR.
Identification and Characterization ofColletotrichumSpecies Associated with Anthracnose Disease ofCamellia oleiferain China
Authors: Wang Yixun , Chen Jing-Yuan , Xu Xiaowen , Cheng Junyong , Zheng Lu , Huang Junbin , Li De-Wei
Published: August 2019

Tea-oil tree (Camellia oleifera Abel) is an important edible oil woody plant with a planting area over 3,800,000 hectares in southern China. Anthracnose is a serious disease of tea-oil tree in southern China, causing severe economic losses and posing a huge threat to the Ca. oleifera industry. Based on recent developments in the classification of Colletotrichum species, the objective of this study was to identify Colletotrichum species associated with tea-oil tree and examine their pathogenicity on leaves and fruits of Ca. oleifera. In total, 232 isolates were obtained from Ca. oleifera leaves and fruits with anthracnose symptoms. These isolates were further characterized based on morphology and multilocus phylogenetic analyses using partial DNA sequences at the ribosomal internal transcribed spacer regions and β-tubulin, actin, calmodulin, glyceraldehyde-3-phosphate dehydrogenase, and chitin synthase-encoding genes. The fungal isolates belong to five species: C. camelliae, C. fructicola, C. siamense, C. aenigma, and C. gloeosporioides. C. camelliae was the most predominant and widely distributed species on fruits of Ca. oleifera (91.4%), followed by C. fructicola (6.3%). However, C. fructicola was common and widely distributed species on leaves (75.9%), followed by C. camelliae (17.2%). There was no evidence of geographical specialization of the different species. Pathogenicity assays showed that all tested isolates, including 20 of C. camelliae, 11 of C. fructicola, four of C. siamense, two of C. aenigma, and one of C. gloeosporioides, were pathogenic to leaves and fruits of Ca. oleifera. Among the five species, C. camelliae species showed strong pathogenicity on both leaves and fruits of Ca. oleifera, and C. fructicola, C. siamense, C. aenigma, and C. gloeosporioides all showed weak pathogenicity on both leaves and fruits. No relationship was found between origin of isolates and their virulence. This is the first description of C. camelliae, C. fructicola, C. siamense, and C. gloeosporioides from the fruits of Ca. oleifera in China.
Low Energy, Lateral Ankle Injuries in Pediatric and Adolescent Patients: A Systematic Review of Ankle Sprains and Nondisplaced Distal Fibula Fractures
Authors: Beck Jennifer J. , VandenBerg Curtis , Cruz Aristides I. , Ellis Henry B.
Published: August 2019

Background:

Lateral ankle injuries are one of the most common musculoskeletal injuries sustained by pediatric and adolescent athletes. These injuries can result in significant time lost from competition, affect performance when returning to play, and represent a significant burden on the health care system as a whole. The purpose of this study was to systematically review the literature on the diagnosis, treatment, and prevention of acute lateral ankle injuries and their chronic effects in pediatric and adolescent athletes (younger than 19 y).

Methods:

This systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines between September and December 2018. PubMed and Google Scholar were systematically searched using the search terms: (“distal fibula fracture” OR “ankle sprain”) AND (“youth” OR “pediatric” OR “adolescent”). All authors participated in article review (N=172) for relevance and age restrictions in which 30 met the inclusion criteria.

Results:

Thirty articles met inclusion criteria [Levels of Evidence I to IV (I: n=4, II: n=16, III: n=9, and IV: n=1)] including distal fibula fracture diagnosis and treatment, and risk factors, prevention, and chronic sequela of lateral ankle injuries in pediatric and adolescent patients.

Conclusions:

Low-energy, lateral ankle injuries are common in pediatric and adolescent patients, yet underrepresented in the medical literature. There is a lack of high-quality literature on diagnosis, treatment, and outcomes after Salter-Harris I distal fibula fractures. Available literature, however, suggests that there remains over diagnosis and over treatment of presumed Salter-Harris I distal fibula fractures. Adolescent ankle sprains dominate the available literature likely due to the high recurrence rate. Youth athletes and coaches should address risk factors and engage in injury prevention programs to prevent and minimize the effect of acute lateral ankle injuries.

Levels of Evidence:

Level III—Systematic review.
Nurse Practitioners and Physician Assistants in Acute and Critical Care: A Concise Review of the Literature and Data 2008–2018
Authors: Kleinpell Ruth M. , Grabenkort W. Robert , Kapu April N. , Constantine Roy , Sicoutris Corinna
Published: August 2019

Objectives:

To provide a concise review of the literature and data pertaining to the use of nurse practitioners and physician assistants, collectively called advanced practice providers, in ICU and acute care settings.

Data Sources:

Detailed search strategy using the databases PubMed, Ovid MEDLINE, and the Cumulative Index of Nursing and Allied Health Literature for the time period from January 2008 to December 2018.

Study Selection:

Studies addressing nurse practitioner, physician assistant, or advanced practice provider care in the ICU or acute care setting.

Data Extraction:

Relevant studies were reviewed, and the following aspects of each study were identified, abstracted, and analyzed: study population, study design, study aims, methods, results, and relevant implications for critical care practice.

Data Synthesis:

Five systematic reviews, four literature reviews, and 44 individual studies were identified, reviewed, and critiqued. Of the research studies, the majority were retrospective with others being observational, quasi-experimental, or quality improvement, along with two randomized control trials. Overall, the studies assessed a variety of effects of advanced practice provider care, including on length of stay, mortality, and quality-related metrics, with a majority demonstrating similar or improved patient care outcomes.

Conclusions:

Over the past 10 years, the number of studies assessing the impact of advanced practice providers in acute and critical care settings continue to increase. Collectively, these studies identify the value of advanced practice providers in patient care management, continuity of care, improved quality and safety metrics, patient and staff satisfaction, and on new areas of focus including enhanced educational experience of residents and fellows.
Survival and Neurologic Recovery After Prompt Diagnosis and Aggressive Management of Severe Idiopathic Hyperammonemic Encephalopathy in a Patient with Acute Myeloid Leukemia
Authors: Mangum Ross , Soler-Alfonso Claudia , Birchansky Sherri , Stevens Alexandra
Published: August 2019

A case of a 19-year-old female with low-risk acute myeloid leukemia is presented who was diagnosed with idiopathic hyperammonemic encephalopathy following the development of abrupt neurologic decline, respiratory alkalosis, and elevated plasma ammonia levels of unknown etiology. Delayed symptom recognition of this exceedingly rare condition contributes to the often fatal outcomes of idiopathic hyperammonemic encephalopathy. As illustrated by this case, prompt diagnosis and utilization of a variety of ammonia-modulating treatment modalities can result in remarkable clinical recovery. This case provides guidance to clinicians in counseling families about the possibility of neurologic recovery in similar clinical scenarios.
Successful Full-term Pregnancies After High-dose Pelvic Radiotherapy for Ewing Sarcoma: A Case Report
Authors: Gutkin Paulina M. , Chen Emily L. , Miller Chelsea J. , Donaldson Sarah S. , Kovalchuk Nataliya , Callejas Michelle J. , Hiniker Susan M.
Published: August 2019

Survivors of childhood cancer are at risk of long-term sequelae that arise as a consequence of cancer treatment. Radiation and chemotherapy treatment in pediatric female patients can have detrimental impacts on fertility, particularly in those with pelvic tumor involvement. We report 2 successful natural full-term pregnancies with vaginal delivery in a woman 12 years after biopsy, irradiation (55.5 Gy), and multi-agent chemotherapy for treatment of pelvic Ewing sarcoma. Both children were born healthy, with no complications in pregnancy or delivery. Fertility preservation and risk assessment following chemotherapy/radiation therapy is evolving, providing new data to effectively counsel and treat young women.
Keeping Time: Implementing Appointment-based Family-centered Rounds
Authors: Bekmezian Arpi , Fiore Darren M. , Long Michele , Monash Bradley J. , Padrez Ryan , Rosenbluth Glenn , Sun Karen I.
Published: August 2019

Background:

Family-centered rounds (FCRs) provide many benefits over traditional rounds, including higher patient satisfaction, and shared mental models among staff. These benefits can only be achieved when key members of the care team are present and engaged. We aimed to improve patient engagement and satisfaction with our existing bedside rounds by designing a new FCR process.

Methods:

We conducted a needs assessment and formed a multidisciplinary FCR committee that identified appointment-based family-centered rounds (aFCRs) as a primary intervention. We designed, implemented, and iteratively refined an aFCR process. We tracked process metrics (rounds attendance by key participants), a balancing metric (time per patient), and outcome metrics (patient satisfaction domains) during the intervention and follow-up periods.

Results:

After implementing aFCR, 65% of patients reported positive experience with rounds and communication. Rounds duration per patient was similar (9 versus 9.4 min). Nurse, subspecialist, and interpreter attendance on rounds was 72%, 60%, and 90%, respectively. We employed a Rounding Coordinator to complete the scheduling and communication required for successful aFCR.

Discussion:

We successfully improved our rounding processes through the introduction of aFCR with the addition of a rounding coordinator. Our experience demonstrates one method to increase multidisciplinary team member attendance on rounds and patient satisfaction with physician communication in the inpatient setting.
Don't Have a Doubt, Get the Catheter Out: A Nurse-Driven CAUTI Prevention Protocol
Authors: Schiessler Melissa M. , Darwin Lisa M. , Phipps Amber R. , Hegemann Lindsay R. , Heybrock Brenda S. , Macfadyen Andrew J.
Published: August 2019

Background:

Despite the use of sterile technique for indwelling urinary catheter insertion, as well as use of the defined catheter-associated urinary tract infection (CAUTI) bundle elements per Children’s Hospitals’ Solutions for Patient Safety, the CAUTI rate in the pediatric intensive care unit (PICU) at a free-standing pediatric hospital was increasing. In 2017, the PICU accounted for 87% of the organization’s CAUTIs and 65% of the total indwelling catheter device days. With an important risk factor for CAUTIs being the duration of catheterization, the indication for catheters became an organizational executive priority.

Methods:

An early 2017 review of the bundle elements identified that the indication for catheterization was not consistently addressed in daily patient rounds. A multidisciplinary project team applying the Plan, Do, Check, Act methodology developed an evidenced-based, nurse-driven indwelling urinary catheter removal protocol. This protocol allows nursing autonomy when removing a catheter by providing clinical indications for catheter use and promoting prompt removal when no longer indicated.

Results:

Indwelling urinary catheter device days in the PICU decreased by 28% within 6 months of protocol implementation. The PICU CAUTI rate declined from 4.8 (per 1,000 device days) in 2017 to 0.8 in 2018, 1 year after protocol implementation.

Conclusions:

Providing the bedside nurse with an evidence-based protocol that is driven by specific patient indications and diagnoses allows them to practice autonomously in catheter removal. Prompt removal of indwelling urinary catheters results in decreased device days and decreased incidence of CAUTIs.
Disclosure of Adverse Events: A Guide for Clinicians
Authors: Peterson Kimberly A. , Rutherford Mary , Drvol Denise , Barkman Darlene , Phipps Amber R. , Hales Roberta , Dawson Aaron , Stevens Laurie , Teman Susan , Teets Jeanette
Published: August 2019

Introduction:

Children’s Hospitals’ Solutions for Patient Safety (SPS) acknowledged a recommendation from the American Academy of Pediatrics to develop education programs on the communication of adverse events with patients and families. SPS set out to create a guide that would outline a standardized disclosure process and provide a training curriculum and tools so that providers would feel better prepared to have effective disclosure conversations.

Methods:

SPS disclosure work began with the development of a project team made up of 9 network hospitals. The team utilized key driver diagrams and process maps to show the relationship between the project aims, key drivers, and specific interventions. The team developed a training curriculum, guide, and tools for each area of improvement. To ensure these were effective, they were tested using case studies and plan-do-study-act cycles.

Results:

One of the cohort hospitals piloted the curriculum and tools, training 48 physicians, nurses, executives, and other allied health professionals. Pretest to posttest scores improved from an average of 82.7% to 90.2%. Survey feedback was favorable with 100% of respondents noting that they strongly agree or agree that attending this educational activity increased or improved their competency, performance, and patient outcomes.

Conclusions:

Initial testing suggests that the developed curriculum is empowering for frontline clinicians. Materials are available in an electronic format on the SPS external website. As member hospitals implement these materials, they will be evaluating learner satisfaction and provider usage. SPS will seek out feedback from these hospitals to further develop the materials and support clinicians.
Tacrolimus Intrapatient Variability, Time in Therapeutic Range, and Risk of De Novo Donor–Specific Antibodies
Authors: Davis Scott , Gralla Jane , Klem Patrick , Stites Erik , Wiseman Alexander , Cooper James E.
Published: August 2019

Background.

Tacrolimus (TAC) is the most important agent for maintenance immunosuppression and prevention of immunologic injury to the renal allograft, yet there remains no consensus on how best to monitor drug therapy. Both high TAC intrapatient variability and low TAC time in therapeutic range (TTR) have been associated with risk of de novo donor–specific antibodies (dnDSA). In this study, we hypothesized that the risk associated with high TAC coefficient of variation (CV) is a result of low TAC TTR rather than the variability itself.

Methods.

We analyzed the risk of dnDSA, acute rejection, or death-censored graft loss by non–dosed-corrected TAC CV and TAC TTR during the first posttransplant year in a cohort of 538 patients with a median follow-up period of 4.1 years.

Results.

Patients with CV >44.2% and TTR <40% (high intrapatient variability and low TTR) had a high risk of dnDSA (adjusted OR = 4.93, 95% confidence interval = 2.02-12.06, P < 0.001) and death-censored graft loss by 5 years (adjusted HR = 4.00, 95% confidence interval = 1.31-12.24, P = 0.015) when compared with patients with CV >44.2% and TTR ≥40% (high intrapatient variability and optimal TTR), while the latter patients had similar risk to patients with CV <44.2% (lower intrapatient variability).

Conclusions.

These data suggest that previously reported immunologic risk associated with high TAC intrapatient variability is due to time outside of therapeutic range rather than variability in and of itself when evaluating absolute non–dose-corrected TAC levels irrespective of reason or indication.