bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of model and algorithms in improving methane yield in an industrial biogas plant
Authors: Dada Opeoluwa Rotimi , Ogunkunle Oyetola , Laseinde Opeyeolu Timothy
Published: October 2023

With the ever-growing application of data science and machine learning in the fourth industrial revolution era, many challenges faced within the energy sector in past decades have now been receiving timely interventions through the proper application of programming and machine learning tools coupled with the implementation and utilization of modern technology. In recent years, balancing in real-time the demand and supply of energy generated from renewable sources such as wind and solar has gained much improvement because of its ability to forecast the quantity of energy that could be produced from the renewable sources using historical data. Likewise, the application of model and algorithms has also helped to predict accurately, the amount of energy that could be produced from a batch of anaerobic digestion process to produce biogas or biomethane of acceptable quality. In this research work, a set of data was collected from an industrial biogas plant and based on the variables from the data set, Design Expert Software version 11 was used to develop mathematical models and algorithms to optimize the production process of the plant based on the feedstock fed into the digesters. The result of the optimization proves that the biogas currently produced from the post-digester tank with methane (CH4) content of about 68.8% can be upgraded to biomethane with methane content of 78.22% without any adjustment to the digesters or production process.
Framework for Adoption of Clean Energy Products in Urban Areas
Authors: Das Shiv Sankar , Mishra Swetalina , Mishra Deepti , Mohanty Ramesh Chandra , Nayak Santosh Kumar , Sahu Rita Kumari , Behera Debashree Debadatta , Nayak Bijaya Bijeta
Published: October 2023

Urban development and clean energy are two crucial components of sustainable development. Cities around the world are facing increasing pressure to reduce their carbon footprint and ensure that they are equipped to meet the energy needs of their growing populations. The use of clean energy for urban development has become an important topic of discussion as it presents a unique opportunity to address both of these challenges simultaneously. The present paper focuses on various aspects such as the benefits for transition to adopt clean energy, developing a framework for adoption of clean energy products for urban areas, possible clean energy products and to understand the satisfaction level of the consumers using the clean energy products in the urban areas of Bhubaneswar, Odisha.
Challenges and problems faced to Quality Control in Cast-In-Place Bored Piling by Rotary Bored Machine at Lalitpur, NEPAL
Authors: Sah Dhiraj Kumar , Bishnoi Surender , Singh Prakash , Serawat Arun , Sharma Prashant
Published: October 2023

In a construction project of G+19 Hotel & Residence, there have been parking problem due to lack of sufficient land. So to minimize these problem double basement have been designed for parking floor. The basement excavation is not easy to excavate without proper protection work for retaining deep excavations. Soil at its natural form, in a construction site is not suitable to completely bear heavy surcharge loads. For such situations, the soil stability needs to be improved to enhance its strengthen capacity and decrease the expected landslide. There are some techniques for retaining deep excavations for basements which are used at site to take surcharge load during excavation. Depending upon the loading conditions and nature of soil at site, a Cast-In-Place Bored Piling by Rotary Bored Machine technique have been adopted. This paper gives the overview and concept of Cast-In-Place Bored Piling by Rotary Bored Machine, discusses their practical applications and problems faced to Quality Control.
Heat Transfer Analysis using Finite Element Method under Convective Boundary Condition
Authors: Gonsalvesa Sheetal , G. Swapnaa
Published: October 2023

The model in this study scrutinizes the effect of convective boundary conditions on the flow of a nanofluid across permeable flat plate. The fundamental equations get altered into a nonlinear form through choosing appropriate similarity transformations. In the process, they are solved mathematically by substantiated FEM code through use of variational finite element method. The outcomes clearly show the characteristics of relevant parameters such as temperature and velocity profiles. When the numerical analysis is evaluated in context of formerly published information, the reliability of the numerical code is conformed. Its found that there is a surge in thermal conductivity when proportion of nanoparticles rises in the fluid. Permeability of plate has a significant influence on the heat transfer and skin friction. The investigation supports the possibility of extending the work to flows of non-Newtonian fluid, three dimensional and for consideration of pressure gradients on arbitrary surfaces. The results practically aid the design of heat transfer systems for futuristic technology involving heat enhancement.
Impact design of die parameters on Severe plastic deformation during Equal channel angular pressing: An overview
Authors: Singh Nagendra , Agrawal Manoj Kumar , Verma Sanjeev Kumar , Tiwari Ashish Kumar
Published: October 2023

Equal channel angular pressing causes less uniform deformation than simple shear, even though its not as obvious as with other metal forming procedures. Investigation is done into how internal and external factors affect the deformity inhomogeneity through Equal .channel angular pressing. Finite element analysis of plastic deformity are integrated with die corner angle and the strain harden ability of metallic workpiece. The material characteristics are significantly influenced by the type of plastic shear deformation that occurs through Equal channel angular pressing and this is primarily impacted by the die geometry, the properties of the material and the process factors. Segmenting the workpiece into a front transient zone, end transient zone, outer less sheared zone and the remaining shear deforming zone allowed researchers to examine the uneven strain distribution throughout the workpiece. The deformed geometry for the non-hardening and it was assumed that rate-insensitive materials would be largely homogeneous. In materials that are strain-rate sensitive, gaps between the upper and lower channels developed, whereas strain-hardening materials experienced the corner gap. The strain hardening and implications of strain-rate sensitivity exponent had a considerable impact on the deformation inhomogeneity. Metals having an ultrafine grain microstructure can be created by severe plastic deformation. The FE models were used to affect the process and they all took as inputs the material properties, load variation, Different velocity and boundary conditioned. For the purpose of evaluating the impact of the channel angle on the AA5083 sample, The FE analysis produced the value of strain distribution. When the channel angle was 1200, there was less strain overall, but there was also less concentrated stress in the channel corner area.
Evolution of Optimum Parameters for EDD in Tool Steel
Authors: Saini Surendra Kumar , Khaja Shaik Mohammed
Published: October 2023

Better toughness, abrasion resistance and machining characteristics make tool steel suitable material for dies and tools. Electrical discharge drilling is thermal energy based spark machining process. In this process metal removes from the work along circumference of hole to be cut is due to spark phenomena. In present study circular cutting on steel is performed with wire electric discharge machine using design of experiment approach. Four design variables pulse on & off time, wire feed and current have taken while material removal rate considered as quality parameters. Total nine experiments conducted on work material using orthogonal array. Taguchi technique is used to identify the significant process parameter on quality parameter.
The solution to the Profit maximization transportation problem using new transportation algorithm
Authors: Gonsalves Sheetal , Wangde Ismail , D’Cunhaa Shilpa Brownil
Published: October 2023

Any engineering system requires engineers to make numerous managerial and technological decisions during the design, building, and maintenance phases. All such decisions aim to either maximize the desired benefit or minimize the amount of effort needed. There is no solitary approach that can effectively address all optimization problems. As a result, number of optimization techniques have been created to address various optimization problems. Transportation problem (TP) formulation is the most significant programing applications in optimization which is attached to everyday life and used in industries under logistics. This study proposed a new algorithm to obtain a basic feasible solution (BFS) for the maximization TP. The approach outlined in this study yields an initial solution that is close to or optimal in most scenarios. A variety of numerical examples are used to demonstrate the new technique. The proposed technique is effective for analyzing balanced or unbalanced transportation problems with maximization objective function.
Optimisation process parameters for Multipass GTAW dissimilar materials of SS316L to INCONEL625
Authors: Tirumala Mani Kumar , Gajana Manohar , Pathipati Yogeswar , Gongati Tharun , Bhanu Prakash Somisetty , Vemanaboina Harinadh
Published: October 2023

This study aims to learn how welds' bead width and tensile strength have changed throughout time. The research welded the multipass dissimilar of nickel-based superalloy Inconel 625 and stainless steel 316L using CCGTAW and ERNiCrMo-3. This experimental cycle made use of the L9 orthogonal array. Analysis of Variance (ANOVA) is used to zero in on and identify the most critical variables. Weld quality is evaluated throughout production using a non-destructive method. Weld quality and tensile strength were tested in Universal testing Machine X-Ray Radiography. Welding current and root gap were shown to be significant factors.
Effect of High Speed Machining on Surface Roughness Characteristics Ra, Rq, RZ
Authors: Khare Sanchit Kumar , Gulati Piyush , Singh Jaiinder Preet , Phull G.S.
Published: October 2023

Today’s machining industries experience a variety of challenges, but achieving high quality in terms of dimensional accuracy, surface quality, and production rate is their key concern. An effort has been made in the current study to investigate the impact of HSM process parameters on different Surface Roughness characteristics Ra, Rq, and Rz. The trials were conducted on Ti-6Al-4V, a material that finds extensive use in the automotive, aerospace, and biomedical industries. Depth of cut, feed rate, cutting speed, and step over were taken into account as HSM inputs for the experiment. Similar to this, the output characteristics Surface roughness parameters Ra, Rq, and Rz were used. The trials were carried out using Taguchi’s standard L9 Orthogonal Array, and the optimization of multi responses was carried out using Grey analysis. The most significant influences on the parameters of surface roughness were found to be cutting speed and depth of cut. A confirmation experiment was performed using the ideal set of parameters to validate the study, and the results were found to be in good agreement with those of the experiment. According to the findings, the HSM method produced a superior surface quality.
Theoretical Study on Weibel instability in the existence of large amplitude Langmuir wave inside a Plasma
Authors: Kumar Amit , Dhawan Rajat , Gupta Ruby , Sabharwal Namita , Sharma Jyotsna
Published: October 2023

This paper investigates how an electrostatic Langmuir wave having large amplitude affects the Weibel instability (WI) in the existence of ions and an electron beam. Two Langmuir side band waves are produced by coupling of EM perturbation to the Langmuir wave. The Langmuir wave (LW) increases the growth rate beyond its linear value. Here, we noticed that the growth rate Γ(sec−1) scales linearly with the electron beam velocity vbe and 1/2 power of the electron beam density nbe. As we increase the density of ions inside the plasma, the growth rate stabilizes. Additionally, we find that the growth rate is very sensitive to the plasma frequency of ions. Therefore, our work finds an application in space, galactic cosmic rays and supernovas. Also, our work covers a range of application from the development of fusion power to understand the various astrophysical phenomena.
Analysis of Non-Pneumatic Tyre
Authors: Shivakumar Patthi , Gupta G. Srinivasa
Published: October 2023

Mostly pneumatic tyres are used for fast moving vehicle and solid tyres are used in less load carrying slow moving vehicle. Conventional tyres are manufactured using materials like rubber, EVA plastic, etc. Based on the load carrying components of the frame body the number of tyres and the material of the tyre is decided for motion possibility and stability of the body. In this project we are going to analyze the non-pneumatic wheelchair tyre. The strength variation is analyzed by comparing existing tyre and non-pneumatic tyre pattern. And comparison is done for modification of existing design for improving properties like strength and durability.
Deep learning system for assessing diabetic retinopathy prevalence and risk level estimation
Authors: Biswas Ankur , Banik Rita
Published: October 2023

Diabetic retinopathy, one of the foremost problems brought on by Diabetes Mellitus has seen an exponential rise in incidence due to the exponential growth of diabetics worldwide and causes visual issues and sightlessness owing to deformity of individual retina. An early detection and diagnosis are necessary to stop DR from progressing into severe stages and to stop blindness for which regular screening of eye is mandatory. To do this, several machine learning (ML) models are available. However, when used with bigger datasets, classical ML models either need more training time and have less generalisation in feature extraction and classification than when used with smaller data volumes. As a result, Deep Learning (DL), a newer ML paradigm that can manage a relatively small data volume with aid of effective data processing methods is presented. They do, still, often use bigger data in the deep network structure to improve feature extraction and picture classification performance. This study presents a CNN model for DR classification and compares with other variants of pre-trained DL models for initial recognition of DR through binary and multi-class classification. The attained result of 97% accuracy reveals that pre-trained ResNet model’s efficacy is better in diagnosing DR.
Bearing capacity mapping of Morang district for shallow foundation
Authors: Deo Ujjwal , Singh Prakash , Bishnoi Surender , Kumar Ranjan
Published: October 2023

Foundation is the part of all structure, which helps transmit the all the loads from above structure to the ground. The bearing capacity value mainly affected by two major factors, they are type of soil and also the location where the stratum. Due to various reasons such as; Economy, miser, unconsciousness etc, people don’t conduct soil test in many cases and starts to build high rise buildings in different locations. From the prevention of collapse and settlement of building bearing capacity of soil should be checked. Zonation mapping of bearing capacity is inevitable in many cases of newer and expansion storey construction. In many countries, zoning mapping of bearing capacity has been available for crowd or urbanized cities. In case of Nepal, there are absences of such zoning maps. The thesis report tries to fill such gap present in Nepal. Different bearing capacity has been found using different tests; SPT Value, Terzaghi, and among them least of the resulted value of bearing capacity is used for Zonation mapping of Morang district of Nepal. These targets are achieved by various data and tests conducted in the soil investigation with boring logs and SPT N value from 239 different locations and terrain around Morang District of Nepal. The methods initially adopted are collecting, selecting, grouping and plotting the data Location in Morang District map using GIS. Various analytical, experimental and theoretical approaches also used for the estimating and analyzing bearing capacity of soil. The research shows that the bearing capacity of soil of Morang ranges from 50kPa to 628kPa.
Roller Pump Induced Tubing Wear: Another Argument in Favor of Arterial Line Filtration
Authors: Kurusz M. , Christman E. W. , Williams E. H. , Tyers G. F. O.
Published: October 2023

Pump head tubing was studied to determine if internal wear occurred during routine cardiopulmonary bypass. Several segments of silicone rubber tubing were examined in a scanning electron microscope following clinical perfusion. In each case, the proper degree of occlusion had been set just prior to beginning bypass. The roller pump was a six-inch dual roller type, and the tubing was 3/8 inch ID with 3/32 inch wall thickness. Blood flow rates ranged from 3.8 to 5.2 liters per minute, and duration of the pump runs ranged from 35 to 220 minutes. Evidence of tubing wear on the lumenal surfaces was observed and was related to time and flow rates. Two grooves opposite one another and corresponding to the location of maximum flexure were present in every sample examined. Alterations in the tubing surface were seen in the areas adjacent to the grooves. Craters ranging from <10 µm to >50 µm along with some degree of smoothing of the normal surface texture were seen. Presumably, some spallation had occurred, and particles had been pumped downstream. Use of an arterial line filter with this type of tubing is recommended.
Weight Gain and Cardiopulmonary Bypass
Authors: Vertrees Roger A. , Stark Maryann , Auvil Jackson , Rohrer Charlene , Rousou John H. , Engelman Richard M.
Published: October 2023

Seventy-two consecutive patients undergoing coronary revascularization were divided initially into three groups consisting of those with perfusion time less than or equal to 90 minutes (Group I), those with perfusion time between 90 and 150 minutes (Group II), and those with perfusion time 150 minutes or longer (Group III). The patients having the longest perfusion displayed, as anticipated, the highest weight gain of 4.4 ± 0.6 Kg following cardiopulmonary bypass in contrast to 2.6 ± 0.3 Kg in Group II and 2.1 ± 0.3 Kg in Group I (p < 0.05). This corresponds to a linear progression with increasing weight gain proportional to increasing perfusion time (0.02-0.03 Kg/min of bypass).

These same 72 patients were then divided into two groups: Group A having weight gain less than 2.0 Kg and Group B with weight gain of 2.0 or more Kg. Group B showed a significant reduction of 39% in the serum protein level and 28% in serum albumin as compared to the control level. This is significantly different from the 28% reduction in total serum protein and 17% reduction in serum albumin as was noted in Group A, having the shorter bypass interval (p < 0.05). Thus, while the duration of perfusion is primarily responsible for fluid accumulation and weight gain, the low serum protein may serve to accentuate edema formation. Hemodilution and nonpulsatile flow are factors promoting tissue edema during cardiopulmonary bypass.
Research on highly dynamic 3D measurement method based on RGB color fringe projection
Authors: Fu Ling , Gao Dingshan
Published: October 2023

Metal parts with highly dynamic areas often appear in industrial production measurements. However, if the traditional fringe projection technique is used to project fringe onto the surface of these metal parts, the light energy will be excessively concentrated and the image will be saturated, resulting thus in the loss of fringe information. To effectively address the high reflectivity problem of the object under test in fringe projection, background normalized Fourier transform contouring was combined with adaptive fringe projection in this work and a new method for performing highly dynamic 3D measurements was proposed. To reduce the number of the acquired images by the camera, a monochromatic fringe of different frequencies was put into the RGB channel to make color composite fringe, and then a color camera was used to acquire the deformed color composite fringe map. The images acquired by the color camera were then separated into three channels to obtain three deformed stripe maps. The crosstalk was also removed from these three images, and the 3D shape of the object was reconstructed by carrying out Fourier transform contouring with background normalization. From our experiments, it was demonstrated that the root mean square error of the proposed method can reach 0.191 mm, whereas, unlike the traditional methods, the developed method requires four images.
Abortion in the First Trimester. Guideline of the DGGG (S2k-Level, AWMF Registry No. 015-094, December 2022) – Part 2 with Recommendations for Surgical Termination of
Pregnancy and Follow-up Care After Termination of Pregnancy
Authors: David Matthias , Achtenhagen Anne , Bamberg Christian , Bormann Cornelia , Felderhoff-Müser Ursula , Groth Sylvia , Hänel Kristina , König Klaus , Korell Matthias , Michl Susanne , Redler Silke , Schleußner Ekkehard , Seyler Helga , Wallwiener Markus , Wallwiener Stephanie
Published: October 2023

Purpose The aim was to develop evidence-based recommendations where possible. The guideline presents the medical principles and scientific evidence for indications, counselling of
affected persons, performing terminations, the choice of method, and the care and monitoring of a terminated pregnancy up until week 12 + 0 of gestation p. c.

Methods In accordance with the requirements for an S2k-guideline, the contents of the guideline were drafted following a systematic search of the literature by a representative
interdisciplinary group of experts. Guideline authors held several formal meetings under the auspices of the German Society for Gynaecology and Obstetrics (DGGG) during which the contents of
the guideline were finalised and agreed upon.

Recommendations The guideline provides recommendations on the surgical termination of pregnancy and follow-up care after termination of pregnancy.
Die Rechtsfrage: Warum erhalten Klient*innen keine neue Verordnung?
Authors: Schlegel Thomas
Published: October 2023

„Bei einem langfristigen Heilmittelbedarf oder besonderen Verordnungsbedarf wird das Budget von Ärzt*innen meines Wissens nach nicht belastet. In der Praxis komme ich jedoch häufig in die Situation, dass sie keine weiteren Verordnungen ausstellen, weil sie damit ihr Budget überschreiten würden. In welchen Fällen können Ärzt*innen tatsächlich keine weiteren Verordnungen ausstellen?”

Therapeutin aus Niedersachsen
Fall für Drei – Dem Delir begegnen
Authors: Gätz Natalie , Alecu Jeni , von Ritter Renate , Holzhäuser Kathrin
Published: October 2023

Ein Klient kommt aufgrund von Rückenschmerzen und einem Infekt in die Akutgeriatrie. Bald entwickelt sich zusätzlich ein Delir, was die gesundheitliche Krise verschärft. Der Artikel gibt einen Einblick in die interdisziplinäre Arbeit von Medizin, Demenzbeauftragter und Ergotherapie.
Teilhabe nicht vergessen! – Langzeittherapie bei Morbus Parkinson
Authors: Orellana Amy
Published: October 2023

Ambulant tätige Ergotherapeut*innen arbeiten immer wieder mit Klient*innen, die schon seit Jahren in die Therapie kommen. Amy Orellana gibt Anregungen, wie man die Betätigung und Teilhabe bei Menschen mit Morbus Parkinson auch bei langfristigem Heilmittelbedarf ins Zentrum der Therapie stellen kann.
Kontrastverstärkte Sonografie (CEUS) zur Diagnostik fokaler Leberläsionen
Authors: Kallenbach Michael , Qvartskhava Natalia , Weigel Christian , Dörffel Yvonne , Berger Jens , Kunze Georg , Luedde Tom
Published: October 2023

Aufgrund des Trends zum vermehrten Einsatz der Bildgebung und der steigenden Awareness bei Risikopatienten werden gastroenterologisch und hepatologisch tätige Ärztinnen und Ärzte häufiger mit Patienten mit unklaren Leberläsionen konfrontiert. In der Differenzierung dieser Raumforderungen hielten CT und MRT im klinischen Alltag zunehmend Einzug in primäre Diagnostikschritte. Die kontrastverstärkte Sonografie stellt demgegenüber ein sehr effektives und kosteneffizientes Verfahren zur Beurteilung fokaler Leberläsionen dar. Der Erfolg der Methode beruht nicht nur auf der Darstellung der Mikrovaskularisation in Echtzeit. Wird die Sonografie vom Behandelnden selbst durchgeführt, kann dieser die genaue Kenntnis der Anamnese und der klinischen Befunde nutzen, um den Untersuchungsablauf gezielt anzupassen und den sonographischen Befund mit größerer Treffsicherheit zu interpretieren („klinische Sonografie“). Gleichzeitig versetzt die Methode den Behandelnden in die Lage, Diagnostik und Therapieentscheidung in den eigenen Händen zusammenzuführen. Exzellente Ergebnisse erzielt die kontrastverstärkte Sonografie – wie alle anderen bildgebenden Verfahren auch – nur bei ausreichender Qualifikation des Untersuchenden.

Dieser Beitrag stellt die sonographischen Charakteristika der häufigsten Leberläsionen übersichtlich dar und zeigt deren Kontrastierungsmuster anschaulich anhand von Videos (via QR-Code abrufbar). Der Artikel verdeutlicht, dass die KM-Sonografie aus hepatologischer Sicht in Zukunft einen noch größeren Stellenwert haben könnte und aus Sicht der Autoren haben sollte.
Schwerelos – Steh- und Bewegungshilfe „Standing Ovation“
Authors: Frank Petra
Published: October 2023

Stehen oder gehen und gleichzeitig die Hände frei haben, um zu arbeiten oder zu kochen: Für Menschen, die auf einen Rollstuhl oder auf Unterarmstützen angewiesen sind, ist das oft schwer möglich. Als Peter Lammer nach einem Unfall in dieser Situation war, erfand er kurzerhand die Steh- und Bewegungshilfe Standing Ovation, um weiter als Koch arbeiten zu können.
Exercise and Atrial Fibrillation: The Dose Makes the Poison? A
Narrative Review
Authors: Zacher Jonas , Filipovic Karlo , Predel Georg , Schmidt Thomas
Published: October 2023

“All things are poison, and nothing is without poison; the dosage alone
makes it so a thing is not a poison” (Paracelsus, ~ 1538 AD).
This well-known quote seems to aptly summarize the current understanding of the
interaction between exercise and atrial fibrillation (AF). A host of data
strongly suggests that regular exercise has a protective effect against
developing AF. A small but well-conducted group of trials also demonstrates
beneficial effects of exercise in the treatment of AF. Recently, however,
potentially detrimental effects of large volumes of high-intensity exercise on
the probability of developing AF have moved into the sports-cardiological focus.
This effect is well documented for elite athletes; data regarding the general
population is less clear. This review presents the current data regarding the
protective, therapeutic and potentially risk-enhancing effects of exercise
regarding AF. The authors demonstrate that the benefits are clear and strongly
outweigh the potential disadvantages.
Achieving Correct Balance in Total Knee Arthroplasty with Fixed Varus Deformity
Authors: Sarrel Kara , Weinberg Maxwell , Scuderi Giles
Published: October 2023

Varus knee deformity is one of the most common deformities presenting for total knee arthroplasty (TKA). When present, a varus knee deformity contributes to overload of the medial joint compartment during gait, leading to increased medial compartment forces as well as lateral soft tissue lengthening. Additionally, a fixed varus deformity is associated with medial soft tissue contractures of the deep and superficial medial collateral ligament (MCL) and posteromedial capsule. With a fixed varus deformity, soft tissue releases may be necessary to create equivalent and rectangular flexion and extension gaps. There may also be anteromedial tibial bone defects, medial femoral condyle defects, and occasionally flexion contractures, especially in more severe cases. In cases of severe varus deformity with medial tibial bone loss, bone defects must be addressed to ensure adequate implant support. In many cases, a primary knee implant can be utilized in cases of varus knee deformity, but occasionally prostheses with higher levels of constraint may be required to balance and stabilize the knee. TKA has had a successful track record, with high levels of long-term implant survivorship even in cases of severe varus. Iatrogenic MCL instability and tibial aseptic loosening are complications associated with TKA in cases of severe varus, and multiple methods to avoid complications are presented here.
Anatomic Referencing Restores the Anatomy of the Distal Femur with Less Compromise
Authors: Knapp Paul W. , Scuderi Giles R.
Published: October 2023

Historically, anterior referencing and posterior referencing are two specific techniques that surgeons can use for proper sizing of the femoral component in total knee arthroplasty (TKA). In this review, we introduce the concept of “anatomic referencing” which has become useful with more incremental sizes of the femoral component to more perfectly match the native anatomy of each patient and reduce overstuffing of the patellofemoral joint and medial-lateral (ML) overhang. Fifty consecutive TKA cases were reviewed where the novel anatomic referencing technique was used. Lateral radiographic projections were obtained preoperatively and postoperatively. The posterior condylar offset (PCO) was evaluated on the lateral radiographs by measuring the distance between the tangent line of the femoral diaphysis posterior cortex and the posterior condylar margin. PCO ratio (PCOR) was calculated by dividing the PCO by the distance between the posterior condylar border and a tangent line along the anterior cortex of the femoral diaphysis. Forty-five patients (50 TKAs) were reviewed. Average age of the patients was 70.34, range: 47–91. There were 19 males and 26 females reviewed in this series. On average, the delta PCOR was 0.022 (standard deviation = 0.032; min: –0.049, max: 0.082). When grouping our results into three main groups: < –0.03, –0.03 to 0.03, and > 0.03, we found that 62% fell within the –0.03 to 0.03 range. There was no statistically significant difference in delta PCOR between standard and narrow implants (p = 0.418). The proposed novel anatomic referencing technique has allowed for proper sizing of patients' femurs in the anteroposterior and ML direction while avoiding component overhang or the need for component downsizing to obtain a proper ML fit. This radiographic review confirmed this to be a highly accurate and reproducible technique.
Examination of Diels–Alder/Tsuji–Trost Route towards Kopsia Alkaloids
Authors: Mikhaylov Andrey A. , Zhigileva Ekaterina A. , Molchanova Marina V. , Solyev Pavel N. , Korlyukov Alexander A. , Baranov Mikhail S.
Published: October 2023

A reaction sequence of Diels–Alder cycloaddition and Tsuji–Trost allylation was examined in terms of its application to the synthesis of kopsinine and the related Kopsia alkaloids. Results of the studies in two synthetic directions are presented herein: 1) synthesis of the properly substituted diene, required for the Diels–Alder step; and 2) model studies and optimization of the key reaction sequence in the absence of side-chain. Details on the challenging introduction of the side-chain into tetrahydrocarboline ketone and its silylation, resulting in rare but unproductive vinylogous Claisen cyclization, and the successful Mannich/Mukaiyama aldol sequence are disclosed in the first direction. In the second direction, the endo-selective Diels–Alder reaction with allyl acrylate and Tsuji–Trost allylation providing incorrect stereochemistry are disclosed. Interaction of both dienes with an alkyne provides carbazoles via Alder–Rickert reaction.
Identifying and Addressing Barriers to Implementing Core Electronic Health Record Use Metrics for Ambulatory Care: Virtual Consensus Conference Proceedings
Authors: Levy Deborah R. , Moy Amanda J. , Apathy Nate , Adler-Milstein Julia , Rotenstein Lisa , Nath Bidisha , Rosenbloom S. Trent , Kannampallil Thomas , Mishuris Rebecca G. , Alexanian Aram , Sieja Amber , Hribar Michelle R. , Patel Jigar S. , Sinsky Christine A. , Melnick Edward R.
Published: October 2023

Precise, reliable, valid metrics that are cost-effective and require reasonable implementation time and effort are needed to drive electronic health record (EHR) improvements and decrease EHR burden. Differences exist between research and vendor definitions of metrics.

Process We convened three stakeholder groups (health system informatics leaders, EHR vendor representatives, and researchers) in a virtual workshop series to achieve consensus on barriers, solutions, and next steps to implementing the core EHR use metrics in ambulatory care.

Conclusion Actionable solutions identified to address core categories of EHR metric implementation challenges include: (1) maintaining broad stakeholder engagement, (2) reaching agreement on standardized measure definitions across vendors, (3) integrating clinician perspectives, and (4) addressing cognitive and EHR burden. Building upon the momentum of this workshop's outputs offers promise for overcoming barriers to implementing EHR use metrics.
Educational Status of Minimally Invasive Spine Surgery
Authors: Pereira Bernardo de Andrada , Garg Kanwaljeet , Mamaril-Davis James , Chaurasia Bipin , Guiroy Alfredo , Asghar Jahangir , Turner Jay D. , Hurlbert R. John
Published: October 2023

Introduction The objective of this study was to understand how spine surgeons learn minimally invasive spine surgery (MISS) and how the COVID-19 pandemic impacted the educational experience of MISS. Potential solutions for increasing the spine surgeon's access to MISS educational resources were also discussed.

Methods An internet survey was distributed to neurosurgical and orthopedic spine surgeons across multiple online platforms from April to June 2021, asking specific questions about education and training for MISS. Online survey tools were used to contact spine surgeons in the five geographical continents.

Results A total of 303 spine surgeons responded to the survey: 272 (89.7%) neurosurgeons and 31 (10.3%) orthopedic surgeons. The six countries with the greatest number of participants were: Argentina (n = 70; 23.1%), India (n = 47; 15.5%), Brazil (n = 34; 11.2%), Pakistan (n = 10; 3.3%), Mexico (n = 9; 3.0%), and Chile (n = 8; 2.6%).

Conclusion Most spine surgeons were able to attend virtual learning events during the pandemic, but cadaveric study was still considered the gold standard for learning MISS. Multidisciplinary effort is needed to develop structured curriculums for teaching MISS that include a variety of educational tools such as cadaver laboratory, guidance from experienced surgeons, and virtual demonstrations.
Unusual Breast Malignancies—Going A Step Ahead of Breast Imaging Reporting and Data System
Authors: Arora Jyoti , Gauba Richa
Published: October 2023

With the advent of the Breast Imaging Reporting and Data System (BIRADS), the categorization of the entire gamut of breast lesions has been simplified. However, there are many unusual breast lesions, both benign and malignant, which cannot be categorized accurately using the BIRADS descriptors due to the overlap of features. Carcinomas such as medullary, papillary, and mucinous (colloid) types, may be difficult to recognize as malignant because they may have relatively benign-appearing morphologic features. Well-circumscribed, small, and hyperechoic lesions may not be benign in all cases, and the presence of any microlobulations in margin, vascularity, heterogeneity, round shape, or interval change in size or appearance should raise suspicion of a sinister etiology. Therefore, it is important to be aware of the imaging features of such malignancies so that any mismanagement or undue delay in the diagnosis of any sinister etiology can be avoided.
Outcomes of Injection Laryngoplasty for Deep Interarytenoid Groove
Authors: Mothersole Kelsey H. , Ulualp Seckin O. , Johnson Romaine F. , Brown Ashley F. , Shah Gopi B. , Liu Christopher C. , Chorney Stephen R.
Published: October 2023

Introduction Deep interarytenoid groove (DIG) may cause swallowing dysfunction in children; however, the management of DIG has not been established.

Objective We evaluated the subjective and objective outcomes of interarytenoid augmentation with injection in children with DIG.

Methods Consecutive children under 18 years of age who underwent injection laryngoplasty for DIG were reviewed. Data pertaining to demographics, past medical history, past surgical history, and results of pre and postoperative video fluoroscopic swallow study (VFSS) were obtained. The primary outcome measure was the presence of thin liquid aspiration or penetration on postoperative VFSS. The secondary outcome measure was caregiver-reported improvement of symptoms.

Results Twenty-seven patients had VFSS before and after interarytenoid augmentation with injection (IA). Twenty (70%) had thin liquid penetration and 12 (44%) had thin liquid aspiration before the IA. Thin liquid aspiration resolved in 9 children (45%) and persisted in 11 (55%). Of the 12 children who had thin liquid aspiration prior to IA, 6 (50%) had resolution of thin liquid aspiration after IA.

Conclusions Injection laryngoplasty is a safe tool to improve swallowing function in children with DIG. Further studies are needed to assess the long-term outcomes of IA and identify predictors of successful IA in children with DIG.
Knowledge of and Attitudes Toward Hearing Loss Among Primary Care Physicians in the Public Health Sector of Mauritius
Authors: Foondun Taslima , Pottas Lidia , Soer Maggi
Published: October 2023

Introduction Primary care physicians are essential first points of contact for patients with hearing loss. Thus, knowledge of hearing loss and related aspects is essential to ensure the optimal management of individuals with suspected hearing loss.

Objective This study aimed to determine the knowledge of and attitudes toward hearing loss among primary care physicians in the public health sector in Mauritius.

Methods In this cross-sectional descriptive cohort study, 320 primary care physicians completed an online questionnaire adapted from previous questionnaires on knowledge of and attitudes toward hearing loss. Responses were analyzed using descriptive statistics and cross-sectional analyses.

Results Primary care physicians showed limited knowledge of hearing loss in areas such as early identification and intervention, professionals responsible for hearing assessments, and hearing tests used for assessing hearing sensitivity. However, the responses also showed positive attitudes toward hearing loss. Significant associations between knowledge of and attitudes toward hearing loss were obtained regarding the type of physician, length of practice, and department posted in. Ear, nose, and throat specialists, as well as pediatricians, demonstrated significantly higher scores for both knowledge of and positive attitudes toward hearing loss.

Conclusions The findings highlight a strong need for ongoing medical education to spread awareness about hearing loss among primary care physicians in the public health sector of Mauritius.
Spring-Assisted Cranial Expansion for Multisuture Craniosynostosis: First Case Report from the Indian Subcontinent
Authors: Gujjalanavar Rajendra S. , Doddamani Rajalaxmi , Deraje Vybhav , Gopal Swaroop
Published: October 2023

We present a first use case report from the Indian subcontinent of a 5-month-old child with multisuture craniosynostosis with raised intracranial pressure managed by spring-assisted cranial expansion followed by traditional fronto-orbital advancement and cranial vault remodeling. We emphasize the advantages of spring-assisted cranial expansion in extremely young infants with raised intracranial pressure over posterior vault distraction osteogenesis and open posterior vault remodeling.
Prognostic Neuroimaging Biomarkers in Acute Vascular Brain Injury and Traumatic Brain Injury
Authors: Krawchuk Lindsey J. , Sharrock Matthew F.
Published: October 2023

Prognostic imaging biomarkers after acute brain injury inform treatment decisions, track the progression of intracranial injury, and can be used in shared decision-making processes with families. Herein, key established biomarkers and prognostic scoring systems are surveyed in the literature, and their applications in clinical practice and clinical trials are discussed. Biomarkers in acute ischemic stroke include computed tomography (CT) hypodensity scoring, diffusion-weighted lesion volume, and core infarct size on perfusion imaging. Intracerebral hemorrhage biomarkers include hemorrhage volume, expansion, and location. Aneurysmal subarachnoid biomarkers include hemorrhage grading, presence of diffusion-restricting lesions, and acute hydrocephalus. Traumatic brain injury CT scoring systems, contusion expansion, and diffuse axonal injury grading are reviewed. Emerging biomarkers including white matter disease scoring, diffusion tensor imaging, and the automated calculation of scoring systems and volumetrics are discussed.
Does local democratization improve societal outcomes? Effects of mayoral direct elections in Indonesia
Authors: Lurusati Yasmin , Torenvlied René
Published: October 2023

Local democratization aims to improve the decentralized capacity of governance regimes to generate meaningful municipal spending geared towards realizing societal outcomes. In the late 1990s, following the Asian financial crisis, Indonesia initiated a significant institutional transition from centralistic and authoritarian rule towards decentralized and more democratic governance through the introduction of direct mayoral elections. Extant research analyzed the effects of the introduction of these elections on local public spending and local societal outcomes separately. This paper offers an integrated analysis of the impact of the introduction of direct mayoral elections on both local public spending and local societal outcomes in 456 Indonesian municipalities between 2002 and 2012. Analyses of growth models, using panel data on three domains (education, health, and infrastructure) provided by Indonesian Ministry of Finance, Indonesian Ministry of Home Affairs, and Statistics Indonesia, show that the introduction of direct mayoral elections in Indonesia resulted in an increased growth in educational expenditures. It also improved outcomes in health and infrastructure domains. However, the introduction of direct mayoral elections reversed a positive association between public spending and the attainment of societal outcomes or worsened a negative association between them. These results would support a view on local democratization in Indonesia asserting that the introduction of direct mayoral elections stimulated local clientelist practices rather than local accountability and policy responsiveness.
Ways to bring private investment to the tourism industry for green growth
Authors: Gong Fengxiao , Chen Hui
Published: October 2023

Green economic growth is a crucial subject in environmental economics over the last half-century, emphasizing the need for different economic sectors to adapt their activities based on environmental concerns. This research explores the impacts of green growth, inflation rate, economic uncertainty, green finance, and financial development on the composite indicator of sustainable tourism in 10 ASEAN economies from 2000 to 2021, utilizing the PMG (Pooled Mean Group) technique. The findings reveal that, in the short run, financial development and green finance have insignificant coefficients, while green growth exhibits the most substantial positive coefficient. Economic uncertainty and inflation rate negatively affect sustainable tourism. In the long term, green financing has the most profound impact on sustainable tourism development, along with green growth and deepening financial markets, which accelerate sustainable tourism. Conversely, economic uncertainty and inflation rate have adverse effects on the green tourism industry. Primary practical policies to promote sustainable tourism include providing a comprehensive financial policy package, developing ICT-based tourism services, establishing an early warning system, and leveraging blockchain technology and cryptocurrency in green investments, enabling governments and stakeholders to foster sustainable tourism practices and advance environmental sustainability within the ASEAN region.
Framing influence of emotions and attitudes towards Alzheimer’s disease on Slovak and Spanish laypersons: a cross-cultural approach
Authors: Cuadrado Fátima , Lackova Lucia , Mikulajová Marina , Antolí Adoración , Boleková Veronika , Gellen Michal , Vacas Julia
Published: October 2023

Representations about Alzheimer’s disease (AD) influence both emotions and attitudes towards this dementia. This study aimed to explore how the AD framing used in awareness campaigns influences self-reported emotions and attitudes towards AD, and whether this influence differs between Slovak and Spanish cultures. For this purpose, posters including framed messages on AD (Dualism, Unity, and control) were designed and presented to 275 participants (Mage = 21.23 years, SDage = 5.13, 81.1% females) from Slovakia (n = 134) and Spain (n = 141). To analyse the framing effect, attitudes towards AD were measured twice (before and after the posters display) and a mixed design of repeated measures ANOVA was used to compare both measures. The emotions elicited by the stimulus exposure were also recorded and a MANOVA test was performed on them. Elicited emotions and attitude change were compared in both Slovak and Spanish samples. Results showed that Slovak participants displayed positive attitudes towards AD, but to a lesser extent compared with the Spanish ones. Unity-framed messages resulted in a positive change in attitudes regardless of the participants’ culture and led to a higher degree of happiness, whereas Dualism-framed messages produced more negative emotions (i.e., sadness, anger, fear, and disgust) and had a major impact on participants without changing their attitudes. Using positive frames as Unity seems to be relevant to achieve a positive attitudinal change in both targeted cultures (Slovak and Spanish), even though the Slovak participants initially presented fewer positive attitudes at the beginning. In conclusion, reframing should be considered as a worldwide tool to help improve attitudes towards AD and reduce the stigma associated with this form of dementia in the general population, regardless the culture’s audience.
A whole learning process-oriented formative assessment framework to cultivate complex skills
Authors: Xu Xianlong , Shen Wangqi , Islam A.Y.M. Atiquil , Zhou Yang
Published: October 2023

In the 21st century, cultivating complex skills has become an urgent educational need, especially in vocational training and learning. The widespread lack of formative assessment during complex problem-solving and skill-learning processes limits students’ self-perception of their weakness and teachers’ effective monitoring of students’ mastery of complex skills in class. To investigate methods of how to design and carry out formative assessments for the learning of complex skills, a whole learning process-oriented formative assessment framework for complex skills was established. To verify the feasibility and effects of the formative assessment, a controlled experiment involving 35 students majoring in industrial robotics from one of Shanghai’s Technical Institutes was designed. The results indicate that the formative assessment can effectively promote students’ learning of conceptual knowledge and the construction and automation of cognitive schema as well as improve students’ competency in the implementation and transference of complex skills. In addition, the formative assessment, which can optimize the allocation of psychological effort by increasing the proportion of germane cognitive load within the overall cognitive load, does not place an additional cognitive load on students. It can provide methodological support for promoting students’ learning of complex skills.