bluuebunny/crossref_metadata_2025 huggingface dataset:
Importance performance analysis for smart city implementation in Surabaya, Indonesia
Authors: Felasari S , Roychansyah M S
Published: October 2019

This paper presents a study to measure the implementation of smart city initiatives in Indonesia that has been applied by the city government in various city scales. Various benefits are believed to be gained by applying a smart city concept that emphasizes on the use of information and communication technology. However it depends on the readiness of the city government and its citizens in implementing the smart city concept. Importance Performance Analysis is used to measure the differences between public perception and the real conditions of the smart city implementation. Surabaya city, which was granted as one of the five winners of smart city awards in Indonesia for big city category, is used as a case study. The implementation of smart city’s attributes is compared with the expectation of the citizens. The result of the research shows that the concept of smart city,which is used and implemented by the city government in providing services for its society is not always understood similarly to the societies’ point of view. Involving the community in determining the priority of which attributes and dimensions of smartness in the provision of public services is very important to improve the level of implementation of smart city.
Analysis of spatial parameter formulation in the effect of Green House Gas (GHG) emissions on food security in Surabaya
Authors: Kurniawati U F , Idajati H
Published: October 2019

Surabaya is an urban area that has a population growth rate increasing every year, which is 0.52% in 2010-2013 and increased to 0.55% in 2013-2014. Increasing population growth has an impact on increasing urban food availability. Identification of food availability in Surabaya consists of agriculture and livestock sectors, namely rice production (X1), corn production (X2), cassava production (X3), beef cattle production (X4), dairy cow production (X5), buffalo production (X6), goat production (X7), horse production (X8), and poultry production (X9). Data reduction in sub-districts that have no contribution to the agricultural and livestock sector emissions results in 15 sub-district input data that have a contribution. The spatial regression process. Significance test on the independent variable shows global variables (G), namely rice production (X1), corn production (X2), cassava production (X3), dairy cow production (X5), buffalo production (X6), goat production (X7), and poultry production (X9). While the independent variables that show local variables (L) are beef cattle production (X4) and horse production (X8).
Mapping of triple helix cooperation to develop local economic activation in Kampong Dolly, Surabaya
Authors: Siswanto V K , Sardjito  , Nugroho F E
Published: October 2019

Kampong Dolly was popular back in the days when this district in Surabaya well-known as biggest prostitution area in South East Asia. It was not an easy job to drastically change from prostitute area into tourism destination. This collaboration is very important to do so that the potential of Kampong Dolly can be used as effectively and efficiently as possible in order to improve the welfare of the community. Triple Helix collaboration designed as a capital for developing a Local Economic Activation to support the branding of Dolly Tourism Village, improve community welfare and enhance the competitiveness of the creative industries in Surabaya City to national and international levels. The government uses SMEs scheme to employ ex-prostitute workers, therefore, it need strong commitment and hard work from many stakeholders. SMEs in Kampong Dolly has collaborated with the government, private sector and academics. However, the role of the government and academics still very weak in developing resources and technology. On the other hand, as for the collaboration of the private sector, low investment in terms of technology, which was developed to improve the advantages possessed by SMEs in Dolly Village.
Bureaucratic reform of tourism sector public services in Tana Toraja Regency
Authors: Yusriadi  , Farida U , Bin-Tahir S Z , Misnawati
Published: October 2019

Bureaucratic reform’s goal regarding the tourism is to increase tourist attractiveness by analyzing cultural tourism development efforts from public services. The type of research used is phenomenology. Determination of informants was determined by the snowball method, with data collection techniques carried out by observation, semi-structured interviews, and documentation. This study used 9 informants, 3 domestic tourists, 2 foreign tourists and 4 people from the local government. The data analysis technique used follows an interactive model which includes collection, data condensation, data presentation, and verification/drawing conclusions. The results showed that good service by the regional government of Tana Toraja regency would be directly proportional to the development of tourism objects through the application of information technology as a marketing medium, namely by using online media to be a guide to the progress of the tourism sector. Service quality affects the attractiveness of tourist objects, organizations that manage tourist attractions, and tourists themselves. The success of the bureaucratic reform carried out by the local government of Tana Toraja Regency in the tourism sector regarding public services has a positive impact in increasing the number of tourists.
Development of Self-Propelled Material Handling System
Authors: Walke G A , Rivankar S N , Verlekar S P
Published: October 2019

Material handling system is the vital pillar of manufacturing industries like food, textile, automobile, wood, and other batch type manufacturing system. Research carried out in past shows that material handling accounts for 36% of production cost. A novel material handling system is developed to cut the cost of material transfer and risk of injury. The proposed system consists a mechanism which can self-propel itself and effect the transfer of raw material from one place to another on a shop floor. Since the system is self-propelled, it eliminates external power source in contrast to other material handling systems. The newly developed material handling system utilizes gravitational potential energy of the material loaded on the system to get self-propelled along a straight line. The system returns to original position by retracing the path after unloading the material at the destination. The system not only reduces the energy consumption for material handling but also reduces risk of injury by reducing human interference. It can be used in small and medium size enterprise (SME) to cause improvement in productivity of plant which has limitation on utilization of resources like labour, energy, land and capital.
Study of the lubricating properties of hybrid liquid paraffin with TiO2 and CuO as nano-additives for engine oil application
Authors: Shah Adarsh Kumar , Vineesh K P , Joy M L
Published: October 2019

Mineral based paraffin oil (L14480) lubricant finds it difficult to give optimum characteristics for modern engine application. In this work, possibility of hybrid paraffin oil which consists of paraffin oil (PO) and sesame oil (SESO) in equal proportions to be used for engine oil application is investigated. Properties of hybrid paraffin oil and SAE 20W40 were estimated and compared. Estimation of thermal characteristics of hybrid paraffin oil shows it have comparable properties with SAE 20W40. Low viscosity characteristics of hybrid paraffin oil can be improved by addition of EVA particles. Addition of TiO2 and CuO nanoparticles shows enough improvement in tribological properties of hybrid paraffin oil. Poor oxidative stability of hybrid paraffin oil can be improved by addition of butylated hydroxytoluene (BHT).
Dynamic characteristics analysis of a lead screw by considering the variation in thread parameters
Authors: Syriac Alex S , Chiddarwar Shital S
Published: October 2019

A lead screw is a mechanical transmission device which transforms rotary motion into translational movement. The main elements are screw and nut which establishes connection among them by the means of threads on respective element. It plays a major role in transferring the load between screw and nut during the travel stroke. This paper investigates the behavior of the lead screw, inside the withdrawal part of the circuit breaker of switchgear, by analyzing the mechanical response of the lead screw system. The various thread parameters such as thread pitch, nominal diameter etc. play an important role in force transmission as well as in overall efficiency of the mechanical system. This study is done by creating models of various thread profile such a square thread, acme thread, trapezoidal thread and simulating the results in the finite element analysis software ANSYS Workbench. This paper focuses on the effect of the thread pitch, nominal diameter, helix angle, screw length on the stress state and deformation within the screw. Also, the influence of screw pitch, screw length and screw nominal diameter on the withdrawal part of the circuit breaker’s natural frequency along its whole stroke is carried out using modal analysis.
Powder metallurgy process towards functional gradation of Al-Al2O3 metal ceramic mixture samples
Authors: Nirmalkumar R , Sohgaura Ritwik , Kadoli Ravikiran , Joladarashi Sharnappa
Published: October 2019

Functionally graded materials (FGM) belong to the class of advanced materials whose properties vary along one or more coordinate. In the present study, an attempt has been made to manufacture FGM beams using a powder metallurgy process. The Al and Al2O3 in powder form are mixed to different volume fraction according to the rule of mixture. These samples are ball milled to form a proper blended mixture and to reduce the particle size for 1 hour at 250 rpm with tungsten carbide balls. A cold compacted die made of AISI D2 steel is used for preparing the sample. Different composition of Al and Al2O3 with Al2O3 varying from 0 to 10% is laid in the die using ethanol as the binder. This sample is compressed using hydraulic press with a load varying from 50-70 ton. The compressed sample is removed using a compression moulding machine, then it is sintered to a temperature of 650°C using a muffle furnace to form a smooth graded Al-Al2O3 FGM beam. Various defects such as surface cracks and bending were experienced during the preparation of samples; these defects were overcome by varying the parameters such as loading and sintering temperature.
Influence of vehicle parameters on handling characteristics and its control using torque vectoring
Authors: Mutha Mayuresh , Karanjkar Chinmay , Kadekar Prasad , Nikumb Mandar , Palanivelu Sakthivel
Published: October 2019

Handling characteristics of any vehicle refer to its directional control and stability for given steering input. The vehicle parameters such as mass, mass moment of inertia and location of C.G. play a vital role and decide handling response of vehicle under different scenarios. Safe drive is ensured by vehicle’s responses such as yaw rate, roll rate and vehicle lateral acceleration. This paper presents steady state and transient state simulation of XUV 500 model in accordance with ISO 4138 and ISO 3888 test standards using CarSim-Simulink Co-simulation. Influence of changes in above mentioned parameters on Vehicle response during both tests is investigated. Further, control of power train output using torque vectoring is implemented in both tests and its effect on vehicle response is evaluated. The results show that understeer tendency of the vehicle is reduced in steady state test (Constant radius test: ISO 4138). Critical vehicle responses of yaw rate, roll rate, lateral acceleration and path tracking showed improvement during the DLC manoeuvre (ISO 3888) hence, improving stability at higher lateral accelerations.
Gear loss factor using the load distribution model for varying contact ratio in spur gear drive for improved bending strength
Authors: Ravivarman R , Palaniradja K , Prabhu Sekar R
Published: October 2019

Gear loss factor is one of the imperative parameter in estimating the power loss in a meshing gear pair. This paper demonstrates the prediction of gear loss factor parameter in spur gear drive using the load distribution technique. The aptness of two distinct contact ratios is studied and compared in this paper: Normal Contact Ratio (NCR) and High Contact Ratio (HCR). The described model is studied for gearing strength which is improved through profile modification technique. The ultimate focus is to enhance the gearing strength of the pinion in a spur gear drive by discovering the optimal modification point in the tooth profile with at most balanced stresses in the gear pair considered for the study. Using contact analysis, the stresses developed over the contracting surfaces are predicted through finite element method and it is balanced between the gear and pinion. A gear loss factor is predicted along the path of contact for a complete meshing cycle for this balanced drive. It is uncovered that the methodology utilized encourages significant decrease in the gear loss factor of the HCR pair which is confined with the literature models. The values predicted using the load distribution model shows that the high contact ratio gear drive with increased addendum height has the gear loss factor minimum compared with a normal contact ratio gear drive.
Design Optimization and Loaded Tooth Contact Analysis of Multispeed Gearbox for Low Noise Behaviour
Authors: Mahendran M , Murali V , Baskar N , Srinath V
Published: October 2019

This project aims in the development of Multispeed Gearbox to exhibit low noise behavior during its operation under various load and speed conditions, by optimizing the design parameters with tooth micro-geometry profiles -using Loaded Tooth Contact Analysis (LTCA). Low-noise design is the most important criteria defined by the German customer, for their new 9 -speed gearbox fitted in the high precision tool room CNC Lathes. In loaded condition, gearbox develops noise and vibrations due to the tooth deformations, shaft deflection, internally generated gear tooth loads from non-conjugate meshing action of the gear mesh. Hence selecting the best values during micro-geometry optimization for a multi-speed gearbox becomes complex and needs a unique combination of FEM and analytical tools. LTCA is a very useful optimization tool to study the gear tooth strength evaluations and gear meshing contact characteristics under light and significant loads.
Investigation on Influence of Circumferential Velocity and Lubrication Oil Grades on Scuffing and Thermal Efficiency of Gearbox
Authors: Vaidhyanathan D , Pushparaj A , Mahendran K , Ragunathan V
Published: October 2019

Lubrication oil grades plays major role in reducing the friction to prevent scuffing in gears. Gears transmit power through rolling/sliding contacts between teeth, which must operate reliably for designed life with reduced friction so that there will be minimum wear. Lubrication of tooth contacts, both as a means of minimizing scuffing and as a means of reducing friction due to sliding, is therefore of crucial importance. The circumferential velocity of high speed gearboxes and oil grades plays major role in thermal efficiency of gearboxes. In gearboxes with oil sumps, churning losses contribute for significant portion of the total power loss. Present empirical approaches for examining the churning losses are often limited to certain constraints and operating conditions. Furthermore, they do not provide any information about the oil distribution in the gearbox. In order to overcome these shortcomings, we investigated a steel mill gearbox failure with analytical tools and simulations with the help of renowned software packages and predicted the thermal behavior of the gearbox as function of oil grade and circumferential velocity, also validated later at application.
Real time condition monitoring of hydraulic brake system using naive bayes and bayes net algorithms
Authors: Alamelu Manghai T M , Jegadeeshwaran R , Sakthivel G
Published: October 2019

The vehicles usage is increasing day by day due to the recent, technological development in the automotive field. In a competitive global market in order to survive, the reliability needs to be ensured, through a proper monitoring system. Brake system is one such control component, in which much focus is very much essential. An efficient brake system should provide reliable and effective performance in order to ensure the safety. If it is not properly monitored, it may lead to a serious catastrophic effect such as accidents, brake down, etc. Hence, the brake system needs to be monitored continuously. In this study, an experimental investigation was carried out for monitoring the brake system using vibration signals. An experimental setup which resembles the brake system was fabricated. The vibration signals were acquired under various brake condition such as good and faulty. From the acquired vibration signals, the features were extracted using statistical and histogram feature extraction techniques and feature selection was carried out. The selected features were then classifieds using a Naive Bayes and Bayes Net a classifier. The classification accuracy of all the algorithms were compared for finding the best feature classifier model for monitoring the brake condition.
Milling cutter condition monitoring using machine learning approach
Authors: Patange A D , Jegadeeshwaran R , Dhobale N C
Published: October 2019

The cutting tool condition drives the economy of machining processes in manufacturing industry. The failures in cutting tool are unbearable and affect the drive of machine tool which reduces life. Hence it necessitates reducing power consumption using monitoring cutting tool condition and hence requires an efficient supervision to monitor and predict faults. Simply stated, the condition which curtails cutting tool life highlighted before it turns into a tool wear, breakage and failure. This ensures optimized and effective use of a cutting tool, saves maintenance/repair time, enhances constancy in a process etc. The recent development in Machine Learning (ML) and its applicability for condition monitoring approach has drawn attention of researchers. Machine learning examines existing and past indications to predict conditions in future. This paper presents machine learning based condition monitoring of milling cutter of vertical machining centre (VMC). The vibration signals acquisition of 4 insert milling cutter is carried out with healthy and various fault conditions. The Visual Basic (VB) code and script is used to extract statistical features and decision tree algorithm is used to select relevant features. The different conditions of milling cutter are classified using tree family classifiers. The effort made in this work is to check applicability of ML approach for milling cutter fault diagnosis for reducing power consumption of drive of machine tool.
Recasting Navier–Stokes equations
Authors: Reddy M H Lakshminarayana , Dadzie S Kokou , Ocone Raffaella , Borg Matthew K , Reese Jason M
Published: October 2019

Classical Navier–Stokes equations fail to describe some flows in both the compressible and incompressible configurations. In this article, we propose a new methodology based on transforming the fluid mass velocity vector field to obtain a new class of continuum models. We uncover a class of continuum models which we call the re-casted Navier–Stokes. They naturally exhibit the physics of previously proposed models by different authors to substitute the original Navier–Stokes equations. The new models unlike the conventional Navier–Stokes appear as more complete forms of mass diffusion type continuum flow equations. They also form systematically a class of thermo-mechanically consistent hydrodynamic equations via the original equations. The plane wave analysis is performed to check their linear stability under small perturbations, which confirms that all re-casted models are spatially and temporally stable like their classical counterpart. We then use the Rayleigh-Brillouin scattering experiments to demonstrate that the re-casted equations may be better suited for explaining some of the experimental data where original Navier–Stokes equations fail.
Multi-form solitary wave solutions of the KdV-Burgers-Kuramoto equation
Authors: Tchaho Clovis Taki Djeumen , Omanda Hugues Martial , Mbourou Gaston N’tchayi , Bogning Jean Roger , Kofané Timoléon Crépin
Published: October 2019

This work is dedicated to the construction of solitary wave solutions of the KdV-Burgers-Kuramoto equation. The peculiarity of the solutions obtained for this purpose is that they result from the combination of solitary waves of the bright and dark type thus generating multi-form solutions which are also called hybrid solitary waves. The Bogning-Djeumen Tchaho-Kofané method is used to obtain the results. The reliability and feasibility of these results are tested using numerical simulations.
Do extra compactified dimensions of space cause a substructure underlying the expected eigenstates of a molecule?
Authors: Weber H G
Published: October 2019

Experimental results on NO2 are explained based on the ADD-model of large extra compactified dimensions of space. We assume that gravity is sufficiently strong in a compactification space of the size of the molecule to affect the vibrational motion of the nuclei by causing an asymmetric perturbation in the symmetric stretch vibrational motion of the optically excited state. At the same excitation energy, there are also other electronic states of different symmetry (conical intersection of potential energy surfaces), which may couple with the optically excited state. Due to the gravitational perturbation the nuclei being in the symmetric stretch vibration mode of the optically excited electronic state pass over into the asymmetric stretch vibration mode of an isoenergetic electronic state. This parity conserving change of the vibronic wave function enhances a small gravitational perturbation to an optically detectable signal. The perturbation is associated with a time constant of about 3 μs, which we attribute to fluctuations of the shape of the compactification space induced by a background cosmic field.
20 cm resolution mapping of tundra vegetation communities provides an ecological baseline for important research areas in a changing Arctic environment
Authors: Greaves Heather E , Eitel Jan U H , Vierling Lee A , Boelman Natalie T , Griffin Kevin L , Magney Troy S , Prager Case M
Published: October 2019

Arctic tundra vegetation communities are spatially heterogeneous and may vary dramatically from one meter to the next. Consequently, representing Arctic tundra vegetation communities accurately requires very high resolution raster maps (<5 m grid cell size). However, using remotely sensed data to produce maps with sufficient spatial detail at an extent appropriate for understanding landscape-scale ecological patterns is challenging. In this study, we used predictor layers derived from airborne lidar and high-resolution (∼5 cm) 4-band airborne imagery to classify vegetation communities at 20 cm spatial resolution for three landscapes (12.5 km2 total) near the Toolik Lake research area in the Alaskan Low Arctic. The maps were built using a Random Forest model that was trained and tested on 800 ground reference plots, using classes derived from commonly used legends on existing polygon maps of the area. Withheld test plots (25% of dataset) had a balanced map accuracy of 0.57, kappa of 0.47, and weighted (fuzzy) kappa of 0.65. These maps provide high-resolution plant community information that can serve as important baseline reference data for vegetation monitoring and change detection in this rapidly changing tundra ecosystem, and as validation for coarser scale maps. They also permit fine-scale characterization of landscape phenomena such as community-level nutrient dynamics and wildlife habitat suitability in an important Arctic research site. Our approach demonstrates that very high resolution mapping results can be achieved and validated by integrating high-resolution remote-sensing datasets from multiple sensors in a machine learning model trained on simple field reference data.
Impact of Residents on Operative Time in Aesthetic Surgery at an Academic Institution
Authors: Peterson Erin C , Ghosh Trina D , Qureshi Ali A , Myckatyn Terence M , Tenenbaum Marissa M
Published: October 2019

Background

Duration of surgery is a known risk factor for increased complication rates. Longer operations may lead to increased cost to the patient and institution. While previous studies have looked at the safety of aesthetic surgery with resident involvement, little research has examined whether resident involvement increases operative time of aesthetic procedures.

Objectives

We hypothesized that resident involvement would potentially lead to an increase in operative time as attending physicians teach trainees during aesthetic operations.

Methods

A retrospective cohort analysis was performed from aesthetic surgery cases of two surgeons at an academic institution over a 4-year period. Breast augmentation and abdominoplasty with liposuction were examined as index cases for this study. Demographics, operative time, and resident involvement were assessed. Resident involvement was defined as participating in critical portions of the cases including exposure, dissection, and closure.

Results

A total of 180 cases fit the inclusion criteria with 105 breast augmentation cases and 75 cases of abdominoplasty with liposuction. Patient demographics were similar for both procedures. Resident involvement did not statistically affect operative duration in breast augmentation (41.8 ± 9.6 min vs 44.7 ± 12.4 min, P = 0.103) or cases for abdominoplasty with liposuction (107.3 ± 20.5 min vs 122.2 ± 36.3 min, P = 0.105).

Conclusions

There was a trend toward longer operative times that did not reach statistical significance with resident involvement in two aesthetic surgery cases at an academic institution. This study adds to the growing literature on the effect resident training has in aesthetic surgery.

Level of Evidence: 2
Prevalence of Coxiella burnetii (Legionellales: Coxiellaceae) Infection Among Wildlife Species and the Tick Hyalomma lusitanicum (Acari: Ixodidae) in a Meso-Mediterranean Ecosystem
Authors: González Julia , González Marta G , Valcárcel Félix , Sánchez Maria , Martín-Hernández Raquel , Tercero José María , Olmeda A Sonia
Published: October 2019

Q fever is a worldwide zoonosis caused by Coxiella burnetii (Derrick) Philip. It is a major cause of abortion among sheep and may be responsible for reproductive losses in red deer in Spain. Airborne transmission is the most widespread; however, some studies suggested that ticks may play a role, but little is known about their actual involvement in the C. burnetii cycle. The aim of this study was to determine the role that Hyalomma lusitanicum (Koch) tick plays in the maintenance of this agent among wildlife in the meso-Mediterranean areas. We processed by PCR 53 swabs from wild rabbits, 21 liver samples from red deer, and 236 ticks collected at different stages. Coxiella burnetii DNA was detected in 43.40% of wild rabbits and 38.09% of red deer, supporting the hypothesis that these animals are quite likely to serve as a reservoir in the field. We also found a high prevalence of C. burnetii in ticks (55.66%). It is worth noting that 50.45% of positive ticks were collected from negative hosts, suggesting that the pathogen probably was acquired at a previous tick stage. Our results suggest transstadial transmission, and the presence of bacterial DNA in the offspring of positive female ticks is the first evidence of the transovarial transmission of C. burnetii by H. lusitanicum. Thus, this tick species seems to play an important role as a bridge of infection in the wildlife cycle, although further studies are needed to confirm vector competence.
Investing in our nation’s future military leaders’ synthetic biology knowledge to understand and recognize threats and applications
Authors: Steel J Jordan , Bates Katherine L , Barnhart Michael D
Published: October 2019

Synthetic biology encompasses some of the greatest advancements in biology. With improvements in molecular methods and techniques that allow targeted and highly efficient genome manipulation, the capabilities of engineering biology have significantly increased. These enhancements in biotechnology represent significant potential benefits and risks to the global population. It is important that future leaders are trained and understand the incredible benefits, opportunities and risks associated with synthetic biology. The US Department of Defense (DoD) has issued a technical assessment on the future opportunities of synthetic biology and has encouraged the military institutions to expand and encourage bioengineering research programs. At the US Air Force Academy (USAFA), opportunities are provided for future Air Force officers to recognize the potential and risks associated with synthetic biology by participating in the USAFA Synthetic Biology Education Program (USBEP). Cadets can enroll in synthetic biology courses to learn and master molecular biology techniques and work on independent undergraduate research projects. In addition, cadets have the opportunity to join the USAFA’s International Genetically Engineered Machine (iGEM) team and compete in the international synthetic biology competition. This report includes details on how USAFA has recruited, enrolled and encouraged synthetic biology research and education among future leaders in the US Air Force.
Rethinking the “Indian War”: Northern Indians and Intra-Native Politics in the Western Canada-U.S. Borderlands
Authors: Wadewitz Lissa K
Published: October 2019

The standard interpretation of Washington Territory’s “Indian War” of the mid-1850s is not only east-west in its orientation, it also leaves little room for Indian auxiliaries, let alone mercenaries-for-hire from the north Pacific coast. “Northern Indians” from what later became northwestern British Columbia and southeastern Alaska provided crucial productive, reproductive, and military labor for early Euro-American settlers. Because Coast Salish communities on both sides of the border had experienced decades of raids and conflicts with various groups of northern Indians by the 1850s, Euro-Americans’ hiring of northern Indians in particular illustrates the importance of intra-Indian geopolitics to subsequent events. When placed in this larger context, the “Indian War” of 1855–56 in western Washington must be seen as part of a longer continuum of disputes involving distant Native groups, intra-Indian negotiations, and forms of Indigenous diplomacy. A closer look at how the key players involved attempted to manipulate these connections for their own purposes complicates our understandings of the military conflicts of the mid-1850s and reveals the significance of evolving Native-newcomer and intra-Indian relations in this transformative decade.
CE: Knowledge of Precision Medicine and Health Care: An Essential Nursing Competency
Authors: Lebet Ruth , Joseph Paule V. , Aroke Edwin N.
Published: October 2019

Advances in genetic and genomic research, combined with the rapid development of new technologies, have reshaped our understanding of health and disease processes, generating what have collectively become known as “omics” sciences. These sciences are now an integral part of health care delivery, with nurses and nurse scientists at the forefront, implementing and adapting genomic technologies in the clinical setting while advancing knowledge in these areas. With the increasing focus on precision medicine and health care, integrating genetic and genomic knowledge has become an essential competency in nursing care, research, and education, as it enables nurses to collaborate effectively with patients in improving their health and well-being.
Implementing a Fast-Track Team Triage Approach in Response to Hurricane Maria
Authors: Parak Brittany E. , Hodge Nancy S. , Eccleston Sarah D.
Published: October 2019

Background: Hurricane Maria struck Puerto Rico on September 20, 2017, and caused widespread damage to the island, resulting in decreased access to health care. Sixteen days later, a mobile military hospital (MMH) was deployed to Humacao, Puerto Rico, to provide medical relief. Overcrowding in EDs is a problem in disaster relief responses, as was the case here. Initial triage practices resulted in long wait times and limited access to care, and many people left before being seen by a provider.

Purpose: This study describes the implementation of a combined fast-track and team triage process to quickly and effectively screen patients in the MMH.

Methods: In addition to maintaining a formal triage, our ED staff combined two systems, fast track and team triage, to accommodate the influx of patients. This newly combined approach consisted of a health care provider (an MD, NP, or physician assistant) and an RN to facilitate the evaluation, treatment, and discharge of lower-acuity patients.

Results: During peak operations (days 13 to 26 of the total 31 days of operation), 70% of MMH patients were evaluated, treated, and discharged from the combined fast-track and team triage, while only 28% of patients were sent to formal triage; patients with critical conditions (2% of the total) were sent directly to the ED. The mean number of patients seen daily in the first 10 days of operation (n = 84) increased by an average of 48% (n = 124) in the 14 days of peak operations.

Conclusion: The combined fast-track and team triage approach enabled us to quickly and effectively screen patients and greatly improved clinical outcomes and patient flow in a mobile facility.
Before, after, & after-after
Authors: Rogge Mary Madeline , Gautam Bibha
Published: October 2019

Weight recovery among obese patients who have lost weight through lifestyle modification or bariatric surgery is a common clinical challenge that often leads to patient stigmatization and unexpected health problems. A review of the literature describes how weight loss alters energy homeostasis to limit weight loss and restore lost fat mass in patients who have successfully lost weight.
Bladder cancer
Authors: Farling Kristen Burns
Published: October 2019

Bladder cancer is the most common genitourinary cancer in the United States. Symptoms of bladder cancer mimic those of a urinary tract infection, which can delay timely diagnosis. Because of the high rate of bladder cancer, it is likely advanced practice registered nurses will be responsible for the care of patients with bladder cancer. This article reviews the signs and symptoms of bladder cancer along with management options to safely care for this patient population.
The patient portal
Authors: Elkind Elizabeth C. , Higgins Kathleen M.
Published: October 2019

Hospitals, patient-centered medical homes, and provider practices have either introduced or are in the process of planning for patient portals. The NP plays an important role in the patient engagement initiative. This article explores patient portal strategies and resources to support this technology integration and practice change.
Leaders, managers, and followers
Authors: Valiga Theresa M.
Published: October 2019

All nurses have the potential and responsibility to effect positive change in nursing practice and healthcare. This article details the characteristics of leaders and effective followers and clarifies that one does not need to be in a management position to function as a leader.
Take a deeper look into body surface area
Authors: Smith Linda S.
Published: October 2019

This article reviews the method of measure known as body surface area (BSA) and discusses when and why BSA calculations are used. Techniques for BSA calculation are also described.
Blood Immune Cell Biomarkers in Patient With Lung Cancer Undergoing Treatment With Checkpoint Blockade
Authors: Möller Miriam , Turzer Steffi , Schütte Wolfgang , Seliger Barbara , Riemann Dagmar
Published: October 2019

Characterization of host immune cell parameters before and during immunotherapy is expected to identify predictive biomarkers for clinical outcome. We prospectively monitored blood immune cells from 35 patients with advanced non–small cell lung cancer undergoing checkpoint inhibitor monotherapy. The aim was to identify parameters correlating with better/worse outcome. Peripheral blood was serially collected before each infusion at the onset and at cycle 3 and 5 of immunotherapy. A complete leukocyte blood count, the lymphocytic subpopulations and the percentages of both HLA-DRlow monocytes and dendritic cells (DC) were monitored. Disease control was defined as partial/complete response and stable disease on computed tomography scan according to RECIST 1.1. The predictive value of the immune cell parameters investigated was evaluated by patients’ survival analysis. Forty percent of patients showed a clinical response, and the global median overall survival was 7.0 months (95% confidence interval: 3.5–10.5). Patients with an initial neutrophil-to-lymphocyte ratio (NLR) ≥5.2, and/or an amount of HLA-DRlow monocytes ≥11% and/or a total DC level ≤0.4% of leukocytes did rarely respond to PD-1 inhibitor therapy. Otherwise, the immunotherapy-induced decrease of the neutrophil-to-lymphocyte ratio and/or HLA-DRlow monocytes and the increase of total DC frequencies were correlated with improved therapy response and prolonged overall survival. Blood values in the third cycle of immunotherapy did already reflect the effects observed. On the basis of the 3 immune cell parameters identified we created 3 different variants of scores that enable to stratify patients into groups of risk/therapy response. Our results warrant further investigation in larger prospective clinical trials for validation.
Paragangliomas of the Head and Neck
Authors: Weissmann Thomas , Lettmaier Sebastian , Roesch Johannes , Mengling Veit , Bert Christoph , Iro Heinrich , Hornung Joachim , Janka Rolf , Semrau Sabine , Fietkau Rainer , Putz Florian
Published: October 2019

Objectives:

To investigate local control and functional outcome following state-of-the-art fractionated stereotactic radiotherapy (FSRT) for paragangliomas of the head and neck.

Methods:

In total, 40 consecutive patients with paragangliomas of the head and neck received conventionally FSRT from 2003 to 2016 at the Department of Radiation Oncology of the University Hospital Erlangen. Local control, toxicities, and functional outcome were examined during follow-up. In total, 148 magnetic resonance imaging studies were subjected to longitudinal volumetric analysis using whole tumor segmentation in a subset of 22 patients.

Results:

A total of 80.0% (32/40) of patients received radiotherapy as part of their primary treatment. In 20.0% (8/40) of patients, radiation was used as salvage treatment after tumor recurrence in patients initially treated with surgery alone. The median dose applied was 54.0 Gy (interdecile range, 50.4 to 56.0 Gy) in single doses of 1.8 or 2 Gy. Local control was 100% after a median imaging follow-up of 52.2 months (range, 0.8 to 152.9 mo). The volumetric analysis confirmed sustained tumor control in a subset of 22 patients and showed transient enlargement (range, 129.6% to 151.2%) in 13.6% of cases (3/22). After a median volumetric follow-up of 24.6 months mean tumor volume had diminished to 86.1% compared with initial volume. In total, 52.5% (21/40) of patients reported improved symptoms after radiotherapy, 40% (16/40) observed no subjective change with only 7.5% (3/40) reporting significant worsening.

Conclusions:

State-of-the-art FSRT provides excellent control and favorable functional outcome in patients with paragangliomas of the head and neck. The volumetric analysis provides improved evidence for sustained tumor control.
Impacts of Treatment Modalities on Physical Activity After First Acute Myocardial Infarction in Jordan
Authors: Shajrawi Abedalmajeed , Al-Smadi Ahmed Mohammad , Al-Shawabkeh Ghadeer Khaled , Aljribeea Hanadi Saleh , Khalil Heba
Published: October 2019

Background

Promoting physical activity is a priority after coronary revascularisation for effective long-term cardiovascular care and to avoid further disease progression and complications. But little is known about the effect of different types of acute myocardial infarction (AMI) treatment modalities in changes in physical activity level post-AMI.

Objective

This study aimed to examine changes in physical activity among patients treated with different treatment modalities post–first AMI during early recovery phase at week 2 (time 1) and week 6 (Time 2) after hospitalization.

Methods

A descriptive study was done using a repeated-measures design. Physical activity was measured by a body-worn activity monitor (activPAL3 monitor) for 24 hours a day for full 7 consecutive days at time 1 and time 2 after hospitalization. Demographic and clinical data were collected from patients' records. The study was conducted in 1 setting in Jordan. Participants were met at time 1 and time 2. The study recruited a convenience sample of 94 patients with AMI. Participants did not have access to cardiac rehabilitation. The participants were categorized according to type of AMI treatment modalities into 3 groups: ST-elevation myocardial infarction treated by primary percutaneous coronary intervention, ST-elevation myocardial infarction treated by thrombolytic therapy, and non–ST-elevation myocardial infarction treated by medication.

Results

Patients treated by primary percutaneous coronary intervention had a statistically significant effect on changes in mean steps count and mean stepping time per day better than patients treated by other treatment modalities between weeks 2 and 6 after hospitalization.

Conclusion

The study showed that patients treated with primary percutaneous coronary intervention had better mean steps count and mean stepping time per day between weeks 2 and 6 after hospitalization in comparison with other treatment modalities. These findings could be used for development of effective intervention in the future. Further research using different research methods such as longitudinal studies among different cultures to confirm the finding of this study is recommended.
Patient Concerns in the Immediate Postoperative Period After Mohs Micrographic Surgery
Authors: Giordano Cerrene N. , Mori Shoko , Navarrete-Dechent Cristian , Dusza Stephen W. , Rossi Anthony M. , Nehal Kishwer S. , Lee Erica H.
Published: October 2019

BACKGROUND

Postoperative concerns after Mohs micrographic surgery (MMS) are not well characterized.

OBJECTIVE

To better define patient concerns and contributing characteristics in the immediate postoperative period after MMS.

MATERIALS AND METHODS

A standardized telephone encounter template was implemented to better assess patient concerns in the 24-hour postoperative period. A review was then performed of patients undergoing MMS from October 2016 to July 2017 to assess for the most common patient concerns and association with clinical characteristics.

RESULTS

We included 307 patients. Overall, 60.6% of patients reported a concern. Fifty-four percent of patients reported pain. Most pain was characterized as “a little” (67.7%). On univariate analysis, flap repairs, location on the upper extremities, and swelling were associated with higher mean postoperative pain. Tumor type was not associated with increased pain. On multivariate analyses, patients with larger defects and associated edema were statistically significantly associated with higher degrees of pain.

CONCLUSION

Over half of patients experience postoperative concerns after MMS, most commonly pain. The immediate postoperative period may be an optimal time to identify patient concerns allowing for reassurance or early intervention when necessary.
Update and Review of Bleeding Considerations in Dermatologic Surgery: Hemostatic Techniques and Treatment Strategies for Bleeding Complications
Authors: Iyengar Sanjana , Yeager Danielle G. , Cohen Joel L. , Ozog David M.
Published: October 2019

BACKGROUND

There are many intraoperative and postoperative techniques to aid hemostasis in dermatologic procedures. An updated understanding is critical for the surgeon.

OBJECTIVE

To provide an updated review of methods for hemostasis and therapies for postprocedural purpura and ecchymosis applicable to dermatology.

MATERIALS AND METHODS

A review of Ovid MEDLINE was performed to review the English-language medical literature of hemostatic options and their use in cutaneous surgery. All available publication years were included from 1946 to present.

RESULTS

A comprehensive and current list of hemostatic options used in the intraoperative and postoperative period is provided along with traditional and emerging therapies for postprocedural purpura and ecchymosis.

CONCLUSION

A myriad of options exist for minimizing and treating bleeding complications. The appropriate use and updated knowledge of hemostatic options is provided.
Analysis of U.S. Food and Drug Administration Data on Soft-Tissue Filler Complications
Authors: Ortiz Arisa E. , Ahluwalia Jusleen , Song Silvia S. , Avram Mathew M.
Published: October 2019

BACKGROUND

With the rising popularity of dermal fillers, the number of complications associated with fillers has increased.

OBJECTIVE

To identify and review reports of adverse events involving cosmetic injectable soft-tissue fillers from the FDA Manufacturer and User Facility Device Experience (MAUDE) database from June 1993 to August 2014.

MATERIALS AND METHODS

The authors conducted a search of adverse events within the U.S. Food and Drug Administration database that involved injectable dermal fillers for soft-tissue augmentation from June 1993 to August 2014. Search terms included generic and trade names of commercially available soft-tissue fillers.

RESULTS

Three thousand seven hundred eighty-two complications involving dermal fillers were identified in the MAUDE database. Forty-four percent of complications implicated hyaluronic acid fillers, 40% involved poly-l-lactic acid fillers, 15% complications included calcium hydroxylapatite fillers, and <1% complications arose from polymethylmethacrylate fillers. Common adverse events included lumps, infection, allergic reaction, ischemia, and swelling. Rare events included trigger of autoimmune reactions, visual disturbances, and stroke.

CONCLUSION

Although complications with dermal fillers are infrequent in comparison with the growing number of filler procedures being performed in the United States every year, this study underscores the importance of appropriate skill and training when administering dermal fillers. Physicians using injectable dermal fillers should be trained to recognize potential complications and know how to appropriately manage them.