bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduction in Homologous Blood Transfusions Using a Low Prime Circuit
Authors: DeBois William J. , Sukhram Youram , McVey James , Helm Robert E. , Gold Jeffrey P. , Rosengart Todd , lsom O.W. , Krieger Karl H.
Published: August 2023

Due to a low estimated blood volume, small adults (weight less than 70 kg) undergoing cardiopulmonary bypass (CPB) are at highest risk for low hematocrit and homologous blood transfusion (HBT). To determine whether reductions in HBT could be achieved we compared the use of a low prime circuit (1400 ml) with our standard (2200 ml) cardiopulmonary bypass (CPB) circuit.

Eighty consecutive adult patients (>age 18, <70 kg) undergoing non-emergent CPB were randomly divided into two groups. Group LP (n=40) was the low prime group and group SP (n=40) was the standard prime group. In Group LP, either of two “low prime” hollow fiber membrane oxygenators with a 3/8 X 3/8 inch A-V loop were utilized. Alternately, in Group SP, a larger membrane oxygenator with a 3/8 X 1/2 A-V loop was utilized. Circuits and CPB management were otherwise identical. Excluded from the study were those patients who had bleeding disorders, reoperations, ejection fractions of less than 30% and history of cerebral vascular insufficiency.

Patients were closely matched for age, BSA, gender, preoperative risk and procedure. Mean weight (kg) was less in Group LP (59.2 vs 62.2, P<0.02). Pre-CPB hematocrits (HCT) were similar in both groups. Initial on CPB HCT was higher in Group LP (19.8 vs 18.4, P<0.04). Group LP had a higher frequency of initial on CPB HCTs of 20% or greater (55% vs 33% , P<0.04). Group LP had a lower packed red blood cell (PRBC) transfusion rate on CPB (0.4 vs 0.9 units, P<0.03). Group LP had higher percentage of patients that did not require transfusion on CPB (78% vs 55%, P<0.03). Despite fewer transfusions, Group LP had a higher post CPB HCT (20.6 vs 19.3, P<0.04). A trend was noted with a lower total PRBC transfusion rate in Group LP (1.9 vs 2.4, P=.10). During the entire length of stay, fewer Group LP patients required any homologous transfusion (26/40 versus 34/40, P <0.04). Chest drainage, 24 hour HCT and discharge HCT were similar in both groups. Transfusion of platelets, fresh frozen plasma and cryoprecipitate was similar in both groups. There were no deaths in either group.

Patients with low blood volume are at high risk of homologous transfusion when undergoing CPB. A significant reduction in prime volume appears to be safe, simple and reduces HBTs in these individuals. Prime reduction should be part of a comprehensive multi-modality blood conservation program.
Comparison of Three Methods to Estimate Heparin Loading Dose for Cardiopulmonary Bypass
Authors: Clark T. Dale , Ecklund Jodie M. , McCall Mary M. , Wolk Dennis R. , Riley Jeffrey B.
Published: August 2023

Three available methods used to determine heparin loading dose were studied to determine the most reliable method for reaching a target pre-bypass activated clotting time (ACT) of 510 seconds. One hundred and seven patients were randomly assigned to one of three treatment methods: A) 300 units/kg; B) Hemostasis Management System (HMS); C) RX/DX. Five different lots of heparin were assigned to Groups A and B, and Group C had one heparin lot. Different lots were used to account for possible variations in heparin activity.

Post-skin incision ACTs, post-heparin pre-bypass ACTs, and heparin loading doses were compared. The mean and standard deviation of the post-heparin pre-bypass ACTs were used to determine which method was most reliable to obtain a desired ACT.

There was no statistical difference between different heparin lots. There was no difference in the post-heparin ACTs for the three methods (A:487±135 vs. B:474±105 vs. C:474±111 sec). There was a statistically significant difference between the standard deviation for the HMS and 300 u/kg standard deviations (p<0.05). The HMS has the smallest deviation which makes it the most reliable predictor of heparin loading doses to reach a target ACT for cardiopulmonary bypass.
Hemochron vs. Hemotec Kaolin ACT Comparison with Aprotinin Use in Congenital Heart Surgery
Authors: Ecklund Jodie M. , McCall Mary M. , Southworth Rhonda S. , Blackwell Mindy M. , Riley Jeffrey B.
Published: August 2023

Between July 1994 and January 1995, ten patients underwent reoperative cardiac surgery with cardiopulmonary bypass for correction of various congenital anomalies. The patients' ages ranged from 0.17 to 34 years. Aprotinin was used according to surgeon protocol (200 mg/m2 body surface area initial loading dose and in pump prime, and 50 mg/m2 hourly infusion). The purpose of this study was to compare the simultaneous ACT values obtained from the Hemotec cartridge and the Hemochron kaolin tube.

A 3 ml blood sample was drawn and duplicate ACTs run at four time periods during the procedure: 2 ml in a prewarmed kaolin Hemochron tube and 0.4 ml in each well of a pre-warmed Hemotec cartridge. Information recorded at each time period included: event [pre-CPB, onCPB hypothermia, on-CPB rewarming, post-CPB], temperature, and ACT values from each machine. A total of 74 paired samples were analyzed. Two-way ANOV A was used to compare the values. Multiple comparison tests using the Bonferonni method were performed to maintain the Type I error rate at 0.05. Regression, correlation, and residual analyses were performed. Cohen's kappa statistic was used to assess the degree of agreement between the two devices.

There was a statistically significant difference between the ACT values obtained between the two devices (p<.01); however, the correlation between the values was high and significant (r=0.841, p<.01). The Hemotec was an average of 86 seconds lower than the Hemochron. The kappa statistic was 0.688, which indicates good agreement. The differences between these two devices have been previously reported using the celite Hemochron tubes, and it appears that there is still a difference when both tubes contain kaolin. Differences in the method of clot detection, differences in sample volume, and differences in the adsorption of aprotinin may explain the differences observed in this study. The Hemochron kaolin ACT is an acceptable alternative to the Hemotec ACT for monitoring heparinization when aprotinin is in use in congenital heart surgery.
Cardiopulmonary Bypass Factors Affecting the Development Of Choreoathetosis in Pediatric Patients
Authors: Ecklund Jodie M. , Phelps Vonda K. , Holden Kenton R. , Riley Jeffrey B. , Crawford Fred A. , Sade Robert M.
Published: August 2023

Choreoathetosis (CHO) in pediatric patients following cardiopulmonary bypass (CPB) has no known etiology, although several causal factors have been suggested. The infrequent occurrence in any one institution and the inability to perform prospective studies have made the etiology of CHO difficult to discover. This paper discusses a retrospective analysis of eleven cases of CHO following CPB. To form a control group for matched comparison, each of the eleven CHO patients was matched with a patient who did not develop CHO. Matching parameters included: age at operation within 10%, diagnosis (cyanotic, not cyanotic), race, gender, operation, and date of operation within 12 months.

Fifteen preoperative and CPB variables were evaluated to determine differences between the CHO patients and the control patients. Statistical analysis included odds ratios for matched pairs and two sample t-tests. A p value of 0.05 was chosen to assess statistical significance. Variables found to be significantly different between the study and control groups were: lowest rectal temperature, cooling and warming rates, and lowest arterial blood temperature. From these results, it is concluded that cooling to rectal temperatures less than 15°C or a cooling rate greater than 0.4°C /min is associated with the development of CHO following CPB in these patients.
An Under-Occluded Roller Pump is Less Hemolytic Than a Centrifugal Pump
Authors: Rawn OJ , Harris HK , Riley JB , Yoda ON , Blackwell MM
Published: August 2023

The purpose of this study is to measure and compare the hemolysis produced by roller pumps with varied occlusion settings and a centrifugal pump. The null hypothesis is that there is no difference in the Index of Hemolysis (IH=gm Hb/100 L pumped) produced by a roller pump (RP) at four different occlusion settings and a centrifugal pump (CP) at the same blood flow rate (4.5 L/min) and afterload (250 mmHg, ±10 mmHg) over three hours.

Five identical closed-loop circuits were assembled and primed with saline. The pumps were then calibrated and occlusions were set. In three circuits, the occlusion for the RP was opened at 5 RPMs to support 150, 225, or 300 mmHg (±10 mmHg) against a clamped line. In one circuit, a RP was adjusted to a barely non-occlusive setting (1 cm drop/30 inch gradient). The fifth circuit employed a CP. Prior to testing, the saline in each circuit was replaced with one liter of fresh bovine blood (Hct=22±2%). The IH for each treatment was compared in six trials yielding a statistical power> 0.80.

Analysis of variance with multiple comparison (p≤0.05) demonstrated that compared to the barely non-occlusive setting, the IH in the centrifugal pump was not significantly greater. Under-occluded RP settings yielded IHs significantly less than the CP. It appears that opening the occlusion on a roller pump allows a lower IH compared to traditional RP occlusion setting or centrifugal pumping.
A Comparative Review of Crystalloid, Albumin, Pentastarch and Hetastarch as Perfusates for Cardiopulmonary Bypass
Authors: Myers Gerard J.
Published: August 2023

A comparative review is made of the four most common asanguineous solutions used for the priming of cardiopulmonary bypass equipment. Increasing health care costs and concerns over the administration of blood derived products has cardiac programs examining their practice of using albumin as a routine part of the priming solution for bypass. Emphasis is being placed on the use of crystalloids with synthetic colloids, or crystalloids alone, as the priming agents for extracorporeal circulation.

However new evidence has shown that the use of these solutions, without the addition of albumin, may be associated with the development of a cold induced agglutination. The data reviewed suggests that the ideal priming fluid may still not be available and recommendations are made.
Blood Anion Gaps and Venoarterial Carbon Dioxide Gradients as Risk Factors in Long-Term Extra corporeal Support
Authors: Grist Gary , Thomas Don
Published: August 2023

Increases in the blood anion gap (AG) and venoarterial carbon dioxide gradients [p(VA) CO2 ] may indicate changes in intracellular acid concentration not demonstrated by blood gas measurements. This prospective study examines these two physiologic markers to determine their relationship to extracorporeal membrane oxygenation (ECMO) survival and duration in 100 patients.

Serum electrolytes were drawn every 6 hours and the AG calculated. Simultaneous arterial blood gases and venous blood gases were drawn every 4 hours and the p(V-A)CO2 calculated. Cumulative averages were then calculated from all the AG and p(V-A)CO2 values during each ECMO treatment. The average AG was 11 mEq/L. The average p(V-A)CO2 was 9 mm of mercury (mmHg).

Patients with an AG of 11 mEq/L or less had a 12% mortality and those with a higher AG had a 43% mortality (p=0.0005). Patients with a p(V-A)CO2 of less than 9 mmHg had a 13% mortality and those with a 9 mmHg or higher gradient had a 35% mortality (p=0.0126). Patients with both a low AG and a low p(V-A)CO2 had a 7% mortality and survivors were on ECMO 100 (± 37) hours. Patients with both a high AG and a high p(V-A)CO2 had a 56% mortality and survivors were on ECMO 190 (± 1 05) hours.

Both mortality and survivors’ ECMO time increase as one or both risk factors increase. Patients with increases in both risk factors have a mortality rate 8 times greater and survivors remain on ECMO almost twice as long as those without increased risk factors. Patients may benefit from a perfusion strategy that seeks to minimize the AG and p(V-A)CO2.
Hemostatic Assessment of Patients Undergoing lntraaortic Balloon Pump Therapy
Authors: Ficek Suzanne J. , Stammers Alfred , Deligonul Ubeydullah , Shurmur Scott W. , Alonso Anselmo , Galbraith Timothy
Published: August 2023

Patients undergoing intraaortic balloon pump (IABP) therapy are at risk for developing coagulopathies due to the adverse effects of prolonged exposure of the synthetic surface of the polyurethane balloon to blood components. Hemorrhagic risk has been attributed to a number of factors including thrombocytopenia, vascular injury, and/or platelet degranulation which increase the potential of receiving autogeneic blood transfusions. The present study is a prospective evaluation of coagulation using a viscoelastic monitor (Thrombelastograph- TEG) that measures functional aspects of clot development and stabilization in patients being treated with IABP therapy.

Following Institutional Review Board approval, six patients undergoing IABP therapy for hemodynamic instability were enrolled in this study. Blood samples were taken prior to balloon insertion, at 8, 16, 24, 48, 72, and 96 hours on IABP therapy, and 24 hours following the removal of the balloon when applicable. Samples were incubated with heparinase to degrade heparin and TEG profiles were subsequently determined in duplicate. Measured parameters on the TEG included Rtime, K-time, maximum amplitude, alpha angle, and lysis at 30 and 60 minutes with calculation of the TEG index.

Mortality was 33% following IABP discontinuation. Transfusion of packed red blood cells occurred in 50% of the patients during their balloon pump therapy. Patients demonstrated a significant deviance in fibrinolytic potential from pre-IABP lysis (1.6% ± 1.8) at both 24 hours (18.8% ± 22.9) and 48 hours (21.9% ± 28.5) of therapy (p<0.05) which returned to baseline shortly after balloon removal. Activation of coagulation factors appeared evident by a steadily increasing alpha angle from pre-IABP data (31.1 ± 9.2) throughout the duration of therapy and 24 hour recovery (53 ± 14; p<.005), and by a steadily trending increase in the TEG index pre-IABP (.251 ± 1.4) to post-IABP (2.6 ± 1.7; p<0.05).

The results indicate that IABP therapy induces an increase in fibrinolytic potential at 24 to 48 hours of balloon pump therapy with a paradoxical trend toward increased coagulability, potentially predisposing the patient to hemorrhagic risk.
Rapid Pediatric Cardiopulmonary Support System
Authors: Ojito Jorge W. , McConaghey Todd , Jacobs Jeffrey P. , Burke Redmond P.
Published: August 2023

Emergency cardiopulmonary support (CPS) systems for pediatric patients have not achieved widespread acceptance because they have been limited by extended setup times and large priming volumes requiring blood products. To address these limitations, we developed a miniaturized CPS system which can be rapidly assembled with a small bloodless priming volume. This system was successfully utilized in two infants with congenital heart disease in whom emergent cardiopulmonary support was instituted outside the operating room. The pediatric CPS system proved safe and effective in allowing the salvage of both patients. Further study of this system is warranted to evaluate potential future applications.
An In Vitro Evaluation of an Automatic Clamp for Use with Centrifugal Pumps
Authors: Vocelka Craig R. , Thomas Robert
Published: August 2023

The risk of air emboli is a concern for all perfusionists. A new clamping device for use with centrifugal pumps is designed to clamp both the arterial and venous lines at the first indication of air or retrograde flow, thereby allowing the perfusionist to evaluate the situation and correct the problem before entraining air into the arterial pump head. After evaluating this device in our lab, we conclude that this new safety device should be added to the heart lung machine by all perfusionists using centrifugal pumps.
Perfusion Services National Process Improvement Benchmarking
Authors: Riley J. B. , Kavanaugh T. A.
Published: August 2023

The Joint Commission on Accreditation of Health Care Organizations recommends national and regional benchmarking in the quality improvement process. Benchmarking is comparing your organization's patient care process outcomes to the best. This communication describes a national benchmarking process for peer comparison of indicators in perfusion patient services process improvement.

A databasing communication aplet was designed to facilitate national benchmarking as part of a larger perfusion service management software application. When patient information is entered in the patient database post precedure, patient-specific numeric data and 'yes'/'no' queries are entered at the clinical site. At any time, the local perfusionist system manager may transmit their own data and receive national database group results by modem and a 1-800 phone number. Local indicator outcomes are compared to national results. Strategies are employed to assure that institution and patient name remain anonymous and institution specific data are stored at the clinical site. Participating institutions employ an e-mail aplet to discuss and decide which indicators to employ as a group.

Nine institutions have contributed outcome data for more than 6,425 cardiopulmonary bypass (CPB) procedures to a national database for ten months. National and institutional means for six discrete CPB outcome parameters are compared. The percent 'yes' responses to four procedure-related questions are compared. Joint Commission recommended benchmarking is accomplished while patient care is improved by comparing outcomes.
Conversion to Biventricular Pulsatile Assist as a Bridge to Cardiac Transplantation : A Case Report
Authors: Ruby Dale L. , Lester J. Lancelot
Published: August 2023

A 42 year old male patient presented with chest pain. Cardiac catheterization revealed multivessel coronary disease with a decreased ejection fraction. Following cardiac revascularization, the patient's condition deteriorated and the patient was placed on a Biomedicus left ventricular assist device in the intensive care unit. The following day, an Abiomed BVS 5000 cardiac support system was obtained by the hospital. The patient was brought back to the operating room for implantation of a biventricular pulsatile cardiac assist device and removal of a nonpulsatile left ventricular assist device as a bridge for possible cardiac transplantation. The patient tolerated the procedure well and was transported back to the intensive care unit in stable condition. The patient was accepted for consideration for cardiac transplantation and transported by helicopter to the cardiac transplant center without incident.
[18F]-PSMA-1007-PET for evaluation of kidney function
Authors: Rassek Philipp , Schäfers Michael , Rahbar Kambiz , Backhaus Philipp
Published: August 2023

Purpose Prostate-specific membrane antigen (PSMA) is present in the proximal tubule cells of the kidneys. This results in high renal tracer uptake in PSMA-PET, which may contain useful information on renal function. As part of the evaluation for [177Lu]-PSMA therapies, patients undergo PSMA-PET and additional [99mTc]-mercapto-acetyltriglycine (MAG3) scintigraphy to assess renal function. Aim of this study was to evaluate estimation of renal function with [18F]-PSMA-1007-PET/CT (PSMA-PET) by comparison to timely MAG3-scintigraphies.

Materials and Methods We retrospectively investigated 73 prostate cancer patients with 93 timely available PSMA-PET/CT, MAG3-scintigraphies and serum creatinine. For determination of split renal function in PSMA-PET/CT, we evaluated the relative unilateral total renal PSMA uptake, i.e. SUVmean multiplied by the renal volume (SRFPSMA-TOTAL) and relative unilateral maximal standardized uptake value (SRFSUV). These were compared to MAG3 split renal function (SRFMAG3) using Pearson correlation and receiver operating characteristics analysis. For determination of global renal function, correlation of bilateral total renal PSMA uptake with MAG3 tubular excretion rate and serum creatinine was assessed.

Results SRFMAG3 was strongly correlated with SRFPSMA-TOTAL (r= 0.872, p<0.001) and with SRFSUV (r=0.815, p<0.001). Relevant abnormalities of SRFMAG3 (unilateral renal function < 25 %) could be detected with sensitivities and specificities of 90% and 92% for SRFPSMA-TOTAL, and 80% and 95% for SRFSUV. Measures of absolute renal function were only weakly correlated with bilateral total renal PSMA uptake.

Conclusion Renal [18F]-PSMA-1007 uptake allowed to quantify renal split function with good accuracy based on SRFPSMA-TOTAL or SRFSUV.
Häufigkeit und Situationsbeschreibung von Notarzteinsätzen bei bereits verstorbenen oder im Rettungseinsatz gestorbenen Personen in der Stadt Münster (2017)
Authors: Dasch Burkhard , Betz Ria , Lenz Philipp , Bohn Andreas
Published: August 2023

Hintergrund Bislang existieren in Deutschland nur wenige Untersuchungen zur Häufigkeit und Analyse von Notarzteinsätzen bei bereits verstorbenen oder während des Einsatzes
gestorbenen Personen.

Methodik Retrospektive Analyse sämtlicher Notarztprotokolle der Berufsfeuerwehr Münster und jeglicher Todesbescheinigungen der Stadt Münster des Jahres 2017.

Ergebnisse Ausgewertet wurden 6635 Notarztprotokolle und 3844 Todesbescheinigungen. Bei 262 Einsätzen hatte der Notarzt Kontakt zu verstorbenen/sterbenden Personen, entsprechend 3,9%
(95%-KI: 3,5–4,4%) aller Notarzteinsätze in 2017. In 63,7% der Fälle (167) war bei Eintreffen des Notarztes die Person bereits verstorben. Zu 11,1% (29) bezogen sich Rettungseinsätze auf
Suizide, zu 0,8% (2) auf Verkehrsunfälle mit Todesfolge und zu 6,5% (17) auf die Betreuung von Tumorpatienten in finaler Situation.

Schlussfolgerung Notarzteinsätze bei bereits verstorbenen oder sterbenden Personen sind nicht selten und oft herausfordernd.
Measuring Objective and Subjective Intelligibility Using Speech Materials from the Tracking of Noise Tolerance (TNT) Test
Authors: Kuk Francis , Slugocki Christopher , Korhonen Petri
Published: August 2023

Abstract Background The results of tests measuring objective speech intelligibility are similar to those measuring subjective speech intelligibility using speech materials with minimal context. It is unclear if such is the case with contextual materials.
Purpose This article compares objective and subjective intelligibility difference (OSID) between normal hearing (NH) and hearing impaired (HI) listeners in the unaided and aided modes using speech materials adapted from the Tracking of Noise Tolerance (TNT) test. Research
Design Single-blind within-subjects design. Study Sample Twenty-four NH and 17 HI older adults. Data Collection and Analysis Listeners completed the objective and subjective intelligibility measures at 75 and 82 dB sound pressure level (SPL)
speech input levels. Five signal-to-noise ratios were tested to generate the objective and subjective speech intelligibility performance intensity (P-I) functions. Both NH and HI listeners were tested in the unaided mode. The HI listeners were also tested using their own hearing aids (HAs).
Objective and subjective speech reception thresholds at a 50% criterion (SRT50s) were estimated from each individual P-I function. The difference between the objective SRT50 and subjective SRT50 was used to estimate OSID. Results Objective and subjective SRT50s were significantly
better in NH than in HI listeners (chi-square(1) = 26.29, p < 0.001) at each speech input level in the unaided mode. However, there was a significant interaction between listener group and intelligibility type (chi-square(1) = 9.43,
p = 0.002) where SRT50s were lower for subjective than objective P-I functions only in the HI group. The SRT50s of HI listeners were also affected by hearing mode, where both objective and subjective intelligibility was improved when HI listeners were tested while wearing
their own HAs. In general, objective and subjective SRT50s showed moderate-to-strong correlations across most combinations of listener groups and test conditions (r = 0.59‐0.86, p < 0.01) except for HI listeners tested with their own HAs
(r = 0.39, p = 0.128). Conclusion Similar objective and subjective intelligibility was observed in NH listeners but better subjective intelligibility than objective intelligibility was noted in HI listeners when tested in the unaided
and aided modes.
Decompressive Surgery in the Treatment of Acute Ischemic Stroke during the First Four Waves of the COVID-19 Pandemic in Germany: A Nationwide Observational Cohort Study
Authors: Gheewala Hussain , Aldergham Muath , Rosahl Steffen , Stoffel Michael , Ryang Yu-Mi , Heese Oliver , Gerlach Rüdiger , Burger Ralf , Carl Barbara , Kristof Rudolf A. , Westermaier Thomas , Terzis Jorge , Youssef Farid , Gonzalez Gerardo Rico , Bold Frederic , Allam Ali , Kuhlen Ralf , Hohenstein Sven , Bollmann Andreas , Dengler Julius
Published: August 2023

Background The COVID-19 pandemic has significantly affected acute ischemic stroke (AIS) care. In this study, we examined the effects of the pandemic on neurosurgical AIS care by means of decompressive surgery (DS).

Methods In this retrospective observational study, we compared the characteristics, in-hospital processes, and in-hospital mortality rates among patients hospitalized for AIS during the first four waves of the pandemic (between January 1, 2020 and October 26, 2021) versus the corresponding periods in 2019 (prepandemic). We used administrative data from a nationwide hospital network in Germany.

Results Of the 177 included AIS cases with DS, 60 were from 2019 and 117 from the first four pandemic waves. Compared with the prepandemic levels, there were no changes in weekly admissions for DS during the pandemic. The same was true for patient age (range: 51.7–60.4 years), the number of female patients (range: 33.3–57.1%), and the prevalence of comorbidity, as measured by the Elixhauser Comorbidity Index (range: 13.2–20.0 points). Also, no alterations were observed in transfer to the intensive care unit (range: 87.0–100%), duration of in-hospital stay (range: 14.6–22.7 days), and in-hospital mortality rates (range: 11.8–55.6%).

Conclusion In Germany, compared with the prepandemic levels, AIS patients undergoing DS during the first four waves of the pandemic showed no changes in demographics, rates of comorbidity, and in-hospital mortality rates. This is in contrast to previous evidence on patients with less critical types of AIS not requiring DS and underlines the uniqueness of the subgroup of AIS patients requiring DS. Our findings suggests that these patients, in contrast to AIS patients in general, were unable to forgo hospitalization during the COVID-19 pandemic. Maintaining the delivery of DS is an essential aspect of AIS care during a pandemic.
Propionibacterium acnes: A Difficult-to-Diagnose Ventriculoperitoneal Shunt Infection. Case Report
Authors: Kuzmin Dzmitry , Feigl Guenther C.
Published: August 2023

Background Ventriculoperitoneal (VP) shunt infections are a fairly common complication in both the early and late postoperative periods. Sometimes diagnosis is difficult despite the fact that infection is often accompanied by clinical symptoms. Furthermore, pathogenic bacteria can be detected in the cerebrospinal fluid.

Method We describe a case of chronic VP shunt infection in a 24-year-old female patient who was operated on for posterior fossa pilocytic astrocytoma and needed a VP shunt. The infection revealed itself 5 years after shunt implantation with nonspecific symptoms, and it took approximately 2 years to make a correct diagnosis. Meanwhile, the patient's condition became critical. The infection was caused by Propionibacterium acnes, which is capable of forming biofilms on implants, and which is difficult to identify due to the peculiarity of its cultivation.

Result When the bacterium was identified, the shunt was replaced and antimicrobial therapy was performed, after which the patient's condition improved dramatically and she got back to her normal life.

Conclusions This case shows how difficult the diagnosis of VP shunt infection can be and what clinical significance it can have for the patient.
The Automation of Breast Ultrasonography and the Medical Time Dedicated to the Method
Authors: Alves Katyane Larissa , Freitas-Junior Ruffo , Paulinelli Régis Resende , Borges Marcus Nascimento
Published: August 2023

In this integrative review, we aimed to describe the records of time devoted by physicians to breast ultrasound in a review of articles in the literature, in order to observe whether the automation of the method enabled a reduction in these values. We selected articles from the Latin American and Caribbean Literature in Health Sciences (LILACS) and MEDLINE databases, through Virtual Health Library (BVS), SciELO (Scientific Electronic Library Online), PubMed, and Scopus. We obtained 561 articles, and, after excluding duplicates and screening procedures, 9 were selected, whose main information related to the guiding question of the research was synthesized and analyzed. It was concluded that the automation of breast ultrasound represents a possible strategy for optimization of the medical time dedicated to the method, but this needs to be better evaluated in comparative studies between both methods (traditional and automated), with methodology directed to the specific investigation of this potentiality.
Increased Cesarean Section Rates during the COVID-19 Pandemic: Looking for Reasons through the Robson Ten Group Classification System
Authors: Silva Cassia Elane Berbel da , Guida Jose Paulo Siqueira , Costa Maria Laura
Published: August 2023

Objective To compare cesarean section (CS) rates according to the Robson Ten Group Classification System (RTGCS) and its indications in pregnant women admitted for childbirth during the first wave of the coronavirus disease 2019 (COVID-19) pandemic with those of the previous year.

Materials and Methods We conducted a cross-sectional study to compare women admitted for childbirth from April to October 2019 (before the pandemic) and from March to September 2020 (during the pandemic). The CSs and their indications were classified on admission according to the RTGCS, and we also collected data on the route of delivery (vaginal or CS). Both periods were compared using the Chi-squared (χ2) test or the Fisher exact test.

Results In total, 2,493 women were included, 1,291 in the prepandemic and 1,202 in the pandemic period. There was a a significant increase in the CS rate (from 39.66% to 44.01%; p = 0.028), mostly due to maternal request (from 9.58% to 25.38%; p < 0.01). Overall, groups 5 and 2 contributed the most to the CS rates. The rates decreased among group 1 and increased among group 2 during the pandemic, with no changes in group 10.

Conclusion There was an apparent change in the RTGSC comparing both periods, with a significant increase in CS rates, mainly by maternal request, most likely because of changes during the pandemic and uncertainties and fear concerning COVID-19.
Weaknesses in the Continuity of Care of Puerperal Women: An Integrative Literature Review
Authors: Petersen Ane Gabriele Poli , Kolankiewicz Adriane Cristina Bernat , Casagrande Denise , Pluta Pâmella , Winter Vanessa Dalsasso Batista , de Carvalho Fernanda Fernandes , Tronco Caroline Sissy
Published: August 2023

The aim of the present study was to identify how the transition of care from the hospital to the community occurs from the perspective of puerperal women at risk. An integrative literature review was performed, with the question: “How does the transition of care for at-risk puerperal women from the hospital to the community occur?” The search period ranged from 2013 to 2020, in the following databases: PubMed, LILACS, SciELO, and Scopus. MESH, DeCS and Boolean operators “OR” and “AND” are used in the following crossover analysis: patient transfer OR transition care OR continuity of patient care OR patient discharge AND postpartum period, resulting in 6 articles. The findings denote discontinuity of care, given the frequency of non-adherence to the puerperal consultation. Transition studies of care in the puerperium were not found, which requires proposing new studies.
Numerical investigation of the role of linear and nonlinear forces in determining the direction of electric wind caused by atmospheric pressure DC corona discharge
Authors: Ahmadi H. Soltani , Sohbatzadeh F. , Darzi R. Ebrahimnezhad , Mirzanejhad S.
Published: August 2023

In this study, the force generated by atmospheric positive and negative corona discharges was investigated using a simulation of a wire–cylinder configuration. We provided new insight into the atmospheric corona discharge by introducing a nonlinear force on the charged particles in the vicinity of the wire electrode. To elucidate the origin of both forces in corona discharges, we performed 2D simulations via COMSOL Multiphysics and MATLAB software. It was observed that the direction of nonlinear force is always from the wire to the cylinder regardless of the applied voltage polarity. It was illustrated that the corresponding nonlinear force of the positive corona is larger than that of the negative corona discharge. However, the span of the nonlinear force is greater in the negative corona discharge. The numerical simulation results showed that, in addition to the linear force (Coulomb force), a strong nonlinear force is generated around the wire electrode (powered electrode) that plays a complementary role in the production of electric wind caused by corona discharge. As this nonlinear force is limited to the vicinity of the wire electrode, it is possible to ignore the nonlinear force with a good approximation in the calculation of the total electrohydrodynamic force, but this force cannot be ignored in the process of forming the electric wind.
Design scheme of a high dynamic semi-airborne transient electromagnetic receiving system based on a voltage-controlled amplifier
Authors: Teng Fei , Wang Hualiang , Yu Qi , Li Dongsheng , Lin Tingting
Published: August 2023

The semi-airborne transient electromagnetic (SATEM) technique is established to examine subsurface targets. The SATEM approach is widely used in urban underground space exploration, hydrogeological search, and deep mineral exploration. However, the strength of SATEM signals declines exponentially with the depth of detection, and the SATEM system frequently operates in high electromagnetic noise environments, directly affecting the precision of deep information interpretation. This research presents a high dynamic semi-airborne transient electromagnetic (HDSATEM) receiving system to increase the late SATEM signal intensity. This system mainly comprises a voltage-controlled amplifier (VCA) and a function generator. In addition, the VCA is modulated using the gain voltage produced by the function generator. Consequently, a simulation model has been employed to analyze various functions to compare the dynamic ranges. The actual amplification performance and signal restoration capacity are confirmed using a laboratory test. A field experiment is also carried out to evaluate the actual detection performance of the proposed system compared to standard SATEM receiving and controlled source audio-frequency magneto-telluric systems. The findings indicate that the performance improvement of the HDSATEM receiving system is more than 50% in terms of depth detection compared to that of standard SATEM receiving systems.
Influence of the beam-beam collisions on the energetic particle distribution in large helical device
Authors: Tahara K. , Asai H. , Nuga H. , Murakami S.
Published: August 2023

The influence of Coulomb collisions between energetic particles in a neutral beam injection (NBI)-heated plasma is numerically investigated utilizing the improved collision operator for the orbit-following type of Monte Carlo codes. This nonlinear collision operator enables the collisional effect by non-Maxwellian plasmas including energetic particles to be taken into account. We have implemented it into GNET, one of the orbit-following Monte Carlo codes solving drift kinetic equation in the 5D phase-space, and performed simulations for tangentially injected NBI cases (beam energy: 180 keV), taking account of beam–beam Coulomb collisions. It is found that the beam–beam collisions cause energetic particle orbits to transition from passing to trapped and enhance the collisional transport, which results in the deterioration of the energetic particle confinement.
A low-profile electromechanical packaging system for soft-to-flexible bioelectronic interfaces
Authors: Fallegger Florian , Trouillet Alix , Coen Florent-Valéry , Schiavone Giuseppe , Lacour Stéphanie P.
Published: August 2023

Interfacing the human body with the next generation of electronics requires technological advancement in designing and producing bioelectronic circuits. These circuits must integrate electrical functionality while simultaneously addressing limitations in mechanical compliance and dynamics, biocompatibility, and consistent, scalable manufacturing. The combination of mechanically disparate materials ranging from elastomers to inorganic crystalline semiconductors calls for modular designs with reliable and scalable electromechanical connectors. Here, we report on a novel interconnection solution for soft-to-flexible bioelectronic interfaces using a patterned and machined flexible printed circuit board, which we term FlexComb, interfaced with soft transducing systems. Using a simple assembly process, arrays of protruding “fingers” bearing individual electrical terminals are laser-machined on a standard flexible printed circuit board to create a comb-like structure, namely, the FlexComb. A matching pattern is also machined in the soft system to host and interlock electromechanically the FlexComb connections via a soft electrically conducting composite. We examine the electrical and electromechanical properties of the interconnection and demonstrate the versatility and scalability of the method through various customized submillimetric designs. In a pilot in vivo study, we validate the stability and compatibility of the FlexComb technology in a subdural electrocorticography system implanted for 6 months on the auditory cortex of a minipig. The FlexComb provides a reliable and simple technique to bond and connect soft transducing systems with flexible or rigid electronic boards, which should find many implementations in soft robotics and wearable and implantable bioelectronics.
Giant room-temperature modulation of magnetic anisotropy by electric fields in CoFeB/(011)-PMN-PT multiferroic heterostructures with two distinct initial magnetic anisotropies
Authors: He Lanping , Wang Cangmin , Wang Shaoting , Li Wanyu , Jiang Yang , Ge Weifeng , An Linlin , Qiu Huaili , Chen Meixia , Yang Yuanjun , Wang Lan
Published: August 2023

This paper reports that the in situ growth magnetic field (Hg) during magnetic-phase CoFeB deposition impacts the electric-field control of magnetic anisotropy in Co40Fe40B20/(011)-Pb(Mg1/3Nb2/3)0.7Ti0.3O3 [CoFeB/(011)-PMN-PT] composite multiferroic heterostructures at room temperature. In the Hg1 mode (in situ Hg along the [011¯] direction of the ferroelectric PMN-PT substrate), the electric-field-controlled modulation ratios of the magnetic coercivity HC and saturation magnetic field HS are approximately −47% and +156%, respectively. However, in the Hg2 mode (in situ Hg along the [100] direction of the ferroelectric PMN-PT substrate) of the CoFeB/(011)-PMN-PT multiferroic heterostructure, the electric-field-controlled modulation ratios of the magnetic coercivity HC and saturation magnetic field HS can reach as high as +162% and +393%, respectively. Moreover, the electric-field-controlled magnetic coercive field HC exhibits a butterfly shape when plotted versus the applied electric fields in both modes, which matches the in-plane butterfly strain loop of the ferroelectric PMN-PT substrate. However, the electric-field-controlled saturation magnetic field HS presents a square loop, which is very consistent with the ferroelectric loop of the PMN-PT substrate. This result may be ascribed to the distinct pathway of the ferroelastic domain switching in the (011)-oriented PMN-PT substrate. This study provides a new idea for the design of spintronic devices based on multiferroic heterostructures.
An ultra-high timing resolution pulse generator with spur suppression and correction of errors based on real-time computation
Authors: Liu Hanglin , Fu Zaiming , Kong Dexuan
Published: August 2023

In this paper, a novel ultra-high timing resolution pulse generator is proposed. It is based on the waveform real-time computation method. Through real-time computing and filtering of the waveform samples, a pulse with a 0.1 ps timing resolution pulse could be generated at a 2.5 GSPS sampling rate. Based on the waveform real-time computation method, jitters are injected into the waveform time parameter to break the harmonic components caused by non-integer multiples of the sampling rate and waveform frequency. Waveform spurs are further suppressed using this approach. The pulse error correction is achieved by designing digital filters that complement the waveform distortion features. The complementary digital filters are then combined as Farrow filter coefficients by polynomial fitting. Based on the real-time computation method, pulse width modulation, frequency modulation, and amplitude modulation are easy to realize. The implemented pulse generator has four channels, whose minimum pulse width, edge time, frequency range, and amplitude range are 4, 2.5 ns, 1 μHz–120 MHz, and 50 mVpp–5 Vpp, respectively. All timing resolution and timing accuracy of pulse width, edge time, pulse period, and channel delay are 0.1 and 50 ps, respectively. Timing parameters can be changed continuously without glitches.
A view of American farm policy in transition
Authors: Coppess Jonathan
Published: August 2023

Reauthorization of the Farm Bill is scheduled for 2023 and the agenda of the 118th Congress (2023–2024) elected in the 2022 midterms. The Farm Bill is the main legislative vehicle for American farm and food policy. The Farm Bill was last reauthorized by the Agricultural Improvement Act of 2018, but the years since that time have featured four programs that made direct payments to farmers but were not authorized by Congress in the Farm Bill, commonly referred to as ad hoc assistance. In addition, the 117th Congress (2021–2022) enacted the Inflation Reduction Act which invested an additional US$18 billion into farm conservation programs over multiple years. This article reviews the ad hoc assistance and Inflation Reduction Act with comparisons to previous instances of ad hoc assistance, applying some lessons from history and seeking to gauge the extent to which the non-farm bill efforts provide leading indicators or signals about changes to, or a transition in, American farm policy.
Study of plasma characteristics of hollow cathode in glow discharge
Authors: Qiu Yanzhao , Yu Lu , Zhou Jindong , Zhu Huilong , Yang Danning , Yu Linshan , Chen Rui , Zhang Chengyuan , Ni Ruian , Li Qinghua , Wu Hongyan
Published: August 2023

In order to further investigate the conditions and the coupling mechanisms for generating the hollow cathode effect (HCE) for the process optimization in the field of surface modification, the plasma distribution and density in single glow and double glow hollow cathode discharge (HCD) were explored by experiments and simulations based on the two-dimensional fluid model. Additionally, we investigated the effects of the key parameters on the plasma density, the electron temperature and the potential field during the HCD. The experimental and simulation results showed that the high plasma density is owing to the HCE in the hollow cathode. It is found that there is a critical pore diameter for generating HCE, which is approximately the sum of the thickness of the plasma sheath and four times the electron-neutral mean free path in the single glow discharge while twice thickness of the plasma sheath and four times the electron-neutral mean free path in the double glow discharge. The HCE in the double glow discharge can be observed when the ignition voltage that the source cathode voltage be 250 V greater than the workpiece cathode voltage can be met while the PD value is about 1.5 ∼ 3.8 Torr

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mm. Consequently, we believe that our investigation on the plasma characteristics of hollow cathode in glow discharge will contribute to the development of the more optimal processing parameters for the application of the glow plasma discharge phenomena.
Astronomical measurements 1923–2023: a century of astonishing progress
Authors: Edmunds M G
Published: August 2023

How have advances in technology changed astronomy over the past 100 years? In this very brief review I will give examples of just how closely discovery has followed technical innovation, allowing observations that would previously have seemed impossible. Obviously great progress has come from spaceflight allowing observations from outside the Earth’s atmosphere. But two other factors have also been crucial—the development of efficient detectors of electromagnetic radiation and the application of computers to both instrument control and data analysis. Driving down experimental errors in pursuit of ever-more accurate measurements has been important too. I will particularly highlight advances in cosmology, the nature of galactic nuclei and the discovery of exoplanets.
A review of shape memory alloy artificial muscles in bionic applications
Authors: Du Haoyuan , Li Guorui , Sun Jiyu , Zhang Yanyan , Bai Yunhe , Qian Chen , Liang Yiming
Published: August 2023

As an important part of soft robots, artificial muscles have received increasing attention. And since artificial muscles are developed by imitating the characteristics of biological muscles, they are naturally suitable for bionic applications. Shape memory alloys (SMAs) have been widely used in the field of artificial muscles due to their high energy density, biocompatibility, corrosion resistance, and self-sensing properties. In this review, the bionic applications of SMA artificial muscles are classified and summarized, and they are divided into two categories: bionic robotics (animal imitation) and biomedical (human imitation) applications. In the part of bionic robots, we summarize the applications of SMA artificial muscles in bionic robots such as flying, jumping, walking, crawling and swimming robots according to the motion characteristics. In the part of biomedical applications, we summarize the applications of SMA artificial muscles in various parts of the human body. In addition, this review also counts the proportion of SMA wires and springs used in applications, and provides a reference for the subsequent selection of SMA wires and springs. Finally, the challenges and opportunities of SMA artificial muscles are summarized and prospected.
Weierstrass elliptic function solutions and degenerate solutions of a variable coefficient higher-order Schrödinger equation
Authors: Fan Lulu , Bao Taogetusang
Published: August 2023

In this paper, the auxiliary equation method is used to study the Weierstrass elliptic function solutions and degenerate solutions of the variable coefficient higher order Schrödinger equation, including Jacobian elliptic function solutions, trigonometric function solutions and hyperbolic function solutions. The types of solutions of the variable coefficient higher-order Schrödinger equation are enriched, and the method of seeking precise and accurate solutions is extended. It is concluded that the types of degenerate solutions are related to the coefficients of the equation itself when the degenerate solutions are obtained from the solutions of the Weierstrass elliptic functions. In addition, the solutions form of the equation is extended from the power series expansion form to the Laurent series expansion form, and the corresponding solutions are obtained. After the conversion formula between the Weierstrass elliptic function solutions and the Jacobian elliptic function solutions is constructed, the Jacobian elliptic function solutions of the higher order Schrödinger equation with variable coefficients are also obtained. These have not been previously studied.