bluuebunny/crossref_metadata_2025 huggingface dataset:
INVESTIGATION OF WATERJET EFFLUX NOISE WITH NUMERICAL TECHNIQUES
Authors: Dhavalikar S , Ramkumar J , Kumar CH P , Chaturvedi A
Published: October 2022

The URN resulting from a waterjet propulsion (WJP) is to be accurately estimated for stealth considerations. Such WJP systems are designed to operate either with a submerged jet (wet transom) or with a free surface jet (dry transom). The URN due to the operation of WJP system can be broadly categorized as pump noise and nozzle efflux noise. Pump noise includes mainly the cavitation noise and the tonal mechanical/hydrodynamic noise, whereas the nozzle efflux noise is due to jet impact and bubble entrainment. The present study attempts to implement advanced numerical techniques to estimate URN due to the nozzle efflux of a WJP in both wet and dry transom modes. Large Eddy simulations (LES) are carried out to simulate the hydrodynamics of turbulent multiphase flow behind both submerged and free surface water jets. The impact of water jet on free surface and subsequent bubble generation rate is captured using multiphase volume of fluids (VOF) technique. The impact noise is estimated by directly recording the fluctuating acoustic pressure at certain field
points during the simulation. A blob detection algorithm is implemented to compute the bubble generation rate. A mathematical model to compute the bubble pulsation noise from bubble generation rate is validated and implemented. The
estimated URN levels in wet and dry mode are presented and compared. Key inferences are presented which could be useful in further investigation of URN from water jet of stealth vessels, as well as to investigate bubble noise from propeller
cavitation, air lubrication etc.
AN EVALUATION OF A COATING SYSTEM THAT DELIVERS TOP SPEEDS, SUPERIOR MANOEUVRABILITY AND LONG-RANGE CAPABILITIES FOR THE SUSTAINABLE FUTURE OF WARSHIPS
Authors: van Ruiten M N
Published: October 2022

Coating systems are used in the shipping industry to protect the vessel against corrosion. The other main goal of coating systems is providing optimal hull performance; for warships consisting out of top speed, long-range capabilities, and
superior manoeuvrability. This can be achieved by preventing biofouling and having a smooth hull without paint degradation. However, with current systems, biofouling still has the change to attach to the ship’s hull despite the fact that these coatings have a significant environmental impact. These coatings will last for 3-5 years before it must be replaced as paint degradation develops over time. This results in a life cycle of re-applicating the coating every drydock session and sailing with excessive drag reduction, which involves significantly on the performance, fuel consumption, material
resources, associated transport, and overall costs. An alternative ideal for warships, named Surface Treated Composites (STC), is investigated in this paper. STCs are designed for regular in-water cleaning throughout the lifetime of the coating
without the need for reapplication. Regular in-water cleaning results in a significant drag reduction as the hull can be smooth whenever is needed. STCs therefore offer a viable antifouling strategy that is entirely non-toxic. The application of STCs leads to top speeds, long-range capabilities, superior manoeuvrability, and lower greenhouse gas emissions. This provides in financial benefits for the shipowner or shipping company because fuel is saved greatly and there are no expenses associated with repainting every couple of years. As a result, the STC coating is not only ecologically friendly but also cost-effective.
FULL AND SEMI AUTOMATED EARLY-STAGE SHIP LAYOUT GENERATION
Authors: Hifi N , Courts M
Published: October 2022

The generation of cost-effective ship design solutions to sets of requirements demands a thorough examination of a wide trade space of potential solutions in order to ensure that the ultimately selected solution is the best that can be achieved within an affordable budget. As more options are explored in shorter times then inevitably the degree of detail that can be developed for each solution will decrease, potentially leaving risk that later development will increase the anticipated cost. Early-stage
concept design tools are therefore evolving to provide more detail and faster analysis. The importance of ship layout in earlystage ship sizing has long been recognised and methods are required to generate confidence as quickly as possible, and that a
practical compartment arrangement can be achieved on any given concept. The paper outlines the general approaches used, and presents example outputs, from a tool developed to make use of genetic algorithms and techniques already proven on
existing system generation and analysis toolsets used by BAE Systems Naval Ships. The toolset adopts a staged approach involving a completely flexible mix of automated and manual operations to firstly allocate compartments to zones within a
ship and secondly arrange the compartments within those zones. The tool supports the capture and utilisation of knowledge from experienced designers and enables a rapid generation of preliminary ship layout options, within an integrated concept
trade space exploration process.
PRACTICAL SHIP DESIGN CONSIDERATIONS FOR MISSION MODULARITY
Authors: Kimber A C , Griffiths L
Published: October 2022

In this paper, the authors seek to review the direction mission modularity has been taking us and look forward to how modularity will influence future warship design, and some of the challenges that the naval architect will need to address.
SURVIVABILITY, ADAPTABILITY AND OFFBOARD SYSTEMS AUTONOMOUS AND OFFBOARD SYSTEMS AND THEIR IMPACT ON WARSHIP AND TASK GROUP SURVIVABILITY
Authors: Manley D
Published: October 2022

Developments in Artificial Intelligence, autonomous navigation, tactics and doctrine, recruitment issues and a desire to reduce the combat risk to service personnel are combining to drive the rapid development of offboard capabilities, often autonomous in nature, in the maritime environment. The paper discusses the likely impact of this change in paradigm on naval survivability at platform and task force level before addressing developments in technology and process either in hand or required, that will enable these systems to reach their full potential whilst ensuring that current survivability and combat safety performance is not compromised.
THE ZOOM YEARS: UCL MSC STUDENT WARSHIP DESIGNS THROUGH THE PANDEMIC
Authors: Pawling R J
Published: October 2022

The global pandemic placed enormous strain on teaching, both for staff and students. This was most keenly felt in group projects, such as the UCL postgraduate ship design exercise, the 2019-20 cohort facing intense disruption as they switched “modes” half-way through the year. Despite this, the students were able to develop some innovative designs to meet challenging requirements. This paper provides an overview of the main themes for the last two years, both in the requirements set by staff and particularly the design response, which has included aspects such as optional crewing and future fuels, concluding an update on recent and future developments in the course that are most relevant to naval design.
Investigation of Mobile Learning Readiness of Students According to Tablet Usage
Authors: Rysbayeva Akmaral , Kadirbayeva Roza , Baiyazovna Begaliyeva Saule , Baiseitova Nurila , Makhabbat Assylbek , Аbdigapbarova Ulzharkyn
Published: October 2022

In this study, it was aimed to determine the mobile learning readiness of university students and to examine the change according to tablet usage. The research was carried out in the fall semester of 2021–2022. The study, which was carried out with the participation of 360 university students, was carried out using the survey model. In the research, a 4-week distance education mobile learning training was given to university students. In the study, ‘Mobile Learning Readiness Scale’ was used to collect data. The scale used in the research was delivered and collected by university students online. The analysis of the data was made by using the SPSS programme, frequency analysis and t-test. The results were added to the research in the form of tables. As a result of the research, it was determined that university students have advanced mobile learning readiness.

Keywords: Distance Education, Mobile Learning, Readiness, Tablet, University Students
Software Suite for Self-Paced Learning
Authors: Zhang Meng , Gu Zi Xu , Amer Adan , Sidhu Gaganpreet , Srinivasan Seshasai
Published: October 2022

The faculty of engineering at XYZ University is very diverse with students coming from a variety of socio-economic backgrounds and nationalities. There is an expected level of prerequisite knowledge for courses in the program, especially for subjects in mathematics and physics. Yet, a significant number of students struggle to reach the same level of prior knowledge as their peers due to a lack of educational resources or due to language barriers. Entering lectures without the expected baseline understanding of the concepts increases the risk of cognitive overload because these students exert additional mental effort in retaining the pre-lecture information along with the lecture content. As a solution to this problem, we present a suite of web-based interactive programs that are accessible to the students outside the class.  The Software Suite will provide supplementary material to assist with self-paced learning in a 3rd year undergraduate engineering course, i.e., Finite Element Analysis, at XYZ University’s ABC Department. It will enable students design and analyze various engineering applications, namely, Spring System, Trusses, Beams, Frames, and Heat Transfer along one or two dimensions. The purpose of the interactive platform with several programs is to actively engage the students with this cognitive tool to cement their understanding of the concepts instead of passively perceiving it as a tutor or repository of information.
How Does Social Media Influence Young Chinese Females' Government Trust?
Authors: Guo Yuanyuan
Published: October 2022

This paper makes a multi-group analysis with gender as a grouping variable through a structural equation model and analyzes the intermediary chain role of political knowledge, political participation, and political efficacy between social media and government trust of the youth groups in Beijing. Results show that social media directly affects young females' political participation and does not directly impact young males' political participation. In both groups, political knowledge and political participation have a mediating chain role in social media and government trust. These results implicate that the government should pay attention to the development of social media, make good use of the indirect effect of social media on youths' government trust, focus on promoting correct and healthy political knowledge on social media, cultivate youth political consciousness, create more opportunities for youth political participation, and let the youth understand the significance of political activities, so as to improve their government trust.
Innovative Susceptibility of the Socio-Economic Systems
Authors: Sudomyr Svitlana Mykhaylivna , Zhybak Myron Mykolaiovych , Khrystenko Halyna Mykhaylivna , Zamora Oksana Igorivna , Babenko Vitalina Alekseevna
Published: October 2022

In the process of the given research the concepts of “innovation” and “innovative susceptibility” have been improved; the main blocks of enterprises innovative susceptibility have been identified, for each of them a system of estimated figures and a methodology for calculating the integrated indicator of innovative susceptibility have been developed in the process of research. The practical value of this study lies in providing methodological recommendations on the economic assessment of their innovative susceptibility in order to identify reserves for increasing the ability of enterprises to attract, develop and introduce various innovations.
Mathematic Instruments for Determination of the Innovative Constituent of Farming Enterprises Development
Authors: Hnatyshyn Lyudmyla , Sheludko Lesia , Prokopyshyn Oksana , Makeyeva Lyudmila
Published: October 2022

To secure a continuous activity in the conditions of sustainability of farming enterprises it is necessary to introduce innovations from internal financial source, i.e. profit. The innovative constituent of farming enterprises development is based on determination of the relationship between the elements of the resource component of production potential and profit. Localization and branch-organizational structure of farming enterprises continuously influence combination of the elements of the resource component of production potential, which determines the size of profit. Family farming enterprises need attraction of external sources for innovation financing. Farming enterprises with above 20 ha of arable land generate rather large profit in the process of reproduction. The profit can be reinvested in the innovative development in the next cycle.
Strategic Management of Factories in Conditions of Innovation-Marketing Orientation in the Industrial Market
Authors: Stebliuk Nataliia , Volosova Nataliia , Koberniuk Serhii , Rybak Olena
Published: October 2022

In order to maintain competitive positions in the industrial market, an enterprise should use innovative approaches based on constant analysis of the economic environment and forecasting of possible technological changes in it. The purpose of the study is to investigate the problem of strategic management of an innovative marketing orientation enterprise in order to determine its competitive position in the industrial market. The article deals with an example of the practical application of the methodology for constructing innovative development scenarios and describes the results of the application of each step with the help of reframing theory and methods of economic and mathematical modeling. The integral indicators of the state of the external and internal environment of the enterprise are determined, which allows to take into account the uncertainty factor in the selection and development of the strategy. As a result of the research, scenario modeling was proposed to determine the scenarios of enterprise innovative development.
Supply Chain of Agriculture Extension Agent Quality
Authors: Tamsah Hasmin , Yusriadi Yusriadi , Bata Ilyas Gunawan
Published: October 2022

In this regard, this study aims to analyze the relationship between agriculture extension agent quality with farmers' soft skill competence, teamwork, and its impact on increasing productivity of farmers from the perspective of extension agents. This research was conducted using quantitative methods, with structural equation modeling (SEM)-Amos as a study tool. The study was conducted on 2,350 extension agents (civil servants) in South and West Sulawesi. Until the specified time limit, only 123 extension agents filled out the questionnaire from the total extension agents at the study site. This study found that the quality of agricultural extension agents can improve farmers' productivity through soft skills competence and teamwork. The result contributes to the empirical study limitations of the relationship between agriculture extension agent quality and productivity of farmers, especially the indirect effect through soft skill competence and teamwork, even though this study is in terms of the extension agent itself.
The Contribution of ERP Systems to the Maturity of Internal Audits
Authors: Silva Ana Patrícia , Marques Rui Pedro
Published: October 2022

Maturity models help companies verify whether their maturity goal has been reached and point out some instruments that can be used to reach their desired maturity levels. Furthermore, if the organization's goal is to improve their organizational performance and competitiveness, then it is crucial to use ERP (enterprise resource planning) systems together with innovative accounting procedures and management strategies. Thus, this study aims to combine these two topics: ERP systems and maturity in IA (internal audit), assessing eventual existence of a relationship between these topics. The methodology used was a survey, through a questionnaire, to Portuguese internal auditors. From a sample composed of 83 responses, it is highlighted that although most of the results point to a high level of maturity of the IA, despite the sample size limitation, it was possible to conclude that, among other outcomes, there is no statistical evidence that points to a direct relationship between the use of ERP systems in the audit procedures and maturity levels in IA.
Mobile Health Text Misinformation Identification Using Mobile Data Mining
Authors: Hu Wen-Chen , Pillai Sanjaikanth E. Vadakkethil Somanathan , ElSaid Abdelrahman Ahmed
Published: October 2022

More than six million people died of the COVID-19 by April 2022. The heavy casualties have put people on great and urgent alert, and people have tried to find all kinds of information to keep them from being infected by the coronavirus. This research tries to find out whether the mobile health text information sent to people's devices is correct as smartphones have become the major information source for people. The proposed method uses various mobile information retrieval and data mining technologies including lexical analysis, stopword elimination, stemming, and decision trees to classify the mobile health text information to one of the following classes: (1) true, (2) fake, (3) misinformative, (4) disinformative, and (5) neutral. Experiment results show the accuracy of the proposed method is above the threshold value 50% but is not optimal. It is because the problem, mobile text misinformation identification, is intrinsically difficult.
Hierarchical Spatial Pyramidal Feature Representation Learning for Facial Expression Recognition
Authors: Gafour Yacine , Berrabah Djamel , Djafri Laouni , Benchohra Anouar
Published: October 2022

As the recognition of facial expressions has attracted increasing attention due to its important applications in several fields (security, human-machine interaction, marketing, etc.), thanks to the detection of different possible expressions (happiness, sadness, etc.), this technology is gaining more attention. This article presents a method for the recognition of facial expressions by exploiting spatial information. In this method, the LBP descriptor is proposed to extract local characteristics, and a hierarchical spatial pyramid model is used to capture spatial information in an image. This method enriches the semantic description of visual information, which improves the recognition rate of facial expressions. The experimental analysis was carried out on the CK+ facial expression dataset, which includes seven categories of expressions—“happy,” “sad,” “surprise,” “contempt,” “fear,” “disgust,” “anger”—and it has been given state-of-the-art performance. The recognition results of the system are very satisfactory.
A New Approach for Formal and Coherent Ontology Alignment
Authors: Kolli Manel
Published: October 2022

The ontology alignment process is a big challenge especially in open environments like the semantic web. In this process, the construction of the global ontology corresponds to the application of a succession of operations of change (add new mappings). This is obviously a critical task because the new implementation of changes can make the global ontology incoherent. Inevitably, some mappings will be a source of contradictions in terms of ontology. In order to handle these contradictions, the authors propose in this study a new formal solution based on CTL model checking for a consistent ontology alignment. This model uses the Kripke structure which satisfies the CTL logic formula to model the behaviors of the ontology of alignment. To test the functional utility of the proposed approach, they applied it to several examples and the results showed that the proposed framework is working correctly and that inconsistencies are detected in CTL models.
Improving the Electroplating Coating Uniformity Based on Fuzzy Control of the Setting Value Using the Combined Defuzzification Method with the Presence of Stochastic Influences
Authors: Solovjev Denis S.
Published: October 2022

The article describes a method to improve the uniformity of electroplating using fuzzy logic. This method provides for the replacement of the non-stationary model of the process dynamics in distributed coordinates with the quasi-stationary model of the process dynamics in lumped coordinates. The production knowledge model with "IF-THEN" rules is developed for the stochastic influences taken into account. The dynamic choice of the defuzzification method is justified by solving the problem of minimizing the absolute deviation of the coating thickness average value obtained from the non-stationary model from the predicted value according to the quasi-stationary model at const values of stochastic influences. As an example, fuzzy control of the current for nickel coating is considered, taking into account the stochastic influence of the electroplating time, detail area, temperature and acidity of the electrolyte. The experimental results prove the effectiveness of the combined defuzzification method in comparison with their independent use in the control process.
The Effect of Glazing, Reglazing, and Polishing on Zirconia Biaxial Flexural Strength
Authors: Farhani Suzan Nusantari Inda , Sumarsongko Taufik , Damayanti Lisda
Published: October 2022

Zirconia restorations are usually coated with glazing to provide an aesthetic and reduce wear on opposing teeth. Occlusal adjustments such as grinding and polishing to eliminate occlusal or internal interferences can affect the mechanical properties of zirconia. The purpose of this study was to evaluate the effect of glazing, reglazing, and polishing procedures on the biaxial flexural strength of zirconia ceramic. This experimental study used 20 samples of zirconia discs (12x1,2 mm), which were divided into fourth groups (n=5). The first group was zirconia discs without treatment as control, the second group with glazing treatment, the third group with reglazing treatment, and the fourth group with polishing treatment. Biaxial flexural strength was determined using a piston on three balls technique. The data were analyzed using 1-way ANOVA and t-test. The results of this study showed no statistically significant difference between the group with glazing, reglazing, polishing and the control group (p>0.05). The highest zirconia biaxial flexural strength was found in the polished group but not significant statistically (1913.64 ± 594.28 MPa). The reglazing group with the lowest average biaxial flexural strength was (1413.01 ± 365.66 MPa). It can be concluded that there were no differences in biaxial flexural strength between the polishing, glazing, and reglazing group. The use of polishing can be an alternative technique to improve aesthetics besides glazing and reglazing because it does not impair the biaxial flexural strength of zirconia.
Improved Higher Harmonic Control Analysis for HART-II Rotor
Authors:   Seoul National University, Im Byeonguk ,   Jeonbuk National University, Cho Haeseong , Kang Seunghoon , Kong Geonhyuk , Park Sunhoo , Shin SangJoon
Published: October 2022

A linear quadratic Gaussian controller for active vibratory loads reduction in helicopters is proposed based on a revisited higher harmonic control input. Conventional individual blade control input is redefined by using N-1/rev blade phase lead, N/rev collective, and N+1/rev blade phase lag signals by 1/rev frequencies modulation from the multi-blade coordinate transform. HART-II rotor is analyzed by the multi-body dynamic analysis combined with improved rotation formula on the geometrically exact beam equations equipped with the unsteady dynamic wake. A linear time-invariant representation for HART-II rotor is identified from the responses obtained by recursive Fourier series filter. A MATLAB/Simulink closed-loop control simulation is designed using the identified state-space realization. The N/rev vibratory loads are reduced by 50% while the steady trim function is valid, and the linear control results match well with the nonlinear responses. Furthermore, the multi-variable closed-loop stability estimated by the loop transfer functions using the disk margin analysis provide both gain and phase margins to the present control system.
Analysis Methods for Ground Resonance in Partial Ground Contact
Authors:   German Aerospace Center (DLR), Lojewski Reinhard , Kessler Christoph
Published: October 2022

Soft-in-plane rotor systems are susceptible to a self-induced vibration phenomenon called ground resonance. This dynamic instability results from lag motions of the rotor blades coupling with airframe degrees of freedom while the helicopter is in ground contact. As an addition to previous studies of nonlinear landing gear effects, this work presents the Matrix Pencil Method as a useful additional tool for signal analysis of perturbed nonlinear systems. Contrary to simple logarithmic decrements of decaying time-series, the Matrix Pencil Method allows additional insight into the underlying structure. This makes the method interesting for ground resonance. Additionally, the Lyapunov Exponent Method is introduced to highlight and analyze nonlinear effects in helicopter substitute models.
A Look Back on Flap-Lag Stability after 50 Years
Authors:   Washington University St. Louis, Peters David , Bergantz Andrew
Published: October 2022

Rotor flap-lag problems can occur in rotorcraft systems with flap and lag flexures. The linearized flap-lag equations of motion governing rotor flap-lag motion developed gradually through the years. It took a number of iterations to obtain correct equations. At first, stability was determined by numerical eigenvalue procedures, but the results showed very systematic trends that indicated a deep underlying physics. Finally, use of the Kelvin-Tait-Chetaev theorem and perturbation methods revealed the underlying physics and gave closed-form results for the damping and stability. Now, 50 years later, a look back at the closed-form result shows that they can be improved by simple modifications.
UH-60A Airloads Workshop - Setting the Stage for the Rotorcraft CFD/CSD Revolution
Authors:   US Army DEVCOM AvMC, Yeo Hyeonsoo , Ormiston Robert
Published: October 2022

The UH-60A Airloads Workshop was a unique collaboration of aeromechanics experts from U.S. Government, industry, and academia to address technical issues that hindered accurate rotor loads predictions. The Airloads Workshop leveraged the NASA/Army UH-60A Airloads flight test and NFAC wind tunnel test data. It functioned continuously for 17 years, from 2001 to 2018, and broughtabout one of the most important advancementsin rotorcraft aeromechanics prediction capabilities by successfully demonstrating high-fidelity coupled computational fluid dynamics (CFD) and computational structural dynamics (CSD) analyses for both steady and maneuvering flight. This paper describes the origins of the Airloads Workshop, how it worked, and why it succeeded. Most importantly a collaboration of key experts with diverse backgrounds focused on a common objective is perhaps the most effective approach for challenging problems. The paper surveys the technical activities that led to the successful CFD/CSD coupling for predicting airloads in challenging steady-level and maneuvering flight conditions that opened the door for practical application of CFD methods for designing future advanced rotorcraft. Lessons learned from the collaborative efforts to advance rotorcraft science and technology will continue to play a significant role for future rotorcraft research, design, and development activities.
Retrotransposon mapping in spider monkey genomes of the family Atelidae (Platyrrhini, Primates) shows a high level of LINE-1 amplification
Authors: Dumas Francesca , Perelman Polina L. , Biltueva Larisa , Roelke-Parker Melody E.
Published: October 2022

To investigate the distribution of LINE-1 repeat sequences, a LINE-1 probe was Fluorescence In Situ Hybridized (FISH) on the chromosomes of Ateles geoffroyi and Ateles fusciceps (Atelidae); a LINE-1 probe was also mapped on Cebuella pygmaea (Cebidae) and used as an outgroup for phylogenetic comparison. Ateles spider monkeys have a highly rearranged genome and are an ideal model for testing whether LINE-1 is involved in genome evolution. The LINE-1 probe has been mapped in the two Atelidae species for the first time, revealing a high accumulation of LINE-1 sequences along chromosomal arms, including telomeres, and a scarcity of LINE-1 signals at centromere positions. LINE-1 mapping in C. pygmaea (Cebidae) revealed signals at centromere positions and along chromosome arms, which was consistent with previous published data from other Cebidae species. In a broader sense, the results were analyzed in light of published data on whole-chromosomal human probes mapped in these genomes. This analysis allows us to speculate about the presence of LINE-1 sequences at the junction of human chromosomal syntenies, as well as a possible link between these sequences and chromosomal rearrangements.
Congestive heart failure masquerading as acute abdomen
Authors: Omar Eunizar , Persand Yasheen Krishna
Published: October 2022

Rationale:

As an uncommon manifestation of congestive heart failure, congestive hepatopathy requires an early diagnosis in order to render appropriate care. Misdiagnosis as intraabdominal sepsis may lead to erroneous initial intervention, such as fluid boluses, that can potentially tip an already sick patient with poor reserves over into an extreme state.

Patient’s Concern:

A 65-year-old man was brought to the emergency department for excruciating abdominal pain, vomiting and jaundice. He also had lower limb pitting edema and was hypotensive en route.

Diagnosis:

Congestive hepatopathy.

Interventions:

Intravenous furosemide and fluid restriction.

Outcomes:

The patient declined admission to the cardiology ward and discharged himself against medical advice after his condition was improved in the emergency department.

Lessons:

It is important to pay attention to acute abdominal pain induced by extraabdominal pathologies. In this case of acute decompensated congestive heart failure, early recognition of the cause makes a difference to the management.
Nasal Vaccines for COVID-19
Authors: Spal Simran , Mahajan Anshul , Parvesh A. , Kohli Vipra , Kutikuppala L. V. Simhachalam , Suvvari Tarun Kumar
Published: October 2022

Coronavirus disease (COVID-19), a highly contagious viral respiratory illness, has resulted in widespread human losses, as well as posing more newer difficulties to the global health infrastructure. Vaccination has been a powerful public health tool for preventing deadly diseases, and it is still the most effective weapon when dealing with pandemics. Intranasal vaccines form an important part of the next-generation vaccines being developed to bolster our arsenal against infectious diseases. Nasal delivery of vaccines induces both systemic and local mucosal immune responses to help scale up the war against the inhaled pathogens. Owing to its simplicity, ease, convenience, safety, and higher effectivity, intranasal vaccines are turning out to be a promising alternative to the parenteral and other mucosal routes of administration. Intranasal vaccines are considered more efficacious than conventional parenteral injectable vaccines for influenza virus. The vaccination rate can be increased as the intranasal vaccine is directly delivered into nasal cavity and involves less cumbersome and painless procedure than intravenous administration. Nasal mucosa is an easily accessible organ with rich vascular supply and large surface area available for absorption aiding in quick absorption of vaccine. Furthermore, the intranasal vaccines are more affordable than the conventional vaccines.
Glutathione S-transferase genetic polymorphisms and fluoride-induced reproductive toxicity in men with idiopathic infertility
Authors: He Jun , Mu Yi , Liu Miao , Che Bang-Wei , Zhang Wen-Jun , Chen Ke-Hang , Tang Kai-Fa
Published: October 2022

Male infertility caused by idiopathic oligoasthenospermia (OAT) is known as idiopathic male infertility. Glutathione S-transferase (GST) and fluoride may play important roles in idiopathic male infertility, but their effects are still unknown. Our study examined the relationship between GST polymorphisms and fluoride-induced toxicity in idiopathic male infertility and determined the underlying mechanism. Sperm, blood, and urine samples were collected from 560 males. Fluoride levels were measured by a highly selective electrode method, and GST genotypes were identified using polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (PCR-RFLP). Semen parameters, DNA fragmentation index (DFI), mitochondrial membrane potential (MMP), and oxidative stress (OS) biomarkers were statistically assessed at the P < 0.05 level. Compared with healthy fertile group, semen parameters, fluoride levels, OS biomarkers, sex hormone levels, and MMP and DFI levels were lower in the idiopathic male infertility group. For glutathione S-transferase M1 (GSTM1[-]) and glutathione S-transferase T1 (GSTT1[-]) or glutathione S-transferase P1 (GSTP1) mutant genotypes, levels of semen fluoride, OS, MMP, and DFI were considerably higher, and the mean levels of sperm parameters and testosterone were statistically significant in GSTM1(+), GSTT1(+), and GSTP1 wild-type genotypes. Both semen and blood fluoride levels were associated with oxidative stress in idiopathic male infertility patients. Elevated fluoride in semen with the genotypes listed above was linked to reproductive quality in idiopathic male infertility patients. In conclusion, GST polymorphisms and fluorine may have an indicative relationship between reproductive quality and sex hormone levels, and OS participates in the development of idiopathic male infertility.
Revision of Roux-en-Y-Gastric Bypass – Our Experience in Indian Patients
Authors: Verma Naveen , Wadhawan Randeep , Sehgal Lalit , Veetil Deepa Kizhakke , Gupta Muneendra
Published: October 2022

Background:

The indications for revision bariatric surgery include inadequate weight loss, weight regain, failure to resolve comorbidities, and complications associated with primary surgery.

Objectives:

The objective is to evaluate the outcome of revision of Roux-en-Y gastric bypass (RYGB) and compare the efficacy of different revision procedures for weight regain, resolution of comorbidities, and complications, if any.

Methods:

Revision cases performed between May 2017 and April 2021 were included. The analysis of collected data was carried out for weight loss, resolution of comorbidities, and adverse outcomes.

Results:

Twenty three revision procedures were performed. Two patients were lost to follow-up. The overall complication and reoperation rates were 14.29% and 4.76%, respectively. The follow-up duration was at 6, 12, and 36 months. Twenty-one (91.3%) patients completed 6-month, 18 (78.3%) 12-month, and nine (39.1%) completed 36-month follow-up. The mean postoperative body-mass index at 6, 12, 36 months were 33.07+/−4.15, 33.11+/−4.05, 34.5 ± 8.81, respectively. The mean %excess weight loss (EWL) at 6, 12, 36 months were 39.47+/−13.76, 43.70+/−13.70, 41.14+/−8.48%, respectively. The patients were divided into three groups. Group A - lengthening of biliopancreatic limb (BPL) by 100 cm (n = 6); Group B - placement of ring with a diameter of 7.5 cm in addition to BPL lengthening (n = 12); and Group C - pouch trimming with BPL lengthening by 100 cm (n = 3). %EWL at 6 months was 31.86, 47.69, and 53.49, in Groups A, B, and C, respectively. Similar trends in %EWL were observed in three groups at 12 and 36 months.

Conclusion:

Revision bariatric surgeries are complex procedures. In our study, banded RYGB with BPL lengthening had better outcomes, though a statistical significance could not be established due to the small sample size and retrospective nature of the study.
Long term outcome and late toxicity Of SIB-IMRT in definitive management of head and neck cancers in patients not suitable for chemo-radiotherapy
Authors: Singh Narayan Pratap , Khurana Rohini , Sapru Shantanu , Rastogi Madhup , Gandhi Ajeet Kumar , Rath Satyajeet , Hadi Rahat , Mishra Surendra Prasad , Srivastava Anoop Kumar , Bharti Avinav , Sahni Kamal , Ali Mohammad , Tiwari Ramakant
Published: October 2022

Objective:

To evaluate efficacy and late toxicity of intensity-modulated radiotherapy with simultaneous integrated boost (IMRT-SIB) in definitive management of head-and-neck cancers.

Methods:

In this prospective interventional study, histological proven squamous cell carcinoma of oropharynx, hypopharynx, or larynx with stage T1-3 N0-3 M0 who were not candidates for concurrent chemotherapy were treated with IMRT-SIB with radical intent. Doses prescribed for IMRT-SIB to meet the clinical needs of nodal volumes were either SIB-66 schedule 66 Gray (Gy) prescribed to high risk (HR) planned target volume (PTV), 60 (Gy) to intermediate risk (IR) PTV and 54 Gy to low risk (LR) PTV in 30 fractions or SIB-70 schedule 70 Gy to PTV-HR, 59.4 Gy to PTV-IR and 56 Gy to PTV-LR in 33 fractions.

Result:

Forty-five patients were included. Forty-two patients were treated with SIB-66 schedule and three patients with SIB-70 schedule. The median follow-up period was 21 (6–68) months. There was residual disease in three patients. Recurrence was observed in 24 patients. Most recurrences were in HR volume (n = 19) and three patients had distant failure. Estimated 2-year locoregional control, disease-free survival, and overall survival were 55.55%, 49.7%, and 51.1%, respectively. Grade 3 late skin toxicity, subcutaneous fibrosis, and xerostomia were observed in three patients.

Conclusions:

Efficacy and late toxicity of IMRT-SIB observed in our study suggest it as a suitable treatment option for patients who are not fit for chemoradiation.
Challenging treatment of parameningeal rhabdomyosarcoma with leptomeningeal metastasis
Authors: Aksoy Rahmi Atıl , Güler Elif , Karaali Kamil , Aksu Melek Gamze , Gürer İnanç Elif , Akbaş Hilal , Özay Mine Genç
Published: October 2022

Parameningeal rhabdomyosarcomas (PM RMSs) are rarely seen childhood tumors. Their treatment might be challenging and prognosis is poor compared to other head and neck RMS. Here we report a PM RMS presenting with leptomeningeal seeding metastasis a year after diagnosis. A five-year-old girl presented with an enlarging mass protruding from the right ear and right facial paralysis. Magnetic resonance imaging (MRI) revealed a large mass extending from right external auditory canal to the temporal lobe, pterygoid fossa and nasopharynx with an intracranial component indenting the right temporal lobe and extending into the right cavernous sinus. Trucut biopsy revealed embryonal rhabdomyosarcoma. Cerebrospinal fluid (CSF) cytology was negative for malignant cells. Chemotherapy was started since it was found unresectable. At second week of chemotherapy, radiotherapy was applied to primary tumor location with intensity-modulated radiation therapy (IMRT) technique in 1.8 Gy fractions to total dose of 50.4 Gy. At week 27, MRI showed significant response. At week 36, the patient presented with vomiting and tendency to sleep. MRI was found to be compatible with meningitis and antibacterial therapy was started. At week 39, chemotherapy was stopped. But MRI performed one month later revealed linear contrast enhancements around the spinal cord compatible with leptomeningeal metastases. Chemotherapy and craniospinal irradiation were applied. But the patient did not improve and received palliative treatment. Six months after the completion of radiotherapy the patient died. Treatment of parameningeal rhabdomyosarcomas require multidisciplinary approach including surgery, radiotherapy, and chemotherapy. Prognosis is poor for patients with leptomeningeal spread.
Cancer-Specific Sequences in the Diagnosis and Treatment of NUT Carcinoma
Authors: Lee Mi-Sook , An Sungbin , Song Ji-Young , Sung Minjung , Jung Kyungsoo , Chang Eun Sol , Choi Juyoung , Oh Doo-Yi , Jeon Yoon Kyung , Yang Hobin , Lakshmi Chaithanya , Park Sehhoon , Han Joungho , Lee Se-Hoon , Choi Yoon-La
Published: October 2022

Purpose NUT carcinoma (NC) is a solid tumor caused by the rearrangement of NUTM1 that usually develops in midline structures, such as the thorax. No standard treatment has been established despite high lethality. Thus, we investigated whether targeting the junction region of NUTM1 fusion breakpoints could serve as a potential treatment option for NC. Materials and Methods We designed and evaluated a series of small interfering RNAs (siRNAs) targeting the junction region of BRD4-NUTM1 fusion (B4N), the most common form of NUTM1 fusion. Droplet digital polymerase chain reaction using the blood of patients was also tested to evaluate the treatment responses by the junction sequence of the B4N fusion transcripts.Results As expected, the majority of NC fusion types were B4N (12 of 18, 67%). B4N fusion-specific siRNA treatment on NC cells showed specific inhibitory effects on the B4N fusion transcript and fusion protein without affecting the endogenous expression of the parent genes, resulting in decreased relative cell growth and attenuation of tumor size. In addition, the fusion transcript levels in platelet-rich-plasma samples of the NC patients with systemic metastasis showed a negative correlation with therapeutic effect, suggesting its potential as a measure of treatment responsiveness.Conclusion This study suggests that tumor-specific sequences could be used to treat patients with fusion genes as part of precision medicine for a rare but deadly disease.
Using Learning Analytics to Examine Differences in Assessment Forms From Continuous Versus Episodic Supervisors of Family Medicine Residents
Authors: Lee Ann S. O. , Donoff Christopher , Ross Shelley
Published: October 2022

Background

It is assumed that there is a need for continuity of supervision within competency-based medical education, despite most evidence coming from the undergraduate medical education rather than the graduate medical education (GME) context. This evidence gap must be addressed to justify the time and effort needed to redesign GME programs to support continuity of supervision.

Objective

To examine differences in assessment behaviors of continuous supervisors (CS) versus episodic supervisors (ES), using completed formative assessment forms, FieldNotes, as a proxy.

Methods

The FieldNotes CS- and ES-entered for family medicine residents (N=186) across 3 outpatient teaching sites over 3 academic years (2015-2016, 2016-2017, 2017-2018) were examined using 2-sample proportion z-tests to determine differences on 3 FieldNote elements: competency (Sentinel Habit [SH]), Clinical Domain (CD), and Progress Level (PL).

Results

Sixty-nine percent (6104 of 8909) of total FieldNotes were analyzed. Higher proportions of CS-entered FieldNotes indicated SH3 (Managing patients with best practices), z=-3.631, P<.0001; CD2 (Care of adults), z=-8.659, P<.0001; CD3 (Care of the elderly), z=-4.592, P<.0001; and PL3 (Carry on, got it), z=-4.482, P<.0001. Higher proportions of ES-entered FieldNotes indicated SH7 (Communication skills), z=4.268, P<.0001; SH8 (Helping others learn), z=20.136, P<.0001; CD1 (Doctor-patient relationship/ethics), z=14.888, P<.0001; CD9 (Not applicable), z=7.180, P<.0001; and PL2 (In progress), z=5.117, P<.0001.

Conclusions

The type of supervisory relationship impacts assessment: there is variability in which competencies are paid attention to, which contexts or populations are included, and which progress levels are chosen.
A Reflection and Discussion Exercise on Racial Justice and Equity
Authors: Patnaik Rohan , Attlassy Nabil , Davids Susan , Fletcher Kathlyn E.
Published: October 2022

Background

Residents have valuable perspectives about diversity and equity in medical training, yet many graduate medical education curricula lack dedicated activities focused on such issues.

Objectives

To describe and report feasibility and acceptability of an innovation that uses individual reflection and group discussion to create conversation in our residency program about equity and injustice through the lens of the Black Lives Matter movement.

Methods

In July 2020, we sent a survey with reflection prompts to all postgraduate year 2 and above internal medicine residents. In the discussion session (during required academic time), we presented 10 of the residents' responses to the reflection prompts. After each response was read aloud, the residents had an open discussion. We used thematic analysis to analyze the responses to the reflection prompts. Acceptability was tracked through free-text comments in the survey. Feasibility was measured by the time and resources needed to conduct the session.

Results

We received responses from 24 out of 72 (33%) residents. We identified 10 codes that fell into 4 themes. The most commonly identified codes included anger or frustration toward events, self-reflection on privilege, increased awareness and discussion of racism in daily life, and life being minimally impacted/homeostasis. The 4 overarching themes were (1) awareness, (2) motivation for change, (3) emotional response, and (4) self-reflection.

Conclusions

Using a format of reflection and sharing of anonymous responses was an inexpensive and effective method to begin a discussion about equity and injustice in medicine.
Racial Bias on the Emergency Medicine Standardized Letter of Evaluation
Authors: Kukulski Paul , Schwartz Alan , Hirshfield Laura E. , Ahn James , Carter Keme
Published: October 2022

Background

Studies on components of residency applications have shown evidence of racial bias. The Standardized Letter of Evaluation (SLOE) is an assessment measure for emergency medicine (EM) residency applications and, as more specialties opt to use SLOEs in place of narrative letters of recommendation, understanding bias on standardized assessments is essential.

Objective

To determine whether there is a difference in rankings on the EM SLOE between underrepresented in medicine (UIM) and non-UIM applicants, White and non-White applicants, and to examine whether differences persist after controlling for other characteristics.

Methods

The sample was drawn from medical students who applied to EM residency at the study institution in 2019. We compared rankings between UIM and non-UIM students and between students of each individual race/ethnicity and White students, after controlling for United States Medical Licensing Examination Step scores, Alpha Omega Alpha status, type of school (US MD, US DO, internation medical graduate), Medical Student Performance Evaluation class percentile, affiliated program vs visiting clerkship SLOE, gender and the interaction of race/ethnicity and gender, and adjusted for students submitting multiple SLOEs, using ordinal regression.

Results

There were 1555 applicants to the study institution in 2019; 1418 (91.2%) had a SLOE and self-identified race/ethnicity. After controlling for applicant characteristics, non-UIM students were significantly more likely to be ranked higher than UIM students on “Rank Against Peers,” (OR 1.46, 95% CI 1.03-2.07) and Grade (OR 1.46, 95% CI 1.05-2.04).

Conclusions

Analysis of EM SLOEs submitted to our institution demonstrates racial bias on this standardized assessment tool, which persists after controlling for other performance predictors.