bluuebunny/crossref_metadata_2025 huggingface dataset:
The Incidence of Bacteraemia following Laryngeal Mask Insertion
Authors: Brimacombe J. , Shorney N. , Swainston R. , Bapty G.
Published: January 2019

The incidence of bacteraemia following insertion of the laryngeal mask airway (LMA) was investigated in one hundred fit patients. Four cultures were positive: three represented contamination with skin flora; the other was a microaerophilic streptococcus grown from an anaerobic culture bottle. Although this organism can be pathogenic, it may also represent contamination. Our findings suggest that significant bacteraemia on insertion of the LMA is uncommon and is probably no more than with oral intubation. Antibiotic prophylaxis is of doubtful benefit in these circumstances.
Cranial Computed Tomography in the Assessment of Neurological Complications in Critically Ill Patients with Systemic Lupus Erythematosus
Authors: Yang W. T. , Daly B. D. , Li E. K. , Hutchinson R.
Published: January 2019

The cranial computed tomography findings in 22 critically ill patients with systemic lupus erythematosus in the intensive care unit were reviewed to document the spectrum of pathology encountered and to assess the contribution of cranial computed tomography to the diagnosis and management of such patients, many of whom had severe multisystem disease.

Thirty-one scans were performed in 22 patients, all of which were abnormal. Premature cerebral atrophy was identified in fifteen patients (68%), cerebral infarction in five (23 %), intracranial haemorrhage and cerebral oedema in four each (18%), and hydrocephalus in three (14%). Six patients had multiple pathologies. The cranial computed tomography findings confirmed the clinical diagnosis in 13 of 22 cases (59%) and altered it in nine (41%). The contribution to diagnosis and management justifies transportation and computed tomography scanning. The contribution to patient outcome, however, is uncertain as mortality was 91%.
End-Tidal Oxygen Measurement Compared with Patient Factor Assessment for Determining Preoxygenation Time
Authors: Machlin H. A. , Myles P. S. , Berry C. B. , Butler P. J. , Story D. A. , Heath B. J.
Published: January 2019

Time to adequate preoxygenation was assessed in 200 elective surgical patients, using measurement of end-tidal oxygen concentration. A variety of patient factors were assessed as to their ability to predict the time required to preoxygenate a patient. Of the 200 patients, 23 (11.5%) were unable to be adequately preoxygenated; most of these cases were due to a poor mask fit. The average time for preoxygenation was 154 seconds (range 43–364 seconds). Of those patients who could be preoxygenated, 46 (23%) required more than three minutes. Although a regression equation could be constructed to calculate time required for preoxygenation, the wide standard errors of the coefficients preclude a clinically useful predictive equation.

We thus found that we could not accurately predict time required for preoxygenation and that a routine three minutes preoxygenation may not be sufficient for many patients. However, the measurement of end-tidal oxygen concentration is a very useful method of determining the end-point for preoxygenation.
A Study of a Hospital Staff's Knowledge of Pulse Oximetry
Authors: Kruger P. S. , Longden P. J.
Published: January 2019

A selection of medical and nursing staff and anaesthetic technicians at work on a particular day at a regional Base Hospital were invited to complete a questionnaire to assess their knowledge of the principles of pulse oximetry.

A 98.5% response rate (203 respondents) was achieved from staff in a broad cross section of hospital wards participating in the study. Most of the participants (nursing [N] 87%, medical [M] 91%, anaesthetic technicians [AT] 100%) used pulse oximetry regularly in their daily work. Less than half of the participants (N 36%, M 48% and AT 50%) felt they had adequate training in the use of pulse oximetry. Only 68.5% of participants correctly stated what pulse oximeters measure. Answers to the questions regarding the principles of pulse oximetry, potential errors, normal ranges or the physiology of oxygen haemoglobin dissociation varied but generally reflected limited understanding.

As the use of pulse oximeters extends beyond the operating theatre and intensive care environment, appropriate staff education must ensure a basic understanding of the operating principles of the instrument.
Anaesthesia Workforce in Australia and New Zealand
Authors: Baker A. B.
Published: January 2019

A survey of anaesthetic workforce was undertaken in departments in Australia and New Zealand approved for specialist training by the Australian and New Zealand College of Anaesthetists. When compared to a previous survey 17 years before, the results showed that the number of anaesthetics administered rose, the number of operating theatres (OTs) remained the same, but the surgical beds were reduced. There was a small increase (20%) in full-time specialists with a number of vacancies in establishment. There was, however, a large increase (80%) in Visiting Medical Officer (VMO) sessions and a 40% increase in Registrar positions. At the same time there were very large increases in Recovery Room nurses (125%) and Anaesthetic Assistants (100%).

From this survey and other recent government workforce reports it is possible to derive certain workforce postulates—a specialist anaesthetist will on average anaesthetize approximately 1000 patients per annum, one in every nine people in the population will have an anaesthetic each year, and the working lifespan of a specialist anaesthetist is 30 years with 5% working half-time or less. All of this suggests that the correct Anaesthetists to Population Ratio (APR) should be reset to 1:8,500 for both Australia and New Zealand. The number of trainees required to supply a steady state replacement for this specialist workforce is also derived and the current number of training positions is shown to be in excess of these requirements. When the current shortfall in specialist anaesthetists is corrected there will need to be a gradual reduction (by approximately 40%) in the number of training positions to prevent an oversupply of anaesthetists.

The factors which may potentially alter this forecast are addressed and include: change in the general population; ageing of the population; change in the average number of anaesthetics administered per anaesthetist per year; alteration in anaesthetists’ working lifespan; change in the age distribution of anaesthetists; increased economic usage of operating theatres and changes in the number of College approved training positions.
Bacteraemia during Direct Laryngoscopy and Endotracheal Intubation: A Study Using a Multiple Culture, Large Volume Technique
Authors: Goldstein S. , Wolf G. L. , Kim S. J. , Sierra M. F. , Whitmire C. , Tolentino E. M.
Published: January 2019

Bacteraemia secondary to orotracheal intubation has been reported to occur in 0-5.3% of patients. Bacteraemia detection is dependent upon several factors including the volume of blood per culture and the number of cultures. Prior studies used small volumes of blood and one or two cultures, and may therefore have underestimated the incidence of bacteraemia. Sixty-two adult patients who underwent direct laryngoscopy and endotracheal intubation were studied. Baseline blood cultures were sterile in all patients. After intubation, four blood cultures were obtained in ten minutes, with 10 ml being evenly divided between aerobic and anaerobic media. Two patients (3.2%) became bacteraemic. This is a lower incidence than occurs in association with other procedures for which The American Heart Association does not recommend administration of prophylactic antibiotics. Therefore, prophylactic antibiotics are not recommended prior to direct laryngoscopy. However, when a prophylactic antibiotic is administered prior to surgery, it would be best to administer the antibiotic prior to direct laryngoscopy and intubation.
Evaluation of the Onset Time and Intubation Conditions of Rocuronium Bromide in Children
Authors: McDonald P. F. , Sainsbury D. A. , Laing R. J.
Published: January 2019

We have assessed, in children aged three to eight years, the intubating conditions after administration of rocuronium 0.6 mg/kg at 50 or 60 seconds, in groups of 15 patients. Intubating conditions were excellent in 11, good in 3 and fair in 1 patient at 50 seconds and excellent in 12 and good in 3 patients at 60 seconds. The mean onset time, for all patients, to when the first twitch of the train of four (T1), measured at the adductor pollicis, was depressed to less than 30% and 5% of control was 50 (SD 11.4) seconds and 94 (SD 31.7) seconds respectively. Depression of T1 to less than 30% of control, measured at the adductor pollicis in children, appears to indicate that intubating conditions will be clinically acceptable when using rocuronium.
Comparison of 0.5% Ropivacaine and 0.5% Bupivacaine in Lumbar Epidural Anaesthesia for Lower Limb Orthopaedic Surgery
Authors: McGlade D. P. , Kalpokas M. V. , Mooney P. H. , Buckland M. R. , Vallipuram S. K. , Hendrata M. V. , Torda T. A.
Published: January 2019

The purpose of this study was to compare the epidural use of 0.5% ropivacaine and 0.5% bupivacaine in patients undergoing lower limb orthopaedic surgery.

In a double-blind, randomized, multi-centre study involving 67 patients, thirty-two patients received 20 ml of 0.5% ropivacaine and 35 patients received 20 ml of 0.5% bupivacaine at the L2,3 or L3,4 interspace. Parameters measured were the onset time, duration and spread of sensory block, the onset time, duration and degree of motor block, the quality of anaesthesia and the heart rate and blood pressure profile during block onset.

Four patients (3 ropivacaine, 1 bupivacaine) were excluded from the study due to technical failure of the block. The onset and duration of analgesia at the T10 dermatome (median, interquartile range) was 10 (5-15) minutes and 3.5 (2.7-4.3) hours respectively for ropivacaine, and was 10 (6-15) minutes and 3.4 (2.5-3.8) hours respectively for bupivacaine. Maximum block height (median, range) was T6 (T2-T12) for ropivacaine and T6 (C7-T10) for bupivacaine. Nine patients receiving ropivacaine and eight patients receiving bupivacaine developed no apparent motor block. The incidence of complete motor block (Bromage grade 3) was low in both groups, being 4/27 for ropivacaine and 6/34 for bupivacaine. In the ropivacaine group, motor and sensory block were judged to be satisfactory in 78% of patients. In the bupivacaine group, motor and sensory block were judged to be satisfactory in 71% and 62% of patients respectively. Cardiovascular changes were similar in both groups. No statistical differences were found between the two groups regarding any of the study parameters.
Plasma Somatostatin Correlates with Blunted Thyrotropin Secretion after Stimulation by Thyrotropin-Releasing Hormone in Critical Illness
Authors: Sumita S. , Ujike Y. , Iwasaki H. , Kawamata M. , Schichinohe Y. , Watanabe H. , Namiki A.
Published: January 2019

To clarify whether plasma somatostatin affects thyrotropin secretion in critical illness, plasma somatostatin and thyrotropin responses to thyrotropin-releasing hormone were studied in forty-three critically ill patients. High somatostatin levels were associated with blunted thyrotropin secretion in critically ill patients. There was an inverse correlation between plasma somatostatin levels and the maximum increment of thyrotropin after stimulation by thyrotropin-releasing hormone. Decreased somatostatin and increased thyrotropin secretion before discharge from the intensive care unit were demonstrated in survivors. On the other hand, non-survivors maintained high somatostatin levels and had blunted thyrotropin secretion during their intensive care admission. These results suggest that high plasma somatostatin levels may play a role in the blunted thyrotropin secretion observed in critical illness.
Pharmacokinetics and Pharmacodynamics of Suxamethonium
Authors: Torda T. A. , Graham G. G. , Warwick N. R. , Donohue P.
Published: January 2019

A study was undertaken to determine the time constants of elimination and effect compartment equilibration of suxamethonium and for the slope exponent of the Hill equation. Twelve patients were anaesthetized with thiopentone, fentanyl, and isoflurane in nitrous oxide and oxygen. After allowing conditions to become stable, they were administered three small doses of suxamethonium by rapid intravenous injection. The responses to supramaximal stimulation of the ulnar nerve were recorded by EMG in one and by accelerometry in eleven subjects. Because of failure to recover to control conditions, one subject was deleted from analysis. The recorded drug effect was used in a non-linear curve fitting technique to derive estimates of the pharmacokinetic and pharmacodynamic parameters. The plasma concentration of suxamethonium was adequately represented by a single compartment model. The mean half-life of elimination was 47s with a 95% confidence interval of 24 to 70s; that of effect compartment equilibration, 211s with a 95% confidence range of 139 to 282s. The average slope exponent was 6.4 and its 95% confidence range was 4.6 to 8.2. The data from the first two doses were used to predict the time taken for the third dose to recover 50%. The predictions showed a mean bias of <1% (NS) and a mean error of 21%, with a confidence interval of 5 to 37%. In only two out of eleven subjects was the prediction error greater than 30%.
Anaesthetic Assistants: Their Role in the Development and Resolution of Anaesthetic Incidents
Authors: Kluger M. T. , Bukofzer M. , Bullock M.
Published: January 2019

Trained anaesthetic assistants are considered essential for the safe conduct of anaesthesia. Data from 5837 AIMS (Anaesthetic Incident Monitoring Study) reports were evaluated for issues concerning anaesthetic assistants in the generation and resolution of anaesthetic incidents. “Inadequate assistance” as a contributing factor was identified in 187 reports, whilst “skilled assistance” which minimized the incident was present in 808 cases. One hundred and seventy-two reports specifically commented on anaesthetic assistants in the narrative section of the AIMS form. All surgical specialities were represented. In 147 of these reports the assistant actually contributed to or failed to assist with the incident. Although the majority of outcomes from the reports were uneventful, prolonged stay, awareness and ICU admission did ensue in a small number of cases. The most common incidents were related to problems with equipment, communication and inadequate staffing levels (number and/or skill mix). Results from this study have implications for anaesthetic assistant staffing levels and the orientation of course content.
Incidents in Obstetric Anaesthesia and Analgesia: An Analysis of 5000 AIMS Reports
Authors: Sinclair M. , Simmons S. , Cyna A.
Published: January 2019

We aimed to explore the first 5000 incidents reported to the Australian Incident Monitoring Study (AIMS) involving anaesthesia for obstetric patients and found 203 such incidents. Analysis and classification identified seven main incident groups; regional anaesthetic techniques (33%), anaesthetic equipment problems (13%), “wrong drug” errors (10%), other drug-related problems (16%), difficult/failed intubation (9%), problems with the endotracheal tube (9%) and other problems (10%). When compared to the incidents in the main database, obstetric cases were found to be over-represented with respect to accidental dural puncture, post dural puncture headache, failed intubation in emergency situations and the incidence of certain types of “wrong drug” error. The implications of these reports regarding safe practice of obstetric anaesthesia are discussed.
Personality Profiles of Australian Anaesthetists
Authors: Kluger M. T. , Laidlaw T. , Khursandi D. S.
Published: January 2019

Identification of personality traits in anaesthetists has potential implications for selection of trainees, assessment of coping strategies during times of stress and may have a role in the analysis of critical incidents. A 24 question postal questionnaire based on the Cattell 16PF inventory was sent to specialist anaesthetists in Australia. One hundred and sixty-seven replies were received (33% response rate). Personality traits did not differ when the anaesthetists were grouped for age, number of years qualified and country of qualification. City practitioners rated themselves more inquisitive than country practitioners did (P=0.052). Female anaesthetists self-reported they were calm (P=0.02), patient (P=0.02) and tolerant (P=0.02) more often than their male counterparts, whilst more males reported themselves as highly conscientious (P=0.01). Although some traits were consistent, personality profiles showed significant heterogeneity. Further examination of how personality and coping mechanisms interact may be central to the management of stress and critical incident generation.
Bilevel Non-Invasive Ventilation in Malignant Large Airways Obstruction during Chemotherapy and Radiotherapy
Authors: Grant R. K. , Boots R. J. , McEvoy J. D. S.
Published: January 2019

A case is described of acute respiratory failure secondary to variable intrathoracic large airway obstruction due to a lung neoplasm. Successful ventilation was achieved with facemask bilevel non-invasive ventilatory assistance allowing radiotherapy and chemotherapy to be undertaken.
Airway Management in Ludwig's Angina
Authors: Neff S. P. W. , Merry A. F. , Anderson B.
Published: January 2019

A 37-year-old 91 kg man presented with features of Ludwig's angina. Anaesthesia for incision and drainage of his submandibular abscess was undertaken by two specialist anaesthetists with an otorhinolaryngological surgeon prepared for immediate tracheostomy. After preoxygenation, gas induction with sevoflurane in oxygen was followed by a gush of pus into the oral cavity and laryngospam causing acute upper airway obstruction. This resolved with 25 mg of suxamethonium and an endotracheal tube was passed into the trachea with difficulty. Options for management of the difficult airway in Ludwig's angina are discussed.
Induction of Anaesthesia in Patients with Coronary Artery Disease: A Comparison between Sevoflurane-Remifentanil and Fentanyl-Etomidate
Authors: Wang J. Y. Y. , Winship S. M. , Thomas S. D. , Gin T. , Russell G. N.
Published: January 2019

In a prospective, randomized study, sevoflurane-remifentanil (Group SR) was compared with fentanyl-etomidate (Group FE) for induction of anaesthesia in patients with ischaemic heart disease. Cardiovascular stability, heart rate, mean arterial pressure, rate pressure product, rescue medications and associated myocardial ischaemia were measured. For Group SR (n=20), anaesthesia was induced with vital capacity breaths of sevoflurane 5% in oxygen. After loss of consciousness, the inspired sevoflurane was reduced to 3% and remifentanil was administered as a 0.5 μg.kg−1 bolus over 90 seconds (0.33 μg.kg−1 .min−1) followed by a 0.025 μg.kg−1. min−1 infusion. After intubation, the inspired sevoflurane was reduced to 2%. For Group FE (n =20), anaesthesia was induced with fentanyl 10.5 μg.kg−1 and etomidate 0.2 mg.kg−1 given 60 seconds later. Isoflurane 1% in oxygen was administered after loss of consciousness. Both groups received rocuronium and the trachea was intubated two minutes later. Sevoflurane gaseous induction was smooth, with cardiovascular stability comparable to fentanyl-etomidate. Significantly more patients in Group SR (P<0.05) were on beta-blocking medication, and, overall, the HR and RPP was lower pre-intubation in Group SR. Remifentanil administration was associated with severe bradycardia in three patients and asystole in a fourth. All four patients were on beta-blocking medication and three of the four were on diltiazem. The study was terminated due to the high incidence of bradycardic/asystolic complications in Group SR.
Anaesthesia in the Prone Position for Impalement Injury
Authors: Gattas D.J. , Weber L. S.
Published: January 2019

A 22-year-old man was brought to the Emergency Department in the prone position, having been impaled in the right buttock with a large pitchfork. He was in excruciating pain and nauseated; attempts to move the patient or the pitchfork caused severe pain. Caudal blockade was carried out in the prone position, without moving the patient, and proved to be very efficacious. The pitchfork was then removed painlessly, allowing us to turn the patient supine. A conventional induction of general anaesthesia was then made possible.
Rupert Walter Hornabrook—Australia's First Full-Time Anaesthetist
Authors: Pemberton E. J.
Published: January 2019

Rupert Walter Hornabrook, born in 1871, was the first physician in Australia to devote his medical practice solely to anaesthesia. He was appointed to the Royal Melbourne Hospital in 1909, after an adventurous earlier career which ranged from service in plague hospitals in India to the Boer War in South Africa.

Hornabrook was a colourful character whose work in anaesthesia included popularizing the use of the ethyl chloride-ether sequence in the early 1900s, when chloroform and closed inhalers were the norm. He was also a vigorous campaigner for the recognition of anaesthesia as a branch of medicine in its own right.
Age-Appropriate Pediatric Sports Patient-Reported Outcome Measures and Their Psychometric Properties: A Systematic Review
Authors: Suryavanshi Joash R. , Goto Rie , Jivanelli Bridget ,   PRiSM Outcomes Measures Research Interest Group, Aberdeen Jamila , Duer Timothy , Lam Kenneth C. , Franklin Corinna C. , MacDonald James , Shea Kevin G. , Fabricant Peter D.
Published: January 2019

Background:

Phenomena including early sport specialization and year-round training and competition have contributed to an increase in pediatric sports injuries. There has been a concomitant increase in clinical studies focusing on physically active children and adolescents. These studies include investigations of patient-reported outcome measures (PROMs). While the use of PROMs in pediatric orthopaedics has been increasing, PROMs are often inappropriately applied to study populations for whom they are not specifically validated.

Purpose:

The purpose of this study was to establish a comprehensive list of pediatric- and adolescent-validated PROMs and catalog their psychometric properties as a resource for clinicians and researchers.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review of articles in PubMed, Embase, and the Cochrane library was performed to identify articles developing and validating PROMs appropriate for use in pediatric sports medicine research. The inclusion criteria were as follows: age <18 years, the use of surveys and questionnaires, and the presence of sports-related injuries. The psychometric properties of included PROMs were entered into an electronic database.

Results:

Our search strategy identified 14,708 unique articles, among which 139 studies (0.9%) were included in the final data analysis. Forty-seven distinct PROMs were identified, as well as 160 cross-cultural adaptations. While all identified PROMs were validated in physically active young participants, only 12 (26%) were specifically created initially for active children. Thirty (64%) PROMs were health-related quality-of-life measures; 13 (28%) were psychosocial measures; and 4 (9%) were activity scales. No studies validated PROMs for use with wrist/hand injuries, and only 1 PROM each was valid for hip, back/spinal, and foot/ankle injuries in pediatric sports.

Conclusion:

This systematic review yielded 47 unique PROMs reliable and valid for use in pediatric and adolescent sports medicine. This list will unify clinicians and researchers in using these age-appropriate measures while identifying areas that are still in need of appropriate PROMs for young athletes.
When Data-Driven Decision Making Becomes Data-Driven Test Taking: A Case Study of a Midwestern High School
Authors: Roegman Rachel , Kenney Rachael , Maeda Yukiko , Johns Gary
Published: January 2019

This case study examines how district administrators and high school mathematics and science teachers use data in instructional decision making and what challenges they face in the current accountability context. Findings reveal unique aspects of data use directly related to a high school setting within the context of test-based accountability and illustrate how overlapping systems (state and federal policy, subject area knowledge, district norms, etc.) influence data practices. We conclude with implications for practice and policy around ways to use data to inform instruction beyond passing state assessments.
Perioperative Bridging With Glycoprotein IIb/IIIa Inhibitors Versus Cangrelor: Balancing Efficacy and Safety
Authors: Van Tuyl Joseph S. , Newsome Andrea Sikora , Hollis Ian B.
Published: January 2019

Objective: To review the efficacy and safety of perioperative administration of intravenous (IV) antiplatelet agents as a substitute for oral P2Y12 inhibitors and to provide clinicians guidance on optimal and cost-effective use of these medications. Data Sources: A MEDLINE literature search (1950 to November 2018) was performed using the key search terms abciximab, bridging, cangrelor, cardiac surgery, coronary artery bypass surgery, eptifibatide, intravenous antiplatelet agent, and tirofiban. Additional references were identified from a review of literature citations. Study Selection and Data Extraction: In all, 18 original research reports and case reports/series were included in the review. Data Synthesis: Prevention of postoperative bleeding is critical to decrease morbidity and mortality after cardiac surgery. IV antiplatelet medications have short half-lives and are frequently used to substitute for oral P2Y12 inhibitors to allow platelet function recovery before procedures. Functional recovery of platelets is delayed after abciximab discontinuation and increases postoperative bleeding risk. Eptifibatide and tirofiban have similar pharmacokinetic/pharmacodynamic properties and comparable efficacy and safety in the setting of perioperative bridging. Cangrelor may be considered in patients with renal insufficiency as decreased clearance of eptifibatide or tirofiban may increase the risk of postoperative bleeding. Relevance to Patient Care and Clinical Practice: Comparative studies of IV antiplatelet medications have not been published. Appropriate use of IV antiplatelet medications can prevent perioperative ischemic events and bleeding. Conclusions: Eptifibatide, tirofiban, and cangrelor are preferred over abciximab as a perioperative bridge. The choice of agent should be tailored to clinical characteristics of the patient and institutional acquisition costs.
Ergonomics in Alternative Vehicle Design: Educating Students on the Practical Application of Anthropometric Data
Authors: Wanberg John , Caston Michael , Berthold Derek
Published: January 2019

An instructor taught students to use industry-standard anthropometric data sets by applying them to a long-term, alternative vehicle design project within industrial design courses. Students learned how to verify existing anthropometric data through physical testing using three-dimensional mock-ups to produce a robust, anthropometrically appropriate model that balances multiple design constraints. As a practical exercise, students examined aesthetics and control interface of the vehicle interior focusing on human interaction, optimum comfort, and control within the confined constraints of the aerodynamically optimized vehicle packaging. Ultimately, students gained insights into how to apply ergonomics to new, varied design challenges through these educational tasks.
Addressing Climate Change Through a Low-Cost, High-Impact Carbon Tax
Authors: Geroe Steven
Published: January 2019

This article considers design features of a low-cost, high-impact carbon tax in terms of emissions reductions, drawing on international implementation experience. Costs can be reduced by offsetting carbon taxes with reductions in other taxes, using carbon tax revenue to compensate stakeholders, and incremental implementation. Impacts can be augmented by investing revenue in emissions reduction activity and complementary tax incentives for low-emissions technologies. Jurisdictions that have implemented such carbon taxes have continued to experience strong economic growth. While revenue and distributionally neutral carbon taxes that do not increase the overall tax take or change the distribution of wealth have been effectively introduced in many jurisdictions, this has not been the only approach. The more fundamental conclusion is that carbon taxes are being designed to maximize political acceptability and minimize economic disruption in their implementation context. This evidence of convergence toward low-cost, high-impact carbon tax design elements is establishing a viable pathway for international cooperation on carbon pricing at levels adequate to address climate change. Conversely, recent French experience indicates that carbon tax increases not based on substantial revenue and distributional neutrality may not be viable.
Study on dynamic characteristics of gas films of spherical spiral groove hybrid gas bearings
Authors: Jia Chenhui , Zhang Haijiang , Guo Shijun , Qiu Ming , Ma Wensuo , Zhang Zhuangya
Published: January 2019

According to the gas film force variation law, when the bearing axis is slightly displaced from the static equilibrium position, displacement and velocity disturbance relation expressions for the gas film force increment are constructed. Moreover, combined with the bearing rotor system motion equation, calculation model equations for the gas film stiffness and damping coefficients are established. The axial and radial vibration and velocity of the gas bearings during operation are collected. The instantaneous stiffness and damping coefficients of the gas film are calculated by the rolling iteration algorithm using MATLAB. The dynamic changes in the gas film stiffness and damping under different motion states are analyzed, and the mechanism of the gas film vortex and oscillation is studied. The results demonstrate the following: (1) When the gas bearing is running in the linear steady state in cycle 1, the dynamic pressure effect is enhanced and the stability is improved by increasing the eccentricity; when the gas supply pressure is increased, the static pressure effect is enhanced and the gas film vortex is reduced, but the oscillation is strengthened. (2) With the increase in rotational speed, the gas film vortex force gradually exceeds the gas film damping force, and the stability gradually worsens, causing a fluctuation in the gas film stiffness and damping, following which singularity occurs and a half-speed vortex is formed. Meanwhile, the gas film oscillation is intensified, and the rotor enters the nonlinear stable cycle 2 state operation. (3) As the fluctuation of the film force increases, the instantaneous stiffness and damping oscillation of the film intensifies, most of the stiffness and damping coefficients exhibit distortion, and the rotor operation will enter a chaotic or unstable state. Therefore, the gas bearing stiffness and damping variation characteristics can be used to study and predict the gas bearing operating state. Finally, measures for reducing the vortex and oscillation of the gas film and improving the stability of the gas bearing operation are proposed.
Insights into microbiome research 4: The computational analysis
Authors: Baranzini Sergio E
Published: January 2019

The computational analysis of microbiome samples is a highly specialized task, requiring powerful hardware and deep know-how not only in informatics and statistics but also in ecology and taxonomy. Different approaches must be followed based on the sequencing method (16S or shotgun) and while these can provide partially overlapping information, they are conceptually distinct. Understanding their differences and similarities can be useful in the interpretation of the results of microbiome studies.
Influence of roller defect and coupled roller–inner–outer race defects on the performance of cylindrical roller bearing
Authors: Patel Sachin P , Upadhyay S H
Published: January 2019

In the present study, a novel mathematical model is developed for the deformation between roller and races of cylindrical roller bearing using the effect of tilting and skewing of roller due to thrust load, radial deflection due to normal load, radial internal gap, and individual defect on roller as well as coupled defect on all races and roller. Also, novel roller defect function is proposed for the preparation of simultaneous nonlinear equations. MATLAB is used to solve nonlinear equations for equilibrium conditions of deflection, radial load, thrust load, moment in plane, and total roller loading. However, waviness due to surface irregularity on both races as well as out-of-balance assembly is not considered in this analysis. The bearing is analyzed for individual roller defect as well as coupled races–roller defects to identify the behavior of bearing under speed-varying conditions. The equation of motion is solved through Newmark-β technique. Defect segment of roller consecutively in contact with both races results in higher acceleration. Time-to-impact concept is utilized for the analysis. The acceleration during roller–race defect interaction with intermittent connection is applied in the model for observation. The outcomes are shown in the time domain, orbit, and envelope analysis, which describe the complexity of the system with speed variation for roller defect and coupled roller–inner–outer race defects. The periodic, quasi-periodic, and chaotic phenomena are observed for roller and coupled defects. Simulated frequencies for all defects are compared with theoretical frequencies to validate the model.
Internationalization of education as an emerging field? A framing of international education for cross-domain analyses
Authors: Tarc Paul
Published: January 2019

The internationalization of education (IE) has accelerated across the past two decades. Although there are now a range of representations and theorizations of IE, they find little connection across domains and levels. Toward bolstering a more coherent field of IE, which translates across distinctive expressions of IE, this paper argues for a conceptual approach that includes theorizing IE’s past and present enabling conditions, motivating visions, significant (operational) obstacles, and ensuing tensions. The main contribution is a conceptualization of late 20th century international education, which historically situates the current 21st century IE movement. This conceptualization is informed primarily by a periodization of the International Baccalaureate that surfaces the semantic contours and structuring tensions of international education as embedded in the shifting historical and socio-political conditions of the last 50 years. Semantically, 20th century international education carries with it literal (educational activities across national jurisdictions) and normative/aspirational significations (liberal-humanist education for making a better world). And the structuring tensions of international education are constituted in the entangling of the normative visions, as “education for international understanding,” with the instrumental agendas, as revenue generation. An emerging IE field can draw on the conceptual framing offered in this paper as a basis for theorizing across the somewhat siloed IE discourses.
The effects of UV degradation on the physical, thermal, and morphological properties of industrial nylon 66 conveyor belt fabrics
Authors: Moezzi Meysam , Yekrang Javad , Ghane Mohammad , Hatami Mehdi
Published: January 2019

In this study, nylon 66 industrial fabrics (used in the conveyor belts) were exposed artificially to the accelerated ultraviolet rays and the degradation mechanism was evaluated using spectral, thermal, and morphological analyses. The fabric samples were exposed to six different exposure times in a UV chamber and tensile tests were carried out in the main and bias (45°) directions. The results showed that the shear modulus was reduced in the early stages covering 4 h of the UV radiation because of the linkages breakage and the increase in the amorphous regions. However, after this early stage, the shear modulus started to increase. The Fourier transform infrared spectroscopy (FTIR), scanning electron microscope (SEM) analysis, and X-ray photoelectron spectroscopy (XPS) study were also performed to evaluate the surface morphology and the degradation mechanism of the nylon 66 fibers after UV illumination. The results also revealed that the formation of new links by free radicals caused the change in the bond wavelengths. Furthermore, it was found that there was an interesting mechanism for the UV degradation of nylon 66 fabrics at different exposure times, as confirmed by the results obtained regarding the mechanical properties of the samples. The results of this study can be, therefore, helpful for the industrial application of nylon 66 woven conveyor belts exposed to solar UV radiation.
Reviews of bearing vibration measurement using fast Fourier transform and enhanced fast Fourier transform algorithms
Authors: Lin Hsiung-Cheng , Ye Yu-Chen
Published: January 2019

The rolling element bearing is one of the most critical components in a machine. Vibration signals resulting from these bearings imply important bearing defect information related to the machinery faults. Any defect in a bearing may cause a certain vibration with specific frequencies and amplitudes depending on the nature of the defect. Therefore, the vibration analysis plays a key role for fault detection, diagnosis, and prognosis to reach the reliability of the machines. Although fast Fourier transform for time–frequency analysis is still widely used in industry, it cannot extract enough frequencies without enough samples. If the real frequency does not match fast Fourier transform frequency grid exactly, the spectrum is spreading mostly among neighboring frequency bins. To resolve this drawback, the recent proposed enhanced fast Fourier transform algorithm was reported to improve this situation. This article reviews and compares both fast Fourier transform and enhanced fast Fourier transform for vibration signal analysis in both simulation and practical work. The comparative results verify that the enhanced fast Fourier transform can provide a better solution than traditional fast Fourier transform.
Anticoagulation in patients with Embolic Stroke of Unknown Source
Authors: Spence J David
Published: January 2019

When warfarin was the mainstay of anticoagulation for the prevention of cardioembolic stroke, the paradigm was essentially “we mustn’t anticoagulate anyone unless we prove that the stroke was cardioembolic.” Now that direct-acting oral anticoagulants are available, the paradigm should change. The risk of stroke is highest soon after the initial event, particularly in patients with more than one infarction. Direct-acting oral anticoagulants are not significantly more likely than aspirin to cause severe hemorrhage, and it is now clear that patients with paradoxical embolism are better treated with anticoagulant than aspirin. Percutaneous closure of a patent foramen ovale is better than aspirin, but not better than anticoagulant, and some patients with paradoxical embolism may be better treated with anticoagulant than with percutaneous closure, which cannot prevent pulmonary embolism. Patients in whom cardioembolic stroke is strongly suspected should probably be anticoagulated pending the results of investigations such as echocardiography and prolonged cardiac monitoring for atrial fibrillation, and some of them, in whom the suspicion of a cardioembolic source is very strong, should probably be anticoagulated long term, even if such investigations do not confirm a cardiac source.
Impact of the Nutrition-Friendly School Initiative: analysis of anthropometric and biochemical data among school-aged children in Ouagadougou
Authors: Elkhouri Edde Christelle , Delisle Helene , Dabone Charles , Batal Malek
Published: January 2019

The Nutrition-Friendly School Initiative was developed in 2006 to counter the double burden of malnutrition and implemented on a pilot basis in primary schools in Ouagadougou (Burkina Faso) in 2009. A baseline study was conducted in intervention and control schools and repeated in 2014 to assess the impact. This paper reports on anthropometric and biochemical data in the final and baseline surveys. Both studies were conducted in the fifth grade classes of the same primary schools in Ouagadougou. Six intervention schools had been selected and matched at baseline with six control schools. The total sample consisted of 699 and 651 pupils in 2009 and 2014, respectively. Anthropometric and hemoglobin measurements were performed on all children, whereas serum retinol was measured in a random subsample to assess Vitamin A Deficiency (VAD). Independent t-tests and chi-squared tests were used for comparison of means and proportions, respectively, and multiple logistic regressions were conducted to examine associations between nutritional parameters and school characteristics. Final rates of anaemia and VAD were 32.6% and 26.1%, respectively, down from 40.4% and 38.7% at baseline. The final prevalence rate of stunting was 8.1%, thinness was 8.7% and overweight/obesity was 4.4%. Thinness declined significantly in 2014 compared to 2009, but there was no change in the rate of stunting even though the rate of overweight/obesity showed an upward trend. When comparing intervention with control schoolchildren, the only significant differences found in the final survey were less thinness and less anaemia in the intervention children. However, the prevalence of anaemia was also significantly lower in the intervention group at baseline. Our results point to a significant improvement in the nutritional status of schoolchildren in Ouagadougou and suggest a positive, although modest, role for the Nutrition-Friendly School Initiative in reducing thinness, but not overweight.
A Randomized Controlled, Treat-to-Target Study Evaluating the Efficacy and Safety of Insulin Glargine 300 U/mL (Gla-300) Administered Using Either Device-Supported or Routine Titration in People With Type 2 Diabetes
Authors: Davies Melanie , Bain Steve , Charpentier Guillaume , Flacke Frank , Goyeau Harmonie , Woloschak Michael , Hasslacher Christoph , Vespasiani Giacomo , Edelman Steven
Published: January 2019

Background:

The efficacy/safety of device-supported versus routine titration with Gla-300 in type 2 diabetes (T2DM) was evaluated.

Method:

AUTOMATIX was a 16-week, randomized, open-label, parallel-group, multicenter, noninferiority trial in insulin-treated or insulin-naïve people with T2DM. The fasting self-monitored plasma glucose (FSMPG) target was 90-130 mg/dL (5.0-7.2 mmol/L). Primary endpoint: proportion of participants achieving target FSMPG at week 16 without severe hypoglycemia. Secondary endpoints included: proportion reaching FSMPG target without confirmed (≤70 mg/dL [≤3.9 mmol/L]) or severe hypoglycemia; time to first achieve FSMPG target; mean FSMPG and HbA1c change (baseline to week 16). Safety endpoints included hypoglycemia and adverse events. Patient-reported outcomes (PROs) were also assessed.

Results:

Participants were randomized to device-supported (n = 75) or routine titration (n = 76); 17 participants in the device-supported group discontinued device use. Noninferiority was achieved for the primary endpoint (device-supported: 45.9%, routine: 36.8%; weighted difference: 9.04 [95% CI: −6.75, 24.83]), but not superiority ( P = .262). The proportion reaching FSMPG target range without confirmed (≤70 mg/dL [≤3.9 mmol/L]) or severe hypoglycemia was 34.3% vs 14.5%, respectively. The time at which 50% of the participants achieved the FSMPG target was less in the device-supported than routine titration arm (10 vs 13 weeks). Least squares mean HbA1c reduction, safety profiles, and PROs were similar in both arms. Mean “ease of use” score for the device, assessed by healthcare professionals and participants on a scale of 1-7, was ≥6.

Conclusions:

Device-supported self-titration had a good safety/efficacy profile, and was noninferior to routine titration and well accepted by diabetes specialists and patients.
Acceptance of the Artificial Pancreas: Comparing the Effect of Technology Readiness, Product Characteristics, and Social Influence Between Invited and Self-Selected Respondents
Authors: Oukes Tamara , Blauw Helga , van Bon Arianne C. , DeVries J. Hans , von Raesfeld Ariane M.
Published: January 2019

Background:

Psychosocial factors that may affect acceptance of artificial pancreas (AP) systems have been investigated in small sample sizes of highly motivated, self-selected persons with type 1 diabetes (T1DM) with a focus on product characteristics. We aimed to develop a valid survey to investigate the association of technology readiness and social influence with AP acceptance in a larger sample, including both self-selected and invited respondents with T1DM.

Methods:

An online survey was developed based on established questionnaires. Intention to use the AP was chosen as measure of AP acceptance. T1DM patients who signed up themselves for scientific research into AP systems represented the self-selected group, while patients treated at a teaching hospital represented the invited group. Questionnaire values were compared using independent t-tests and regression analyses.

Results:

The developed survey showed reliability and validity. The survey was completed by 425 self-selected and 109 invited persons. Intention to use the AP was high in both groups, but was significantly higher among self-selected respondents. In both groups, intention to use the AP was most strongly related to product compatibility, followed by product complexity, technology readiness, and product usefulness among invited respondents; and followed by product usefulness and technology innovativeness among self-selected respondents.

Conclusions:

Product characteristics have a stronger relationship with AP acceptance than technology readiness, while social influence does not seem to be associated with AP acceptance. As the (strength of) factors differ between self-selected and invited persons, researchers and product developers should be cautious when relying on self-selected persons with T1DM in the design, development, and testing of AP systems.