bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Basic Knowledge in Critical Care Nursing Between Nurses From the United States and Nurses From Other Countries
Authors: Toth Jean C.
Published: November 2019

• Background No previous research was found that compared basic knowledge in critical care nursing among nurses from different nations. Nurses from outside the United States were invited to participate during reliability testing of the Basic Knowledge Assessment Tool, Version 5.

• Purpose To compare basic knowledge in critical care between nurses from the United States and nurses from other countries and to measure the reliability of the Basic Knowledge Assessment Tool, Version 5.

• Sample Data were collected for 16 months from 682 critical care nurses: 528 from the United States and 154 from other countries.

• Results The Basic Knowledge Assessment Tool, Version 5, was a reliable test for all nurses studied, regardless of country of origin. The level of knowledge of nurses from English-speaking countries other than the United States did not differ from that of nurses from the United States. Scores for nurses from non–English-speaking nations were lower than scores for nurses from the United States. The largest source of variance in scores among all subjects was the length of experience in critical care nursing.

• Conclusions The Basic Knowledge Assessment Tool, Version 5, is a valid and reliable tool for assessing critical care nurses from the United States and the other countries studied. Critical care nurses from English-speaking countries scored higher than nurses from countries where the primary language is not English.
Factors to Consider When Analyzing 12-Lead Electrocardiograms for Evidence of Acute Myocardial Ischemia
Authors: Adams-Hamoda Mary G. , Caldwell Mary A. , Stotts Nancy A. , Drew Barbara J.
Published: November 2019

An important factor to consider when using findings on electrocardiograms for clinical decision making is that the waveforms are influenced by normal physiological and technical factors as well as by pathophysiological factors. Traditionally, the focus of bedside monitoring is detection of arrhythmia. However, continuous ST-segment monitoring for the detection of myocardial ischemia is now readily available. Many factors affect electrocardiographic waveforms and may interfere with diagnosis of myocardial ischemia based on electrocardiographic findings. Accordingly, a principal leadership role for clinical nurse specialists and nurse practitioners is to become knowledgeable about interpretation of 12-lead electrocardiograms and to share this knowledge with staff nurses who care for patients with acute coronary syndromes. The factors that alter electrocardiographic findings are reviewed, and the alterations that interfere with electrocardiogram-based diagnosis of myocardial ischemia are discussed.
Clinician-Implemented Research Utilization in Critical Care
Authors: Hodge Margaret , Kochie Larry D. , Larsen Leslie , Santiago Maurine
Published: November 2019

The application of research findings to practice is critical for improving patients’ outcomes and for ensuring that nursing practice is both cost-efficient and effective. Unfortunately, research findings that clearly should be used are not always implemented, a fact termed the “research-practice gap.” In 2000, as a result of the interest of staff nurses in establishing evidence-based practice, nurses from 7 adult critical care units at the University of California Davis Health System, Sacramento, Calif, began discussions on how to implement such a practice. A critical care research utilization committee was formed with representation from each of the adult critical care units, the emergency department, and the postanesthesia care unit. This committee was responsible for reviewing and revising each critical care policy and procedure on the basis of the best available evidence. The impetus for this project was a concern that current policies and procedures were, in part, based on tradition rather than on science and did not always reflect rapid changes in critical care, including use of new equipment, new treatments, and new findings. This project produced a number of beneficial outcomes. Policies and procedures were revised on the basis of scientific evidence, new research questions were generated on the basis of gaps in the literature, and the number of clinical nurses involved in using research to improve practice increased.
Collaborative Practice: Development, Implementation, and Evaluation of a Weaning Protocol for Patients Receiving Mechanical Ventilation
Authors: Grap Mary Jo , Strickland Dale , Tormey Laura , Keane Kim , Lubin Shannon , Emerson Joanne , Winfield Suzanne , Dalby Paul , Townes Regina , Sessler Curtis N.
Published: November 2019

• Background Use of protocols to reduce weaning time for patients receiving mechanical ventilation helps reduce cost and length of stay. However, implementation of this type of protocol is not easy and requires a consistent collaborative effort.

• Objective To provide a systematic approach to the weaning process by developing, implementing, and evaluating a protocol for weaning patients from mechanical ventilation in a medical respiratory intensive care unit.

• Methods The weaning protocol used was a modification of a protocol developed by Ely et al. Modifications included a more aggressive approach in proceeding to the spontaneous breathing trial, inclusion of the Richmond Agitation-Sedation Scale, and documentation of the production of secretions.

• Results Implementation of the protocol significantly reduced the duration of mechanical ventilation as measured by 8-hour shifts and ventilator days. Although length of stay in the intensive care unit was not significantly reduced (P = .29), a continuing downward trend occurred, from a mean of 8.6 days before the protocol was implemented to 7.9 days during the last 6 months of data collection (P = .07).

• Conclusions The need to provide efficient care requires the collaboration of all disciplines involved in providing patients’ care. The weaning protocol introduced in this study demonstrates the benefits of using a collaborative team to identify best practices and implement them in a practice setting.
The Link Between Teamwork and Patients’ Outcomes in Intensive Care Units
Authors: Wheelan Susan A. , Burchill Christian N. , Tilin Felice
Published: November 2019

• Background Links between teamwork and outcomes have been established in a number of fields. Investigations into this link in healthcare have yielded equivocal results.

• Objective To examine the relationship between the level of self-identified teamwork in the intensive care unit and patients’ outcomes.

• Method A total of 394 staff members of 17 intensive care units completed the Group Development Questionnaire and a demographic survey. The questionnaire is a reliable and valid measure of team development and effectiveness. Each unit’s predicted and actual mortality rates for the month in which data were collected were obtained. Pearson product moment correlations and analyses of variance were used to analyze the data.

• Results Staff members of units with mortality rates that were lower than predicted perceived their teams as functioning at higher stages of group development. They perceived their team members as less dependent and more trusting than did staff members of units with mortality rates that were higher than predicted. Staff members of high-performing units also perceived their teams as more structured and organized than did staff members of lower-performing units.

• Conclusions The results of this study and others establish a link between teamwork and patients’ outcomes in intensive care units. The evidence is sufficient to warrant the implementation of strategies designed to improve the level of teamwork and collaboration among staff members in intensive care units.
Time in Bed After Electrophysiological Procedures (TIBS IV): A Pilot Study
Authors: Gianakos Susan , Keeling Arlene W. , Haines David , Haugh Kathryn
Published: November 2019

• Background Electrophysiological studies of the heart became commonplace in the past decade. Like cardiac catheterizations, electrophysiological studies are often considered “same day” procedures; patients are admitted in the morning, undergo the procedure, recover for several hours while confined to bed, and then are discharged from the hospital. The requisite time in bed varies widely between institutions where electrophysiological studies are performed. Little has been published about the optimal time that patients should remain in bed.

• Objective To determine if the requisite time in bed could be safely reduced by 2 hours for patients recovering from electrophysiological studies done via a femoral venous approach.

• Methods An experimental-control group design was used. A total of 68 patients were randomized to 2 hours (n = 31) or 4 hours (n = 37) of bed rest. Groups were comparable in age and sex. Both groups were observed for 5 hours after the procedure.

• Results The incidence of bleeding did not differ significantly between the experimental and control groups. Bleeding occurred in only 1 patient.

• Conclusions The required 4 hours of bed rest after an electrophysiological study done via a femoral vein approach can safely be reduced to 2 hours. Early ambulation has implications for decreasing the cost of nursing care after the procedure and decreasing length of hospital stay, thus optimizing utilization of beds for recovery.
Comparison of Traditional and Disposable Bed Baths in Critically Ill Patients
Authors: Larson Elaine L. , Ciliberti Theresa , Chantler Christopher , Abraham Jolly , Lazaro Editha M. , Venturanza Majella , Pancholi Preeti
Published: November 2019

• Background For bedridden patients unable to perform personal hygiene measures because of acute illness or chronic debilitation, the bed bath, with either the traditional basin or, more recently, disposable baths, has long been a measure for improving hygiene and comfort.

• Objective To compare the traditional basin bed bath with a prepackaged disposable bed bath in terms of 4 outcomes: time and quality of bath, microbial counts on the skin, nurses’ satisfaction, and costs.

• Methods Forty patients in surgical, medical, or cardiothoracic intensive care units received both types of bath on different days. Baths were observed, timed, and scored for quality. Cultures of the periumbilicus and groin were obtained before and after each bath. At the end of the study, nurses were interviewed about their preferences.

• Results Neither total quality scores nor microbial counts differed significantly between the 2 bath types. Significantly fewer products (P < .001) and less time were used, cost was lower, and nurses’ ratings were significantly better with the disposable bath.

• Conclusion The disposable bath is a desirable form of bathing for patients who are unable to bathe themselves in critical care and long-term care settings, and it may even be preferable to the traditional basin bath.
Clinical Comparison of Automatic, Noninvasive Measurements of Blood Pressure in the Forearm and Upper Arm
Authors: Schell Kathleen , Bradley Elisabeth , Bucher Linda , Seckel Maureen , Lyons Denise , Wakai Sandra , Bartell Deborah , Carson Elizabeth , Chichester Melanie , Foraker Teresa , Simpson Kathleen
Published: November 2019

• Background When the upper arm (area from shoulder to elbow) is inaccessible and/or a standard-sized blood pressure cuff does not fit, some healthcare workers use the forearm to measure blood pressure.

• Objective To compare automatic noninvasive measurements of blood pressure in the upper arm and forearm.

• Methods A descriptive, correlational comparison study was conducted in the emergency department of a 1071-bed teaching hospital. Subjects were 204 English-speaking patients 6 to 91 years old in medically stable condition who had entered the department on foot or by wheelchair and who had no exclusions to using their left upper extremity. A Welch Allyn Vital Signs 420 series monitor was used to measure blood pressure in the left upper arm and forearm with the subject seated and the upper arm or forearm at heart level.

• Results Pearson r correlation coefficients between measurements in the upper arm and forearm were 0.88 for systolic blood pressure and 0.76 for diastolic blood pressure (P < .001 for both). Mean systolic pressures, but not mean diastolic pressures, in the upper arm and forearm differed significantly (t = 2.07, P = .04). A Bland-Altman analysis indicated that the distances between the mean values and the limits of agreement for the 2 sites ranged from 15 mm Hg (mean arterial pressure) to 18.4 mm Hg (systolic pressure).

• Conclusions Despite strict attention to correct cuff size and placement of the upper arm or forearm at heart level, measurements of blood pressure obtained noninvasively in the arm and forearm of seated patients in stable condition are not interchangeable.
Factors That Enable or Complicate End-of-Life Transitions in Critical Care
Authors: Badger James M.
Published: November 2019

• Background Nurses in medical intensive care units are routinely involved in negotiations to maintain or withdraw life support. How nurses move from aggressively attempting to extend life to letting life end is not well understood.

• Objective To explore nurses’ experiences of moving from cure- to comfort-oriented care and to describe factors that inhibit or facilitate such transitions.

• Method A descriptive qualitative research design with brief observation of participants and focus group interviews was used. Participants were 19 female and 5 male nurses in an 18-bed medical intensive care unit in a 719-bed acute care hospital in the northeastern United States.

• Results The transition point between cure- and comfort-oriented care was unclear. Nurses reported that the patient’s age, misunderstanding of the illness by the patient’s family, family discord, and shifting medical care decisions made end-of-life transitions difficult. Conversely, developing a consensus among patients, patients’ families, and staff about the direction of medical therapy; exhausting treatment options; and patients’ lack of response to aggressive medical interventions helped nurses move toward comfort care.

• Conclusions The most distressing situations for staff were dealing with younger patients with an acute life-threatening illness and performing futile care on elderly patients. End-of-life transitions were difficult when patients’ families had conflicts or were indecisive about terminating treatment and when physicians kept offering options that were unlikely to change patients’ prognosis. The most important factor enabling nurses to move from cure- to comfort-oriented care was developing a consensus about the treatment.
Discriminating Between Right Coronary Artery and Circumflex Artery Occlusion by Using a Noninvasive 18-Lead Electrocardiogram
Authors: Wung Shu-Fen
Published: November 2019

• Background Differentiating occlusion of the circumflex branch of the left coronary artery (also called the circumflex artery) from occlusion of the right coronary artery is often difficult because either may be associated with a pattern of acute inferior myocardial infarction on the electrocardiogram.

• Objectives To determine if an inexpensive 18-lead electrocardiogram can provide useful information in differentiating sites of coronary occlusion.

• Methods Continuous 18-lead electrocardiograms, including standard 12-lead, right ventricular, and posterior leads, were recorded in 38 and 50 subjects undergoing percutaneous coronary interventions in the right coronary artery and the circumflex artery, respectively.

• ResultsST-segment elevation in the posterior leads was twice as frequent during occlusion of the circumflex artery as during right coronary occlusion (P < .001). ST-segment elevation in the right ventricular leads and inferior leads occurred more often during occlusion of the right coronary artery than during occlusion of the circumflex artery. ST-segment depression in lead aVL is highly suggestive of right coronary occlusion, whereas ST-segment elevation in posterior leads without depression of the ST segment in lead aVL is highly sensitive and specific for occlusion of the circumflex artery.

• Conclusions ST-segment changes in the 18-lead electrocardiogram can be used to differentiate between occlusions of the circumflex artery and occlusions of the right coronary artery. Knowing which vessel is occluded before percutaneous coronary intervention can help in planning the procedure and recognizing when patients are at high risk for disturbances in conduction at the atrioventricular node.
Early Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy in Intensive Care Patients: Sign of Possible Bowel Injury
Authors: Milanchi Siamak , Allins Alexander
Published: November 2019

• Background Although percutaneous endoscopic gastrostomy may be complicated by iatrogenic bowel injury, most clinicians consider a small pneumoperitoneum on radiographs obtained after the procedure a benign finding of little clinical consequence. The possibility of a relationship between findings of early pneumoperitoneum after percutaneous endoscopic gastrostomy and subsequent iatrogenic bowel injury was examined.

• Methods Charts of 85 patients in a surgical intensive care unit who had undergone percutaneous endoscopic gastrostomy between 2000 and 2005 were retrospectively reviewed. All patients had a follow-up upright chest radiograph obtained after percutaneous endoscopic gastrostomy. The charts of 4 patients with radiographs that showed early pneumoperitoneum were reviewed.

• Results Findings were clinically significant in 1 of the 4 patients. That patient had a perforated transverse colon that required surgical repair. The other 3 patients had no complications.

• Conclusion Pneumoperitoneum after percutaneous endoscopic gastrostomy may be a sign of possible bowel injury and requires further evaluation. It should not be dismissed as benign. Obtaining a chest radiograph after a patient has undergone percutaneous endoscopic gastrostomy is essential.
Fluid resuscitation following multiple trauma
Authors: Sommers MS
Published: November 2019

The initial minutes and hours of nursing care of the trauma victim make a critical difference in the patient's chance for recovery. The critical care and ED nurse's ability to provide fluid resuscitation rapidly to augment the patient's flagging vascular volume is critical to the maintenance of circulation. By administering the most appropriate solution to meet the trauma patient's physiologic requirements, the nurse ensures that the patient will have an adequate circulating volume to meet the oxygenation and nutritional requirements of body tissues. Early, rapid fluid resuscitation is essential to stave off noncompensatory, irreversible shock. By implementing specific nursing care strategies to increase the flow of IV solutions to the patient, the nurse combats the nursing diagnosis appropriate for almost every multiple trauma victim: Fluid Volume Deficit.
Iv NTG: monitoring vital signs hourly versus every two hours
Authors: Ardire L
Published: November 2019

This article explores the pharmacologic rationale for monitoring hourly vital signs and the subsequent effects of disturbances in sleep patterns in the patient who receives a constant infusion of IV NTG. Although some patients may require additional vasoactive drugs to maintain stability of vital signs, this article addresses the monitoring practices for IV NTG in patients with acute MI, unstable angina, or CHF who do not require other vasoactive drugs.
Clinical management of DIC: early nursing interventions
Authors: Epstein C , Bakanauskas A
Published: November 2019

Achievement of successful patient outcomes depends on the availability of a primary nurse responsible for all aspects of nursing care. A consistent caregiver not only has a grasp of phenomena at hand but possesses an overall perspective of recovery. Care can be evaluated and readjusted on a timely basis. Identification of signs of progress as well as deterioration may be facilitated through continuity of care. The primary nurse can provide meaningful, ongoing information to the patient and significant others as a means of optimizing their coping behaviors. Effective nursing care of the patient with DIC is enhanced by a thorough understanding of its pathophysiology and its clinical manifestations. When the critical care nurse has a comprehensive knowledge base and uses purposeful assessment skills, potential complications become much clearer and are avoided. The primary nurse who knows how to prioritize care is capable of anticipating the patient's needs. By integrating theory with practice, the critical care nurse functions from a position of strength in promoting quality patient care.
Myasthenia gravis: the patient in crisis
Authors: Chipps E
Published: November 2019

Crisis in the myasthenic patient is a life-threatening event. The expertise of the critical care nurse is crucial to the prevention of complications and the return of the patient to a functional capacity.
Foliate Lymphoid Aggregates as Novel Forms of Serous Lymphocyte Entry Sites of Peritoneal B Cells and High-Grade B Cell Lymphomas
Authors: Jia Xinkai , Gábris Fanni , Jacobsen Óli , Bedics Gábor , Botz Bálint , Helyes Zsuzsanna , Kellermayer Zoltán , Vojkovics Dóra , Berta Gergely , Nagy Nándor , Jakus Zoltán , Balogh Péter
Published: November 2019

The cellular homeostasis of lymphoid tissues is determined by the continuous interactions of mobile hematopoietic cells within specialized microenvironments created by sessile stromal cells. In contrast to the lymph nodes and mucosal lymphoid tissues with well-defined entry and exit routes, the movement of leukocytes in the peritoneal cavity is largely unknown. In this study, we report that, in addition to the omental milky spots and fat-associated lymphoid clusters, in mice, the serous surface of the mesenteric adipose streaks contains lymphocyte-rich organoids comprised of a highly compacted leaf-like part connected to the adipose tissue that can also efficiently bind B cells and high-grade B cell lymphoma (diffuse large B cell lymphoma) cells. Denoted as foliate lymphoid aggregates (FLAgs), these structures show incomplete T/B segregation and a partially differentiated stromal architecture. LYVE-1–positive macrophages covering FLAgs efficiently bind i.p. injected normal B cells as well as different types of diffuse large B cell lymphoma cells. Within FLAgs, the lymphocytes compartmentalize according to their chemokine receptor pattern and subsequently migrate toward the mesenteric lymph nodes via the mesenteric lymphatic capillaries. The blood supply of FLAgs includes short vascular segments displaying peripheral lymph node addressin, and the extravasation of lymphocytes to the omental and mesenteric adipose tissues is partly mediated by L-selectin. The appearance of i.p. injected cells in mesenteric lymph nodes suggests that the mesentery-associated lymphatics may also collect leukocytes from the fat-associated lymphoid clusters and FLAgs, thus combining the mucosal and serous exit of mobile leukocytes and increasing the range of drainage sites for the peritoneal expansion of lymphoid malignancies.
Patrolling Monocytes Control NK Cell Expression of Activating and Stimulatory Receptors to Curtail Lung Metastases
Authors: Narasimhan Prakash Babu , Eggert Tobias , Zhu Yanfang Peipei , Marcovecchio Paola , Meyer Melissa A. , Wu Runpei , Hedrick Catherine C.
Published: November 2019

The role of nonclassical, patrolling monocytes in lung tumor metastasis and their functional relationships with other immune cells remain poorly defined. Contributing to these gaps in knowledge is a lack of cellular specificity in commonly used approaches for depleting nonclassical monocytes. To circumvent these limitations and study the role of patrolling monocytes in melanoma metastasis to lungs, we generated C57BL/6J mice in which the Nr4a1 superenhancer E2 subdomain is ablated (E2−/− mice). E2−/− mice lack nonclassical patrolling monocytes but preserve classical monocyte and macrophage numbers and functions. Interestingly, NK cell recruitment and activation were impaired, and metastatic burden was increased in E2−/−mice. E2−/− mice displayed unchanged “educated” (CD11b+CD27+) and “terminally differentiated” (CD11b+CD27−) NK cell frequencies. These perturbations were accompanied by reduced expression of stimulatory receptor Ly49D on educated NK cells and increased expression of inhibitory receptor NKG2A/CD94 on terminally differentiated NK cells. Thus, our work demonstrates that patrolling monocytes play a critical role in preventing lung tumor metastasis via NK cell recruitment and activation.
Trauma-induced coagulopathy: Incidence and outcome in patients with isolated traumatic brain injury in a level I trauma care center in India
Authors: Rani Poonam , Panda Nidhi , Hazarika Amarjyoti , Ahluwalia Jasmina , Chhabra Rajesh
Published: November 2019

Context: Trauma-induced coagulopathy (TIC) is life-threatening in head injury patients, and there is a lack of Indian data on its incidence and outcome. Aims: In this study, incidence and outcome related to coagulopathy were assessed in patients with moderate-to-severe isolated traumatic brain injury (iTBI). Settings and Design: A prospective observational study carried out in patients admitted within 24 h of injury. Materials and Methods: One hundred patients with moderate-to-severe iTBI were included. Samples for coagulation tests (prothrombin time [PT], PT index [PTI], international normalization ratio [INR], activated partial thromboplastin time, and platelet count) were collected at 5 points of time for 72 h. TIC was diagnosed if any three readings were abnormal during this period. Patients were also followed up posthospital discharge using the Glasgow Outcome Score (GOS) at 1 and 3 months. Statistical Analysis: Data were analyzed using SPSS ver. 21. Logistic regression analysis was employed to determine individual coagulation test as best predictors for mortality. P < 0.05 was considered statistically significant. Results: The incidence of TIC was found to be 62%; it was 63.75% in severe head injury and 55% in moderate head injury patients. Deranged INR at the time of hospital admission (odds ratio [OR] 4.38) and PTI at 24 h (OR 3.913) are highly predictive of mortality. There was no significant difference in GOS score at 1 and 3 months. Conclusions: The incidence of TIC in our study was 62% among iTBI patients. It contributes to increased mortality at 1 and 3 months. However, the neurological outcome was not different in between the groups.
Effect of anesthetic agents on cognitive function and peripheral inflammatory biomarkers in young patients undergoing surgery for spine disorders
Authors: Sahoo Asish , Panda Nidhi , Sabharwal Pranshuta , Luthra Ankur , Balu Mukilan , Chauhan Rajeev , Bhagat Hemant
Published: November 2019

Background: Exposure to anesthesia has been postulated to affect the cognitive function by inciting central nervous system inflammation. Hence, we planned to compare the psychometrical effects of anesthetic agents propofol, desflurane, or sevoflurane on postoperative cognitive function and also measure the change in concentration of serum S-100β, interleukin (IL)-6, and tumor necrosis factor (TNF)-α to look for the contribution of systemic inflammation. Methods: This was a prospective, double-blind, randomized controlled trial. Intuitional ethical committee approval and consent from patients were obtained. We enrolled 66 patients, allocated into three equal groups to receive either sevoflurane (n = 22), desflurane (n = 22), or propofol (n = 22). Standard anesthesia protocol was followed titrated to a bispectral index of 40–60. Patients with preoperative mini-mental state examination ≤23 were excluded. Each patient was assessed thrice with battery of cognitive tests in preoperative period (baseline), after 72 h (early postoperative cognitive dysfunction [POCD]), after 3 months (delayed POCD) of surgery. Serum levels of IL-6, TNF-α, and S-100β were measured preoperatively and 72 h after surgery. Results: Mean scores of various psychometric tests improved slightly in early postoperative period which was not statistically significant (P > 0.5). In delayed postoperative period, there was significant improvement in scores as compared to baseline (P < 0.5) in all the groups. There was nonsignificant change in the levels of biomarkers S-100β, TNF-α, and IL-6 between baseline and postoperative period in all the groups. Conclusion: In young patients, there is no effect of anesthesia on postoperative cognitive functions. There is no association of inflammatory markers with respect to the patient's cognitive status.
Endoscopic surgery for thalamic hemorrhage with intraventricular hemorrhage: Effects of combining evacuation of a thalamic hematoma to external ventricular drainage
Authors: Shimizu Yu , Tsuchiya Katsuhiro , Fujisawa Hironori
Published: November 2019

Objectives: Intraventricular hemorrhage (IVH) caused by thalamic hemorrhage leads to hydrocephalus, increased intracranial pressure, and reduced levels of consciousness. The aim of this study was to investigate the efficacy and compare the results of endoscopic surgery for the evacuation of a thalamic and intraventricular hematoma against those of external ventricular drainage (EVD) surgery. Materials and Methods: From January 2010 to December 2018, 68 patients with IVH caused by thalamic hemorrhage were treated in our department. Our study was approved by the Institutional Ethics Committee. The included patients were randomly divided into an EVD group and an endoscopic surgery group. The outcome was measured after 3 months using a 30-day mortality rate, pneumonia onset rate, ventriculoperitoneal (VP) shunt dependency rate, and Glasgow Outcome Scale (GOS) score. Results: Thirty-eight of the 68 patients were randomly assigned to the endoscopic surgery group and 30 were assigned to the EVD group. Patients treated with endoscopic surgery had significantly less drainage dependency on day 30 (P = 0.00014 < 0.00005) in comparison to those treated with EVD. The difference in the functional outcomes between the two groups of patients was mainly dependent on the onset of pneumonia and the consciousness level at the time of admission. The onset rate of aspiration-related pneumonia until day 30 was 11% in the endoscopic surgery group and 45% in the EVD group. The VP shunt rates were 27.8% in the endoscopic surgery group and 60% in the EVD group. The endoscopic surgery group had a significantly lower VP shunt rate compared with the EVD group. Intracerebral hemorrhage evacuation late was found to be associated with shunt-dependent rate and hospitalization. Conclusions: Endoscopic surgery was found to be associated with a lower GOS score and lower onset rates for shunt-dependent hydrocephalus and aspiration-related pneumonia in comparison to EVD. High evacuation rate was associated with lower shunt-dependent rate and short hospitalization.
Cardiovascular changes and lumbar spine surgery: A neglected entity
Authors: Mahajan Shalvi , Swami Adarsh , Kumar Amit
Published: November 2019

Cardiovascular changes following lumbar spine surgeries in the prone position have been less commonly described. Here, we report a case of an elderly male patient undergoing lumbar spine decompression and transforaminal interbody fusion who developed multiple but transient episodes of hypotension and bradycardia. Anesthesiologist should be vigilant while monitoring such patients and should use invasive blood pressure monitoring if possible, so as to detect transient cardiovascular episodes which may progress and results in a dreadful outcome.
An Uncommon Presentation of an Uncommon Colonic Neoplasia
Authors: Bodh Vishal , Sharma Rajesh , Sharma Brij
Published: November 2019

Intussusception in adult is a rare clinical entity. The clinical presentation of adult intussusception is often nonspecific. Majority of the cases have been reported as chronic, consistent with partial obstruction. We report a case of a 53‑year‑old male, who presented with chronic diarrhea and vague abdominal discomfort. He was incidentally detected to have colocolic intussusception secondary to colonic lipoma during diagnostic colonoscopy.
Double‑Scope Peroral Endoscopic Myotomy Technique: Light at the End of the Tunnel!
Authors: Bawane Piyush , Mahadevan B. , Jain Mayank , Chenduran S. N. K. , Sridhar C. G. , Ravi R. , Venkataraman Jayanthi
Published: November 2019

Peroral Endoscopic Myotomy has become the preferred therapy for achalasia cardia.An important predictor of the success and safety of this technique remains the correct identification of the Esophago gastric junction and the extent of myotomy. However, this key step may be difficult in a subset of patients. The present case highlights the use of double scope technique to manage such technical issues.
Endoscopic Management of Colonoscopy‑related Perforation
Authors: Khoo Stanley , Chan Wah-Kheong , Mahadeva Sanjiv
Published: November 2019

Colonoscopy‑related perforation is a rare but serious complication. The type of perforation depends on whether it was caused by a diagnostic examination or as a sequelae to a therapeutic procedure. Although traditionally managed by surgery, endoscopic management is increasingly used. This review focuses on the currently available methods of endoscopic management following colonoscopy‑related perforation, together with a brief review of their efficacy. With better development of endoscopic accessories such as through‑the‑scope and over‑the‑scope clips, and increasing experience by endoscopists, it is now recommended that endoscopic management should be the preferred initial treatment modality of colonoscopy‑related perforation.
Gastric Migration of Colonic Self‑expanding Metal Stent: Rare Complication Postcolonic Stenting
Authors: Sundaram Sridhar , Mazumdar Srijan , Patil Prachi , Mehta Shaesta
Published: November 2019

Colonic self‑expanding metal stent (SEMS), although associated with high technical and functional success in malignant colonic obstruction, may be associated with complications such as migration. Furthermore, fistulous tract formation with SEMS in situ has been reported only in few case reports previously. Here, we present a case of colonic SEMS migrating through a gastrocolic fistula into the stomach. There are no previous reports of migration of a colonic SEMS into a proximal segment of the gastrointestinal tract.
An improved bound on the packing dimension of Furstenberg sets in the plane
Authors: Orponen Tuomas
Published: November 2019

Let

0 \leq s \leq 1

. A set

K \subset \mathbb{R}^{2}

is a Furstenberg

s

-set if for every unit vector

e \in S^{1}

, some line

L_{e}

parallel to

e

satisfies

\dim_H [K \cap L_{e}] \geq s.

The Furstenberg set problem, introduced by T. Wolff in 1999, asks for the best lower bound for the dimension of Furstenberg

s

-sets. Wolff proved that

\dim_H K \geq \max\{s + 1/2,2s\}

and conjectured that

\dim_H K \geq (1 + 3s)/2

. The only known improvement to Wolff's bound is due to Bourgain, who proved in 2003 that

\dim_H K \geq 1 + \epsilon

for Furstenberg

1/2

-sets

K

, where

\epsilon > 0

is an absolute constant. In the present paper, I prove a similar

\epsilon

-improvement for all

1/2 < s < 1

, but only for packing dimension:

\dim_p K \geq 2s + \epsilon

for all Furstenberg

s

-sets

K \subset \mathbb{R}^{2}

, where

\epsilon > 0

only depends on

s

.

The proof rests on a new incidence theorem for finite collections of planar points and tubes of width

\delta > 0

. As another corollary of this theorem, I obtain a small improvement for Kaufman's estimate from 1968 on the dimension of exceptional sets of orthogonal projections. Namely, I prove that if

K \subset \mathbb{R}^{2}

is a linearly measurable set with positive length, and

1/2 < s < 1

, then

\dim_H \{e \in S^{1} : \dim_p \pi_{e}(K) \leq s\} \leq s - \epsilon

for some

\epsilon > 0

depending only on

s

. Here

\pi_{e}

is the orthogonal projection onto the line spanned by

e

.
Design and Development of Automotive Battery Management System
Authors: Dange Dipali , Ballal Radhika , Murali Meera , Sonawane D.N. , Prakash AK
Published: November 2019

Battery operated vehicle needs accurate management system because of its quick changes in State of Charge (SoC) due to aggressive acceleration profiles and regenerative braking. Li-ion battery needs control over its operating area for the safe working. The main objective of the proposed system is to develop a BMS having algorithms to estimate accurate SoC, balance individual cells, thermal management, and provide safe area of operation defined by voltage and temperature. Proposed methodology uses Coulomb Counting as well as Model-based Design approach wherein nonlinear behavior of battery is modeled as Equivalent Circuit Model to compute the SoC and degradation effect on battery to decide the end of life of battery. Also performing Inductive Active Balancing on cells to equalize the charge. The study aims on deploying the model-based system on embedded platform which would help industry to reduce the model development time and focus on development of controlling algorithms for high end users. Active Balancing Architecture proposed here reduces the complexity of algorithm and at the same time decreases the balancing time.
Queering Post-Black Art
Authors: Murray Derek Conrad
Published: November 2019

What impact do sexual politics and queer identities have on the understanding of blackness as a set of visual, cultural and intellectual concerns? In Queering Post-Black Art, Derek Conrad Murray argues that the rise of female, gay and lesbian artists as legitimate African-American creative voices is essential to the development of black art. He considers iconic works by artists including Glenn Ligon, Kehinde Wiley, Mickalene Thomas and Kalup Linzy, which question whether it is possible for blackness to evade its ideologically over-determined cultural legibility. In their own unique, often satirical way, a new generation of contemporary African American artists represent the ever-evolving sexual and gender politics that have come to define the highly controversial notion of post-black art. First coined in 2001, the term post-black resonated because it articulated the frustrations of young African-American artists around notions of identity and belonging that they perceived to be stifling, reductive and exclusionary. Since then, these artists have begun to conceive an idea of blackness that is beyond marginalization and sexual discrimination.
Evaluation of Virtual Reference Station Constraints for GNSS Tropospheric Tomography in Austria Region
Authors: Adavi Zohreh , Weber Robert
Published: November 2019

Abstract. One of the most promising methods of GNSS meteorology is GNSS Tomography.
This method can be used for the determination of water vapor distribution,
which contributes to the reliability of weather forecasting and early
warning of severe weather. Therefore, GNSS Tomography is a valuable source
of information for meteorological and weather forecast. The system of
equations of this problem is mixed-determined because propagated signals do
not pass through some of the model elements within the area of interest.
Consequently, the normal matrix is close to singular without any unique
solution. To avoid singularity and achieve a unique solution, additional
sources or horizontal and/or vertical constraints are usually applied. Here, three schemes have been considered for remedying the rank deficiency of the problem. In the first scheme, minimum horizontal and vertical constraints were imposed on the system of observation equations. Then, we have defined three schemes to evaluate the impact of Virtual Reference Stations (VRS) in comparison to horizontal and vertical constraints in the sparse GNSS network. Within a network of Austrian GNSS reference stations these schemes have been analyzed and validated with available radiosonde profiles for the period DoY 245–256 in 2017. According to our results, the consistency of the estimated refractivity field with radiosonde profiles in the dense GNSS network was generally better (RMSE 2.80 ppm) than for the two other schemes in the period of interest. Moreover, in the sparse GNSS network, the average of RMSE for schemes with VRS stations and constraints equation was about 3.02 and 3.27 ppm, respectively. Hence, the obtained results illustrate that applying VRS stations in the sparse GNSS network can lead to a better solution in comparison to applying horizontal and vertical constraints.
Evaluating integrated surface/subsurface permafrost thermal hydrology models in ATS (v0.88) against observations from a polygonal tundra site
Authors: Jan Ahmad , Coon Ethan T. , Painter Scott L.
Published: November 2019

Abstract. Numerical simulations are essential tools for understanding the complex hydrologic response of Arctic regions to a warming climate. However, strong coupling among thermal and hydrological processes on the surface and in the subsurface and the significant role that subtle variations in surface topography have in regulating flow direction and surface storage lead to significant uncertainties. Careful model evaluation against field observations is thus important to build confidence. We evaluate the integrated surface/subsurface permafrost thermal hydrology models in the Advanced Terrestrial Simulator (ATS) against field observations from polygonal tundra at the Barrow Environmental Observatory. ATS couples a multiphase, three-dimensional representation of subsurface thermal hydrology with representations of overland nonisothermal flows, snow processes, and surface energy balance. We simulated thermal hydrology of three-dimensional ice-wedge polygons with generic but broadly representative surface microtopography. The simulations were forced by meteorological data and observed water table elevations in ice-wedge polygon troughs. With limited calibration of parameters appearing in the soil evaporation model, the three-year simulations agreed reasonably well with snow depth, summer water table elevations in the polygon center, and high-frequency soil temperature measurements at several depths in the trough, rim, and center of the polygon. Upscaled evaporation is in good agreement with flux tower observations. The simulations were found to be sensitive to parameters in the bare soil evaporation model, snowpack, and the lateral saturated hydraulic conductivity. The study provides new support for an emerging class of integrated surface/subsurface permafrost simulators, and provides an optimized set of model parameters for use in watershed-scale projections of permafrost dynamics in a warming climate.
Measuring the seismic risk along the Nazca-Southamerican subduction front: Shannon entropy and mutability
Authors: Vogel Eugenio E. , Brevis Felipe G. , Pastén Denisse , Muñoz Víctor , Miranda Rodrigo A. , Chian Abraham C.-L.
Published: November 2019

Abstract. Four geographical zones are defined along the trench that is formed due to the subduction of the Nazca Plate underneath the South American plate; they are denoted A, B, C and D from North to South; zones A, B and D have had a major earthquake after 2010 (8.0), while zone C has not, thus offering a contrast for comparison. For each zone a sequence of intervals between consecutive seisms with magnitudes ≥ 3.0 is formed and then characterized by Shannon entropy and mutability. These methods show correlation after a major earthquake in what is known as the aftershock regime but they show independence otherwise. Exponential adjustments for these parameters reveal that mutability offers a wider range for the parameters characterizing the recovery to the values of the parameters defining the background activity for each zone before a large earthquake. It is found that the background activity is particularly high for zone A, still recovering for Zone B, reaching values similar to those of Zone A in the case of Zone C (without recent major earthquake) and oscillating around moderate values for Zone D. It is discussed how this can be an indication for more risk of an important future seism in the cases of Zones A and C. The similarities and differences between Shannon entropy and mutability are discussed and explained.
Investigation of the weather conditions during the collapse of the Morandi Bridge in Genoa on 14 August 2018
Authors: Burlando Massimiliano , Romanic Djordje , Boni Giorgio , Lagasio Martina , Parodi Antonio
Published: November 2019

Abstract. On 14 August 2018, Morandi Bridge in Genoa, Italy, collapsed sending vehicles and tons of rubble to the ground about 40 m below and killing 43 people. Preliminary investigations indicated poor design, questionable building practices and insufficient maintenance or a combination of these factors as a possible cause of collapse. However, at the time of collapse, a thunderstorm associated with strong winds, lightning and rain was developed over the city. While it is still not clear whether or not it played a role in this disaster, the present paper documents the weather conditions during the collapse and analyzes in detail a downburst that occurred at the time of the collapse a few kilometers from the bridge. The thunderstorm is analyzed using direct and remote measurements in an attempt to describe the evolution of the cumulonimbus cloud as it approached the coast from the sea. The detected downburst is investigated using a lidar scanner and the anemometric network in the Port of Genoa. The paper shows that the unique lidar measurements enabled a partial reconstruction of the gust front shape and displacement velocity. The Weather Research and Forecasting (WRF) simulations, carried out with three different forcing conditions, forecasted the cumuliform convection at larger scales but did not accurately replicate the downburst signature at the surface that was measured by radar, lidar, and anemometers. This result demonstrates that the localized wind conditions during the collapse time could not be operationally forecasted.
Tensiones territoriales emergentes en la configuración de paisajes productivos en el suroeste de Antioquia (Colombia)
Authors: Montoya Arango Vladimir , Perdomo Sánchez Jenni Carolina
Published: November 2019

En el caso de la configuración de paisajes productivos en el suroeste de Antioquia (Colombia), se discute la manera en que el río Cauca en su curso medio ha sido convertido en un eje de intervención económica, en el que prevalecen las prácticas del desarrollo como crecimiento económico y las políticas neoliberales que generan disputan con los modos de vida locales. Con base en trabajo etnográfico y análisis de cartografía temática, se busca dar cuenta de la manera en que la expansión geográfica del capitalismo produce despojo y confinamiento, a la vez que da lugar al surgimiento de nuevas subjetividades y formas de movilización social.