bluuebunny/crossref_metadata_2025 huggingface dataset:
SF6 catalytic degradation in a γ‐Al2O3 packed bed plasma system: A combined experimental and theoretical study
Authors: Cui Zhaolun , Zhou Chang , Jafarzadeh Amin , Meng Shengyan , Yi Yanhui , Wang Yufei , Zhang Xiaoxing , Hao Yanpeng , Li Licheng , Bogaerts Annemie
Published: July 2022

Effective abatement of the greenhouse gas sulphur hexafluoride (SF6) waste is of great importance for the environment protection. This work investigates the size effect and the surface properties of γ‐Al2O3 pellets on SF6 degradation in a packed bed dielectric barrier discharge (PB‐DBD) system. Experimental results show that decreasing the packing size improves the filamentary discharges and promotes the ignition and the maintenance of plasma, enhancing the degradation performance at low input powers. However, too small packing pellets decrease the gas residence time and reduce the degradation efficiency, especially for the input power beyond 80 W. Besides, lowering the packing size promotes the generation of SO2, while reduces the yields of S‐O‐F products, corresponding to a better degradation. After the discharge, the pellet surface becomes smoother with the appearance of S and F elements. Density functional theory calculations show that SF6 is likely to be adsorbed at the AlIII site over the γ‐Al2O3(110) surface, and it is much more easily to decompose than in the gas phase. The fluorine gaseous products can decompose and stably adsorb on the pellet surface to change the surface element composition. This work provides a better understanding of SF6 degradation in a PB‐DBD system.
STDC‐MA network for semantic segmentation
Authors: Lei Xiaochun , Lu Linjun , Jiang Zetao , Gong Zhaoting , Lu Chang , Liang Jiaming , Xie Junlin
Published: July 2022

Semantic segmentation is applied extensively in autonomous driving and intelligent transportation with methods that highly demand spatial and semantic information. Here, an STDC‐MA network is proposed to meet these demands. First, the STDC‐Seg structure is employed in STDC‐MA to ensure a lightweight and efficient structure. Subsequently, the feature alignment module is applied to understand the offset between high‐level and low‐level features, solving the problem of pixel offset related to upsampling on the high‐level feature map. The approach implements the effective fusion between high‐level features and low‐level features. A hierarchical multiscale attention mechanism is adopted to reveal the relationship among attention regions from two different input sizes of one image. Through this relationship, regions receiving much attention are integrated into the segmentation results, thereby reducing the unfocused regions of the input image and improving the effective utilisation of multiscale information. STDC‐MA maintains the segmentation speed as the STDC‐Seg network while improving the segmentation accuracy of small objects. STDC‐MA was verified on the validation dataset of Cityscapes. The segmentation result of STDC‐MA attained 78.32% mIOU with the input of 0.5× scale, 4.92% higher than STDC‐Seg.
Cross‐organisational data sharing framework based on blockchain‐probes
Authors: Jia Xiaofeng , Xu Wenjing , Deng Pan , Gao Song , Tang Lin , Wang Yuhang , Zhang Min , Bao Lulu , Lin Dingding
Published: July 2022

With the development of information technology, various social fields have gradually realised informatisation and digitisation, and today's society has entered the era of big data. A large amount of data exists in different departments and systems. At present, cross‐organisational data sharing is often realised by point‐to‐point authorisation. However, there are still some threats in the management and control schedule for the whole region. To realise secure and credible data sharing, this paper proposes a cross‐organisational data‐sharing framework based on Blockchain‐Probes using distributed digital identity technology. By using a star data link of the complex network, our system realises the synchronisation of heterogeneous data sources by using a data probe as the inter‐central transmission carrier to link different data sources. The proposed framework is applied to the real scenario; compared with the traditional method, the efficiency and accuracy are improved, and the total cost is reduced by 60%. The framework could be employed in multiple complex system application scenarios such as transportation, finance and urban management.
Point‐track association method with unknown system model
Authors: Wei Xiong , Gu Xiangqi , Yaqi Cui
Published: July 2022

The point‐track association methods are proposed on the premise that the system models are known, which obviously does not conform to the actual air target detection environment. Considering this situation, for the point‐track association problems in clutter environment, a point‐track association method with unknown system model (USMA) is proposed. The method integrates reinforcement learning (RL) theory and traditional point‐track association framework, utilises the association process migration of different models, simplifies the entire learning process, and improves the generalisation ability by designing an adaptive mechanism. The experimental results show that when the system model is unknown, the USMA method can more accurately correlate to the measurements, and can also solve the problems of point‐track association with a certain clutter density. Compared with other methods, the USMA method performs better.
Video key frame extraction based on scale and direction analysis
Authors: Dong Yanlei , Zhang Yunzuo , Zhang Jiayu , Zhang Xiuqing
Published: July 2022

Currently, efficient and accurate key frame extraction for massive videos remains a challenge, especially in surveillance applications. To overcome the inaccuracy of traditional key frame extraction, this paper proposes a method for key frame extraction via analyzing scale and direction of motion trajectory on spatiotemporal slice (MTSS). The proposed method employs both local and global motion state changes of object as the metric to extract key frames and meanwhile gives a strategy which integrates coarse extraction with partial fine re‐extraction of spatiotemporal slices to capture these state changes. Firstly, coarse extraction of spatiotemporal slices is employed to detect motion segments. Then partial fine re‐extraction is performed on the motion segments to obtain MTSS. Finally, the frames at the inflexions of scale and direction of MTSS are extracted as key frames. The experimental results have demonstrated that the proposed method outperforms existing state‐of‐the‐art methods in terms of accuracy for various videos while requiring a comparable or even less computation time.
Galaxy populations in the Hydra I cluster from the VEGAS survey
Authors: La Marca Antonio , Iodice Enrichetta , Cantiello Michele , Forbes Duncan A. , Rejkuba Marina , Hilker Michael , Arnaboldi Magda , Greggio Laura , Spiniello Chiara , Mieske Steffen , Venhola Aku , Spavone Marilena , D’Ago Giuseppe , Raj Maria Angela , Ragusa Rossella , Mirabile Marco , Rampazzo Roberto , Peletier Reynier , Paolillo Maurizio , Challapa Nelvy Choque , Schipani Pietro
Published: July 2022

In this work, we extend the catalog of low-surface brightness (LSB) galaxies, including ultra-diffuse galaxy (UDG) candidates, within ≈0.4Rvir of the Hydra I cluster of galaxies based on deep images from the VST Early-type GAlaxy Survey (VEGAS). The new galaxies were found by applying an automatic detection tool and carrying out additional visual inspections of g and r band images. This led to the detection of 11 UDGs and 8 more LSB galaxies. For all of them, we assessed the cluster membership using the color–magnitude relation derived for early-type giant and dwarf galaxies in Hydra I. The UDGs and new LSB galaxies found in Hydra I span a wide range of central surface brightness (22.7 ≲ μ0, g ≲ 26.5 mag arcsec−2), effective radius (0.6 ≲ Re ≲ 4.0 kpc), and color (0.4 ≤ g − r ≤ 0.9 mag), and have stellar masses in the range ∼5 × 106 − 2 × 108 M⊙. The 2D projected distribution of both galaxy types is similar to the spatial distribution of dwarf galaxies, with over-densities in the cluster core and north of the cluster center. They have similar color distribution and comparable stellar masses to the red dwarf galaxies. Based on photometric selection, we identify a total of nine globular cluster (GC) candidates associated to the UDGs and four to the LSB galaxies, with the highest number of candidates in an individual UDG being three. We find that there are no relevant differences between dwarfs, LSB galaxies, and UDGs: the structural parameters (i.e., surface brightness, size, color, and n-index) and GC content of the three classes have similar properties and trends. This finding is consistent with UDGs being the extreme LSB tail of the size–luminosity distribution of dwarfs in this environment.
SN 2018bsz: A Type I superluminous supernova with aspherical circumstellar material
Authors: Pursiainen M. , Leloudas G. , Paraskeva E. , Cikota A. , Anderson J. P. , Angus C. R. , Brennan S. , Bulla M. , Camacho-Iñiguez E. , Charalampopoulos P. , Chen T.-W. , Delgado Mancheño M. , Fraser M. , Frohmaier C. , Galbany L. , Gutiérrez C. P. , Gromadzki M. , Inserra C. , Maund J. , Müller-Bravo T. E. , Muñoz Torres S. , Nicholl M. , Onori F. , Patat F. , Pessi P. J. , Roy R. , Spyromilio J. , Wiseman P. , Young D. R.
Published: July 2022

We present a spectroscopic analysis of the most nearby Type I superluminous supernova (SLSN-I), SN 2018bsz. The photometric evolution of SN 2018bsz has several surprising features, including an unusual pre-peak plateau and evidence for rapid formation of dust ≳200 d post-peak. We show here that the spectroscopic and polarimetric properties of SN 2018bsz are also unique. While its spectroscopic evolution closely resembles SLSNe-I, with early O II absorption and C II P Cygni profiles followed by Ca, Mg, Fe, and other O features, a multi-component Hα profile appearing at ∼30 d post-maximum is the most atypical. The Hα is at first characterised by two emission components, one at ∼+3000 km s−1 and a second at ∼ − 7500 km s−1, with a third, near-zero-velocity component appearing after a delay. The blue and central components can be described by Gaussian profiles of intermediate width (FWHM ∼ 2000–6000 km s−1), but the red component is significantly broader (FWHM ≳ 10 000 km s−1) and Lorentzian. The blue Hα component evolves towards a lower-velocity offset before abruptly fading at ∼ + 100 d post-maximum brightness, concurrently with a light curve break. Multi-component profiles are observed in other hydrogen lines, including Paβ, and in lines of Ca II and He I. Spectropolarimetry obtained before (10.2 d) and after (38.4 d) the appearance of the H lines shows a large shift on the Stokes Q – U plane consistent with SN 2018bsz undergoing radical changes in its projected geometry. Assuming the supernova is almost unpolarised at 10.2 d, the continuum polarisation at 38.4 d reaches P ∼ 1.8%, implying an aspherical configuration. We propose that the observed evolution of SN 2018bsz can be explained by highly aspherical, possibly disk-like, circumstellar material (CSM) with several emitting regions. After the supernova explosion, the CSM is quickly overtaken by the ejecta, but as the photosphere starts to recede, the different CSM regions re-emerge, producing the peculiar line profiles. Based on the first appearance of Hα, we can constrain the distance of the CSM to be less than ∼6.5 × 1015 cm (430 AU), or even lower (≲87 AU) if the pre-peak plateau is related to an eruption that created the CSM. The presence of CSM has been inferred previously for other SLSNe-I, both directly and indirectly. However, it is not clear whether the rare properties of SN 2018bsz can be generalised for SLSNe-I, for example in the context of pulsational pair instability, or whether they are the result of an uncommon evolutionary path, possibly involving a binary companion.
Chandrafollow-up of the Hectospec Cluster Survey: Comparison of caustic and hydrostatic masses and constraints on the hydrostatic bias
Authors: Logan Crispin H. A. , Maughan Ben J. , Diaferio Antonaldo , Duffy Ryan T. , Geller Margaret J. , Rines Kenneth , Sohn Jubee
Published: July 2022

Context.Clusters of galaxies are powerful probes with which to study cosmology and astrophysics. However, for many applications, an accurate measurement of a cluster’s mass is essential. A systematic underestimate of hydrostatic masses from X-ray observations (the so-called hydrostatic bias) may be responsible for tension between the results of different cosmological measurements.

Aims.We compare X-ray hydrostatic masses with masses estimated using the caustic method (based on galaxy velocities) in order to explore the systematic uncertainties of both methods and place new constraints on the level of hydrostatic bias.

Methods.Hydrostatic and caustic mass profiles were determined independently for a sample of 44 clusters based onChandraobservations of clusters from the Hectospec Cluster Survey. This is the largest systematic comparison of its kind. Masses were compared at a standardised radius (R500) using a model that includes possible bias and scatter in both mass estimates. The systematics affecting both mass determination methods were explored in detail.

Results.The hydrostatic masses were found to be systematically higher than caustic masses on average, and we found evidence that the caustic method increasingly underestimates the mass when fewer galaxies are used to measure the caustics. We limit our analysis to the 14 clusters with the best-sampled caustics where this bias is minimised (≥210 galaxies), and find that the average ratio of hydrostatic-to-caustic mass atR500isM500,X/M500,C= 1.12−0.10+0.11.

Conclusions.We interpret this result as a constraint on the level of hydrostatic bias, favouring small or zero levels of hydrostatic bias (less than 20% at the 3σlevel). However, we find that systematic uncertainties associated with both mass estimation methods remain at the 10 − 15% level, which would permit significantly larger levels of hydrostatic bias.
Accreting neutron stars from the nuclear energy-density functional theory
Authors: Fantina A. F. , Zdunik J. L. , Chamel N. , Pearson J. M. , Suleiman L. , Goriely S.
Published: July 2022

Context. The accretion of matter onto the surface of a neutron star in a low-mass X-ray binary triggers X-ray bursts, whose ashes are buried and further processed thus altering the composition and the properties of the stellar crust.

Aims. In this second paper of a series, the impact of accretion on the equation of state and on the global properties of neutron stars is studied in the framework of the nuclear energy-density functional theory.

Methods. Considering ashes made of 56Fe, we calculated the equations of state using the same Brussels-Montreal nuclear energy-density functionals BSk19, BSk20, and BSk21, as those already employed for determining the crustal heating in our previous study for the same ashes. All regions of accreting neutron stars were treated in a unified and thermodynamically consistent way. With these equations of state, we determined the mass, radius, moment of inertia, and tidal deformability of accreted neutron stars and compared with catalyzed neutron stars for which unified equations of state based on the same functionals are available.

Results. The equation of state of accreted neutron stars is found to be significantly stiffer than that of catalyzed matter, with an adiabatic index Γ ≈ 4/3 throughout the crust. For this reason, accreting neutron stars have larger radii. However, their crustal moment of inertia and their tidal deformability are hardly changed provided density discontinuities at the interface between adjacent crustal layers are properly taken into account.

Conclusions. The enhancement of the stiffness of the equation of state of accreting neutron stars is mainly a consequence of nuclear shell effects, thus confirming the importance of a quantum treatment as stressed in our first study. With our previous calculations of crustal heating using the same functionals, we have thus obtained consistent microscopic inputs for simulations of accreting neutron stars.
Characterising the orbit and circumstellar environment of the high-mass binary MWC 166 A
Authors: Zarrilli Sebastian A. , Kraus Stefan , Kreplin Alexander , Monnier John D. , Gardner Tyler , Mérand Antoine , Morrell Sam , Davies Claire L. , Labdon Aaron , Ennis Jacob , Setterholm Benjamin , Le Bouquin Jean-Baptiste , Anugu Narsireddy , Lanthermann Cyprien , Schaefer Gail , ten Brummelaar Theo
Published: July 2022

Context. Stellar evolution models are highly dependent on accurate mass estimates, especially for highly massive stars in the early stages of stellar evolution. The most direct method for obtaining model-independent stellar masses is derivation from the orbit of close binaries.

Aims. Our aim was to derive the first astrometric plus radial velocity orbit solution for the single-lined spectroscopic binary star MWC 166 A, based on near-infrared interferometry over multiple epochs and ∼100 archival radial velocity measurements, and to derive fundamental stellar parameters from this orbit. A supplementary aim was to model the circumstellar activity in the system from K band spectral lines.

Methods. The data used include interferometric observations from the VLTI instruments GRAVITY and PIONIER, as well as the MIRC-X instrument at the CHARA Array. We geometrically modelled the dust continuum to derive relative astrometry at 13 epochs, determine the orbital elements, and constrain individual stellar parameters at five different age estimates. We used the continuum models as a base to examine differential phases, visibilities, and closure phases over the Br γ and He I emission lines in order to characterise the nature of the circumstellar emission.

Results. Our orbit solution suggests a period of P = 367.7 ± 0.1 d, approximately twice as long as found with previous radial velocity orbit fits. We derive a semi-major axis of 2.61 ± 0.04 au at d = 990 ± 50 pc, an eccentricity of 0.498 ± 0.001, and an orbital inclination of 53.6 ± 0.3°. This allowed the component masses to be constrained to M1 = 12.2 ± 2.2 M⊙ and M2 = 4.9 ± 0.5 M⊙. The line-emitting gas was found to be localised around the primary and is spatially resolved on scales of ∼11 stellar radii, where the spatial displacement between the line wings is consistent with a rotating disc.

Conclusions. The large spatial extent and stable rotation axis orientation measured for the Br γ and He I line emission are inconsistent with an origin in magnetospheric accretion or boundary-layer accretion, but indicate an ionised inner gas disc around this Herbig Be star. We observe line variability that could be explained either with generic line variability in a Herbig star disc or V/R variations in a decretion disc scenario. We have also constrained the age of the system, with relative flux ratios suggesting an age of ∼(7 ± 2)×105 yr, consistent with the system being composed of a main-sequence primary and a secondary still contracting towards the main-sequence stage.
Finding the birthplace of HMXBs in the Galaxy usingGaiaEDR3: Kinematical age determination through orbit integration
Authors: Fortin Francis , García Federico , Chaty Sylvain
Published: July 2022

Context.High-mass X-ray binaries (HMXBs) are produced after the first supernova event in a massive binary. These objects are intrinsically young and can suffer from a significant natal kick. As such, the progenitors of HMXBs are likely to have formed away from the current location of the X-ray emitting systems.

Aims.We aim to find the birthplace of the known HMXBs of our Milky Way. Specifically, we want to answer the question of whether the formation of HMXBs can be associated with open stellar clusters and/or Galactic spiral structures and, from that, infer the time elapsed since the first supernova event.

Methods.We used astrometric data fromGaiaEarly Data Release 3 to initialise the position and velocity of each known HMXB from the Galaxy, and to integrate their motion back in time. In parallel, we performed the same calculations on a sample of 1381 open clusters detected byGaiaas well as for four Galactic spiral arms for which shape and motion have also been recently modelled usingGaiadata. We report on all the encounter candidates between HMXBs and clusters or spiral arms in the past 100 Myr.

Results.In our sample of 26 HMXBs, we infer that seven were born in clusters and eight were born near a Galactic spiral arm, and we conclude that seven others could have formed isolated from these Galactic structures. The birthplaces of the remaining four HMXBs are still inconclusive due to a combination of great distance, poor astrometric data, and a lack of a known open cluster in the vicinity. We provide the kinematical age since the supernova of 15 HMXBs.

Conclusions.The astrometry fromGaiaand the orbit integration we employed are effective at finding the birthplaces of HMXBs in the Milky Way. By considering the biases in our data and method, we find it is likely that the progenitors of HMXBs preferentially formed alongside other massive stars in open clusters.
Penalization method for the Navier–Stokes–Fourier system
Authors: Basarić Danica , Feireisl Eduard , Lukáčová-Medvid’ová Mária , Mizerová Hana , Yuan Yuhuan
Published: July 2022

We apply the method of penalization to the Dirichlet problem for the Navier–Stokes–Fourier system governing the motion of a general viscous compressible fluid confined to a bounded Lipschitz domain. The physical domain is embedded into a large cube on which the periodic boundary conditions are imposed. The original boundary conditions are enforced through a singular friction term in the momentum equation and a heat source/sink term in the internal energy balance. The solutions of the penalized problem are shown to converge to the solution of the limit problem. In particular, we extend the available existence theory to domains with rough (Lipschitz) boundary. Numerical experiments are performed to illustrate the efficiency of the method.
Vibration monitoring of a hydroelectric power generation unit: Improved indicators of rotor health based on orbital analysis
Authors: Daga Alessandro Paolo , Garibaldi Luigi , Cuvato Damiano , Bonjean Manuel , Sannolo Antonino , Artaz Lorenzo
Published: July 2022

Hydropower generation units (HGUs) are electromechanical systems meant to transform the potential energy of flowing water (i.e., a renewable energy source) into electrical energy. Thanks to their high manoeuvrability and green footprint, nowadays, HGUs are mission-critical assets for grid operators, as the global energy policy is pushing for a more ecological and healthier energy production. Condition monitoring becomes then a fundamental task for fostering safety while optimizing the maintenance regime of such HGUs. In this regard, this work is meant to improve an ISO20816-based vibration monitoring system by proposing further rotor health indicators based on orbital analysis. The proposed improvement is implemented on a real HGU of the Signayes hydroelectric power plant from C.V.A. S.p.A. − Compagnia Valdostana delle Acque − Compagnie Valdôtaine des Eaux.
Endophthalmitis aus ophthalmopathologischer Sicht
Authors: Herwig-Carl Martina C. , Holz Frank , Löffler Karin U.
Published: July 2022

Die Endophthalmitis ist eine der schwersten ophthalmologischen Notfälle. Bei den meisten Patienten kommt es nach dem Ereignis zu einer bleibenden Visusminderung, das Auge kann aber in den
meisten Fällen erhalten werden. Wenn das Auge nach einer Endophthalmitis enukleiert wird, kann die ophthalmopathologische Aufarbeitung des Bulbus unter Berücksichtigung der klinischen
Vorgeschichte zumindest wertvolle Informationen zum letztlich frustranen Krankheitsverlauf geben, die dann auch zukünftigen Patienten zugutekommen können. Oft ergeben sich auch relevante
Aspekte im Hinblick auf das therapeutische Vorgehen. Beispielhaft soll die Notwendigkeit einer perforierenden Keratoplastik mit großem Transplantatdurchmesser und evtl. Entfernung von
Linsenkapsel mit Kapselsack bei therapieresistenter Pilzendophthalmitis genannt werden. An 5 enukleierten Augen werden im Folgenden verschiedene Ausprägungsgrade und Entstehungswege der
exogenen und selteneren endogenen Endophthalmitis klinisch und ophthalmopathologisch verständlich aufgearbeitet. Zusammenfassend erfordert eine Endophthalmitis schnelles Handeln, dennoch
gilt es, verschiedene Differenzialdiagnosen auszuschließen. Die histopathologische Aufarbeitung enukleierter Augen ist hilfreich, um den Krankheitsverlauf nachzuvollziehen und kann auch
forensische Bedeutung haben.
Perioperative Antibiotics and Other Factors Associated with Postcesarean Infections: A Case-Control Study
Authors: Duffy Cassandra R. , Oberhardt Matthew , Ross Naima , Ewing Julie , Messina Maria , Fitzgerald Kelly , Saiman Lisa , Goffman Dena
Published: July 2022

Objective Our objective was to determine modifiable risk factors associated with surgical site infection (SSI) and postpartum endometritis. We hypothesized that inappropriate surgical antibiotic prophylaxis would be a risk factor for both types of infections.

Study Design This was a single-center case-control study of SSI and endometritis after cesarean delivery over a 2-year period from 2016 to 2017. Cases were identified by International Classification of Diseases, 10th Revision diagnosis codes, infection control surveillance, and electronic medical records search and were subsequently confirmed by chart review. Three controls were randomly selected for each case from all cesareans ± 48 hours from case delivery. Demographic, pregnancy, and delivery characteristics were abstracted. Separate multivariable logistic regression models were used to assess factors associated with SSI and endometritis. Postpartum outcomes, including length of stay and readmission, were also compared.

Results We identified 141 cases of SSI and endometritis with an overall postpartum infection rate of 4.0% among all cesarean deliveries. In adjusted analysis, factors associated with both SSI and endometritis were intrapartum delivery, classical or other (non–low-transverse) uterine incision, and blood transfusion. Factors associated with SSI only included inadequate antibiotic prophylaxis, public insurance, hypertensive disorder of pregnancy, and nonchlorhexidine abdominal preparation; factors only associated with endometritis included β-lactam allergy, anticoagulation therapy, and chorioamnionitis. Among cases, 34% of those with SSI and 25% of those with endometritis did not receive adequate antibiotic prophylaxis, compared with 12.9 and 13.5% in control groups, respectively. Failure to receive appropriate antibiotic prophylaxis was associated with an increased risk of SSI (adjusted odds ratio [aOR]: 4.4, 95% confidence interval [CI]: 1.3–15.6) but not endometritis (aOR 0.9, 95% CI 0.4–2.0).

Conclusion Inadequate surgical antibiotic prophylaxis was associated with an increased risk of SSI but not postpartum endometritis, highlighting the different mechanisms of these infections and the importance of prioritizing adequate surgical prophylaxis. Additional potentially modifiable factors which emerged included blood transfusion and chlorhexidine skin preparation.

Key Points
Facilitating Health Information Exchange to Improve Health Outcomes for School-Aged Children: School Nurse Electronic Health Record Access
Authors: Baker Christina , Loresto Figaro , Pickett Kaci , Samay Sadaf Sara , Gance-Cleveland Bonnie
Published: July 2022

Background and Objectives School-aged children with chronic conditions require care coordination for health needs at school. Access to the student's accurate, real-time medical information is essential for school nurses to maximize their care of students. We aim to analyze school nurse access to medical records in a hospital-based electronic health record (EHR) and the effect on patient outcomes. We hypothesized that EHR access would decrease emergency department (ED) visits and inpatient hospitalizations.

Methods This retrospective secondary data analysis was conducted using EHR data 6 months pre- and post-school nurse access to students' hospital-based EHR. The main outcome measures were the ED visits and inpatient hospitalizations.

Results For the sample of 336 students in the study, there was a 34% decrease in ED visits from 190 visits before access to 126 ED visits after access (p <0.01). Inpatient hospitalizations decreased by 44% from 176 before access to 99 after access (p <0.001). The incident rate of ED visits decreased (IRR: 0.66; 95% CI: 0.53–0.83; p = 0.00035), and hospitalizations decreased (IRR: 0.56; 95% CI: 0.44–0.72; p <0.0001) from pre to post access. These findings suggest school nurse access to medical records is a positive factor in improving school-aged patient outcomes.

Conclusion School nurse access to medical records through the hospital-based EHR may be a factor to improve patient outcomes by utilizing health information technology for more efficient and effective communication and care coordination for school-aged children with chronic medical conditions.
Ureteral Stent Colonization and Urinary Tract Infection in Children Undergoing Minimally Invasive Pyeloplasty
Authors: Neheman Amos , Sabler Itay M. , Beberashvili Ilia , Goltsman Galina , Verchovsky Guy , Kord Eyal , Yossepowitch Orit , Zisman Amnon , Stav Kobi
Published: July 2022

Introduction Minimally invasive pyeloplasty (MIP), namely, laparoscopic and robot-assisted interventions, has gained popularity in recent years. Double-J ureteral stents are frequently inserted during surgery. Foreign bodies in the urinary tract are considered as risk factor for developing urinary tract infection (UTI). This study aimed to specify the bacteria cultured from urine and stents responsible for UTI in children with indwelling ureteral stents undergoing MIP.

Patients and Methods We retrospectively reviewed medical records of 30 children (22 boys and 8 girls) who had undergone MIP between 2014 and 2017. Median age at surgery was 2.7 years (interquartile range [IQR]: 0.5–7.9). Urine cultures were obtained before surgery, before stent removal, 1 month after stent removal, and if UTI was suspected. Stents were removed 4 to 8 weeks after surgery and cultured. Patients' demographics, types of stents, and surgical details were recorded.

Results Median stent indwelling time was 5.09 weeks (IQR: 4–6). Postoperative febrile UTI developed in 4/30 (13%) patients. Afebrile UTI occurred in another 4/30 (13%) patients. Stent cultures were positive in 19/30 (63%) patients. Stent and urinary cultures were identical in only one patient. Three of four patients with preoperative asymptomatic bacteriuria developed postoperative UTI. There was no association between UTI, gender, stent diameter, and duration of indwelling catheter.

Conclusion After MIP, febrile UTI and afebrile UTI occurred in about one quarter of patients. Pathogens isolated postsurgically from urinary cultures were unrelated to those colonizing the stents. Therefore, routine stent culturing is of low clinical significance. Moreover, small-caliber stents and longer indwelling periods were not risk factors for UTI. Optimizing antibiotic treatment for children with preoperative UTI may potentially prevent morbidity after surgery.
Laparoscopic Ureteral Reimplantation after Failed Open Surgery: Incorporating the Psoas Hitch Maneuver for Sufficient Tunnel Length
Authors: Shumaker Andrew D. , Kord Eyal , Dubrov Vitaly , Bondarenko Sergey , Visman Yakatwrina , Stav Kobi , Zisman Amnon , Neheman Amos
Published: July 2022

Background Failure after open ureteral reimplantation has been reported to occur in 2 to 7% of cases. While a second open reconstructive surgery is appropriate in most cases, there are data suggesting similar outcomes utilizing the laparoscopic approach. The objective of this study is to describe a modification and report our experience with laparoscopic ureteral reimplantation after failed open reimplantation reinforced with a psoas hitch.

Materials and Methods A retrospective review of pediatric patients who underwent laparoscopic ureteral reimplantation after failed open surgery between September 2012 and April 2018 at three different academic centers was performed. Patient demographics, surgical indications, complications, and outcomes were reviewed. Either ipsilateral ureteral reimplantation with a combined intravesical and extravesical approaches or a cross-trigonal extravesical approach was utilized, depending on the length of the ureter. In all cases, a psoas hitch was performed to gain a longer submucosal tunnel and relieve tension, thus facilitating an efficient antireflux mechanism.

Results Seventeen patients underwent a laparoscopic ureteral reimplantation after failed open surgery. Median age at second surgery was 106 months (interquartile range [IQR]: 53–122.5). Ipsilateral ureteral reimplantation with a combined intravesical and extravesical approaches was performed in 11 cases and cross-trigonal extravesical approach in 6 cases. Median ureteral diameter before the redo surgery was 16 mm (IQR: 14.5–18.5) and after surgery was 6 mm (IQR: 3.5–8.5) (p < 0.001). Postoperative mercaptoacetyltriglycine renal scan showed a nonobstructive pattern and stable renal function in all cases.

Conclusion Laparoscopic ureteral reimplantation with incorporation of a psoas hitch after failed open reimplantation is safe and effective.
Seasonal Variation of Congenital Diaphragmatic Hernia: A Review of the Literature and Database Report from the United States and Canada
Authors: Doktor Fabian , Antounians Lina , Miller Jason , Harb Maria , Meats Tracy , Bercovitch Rachel , Ireland Dawn , Zani Augusto
Published: July 2022

Introduction The etiology of congenital diaphragmatic hernia (CDH) remains unknown and only 10 to 30% of patients have a genetic cause. Seasonal variation is known to contribute to the development of some congenital anomalies. Our aim was to investigate whether CDH births have seasonal variation.

Materials and Methods A literature review was conducted for CDH and seasonality. Moreover, data from the CDH International Patient Registry Database were collected for infants with due dates between 2008 and 2014. Due dates were used to determine seasonal distribution of births. Birth rates per month in the United States and Canada were extracted from publicly available databases. Data were analyzed using analysis of variance and contingency tables.

Results First, the literature review revealed 11 articles, of which 3 were eligible for inclusion. These studies reported conflicting results on seasonality of CDH. Second, we extracted due dates from the CDH International Patient Registry Database (1,259 patients) and found that there were fewer due dates in winter months (12.1 ± 4 patients/month) than in summer (16.7 ± 6 patients/month; p = 0.011) and fall months (16.3 ± 5 patients/month; p = 0.022). Although this trend was similar to that of all births in the United States and Canada, a lower incidence was observed in winter for CDH infants (20.2%) than for the general population (24.1%, p = 0.0012). CDH survival rate did not vary by season.

Conclusion This study provides evidence for a seasonal variation of CDH births. No causative link was established between CDH development and seasonality. Population-based studies with a focus on exposome data are needed to explain seasonal variation in CDH.
Routine Maternal Vaccine Uptake during the COVID-19 Pandemic
Authors: Cotter Savannah , Taylor Lauren , Grace Rebecca , Miao Di , Ratan Bani M.
Published: July 2022

Objective This study examines the impact of the coronavirus disease 2019 (COVID-19) pandemic on influenza and tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine uptake in a pregnant, low-income population.

Study Design This retrospective cohort study included women initiating prenatal care before (May–November 2019) or during the COVID-19 pandemic (May–November 2020) at two large Medicaid clinics. All patients entered prenatal care before 20 weeks and delivered full-term. Medical records were reviewed for vaccine uptake and demographic data. Multivariate logistic regression analysis was used to compare vaccination rates prior to and during the COVID-19 pandemic. Additional analysis was performed to identify association of demographic factors with vaccine uptake. IRB approval was obtained for this study.

Results A total of 939 patients met inclusion criteria, with 462 initiating care prior to and 477 initiating care during the COVID-19 pandemic. Influenza vaccination uptake was 78% (362/462) in the prepandemic group, significantly decreasing to 61% (291/477) in the pandemic group (p <0.01, odds ratio [OR] = 0.38, confidence interval [CI]: 0.26–0.53). Tdap vaccination uptake was 85% (392/462) in the prepandemic group, significantly decreasing to 76% (361/477) in the pandemic group (p <0.01, OR = 0.56, CI: 0.40–0.79). The decrease in influenza vaccine uptake was most significant in non-Hispanic Black patients, decreasing from 64% (73/114) in the prepandemic group to 35% (35/101) in the pandemic group (p <0.01, OR = 0.30, CI: 0.17–0.52), while there was no significant difference in age or parity in relation to vaccination status.

Conclusion Routine vaccination uptake significantly decreased during the COVID-19 pandemic in a low-income population of pregnant women, with decrease more pronounced on influenza vaccine than on Tdap vaccine uptake, especially in non-Hispanic Black patients.

Key Points
Development and Validation of a Neonatal Physical Maturity Score for Low- and Middle-Income Countries
Authors: Krishnan Vaisakh , Kumar Vijay , Vegda Hemadri , Ujjanappa Vidya , Manari Anju , Thamunni Ajithkumar V. , P. Ashraf T. , Devadas Sahana , Fattepur Sudindrashayana , Basett Paul , Thayyil Sudhin
Published: July 2022

Objective Currently available gestational age scoring systems are complex and inaccurate for wider use in low- and middle-income countries (LMIC), particularly in infants with neonatal encephalopathy. Here, we aimed to develop a scoring system based on physical characteristics for identifying late preterm infants from term infants.

Study Design This was a prospective observational study conducted in 2 phases- the discovery phase and validation phase. In the first phase, we examined the accuracy of 10 objective physical characteristics in a prospective cohort of 1,006 infants recruited from three hospitals in South India. A weighted scoring system and a photo card were then developed based on the six best performing characteristics which were validated in another prospective cohort of 1,004 infants.

Results The final score had a sensitivity of 66.0% (95% confidence intervals [CIs], 58.4–73.8%), specificity of 80.0% (95% CI, 77.2–82.7%), and a negative predictive value of 93.0% (95% CI, 90.5–94.5%).

Conclusion This scoring system may have wider applications in LMIC, particularly in community settings and in infants with neonatal encephalopathy.

Key Points
Delayed Aspiration of Air Emboli from the Central Venous Catheter in a Case of Suspected Massive Venous Air Embolism: A Therapeutic Success
Authors: Khandelwal Ankur , Nayak Sudhansu S. , Bhatia Anshil , Shrivastava Amit K. , Bhardwaj Vikas
Published: July 2022

Venous air embolism (VAE), though, clinically benign in majority of cases, the significant ones can lead to life-threatening cardiopulmonary and neurological consequences. Though studies mention the success rate of only 6 to 16% in aspirating air from the central venous catheter (CVC) during VAE, the technique is very specific for diagnosing VAE and has high therapeutic significance. We report a case in which delayed aspiration of air emboli from the CVC in suspected massive VAE during decompressive craniectomy resulted in rapid resolution of hemodynamic instability. If not inserted previously, CVC may be considered in a hemodynamically unstable patient with suspected VAE.
Understanding How Older Adults with Communication Difficulties Access Health Services: What We Can Learn from the National Health and Aging Trends Study (NHATS)
Authors: Baylor Carolyn , Brown Cait , Mroz Tracy M. , Burns Michael
Published: July 2022

People with communication disorders face barriers to accessing safe and respectful healthcare. These barriers result in increased healthcare complications and inefficiencies, both of which contribute to increased healthcare costs. One obstacle to advocating for accommodations that could improve healthcare for this population is the absence of cost effectiveness studies of such accommodations specifically, as well as a paucity of data defining the needs of this population in general. The purpose of this study was to explore how people with communication and swallowing difficulties are characterized in the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries aged 65 and older, and how they manage their healthcare. Cross-sectional data from the NHATS rounds 5 to 9 (2015–2019) resulted in 8,038 unique respondents, 3,243 of who reported speech, memory, hearing, and/or swallowing difficulties. More than 90% of respondents with communication difficulties reported having a regular doctor. Less than 60% of respondents with communication difficulties had a family member or caregiver go to medical appointments with them, and around 70% of that subset of participants received help from that caregiver with communication during appointments. Fewer than 15% of respondents with communication difficulties used the internet for healthcare communication or information. Less than 5% of respondents across all communication difficulty categories had received rehabilitation services for communication in the year prior to their survey responses. While the information gleaned from NHATS points to likely gaps between the needs people with communication disorders may have for safe and accessible healthcare, and the support available, future research is needed to improve and clarify how communication disorders are defined and characterized in large-scale surveys to generate more interpretable data. These stronger empirical foundations are needed to support cost-effectiveness analyses to advocate for better communication accessibility of healthcare settings.
Pediatric Microcuff Tube for Neurosurgical Procedures: A Boon or Bane?
Authors: Thakkar Keta , Sethuraman Manikandan , Hrishi Ajay P.
Published: July 2022

Pediatric Microcuff endotracheal tubes have come into vogue in the last few years. It overcomes the problems faced with the uncuffed or conventional cuffed tubes used in the pediatric population. In addition, the more distal placement of the polyurethane cuffs in these tubes eliminates the risk of airway mucosal injury and hence postoperative stridor. This makes it an attractive option for neurosurgical patients where there is a high incidence of cranial nerve deficit, airway edema, and the requirement of prolonged postoperative ventilation. But due to this particular design, Murphy's eye is not incorporated in the tube, which can potentially hamper ventilation, especially when used for long duration surgery. With the help of our case report, we would like to warn the readers regarding this life-threatening complication that resulted in hypoxia in a 1-year-old child in the postoperative period.
Retrospective Analysis of 1998 Patients Diagnosed with Brain Death between 2011 and 2019 in Turkey
Authors: Sipahioglu Hilal , Elay Gulseren , Bingol Nezahat , Bahar Ilhan
Published: July 2022

Background Organ transplantation reduces mortality and morbidity in patients with end-stage organ failure. The number of living organ donations is not enough to meet the current organ transplantation need; therefore, there is an urgent need for organ donation from cadavers. We aimed to determine the organ donation rates and reveal the obstacles against donation.

Methods This study is designed as a retrospective multicenter study consisting of eight university hospitals, three training and research hospitals, 26 state hospitals, and 74 private hospitals in nine provinces in Turkey. A total of 1,998 patients diagnosed with brain death between January 2011 to April 2019 were examined through the electronic medical records data system.

Results Median patient age was 38 (IQR: 19–57), and 1,275 (63.8%) patients were male. The median time between the intensive care unit admission and brain death diagnosis was 56 (IQR:2–131) hours. The most commonly used confirmatory diagnostic test was computed tomography in 216 (30.8%) patients, and the most common cause of brain death was intraparenchymal hemorrhage with 617 (30.9%) patients. A total of 1,646 (82.4%) families refused to permit organ donation. The most common reasons for refusal were family disagreement (68%), social/relative pressure (24%), and religious beliefs (8%).

Conclusions Many families refuse permission for organ donation; some of the provinces included in this study experienced years of exceptionally high refusal rates.
Incidence and Perioperative Risk Factors of Delayed Extubation following Pediatric Craniotomy for Intracranial Tumor: A 10-Year Retrospective Analysis in a Thailand Hospital
Authors: Sangtongjaraskul Sunisa , Yuwapattanawong Kornkamon , Sae-phua Vorrachai , Jearranaiprepame Thichapat , Paarporn Paweena
Published: July 2022

Background The determination of extubation (early or delayed) after pediatric craniotomy for intracranial tumor should be carefully considered because each has its pros and cons. The aim of this study was to investigate the incidence of the delayed extubation in these patients. The secondary goal was to identify the perioperative factors influencing the determination of delayed extubation.

Methods This retrospective study was performed in pediatric patients with intracranial tumor who underwent craniotomy at a university hospital between April 2010 and March 2020. Preoperative and intraoperative variables were examined. The variables were compared between the delayed extubation and early extubation group.

Results Forty-two of 286 pediatric patients were in the delayed extubation group with an incidence of 14.69%. According to multivariate analyses, the risk factors that prompted delayed extubation were the intracranial tumor size ≥ 55 mm (adjusted odds ratio [AOR], 2.338; 95% confidence interval [CI], 1.032–5.295; p = 0.042), estimated blood loss (EBL) ≥ 40% of calculated blood volume (AOR, 11.959; 95% CI, 3.457–41.377; p < 0.001), blood transfusion (AOR, 3.093; 95% CI, 1.069–8.951; p = 0.037), duration of surgery ≥ 300 minutes (AOR, 2.593; 95% CI, 1.099–6.120; p = 0.030), and completion of the operation after working hours (AOR, 13.832; 95% CI, 2.997–63.835; p = 0.001).

Conclusions The incidence of delayed extubation after pediatric craniotomy was 14.69%. The predictive factors were the size of tumor ≥ 55 mm, EBL ≥ 40% of calculated blood volume, blood transfusion, duration of surgery ≥ 300 minutes, and completion of surgery after routine working hours.