bluuebunny/crossref_metadata_2025 huggingface dataset:
Le pouvoir politique
Authors: Ricœur Paul
Published: September 2019

Si la conception théologique du pouvoir politique est en train de disparaître (le peuple a pris la place de Dieu), elle ne concerne que les rapports de domination. S’ouvre en effet alors le champ d’une théologie politique du vivre-ensemble, qui s’ordonne selon des rapports de coopération.
Peut-on faire l’histoire de tout ?
Authors: Schaub Jean-Frédéric
Published: September 2019

Une tentation post-démocratique se fait jour en histoire qui, contre l’universalisme, prend la forme d’un cloisonnement des savoirs. Mais se donner les moyens de connaître – et d’abord en apprenant les langues – est un viatique plus sûr que la revendication d’appartenances.
Quand l’ornement devient sujet : le papier peint dans quelques tableaux de l’avant-garde de la fin du XIX e siècle
Authors: Ameille Brice
Published: September 2019

Élément central de la décoration intérieure, le papier peint apparaît dans de nombreux tableaux de la fin du xix e siècle. La relation de cet ornement avec la scène représentée est ici interrogée, depuis l’œuvre de Gauguin où il apparaît comme le signe du symbolisme, jusqu’à celle de Vuillard où il est à ce point omniprésent qu’il se pose en véritable sujet. Ce nouveau rapport prouve ainsi que l’art décoratif joue bel et bien un rôle matriciel dans la modernité picturale.
Early Results of a Modern Uncemented Total Knee Arthroplasty System
Authors: Manoli Arthur , Markel Jacob F. , Pizzimenti Natalie M. , Markel David C.
Published: September 2019

Historically, cementless total knees were associated with early failure, which made cemented total knee arthroplasty the gold standard. Manufacturers have introduced newer uncemented technologies that provide good initial stability and use highly porous substrates for bony in-growth. The authors hypothesized that the implants would have equivalent 90-day clinical and economic outcomes. Prospectively collected data on 252 uncemented knees in the Michigan Arthroplasty Registry Collaborative Quality Initiative database were reviewed. Ninety-day outcomes, demographics, length of stay, complications, emergency department visits, readmissions, and financial data were compared with those of an age-matched group of cemented knees. Uncemented knees had shorter length of stay (1.58 vs 1.87 days;
P
<.01), were more frequently discharged home (90.48% vs 68.75%;
P
<.0001), and used less home care (6.35% vs 19.14%;
P
<.0001) or extended care facilities (2.78% vs 11.72%;
P
=.0001). More uncemented knees had “no complications.” Moreover, there were no re-operations in uncemented knees, compared with 19 reoperations in cemented knees. Uncemented knees were better than age-matched counterparts for Knee injury and Osteoarthritis Outcome Score (63.69 vs 47.10, n=85 and n=43,
P
<.0001) and Patient-Reported Outcomes Measurement Information System (PROMIS) T-Physical and T-Mental scores (44.12 vs 39.45,
P
<.0001; 51.84 vs 47.82,
P
=.0018). Cemented cases were more expensive overall, and surgical ($6806.43 vs $5710.78;
P
<.01) and total hospital ($8347.65 vs $7016.11;
P
<.01) costs were higher. The 90-day readmission and hospital outpatient costs were not significantly different between designs. Uncemented total knee arthroplasty, when using modern technologies, is successful and economically viable for an at-risk bundle. The results of this study should alleviate fears of increased cost, early failure, complications, or poor outcomes with the use of a modern uncemented total knee arthroplasty. [
Orthopedics
. 2019; 42(6):355–360.]
The Effect of Femoral Cutting Jig Design on Restoration of Femoral Offset in Posterior-Referenced Total Knee Arthroplasty
Authors: Coyle Ryan M. , Bas Marcel A. , Rodriguez Jose A. , Hepinstall Matthew S.
Published: September 2019

Femoral component sizing and rotation in total knee arthroplasty (TKA) affects patellofemoral tracking and tibiofemoral mechanics. Posterior referencing is said to optimize restoration of posterior condylar offset. However, it typically allows the surgeon to select 3° to 5° of external rotation to the posterior condylar axis, inevitably changing the offset of one or both condyles. The axis about which external rotation occurs varies between the jigs of various TKA systems. The location of this axis can result in a medial, central, or lateral reference point for posterior offset restoration. Variations in jig design will result in varying posterior offset changes at the same jig setting, with differential effects on balance between the flexion and extension gaps. Using identical Sawbones in a controlled laboratory setting, 9 TKA instrumentation systems were examined. Two systems referenced medially, 1 referenced laterally, and 6 referenced centrally. The authors measured distal and posterior resections in both 3° and 5° of external rotation to the posterior condylar axis. They calculated changes in both distal and posterior joint lines using resection measurements and implant specifications. Posterior resection thicknesses were greatest with instruments that referenced laterally and least with instruments that referenced medially. With increasing external rotation, instruments that referenced off the lateral femoral condyle introduced the greatest mismatch between the distal and posterior joint lines, as compared with instruments that referenced centrally or medially. Surgeons should be aware that laterally referencing systems can differentially restore distal and posterior joint lines at higher settings of femoral external rotation, potentially introducing incongruity between flexion and extension gaps if the posterior slope of the tibia is maintained. This may be particularly problematic if flexion laxity is increased by posterior cruciate ligament sacrifice. [
Orthopedics
. 2019; 42(6):316–322.]
Advanced Baseball Metrics Indicate Significant Decline in MLB Pitcher Value After Tommy John Surgery
Authors: Selley Ryan S. , Portney Daniel A. , Lawton Cort D. , Shockley Michael D. , Christian Robert A. , Saltzman Matthew D. , Hsu Wellington K.
Published: September 2019

There are conflicting reports regarding the efficacy of Major League Baseball (MLB) pitchers following medial ulnar collateral ligament reconstruction (UCLR). As advanced baseball metrics have revolutionized the way general managers define pitchers' value, the authors believe that these should be used to measure clinical outcomes after UCLR. All MLB pitchers who underwent UCLR from April 1, 1991, through July 1, 2016, were compiled (N=253). Pitcher demographics and statistics were collected for up to 3 full seasons preceding and following surgery. Data for pitching controls (all MLB [AMLB] pitchers) were also collected (N=14,756). Prior to surgery, pitchers with UCLR were significantly better than the AMLB pitchers in nearly all advanced value-based statistics: higher wins above replacement (WAR; 0.93 vs 0.78; 95% confidence interval [CI], 0.80–1.06), lower fielding independent pitching (FIP; 4.23 vs 4.51; 95% CI, 4.12–4.34), lower expected fielding independent pitching (xFIP; 4.17 vs 4.38; 95% CI, 4.06–4.28), higher win probability added (WPA; 0.21 vs 0.05; 95% CI, 0.1–0.32), and higher leverage index (pLI; 1.03 vs 0.96; 95% CI, 0.99–1.06). Pitchers who returned to play after UCLR demonstrated significantly lower value with worse WAR, FIP, WPA, and pLI (
P
<.05). Conversely, after excluding pitchers who failed to achieve a sustained return to play of greater than 1 year, there were no significant decreases in value after surgery. The authors conclude that, prior to injury, pitchers who have UCLR are more valuable than average MLB pitchers. However, UCLR pitchers perform worse when compared with their presurgical values. This may be affected by players not being able to continue their careers for more than 1 year. [
Orthopedics
. 2019; 42(6):349–354.]
Respiratory Syncytial Virus: Spectrum of Clinical Manifestations and Complications in Children
Authors: Rostad Christina A.
Published: September 2019

Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection in infants and young children. Despite its substantial disease burden, no effective vaccine is available. Clinical manifestations of RSV encompass the spectrum of acute upper and lower respiratory tract infection. Hallmarks of the virus are its propensity to progress to lower respiratory disease and to cause disproportionate disease severity at extremes of ages. Acute RSV infection may be complicated by secondary bacterial infections and respiratory failure requiring mechanical ventilation and prolonged hospitalization. In the developed world, most RSV infections are self-limited; however, globally, RSV is a significant cause of mortality in children younger than age 5 years. Severe RSV infection in infancy has also been associated with the development of childhood asthma. Thus, the extensive disease burden of RSV and its attributable mortality portend the urgency of vaccine development targeted toward populations disproportionately affected by severe disease.

[
Pediatr Ann.
2019;48(9):e349–e353.]
The Role of Motivational Interviewing in Children and Adolescents in Pediatric Care
Authors: Desai Nikita
Published: September 2019

Motivational interviewing (MI) addresses patient ambivalence about a desired goal in a directed, patient-centered manner. MI intervention is established as a therapeutic tool within the pediatric population with positive outcomes for obesity, asthma, medication adherence, and HIV management. MI is especially promising within the adolescent population where increasing independence tends to contribute to poorer health outcomes. Multidisciplinary adaptation of the MI format works well to address traditionally difficult pediatric care issues such as obesity. In the future, MI training of physicians may incorporate an online medium for wider distribution. More research is required to determine the most efficacious style and to support the generalizability and reproducibility of MI interventions for widespread application.

[
Pediatr Ann.
2019;48(9):e376–e379.]
Verandering van de demografische structuren en van de geografie van de Europeanen in Brussel tussen 2000 en 2018
Authors: Casier Charlotte
Published: September 2019

In 2018 waren er 275 000 onderdanen van de Europese Unie in het Brussels Hoofdstedelijk Gewest, ofwel 23 % van de bevolking die in het Brussels Gewest gedomicilieerd is. Dit is het gevolg van de aanhoudende stijging van de omvang van deze groep tussen 2000 en 2018 door de sterke immigratie vanuit de nieuwe EU-lidstaten, maar ook de constante toename van het aantal Fransen en de herneming van de migratie vanuit Zuid-Europa sinds 2008. Op geografisch gebied is de aanwezigheid van Europeanen tussen 2000 en 2015 toegenomen in het zuidoosten van de eerste stadsgordel, hoewel de sterke toename van Polen, Roemenen en Bulgaren tegelijkertijd bijdraagt tot de versterking van de Europese aanwezigheid in bepaalde wijken in het westen van Brussel.
Peut-on parler d’un « âge d’or » de la réhabilitation en matière pénale ? Sens et usages de l’idéal de réhabilitation dans une réforme pénale brésilienne
Authors: Raupp Mariana
Published: September 2019

Le constat que la réhabilitation fut l’orientation pénale dominante dans le monde occidental pendant la période dite des Trente Glorieuses est très répandu dans la littérature criminologique, mais rarement documenté par les recherches empiriques. On en sait peu sur les pratiques législatives, judiciaires ou correctionnelles que cet idéal fondait. Cet article veut apporter un nouvel éclairage sur ce constat à partir de l’étude des différents usages du discours de la réhabilitation dans une commission de réforme pénale active dans les années 1980 au Brésil et considérée comme progressiste. À partir de l’analyse de documents de réflexion et de propositions législatives élaborés par cette commission ainsi que d’entretiens avec ses membres, notre recherche montre que les réformateurs ont adressé la réhabilitation au système politique et aux tribunaux. Destinée au système politique, la réhabilitation fut très valorisée et signifiait améliorer les conditions de vie dans les prisons. Destinée aux tribunaux lors de la détermination et de l’aménagement de la peine, elle fut très dévalorisée et marginalisée au profit de la rétribution et de la dissuasion. Ces résultats suggèrent que les réformateurs déresponsabilisent les tribunaux de tenir compte de l’inclusion sociale du justiciable ; cela reste une préoccupation pour le système politique qui doit mettre en place des programmes favorisant leur resocialisation. Lorsque la réhabilitation est placée dans la prise de décision sur la peine, et donc une affaire du droit criminel, sa portée demeure très limitée et elle n’y joue pas un rôle dominant.
Solidification of Ni-Ti Shape Memory Alloy: Modeling and Simulation
Authors: Carvalho L. Cordeiro , Barbosa de Lima A.G. , de Miranda Vansostenes Antonio Machado , de Oliveira J.M. Freitas , de Lima E. Santana
Published: September 2019

The shape memory alloys have been used in the most different sectors such as aerospace, automotive and biomedical due to their ability to return to their original shape when subjected to high temperatures. Modeling and numerical simulation have become great allies in engineering due to the possibility of solving complex problems, especially in cases where experimental research is limited. In the present study, a two-dimensional mathematical model was developed to describe the solidification process of a Ni-Ti alloy in stainless steel metal mold sand confined. It was considered the flow of a refrigerant fluid (air) in the top of the mold. The energy conservation equation, including the phase change term, was discretized using finite volume method (FVM) and a fully implicit formulation. Results of the Ni-Ti alloy and mold temperature distributions over time are presented and analyzed. It was verified that results are independent of the mesh size and time step. The last point to be solidified is located at the top left corner of the study domain and the temperature distribution over time proved to be satisfactory for the absence of internal defects, such as voids, cracks, residual stresses and macro segregation.
Heat Transfer in a Fixed Bed Elliptic-Cylindrical Reactor: A Pseudo-Homogeneous Model with First-Order Chemical Reaction Term
Authors: da Silva R. Moura , Pereira A. Santos , de Miranda Vansostenes Antonio Machado , de Oliveira J.M. Freitas , Barbosa de Lima A.G.
Published: September 2019

In this work a transient three-dimensional mathematical model was developed using cylindrical-elliptic coordinate system and thermo-physical properties as functions of the position or temperature. The aim is to predict heat transfer in an elliptic-cylindrical fixed bed reactor subjected to a chemical reaction of first order whose heat of reaction is given by the power law. The governing equation of the phenomenon is solved using the finite volume method, and the WUDS interpolation scheme, and the fully implicit method. Results are presented and discussed by varying reagent concentration, Arrhenius pre-exponential factor and reagent temperature at the reactor inlet. It was found that: first-order reactions at low molar concentrations have few effect in the temperature distribution and high molar concentrations, from 0.8 kmol/m3, increase the radial temperature gradients; an increase in the inlet temperature of reactor favours the increase in the heating zone in the centre of the equipment, but does not significantly alter the radial temperature gradients; the Arrehnius pre-exponential factor varying in the same order of magnitude as the concentration of reagents practically produces the same field of temperature in the reactor,
Two-Phase Flow (Oil and Water) in Ducts with the Elliptical Cross-Section: Modeling and Simulation
Authors: de Oliveira J.L. , Barbosa de Lima A.G. , Pereira Ramos R. , Fernandes Magalhães H. Luma , Gomes dos Santos W.R. , de Farias Neto Severino Rodrigues
Published: September 2019

In the oil industry, pipelines (circular ducts) are widely used for the transportation of oil and yours derived. Because of their advantages, such as low operating cost and increased safety during transportation, pipelines have become indispensable for transporting oil in large quantities and for long distances. As an alternative to this problem, the transport of oil and water can be accomplished using ducts with an elliptical cross-section. Thus, this work has the objective of studying the flow of oil and water in cylindrical ducts with an elliptical cross-section by using the Ansys CFX software. Results of the velocity, pressure and volumetric fraction distributions of the oil and water phases are presented and analyzed. By applying the same inlet velocity to oil and water, revealed that the elliptical duct, with aspect ratio equal to 5.0, has a pressure drop less (84.2%) than the pressure drop obtained for one duct of circular cross-section (aspect ratio equal to 1.0).
Radial pseudoaneurysm in elderly: a rare event with undefinied therapeutical approach. A case report and literature review
Authors: Gallinoro Emanuele , Natale Francesco , D’Elia Saverio , Golino Paolo , Cimmino Giovanni
Published: September 2019

Radial artery pseudoaneurysm (RAP) after cardiac catheterization in elderly patients is a rare complication. Clinical manifestations are pain, swelling and haematoma of the harm. The diagnosis is made through doppler ultrasonography, but the best therapeutical option is still matter of debate. Traditionally, surgical treatment has been considered the gold standard but new and less invasive strategies have been recently proposed: ultrasound-guided compression and local injection of thrombin. In this report we describe the unique case of an 84-year-old female patient who developed radial artery pseudoaneurysm after a failed radial artery access for cardiac catheterization. Finally, the pseudoaneurysm was successfully treated by surgical approach as several attempts of local compression failed. We aimed also at reviewing the treatment options of RAP in elderly patients (>75 years old) and the safety/effectiveness reported in literature.
The phyllotaxis of the aortic valve
Authors: Moscarelli Marco , De Paulis Ruggero
Published: September 2019

Biological systems ubiquitously and inevitably exhibit stochasticity in traits from the molecular level to the multicellular and morphological level. However, there are several examples of natural events that might be described in mathematical terms. Plants grow in a structured and geometric way to maximize their sun exposure for photosynthesis while reducing the stress. The ‘Fibonacci sequence’ and its ‘golden ratio’ are considered a mathematical regularity and model that is one of the corner-stone of the ‘phyllotaxis’, the part of the botany that studies how plants branch. Nevertheless, we currently do not know if such mathematical model can be applied to humans. Different authors have hypothesized that ‘fractal’ might be identified along with the ‘golden-ratio’ in the human body (coronary artery, heart valves etc.). The aortic valve and the aortic root might represent an interesting model of human fractal geometry, where the phyllotactic rules can be reasonably applied, and where deviation from normality might results in dysfunction. However, in the absence of scientific validations, such report represents only the authors’ perceptions of a beautiful shape.
Coliform removal in a constructed wetland system used in post-swine effluent treatment
Authors: Amorim Fabiana De , Mota e Silva Jaíza Ribeiro , Fia Ronaldo , Oliveira Luiz Fernando Coutinho de , Campos Cláudio Milton Montenegro
Published: September 2019

This study evaluated the efficiency of a constructed wetland system (CWS) in removing total coliforms (TC) and thermotolerant coliforms (ThC) of swine wastewater, as a complementary treatment to an anaerobic system. At Stage 1, the experimental system was combined using a vertical flow constructed wetland system (VFCWS) cultivated with Tifton 85 grass in series with a horizontal subsurface flow constructed wetland system (HFCWS1) cultivated with Taboa. In HFCWS1, the hydraulic detention times (HDT) were 4.7, 3.1 and 2.3 days and the surface application rates (SAR) were 294, 319 and 397 kg ha-1 d-1 of COD, in Phases I, II and III, respectively. At Stage 2, the experimental system was combined using a horizontal subsurface flow constructed wetland system (HFCWS2) cultivated with Tifton 85 grass, HDT were 6.1, 2.0 and 0.5 days and the SAR were 850, 656 and 6.34 kg ha-1 d-1 of COD, in Phases I, II and III, respectively. In Stage 1, it was verified that the VFCWS was more efficient in coliform removal when compared to HFCWS1. When only HFCWS were compared, coliform removal in Stage 1 was between 1 and 2 log units in HFCWS1. In the stage 2, the HFCWS2 was more limited, with the highest removal efficiencies during Phase I of 1.6 and 0.8 log units for TC and ThC, respectively. In general, the association resulted in efficiencies that ranged from 96.4 to 99.0% for TC, 94.2 and 97.6% for ThC, equivalent to the average removal of 1.2 to 2 log units, considered satisfactory.
On the energy variant of the sum-product conjecture
Authors: Rudnev Misha , Shkredov Ilya D. , Stevens Sophie
Published: September 2019

We prove new exponents for the energy version of the Erdős–Szemerédi sum-product conjecture, raised by Balog and Wooley. They match the previously established milestone values for the standard formulation of the question, both for general fields and the special case of real or complex numbers, and appear to be the best ones attainable within the currently available technology. Further results are obtained about multiplicative energies of additive shifts and a strengthened energy version of the “few sums, many products” inequality of Elekes and Ruzsa. The latter inequality enables us to obtain a minor improvement of the state-of-the-art sum-product exponent over the reals due to Konyagin and the second author, up to 4/3 + 1/1509. An application of energy estimates to an instance of arithmetic growth in prime residue fields is presented.
Compression Ratio and Intake Air Temperature Effect on the Fuel Flexibility of Compression Ignition Engine
Authors: AlRamadan Abdullah S. , Ben Houidi Moez , Aljohani Bassam S. E. , Eid Hassan , Johansson Bengt
Published: September 2019

The effect of compression ratio (CR) and intake air temperature on the combustion characteristics of fuels with different octane ratings were investigated on a single-cylinder heavy duty engine. The study focused on Primary Reference Fuels (PRFs) and commercial grade diesel with octane numbers ranging from 0 to 100. The engine was configured at a CR of 11.5:1, which is lower than typical heavy-duty compression ignition CI engines. This aims to compare the fuels’ burning regime with recently reported measurements at CR17:1. Experiments were performed at different intake air temperatures of 20 to 80 °C and net indicated mean effective pressure (IMEPNet) of 5 to 20 bar. The injection rates have been characterized to determine the hydraulic delay of the injector and thus define the actual ignition delay time. At low loads, diesel-like fuels were found to burn in partially premixed combustion (PPC) mode whereas high octane fuels did not ignite. At high loads, fuels combustion becomes diffusion driven regardless of their RON or MON values. The effect of intake air temperature on the combustion characteristics depended on the combination of the octane ratings and the engine load. At high loads, fuels with low octane numbers were insensitive to the change of the intake air temperature. The ignition delay time was short enough to maintain a diffusion driven combustion. At lower loads, it is more challenging to reach conditions where the combustion characteristics are invariant regardless of the fuel’s RON and MON values (Fuel Flexible). At the low tested compression ratio of 11.5:1, the extent of fuel flexibility is limited to only high loads (IMEPNet = 20 bar) whereas it is extended to intermediate loads (IMEPNet = 10 and 15 bar) at CR17:1.
Influence of Injection Strategies on Engine Efficiency for a Methanol PPC Engine
Authors: Svensson Erik , Tuner Martin , Verhelst Sebastian
Published: September 2019

Partially premixed combustion (PPC) is one of several advanced combustion concepts for the conventional diesel engine. PPC uses a separation between end of fuel injection and start of combustion, also called ignition dwell, to increase the mixing of fuel and oxidizer. This has been shown to be beneficial for simultaneously reducing harmful emissions and fuel consumption. The ignition dwell can be increased by means of exhaust gas recirculation or lower intake temperature. However, the most effective means is to use a fuel with high research octane number (RON). Methanol has a RON of 109 and a recent study found that methanol can be used effectively in PPC mode, with multiple injections, to yield high brake efficiency. However, the early start of injection (SOI) timings in this study were noted as a potential issue due to increased combustion sensitivity. Therefore, the present study attempts to quantify the changes in engine performance for different injection strategies. Simulations were performed on a heavy-duty multi-cylinder compression ignition engine fueled with methanol. Two operating conditions with different engine load were chosen from the European stationary cycle. Three different injection strategies were applied: 1) SOI > −160°ca aTDC 2) SOI > −40°ca aTDC 3) SOI > −25°ca aTDC. The engine settings were selected to maximize the brake efficiency for each case and the sensitivity of combustion to inlet conditions was analyzed. For the high load operating point, the brake efficiency was 2.2 %pt. higher for case 1 compared to case 3, while this difference was only 0.5 %pt. for the low load operating point. However, the combustion phasing for case 1 and 2 at the high load point proved to be very sensitive to inlet temperature, inlet pressure and oxygen concentration.
Gender Differences in Retention and Promotion Among Generalists Who Graduated From Research-Intensive Fellowships
Authors: Chaiyachati Krisda H. , Liao Joshua M. , Weissman Gary E. , Hubbard Rebecca A. , Morgan Anna U. , Buehler Anna , Shea Judy A. , Armstrong Katrina A.
Published: September 2019

Background

Generalists who pursue research-intensive fellowships develop research skills and mentor-mentee relationships. Whether gender disparities in retention and promotion exist among this research-trained cohort is understudied.

Objective

We measured whether disparities exist among graduates of research-intensive fellowships and how mentorship influences them.

Methods

We surveyed generalists (internal medicine, pediatrics, family medicine, combined internal medicine–pediatrics) between July and August 2016 who graduated from research-intensive fellowships. Generalists (“mentees”) were asked whether they remained or were promoted, and to name up to 10 influential mentors during or within 5 years of fellowship. Multivariable logistic regression estimated associations between mentee gender and retention and promotion. Next, we separately included 3 network characteristics: (1) mentee degrees (number of mentors reported per mentee); (2) mean mentor betweenness centrality (importance of each mentor within the network); and (3) largest community membership (mentee status in the largest interconnected mentor-mentee group within the network). All models adjusted for generalists' race, specialty, fellowship institution, and publications.

Results

One hundred sixty-two graduates (51%) representing 19 institutions responded. In adjusted analyses, compared to men, women were as likely to remain in academic medicine (odds ratio [OR] 1.88; 95% confidence interval [CI] 0.72–4.89; P = .20), but less likely to be promoted within 5 years of fellowship (OR 0.26; 95% CI 0.09–0.80; P = .018). Inclusion of network measures did not alter these associations.

Conclusions

Despite remaining in academic medicine as frequently as their male counterparts, fellowship-trained women were promoted less often. Features of mentors, measured using network analysis, may not explain these observed differences.
Good Clinical Practices toward Safe Blood Transfusion: A Study of Blood Transfusion Process and providing Suggestions for streamlining the Same
Authors: Shrivastava Akash A , Somu G , Dayananda M
Published: September 2019

Introduction

Wrong blood transfusion (BT) is a medical negligence. Every hospital must have a strong policy to check incorrect BT and see to it that these policies are strictly implemented at the time of transfusion.

Wrong BT can occur due to carelessness of the staff and shortcomings in verification of the blood bag. The reasons can be avoided and wrong BT can be prevented by the formation of a checklist consisting of the important details to be verified before initiating transfusion. The checklist should not be very long and time-consuming, but very comprehensive and consists of only absolutely essential things to be checked.

Aim

To study the BT process and providing suggestions for streamlining the process of BT.

Objectives

• To analyze the nears miss incidents during BT.

• To identify the errors in the process of transfusion.

• To streamline the process by introducing checklist/work instructions for reducing errors.

Materials and methods

• Analysis of safety reports regarding BT.

• Process-based root cause analysis was done at the time of issue and at ward level.

• Feedback regarding BT was taken from the staff working at blood bank and nursing professionals.

The study was divided into two phases:

Phase 1: January—April 2014

Phase 2: May—August 2014

All the reports from phase 1 of the study were analyzed. Based on the observations, interventions in the form of checklist and work instructions to the nursing staff were implemented in the hospital in the month of April and then the safety reports for the next 4 months were analyzed.

Interventions done: A “4C” checklist was created with just four elements that could be orally or mentally reviewed before beginning transfusion. Specific work instructions were also issued to the nursing staff at the ward level to prevent any errors during labeling of the samples being sent for cross match and blood grouping before BT.

Results

The number of BT-related safety incidents observed in phase 1 reduced in phase 2 though the workload in terms of samples received remained comparable for the two phases. However, a declining trend for the reporting of incidents was also seen through the phases.

How to cite this article

Shrivastava AA, Somu G, Dayananda M. Good Clinical Practices toward Safe Blood Transfusion: A Study of Blood Transfusion Process and providing Suggestions for streamlining the Same. Int J Res Foundation Hosp Healthc Adm 2016;4(1):1-4.
Use of CRABEL Scores to improve Quality of Medical Records Documentation in Hospitals
Authors: Raza Arif
Published: September 2019

Introduction

This study is based on an approach employed by a medical college hospital for improving the adequacy of documentation in their medical records. The hospital utilized CRABEL scoring tool to screen and score their medical records and then used this information as a feedback to their clinical departments for encouraging them to improve their record documentation.

Aim

The study aims to determine whether the approach of the hospital resulted in any significant change in adequacy of their medical record documentation.

Materials and methods

Baseline sample of 250 current medical records (stratified random) from four clinical departments were scored using CRABEL scoring method to determine baseline average score and number of files with high scores (score > 0.85). Feedbacks on scores were given to departments, along with the information on areas for improvement. Scoring and feedback were repeated every month for six consecutive months, with sample size of 230 to 271. Trends in average score and number of files with high scores were observed. Difference between average scores of baseline sample and sample at the end of 6 months was statistically tested. Number of files with high scores, in departments where approach was carried out was compared with number of files with high scores, in departments were approach was not carried out, to check statistically significant difference, if any

Results

The trend showed a continuous monthly improvement in both average scores and number of files with high scores. Improvement was found in files of all clinical departments with minor variations. The chi-square test and Student's t test showed a significant difference at p < 0.05 (p for chi square — 0.001 and for t-test — 0.04).

Conclusion

The hospital's approach was found to be successful in improving the adequacy of documentation in medical records.

Clinical significance

Medical record constitutes the most important record in a clinical setting. Completeness of medical record is essential for proper patient care, but is a challenge in most organization. The approach has proven successful in this study and can be replicated in other settings for improvement.

How to cite this article

Raza A. Use of CRABEL Scores to improve Quality of Medical Records Documentation in Hospitals. Int J Res Foundation Hosp Healthc Adm 2016;4(1):5-10.
A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior
Authors: Sharma DK
Published: September 2019

It is generally believed that big changes can be brought about by big interventions. Sometimes, small interventions also can show spectacular results. This case describes the impact of simple intervention, audit and feedback on change in the behavior of clinicians. In this case, the impact of simple intervention in the form of passive feedback has been documented. All the prescriptions received in pharmacy during the period of study were scrutinized for specific prescription errors. An overall error rate of 0.12% was observed in phase 1 of the study, which was reduced to 0.04% during phase 2 of the study after implementation of the intervention, which further dropped to zero during phase 3. It was concluded that a simple audit and feedback nudged the recipients of the feedback to modify their behavior.

How to cite this article

Tadia VK, Ahlawat R, Arya SK, Sharma DK. A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior. Int J Res Foundation Hosp Health Adm 2016;4(1):31-34.
A Comparative Study of Addition of Midazolam to Lignocaine—Bupivacaine vs only Lignocaine— Bupivacaine in Brachial Plexus Block
Authors: Dalvi Naina P , Salunkhay Harshali , Mohite Shubha N
Published: September 2019

Introduction

This prospective, randomized, double-blind study compared the onset and duration of sensory blockade, motor blockade, and analgesia with lignocaine, bupivacaine, and midazolam combination vs only lignocaine, bupivacaine in brachial plexus block.

Materials and methods

Patients of either sex, aged 18–60 years, American Society of Anesthesiologists grade I/II, posted for upper limb surgeries to be performed under supraclavicular brachial plexus block with the help of peripheral nerve stimulator were administered either 10 ml 0.5% bupivacaine with 50 μg/kg midazolam (preservative free) + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine– bupivacaine–midazolam (LBM) or 10 ml 0.5% bupivacaine + 20 ml 2% lignocaine with adrenaline (1:200,000) in Group lignocaine–bupivacaine (LB).

Onset and duration of sensory and motor blockade were monitored. Postoperative analgesia was graded with visual analog scale. Sedation was monitored with Ramsey sedation score.

Results

A total of 60 patients were randomized to the group LBM (n = 30) and group LB (n = 30). The analgesia was significantly prolonged in the study group, with a mean of 11.72 ± 1.924 hours as compared with a mean of 6.383 ± 1.031 hours in the control group. Sedation scores were higher in the study group, that is, group LBM compared to group LB postoperatively.

Conclusion

In conclusion, midazolam when added to bupivacaine and adrenalized lignocaine for supraclavicular brachial plexus block hastens the onset of sensory and motor blockade. This combination improves analgesia, as manifested by lower pain scores and prolonged duration of analgesia.

How to cite this article

Dalvi NP, Salunkhay H, Mohite SN. A Comparative Study of Addition of Midazolam to Lignocaine–Bupivacainevsonly Lignocaine–Bupivacaine in Brachial Plexus Block. Res Inno in Anaesth 2016;1(1):5-9.
A Study of Noninvasive Cardiac Output and Other Cardiorespiratory Parameters in Various Neurosurgical Positions
Authors: Karnik Hemangi S , Nerurkar Aparna A , Bawankule Nishant
Published: September 2019

Background

Neurosurgical patients are operated in supine, prone, lateral, and sitting positions, which cause physiological changes in cardiorespiratory parameters. Noninvasive cardiac output (NICO) monitor developed by Novametrix Medical System Inc is a noninvasive cardiac output monitor, which also measures and displays other parameters like stroke volume, cardiac index, pulmonary capillary blood flow, alveolar and dead space ventilation, peak flow rates, airway pressures, and respiratory volumes. We felt that a study using the NICO monitor in anesthetized patients undergoing neurosurgery in different positions would quantify the cardiopulmonary changes, identify risk factors, and improve intraoperative management.

Materials and methods

A total of 40 consecutive patients undergoing neurosurgical procedures—20 in prone, 16 in lateral and 4 in sitting position—were studied. The hemodynamic and cardiorespiratory parameters were noted in supine position about 15 minutes after induction of general anesthesia using standard protocol and 15 minutes after giving surgical position using NICO monitor.

Conclusion

We conclude that under anesthesia, the prone and sitting positions negatively affect derived cardiac parameters like cardiac output, cardiac index, and stroke volume, and lateral position tends to improve these parameters while the respiratory parameters are not significantly affected.

How to cite this article

Karnik HS, Nerurkar AA, Bawankule N. A Study of Noninvasive Cardiac Output and Other Cardiorespiratory Parameters in Various Neurosurgical Positions. Res Inno Anaesth 2016;1(1):19-24.
A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block
Authors: Sahu Sindil Kumar , Badole Usha
Published: September 2019

Orthopaedic upper limb surgeries are commonly performed under brachial plexus block. Ultrasound guidance significantly improves the quality of nerve block with lesser number of complications, although complications cannot be eliminated completely. Ipsilateral recurrent laryngeal nerve palsy is a rare complication associated with supraclavicular approach. We report a case of 28 year old female who developed hoarseness of voice following ultrasound guided supraclavicular brachial plexus block. The diagnosis of ipsilateral recurrent laryngeal nerve palsy requires a high index of suspicion and it should always be kept in differential diagnosis when a patient develops hoarseness of voice or respiratory compromise after supraclavicular brachial plexus block.

How to cite the article

Sahu SK, Badole U. A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block. Res Inno Anaesth 2016;1(1):30-31.
Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries
Authors: Dalvi Naina P , Patil Narendra
Published: September 2019

Introduction

This single-center, prospective, randomized, double-blind study compares the effect of intrathecal fentanylbupivacaine and tramadol-bupivacaine on the onset and duration of sensory and motor blockade, as well as postoperative analgesia in lower abdominal surgeries.

Materials and methods

Patients of either sex, aged 18 to 60 years, American Society of Anesthesiologists (ASA) grade I/II undergoing lower abdominal surgeries like appendicectomy, inguinal hernia repair surgery, and hydrocele surgery were administered either 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 μg) of fentanyl citrate (group F) or 2.5 mL of 0.5% bupivacaine + 0.5 mL (25 mg) of tramadol (group T) intrathecally.

Monitoring of the vital parameters, onset and duration of sensory and motor block, duration of postoperative analgesia, visual analog scale (VAS) score, sedation score, and any adverse drug reactions was done at predetermined intervals.

Results

Sixty patients were randomized to the group F (n = 30) and group T (n = 30). The duration of sensory blockade was significantly prolonged in group F (314.66 ± 49.25 minutes) as compared to group T (261.66 ± 27.92 minutes). Similarly, duration of motor blockade was longer in group F (263.66 ± 40.97 minutes) compared to group T (214.66 ± 26.61 minutes). The total duration of analgesia was significantly prolonged (p < 0.001) in group F (412 ± 97.888 minutes) compared to group T (301 ± 38.75 minutes).

Hemodynamic parameters, such as pulse, systolic blood pressure, diastolic blood pressure and oxygen saturation were comparable in both the groups. Visual analog scores were significantly lower in the group F patients as compared to the group T patients. The group F patients had got significantly higher sedation scores as compared to Group T patients.

Discussion

Fentanyl 25 μg, when added to 2.5 mL of 0.5% hyperbaric bupivacaine, confers prolonged duration of sensory and motor blockade than 25 mg tramadol added to 2.5 mL of 0.5% hyperbaric bupivacaine. The bupivacaine-fentanyl combination prolonged duration of sensory and motor blockade, improved analgesia, as manifested by lower pain scores, and prolonged duration of postoperative analgesia.

How to cite this article

Dalvi NP, Patil N. Comparison of Effect of Intrathecal Fentanyl-bupivacaine and Tramadol-bupivacaine Combination on Postoperative Analgesia in Lower Abdominal Surgeries. Res Inno in Anesth 2016;1(2):35-40.
Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients
Authors: Mathew Johann
Published: September 2019

Background

Anticipating a difficult airway is of prime importance to an anesthesiologist. Data available are inconclusive to say that tracheal intubation is more difficult in the obese. The deficiency occurring with individual factors can be avoided by adopting multiple airway assessment factors. In this study, we aim to compare the incidence of difficult intubation between obese and nonobese patients and compare three predictors of difficult intubation.

Study design

Prospective observational study.

Materials and methods

About 250 patients were assigned to two groups, obese and nonobese based on their body mass index. Preoperatively, neck circumference (NC), mouth opening, thyromental distance (TMD), neck extension, NC/TM ratio, Mallampati classification (MPC), and Wilson score (WS) were calculated. Difficulty of intubation was assessed using the intubation difficulty scale (IDS). All tracheal intubations were performed by anesthetists with more than 2 years of experience.

Statistical analysis used

Data analysis was done with the help of Statistical Package for the Social Sciences (SPSS) version 15, MedCalc version 11, and Epi data software. Qualitative data are presented with the help of frequency and percentage table, and association among various study parameters is done with chi-square test.

Results

The incidence of difficult intubation determined by the IDS (≥5) was more frequent in the obese group (88.6% in obese vs 11.4% in nonobese). Of the three variables, WS was found to be statistically significant (p < 0.005). Neck circumference to thyromental ratio is a new predictor for difficult tracheal intubation (DTI). But an NC/TM ratio of ≥5 gives high false positive for our population.

How to cite this article

Mathew J, Gvalani SK. Comparison of Incidence of Difficult Intubation between Obese and Nonobese Patients, and Comparison of Three Predictors of Difficult Intubation in Obese Patients. Res Inno in Anesth 2016;1(2):41-44.
Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure
Authors: Pradeep L
Published: September 2019

Context

The duration of neuromuscular block with rocuronium is affected by old age as well as renal impairment. It would be helpful for anesthetists to know the variation in the block in elderly patients with renal failure and the significance of neuromuscular monitoring in this group.

Aim

The aim of our study is to investigate the neuromuscular effects of 0.6 mg/kg rocuronium under general anesthesia in young adults and elderly patients with or without renal failure.

Study design

Prospective randomized controlled study.

Materials and methods

Young and elderly 100 patients were divided into 4 groups of 25 each, with or without renal failure. General anesthesia with propofol 2 mg kg intravenous (iv), fentanyl 2 μg kg iv, and 60% N2O in O2 were given. Neuromuscular monitoring was started immediately after the induction of anesthesia and before the administration of muscle relaxant. After the stabilization of control responses, 0.6 mg kg rocuronium was injected intravenously. The onset time, time to achieve maximum block, and the recovery times were noted.

Statistical analysis used

The statistical analysis of the data from the study was performed with the Statistical Package for the Social Sciences (SPSS) software for Window Release 14.0. One-way analysis of variance, Bonferroni's, and chi-square test were used to compare patients’ characteristics.

Results

The duration of block as well as the recovery indices were significantly prolonged in the elderly compared to the young patients. Maximum prolongation was observed in the elderly group with renal failure. This underlines the importance of neuromuscular monitoring in these patients.

How to cite this article

Gvalani SK, Pradeep L. Comparison of Neuromuscular Blockade with Rocuronium in Young and Elderly Patients with or without Renal Failure. Res Inno in Anesth 2016;1(2):45-51.
Emergency Craniotomy for Extradural Hematoma Evacuation in a Known Case of von Willebrand Disease: Anesthetic Implications
Authors: Baldwa Namita Mahesh , Dave Sona , Gujjar Pinakin
Published: September 2019

We report the successful management of an emergency craniotomy performed for extradural hematoma (EDH) evacuation in a known case of von Willebrand disease (vWD).

The case presented a challenge because vWD is associated with extensive bleeding, which was compounded by the emergency nature and type of the surgery. Extensive laboratory investigations could not be carried out, and preoperative optimization was limited.

How to cite this article

Baldwa N, Dave S, Gujjar P. Emergency Craniotomy for Extradural Hematoma Evacuation in a Known Case of von Willebrand Disease: Anesthetic Implications. Res Inno in Anesth 2016;1(2):58-60.