bluuebunny/crossref_metadata_2025_split huggingface dataset:
Skin tears: introducing best practice
Authors: Fronzo Camila 
Published: February 2022

In an Essity-sponsored symposium, three key opinion leaders discussed the importance of developing, sharing and applying best practice in skin tear management. Camila Fronzo summarises the key points presented at the EWMA and Journées Cicatrisations conference 2021 This conference report offers an introduction to the symposium ‘Skin integrity: introducing best practice in skin tears’, held in October as part of the joint European Wound Management Association (EWMA) and Journées Cicatrisations virtual conference 2021. The first speaker, Karen Campbell, listed the individual and mediating factors that could affect skin tear development. She then summarised the three types of skin tears, and mentioned the dos and don'ts when treating these wounds. The next speaker, Wendy White, highlighted the importance of creating awareness, changing perceptions and implementing change around skin tear management. She shared the results on staff education from a recent quality improvement project, aimed at improving skin integrity and reducing skin tears in an aged care facility in Western Australia. The third and final speaker, Sitthichai Rees, presented further findings from the same project, focusing on the effects on skin tear incidence. His call to action can be followed by any health professional managing skin tears.
Medial plantar artery-based perforator and island flaps: a case series of applications in sole defects
Authors: Haq Ansarul , Singh Veena , Sharma Sarsij 
Published: February 2022

Background: Soft tissue defects of the plantar foot pose a challenge to the reconstructive surgeon. The plantar region of the foot has a unique skin structure, which helps in its paramount functions of weight-bearing and providing protective sensation. It is best replaced with tissue of its own kind. The medial plantar artery (MPA) flap fulfils all the requirements of an ideal replacement for small-to-medium-sized defects in the mid plantar and heel region. This study describes our experience with MPA-based flaps for small-to-medium-sized defects of the plantar foot. Method: The study was conducted in a tertiary referral hospital between April 2017 and March 2020 on patients who presented with defects on the mid plantar region and heel. MPA perforator (MPAP) flap or island flap were applied. The donor site was covered with split-thickness skin grafts. Results: The study included 21 patients. MPAP flap was applied in nine patients and the island flap was applied in 12 patients. The mean age of the patients was 37.95 years and the mean flap size was 36.6cm2. All flaps survived well. In two patients, venous congestion developed which resolved spontaneously, while three patients had small graft loss which also healed with conservative treatment. All patients regained protective sensation within five months of flap coverage. Conclusion: Based on the MPA, both perforator and island flaps can be raised due to the fairly constant position of the perforators. These flaps have the advantage of robust vascularity with the replacement of identical tissue for weight-bearing functions along with acceptable aesthetic outcomes. Since they also have the added advantage of conferring sensation, they can be used as a primary option in cases of small-to-medium-sized plantar foot defects.
Superabsorbent charcoal dressing versus silver foam dressing in wound area reduction: a randomised controlled trial
Authors: Probst Sebastian , Saini Camille , Rosset Chantal , Skinner Monika Buehrer 
Published: February 2022

Aim: This study aimed to compare the effect of a novel sterile polyacrylate wound pad with activated carbon cloth treatment with a standard non-adhesive hydrocellular foam dressing with silver in reducing wound area. Method: A multicentre randomised controlled open-label wound-dressing trial was conducted in two wound care outpatient clinics in western Switzerland from November 2018 to March 2020. Results: A total of 77 successive patients were randomised to receive either a sterile polyacrylate wound pad with activated carbon cloth treatment (n=38) or the standard non-adhesive hydrocellular foam dressing with silver (n=39). Reduction in wound area was the primary outcome, whereas the application period of the dressing, odour, maceration and pain were the secondary outcomes. Wound area was measured at baseline and during each wound dressing change until the dressings were no longer indicated. Wound area reduced faster in the intervention group than in the control group (0.45cm2 per day vs. 0.2cm2 per day), although the application period was longer in the intervention group compared with the control group (9.5 days vs. 8.1 days). Maceration reduction was more pronounced in the intervention group (-2.07cm2) than in the control group (-0.71cm2). Odour, pain and infection were similar in both groups. Conclusion: Sterile polyacrylate wound pad dressings with activated carbon cloth reduced the wound area, as well as the maceration area, faster than the non-adhesive hydrocellular foam dressing with silver.
Cost and clinical effectiveness of aggressive surgical debridement and delayed primary closure of infected cardiac surgical wounds
Authors: Yousafzai Sajjad Mohammad , Ugurlucan Murat , Awan Abid , Canver Charles C 
Published: February 2022

Objective: Postoperative wound infection in cardiac surgery remains a subject of significant concern due to associated morbidity, prolonged hospital stay and rise in treatment cost. A conservative management approach to postoperative wound infection with topical dressings and healing by secondary intention is not cost-effective and cosmetic results are less acceptable. We developed our institutional protocol for the treatment of infected postoperative cardiac surgical wounds to reduce hospital stay and improve cosmetic outcome. This study aims to compare our institutional protocol with the conservative management approach. Methods: Adult patients with postoperative superficial or deep sternal and/or leg wound infection were divided into two equal-sized groups and data collected from medical records. Group A was treated according to our institutional protocol of aggressive surgical debridement and delayed primary closure. Group B was treated according to conservative management with topical antiseptic wound dressings and healing by secondary intention. Data were analysed in retrospect with comparative statistics. Results: A total of 30 patients took part in the study. Group A (n=15, seven male, eight female) had a mean age of 55.34±12.84 years. Group B (n=15, eight male, seven female) had a mean age of 56.46±10.21 years. Mean length of hospital stay in Group A and Group B was 5.13±2.06 and 36.67±22.28 days, respectively (p<0.0001). Calculated mean hospital costs were 16,271.61±6815.50 Saudi Riyals (approximately equivalent to $4330±700 USD) in Group A and 116,212.2±26,311 Saudi Riyals (approximately equivalent to $30,932±1813 USD) in Group B (p<0.05). Patients in Group A had linear scars comparable with primary postoperative wound scars, whereas patients in Group B had excessive non-linear scarring. Conclusion: In this study, cost and clinical effectiveness of aggressive surgical debridement and delayed primary closure was superior to conservative management with topical antiseptic wound dressings and healing by secondary intention in terms of a shorter hospital stay and better cosmetic outcome.
Pressure injuries in surgical patients: a comparison of Norton, Braden and Waterlow risk assessment scales
Authors: Gurkan Aysel , Kirtil Inci , Aydin Yesim Dikmen , Kutuk Gamzegul 
Published: February 2022

Objective: This study aims to determine the predictive power of the Norton, Braden and Waterlow scales in determining risk of pressure injury (PI) in surgical patients. Method: This prospective study was carried out in the surgery clinic of a training and research hospital in Istanbul, Turkey between January and April 2017. The study sample consisted of adult patients aged ≥18 years and who did not have PI on admission to the clinic, had abdominal surgery under general anaesthesia and who stayed in the clinic for at least 48 hours. The data were collected using the Turkish versions of the Norton, Braden and Waterlow risk assessment scales. The predictive validity of PI risk assessment tools was assessed based on their sensitivity, specificity, positive and negative predictive values and the area under the receiver operating characteristic (ROC) curve. Predictive capacity was measured as relative risk (RR) with 95% confidence intervals (CI). Results: The study sample included 250 patients, and the incidence of PI was 12%. The sensitivity, specificity, positive predictive value and negative predictive value were: 83.3%, 45.4%, 17.2% and 95.2%, respectively, for the Norton scale (a cut-off point of 14); 100%, 40.4%, 18.6% and 100%, respectively, for the Braden scale (a cut-off point of 16); and 100%, 48.1%, 20.8% and 100%, respectively, for the Waterlow scale (a cut-off point of 10). The areas under the ROC curve were 0.749 for the Norton, 0.771 for the Braden and 0.971 for the Waterlow scales. This study's findings produced the following predictive capacity indicators: Norton (RR=3.62; 95%CI=1.43–9.14), Braden (RR=33.88; 95%CI=2.09–547.66); and Waterlow (RR=45.01; 95%CI=2.78–727.97). Conclusion: In this study, the Waterlow scale demonstrated the best values of predictive validity among the three scales in the assessment of PI risk. However, all three scales had low specificity despite high sensitivity in terms of a good risk prediction. No definitive decision could be reached on the predictive capacities of the scales because of wide CIs.
Cost-effectiveness of dehydrated human amnion/chorion membrane allografts in lower extremity diabetic ulcer treatment
Authors: Tettelbach William H , Armstrong David G , Chang Thomas J , Jong Julie L De , Glat Paul M , Hsu Jeffrey H , Kelso Martha R , Niezgoda Jeffrey A , Labovitz Jonathan M , Hubbs Brandon , Forsyth R Allyn , Cohen Benjamin G , Reid Natalie M , Padula William V 
Published: February 2022

Objective: To evaluate the cost-effectiveness and budget impact of using standard care (no advanced treatment, NAT) compared with an advanced treatment (AT), dehydrated human amnion/chorion membrane (DHACM), when following parameters for use (FPFU) in treating lower extremity diabetic ulcers (LEDUs). Method: We analysed a retrospective cohort of Medicare patients (2015–2019) to generate four propensity-matched cohorts of LEDU episodes. Outcomes for DHACM and NAT, such as amputations, and healthcare utilisation were tracked from claims codes, analysed and used to build a hybrid economic model, combining a one-year decision tree and a four-year Markov model. The budget impact was evaluated in the difference in per member per month spending following completion of the decision tree. Likewise, the cost-effectiveness was analysed before and after the Markov model at a willingness to pay (WTP) threshold of $100,000 per quality adjusted life year (QALY). The analysis was conducted from the healthcare sector perspective. Results: There were 10,900,127 patients with a diagnosis of diabetes, of whom 1,213,614 had an LEDU. Propensity-matched Group 1 was generated from the 19,910 episodes that received AT. Only 9.2% of episodes were FPFU and DHACM was identified as the most widely used AT product among Medicare episodes. Propensity-matched Group 4 was limited by the 590 episodes that used DHACM FPFU. Episodes treated with DHACM FPFU had statistically fewer amputations and healthcare utilisation. In year one, DHACM FPFU provided an additional 0.013 QALYs, while saving $3,670 per patient. At a WTP of $100,000 per QALY, the five-year net monetary benefit was $5003. Conclusion: The findings of this study showed that DHACM FPFU reduced costs and improved clinical benefits compared with NAT for LEDU Medicare patients. DHACM FPFU provided better clinical outcomes than NAT by reducing major amputations, ED visits, inpatient admissions and readmissions. These clinical gains were achieved at a lower cost, in years 1–5, and were likely to be cost-effective at any WTP threshold. Adoption of best practices identified in this retrospective analysis is expected to generate clinically significant decreases in amputations and hospital utilisation while saving money.
Numerical Study of The Effect of Penstock Dimensions on a Micro-hydro System using a Computational Fluid Dynamics Approach
Authors: Putra Yoga Satria , Noviani Evi , Muhardi Muhardi 
Published: February 2022

The performance of a micro-hydro system needs always to be improved so that the electrical power produced can be more optimal. This article aims to study numerically the effect of penstock dimensions on the potential of electrical energy in a micro-hydro system using a computational fluid dynamics (CFD) approach. The study of the effect of dimensions on the performance of a hydropower system is still quite rare. In this paper, the impact of dimensions on the micro-hydro system has been analysed by constructing thirty simulations of water flow in the penstock consisting of five variations of penstock slope ( and ) for six penstock diameter variations ( m, m, m, m, m, and m). The simulation was built using the open-source CFD software OpenFOAM which applies the finite volume method to solve the Navier-Stokes equation as a flow model. The simulated water velocity profile is then validated against the velocity profile of the analytical solution (power-law) for turbulent flow in the pipe. Energy loss analysis on the penstock has been carried out to determine the cause of the energy loss in the penstock characterised by loss coefficient . An enormous value will impact the decrease in the electric power potential of a micro-hydro system. The total length of the penstock induces the variation of the which affects the changes in the electrical power of the micro-hydro system. The shorter will increase the electric power potential of a micro-hydro system. With a high flow velocity of water in the penstock ( m/s), the electric power increases linearly with increasing the diameter value of the penstock. The analysis results show that the penstock dimensions can affect the changes in the electric power of the micro-hydro system. In addition, the work presented in this article has shown that the CFD approach can be used as a low-cost initial step in building an actual micro-hydro system
The Rising Electoral Role of Polarization & Implications for Policymaking in the United States Senate: Assessing the Consequences of Polarization in the Senate from 1914–2020
Authors: Algara Carlos , Johnston Savannah 
Published: February 2022

AbstractThe dramatic Democratic victories in the 2021 Georgia U.S. Senate runoffs handed Democrats their first majority since 2015 and, with this, unified Democratic control of Washington for the first time since 2011. While Democratic Leaders and President Joe Biden crafted their agenda, any hope of policy passage rested on complete unity in a 50–50 Senate and a narrow majority in the U.S. House. Against this backdrop, the 117th Senate is the most polarized since direct-election began in 1914 and, by popular accounts, the least deliberative in a generation. In this article, we examine the implications of partisan polarization for policymaking in the U.S. Senate throughout the direct-election era. First, we show that greater polarization coincides with more partisan Senate election outcomes, congruent with recent trends in the House. Today, over 90% of Senators represent states carried by their party’s presidential nominee. Secondly, we show that polarization coincides with higher levels of observable obstruction, conflict, partisan unity, and narrower majorities. Lastly, we show that this polarization coincides with lower levels of deliberation in the form of consideration of floor amendments and committee meetings. Taken together, we paint a picture of a polarized Senate that is more partisan, more obstructionist, and less deliberative.
Get Out of the Way: Joe Biden, the U.S. Congress, and Executive-Centered Partisanship During the President’s First Year in Office
Authors: Jacobs Nicholas F. , Milkis Sidney M. 
Published: February 2022

AbstractOn the campaign trail and at his inauguration, Joe Biden pledged, above all else, to be a uniter to restore the soul of America. At the end of his first year in office, many campaign promises have been met, but unity has not been one. Far from transcending partisanship as promised, Biden has embraced the levers of presidential discretion and power inherent within the modern executive office to advance partisan objectives. He is not just a victim of polarization, but actively contributes to it. This is not unexpected. Rather it is the culmination of a decades-long reorientation within both major parties: the rise of an executive-centered party-system, with Democrats and Republicans alike relying on presidents and presidential candidates to pronounce party doctrine, raise campaign funds, campaign on behalf of their partisan brethren, mobilize grass roots support, and advance party programs. Like Barack Obama and Donald Trump before him, Biden has aggressively used executive power to cut the Gordian knot of partisan gridlock in Congress. Even pandemic politics is not immune to presidential partisanship; in fact, it has accentuated the United States’ presidency-centered democracy, which weakens the public resolve to confront and solve national problems.
Design of a miniaturized branch line microstrip coupler with a simple structure using artificial neural network
Authors: Roshani Saeed , Azizian Javad , Roshani Sobhan , Jamshidi Mohammad (Behdad) , Parandin Fariborz 
Published: February 2022

Abstract
In this paper, a compact branch microstrip coupler with the simple structure using T-shaped resonators and open-ended stubs at 1.8 GHz is designed and fabricated. The proposed coupler creates two transmission zeros at 3.4 and 3.87 GHz, with more than 50 dB attenuation level, which resulted in a good harmonic suppression at 2nd harmonic. Artificial neural network (ANN) has been utilized to extract the transfer function of the proposed coupler resonator for the first time, so the values of the transmission zeros can be located in the desired frequency. This technique can also be used for the other electrical devices. The designed device has a small size of 28 mm × 30 mm (0.9 λ × 0.95 λ), which shows more than 35% size reduction compared to the typical branch-line coupler with λ/4 branch lines. The proposed coupler is simulated using Advanced Design System (ADS) software and fabricated on Rogers Duroid 5880 substrate (ε
r = 2.2, h = 31 mil). The simulation and measurement results verify the correct performance of the designed coupler.
Entropy, Transformations and Sustainability of Industrial Life Cycles
Authors: Hornbogen Erhard 
Published: February 2022

Abstract
Life cycles of materials are analysed in a systematic manner as a six-stage process. It starts with primary or secondary raw materials and ends with recycling or deposition of waste. The purpose of the industrial process is the transformation of matter into materials from which useful goods are produced. The complete cycle can be described as a sequence of man-made transformations with defined changes in entropy and energy. Entropy is the measure for any type of disorder. Changes in entropy are due to separation (mining, purification: negative entropy), ordering (consolidation, construction: negative entropy) or disordering (mixing, crushing: positive entropy).
Sustainability comprises undesired, irreversible changes of our environment. It can be regarded as an inverse function of the raise in entropy. We have to distinguish entropy with respect to matter, energy and information. In our context, entropy changes due to different distributions of matter are of primary importance. Sustainability implies that increases in entropy due to industrial activities must be balanced, as much as possible, by extraterrestrial negative entropy. This requires the evaluation and comparison of entropy efficiency for the production of goods with defined useful properties.
Local Characterization of the Diffusion Process during Discontinuous Precipitation: A Review
Authors: Zieba Pawel , Gust Wolfgang 
Published: February 2022

Abstract
The paper summarizes the recent studies on the diffusive mass transport accompanying the discontinuous precipitation (DP). The studies were performed by applying a local characterization of the kinetics of the DP reaction. In order to accomplish this, a technique of the analytical electron microscopy was used to measure the solute concentration profiles left behind the moving reaction front of single cells. Such an approach, combined with the information on the local values of the lamella thickness and growth rate of the cell, enabled for the first time the determination of local values of the grain boundary diffusivity in the systems Al–Zn, Ni–Sn, Cu–In, Ni–In and Co–Al. The obtained values were comparable to those resulting from the use of the global treatment of the diffusion problem for the DP reaction and the data on the radiotracer diffusion along stationary grain boundaries. This clearly indicates that there is no difference in the rate of diffusion along stationary and moving grain boundaries.
The Dependence of Abnormal Grain Growth on Initial Grain Size in 316 L Stainless Steel
Authors: Lee Sang-Hyun , Choi Jeong Sik , Yoon Duk Yong 
Published: February 2022

Abstract
When 316 L stainless steel specimens are compressed to 30% and annealed at 1300 °C, primary recrystallization rapidly occurs and grains grow normally during further annealing treatment. Thus by annealing for various periods at 1300 °C, specimens with varying average sizes with identical normalized grain size distributions are obtained. When these specimens are heat-treated again at temperatures below 1150 °C, abnormal grain growth (AGG) occurs depending critically on the initial grain size.With decreasing initial grain size, AGG begins earlier during the heat-treatment, and if the initial grain size is large, only slow grain growth occurs without any distinct AGG for periods up to 48 and 96 h. It is observed that AGG occurs by faster growth of large grains with their velocities expected to increase nonlinearly with the driving force arising from the size difference. Because the AGG structure develops gradually, there is not really a well defined incubation time. With the same initial grain size the initiation ofAGGis slower at lower temperatures. A step heat-treatment experiment shows that if there are large grains embedded in the matrix of fine grains, they can grow abnormally under the condition where no AGG occurs with a narrow grain size distribution. The extremely slow grain growth with initially large average grain sizes is attributed to the low grain boundary velocity limited by the boundary step nucleation or growth. It is proposed that the same boundary step mechanism is qualitatively consistent with abnormal growth of the large grains with singular grain boundaries at low temperatures.