bluuebunny/crossref_metadata_2025 huggingface dataset:
Opioid prescription and postoperative outcomes in pediatric patients
Authors: Whelan Rachel L. , McCoy Jennifer , Mirson Leonid , Chi David H.
Published: December 2018

Objectives/Hypothesis

To determine if the amount of opioid prescribed and postoperative outcomes after adenotonsillectomy changed following implementation of mandated opioid consent forms.

Study Design

Retrospective cohort study.

Methods

Patients undergoing adenotonsillectomy 6 months before and after implementation of mandated opioid consent forms at a tertiary‐care pediatric hospital were studied. Demographics, operative data, weight‐based opioid dosage, and postoperative outcome measures, including nursing calls, emergency department (ED) visits, hospital readmission, and bleed rates, were collected and analyzed.

Results

Of 300 patients, opioid prescription was provided for 211 patients (70.3%), 112 preconsent (74.7%) and 99 postconsent (66.0%). Mean (standard deviation) total opioid prescribed (milligrams/kilogram) was significantly higher preconsent 4.8 (5.6) than postconsent 3.2 (4.7), (P = .003). There were no differences between number of nursing calls (P = .134) or ED visits (P = .083). Interestingly, preconsent patients had more hospital readmission for pain/dehydration (odds ratio OR: 368, P = .016) and bleeding concerns (OR: 244, P = .003).

Conclusions

A mandated consent form prior to opioid prescription was associated with decreased overall opioid prescription without resultant increase in postoperative complications in pediatric patients. These data provide support for minimizing opioid prescription on a systems‐based level.

Level of Evidence

4

Laryngoscope, 129:1477–1481, 2019
Perioperative Analgesia for Patients Undergoing Septoplasty and Rhinoplasty: An Evidence‐Based Review
Authors: Nguyen Brandon K. , Yuhan Brian T. , Folbe Elana , Eloy Jean Anderson , Zuliani Giancarlo F. , Hsueh Wayne D. , Paskhover Boris , Folbe Adam J. , Svider Peter F.
Published: December 2018

Objectives/Hypothesis

Opioid misuse and diversion is a pressing topic in today's healthcare environment. The objective of this study was to conduct a review of non‐opioid perioperative analgesic regimens following septoplasty, rhinoplasty, and septorhinoplasty.

Study Design

Evidence‐based systematic review.

Methods

PubMed, MEDLINE, Cochrane Library, and Embase databases were reviewed for articles related to perioperative analgesic use in septoplasty, rhinoplasty, and septorhinoplasty. Quality of studies were assessed via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria, Jadad scores, and the Cochrane bias tool. Patient demographic data and clinical outcomes, including medication type, dose, administration time, pain scores, and adverse events, were obtained from included studies. Summary tables detailing the benefits and harms of each investigated regimen are included.

Results

Thirty‐seven studies met inclusion criteria for this evidence‐based review. The quality of the studies was determined to be of moderate quality based off of GRADE standardized criteria with a mean Jadad score of 3.1. A preponderance of evidence showed reduced perioperative pain scores and rescue analgesic requirements, supporting the use of local anesthetics for analgesic control. Nonsteroidal anti‐inflammatory drugs (NSAIDs) demonstrated similar decreased visual analog scores and postoperative analgesic demand; however, increased adverse events in this class warrant caution.

Conclusions

Contemporary literature supports the use of NSAIDs, gabapentin, local anesthetics, and α‐agonists as effective perioperative analgesic opioid alternatives for septoplasty and septorhinoplasty. Local anesthetic use is a cost‐effective option resulting in decreased postoperative pain scores and rescue analgesic requirements. Further large‐scale, multi‐institutional, controlled studies are needed to provide definitive recommendations.

Level of Evidence

NA

Laryngoscope, 129:E200–E212, 2019
Analysis of neuromonitoring signal loss during retroauricular versus conventional thyroidectomy
Authors: Ban Myung Jin , Chang Eun Hae Estelle , Lee Dong Yun , Park Jae Hong , Lee Chan , Kim Da Hee , Kim Joo Hyun , Koh Yoon Woo
Published: December 2018

Objective

Loss of signal (LOS) during intraoperative neuromonitoring (IONM) of robotic or endoscopic thyroidectomy via a retroauricular approach (RAT) and during conventional open thyroidectomy (COT) was investigated to compare the risk of recurrent laryngeal nerve (RLN) injury between the two groups.

Study Design

Original article.

Methods

This is a retrospective case series study performed between May 2014 and September 2016. IONM using the NIM 3.0 system (Medtronic Xomed, Inc., Jacksonville, FL) was used for this study. Pre‐ and postoperative vocal cord functions were assessed using a flexible laryngoscope. LOS types noted intraoperatively and their associations with postoperative vocal cord palsy (VCP) were evaluated. LOS rate and temporary and permanent VCP rates were compared between the two groups. The surgical events associated with LOS were also documented and analyzed in this study.

Results

In total, 153 patients were recruited, and 111 patients were enrolled in the RAT group; the remaining 42 patients were enrolled in the COT group. No statistically significant differences in intraoperative LOS (P = 0.812) and postoperative VCP rates (early, permanent; P = 0.259 and P = 0.577, respectively) between the two groups were observed. IONM accuracy of predicting postoperative VCP was 99.1% in our case series.

Conclusion

On the basis of IONM findings, the risks of injury to RLN were similar between the two groups. Comparison of LOS was an objective method for verifying the novel RAT approach. We applied our IONM protocol and troubleshooting algorithm during RAT with acceptable accuracy, but the international standardized method of IONM is applicable and recommended for reducing false results using vagal nerve stimulation.

Level of Evidence

3b

Laryngoscope, 129:2199–2204, 2019
Land management and sustainable use of land resources in the case of Burkina Faso
Authors: Bazame Rodrigue , Tanrıvermis Harun , Kapusuz Yunus Emre
Published: December 2018

This paper aims to analyse the land use and land management system in Burkina Faso. First, land use change and its drivers over the period 1983–2014 have been assessed using a multiple linear regression analysis. Additionally, based on documentary analysis and interviews, land use policy implementation and institutional issues have been assessed. Agricultural land increased by 35.42% during the period examined, and econometric estimation shows that change in agricultural land is mostly driven by social factors such as population density, economic factors such as value added in the three main sectors, and spatial factors such as other types of land. In terms of land policy, the first Agrarian and Land Reform Act in 1984 initiated a successive land management policy in the country's agenda. Even if policy adoption is relatively sufficient in the country, public institutions' capacity to implement a successful sustainable land management model regarding land access, land development, land resources protection, land market, and investments in infrastructure remains very limited. Therefore, the main conclusion of this paper is that beyond socioeconomic and biophysical factors as driven by land use change, political, and institutional failure may amplify their effects.
Determination of microbiological characteristics in the digestive tract of different ruminant species
Authors: Zhang Tian , Mu Yingyu , Zhang Deqing , Lin Xueyan , Wang Zhonghua , Hou Qiuling , Wang Yun , Hu Zhiyong
Published: December 2018

Holstein dairy cows, Chinese Luxi Yellow cattle, Chinese Laoshan dairy goats, and Chinese Bohai Black cattle were selected for the study. The 16S rDNA sequencing technique was used to analyze the microflora in the digestive tract. The rumen flora in high milk‐yield Holstein dairy cows showed significantly higher proportions of Treponema, Butyrivibrio, Coprococcus, Shuttleworthia, Lachnospira, and Selenomonas, compared with the rumen flora in Chinese Bohai Black cattle and Chinese Luxi Yellow cattle (p < 0.05). In addition, the abundances of Succiniclasticum, Ruminococcus, and Fibrobacter in the rumen fluid of high‐yield dairy cows were significantly higher than those in rumen flora of dairy goats. Compared with ruminal flora in Chinese Luxi Yellow cattle, the rumen flora in high‐yield dairy cattle showed significantly higher Prevotella. Compared with the rumen flora in Chinese Laoshan dairy goats, Chinese Bohai Black cattle, and Chinese Luxi Yellow cattle, the flora in high‐yielding dairy cows showed significantly lower proportions of CF231, 02d06, Oscillospira, RFN20, Desulfovibrio, Methanobrevibacter, and SHD‐231. In addition, compared with the rumen flora in dairy goats, the rumen flora in high‐yielding dairy cattle displayed significantly lower proportion of Enterococcus. Compared with the rumen flora in Chinese Bohai Black cattle, the flora in high‐yielding dairy cattle exhibited significantly lower Ruminococcus, YRC22, Pseudobutyrivibrio, L7A_E11, BF311, p‐75‐a5, and Dehalobacterium. Compared with the rumen flora in Chinese Luxi Yellow cattle, the flora in the high‐yield dairy cows also displayed significantly lower proportions of Ruminococcus, YRC22, BF311, Paludibacter, and Dehalobacterium.
NADPH‐related processes studied with a SoxR‐based biosensor in Escherichia coli
Authors: Spielmann Alina , Baumgart Meike , Bott Michael
Published: December 2018

NADPH plays a crucial role in cellular metabolism for biosynthesis and oxidative stress responses. We previously developed the genetically encoded NADPH biosensor pSenSox based on the transcriptional regulator SoxR of Escherichia coli, its target promoter PsoxS and eYFP as fluorescent reporter. Here, we used pSenSox to study the influence of various parameters on the sensor output in E. coliduring reductive biotransformation of methyl acetoacetate (MAA) to (R)‐methyl 3‐hydroxybutyrate (MHB) by the strictly NADPH‐dependent alcohol dehydrogenase of Lactobacillus brevis (LbAdh). Redox‐cycling drugs such as paraquat and menadione strongly activated the NADPH biosensor and mechanisms responsible for this effect are discussed. Absence of the RsxABCDGE complex and/or RseC caused an enhanced biosensor response, supporting a function as SoxR‐reducing system. Absence of the membrane‐bound transhydrogenase PntAB caused an increased biosensor response, whereas the lack of the soluble transhydrogenase SthA or of SthA and PntAB was associated with a strongly decreased response. These data support the opposing functions of PntAB in NADP+ reduction and of SthA in NADPH oxidation. In summary, the NADPH biosensor pSenSox proved to be a useful tool to study NADPH‐related processes in E. coli.
Design of a circular dual‐loop antenna for a GPS array element using an extended cavity structure
Authors: Hur Jun , Byun Gangil , Kim JongSung , Kim Misuk , Ko Jinwon , Choo Hosung
Published: December 2018

This article proposes a circular dual‐loop antenna for a very small Global Positioning System array with an extended cavity structure. The antenna element consists of lower and upper circular loops printed on a high‐dielectric ceramic substrate and an extended cavity structure above the ground plane to improve the isolation characteristic. To demonstrate the suitability of the proposed antenna, antenna characteristics are measured in a full‐anechoic chamber, and its performances such as bore‐sight gain, mutual coupling, and near‐field as a function of extended cavity height are analyzed. The results confirm that the proposed antenna structure can minimize the gain degradation by improving the isolation characteristic and is therefore suitable for use in very small arrays.
Internet interventions for mental health in university students: A systematic review and meta‐analysis
Authors: Harrer Mathias , Adam Sophia H. , Baumeister Harald , Cuijpers Pim , Karyotaki Eirini , Auerbach Randy P. , Kessler Ronald C. , Bruffaerts Ronny , Berking Matthias , Ebert David D.
Published: December 2018

Objectives

Mental health disorders are highly prevalent among university students. Universities could be an optimal setting to provide evidence‐based care through the Internet. As part of the World Mental Health International College Student initiative, this systematic review and meta‐analysis synthesizes data on the efficacy of Internet‐based interventions for university students' mental health.

Method

A systematic literature search of bibliographical databases (CENTRAL, MEDLINE, and PsycINFO) for randomized trials examining psychological interventions for the mental health (depression, anxiety, stress, sleep problems, and eating disorder symptoms), well‐being, and functioning of university students was performed through April 30, 2018.

Results

Forty‐eight studies were included. Twenty‐three studies (48%) were rated to have low risk of bias. Small intervention effects were found on depression (g = 0.18, 95% confidence interval [CI; 0.08, 0.27]), anxiety (g = 0.27, 95% CI [0.13, 0.40]), and stress (g = 0.20, 95% CI [0.02, 0.38]). Moderate effects were found on eating disorder symptoms (g = 0.52, 95% CI [0.22–0.83]) and role functioning (g = 0.41, 95% CI [0.26, 0.56]). Effects on well‐being were non‐significant (g = 0.15, 95% CI [−0.20, 0.50]). Heterogeneity was moderate to substantial in many analyses. After adjusting for publication bias, effects on anxiety were not significant anymore.

Discussion

Internet interventions for university students' mental health can have significant small‐to‐moderate effects on a range of conditions. However, more research is needed to determine student subsets for which Internet‐based interventions are most effective and to explore ways to increase treatment effectiveness.
Body Composition Technology: Implications for the ICU
Authors: Mundi Manpreet S. , Patel Jayshil J. , Martindale Robert
Published: December 2018

Malnutrition continues to be highly prevalent in hospitalized and critically ill patients and is associated with significant morbidity and mortality. Additionally, survivors of critical illness have an increased risk for sarcopenia, which leads to weakness and physical debilitation that can persist for years. Nutrition risk assessment tools have been developed and validated in critically ill patients but have limitations. Variables such as body weight, body mass index, weight change, or percentage of food intake can be difficult to obtain in critically ill patients and may be misleading given changes in body composition, such as an increase in body water. Assessment of body composition through new techniques provides a unique opportunity to counter some of these limitations and develop improved methods of nutrition risk assessment based on objective data. The present manuscript provides a review of the most commonly available clinical technology for assessment of body composition (bioimpedance, computed tomography, and ultrasound), including data from trials in critically ill patients highlighting the benefits and weaknesses of each modality.
Yacimientos Petrolíferos Fiscales (YPF): History and legacy
Authors: Viña Gonzalo Ariel , Ferrara Pablo
Published: December 2018

This paper aims at providing an overview of Argentine National Oil Company (NOC) “Yacimientos Petrolíferos Fiscales” (YPF) role in Argentina's energy policy. In order to do it, the work takes off from NOCs roles vis‐à‐vis private oil and gas corporations, moving to YPF's history, and its energy socioeconomic effects.
The assembly nanohybrid of graphene with lamellar zirconium phenylphosphonate for improving flame retardancy and mechanical properties of polypropylene
Authors: Chen Xianfeng , Yun Yalong , Fan Ao , Yuan Bihe , Shang Sheng , He Song
Published: December 2018

Zirconium phenylphosphonate (ZrPP) nanoplatelets are decorated on the surface of reduced graphene oxide (RGO) based on π–π assembly interactions. The structure, composition, and morphology of ZrPP‐RGO assembly nanohybrid are well characterized. The dispersion of graphene in the nonpolar polypropylene (PP) matrix is improved by this modification. The enhancement mechanisms of dispersion in polymer matrix are clearly demonstrated. Significant improvements in flame retardancy and fire safety of PP are obtained by the incorporation of this assembly nanohybrid. Peak heat release rate and total heat release of PP composite containing 2 wt% ZrPP‐RGO assembly nanohybrid decrease by 35.8% and 23.6%, respectively, compared to those of neat PP. The assembly nanohybrid exhibits higher flame‐retardant effect than the counterparts of RGO and ZrPP. Furthermore, storage modulus of PP is greatly improved by this nanohybrid. This work proposes a novel method to prepare graphene‐based organic–inorganic nanohybrid and will expand the application of graphene. POLYM. COMPOS., 40:E1757–E1765, 2019. © 2018 Society of Plastics Engineers
Novel biodegradable composites based on PHBV: Effect of nanocellulose incorporation on the non‐isothermal crystallization kinetic and structural parameters
Authors: Benini Kelly C.C.C. , Ornaghi Júnior Heitor L. , Bianchi Otavio , de Magalhães Welington Ferreira , Henriques Fernando Fulgêncio , Windmoller Dario , Voorwald Herman J.C. , Cioffi Maria O.H.
Published: December 2018

This study presents the non‐isothermal behavior of poly(3‐hydroxybutyrate‐co‐3‐hydroxyvalerate) (PHBV) biodegradable films with 1–5 wt% of cellulose nanoparticles (CNs) manufactured by solution casting using N,N‐dimethylformide and chloroform as the solvents. X‐ray diffraction and scanning electron microscopy with field emission gun were performed for CNs in order to determine its morphology and crystalline properties. The effect of non‐isothermal crystallization of PHBV and its nanocomposites was studied using differential scanning calorimetry technique. The incorporation of CNs increases the crystallization rate with up to 3 wt%. Structural parameters were studied using positron annihilation lifetime spectroscopy and small‐angle X‐ray scattering. The free volume does not change upon CNs addition in spite of form less perfect crystals and increase the lamellar thickness. POLYM. COMPOS., 40:3156–3165, 2019. © 2018 Society of Plastics Engineers
Fabrication of CNT/ION hybrids and their impact on the biomedical applicability of PCL‐based composite films
Authors: Świętek Małgorzata , Tokarz Waldemar , Benko Aleksandra , Nocuń Marek , Mázl‐Chánová Eliška , Błażewicz Marta
Published: December 2018

To meet requirements of regenerative medicine, novel biomaterials should either mimic natural tissues or enable multi‐way stimulation of cells. In this study, we prepared two types of hybrids, differing in composition and morphology by decorating CNTs with iron oxide nanoparticles (IONs), and introduced them into the poly(ε‐caprolactone) (PCL) to prepare biocompatible composite films using casting method. The effect of the type of multi‐walled carbon nanotube (MWCNT)/ION hybrid and its content on the composites’ parameters that are important for cell‐biomaterial interaction that is, surface morphology, wettability, surface energy, and mechanical properties, was examined and compared with results obtained for the PCL, PCL/MWCNT and PCL/ION films. Additionally, materials with IONs were characterized in terms of their magnetic properties. Irrespective of the nanoaddition type, CNT‐based films with content of CNTs up to 1 wt% were characterized by similar surface parameters (completely distinguishable from the PCL film). Pristine CNTs were found to improve the tensile strength of the PCL films while IONs caused its reduction. Interestingly, composites containing 1 wt% of the hybrid, with a 1:1 ratio of MWCNTs and IONs, exhibited tensile strength similar to the PCL/CNTs film. Decoration of CNTs with IONs was found to significantly improve the dispersion level of magnetic phase within the polymer. POLYM. COMPOS., 40:E1818–E1830, 2019. © 2018 Society of Plastics Engineers
Enhancing the flame retardancy of polyamide 6 by guanidine sulfamate‐modified carbon nanoparticles: Carbon nanotubes versus graphite oxide
Authors: Sheng Zhang , Jia Guo , Yongyuan Sun , Zhaoxia Lv , Xiaodong Jin , Xiaodong Liu , Xiaoyu Gu , Hongfei Li , Jun Sun
Published: December 2018

Different carbon nanoparticles including multi‐wall carbon nanotubes (MWNT) and graphite oxide (GO) were used to prepare polyamide 6 (PA6) composites with enhanced flame retardancy by grafting guanidine sulfamate (GAS) on nanoparticles. The modified nanoparticles were compounded with PA6 by melt blending, and the flame retardancy of PA6 was evaluated by limiting oxygen index (LOI), vertical burning (UL94), and cone calorimetry tests. The results indicated that the presence of 3 wt% MWNT‐GAS could increase the LOI of PA6 composites from 22.0 to 24.1% and the addition of 3 wt% GO‐GAS can further increase the LOI value to 25.5%, the peak heat release rate values were decreased from 780.7 to 588.1 kW/m2 (MWNT‐GAS) and 435.6 kW/m2 (GO‐GAS). The possible mechanisms for both flame retardancy and permeation path were also discussed. These two nanoparticles can exhibit good barrier effects by the formation of protective char layers. Besides, the tensile strength of PA6/MWNT‐GAS composites reached its maximum value of 45.8 MPa while 1% MWNT‐GAS was added. POLYM. COMPOS., 40:E1884–E1892, 2019. © 2018 Society of Plastics Engineers
Effect of clay on the dielectric properties of novel fluorinated methacrylate nanocomposites
Authors: Douiri Hanen , Ghorbel Nouha , Raihane Mustapha , Arous Mourad , Ilsouk Mohamed , Lahcini Mohammed , Yagci Yusuf , Tasdelen Mehmet Atilla , Kallel Ali
Published: December 2018

In this work, the dielectric properties of nanocomposites based on poly(2,2,2‐trifluoroethyl methacrylate) copolymer (PMATRIF) and vinylbenzyl‐functionalized montmorillonite (MMT) nanoparticles prepared via in situ free radical polymerization were studied. The effect of different loadings of (MMT) filler (in weight ratios of 1, 3, and 5%) on the molecular dynamics and polarization of PMATRIF was investigated using broadband dielectric spectroscopy from 10−1 to 106 Hz and at temperatures between 20 and 170°C. For PMATRIF matrix, the real part ε′ and the imaginary part ε″ of the dielectric permittivity curves revealed four dielectric processes β, α, αβ, and ionic conduction phenomenon. Furthermore, it was found that incorporating MMT led to an increase in the dielectric losses and generated additional relaxation processes known as Maxwell–Wagner Sillars polarization. Calculation of the activation energy for the different processes revealed that α relaxation followed the Vogel–Fulcher–Tammann–Hesse dependency while the other processes were suitably fitted with the Arrhenius law. In order to probe matrix/MMT interface properties, dielectric strength of the interfacial polarization Δε is calculated by fitting the dielectric permittivity through the known Havriliak–Negami model. POLYM. COMPOS., 40:3333–3341, 2019. © 2018 Society of Plastics Engineers
The potential for concentrator photovoltaics: A feasibility study in India
Authors: Kamath Harsh G. , Ekins‐Daukes Nicholas J. , Araki Kenji , Ramasesha Sheela K.
Published: December 2018

India has aggressive plans for scaling up photovoltaic installations in the coming decades. Currently fixed tilt, flat plate crystalline silicon (c‐Si) technology sets the standard for cost and performance and is both robust and relatively easy to deploy. Concentrator photovoltaics (CPV) systems have a different cost structure; using solar cells with the highest efficiencies, system efficiencies greater than 30% are possible, but the system is also more sensitive to meteorological conditions. India has a complex and varied atmosphere that prevents a straightforward comparison of technologies, and hence, in this paper, we use a computer model to simulate the power output from CPV systems located in locations in India where the Aerosol Robotic Network (AERONET) stations are based and additionally, in Bangalore where we have a CPV test station. We quantify the increased intermittency suffered by CPV systems that arises from the larger dynamic range in direct beam irradiance over global irradiance. Nevertheless, by calculating the target system costs required to attain a competitive levelized cost of electricity (LCOE), we find that CPV systems in some, but not all locations have the opportunity to compete against dual‐axis tracked and inclined c‐Si based PV in India
Privatizing or Annihilating Social Security: What the United States Can Learn From Chile's Privatization
Authors: Borzutzky Silvia
Published: December 2018

This article argues that based on Chile's 38‐year experience with a privately administered, fully funded, defined contribution system, the adoption of this kind of approach in the United States will be very damaging. We argue that this policy will be especially harmful to low‐income groups, to women, to both racial and gender minorities, and to those who have part‐time employment or find themselves in and out of the labor market. Additionally, this kind of policy does not solve the financial problems of the Social Security system. In fact, transferring either the entire, or a part of the payroll tax to private accounts will add a new burden to the fiscal coffers via transition costs, as fiscal receipts will diminish and the obligation to pay pensions to old and new retirees will continue. From the standpoint of the insured and potential retiree, the cost of administering the retirement accounts will increase, but there is no certainty that the benefits will increase due to the unpredictable nature of the market and the increase in administrative costs. Most importantly, for lower‐income groups, the redistributive effect that Social Security has today will be eliminated.
Implementation of Medicaid‐Funded Long‐Term Care: The Impact of Prior History on the Development of the Nursing Home Industry
Authors: Kingsley David E.
Published: December 2018

Growth of the “nursing home” industry was enhanced considerably by passage of Medicare and Medicaid in 1965 (Public Law 89–97, Titles XVIII and XIX of amendment to the Social Security Act). Injection of federal funds into Medicare for extended‐care nursing (ETC) and into Medicaid for means‐tested, long‐term care (LTC) spurred the growth of for‐profit and nonprofit enterprises. Prior to 1965, the effects of vendor payments for Medicare and Medicaid and federal low‐interest real estate loans for facility construction resulted in the initial development of a specialty real estate industry that was to become an important substrate in extended‐ and long‐term medical care. Although the LTC industry has evolved over the decades, the basic structure and function of the industry had been established prior to passage of the 1965 Social Security Amendments. The power and influence of Southern Democrats, the American Medical Association, and ultraconservative Republicans were major factors in development of a nursing home system designed for welfare medicine, state control, and industrialization. No vision of care for a looming precipitous growth in an elderly population needing long‐term care in skilled‐nursing facilities guided congressional debate during the enactment of Medicaid. The Medical Assistance for the Aged Act (MAA or “Kerr‐Mills“) and other legislation preceding the passage of Medicaid established precedent for vendor payments, spend downs, and, consequently, means‐testing. Kerr‐Mills codified elderly individuals too poor to pay for medical care but not poor enough to qualify for Old Age Assistance into a new category of U.S. resident: “the medically indigent.” This categorization through legislation of poor Americans needing care would have far‐reaching consequences in the U.S. medical care system. By legislating a categorical, means‐tested, industrialized, long‐term care system into existence, Congress ensured that the nursing home system would be characterized by the “total institution” as opposed to maximum support for community and home‐based systems. Excessive institutionalization of the frail elderly and disabled in institutions based on profitability and, hence, economy and efficiency, has been responsible for an industry with revenues approaching a half trillion dollars. From the view of Southern Democrats and their allies, Medicaid‐funded, long‐term care has been well implemented. Advocates for patients and most scholars believe that it has failed the patients whom it was intended to serve.
Longitudinal analysis of bronchodilator response in asthmatics and effect modification of age‐related trends by genotype
Authors: Sordillo Joanne E. , McGeachie Michael , Lutz Sharon M. , Lasky‐Su Jessica , Tantisira Kelan , Tsai Ching Hui , Dahlin Amber , Kelly Rachel , Wu Ann Chen
Published: December 2018

Background and Objectives

Genome Wide Association Studies (GWAS) have identified genetic polymorphisms associated with bronchodilator response (BDR), but it is unknown how these associations change across life stages. We examined the impact of genetic variants on BDR from childhood to adulthood in asthmatics to uncover potential effect modification by age.

Methods

We searched the National Human Genome Research Institute (NHGRI) catalog of published GWAS to obtain a list of genetic associations with BDR, and tested them for effect modification by age in 604 subjects from the Childhood Asthma Management Program (CAMP), a clinical trial with longitudinal measures of BDR (age range 5‐30 years). We performed longitudinal analyses using linear mixed models and visualized longitudinal changes in BDR using generalized additive models with repeated measures, adjusting for treatment group, sex, and main effects of age and additive genotype.

Results

Increasing age was associated with decreased BDR (−0.24% per year). Polymorphisms rs295137 (T allele) near SPATS2L and rs2626393 (C allele) near ASB3 demonstrated their strongest associations with BDR in early childhood through adolescence, with a large decrease in their magnitude of effect from adolescence onward. The effect estimate for % BDR associated with rs295137 genotype (Beta = 1.3; 95%CI 0.6‐2.1) was diminished by age (interaction term = −0.06, P = 0.004). The effect estimate for rs2626393 (Beta = −0.92 (95%CI −1.7 to −0.2) was also modified by age (interaction term = 0.05, P = 0.0004).

Conclusions

Polymorphisms associated with BDR in childhood may not be relevant for predicting adolescent and adult BDR, which could reflect age‐related changes in asthma phenotypes.
Long‐term outcomes of combining prostate brachytherapy and metastasis‐directed radiotherapy in newly diagnosed oligometastatic prostate cancer: A retrospective cohort study
Authors: Tsumura Hideyasu , Ishiyama Hiromichi , Tabata Ken‐ichi , Sekiguchi Akane , Kawakami Shogo , Satoh Takefumi , Kitano Masashi , Iwamura Masatsugu
Published: December 2018

Background

Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trial showed the survival benefit for prostate radiotherapy in newly diagnosed prostate cancer patients with a low metastatic burden. The result raises the next question whether additional radiotherapy to metastatic sites could improve the survival in those with a low metastatic burden.

Methods

We evaluated the efficacy and safety of prostate‐directed radiotherapy (PDRT) with or without metastasis‐directed radiotherapy (MDRT) in newly diagnosed oligometastatic patients who underwent combination of high‐dose‐rate prostate brachytherapy, external beam radiotherapy, and androgen deprivation therapy. Forty patients with bone metastasis and node positive prostate cancer were retrospectively analyzed. Of these, 22 (55%), 3 (7%), and 15 (38%) patients had N1M0, M1a, and M1b, respectively. Eighteen patients (45%) received MDRT to all metastatic sites. All patients initially underwent ≧6 months of androgen deprivation therapy. Oligometastatic disease was defined as presence of five or fewer metastatic lesions. Median follow‐up period was 62.5 months.

Results

Of the 40 patients, the 5‐year castration‐resistant prostate cancer (CRPC)‐free survival rate and cancer‐specific survival was 64.4% and 87.9%, respectively. Pre‐ or post‐treatment predictive value including prostate‐specific antigen (PSA) at diagnosis ≥20 ng/mL, Gleason grade group 5, positive biopsy core rate ≥51%, PSA nadir level of ≥0.02 ng/mL after the radiotherapy, and no MDRT were significantly associated with progression to CRPC. Patients with MDRT had significantly higher probability of achieving a PSA level of <0.02 ng/mL than those without the therapy (88.8% vs 54.5%, P = 0.0354) and consequently had a better CRPC‐free survival than those without the therapy (HR 0.319, 95%CI: 0.116‐0.877). Comparing PDRT alone, PDRT with MDRT did not significantly increase the incidences of genitourinary and gastrointestinal toxicities.

Conclusions

This single‐institutional study revealed the feasibility of combining prostate brachytherapy and MDRT for newly diagnosed oligometastatic prostate cancer. This combined approach has potential to prolong CRPC‐free survival.
Regeneration of aged DMF for use in solid‐phase peptide synthesis
Authors: Magtaan Jordan Kevin , Devocelle Marc , Kelleher Fintan
Published: December 2018

Dimethylformamide (DMF), which is still the most commonly used solvent for Fmoc‐SPPS, has the potential for degradation over time on exposure to air (and water vapour) and storage, to give dimethylamine and formic acid impurities. In particular, dimethylamine can lead to unwanted deprotection of the fluorenylmethyloxycarbonyl (Fmoc) group during, for example, the initial loading of Fmoc amino acids in SPPS, which leads reduced calculated loading values. We have found that treatment of such aged DMF by simple sparging with an inert gas (N2), or vacuum sonication, can regenerate the DMF in order to restore loading levels back to those found for newer, fresh, DMF samples.
Adaptive sliding‐mode control for Mars entry trajectory tracking with finite‐time convergence
Authors: Shen Ganghui , Xia Yuanqing , Ma Dailiang , Zhang Jinhui
Published: December 2018

This paper presents a novel adaptive sliding‐mode control (ASMC) method for Mars entry guidance and the finite‐time convergence in the presence of large uncertainties can be guaranteed. With the help of gain adaptive law, the nonoverestimating value of control gains can be achieved, and then, the chattering can be attenuated by the proposed ASMC method. Meanwhile, the extended state observer is introduced to estimate and compensate for uncertainties and the nonoverestimating problem is resolved further. In addition, the proposed method does not require any knowledge on the upper bound of uncertainty, which yields to be used in practical systems. Finally, the numerical simulation results are given to demonstrate the effectiveness of the proposed guidance law.
Robust nonfragile observer‐based control of switched discrete singular systems with time‐varying delays: A sliding mode control design
Authors: Han Yueqiao , Kao Yonggui , Park Ju H.
Published: December 2018

This paper is devoted to the robust
sliding mode control issue for a type of switched discrete singular systems with time‐varying delays under arbitrary switching. Since the system states are not available, the nonfragile observer strategy is used to generate the state estimation. By designing a novel sliding surface function, which is established on the estimation, new sufficient conditions via linear matrix inequalities are derived so that the closed‐loop system is admissible with an
disturbance attenuation level γ. Furthermore, sliding mode controllers are given to guarantee the reachability of the quasi‐sliding mode and weaken the chattering. At last, examples are presented to verify the validity of our provided approach.
CCM‐SLAM: Robust and efficient centralized collaborative monocular simultaneous localization and mapping for robotic teams
Authors: Schmuck Patrik , Chli Margarita
Published: December 2018

Robotic collaboration promises increased robustness and efficiency of missions with great potential in applications, such as search‐and‐rescue and agriculture. Multiagent collaborative simultaneous localization and mapping (SLAM) is right at the core of enabling collaboration, such that each agent can colocalize in and build a map of the workspace. The key challenges at the heart of this problem, however, lie with robust communication, efficient data management, and effective sharing of information among the agents. To this end, here we present CCM‐SLAM, a centralized collaborative SLAM framework for robotic agents, each equipped with a monocular camera, a communication unit, and a small processing board. With each agent able to run visual odometry onboard, CCM‐SLAM ensures their autonomy as individuals, while a central server with potentially bigger computational capacity enables their collaboration by collecting all their experiences, merging and optimizing their maps, or disseminating information back to them, where appropriate. An in‐depth analysis on benchmarking datasets addresses the scalability and the robustness of CCM‐SLAM to information loss and communication delays commonly occurring during real missions. This reveals that in the worst case of communication loss, collaboration is affected, but not the autonomy of the agents. Finally, the practicality of the proposed framework is demonstrated with real flights of three small aircraft equipped with different sensors and computational capabilities onboard and a standard laptop as the server, collaboratively estimating their poses and the scene on the fly.
Anomalous cluster detection in spatiotemporal meteorological fields
Authors: Ramachandra Bharathkumar , Dutton Benjamin , Vatsavai Ranga Raju
Published: December 2018

Finding anomalous regions in spatiotemporal climate data is an important problem with a need for greater accuracy. The collective and contextual nature of anomalies (e.g., heat waves) coupled with the real‐valued, seasonal, multimodal, highly correlated, and gridded nature of climate variable observations poses a multitude of challenges. Existing anomaly detection methods have limitations in the specific setting of real‐valued areal spatiotemporal data. In this paper, we develop a method for extreme event detection in meteorological datasets that follows from well known distribution‐based anomaly detection approaches. The method models spatial and temporal correlations explicitly through a piecewise parametric assumption and generalizes the Mahalanobis distance across distributions of different dimensionalities. The result is an effective method to mine contiguous spatiotemporal anomalous regions from meteorological fields which improves upon the current standard approach in climatology. The proposed method has been evaluated on a real global surface temperature dataset and validated using historical records of extreme events.
Optimal vertical configuration of combined energy dissipation outriggers
Authors: Xing Lili , Zhou Ying , Aguaguiña Mario
Published: December 2018

The damped outrigger system emerged as an improvement of the conventional outriggers with the aim to provide supplemental damping and to contribute to the vibration control in super tall buildings where this system is usually applied. In addition to viscous dampers (VDs), buckling‐restrained braces (BRBs) have also been employed as energy dissipating members in outriggers. Nevertheless, the combined use of outriggers with VDs and BRBs in the same structure has not yet been studied. Such combination can contribute to achieve an effective multiperformance design of super tall buildings. This paper presents a study whose main objective was to determine the optimal vertical combination of two types of energy dissipation outriggers to control the seismic responses of a 9‐zone super tall model structure. Outriggers with VDs (OVDs) and outriggers with BRBs (OBRBs) were placed at the different zones of the structure considering all the possible combinations and in configurations of up to four outriggers. The effects of these combinations on the seismic performance of the structure were studied through parametric analysis and optimization methods. This form of the outrigger system is defined in this paper as combined energy dissipation outrigger system. The results indicate that when two energy dissipation outriggers are used, the combination of OBRB plus OVD shows superior seismic performance compared with other double‐outrigger configurations. In addition, the results show that the locations of OVDs and OBRBs play an important role in the structure behavior; it was found that it is more beneficial to place OBRBs above OVDs.
Multiobjective optimal placement of active tendons to control irregular multistory buildings with soil–structure interaction
Authors: Nazarimofrad Ebrahim , Farahani Sina , Zahrai Seyed Mehdi
Published: December 2018

In recent decades, many researchers have conducted research studies on structural control to improve the safety and serviceability of high‐rise buildings against earthquakes and strong winds. On the other hand, applying active control systems and controlling strategies in buildings are costly process, and it is necessary to reduce the number of controllers.

In this paper, a multiobjective genetic algorithm is proposed to optimize the placement of active tendons in a 2D shear frame and a 3D irregular building considering soil–structure interaction effect to reduce active control cost and response of structures at the same time. For multiobjective optimization, multiobjective genetic algorithm of the MATLAB toolbox is used to find a set of Pareto optimal solutions for a multiobjective minimization. The results indicate that the method is capable of finding the number and location of the required active tendons in both 2D shear frame and 3D irregular building with 10 and 20 stories while the base shear of structure is minimized. The specific advantage of the employed algorithms is to reduce the number of mounted active tendons approximately by 50%.
Research domain criteria from neuroconstructivism: A developmental view on mental disorders
Authors: Campos Ruth , Nieto Carmen , Núñez María
Published: December 2018

Neuroconstructivism can provide Research Domain Criteria (RDoC) with a developmental framework to understand mental disorders. Neuroconstructivism proposes that mental disorders are the outcome of a developmental trajectory. Based on this assumption, symptoms would reveal the system's adaptation to optimize functioning according to the system's experience of the physical and social contexts. RDoC adopts a translational research approach with the aim of detecting, curing, and preventing mental illness. More specifically this involves to: (a) identify early signs of mental disorders, (b) find the optimal patient‐treatment fit, and (c) design efficient interventions to prevent the system's eventual pathological functioning. We propose that meeting RDoC's threefold objective necessarily involves predicting the system's developmental trajectory. Such endeavor requires counting with assessment tools that are sensitive to both the process of development and its different contexts; the measures provided by these tools will allow identifying the risk and protective factors that make the system vulnerable to depart from a typical developmental trajectory. Including vectors relative to time and contexts in a relevant part of the matrix will make of RDoC a truly integrative model, which considers the relationships between behavior and neural circuits throughout the developmental pathway.

This article is categorized under:

Psychology > Brain Function and Dysfunction

Neuroscience > Clinical Neuroscience

Neuroscience > Development
Titanic'smirage, part 3: A case of mistaken identity, low‐lying distress rockets and ‘miraging’ star glitters
Authors: Zinkova Mila
Published: December 2018

This article (the third of four articles that look into theTitanicmirage theory) presents eyewitness accounts of theTitanic'sdistress rockets and the appearance of the stricken liner and compares them with the ways mirages manifest themselves. It is argued here that flickering lights and twinkling stars could have made the signals from Morse lamps undetectable. However, they do not indicate the certain presence of super refraction. The presence of a mirage cannot be ruled out; however, this investigation demonstrates that even if a mirage was present, it had no significant effect on any aspect of the tragedy.
Big data processing tools: An experimental performance evaluation
Authors: Rodrigues Mário , Santos Maribel Yasmina , Bernardino Jorge
Published: December 2018

Big Data is currently a hot topic of research and development across several business areas mainly due to recent innovations in information and communication technologies. One of the main challenges of Big Data relates to how one should efficiently handle massive volumes of complex data. Due to the notorious complexity of the data that can be collected from multiple sources, usually motivated by increasing data volumes gathered at high velocity, efficient processing mechanisms are needed for data analysis purposes. Motivated by the rapid growth in technology, development of tools, and frameworks for Big Data, there is much discussion about Big Data querying tools and, specifically, those that are more appropriated for specific analytical needs. This paper describes and evaluates the following popular Big Data processing tools: Drill, HAWQ, Hive, Impala, Presto, and Spark. An experimental evaluation using the Transaction Processing Council (TPC‐H) benchmark is presented and discussed, highlighting the performance of each tool, according to different workloads and query types.

This article is categorized under:

Technologies > Computer Architectures for Data Mining

Fundamental Concepts of Data and Knowledge > Big Data Mining

Technologies > Data Preprocessing

Application Areas > Data Mining Software Tools
Lessons from 30 years of population viability analysis of wildlife populations
Authors: Lacy Robert C.
Published: December 2018

Population viability analysis (PVA) has been used for three decades to assess threats and evaluate conservation options for wildlife populations. What has been learned from PVA on in situ populations are valuable lessons also for assessing and managing viability and sustainability of ex situ populations. The dynamics of individual populations are unpredictable, due to limited knowledge about important factors, variability in the environment, and the probabilistic nature of demographic events. PVA considers such uncertainty within simulations that generate the distribution of likely fates for a population; management of ex situ populations should also take into consideration the uncertainty in our data and in the trajectories of populations. The processes affecting wildlife populations interact, with feedbacks often leading to amplified threats to viability; projections of ex situ populations should include such feedbacks to allow for management that foresees and responds to the cumulative and synergistic threats. PVA is useful for evaluating conservation options only if the goals for each population and measures of success are first clearly identified; similarly, for ex situ populations to contribute maximally to species conservation, the purposes for the population and definitions of sustainability in terms of acceptable risk must be documented. PVA requires a lot of data, knowledge of many processes affecting the populations, modeling expertize, and understanding of management goals and constraints. Therefore, to be useful in guiding conservation it must be a collaborative, trans‐disciplinary, and social process. PVA can help integrate management of in situ and ex situ populations within comprehensive species conservation plans.