bluuebunny/crossref_metadata_2025 huggingface dataset:
Ulcerative keratitis caused by beta‐hemolyticStreptococcus equiin 11 horses
Authors: Brooks D. E. , Andrew S. E. , Biros D. J. , Denis H. M. , Cutler T. J. , Strubbe D. T. , Gelatt K. N.
Published: August 2023

PurposeTo describe 11 clinical cases of ulcerative keratitis in horses associated with betahemolyticStreptococcus equiin Florida, USA.

MethodsRetrospective clinical study (1996–99).

ResultsBeta‐hemolyticStreptococcus equiwas cultured from 11 horses with deep ulcers, descemetoceles or iris prolapse (n= 8), a suture abscess found with a penetrating keratoplasty for a stromal abscess (n= 1), and ulceration that developed following keratectomy/irradiation for corneal squamous cell carcinoma (n= 2). Beta‐hemolyticStreptococcus equisubspecieszooepidemicuswas found in 10 eyes and subspeciesequiin one. Marked signs of uveitis including miosis and hypopyon were present in 8/11 (72.7%) eyes. Keratomalacia was severe in all eyes. The mean diameter of the ulcers associated with betahemolyticStreptococcuswas 10.2 ± 6.1 mm. Eight of the eyes required conjunctival flap surgery (four grafts dehisced) and one eye corneal transplantation. Two eyes were treated with medication only. Isolate sensitivity to antibiotics included ampicillin (6/11), bacitracin (11/11), cephalothin (11/11), chloramphenicol (11/11), gentamicin (5/11), polymyxin B (2/11), and tobramycin (1/11). All isolates were resistant to neomycin. The average healing time was 44.7 ± 26.7 days. The visual outcome was positive in 8/11 eyes, and the globe retained in 9/11 eyes.

ConclusionsAlthough Gram‐positive bacteria predominate in the normal conjunctival microflora of horses throughout the world, Gram‐negative bacteria and fungi are more often isolated from equine ulcers. Beta‐hemolyticStreptococcusspp. are associated with a very aggressive ulcerative keratitis with the capability to digest conjunctival graft tissue. Clinical signs are pronounced. Aggressive surgical and intensive medical therapy with topical antibiotics and protease inhibitors is indicated.
Immunohistochemistry of the extracellular matrix of the normal equine lamina cribrosa
Authors: Brooks D. E. , Komaromy A. M. , Garcia‐Fernandez M. C. , Cutler T. J. , Samuelson D. A. , Kallberg M. E.
Published: August 2023

Purpose To use immunohistochemical techniques to identify and localize the structural macromolecules of the extracellular matrix (ECM) of the normal adult equine lamina cribrosa in order to make comparisons to the extracellular matrix of the lamina cribrosa of horses with glaucoma.

Methods Normal eyes of five adult horses between 5 and 10 years of age were fixed in 10% neutral buffered formalin and embedded in paraffin. Polyclonal rabbit‐derived antibodies against human elastin, laminin, fibrillin‐1, and collagen types I, III and IV, and polyclonal goat‐derived antibodies against collagen type VI were used as primary antibodies.

Transverse and longitudinal histologic sections of the optic nerve head and lamina cribrosa were stained using several dilutions of the primary antibodies, biotinylated link antibody, horseradish peroxidase‐labeled streptavidin, and 3,3′‐diaminobenzidine as a chromogen.

The immunohistochemical staining patterns were qualitatively interpreted.

Results The normal adult horse lamina cribrosa labeled positively for collagen types I, III and VI, laminin, elastin and fibrillin. Collagen type VI staining of the laminar ECM was most intense, followed by labeling for collagen types III and I, respectively. Laminar blood vessels were weakly positive for laminin and slightly positive for type IV collagen. The scleral ECM of the laminar insertion zone had more intense labeling for collagen types I and VI than did the laminar plates.

Conclusions The extracellular matrix of the laminar plates of the adult equine lamina cribrosa is similar to the dog as it consists of elastic and collagen fibers (with collagen types VI, III and I). Both the normal dog and horse lamina display more intense staining of collagen type VI than is found in the ECM of the normal human lamina cribrosa. The macromolecular structure of the equine lamina cribrosa suggests that it is a very resilient structure that may provide some protection to the optic nerve axons during episodes of elevated intraocular pressure.
In vitroanalysis of antiangiogenic activity of fungi isolated from clinical cases of equine keratomycosis
Authors: Welch Patrick M. , Gabal Moustafa , Betts Daniel M. , Whelan Nick C. , Studer Michele E.
Published: August 2023

ObjectiveThe goal of this project was to explore the possibility that fungal organisms produce metabolites that inhibit angiogenesis.

ProceduresFungal cultures were obtained from cases of keratomycosis, grown in Sabouraud's dextrose broth, and sterile filtered for use in experiments. The Matrigel assay was used to screen the filtrate samples for antiangiogenic activity. Martigel is a basement membrane matrix that supports the differentiation of human umbilical vein endothelial (HUVE) cells into a capillary‐like network of tubules. HUVE cells were cultured using standard techniques and passaged at confluence, with all cells being used at passage 3–6. HUVE cells (40 000 cells) were pipetted into each well of a 24‐well tissue‐culture plate coated with Matrigel. An aliquot of fungal media filtrate was added to each well and the plates allowed to incubate for 18 h, at which time they were evaluated for tubule formation.

ResultsTwo fungal isolates showed inhibition of tubule formation. The addition of 100, 200 and 400 μL of the fungal media filtrate from the first isolate (Fusariumsp. 99A34574) produced a consistent and dose‐dependent inhibition of tubule formation. The second isolate (Aspergillussp. 271599) did not show inhibition of tubule formation with 100 or 200 μL added to the wells, however, it did show inhibition at 400 μL/well. The remaining three isolates did not cause inhibition at any concentration.

ConclusionsOur findings suggest that certain fungal organisms produce metabolites that inhibit tubule formationin vitro, and that these metabolites may play a significant role in altering the host vascular response to fungal infections of the cornea.
Inferomedial placement of a single‐entry subpalpebral lavage tube for treatment of equine eye disease
Authors: Giuliano Elizabeth A. , Maggs David J. , Moore Cecil P. , Boland Lisa A. , Champagne Erin S. , Galle Laurence E.
Published: August 2023

The objective of this study was to describe method of placement, and frequency and severity of complications associated with a subpalpebral lavage system placed in the medial aspect of the equine inferior eyelid. The inferomedial subpalpebral lavage (ISPL) tube is positioned deep in the medial aspect of the inferior conjunctival fornix so that the footplate lies flat between the lower eyelid and the anterior surface of the nictitans. Retrospective data from the placement of 92 ISPL systems placed in 86 horses during a 31‐month period were examined. Tube placement was performed using sedation and regional anesthesia only in 59% of horses. The median duration of tube placement was 19 days (range: 1–61 days). Seventy‐one horses were treated for up to 55 days following discharge from hospital with an ISPL tube in place. No complications were reported with 59% of ISPL systems. Non‐ocular complications were found in 38% of ISPL systems and included tube displacement from the conjunctival fornix (18%), suture loss requiring resuturing of the system to the horse's head (14%), and damage necessitating replacement of the injection port (6%). Ocular complications were recorded in 3% of horses and were limited to inferior eyelid swelling. Vision was retained in 88% of horses. The ISPL system is easily and safely placed, and well tolerated for extended periods. It appears to be associated with infrequent and minor complications when compared with placement of subpalpebral lavage tubes in the superior eyelid.
Cataract phacofragmentation in horses
Authors: Millichamp Nicholas J. , Dziezyc Joan
Published: August 2023

Cataract surgeries were carried out in fifty‐one eyes of 36 horses over a 15‐year period. Cataracts were removed using phacofragmentation and aspiration. Useful vision was restored after surgery in 30 horses. One year after surgery 16 of the 19 horses for which follow up information was available were still visual with several still being used as working horses. At 5–6 years after surgery three horses were still visual. The most frequent intraoperative complication was tearing of the posterior lens capsule. The most frequent postoperative problem was superficial corneal ulceration. Four eyes in three horses developed postoperative infectious endophthalmitis resulting in blindness.
Systemic effects of topical and subconjunctival ophthalmic atropine in the horse
Authors: Williams Melanie M. , Spiess Bernhard M. , Pascoe Peter J. , O'Grady Michael
Published: August 2023

Objective To identify any systemic effects of topical and subconjunctival administration of atropine sulfate in the horse.

Animals studied Six mature grade horses were treated hourly in one eye with topical ophthalmic atropine drops for 24 h. Five horses were treated subconjunctivally in one eye with 3 mg of atropine sulfate.

Procedures Pupillary light reflexes, pupil size, electrocardiographic parameters, girth measurements, intestinal motility, and clinical signs of abdominal pain were monitored.

Results Alteration in ausculated gut motility and clinical signs of abdominal pain were the most sensitive indicators of the systemic manifestations of the topically applied atropine. Gut motility was absent in all horses for periods of 2–18 h in all four abdominal quadrants in horses given topically administrated atropine. Sings of abdominal pain were observed in four of six horses that received topical atropine. In the subconjunctival test study, gut motility was absent in three horses for periods of 3–7 h. Uniocular subconjunctival injection of 3 mg atropine sulfate produced signs of abdominal pain in one of six horses.

Conclusion The ophthalmic administration of atropine can affect gut motility and induce signs of colic in selected horses.
Orbital fibroma in a horse
Authors: Colitz Carmen M. H. , Gilger Brian C. , Davidson Michael G.
Published: August 2023

An 11‐year‐old American Quarterhorse gelding presented for moderate periorbital swelling and exophthalmia of the left eye. The menace response, and direct and consensual pupillary light reflexes were absent in the left eye. Conjunctival hyperemia, blepharedema, a mydriatic pupil, resistance to retropulsion, and an increased intraocular pressure were present. A soft‐tissue mass could be palpated in the left retrobulbar space by pressing onto the orbit over the supraorbital fossa. Incomplete surgical resection of the mass was performed and histopathologic evaluation was consistent with a fibroma. Normal pupillary light reflexes and vision returned following surgery. The mass has not recurred 14 months after surgery.
Lateral interaction by Laplacian‐based graph smoothing for deep neural networks
Authors: Chen Jianhui , Wang Zuoren , Liu Cheng‐Lin
Published: August 2023

Lateral interaction in the biological brain is a key mechanism that underlies higher cognitive functions. Linear self‐organising map (SOM) introduces lateral interaction in a general form in which signals of any modality can be used. Some approaches directly incorporate SOM learning rules into neural networks, but incur complex operations and poor extendibility. The efficient way to implement lateral interaction in deep neural networks is not well established. The use of Laplacian Matrix‐based Smoothing (LS) regularisation is proposed for implementing lateral interaction in a concise form. The authors’ derivation and experiments show that lateral interaction implemented by SOM model is a special case of LS‐regulated k‐means, and they both show the topology‐preserving capability. The authors also verify that LS‐regularisation can be used in conjunction with the end‐to‐end training paradigm in deep auto‐encoders. Additionally, the benefits of LS‐regularisation in relaxing the requirement of parameter initialisation in various models and improving the classification performance of prototype classifiers are evaluated. Furthermore, the topologically ordered structure introduced by LS‐regularisation in feature extractor can improve the generalisation performance on classification tasks. Overall, LS‐regularisation is an effective and efficient way to implement lateral interaction and can be easily extended to different models.
D2LFS2Net: Multi‐class skin lesion diagnosis using deep learning and variance‐controlled Marine Predator optimisation: An application for precision medicine
Authors: Dillshad Veena , Khan Muhammad Attique , Nazir Muhammad , Saidani Oumaima , Alturki Nazik , Kadry Seifedine
Published: August 2023

In computer vision applications like surveillance and remote sensing, to mention a few, deep learning has had considerable success. Medical imaging still faces a number of difficulties, including intra‐class similarity, a scarcity of training data, and poor contrast skin lesions, notably in the case of skin cancer. An optimisation‐aided deep learning‐based system is proposed for accurate multi‐class skin lesion identification. The sequential procedures of the proposed system start with preprocessing and end with categorisation. The preprocessing step is where a hybrid contrast enhancement technique is initially proposed for lesion identification with healthy regions. Instead of flipping and rotating data, the outputs from the middle phases of the hybrid enhanced technique are employed for data augmentation in the next step. Next, two pre‐trained deep learning models, MobileNetV2 and NasNet Mobile, are trained using deep transfer learning on the upgraded enriched dataset. Later, a dual‐threshold serial approach is employed to obtain and combine the features of both models. The next step was the variance‐controlled Marine Predator methodology, which the authors proposed as a superior optimisation method. The top features from the fused feature vector are classified using machine learning classifiers. The experimental strategy provided enhanced accuracy of 94.4% using the publicly available dataset HAM10000. Additionally, the proposed framework is evaluated compared to current approaches, with remarkable results.
Hierarchical game theoretical distributed adaptive control for large scale multi‐group multi‐agent system
Authors: Dey Shawon , Xu Hao
Published: August 2023

This paper introduces a distributed adaptive formation control for large‐scale multi‐agent systems (LS‐MAS) that addresses the heavy computational complexity and communication traffic challenges while directly extending conventional distributed control from small scale to large scale. Specifically, a novel hierarchical game theoretic algorithm is developed to provide a feasible theory foundation for solving LS‐MAS distributed optimal formation problem by effectively integrating the mean‐field game (MFG), the Stackelberg game, and the cooperative game. In particular, LS‐MAS is divided into multiple groups geographically with each having one group leader and a significant amount of followers. Then, a cooperative game is used among multi‐group leaders to formulate distributed inter‐group formation control for leaders. Meanwhile, an MFG is adopted for a large number of intra‐group followers to achieve the collective intra‐group formation while a Stackelberg game is connecting the followers with their corresponding leader within the same group to achieve the overall LS‐MAS multi‐group formation behavior. Moreover, a hybrid actor–critic‐based reinforcement learning algorithm is constructed to learn the solution of the hierarchical game‐based optimal distributed formation control. Finally, to show the effectiveness of the presented schemes, numerical simulations and Lyapunov analysis is performed.
Wideband low‐profile magneto–electric dipole antenna stacked with patch and metasurface
Authors: Nagarnaik S. , Mukherjee J.
Published: August 2023

Here, a novel low‐profile wideband and high‐gain magnetoelectric dipole antenna with metasurface superstrate is proposed. The magnetoelectric dipole antenna printed on single layer consists of a probe fed patch with four shorted patches arranged symmetrically. Gain enhancement is achieved by placing two side walls and metasurface superstrate with an air gap. Additional rectangular patch connected to the same probe is placed above the magnetoelectric dipole antenna within an air gap. This improves impedance bandwidth, gain and efficiency significantly. Overall profile of antenna is 0.15 λ0, which is lower compared to conventional magnetoelectric dipole antennas with a profile of 0.25λ0. The proposed antenna fabricated on FR4 substrate shows 57% of wide impedance bandwidth from 3.63 to 6.57 GHz with overall size of 1λ0 × 1λ0 × 0.15λ0. The maximum gain in the operating band is 10.2 dBi.
Multi‐objective single‐shot neural architecture search via efficient convolutional filters
Authors: Shariatzadeh Seyed Mahdi , Fathy Mahmood , Berangi Reza
Published: August 2023

This paper presents a novel approach for fast neural architecture search (NAS) in Convolutional Neural Networks (CNNs) for end‐to‐end License Plate Recognition (LPR). The authors propose a one‐shot schema that considers the efficiency of different convolutional filters to create a search space for more efficient architectures on vector processing cores. The authors’ approach utilizes a super‐network for LPR using Connectionist‐Temporal‐Cost (CTC) and ranks the importance of filters to generate a fine‐grain list of architectures. These architectures are evaluated in a multi‐objective manner, resulting in several Pareto‐optimal architectures with different computational costs and validation errors. Rather than using a single complicated building block for all layers, the authors’ method allows each stage to select a custom building block with fewer or more operations. The authors show that their super‐network is flexible to calculate filters of any required size and stride in each stage while keeping it efficient by the structural pruning. The authors’ experiments, which were performed on Iranian LPR, demonstrate that this method produces a variety of fast and efficient CNNs. Furthermore, the authors discuss the potential of this method for use in other areas of CNN application.
Design consideration for frequency containment reserve provisions by a multi‐terminal HVDC system
Authors: Shinoda Kosei , Dai Jing , Bakhos Gianni , Gonzalez‐Torres Juan Carlos , Benchaib Abdelkrim , Bacha Seddik
Published: August 2023

Frequency control is considered to be an important function of multi‐terminal HVDC (MTDC) systems. Sharing frequency containment reserves (FCRs) among interconnected AC systems using HVDC technology is particularly attractive in the European context. However, coordination of the contribution between systems with different sizes, quality requirements, and dynamic characteristics requires harmonized rules and well‐defined control strategies. If the controllers are not properly designed, they can lead to disproportional supports, noncompliance with the existing regulation framework, or even degradation of the frequency quality. This paper presents a general analytical methodology for assessing the compliance of MTDC grid control solutions to the essential requirements of the FCR framework, and then examines three different implementation solutions as illustrative examples to validate the method. Through this process, the interaction mechanisms behind each solution are analytically clarified. The performance analyses are then confirmed using load‐frequency models of CE, Nordic, and GB systems coupled with a three‐terminal DC system. It is revealed that, while certain control solutions result in insufficient performance with respect to the desired FCR provision, the newly proposed distributed solution for each pair of converters is the most compliant with the existing framework thanks to the highest degrees of freedom.
A grid voltage perturbations based bidirectional impedance uniform control for grid‐connected DC/AC converter
Authors: Liu Li , Ding Yu , Peng Fei , Tian Yanjun , Wang Kun , Chen Zhe
Published: August 2023

For bidirectional grid‐connected DC/AC converters, the power flow variation substantially alters the system stability, and especially severs under heavy load. Towards this problem, this paper proposes a novel impedance uniform control method to eliminate the stability degradation under power flow variations, which is achieved by reshaping the converter negative incremental impedance to resistive in the stability fragile mode. The d‐axis voltage perturbation is extracted to dynamically modify the active power current reference. Hence, the system bidirectional damping performance can be simultaneously improved by this dedicated design. Without switching control modes or sacrificing dynamic performance, the grid‐connected converter system can maintain satisfied stability under bidirectional power flow variations. Finally, the effectiveness of the proposed control method has been validated by both simulations and experiments.
Spatial focusing algorithm for source enumeration with rotating uniform circular sonar arrays
Authors: Liang Guolong , Liu Guolong , Hao Yu , Zou Nan , Zhao Chunpeng
Published: August 2023

Source enumeration with large snapshots is feasible for a static uniform circular sonar array (UCSA). However, the dimension of the signal subspace in the array coordinate system exceeds the number of signal sources due to the rotation of the UCSA, which makes standard source enumeration ineffective. To address this issue, a spatial focusing approach for source enumeration with rotating UCSAs is presented. The approach is based on the concept of phase‐mode excitation and makes use of the UCSA heading information to achieve spatial focusing. The proposed algorithm provides reliable source enumeration with a high signal‐to‐noise ratio (SNR) when compared to the previous signal‐subspace transformation (SST) method. Simulations demonstrate that the proposed algorithm outperforms the other three methods in the conditions of a low SNR and a small angular separation.
Higher order ionospheric effects in testing gravitational redshift by space frequency signal transfer
Authors: Zhang Pengfei , Shen Wen-Bin , Wang Chenxiang , Shen Ziyu , Cai Chenghui , Sun Xiao , Xu Wei , Xu Rui , Ruby Abdelrahim , Ashry Mostafa
Published: August 2023

Context.When a microwave passes through the ionosphere, it produces ionospheric refraction and path bending, leading to changes in frequency and reducing the accuracy of frequency transmission. Currently, the Atomic Clock Ensemble in Space (ACES, 2023) and China Space Station (CSS, 2022) carry atomic clocks with a long-term stability of 10−16and 10−18. The accuracy of the frequency comparison and gravitational redshift (GRS) test matches the corresponding order of magnitude.

Aims.Based on ground-space frequency links and considering the frequency shift caused by the higher order terms of the ionosphere, the gravitational redshift (GRS) test could be achieved at a higher level of accuracy.

Methods.We formulated a higher order ionospheric frequency shift model and analyzed the ionosphere effects on the one-way frequency transfer, as well as the dual- and tri-frequency combination methods, for frequency transfer between a space station (ACES or CSS) and a ground-based station.

Results.The analysis shows that for one-way frequency transfer, the second-order ionospheric frequency shift is about 10−15, 10−17, and 10−18for theS-,Ku-, andKa-bands, respectively. The second- and third-order ionospheric frequency shifts were eliminated using the dual-frequency combination method for CSS frequency transfer. When using the tri-frequency combination method for frequency transfer, the second ionospheric frequency shifts are about 10−16~ 10−17for ACES and 10−19for CSS, while the third-order frequency shifts are smaller than 10−19for two missions.

Conclusions.Concerning the current atomic clock’s accuracy and microwave link frequencies for ACES and CSS missions, the second-order ionospheric frequency shift needs to be considered and eliminated, but the third-order term does not need to be considered. To get the accuracy of the GRS test to reach 10−6~ 10−8, we can use the dual- or tri-frequency combination method. Our study also shows that even for the mm accuracy level requirement, the third-order ionospheric frequency shift can be neglected.
Measuring the numerical viscosity in simulations of protoplanetary disks in Cartesian grids
Authors: Joseph Jibin , Ziampras Alexandros , Jordan Lucas , Turpin George A. , Nelson Richard P.
Published: August 2023

Context. Hydrodynamical simulations solve the governing equations on a discrete grid of space and time. This discretization causes numerical diffusion similar to a physical viscous diffusion, the magnitude of which is often unknown or poorly constrained. With the current trend of simulating accretion disks with no or very low prescribed physical viscosity, it has become essential to understand and quantify this inherent numerical diffusion in the form of a numerical viscosity.

Aims. We study the behavior of the viscous spreading ring and the spiral instability that develops in it. We aim to use this setup to quantify the numerical viscosity in Cartesian grids and study its properties.

Methods. We simulated the viscous spreading ring and the related instability on a two-dimensional polar grid using PLUTO as well as FARGO, ensuring the convergence of our results with a resolution study. We then repeated our models on a Cartesian grid and measured the numerical viscosity by comparing results to the known analytical solution using PLUTO and Athena++.

Results. We find that the numerical viscosity in a Cartesian grid scales with resolution as approximately vnum ∝ Δx2 and is equivalent to an effective α ~ 10−4 for a common numerical setup. We also showed that the spiral instability manifests as a single leading spiral throughout the whole domain on polar grids. This is contrary to previous results and indicates that sufficient resolution is necessary in order to correctly resolve the instability.

Conclusions. Our results are relevant in the context of models where the origin should be included in the computational domain, or when polar grids cannot be used. Examples of such cases include models of disk accretion onto a central binary and, inherently, Cartesian codes.
Therapeutic efficacy and safety of artesunate + amodiaquine and artemether + lumefantrine in treating uncomplicated Plasmodium falciparum malaria in children on the rainy south-east coast of Madagascar
Authors: Irinantenaina Judickaëlle , Carn Gwénaëlle , Randriamiarinjatovo Dina Ny Aina Liantsoa , Harimanana Aina Nirina , Razanatsiorimalala Seheno , Ralemary Nicolas , Randriarison Maurice , Razafinjato Celestin , Hotahiene Raphael , Randrianarivelojosia Milijaona
Published: August 2023

Malaria is a major public health problem in Madagascar, particularly in coastal areas. We conducted a randomized, controlled, parallel-group study of artemisinin-based combination therapy (ACT) in Mananjary and Farafangana, two localities on the rainy south-east coast of Madagascar, from March to September 2018. The efficacy and safety of artesunate + amodiaquine (ASAQ) and artemether + lumefantrine (AL) were assessed according to the WHO protocol with a 28-day follow-up. Children aged 6 months to 14 years with uncomplicated Plasmodium falciparum malaria were randomized to receive ASAQ or AL for three days (1:1). 347/352 (98.5%) randomized patients reached the study endpoint on day 28. Crude adequate clinical and parasitological response (ACPR) rates were 100% (95% CI: 98.8–100%) in the ASAQ group and 96% (95% CI: 93.1–98.9%) in the AL group (per protocol population). However, the PCR-corrected ACPR rate was 97.7% (95% CI: 95.4–100%) in the AL group. Two cases of recrudescence and three of re-infection were observed. Mild and moderate adverse events, including gastrointestinal and/or nervous disorders, were reported in 11.9% (42/352) of patients. We found that ASAQ and AL were safe and efficacious for treating uncomplicated P. falciparum malaria. They may be used for treatment at health facilities and at the community level, and for mass drug administration campaigns.
Deep learning-based schemes for singularly perturbed convection-diffusion problems
Authors: Beguinet Adrien , Ehrlacher Virginie , Flenghi Roberta , Fuente Maria , Mula Olga , Somacal Agustin
Published: August 2023

Deep learning-based numerical schemes such as Physically Informed Neural Networks (PINNs) have recently emerged as an alternative to classical numerical schemes for solving Partial Differential Equations (PDEs). They are very appealing at first sight because implementing vanilla versions of PINNs based on strong residual forms is easy, and neural networks offer very high approximation capabilities. However, when the PDE solutions are low regular, an expert insight is required to build deep learning formulations that do not incur in variational crimes. Optimization solvers are also significantly challenged, and can potentially spoil the final quality of the approximated solution due to the convergence to bad local minima, and bad generalization capabilities. In this paper, we present an exhaustive numerical study of the merits and limitations of these schemes when solutions exhibit low-regularity, and compare performance with respect to more benign cases when solutions are very smooth. As a support for our study, we consider singularly perturbed convection-diffusion problems where the regularity of solutions typically degrades as certain multiscale parameters go to zero.
Accelerating metabolic models evaluation with statistical metamodels: application to Salmonella infection models
Authors: Frioux Clémence , Huet Sylvie , Labarthe Simon , Martinelli Julien , Malou Thibault , Sherman David , Taupin Marie-Luce , Ugalde-Salas Pablo
Published: August 2023

Mathematical and numerical models are increasingly used in microbial ecology to model the fate of microbial communities in their ecosystem. These models allow to connect in a mechanistic framework species-level informations, such as the microbial genomes, with macro-scale features, such as species spatial distributions or metabolite gradients. Numerous models are built upon species-level metabolic models that predict the metabolic behaviour of a microbe by solving an optimization problem knowing its genome and its nutritional environment. However, screening the community dynamics with these metabolic models implies to solve such an optimization problem by species at each time step, leading to a significant computational load further increased by several orders of magnitude when spatial dimensions are added.

In this paper, we propose a statistical framework based on Reproducing Kernel Hilbert Space (RKHS) metamodels that are used to provide fast approximations of the original metabolic model. The metamodel can replace the optimization step in the system dynamics, providing comparable outputs at a much lower computational cost. We will first build a system dynamics model of a simplified gut microbiota composed of a unique commensal bacterial strain in interaction with the host and challenged by a Salmonella infection. Then, the machine learning method will be introduced, and particularly the ANOVA-RKHS that will be exploited to achieve variable selection and model parsimony. A training dataset will be constructed with the original system dynamics model and hyper-parameters will be carefully chosen to provide fast and accurate approximations of the original model. Finally, the accuracy of the trained metamodels will be assessed, in particular by comparing the system dynamics outputs when the original model is replaced by its metamodel. The metamodel allows an overall relative error of 4.71% but reducing the computational load by a speed-up factor higher than 45, while correctly reproducing the complex behaviour occurring during Salmonella infection. These results provide a proof-of-concept of the potentiality of machine learning methods to give fast approximations of metabolic model outputs and pave the way towards PDE-based spatio-temporal models of microbial communities including microbial metabolism and host-microbiota-pathogen interactions.
Instabilitäten und Arthrose des Sternoklavikulargelenks
Authors: Plath Johannes E. , Martetschläger Frank , Moroder Philipp , Sandmann Gunther
Published: August 2023

Die Verletzung des Sternoklavikulargelenks (SCG) ist mit 3% der Schulterverletzungen und < 1% der Instabilitäten eine sehr seltene Verletzung. Folglich wird sowohl die Versorgung akuter Instabilitäten wie auch ihrer Folgezustände (chronische Instabilitäten/SCG-Arthrose) kontrovers diskutiert. Erfolgte bisher die Behandlung zumeist konservativ, so ist in den letzten Jahren eine Tendenz zur operativen Therapie zu erkennen. Durch erhebliche Gewalteinwirkung, wie sie bei Verkehrsunfällen oder Kontaktsportarten zu finden ist, kann es zur Zerreißung des an sich äußerst stabilen Bandapparates zwischen medialer Klavikula und Sternum kommen. Während die anteriore Luxation in den meisten Fällen leichter zu reponieren ist, verbleibt in bis zu 50% der Fälle eine Instabilität. Die posteriore Instabilität bedarf in den meisten Fällen – insbesondere auch aufgrund der anatomischen Nähe zu wichtigen kardiopulmonalen Strukturen – einer raschen Reposition. Sofern dies gelingt, ist die
Rate persistierender Instabilitäten gering. Für die chronischen Instabilitäten hat sich in den letzten Jahren die Rekonstruktion/Augmentation des Bandapparates mit Sehnengrafts in der „Figure-of-8-Konfiguration“ als Standardtechnik erwiesen. Für die Arthrose des SCG kommen OP-Techniken wie die Resektion des medialen Klavikulaendes dann in Betracht, wenn die konservative Therapie als gescheitert anzusehen ist.
Orthopädie und Unfallchirurgie 2023 – haben wir genug Nachwuchs?
Authors: Ruchholtz Steffen , Blätzinger Markus , Schädel-Höpfner Michael , Böcker Wolfgang , Kladny Bernd , Pennig Dietmar , Rudert Maximilian
Published: August 2023

Allgemein zeichnet sich für Deutschland ein zunehmender Ärztemangel ab. Im Rahmen der
vorliegenden Umfrage soll die aktuelle Situation für orthopädische und/oder
unfallchirurgische Kliniken (O und U) dargestellt werden.

Die Umfrage wurde vom 22.11. bis 5.12.2022 rein webbasiert über die Akademie für
Unfallchirurgie (AUC) und über den Verband der Leitenden Orthopäden und Unfallchirurgen
(VLOU) durchgeführt.

185 Kliniken haben den Onlinefragebogen beantwortet. Unter den Antwortenden befanden
sich ca. 20% Universitätskliniken und Maximalversorger sowie ein Drittel
Schwerpunktversorger bzw. Grund- und Regelversorger. Mehr als die Hälfte (55%) der
Abteilungen gibt im Median 2,7 unbesetzte Stellen an. Freie Oberarztstellen gibt es in 47%
der Abteilungen mit offenen Stellen, freie Facharztstellen in 33% und freie
Assistenzarztstellen in 89%. In den Universitätskliniken bzw. Maximalversorgern wurden im
Vergleich zu den anderen O- und U-Kliniken am wenigsten offene Stellen (31–41%) angegeben.
Bezüglich der Einschätzung der Chefärzte zur Bewerbersituation allgemein wurden durchweg
negative Angaben gemacht.

Mehr als die Hälfte der antwortenden Kliniken hatten unbesetzte Arztstellen. Um der
Entwicklung des zunehmenden Ärztemangels in O und U entgegenzuwirken, muss die generelle
Situation im Sinne einer Steigerung der klinisch tätigen Studienabgänger*innen und einer
Verbesserung der Arbeitsbedingungen für Ärztinnen und Ärzte optimiert werden. Gleichzeitig
sollten Abteilungen mit Studierendenausbildung ihre Aktivität mit Blick auf eine Steigerung
der Attraktivität des Faches O und U erhöhen.
Industry Payments and Academic Influence in Reconstructive Microsurgery
Authors: Sethi Ila , Mellia Joseph A. , Murphy Alexander I. , Diatta Fortunay , Asadourian Paul , Fischer John P. , Azoury Saïd C. , Bui Duc T.
Published: August 2023

Background Financial relationships between industry and microsurgeons help facilitate innovation but have the potential to bias a surgeon's academic work. To better understand industry–academic relationships, this study investigated the association between industry payments made to microsurgeons and their academic influence.

Methods A cross-sectional analysis of microsurgeons at Accreditation Council for Graduate Medical Education–accredited plastic surgery residency programs during the 2020–2021 academic year was performed. The Center for Medicare and Medicaid Services' Open Payments Database was used to collect industry payments (research and nonresearch related) to each surgeon. Academic influence was measured by Hirsch index (h-index) and number of publications. Mann–Whitney's U and Kruskal–Wallis' tests were used for statistical analysis.

Results Of the 199 microsurgeons identified, 156 (78.39%) received an industry nonresearch payment, but 0 (0.0%) received an industry research payment. Surgeons who received any amount of industry payments did not have a higher mean h-index or higher mean number of publications than surgeons with no industry payments. However, surgeons with total industry payments more than $10,000 (n = 15) had a higher number of publications than surgeons with no industry payments (135.47 vs. 36.02, p = 0.0074), $1 to $1,000 in payments (135.47 vs. 34.37, p = 0.0006), and $1,000 to $10,000 in payments (135.47 vs. 45.43, p = 0.0268). Surgeons with total industry payments more than $10,000 also had higher h-indices than surgeons with $1 to $1,000 in payments (24.4 vs. 10.34, p = 0.0039) and $1,000 to $10,000 in payments (24.4 vs. 11.34, p = 0.0413).

Conclusion Industry funding is associated with higher h-index and higher number of publications for high earners (> $10,000). Private companies may favor these surgeons for their academic expertise.
Definitions, phenomenology, diagnosis, and management of the disorders of laughter and crying in amyotrophic lateral sclerosis (ALS): Consensus from ALS and Motor Neuron Disease Scientific Department of the Brazilian Academy of Neurology
Authors: Gondim Francisco de Assis Aquino , Pinto Wladimir Bocca Vieira de Rezende , Chieia Marco Antônio Troccoli , Correia Carolina da Cunha , Cunha Francisco Marcos Bezerra , Dourado Jr Mário Emílio Teixeira , França Júnior Marcondes Cavalcante , Marques Júnior Wilson , Oliveira Acary Souza Bulle , Rodrigues Cleonisio Leite , Silva Delson José da , Dias-Tosta Elza
Published: August 2023

The spectrum of neuropsychiatric phenomena observed in amyotrophic lateral sclerosis (ALS) is wide and not fully understood. Disorders of laughter and crying stand among the most common manifestations. The aim of this study is to report the results of an educational consensus organized by the Brazilian Academy of Neurology to evaluate the definitions, phenomenology, diagnosis, and management of the disorders of laughter and crying in ALS patients. Twelve members of the Brazilian Academy of Neurology - considered to be experts in the field - were recruited to answer 12 questions about the subject. After exchanging revisions, a first draft was prepared. A face-to-face meeting was held in Fortaleza, Brazil on 9.23.22 to discuss it. The revised version was subsequently emailed to all members of the ALS Scientific Department from the Brazilian Academy of Neurology and the final revised version submitted for publication. The prevalence of pseudobulbar affect/pathological laughter and crying (PBA/PLC) in ALS patients from 15 combined studies and 3906 patients was 27.4% (N = 1070), ranging from 11.4% to 71%. Bulbar onset is a risk factor but there are limited studies evaluating the differences in prevalence among the different motor neuron diseases subtypes, including patients with and without frontotemporal dementia. Antidepressants and a combination of dextromethorphan and quinidine (not available in Brazil) are possible therapeutic options. This group of panelists acknowledge the multiple gaps in the current literature and reinforces the need for further studies.
Use of a Medication Safety Audit and Feedback Tool in the Emergency Department Is Affected by Prescribing Characteristics
Authors: Burningham Zach , Jackson George L. , Kelleher Jessica L. , Morris Isis , Stevens Melissa B. , Cohen Joy , Maloney Gerald , Sauer Brian C. , Halwani Ahmad S. , Chen Wei , Vaughan Camille P.
Published: August 2023

Background The Enhancing Quality of Prescribing Practices for Older Veterans Discharged from the Emergency Department (EQUIPPED) program developed an audit and feedback health information technology (IT) solution with the intent to replace the in-person academic detailing service provided by the program. The EQUIPPED dashboard provides emergency department (ED) providers with a personalized view of their prescribing performance.

Objectives Here, we analyze the association between ED provider characteristics and viewership of the EQUIPPED dashboard, adding insight into strategies for addressing barriers to initial use.

Methods We performed a retrospective analysis of EQUIPPED dashboard viewership among four Veterans Affairs (VA) EDs. We extracted quantitative data from user interaction logs to determine evidence of dashboard use. Provider characteristics and baseline potentially inappropriate medication (PIM) prescribing rate were extracted from the VA's Corporate Data Warehouse. Logistic regression was used to examine the association between dashboard use and provider characteristics.

Results A total of 82 providers were invited to receive audit and feedback via the EQUIPPED dashboard. Among invited providers, 40 (48.7%) had evidence of at least 1 dashboard view during the 1-year feedback period. Adjusted analyses suggest that providers with a higher baseline PIM prescribing rate were more likely to use the dashboard (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.01–1.47). Furthermore, providers at ED site D were more likely to use the dashboard in comparison to the other sites (OR: 9.99; 95% CI: 1.72–58.04) and reportedly had the highest site-level baseline PIM rate.

Conclusion Providers with lower PIM prescribing rates (i.e., <5%) receive communication from an integrated dashboard reminder system that they are “optimal prescribers” which may have discouraged initial attempts to view the dashboard. Site D had the highest baseline PIM rate, but further qualitative investigation is warranted to better understand why site D had the greatest users of the dashboard.
Development and Validation of SafeHIT: An Instrument to Assess the Self-Reported Safe Use of Health Information Technology
Authors: Salahuddin Lizawati , Ismail Zuraini , Abdul Rahim Fiza , Anawar Syarulnaziah , Hashim Ummi Rabaah
Published: August 2023

Background Implementing health information technology (HIT) may cause unintended consequences and safety risks when incorrectly designed and used. Yet, the tools to assess self-reported safe use of HIT are not well established.

Objective This study aims to develop and validate SafeHIT, an instrument to assess self-reported safe use of HIT among health care practitioners.

Methods Systematic literature review and a semistructured interview with 31 experts were adopted to generate SafeHIT instrument items. In total, 450 physicians from various departments at three Malaysian public hospitals participated in the questionnaire survey to validate SafeHIT. Exploratory factor analysis and confirmatory factor analysis (CFA) were undertaken to explore the items that best represent a specific construct and to confirm the reliability and validity of the SafeHIT, respectively.

Results The final SafeHIT consisted of 14 constructs and 58 items in total. The result of the CFA confirmed that all constructs demonstrated adequate convergent and discriminant validity.

Conclusion A reliable and valid theoretically underpinned measure of determinants of safe HIT use behavior has been developed. Understanding external factors that influence safe HIT use is useful for developing targeted interventions that favor the quality and safety of health care.
Thrust performance of the rocket-based combined-cycle engine under ejector mode
Authors: Yao Yizhi , Gu Rui , Sun Mingbo , Li Peibo , Huang Yuhui , An Bin , Wang Jiaoru , Li Menglei , Wang Taiyu , Chen Jikai
Published: August 2023

The Rocket-Based Combined-Cycle (RBCC) engine integrates the preponderance of ramjet and rocket engines. It can perform excellently at a lower Mach number than a ramjet while consuming less fuel than the rocket. The higher specific impulse under lower flight Mach conditions guarantees the competitiveness and application prospect of an RBCC engine for reusable space transportation and hypersonic cruise vehicles. With a wide range of Mach numbers, the flow choking between primary and secondary streams in the inner flow passage of the engine becomes complicated. The flow choking not only affects the mass flow ratio between the air stream and rocket plume but also determines the thrust performance of the engine. However, the relationship between flow-choking states and thrust performance has not been revealed. This investigation aimed to provide a better design reference for the RBCC trajectory design and a basis for the RBCC engine geometry design so that the thrust performance under different flow choking states was studied. The findings indicate that the engine is more favorable in the supersonic regime status than others. At the premise of the lower total pressure air stream condition, the thrust of the RBCC engine is attributed to the rocket pressurization effect. On the contrary, its thrust is ascribed to the air stream when the air stream total pressure is higher. Besides, the thrust augmentation of the RBCC engine is essentially due to the larger entrainment ratio. There is a rocket mass flow rate range in different mixer diameters, named region B in this paper, in which the air mass flow rate can be boosted with the rocket mass flow rate and the specific impulse ratio is higher than the rocket specific impulse. Significantly, the RBCC design state should be maintained in region B to meet the operational requirements of engines under the precondition of an insufficient flight Mach number.
Different estimation methods for the generalized unit half-logistic geometric distribution: Using ranked set sampling
Authors: Alsadat Najwan , Hassan Amal S. , Gemeay Ahmed M. , Chesneau Christophe , Elgarhy Mohammed
Published: August 2023

The generalized unit half-logistic geometric distribution (GUHLGD) is a modern two-parameter unit distribution with attractive shape flexibility for the corresponding probability density and hazard rate functions. Due to its versatility, it may be used to model a variety of current bounded real-world datasets. On the other hand, an effective sampling strategy for both parametric and non-parametric inferences is the ranked set sampling (RSS) method. This article focuses on estimating the parameters of the GUHLGD based on the RSS method as well as the simple random sampling (SRS) method. Eleven traditional estimation methods are taken into consideration, including the percentile, Cramér–von Mises, maximum likelihood, Anderson–Darling, right-tailed Anderson–Darling, left-tailed Anderson–Darling, least squares, weighted least squares, minimum spacing absolute-log distance, maximum product of spacing, and minimum spacing absolute distance methods. A Monte Carlo simulation is employed to compare the performance of the resultant estimates based on some accuracy measures. We draw the conclusion that, for both sampling procedures, the maximum likelihood estimation methodology is the best option among the rest based on the partial and total ranking measures. The estimates based on the RSS method are more efficient than the others based on the SRS method. Results from actual data further support the advantage of the RSS design over the SRS design.