bluuebunny/crossref_metadata_2025 huggingface dataset:
Benefits and harms of pregabalin in the management of neuropathic pain: a rapid review and meta-analysis of randomised clinical trials
Authors: Onakpoya Igho J , Thomas Elizabeth T , Lee Joseph J , Goldacre Ben , Heneghan Carl J
Published: January 2019

Objective

To assess the benefits and harms of pregabalin in the management of neuropathic pain.

Design

Rapid review and meta-analysis of phase III, randomised, placebo-controlled trials.

Participants

Adults aged 18 years and above with neuropathic pain defined according to the International Association for the Study of Pain criteria.

Interventions

Pregabalin or placebo.

Primary and secondary outcome measures

Our primary outcomes were pain (as measured using validated scales) and adverse events. Our secondary outcomes were sleep disturbance, quality of life, Patient Global Impression of Change, Clinician Global Impression scale, anxiety and depression scores, overall discontinuations and discontinuations because of adverse events.

Results

We included 28 trials comprising 6087 participants. The neuropathic pain conditions studied were diabetic peripheral neuropathy, postherpetic neuralgia, herpes zoster, sciatica (radicular pain), poststroke pain and spinal cord injury-related pain. Patients who took pregabalin reported significant reductions in pain (numerical rating scale (NRS)) compared with placebo (standardised mean difference (SMD) −0.49 (95% CI −0.66 to −0.32, p<0.00001), very low quality evidence). Pregabalin significantly reduced sleep interference scores (NRS) compared with placebo (SMD −0.38 (95% CI −0.50 to −0.26, p<0.00001), moderate quality evidence. Pregabalin significantly increased the risk of adverse events compared with placebo (RR 1.33 (95% CI 1.23 to 1.44, p<0.00001, low quality evidence)). The risks of experiencing weight gain, somnolence, dizziness, peripheral oedema, fatigue, visual disturbances, ataxia, non-peripheral oedema, vertigo and euphoria were significantly increased with pregabalin. Pregabalin was significantly more likely than placebo to lead to discontinuation of the drug because of adverse events (RR 1.91 (95% CI 1.54 to 2.37, p<0.00001), low quality evidence).

Conclusion

Pregabalin has beneficial effects on some symptoms of neuropathic pain. However, its use significantly increases the risk of a number of adverse events and discontinuation due to adverse events. The quality of the evidence from journal publications is low.
Fecundability among Danish women with a history of miscarriage: a prospective cohort study
Authors: Wildenschild Cathrine , Riis Anders H , Ehrenstein Vera , Hatch Elizabeth E , Wise Lauren A , Rothman Kenneth J , Sørensen Henrik T , Mikkelsen Ellen M
Published: January 2019

Objective

To examine the association between history of miscarriage and fecundability (the cycle-specific probability of conception).

Design

Nationwide prospective cohort study using web-based questionnaires.

Setting

Denmark, 2007–2012.

Participants

977 women attempting to conceive, not using fertility treatment, and with a reproductive history of only miscarriage or only live birth.

Exposure and outcome measures

Information on previous pregnancy outcomes, including miscarriage, came from self-report or from relevant registries. Participants were followed for up to 12 months or until they reported a pregnancy, stopped trying to conceive or started fertility treatment, whichever came first. We used Kaplan-Meier methods to estimate cumulative probabilities of conception for women whose reproductive history included only miscarriage or only live birth. Using proportional probabilities regression modelling, we computed fecundability ratios (FR) with 95% CI comparing women with a history of only miscarriage with women with a history of only live birth.

Results

After adjustment for potential confounders, the cumulative probabilities of conception within 12 cycles of follow-up were 85% (95% CI 81% to 89%) for women with a history of 1 miscarriage, 85% (95% CI 73% to 92%) for women with a history of ≥2 miscarriages and 88% (95% CI 87% to 89%) for women whose reproductive history included only live birth. Adjusted FRs were 0.87 (95% CI 0.71 to 1.07) and 0.65 (95% CI 0.36 to 1.17) for women with a history of 1 and ≥2 miscarriages, respectively.

Conclusions

Our results indicate that women with a history of miscarriage may have slightly reduced fecundability compared with women with a history of only live birth. The reduction in fecundability was greater for women with repeated miscarriages, although the estimates were imprecise. Despite a potential delay in conception, women with previous miscarriage may have similar probability of pregnancy by 12 cycles of attempts to women with proven fertility.
Regional citrate versus systemic heparin anticoagulation for continuous renal replacement therapy in critically ill patients with acute kidney injury (RICH) trial: study protocol for a multicentre, randomised controlled trial
Authors: Meersch Melanie , Küllmar Mira , Wempe Carola , Kindgen-Milles Detlef , Kluge Stefan , Slowinski Torsten , Marx Gernot , Gerss Joachim , Zarbock Alexander
Published: January 2019

Introduction

Acute kidney injury (AKI) is a well-recognised complication of critical illness which is of crucial importance for morbidity, mortality and health resource utilisation. Renal replacement therapy (RRT) inevitably entails an escalation of treatment complexity and increases costs for those patients with severe AKI. However, it is still not clear whether regional citrate anticoagulation or systemic heparin anticoagulation for continuous RRT (CRRT) is most appropriate. We hypothesise that, in contrast to systemic heparin anticoagulation, regional citrate anticoagulation for CRRT prolongs filter life span and improves overall survival in a 90-day follow-up period (coprimary endpoints).

Methods and analysis

We will conduct a prospective, randomised, multicentre, clinical trial including up to 1450 critically ill patients with AKI requiring CRRT. We suggest to investigate the effect of regional citrate anticoagulation for CRRT as compared with systemic heparin anticoagulation. The two coprimary outcomes are filter life span and overall survival in a 90-day follow-up period. Secondary outcomes are length of stay in the intensive care unit; length of hospitalisation; duration of CRRT; recovery of renal function at days 28, 60, 90 and 1 year; requirement for RRT after days 28, 60, 90 and 1 year; 28 days, 60 days, 90 days and 1-year all-cause mortality; major adverse kidney events at days 28, 60, 90 and 1 year; bleeding complications; transfusion requirements; infection rate and costs of RRT. Additionally, in an add-on study involving several of the participating centres, blood samples from recruited patients will be collected at different time points to analyse whether the anticoagulation strategy has an impact on immune response as evidenced by leucocyte recruitment and function.

Ethics and dissemination

The RICH trial has been approved by the Federal Institute for Drugs and Medical Devices, the leading Ethics Committee of the University of Münster and the corresponding Ethics Committee at each participating site.

Trial registration number

NCT02669589.
Adjuvant rituximab, a potential treatment for the young patient with Graves’ hyperthyroidism (RiGD): study protocol for a single-arm, single-stage, phase II trial
Authors: Cole Michael , Hynes Ann Marie , Howel Denise , Hall Lesley , Abinun Mario , Allahabadia Amit , Barrett Timothy , Boelaert Kristien , Drake Amanda J , Dimitri Paul , Kirk Jeremy , Zammitt Nicola , Pearce Simon , Cheetham Tim
Published: January 2019

Introduction

Graves’ disease (Graves’ hyperthyroidism) is a challenging condition for the young person and their family. The excess thyroid hormone generated by autoimmune stimulation of the thyroid stimulating hormone receptor on the thyroid gland can have a profound impact on well-being. Managing the young person with Graves’ hyperthyroidism is more difficult than in older people because the side effects of conventional treatment are more significant in this age group and because the disease tends not to resolve spontaneously in the short to medium term. New immunomodulatory agents are available and the anti-B cell monoclonal antibody rituximab is of particular interest because it targets cells that manufacture the antibodies that stimulate the thyroid gland in Graves’.

Methods and analysis

The trial aims to establish whether the combination of a single dose of rituximab (500 mg) and a 12-month course of antithyroid drug (usually carbimazole) can result in a meaningful increase in the proportion of patients in remission at 2 years, the primary endpoint. A single-stage, phase II A’Hern design is used. 27 patients aged 12–20 years with newly presenting Graves’ hyperthyroidism will be recruited. Markers of immune function, including lymphocyte numbers and antibody levels (total and specific), will be collected regularly throughout the trial.

Discussion

The trial will determine whether the immunomodulatory medication, rituximab, will facilitate remission above and beyond that observed with antithyroid drug alone. A meaningful increase in the expected proportion of young patients entering remission when managed according to the trial protocol will justify consideration of a phase III trial.

Ethics and dissemination The trial has received a favourable ethical opinion (North East - Tyne and Wear South Research Ethics Committee, reference 16/NE/0253, EudraCT number 2016-000209-35). The results of this trial will be distributed at international endocrine meetings, in the peer-reviewed literature and via patient support groups.

Trial registration number

ISRCTN20381716.
Developing an intervention to increase REferral and uptake TO pulmonary REhabilitation in primary care in patients with chronic obstructive pulmonary disease (the REsTORE study): mixed methods study protocol
Authors: Early Frances , Wilson Patricia , Deaton Christi , Wellwood Ian , Dickerson Terry , Ward James , Jongepier Lianne , Barlow Ruth , Singh Sally J , Benson John , Brimicombe James , Kim Lois , Haque Hena , Fuld Jonathan
Published: January 2019

Introduction

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease associated with breathlessness, inability to exercise, frequent infections, hospitalisation and reduced quality of life. Pulmonary rehabilitation (PR), providing supervised exercise and education, is an effective and cost-effective treatment for COPD but is significantly underused. Interventions to improve referral and uptake have been tested and some positive results reported. However, interventions are diverse and no clear recommendations for practice can be made. This study aims to understand the challenges to referral and uptake in primary care, where most referrals originate, and to develop a flexible toolkit of resources to support referral and uptake to PR in primary care in the UK.

Methods and analysis

This is a mixed methods study informed by normalisation process theory and burden of treatment theory. In the first phase, general practitioners, practice nurses and PR providers will be invited to complete an online survey to inform a broad exploration of the topic areas. In phase 2 interviews and focus groups will be conducted with patients, healthcare professionals (HCP) in primary care, PR providers and commissioners to gain an in-depth understanding of the issues and needs. Toolkit development in phase 3 will draw together the learning from phases 1 and 2 and employ an iterative development process to build the toolkit jointly with patients and HCPs. It will be tested in primary care for usability and acceptability.

Ethics and dissemination

The study has ethical and Health Research Authority approval (Research Ethics Committee reference number 17/EE/0136). It is registered with the International Standard Registered Clinical/Social Study Number (ISRCTN) registry (trial ID:ISRCTN20669629, assignment date 20 March 2018, trial start date 1 April 2016). Dissemination will be aimed at patients, carers/families, service providers, commissioners and national interest groups. Methods will include conferences, presentations, academic publications and plain English reports and will be supported by the British Lung Foundation.

Trial registration number

ISRCTN20669629; Pre-results.
Impact of palliative home care support on the quality and costs of care at the end of life: a population-level matched cohort study
Authors: Maetens Arno , Beernaert Kim , De Schreye Robrecht , Faes Kristof , Annemans Lieven , Pardon Koen , Deliens Luc , Cohen Joachim
Published: January 2019

Objectives

To evaluate the impact of palliative home care support on the quality of care and costs in the last 14 days of life.

Design

Matched cohort study using linked administrative databases.

Setting

All people who died in Belgium in 2012 (n=107 847).

Participants

8837 people who received palliative home care support in the last 720 to 15 days of life matched 1:1 by propensity score to 8837 people who received usual care.

Intervention

Receiving the allowance for palliative home patients, multidisciplinary palliative home care team visit or palliative nurse or physiotherapist visit at home.

Main outcome measures

Home death, number of family physician contacts, number of primary caregiver contacts, hospital death, hospital admission, intensive care unit (ICU) admission, emergency department (ED) admission, diagnostic testing, blood transfusion and surgery. Total inpatient and outpatient costs. All outcomes were measured in the last 14 days of life.

Results

In the unmatched cohort, 11 149 (13.5%) people received palliative home care support in the last 720 to 15 days of life. After matching, those using palliative home care support had, compared with those who did not, more family physician contacts (mean 3.1 [SD=6.5] vs 0.8 [SD=1.2]), more chance of home death (56.2%vs13.8%; relative risk [RR]=4.08, 95% CI 3.86 to 4.31), lower risk of hospital admission (27.4%vs60.8%; RR=0.45, 95% CI 0.43 to 0.46), ICU admission (18.3%vs40.4%; RR=0.45, 95% CI 0.43 to 0.48) or ED admission (15.2%vs28.1%; RR=0.54, 95% CI 0.51 to 0.57). Mean total costs of care were lower for those using palliative home care support (€3081 [95% CI €3025 to €3136] vs €4698 [95% CI €4610 to €4787]; incremental cost: −€1617 [p<0.001]).

Conclusions

Palliative home care support use positively impacts quality of care and reduces total costs of care at the end of life in Belgium. Policy makers and healthcare practitioners should increasingly focus on communicating the existing options for palliative home care support to patients and their caregivers.
Transgender persons’ HIV care (dis)engagement: a qualitative evidence synthesis protocol from an ecological systems theory perspective
Authors: Canoy Nico , Thapa Subash , Hannes Karin
Published: January 2019

Introduction

There seems to be little information on interactional patterns of enabling and constraining factors contributing to HIV care engagement across systems and across time. Understanding these patterns from a (micro–meso–macro–exo) systems perspective can provide rich insights on relevant social networks affecting transgender populations. In this review, we will synthesise the wealth of literature on transgender persons’ engagement in the HIV care continuum.

Methods and analysis

We will perform a networked systems approach to qualitative evidence synthesis of relevant qualitative research data generated from primary qualitative, mixed-method and evaluation studies exploring HIV care engagement among diverse transgender populations. Studies not using qualitative methods and studies not published in English will be excluded from this review. Empirical studies will be identified via a search in major databases such as PubMed, Scopus, ERIC, Embase, Web of Science, Sociological Abstracts, PsychInfo and Social Services Abstract in January 2019. Two reviewers will independently screen the studies for inclusion, assess their quality and extract data. In case some of the system levels in the network are ill-covered by empirical studies, non-empirical studies will be considered for inclusion. The qualitative evidence synthesis includes a summary of descriptive data (first order), an exploration of relationships between system levels or their components (second order) and a structured summary of research evidence through narrative synthesis. The narrative synthesis will be extended with an overall social network analysis that visualises important nodes and links cutting across ecological systems.

Ethics and dissemination

Ethical approval is not required to conduct this review. Review findings will be disseminated via peer-reviewed academic journals and a targeted information campaign towards organisations that work with our population of interest.

PROSPERO registration number

CRD42018089956.
The effect of ketorolac on posterior thoracolumbar spinal fusions: a prospective double-blinded randomised placebo-controlled trial protocol
Authors: Claus Chad F , Lytle Evan , Tong Doris , Sigler Diana , Lago Dominick , Bahoura Matthew , Dosanjh Amarpal , Lawless Michael , Slavnic Dejan , Kelkar Prashant , Houseman Clifford , Bono Peter , Richards Boyd , Soo Teck M
Published: January 2019

Introduction

Ketorolac has been shown to provide quality postoperative pain control and decrease opioid requirement with minimal side effects following spinal surgery. However, the literature addressing its use in spinal fusions is highly variable in both its effectiveness and complications, such as pseudarthrosis. Recent literature postulates that ketorolac may not affect fusion rates and large randomised controlled trials are needed to demonstrate ketorolac as a safe and effective adjuvant treatment to opioids for postoperative pain control.

Methods and analysis

This is a multihospital, prospective, double-blinded, randomised placebo-controlled trial. Data concerning fusion rates, postoperative opioid use, pain scores, length of stay will be recorded with the aim of demonstrating that the use of ketorolac does not decrease thoracolumbar spinal fusion rates while identifying possible adverse events related to short-term minimal effective dose compared with placebo. Additionally, this investigation aims to demonstrate a decrease in postoperative opioid use demonstrated by a decrease in morphine equivalence while showing equivalent postoperative pain control and decrease the average length of stay.

Ethics and dissemination

Ethical approval was obtained at all participating hospitals by the institutional review board. The results of this study will be submitted for publication in peer-reviewed journals.

Trial registration number

NCT03278691.
Two-peaked increase of serum myosin heavy chain-α after triathlon suggests heart muscle cell death
Authors: Danielsson Tom , Schreyer Hendrik , Woksepp Hanna , Johansson Therese , Bergman Patrick , Månsson Alf , Carlsson Jörg
Published: January 2019

Objective

It has been suggested that the mechanism behind cardiac troponin elevation after strenuous exercise is passage through a cell membrane with changed permeability rather than myocardial cell death. We hypothesised that an increase of cardiac specific myosin heavy chain-alpha (MHC-α; 224 kDa compared with cardiac troponin T’s (cTnT) 37 kDa) could hardly be explained by passage through a cell membrane.

Methods

Blood samples were collected from 56 athletes (15 female, age 42.5±9.7, range 24–70 years) before, directly after and on days 1–8 after an Ironman. Biomarkers (C reactive protein (CRP), cTnT, creatine kinase (CK), MHC-α, myoglobin (MG), creatinine (C) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were measured.

Results

The course of MHC-α concentration (µg/L) was 1.33±0.53 (before), 2.57±0.78 (directly after), 1.51±0.53 (day 1), 2.74±0.55 (day 4) and 1.83±0.76 (day 6). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ± 80 ng/L (12–440; reference<15), NT-proBNP 776±684 ng/L (92–4700; ref.<300), CK 68±55 µkat/L (5–280; ref.<1.9), MG 2088±2350 µg/L (130–17 000; ref.<72) and creatinine 100±20 µmol/L (74–161; ref.<100), CRP 49±23 mg/L (15–119; ref.<5).

Conclusion

MHC-α exhibited a two-peaked increase which could represent a first release from the cytosolic pool and later from cell necrosis. This is the first investigation of MHC-α plasma concentration after exercise.
Simple and powerful: a consultant and governance-led bereavement service
Authors: Grimes Caris E , Stringer Belinda , Roberts-Jones Linda
Published: January 2019

Background

Following bereavement, families can be left with unanswered questions or issues of concern. We piloted a bereavement service model which was consultant and governance-led with the aim to reduce complaints, reduce litigation, reduce coroners' inquests and support families.

Methods

Following the death of a patient, the next of kin was sent an invitation. Those that responded were offered a 1-hour appointment with a consultant, senior sister and a member of the governance team. Notes were taken to track themes and feedback sheets were introduced to gauge the usefulness of the service to families.

Results

Of 121 invitations sent out, 18 families (14.8%) used the service. Two families had already sought legal advice. Neither acted further. 44% said they would have made a complaint if the service had not been available. 78% stated that they had obtained closure.

Conclusion

A bereavement service model which is consultant and governance led may reduce complaints and reduce litigation.
Microbiota fermentation-NLRP3 axis shapes the impact of dietary fibres on intestinal inflammation
Authors: Singh Vishal , Yeoh Beng San , Walker Rachel E , Xiao Xia , Saha Piu , Golonka Rachel M , Cai Jingwei , Bretin Alexis Charles Andre , Cheng Xi , Liu Qing , Flythe Michael D , Chassaing Benoit , Shearer Gregory C , Patterson Andrew D , Gewirtz Andrew T , Vijay-Kumar Matam
Published: January 2019

Objective

Diets rich in fermentable fibres provide an array of health benefits; however, many patients with IBD report poor tolerance to fermentable fibre-rich foods. Intervention studies with dietary fibres in murine models of colonic inflammation have yielded conflicting results on whether fibres ameliorate or exacerbate IBD. Herein, we examined how replacing the insoluble fibre, cellulose, with the fermentable fibres, inulin or pectin, impacted murine colitis resulting from immune dysregulation via inhibition of interleukin (IL)-10 signalling and/or innate immune deficiency (Tlr5KO).

Design

Mice were fed with diet containing either cellulose, inulin or pectin and subjected to weekly injections of an IL-10 receptor (αIL-10R) neutralising antibody. Colitis development was examined by serological, biochemical, histological and immunological parameters.

Results

Inulin potentiated the severity of αIL10R-induced colitis, while pectin ameliorated the disease. Such exacerbation of colitis following inulin feeding was associated with enrichment of butyrate-producing bacteria and elevated levels of caecal butyrate. Blockade of butyrate production by either metronidazole or hops β-acids ameliorated colitis severity in inulin-fed mice, whereas augmenting caecal butyrate via tributyrin increased colitis severity in cellulose containing diet-fed mice. Elevated butyrate levels were associated with increased IL-1β activity, while inhibition of the NOD-like receptor protein 3 by genetic, pharmacologic or dietary means markedly reduced colitis.

Conclusion

These results not only support the notion that fermentable fibres have the potential to ameliorate colitis but also caution that, in some contexts, prebiotic fibres can lead to gut dysbiosis and surfeit colonic butyrate that might exacerbate IBD.
Neuroform Atlas Stent System for the treatment of intracranial aneurysm: primary results of the Atlas Humanitarian Device Exemption cohort
Authors: Jankowitz Brian T , Hanel Ricardo , Jadhav Ashutosh P , Loy David N , Frei Donald , Siddiqui Adnan H , Puri Ajit S , Khaldi Ahmad , Turk Aquilla S , Malek Adel M , Sauvageau Eric , Hetts Steven W , Zaidat Osama O
Published: January 2019

Background and objective

Stent-assisted coil embolization is a well-established treatment of intracranial wide-necked aneurysms. The Neuroform Atlas Stent System is a new generation microstent designed to enhance coil support, conformability, deliverability, and improve deployment accuracy. We present the 1-year efficacy and angiographic results of the Humanitarian Device Exemption (HDE) cohort from the Atlas Investigational Device Exemption (IDE) clinical trial.

Method

The Atlas IDE trial is a prospective, multicenter, single-arm, open-label study of unruptured wide-necked intracranial aneurysms treated with the Neuroform Atlas stent and approved coils. The primary efficacy endpoint was the rate of 12-month complete aneurysm angiographic occlusion (Raymond class I) without target aneurysm retreatment or significant parent artery stenosis (>50%) at the target location. The primary safety endpoint was the rate of major ipsilateral stroke or neurological death within 12 months. Imaging core laboratory and Clinical EventsCommittee adjudicated the primary endpoints.

Results

30 patients were enrolled at eight US centers, with 27 patients completing the 12-month angiographic follow-up. The mean age was 59.4±11.8 years and 24/30 patients (80%) were women. The mean aneurysm size was 5.3±1.7 mm and the dome:neck ratio was 1.1±0.2. Procedural technical success of Neuroform Atlas Stent deployment was 100%. 27 patients completed 12-month angiographic follow-up and 30 patients completed their 6-month follow-up. When applying the last observation carried forward method, the primary efficacy endpoint was observed in 26/30 patients (86.7%, 95% CI 69.3% to 96.2%) compared with 25/27 patients (92.6%, 95% CI 75.7% to 99.1%) who completed the 12-month angiographic follow-up. The primary safety endpoint of stroke occurred in one patient (3.3%), who made a complete clinical recovery at discharge. There were no neurological deaths.

Conclusion

The Neuroform Atlas stent in conjunction with coils demonstrated a high rate of complete aneurysm occlusion at 12-month angiographic follow-up, with an improved safety profile in the HDE cohort.

Clinical trial.gov registration number

NCT0234058;Results
Significance of simulated conventional images on dual energy CT after endovascular treatment for ischemic stroke
Authors: Ebashi Ryo , Ogata Atsushi , Nishihara Masashi , Inoue Kohei , Yoshioka Fumitaka , Takase Yukinori , Masuoka Jun , Yakushiji Yusuke , Irie Hiroyuki , Hara Hideo , Abe Tatsuya
Published: January 2019

Background and purpose

CT scans often reveal post-interventional cerebral hyperdensities (PCHDs) immediately after intra-arterial thrombectomy (IAT) for ischemic stroke. Dual energy CT (DE-CT) can indicate whether PCHDs are caused by hemorrhage or iodinated contrast. Hyperdense lesions, detected on DE-CT with the use of iodinated contrast, could be associated with delayed hemorrhagic transformation and poor outcome. However, the quantitative indicators in DE-CT for predicting delayed hemorrhagic transformation remain unclear. We assessed such indicators for predicting delayed hemorrhagic transformation.

Material and methods

We retrospectively analyzed 52 consecutive acute ischemic stroke patients who underwent IAT. Simulated conventional CT (sCCT) images were obtained immediately after a DE-CT scan. Virtual, unenhanced, non-contrast (VNC) imaging was performed after reconstruction. Hounsfield units (HU) of the infarct areas observed on the sCCT were measured. The association of HU on sCCT with hemorrhage on VNC and delayed parenchymal hemorrhage (PH) was evaluated.

Results

The HU of sCCT with hemorrhage on VNC was significantly higher than without it (377.9±385 HU vs 83.5±37.9 HU; P<0.0001). The cut-off index was 80 HU, which displayed 100% sensitivity, 63.8% specificity, 22.3% positive predictive value, and 100% negative predictive value (P=0.0001, area under the curve (AUC)=0.89). The HU with delayed PH was substantially higher than without it (250.8±382.2 HU vs 93.7±64.8 HU; P=0.01). The cut-off index was 78 HU, which showed 100% sensitivity, 61% specificity, 25% positive predictive value, and 100% negative predictive value (P=0.049, AUC=0.76).

Conclusion

sCCT images on DE-CT are useful for excluding intracerebral hemorrhage and delayed PH.
Statistical ranking of electromechanical dyssynchrony parameters for CRT
Authors: Cazeau Serge , Toulemont Matthieu , Ritter Philippe , Reygner Julien
Published: January 2019

Objective

Mechanical evaluation of dyssynchrony by echocardiography has not replaced ECG in routine cardiac resynchronisation therapy (CRT) evaluation because of its complexity and lack of reproducibility. The objective of this study was to evaluate the potential correlations between electromechanical parameters (atrioventricular, interventricular and intraventricular from the dyssynchrony model presented in 2000), their ability to describe dyssynchrony and their potential use in resynchrony.

Methods

455 sets of the 18 parameters of the model obtained in 91 patients submitted to various pacing configurations were evaluated two by two using a Pearson correlation test and then by groups according to their ability to describe dyssynchrony, using the Column selection method of machine learning.

Results

The best parameter is duration of septal contraction, which alone describes 25% of dyssynchrony. The best groups of 3, 4 and ≥8 variables describe 59%, 73% and almost 100% of dyssynchrony, respectively. Left pre-ejection interval is highly and significantly correlated to a maximum of other variables, and its decrease is associated with the favourable evolution of all other correlated parameters. Increase in filling duration and decrease in duration of septum to lateral wall contraction difference are not associated with the favourable evolution of other parameters.

Conclusions

No single electromechanical parameter alone can fully describe dyssynchrony. The 18-parameter model can be simplified, but still requires at least 4–8 parameters. Decrease in left pre-ejection interval favourably drives resynchrony in a maximum of other parameters. Increase in filling duration and decrease in septum–lateral wall difference do not appear to be good CRT targets.
Reducing the number of unnecessary routine laboratory tests through education of internal medicine residents
Authors: Faisal Annum , Andres Kayla , Rind Jubran Afzal Khan , Das Aparna , Alter David , Subramanian Jeevarathna , Koehler Tracy J , Parker Jessica , Bernicchi Nathan
Published: January 2019

Introduction

The Choosing Wisely guidelines advise against ordering routine blood tests for hospitalised patients unless they change management. Unnecessary testing can lead to adverse effects (eg, iatrogenic anaemia, poor sleep quality, risk for infections and increased cost of care).

Methods

An 8-week quality initiative aimed at reducing unnecessary blood tests was implemented in three internal medicine resident inpatient services. The initiative included a 30 min educational session, reminders prior to rotation and midrotation and posters in work areas that displayed lab pricing and urged judicious testing. Residents were encouraged to justify the purpose of ordering tests in their daily progress notes. Attending physicians were made aware of the initiative. Preintervention and postintervention time points were used to compare key metrics. A >10% decrease between time periods was used as an evaluation criterion.

Results

There were 293 patient records reviewed in the preintervention period and 419 in the postintervention period. The two groups were similar in terms of age and gender. Median blood test count (complete blood count/basic metabolic profile/comprehensive metabolic profile) decreased from 4 to 2 tests per patient per day (50 % decrease) after the intervention. The median length of hospital stay decreased from 4.9 to 3.9 days (21% decrease). A decreased percentage of people requiring transfusions was also noted (2016: 6.1%, 2017: 2.9%).

Conclusion

The frequency of unnecessary routine blood tests ordered in the hospital can be decreased by educating resident physicians, making them cost conscious and aware of the indications for ordering routine labs. Frequent reminders are needed to sustain the educational benefit.
Enhanced Data Covariance Estimation Using Weighted Combination of Multiple Gaussian Kernels for Improved M/EEG Source Localization
Authors: Martinez-Vargas J. D. , Duque-Muñoz L. , Vargas-Bonilla F. , Lopez J. D. , Castellanos-Dominguez G.
Published: January 2019

In the recent past, estimating brain activity with magneto/electroencephalography (M/EEG) has been increasingly employed as a noninvasive technique for understanding the brain functions and neural dynamics. However, one of the main open problems when dealing with M/EEG data is its non-Gaussian and nonstationary structure. In this paper, we introduce a methodology for enhancing the data covariance estimation using a weighted combination of multiple Gaussian kernels, termed WM-MK, that relies on the Kullback–Leibler divergence for associating each kernel weight to its relevance. From the obtained results of validation on nonstationary and non-Gaussian brain activity (simulated and real-world EEG data), WM-MK proves that the accuracy of the source estimation raises by more effectively exploiting the measured nonlinear structures with high time and space complexity.
Wave packet broadening through different semiconducting mediums: A meshless multi-quadric radial base function study
Authors: Ghorbani Mehrzad , Solaimani M.
Published: January 2019

In this paper, we have studied the effect of conduction band nonparabolicity on wave packet broadening in different semiconducting mediums. Here, through a fourth derivative of the wavefunction, we have included the nonparabolicity effect into the one-dimensional Schrödinger equation. We have solved this equation by means of a meshless radial base function approach. We have compared five different semiconducting mediums GaAs, GaN, AlN, InSb and GaSb and showed that the wave packet broadens slower in systems with larger effective masses and smaller nonparabolicity parameters. Thus, we can manage and control the dispersion of a Gaussian wave packet utilizing the nonparabolicity and effective mass parameters.
Interacting dark side of universe through generalized uncertainty principle
Authors: Rashki M. , Fathi M. , Mostaghel B. , Jalalzadeh S.
Published: January 2019

We investigate the impact of the generalized uncertainty principle proposed by some approaches to quantum gravity such as string theory and doubly special relativity on the cosmology. Using generalized Poisson brackets, we obtain the modified Friedmann and Raychaudhuri equations and suggest a dynamical dark energy to explain the late-time acceleration of the universe. After considering the interaction between dark matter and dark energy, originated from the minimal length, we obtain the effective cosmological parameters and equation of state parameter for dark matter and dark energy. Finally, we show that the resulting model is equivalent to the Phantom and Tachyon fields.
Dark matter effect attributed to the inherent structure of cosmic space
Authors: Tenev T. G. , Horstemeyer M. F.
Published: January 2019

We propose that anomalous gravitational effects currently attributed to dark matter can alternatively be explained as a manifestation of the inherent structure of space at galactic length scales. Specifically, we show that the inherent curvature of space amplifies the gravity of ordinary matter such that the effect resembles the presence of the hypothetical hidden mass. Our study is conducted in the context of weak gravity, nearly static conditions, and spherically symmetric configuration, and leverages the Cosmic Fabric model of space developed by Tenev and Horstemeyer [T. G. Tenev and M. F. Horstemeyer, Int. J. Mod. Phys. D 27 (2018) 1850083; T. G. Tenev and M. F. Horstemeyer, Rep. Adv. Phys. Sci. 2 (2018) 1850011, arXiv:1808.08804].
Cosmic acceleration from coupling of baryonic and dark matter components: Analysis and diagnostics
Authors: Agarwal Abhineet , Myrzakulov R. , Pacif S. K. J. , Shahalam M.
Published: January 2019

In this paper, we examine a scenario in which late-time cosmic acceleration might arise due to the coupling between baryonic matter and dark matter without the presence of extra degrees of freedom. In this case, one can obtain late-time acceleration in Jordan frame and not in Einstein frame. We consider two different forms of parametrization of the coupling function, and put constraints on the model parameters by using an integrated dataset of Hubble parameter, Type Ia supernova and baryon acoustic oscillations. The models under consideration are consistent with the observations. In addition, we perform the statefinder and [Formula: see text] diagnostics, and show that the models exhibit a distinctive behavior due to the phantom characteristic in future which is a generic feature of the underlying scenario.
SMALL-TIME ASYMPTOTICS IN GEOMETRIC ASIAN OPTIONS FOR A STOCHASTIC VOLATILITY JUMP-DIFFUSION MODEL
Authors: JAFARI HOSSEIN , RAHIMI GHAZALEH
Published: January 2019

The aim of this paper is to study the small time to maturity of the behavior of the geometric Asian option price and implied volatility under a general stochastic volatility model with Lévy process. The volatility process does not need to be a diffusion or a Markov process, but the future average volatility in the model is a nonadapted process. An anticipating Itô formula for Lévy process and the decomposition of the price (Hull–White formula) are obtained using the Malliavin calculus techniques. The decomposition formula is applied to find the small-time limit of the geometric Asian option price and the implied volatility for the model in at-the-money and out-of-the-money cases.
Typical long-time behavior of ground state-transformed jump processes
Authors: Kaleta Kamil , Lőrinczi József
Published: January 2019

We consider a class of Lévy-type processes derived via a Doob transform from Lévy processes conditioned by a control function called potential. These ground state transformed processes (also called [Formula: see text]-processes) have position-dependent and generally unbounded components, with stationary distributions given by the ground states of the Lévy generators perturbed by the potential. We derive precise upper envelopes for the almost sure long-time behavior of these ground state-transformed Lévy processes, characterized through escape rates and integral tests. We also highlight the role of the parameters by specific examples.
Algebraically hyperbolic manifolds have finite automorphism groups
Authors: Bogomolov Fedor A. , Kamenova Ljudmila , Verbitsky Misha
Published: January 2019

A projective manifold [Formula: see text] is algebraically hyperbolic if there exists a positive constant [Formula: see text] such that the degree of any curve of genus [Formula: see text] on [Formula: see text] is bounded from above by [Formula: see text]. A classical result is that Kobayashi hyperbolicity implies algebraic hyperbolicity. It is known that Kobayashi hyperbolic manifolds have finite automorphism groups. Here, we prove that, more generally, algebraically hyperbolic projective manifolds have finite automorphism groups.
On a class of generalized Monge–Ampère type equations
Authors: Qiu Weifeng , Tang Lan
Published: January 2019

In this paper, we consider generalized solutions to the Dirichlet problem for a class of generalized Monge–Ampère equations. For such generalized solutions, we give a complete proof for the so-called comparison principle.
Standing waves for weakly coupled nonlinear Schrödinger systems
Authors: Goulart Claudiney , Silva Elves A. B.
Published: January 2019

This paper is concerned with the application of variational methods in the study of positive solutions for a system of weakly coupled nonlinear Schrödinger equations in the Euclidian space. The results on multiplicity of positive solutions are established under the hypothesis that the coupling is either sublinear or superlinear with respect to one of the variables. Conditions for the existence or nonexistence of a positive least energy solution are also considered.
Lp Neumann problem for some Schrödinger equations in (semi-)convex domains
Authors: Yang Sibei , Yang Dachun
Published: January 2019

Let [Formula: see text], [Formula: see text] be a bounded (semi-)convex domain in [Formula: see text] and the non-negative potential [Formula: see text] belong to the reverse Hölder class [Formula: see text]. Assume that [Formula: see text] and [Formula: see text], where [Formula: see text] denotes the Muckenhoupt weight class on [Formula: see text], the boundary of [Formula: see text]. In this paper, the authors show that, for any [Formula: see text], the Neumann problem for the Schrödinger equation [Formula: see text] in [Formula: see text] with boundary data in (weighted) [Formula: see text] is uniquely solvable. The obtained results in this paper essentially improve the known results which are special cases of the results obtained by Shen [Indiana Univ. Math. J. 43 (1994) 143–176] and Tao and Wang [Canad. J. Math. 56 (2004) 655–672], via extending the range [Formula: see text] of [Formula: see text] into [Formula: see text].
Uncertainty Analysis of Excitation Conditions on Performance of Nonlinear Monostable Energy Harvesters
Authors: Li Yi , Zhou Shengxi , Litak Grzegorz
Published: January 2019

Nonlinear energy harvesters were found to be sensitive to excitation conditions. In order to reveal the influence mechanism of the excitation condition on the energy harvesting performance, this paper presents an uncertainty analysis for nonlinear monostable energy harvesters (NMEHs). An improved interval extension based on the second-order Taylor’s series is presented as a new uncertainty analysis method. A mathematic example is used to demonstrate that the bounds of responses based on this method are more accurate than the classic interval extension when the dependence of the response on the uncertain variable is nonlinear. Meanwhile, the results from the Monte Carlo simulation are used to verify the accuracy of the proposed method. It is confirmed that the proposed method is suitable for quantifying the propagation of the uncertain level and frequency of the excitation for the NMEH. The results show that the output voltage of the NMEH is more sensitive to the frequency than the level of excitation, for which the influence mechanism is revealed.
A New Family of Explicit Model-Based Integration Algorithms for Structural Dynamic Analysis
Authors: Fu Bo , Feng De-Cheng , Jiang Huanjun
Published: January 2019

A new family of explicit model-based integration algorithms for solving the equations of motion for linear and nonlinear systems is developed. These algorithms are also known as structure-dependent algorithms because the integration parameters are functions of the complete model of the structural system. A variety of numerical properties of the proposed algorithms, including consistency and local truncation error, stability, numerical dispersion and energy dissipation, overshooting, and frequency response under arbitrary excitation, are investigated using the discrete control theory and amplification matrix for linear elastic systems. In addition, the discrete control theory is applied for assessing the stability of the proposed algorithms for nonlinear structural systems. It is observed that the proposed algorithms exhibit the same numerical characteristics as the well-known Newmark family of integration algorithms. Compared with three existing model-based integration algorithms, i.e. the Chen–Ricles, modified Chen–Ricles, and Gui’s algorithms, the proposed algorithms possess more general and versatile numerical features. As a result, the new family of explicit model-based integration algorithms can be potentially used to solve complicated linear and nonlinear structural dynamics problems.
Extremal rays of Betti cones
Authors: Ananthnarayan H. , Kumar Rajiv
Published: January 2019

We study the Betti cone of modules of a standard graded algebra over a field, and find a class of modules whose Betti diagrams span extremal rays of the Betti cone. We also identify a class of one-dimensional Cohen–Macaulay rings with certain Hilbert series, for which the Betti cone is spanned by these extremal rays. These results lead to an algorithm for the decomposition of Betti table of modules, into the extremal rays, over such rings, and also help to obtain bounds for the multiplicity of the given module.
The global dimension of the algebras of polynomial integro-differential operators 𝕀n and the Jacobian algebras 𝔸n
Authors: Bavula V. V.
Published: January 2019

The aim of the paper is to prove two conjectures from the paper [V. V. Bavula, The algebra of integro-differential operators on a polynomial algebra, J. London Math. Soc. (2) 83 (2011) 517–543, arXiv:math.RA/0912.0723] that the (left and right) global dimension of the algebra [Formula: see text] of polynomial integro-differential operators and the Jacobian algebra [Formula: see text] is equal to [Formula: see text] (over a field of characteristic zero). The algebras [Formula: see text] and [Formula: see text] are neither left nor right Noetherian and [Formula: see text]. Furthermore, they contain infinite direct sums of nonzero left/right ideals and are not domains. An analogue of Hilbert’s Syzygy Theorem is proven for the algebras [Formula: see text], [Formula: see text] and their factor algebras. It is proven that the global dimension of all prime factor algebras of the algebras [Formula: see text] and [Formula: see text] is [Formula: see text] and the weak global dimension of all the factor algebras of [Formula: see text] and [Formula: see text] is [Formula: see text].
Data Analytics: Intelligent Anti-Phishing Techniques Based on Machine Learning
Authors: Baadel Said , Lu Joan
Published: January 2019

According to the international body Anti-Phishing Work Group (APWG), phishing activities have skyrocketed in the last few years and more online users are becoming susceptible to phishing attacks and scams. While many online users are vulnerable and naive to the phishing attacks, playing catch-up to the phishers’ evolving strategies is not an option. Machine Learning techniques play a significant role in developing effective anti-phishing models. This paper looks at phishing as a classification problem and outlines some of the recent intelligent machine learning techniques (associative classifications, dynamic self-structuring neural network, dynamic rule-induction, etc.) in the literature that is used as anti-phishing models. The purpose of this review is to serve researchers, organisations’ managers, computer security experts, lecturers, and students who are interested in understanding phishing and its corresponding intelligent solutions. This will equip individuals with knowledge and skills that may prevent phishing on a wider context within the community.