bluuebunny/crossref_metadata_2025 huggingface dataset:
Working with lay midwives to improve the detection of neonatal complications in rural Guatemala
Authors: Juarez Michel , Juarez Yolanda , Coyote Enma , Nguyen Tony , Shaw Corey , Hall-Clifford Rachel , Clifford Gari , Rohloff Peter
Published: January 2020

Background

Globally most neonatal deaths occur within the first week of life and in low-income and middle-income countries. Strengthening health system linkages for frontline providers—such as lay midwives providing home-based obstetrical care—may improve neonatal outcomes in these settings. Here, we conducted a quality improvement study to increase the detection of neonatal complications by lay midwives in rural Guatemala, thereby increasing referrals to a higher level of care.

Methods

A quality improvement team in Guatemala reviewed drivers of neonatal health services provided by lay midwives. Improvement interventions included training on neonatal warning signs, optimised mobile health technology to standardise assessments and financial incentives for providers. The primary quality outcome was the rate of neonatal referral to a higher level of care.

Results

From September 2017 to September 2018, participating midwives attended 869 home deliveries and referred 80 neonates to a higher level of care. A proportion control chart, using the preintervention period from January to September 2017 as the baseline, showed an increase in the referral rate of all births from 1.5% to 9.9%. Special cause was obtained in January 2018 and sustained except for May 2018. The proportion of neonates receiving assessments by midwives in the first week of life increased to >90%. A trend toward an increasing number of days between neonatal deaths did not attain special cause.

Conclusions

Structured improvement interventions, including mobile health decision support and financial incentives, significantly increased the detection of neonatal complications and referral of neonates to higher levels of care by lay midwives operating in rural home-based settings in Guatemala. The results show the value of improving the integration of lay midwives and other first responders into neonatal systems of care in low-resource settings.
Acceptability of a ‘treat to target’ approach in inflammatory bowel disease to patients in clinical remission
Authors: Selinger Christian , Carbonell Jenelyn , Kane John , Omer Mandour , Ford Alexander Charles
Published: January 2020

Background

A ‘treat to target’ approach aiming for remission of clinical symptoms and absence of mucosal inflammation has been proposed in inflammatory bowel disease (IBD). We aimed to establish whether patients with IBD in clinical remission find this approach acceptable.

Methods

Patients in glucocorticosteroid-free clinical remission underwent a face-to-face structured, quantitative interview and rated the acceptability of treat to target on a 10-point Likert scale. We analysed factors associated with agreement to treat to target.

Results

The cohort comprised 298 patients (144 Crohn’s disease, 136 ulcerative colitis, 18 IBD-unclassified). Elevated C-reactive protein was found in 24.4% and elevated faecal calprotectin in 17.7%. Overall, 66.2% of patients rated a treat to target approach as acceptable (Likert scale ≥8). Acceptable treatment aims for patients were avoidance of flare, hospitalisation, surgery and colorectal cancer. Using binary logistic regression analysis the following were not predictive of accepting a treat to target approach: age, diagnosis, disease phenotype, surgical history, disease duration, patient knowledge, adherence, anxiety, depression and patient-reported control of disease. Better adherence to current therapy was associated with accepting a treat to target approach (B=0.16, p=0.039).

Conclusion

In a cohort of patients in clinical remission, where this strategy is most relevant, two-thirds of patients agreed with treat to target. Patients with better current adherence were more likely to accept treat to target. Patient education and counselling materials will need to be developed to convince a substantial minority of patients of the importance of treat to target.
Regulatory T-cell therapy in Crohn’s disease: challenges and advances
Authors: Clough Jennie N , Omer Omer S , Tasker Scott , Lord Graham M , Irving Peter M
Published: January 2020

The prevalence of IBD is rising in the Western world. Despite an increasing repertoire of therapeutic targets, a significant proportion of patients suffer chronic morbidity. Studies in mice and humans have highlighted the critical role of regulatory T cells in immune homeostasis, with defects in number and suppressive function of regulatory T cells seen in patients with Crohn’s disease. We review the function of regulatory T cells and the pathways by which they exert immune tolerance in the intestinal mucosa. We explore the principles and challenges of manufacturing a cell therapy, and discuss clinical trial evidence to date for their safety and efficacy in human disease, with particular focus on the development of a regulatory T-cell therapy for Crohn’s disease.
Pericardial diseases in patients with cancer: contemporary prevalence, management and outcomes
Authors: Imazio Massimo , Colopi Marzia , De Ferrari Gaetano Maria
Published: January 2020

Neoplastic pericardial effusion is a common and serious manifestation of advanced malignancies. Lung and breast carcinoma, haematological malignancies, and gastrointestinal cancer are the most common types of cancer involving the pericardium. Pericardial involvement in neoplasia may arise from several different pathophysiological mechanisms and may be manifested by pericardial effusion with or without tamponade, effusive-constrictive pericarditis and constrictive pericarditis. Management of these patients is a complex multidisciplinary problem, affected by clinical status and prognosis of patients.
Prediction of emergency cesarean section by measurable maternal and fetal characteristics
Authors: Guan Ping , Tang Fei , Sun Guoqiang , Ren Wei
Published: January 2020

Objective

To analyze the maternal and fetal factors affecting emergency cesarean section (EmCS) and establish a risk scoring system to quantitatively predict the risk of EmCS.

Design

A total of 10,295 pregnant women were enrolled in this study. The influence of maternal and fetal factors on the risk of EmCS was analyzed.

Results

991 (9.63%) cases of failed vaginal delivery received EmCS. The two main causes of EmCS were fetal distress (67.21%) and abnormal fetal position (14.93%). There were significant differences in 17 maternal and fetal factors between the normal vaginal delivery (NVD) and EmCS groups (p<0.05 for all). Univariate and multivariate regression analyses showed that nine maternal and infant factors were independent risk factors (p<0.05 for all). The major factors were abnormal quantity of amniotic fluid (OR 6.867, 95% CI 4.442 to 10.618), nulliparous (OR 4.336, 95% CI 3.074 to 6.115), induction of labor (OR 5.300, 95% CI 4.514 to 6.224) and abnormal characters of amniotic fluid (OR 3.126, 95% CI 2.708 to 3.608). A risk scoring system (six grades) was established based on those factors which showed high discriminative power. The rate of EmCS was 1.30%, 2.57%, 5.83%, 13.94%, 21.75% and 39.71% in grades 1, 2, 3, 4, 5 and 6, respectively. The area under the curve of the risk scoring system was 0.787, indicating that the regression model of the risk factors had a good predictive ability.

Conclusion

An effective risk scoring system has been developed to quantitatively assess the risk of EmCS based on measurable maternal and fetal factors. The system is simple, easy to operate and has good repeatability in clinical practice.
Cancer patients’ views and understanding of genome sequencing: a qualitative study
Authors: Bartley Nicci , Best Megan , Jacobs Chris , Juraskova Ilona , Newson Ainsley J , Savard Jacqueline , Meiser Bettina , Ballinger Mandy L , Thomas David M , Biesecker Barbara , Butow Phyllis
Published: January 2020

Background

Little is known about knowledge of, and attitudes towards, genome sequencing (GS) among individuals with a personal history of cancer who decide to undergo GS. This qualitative study aimed to investigate baseline knowledge and attitudes among individuals previously diagnosed with a cancer of likely genetic origin who have consented to GS.

Methods

Semistructured interviews were conducted with purposively selected participants (n=20) from the longitudinal Psychosocial Issues in Genomic Oncology study, within a month of consenting to GS and prior to receiving any results. Participants were adults with a cancer of likely genetic aetiology who are undertaking GS as part of a larger genetic study.

Results

Analysis identified three main themes: limited understanding of genomics; multifactorial motivation; and complex decision making. While motivations such as obtaining health information about self and family appear to be the main drivers for undertaking GS, these motivations are sometimes based on limited knowledge of the accuracy and utility of GS, creating unrealistic expectations. This in turn can prolong the deliberation process and lead to ongoing decisional conflict.

Conclusion

Understanding the degree and nature of patient understanding of GS, as well as their attitudes and decision-making processes, will enable healthcare professionals to better manage patient expectations and appropriately engage and support patients to make an informed decision when pursuing GS.
Targeting the centromedian thalamic nucleus for deep brain stimulation
Authors: Warren Aaron E L , Dalic Linda J , Thevathasan Wesley , Roten Annie , Bulluss Kristian J , Archer John
Published: January 2020

Objectives

Deep brain stimulation (DBS) of the centromedian thalamic nucleus (CM) is an emerging treatment for multiple brain diseases, including the drug-resistant epilepsy Lennox-Gastaut syndrome (LGS). We aimed to improve neurosurgical targeting of the CM by: (1) developing a structural MRI approach for CM visualisation, (2) identifying the CM’s neurophysiological characteristics using microelectrode recordings (MERs) and (3) mapping connectivity from CM-DBS sites using functional MRI (fMRI).

Methods

19 patients with LGS (mean age=28 years) underwent presurgical 3T MRI using magnetisation-prepared 2 rapid acquisition gradient-echoes (MP2RAGE) and fMRI sequences; 16 patients proceeded to bilateral CM-DBS implantation and intraoperative thalamic MERs. CM visualisation was achieved by highlighting intrathalamic borders on MP2RAGE using Sobel edge detection. Mixed-effects analysis compared two MER features (spike firing rate and background noise) between ventrolateral, CM and parafasicular nuclei. Resting-state fMRI connectivity was assessed using implanted CM-DBS electrode positions as regions of interest.

Results

The CM appeared as a hyperintense region bordering the comparatively hypointense pulvinar, mediodorsal and parafasicular nuclei. At the group level, reduced spike firing and background noise distinguished CM from the ventrolateral nucleus; however, these trends were not found in 20%–25% of individual MER trajectories. Areas of fMRI connectivity included basal ganglia, brainstem, cerebellum, sensorimotor/premotor and limbic cortex.

Conclusions

In the largest clinical trial of DBS undertaken in patients with LGS to date, we show that accurate targeting of the CM is achievable using 3T MP2RAGE MRI. Intraoperative MERs may provide additional localising features in some cases; however, their utility is limited by interpatient variability. Therapeutic effects of CM-DBS may be mediated via connectivity with brain networks that support diverse arousal, cognitive and sensorimotor processes.
Emergency preparedness, resilience and response to a biological outbreak
Authors: Welby-Everard P , Quantick O , Green A
Published: January 2020

Major disease outbreaks continue to be a significant risk to public health, with pandemic influenza or an emerging infectious disease outbreak at the top of the UK National Risk Register. The risk of deliberate release of a biological agent is lower but remains possible and may only be recognised after casualties seek medical attention. In this context the emergency preparedness, resilience and response (EPRR) process protects the public from high consequence infectious diseases, other infectious disease outbreaks and biological agent release. The core elements of the EPRR response are recognition of an outbreak, isolation of patients, appropriate personal protective equipment for medical staff and actions to minimise further disease spread. The paper discusses how high-threat agents may be recognised by clinicians, the initial actions to be taken on presentation and how the public health system is notified and responds. It draws on the national pandemic influenza plans to describe the wider response to a major disease outbreak and discusses training requirements and the potential role of the military.
Psychosocial work stressors and risk of mortality in Australia: analysis of data from the Household, Income and Labour Dynamics in Australia survey
Authors: Taouk Yamna , LaMontagne Anthony D , Spittal Matthew J , Milner Allison
Published: January 2020

Objective

To examine the association between exposures to psychosocial work stressors and mortality in a nationally representative Australian working population sample.

Methods

18 000 participants from the Household, Income and Labour Dynamics in Australia survey with self-reported job demands, job control, job security and fair pay psychosocial work stressors exposures at baseline were followed for up to 15 waves. Cox proportional hazards regression models were used to examine the association between psychosocial work stressors and mortality. Models were serially adjusted for each subgroup of demographic, socioeconomic, health and behavioural risk factors.

Results

Low job control was associated with a 39% increase in the risk of all-cause mortality (HR 1.39; 95% CI 1.04 to 1.85), controlling for demographic, socioeconomic, health and behavioural factors. A decreased risk of mortality was observed for workers with exposure to high job demands (HR 0.76; 95% CI 0.60 to 0.96, adjusted for gender and calendar), but the risk was attenuated after serially adjusting for socioeconomic status, health (HR=0.84; 95% CI 0.65 to 1.08) and behavioural (HR=0.79; 95% CI 0.60 to 1.04) factors. There did not appear to be an association between exposure to job insecurity (HR 1.03; 95% CI 0.79 to 1.33) and mortality, or unfair pay and mortality (HR 1.04; 95% CI 0.80 to 1.34).

Conclusions

Low job control may be associated with an increased risk of all-cause mortality. Policy and practice interventions that reduce the adverse impact of low job control in stressful work environments could be considered to improve health and decrease risk of mortality.
Lane-based vehicular speed characteristics analysis for freeway work zones using aerial videos
Authors: Wang Zhongyu , He Wenya , Zhang Xi , Wang Yanli , Wu Bing , Wang Yinhai
Published: January 2020

Work zones which are usually referred to as traffic bottlenecks or critical points may lead to reductions in both operational performance and safety. Researchers have conducted extensive studies on speed characteristics in freeway work zones. However, most of these studies are based on simulation data or are travel direction-based rather than lane-based. By utilizing the video recording capability of drones, this paper aims to provide methodologies and the workflow in exploring the vehicular speed characteristics in freeway work zones with considerations for lane and location deviations. A four-to-three lane work zone on Huhang Expressway between Downtown Shanghai and Songjiang in China was selected for data collection. Then free flow speed variation pattern is analyzed, a speed prediction model is proposed, and the speed–flow relationship is investigated on each lane at nine virtual sections along the work zone. It is found that the merging area affects the speeds mainly in the segment from 200 m upstream of the taper to the start of the activity area, which is the most important risk area in the work zone, and the speed characteristics depend on vehicle types (trucks versus automobiles) as well as lane locations. It is also showed that drones are valuable and effective tools for data collection for vehicular speed characteristics analysis in freeway work zones and it is easy to extract the information needed.
Unique songbird communities in mature riparian spruce forest compared with upland forest in southern Yukon
Authors: Cooke Hilary A. , Tauzer Lila M.
Published: January 2020

There has been limited study of songbird communities in different habitats of the lowland boreal forests of southern Yukon, including the mature forest valued for timber harvest. Our goal was to describe the songbird community during the breeding season in a mature (≥80 years since wildfire) forest dominated by white spruce (Picea glauca (Moench) Voss) adjacent to streams (n = 23) and wetlands (n = 15) compared with a nearby upland forest. Based on point count surveys, songbird communities were unique in the mature forest in the riparian forest edge position, including greater species richness and four significant riparian indicator species. Songbird communities were also unique in the forest adjacent to streams versus wetlands. We mapped species observations along 300 m transects from riparian to upland forests and identified nine species with greater abundance closer to the riparian forest edge. Many of these species are typically associated with riparian and wetland habitats for breeding. Most of the variability in the songbird community was explained by study site, likely related to high variability in forest type and amount of wetland and open water but also to unmeasured habitat characteristics. Our results increase the knowledge of songbird communities in this unique boreal region and suggest that riparian reserve zones in forest management may be useful for protecting songbird habitat.
Search for proton emission of the isomeric $$\mathbf {10^+}$$ state in $$\mathbf {^{54}}$$Ni
Authors: Stahl K. , Wendt A. , Reiter P. , Rudolph D. , Blazhev A. , Bruyneel B. , Eberth J. , Fahlander C. , Fransen C. , Golubev P. , Hess H. , Hoischen R. , Holler A. , Kalkühler M. , Kotthaus T. , Lersch D. , Pascovici G. , Seidlitz M. , Siebeck B. , Taprogge J. , Warr N. , Wiens A. , Zell O.
Published: January 2020

Several experiments were conducted at the 10 MV Van-de-Graaff tandem accelerator at the Institute of Nuclear Physics, Cologne, to detect proton emission from the isomeric 6457-keV $$10^+$$10+ state in $$^{54}\hbox {Ni}$$54Ni. Excitation functions for two fusion–evaporation reactions were measured to maximise the population of the rare two-neutron evaporation channel from a $$^{56}\hbox {Ni}$$56Ni compound nucleus. The search for delayed proton emission was based on the $$^{28}\hbox {Si}$$28Si($$^{28}\hbox {Si},2n$$28Si,2n)$$^{54}\hbox {Ni}$$54Ni reaction at a beam energy of 70 MeV. For this reaction, a cross-section limit for the population of the $$10^+$$10+ state in $$^{54}\hbox {Ni}$$54Ni and its proton-decay branch was determined to be $$\sigma < 22$$σ<22 nb.
A metric-affine version of the Horndeski theory
Authors: Helpin Thomas , Volkov Mikhail S.
Published: January 2020

We study the metric-affine versions of scalar-tensor theories whose connection enters the action only algebraically. We show that the connection can be integrated out, resulting in an equivalent metric theory. Specifically, we consider the metric-affine generalisations of the subset of the Horndeski theory whose action is linear in second derivatives of the scalar field. We determine the connection and find that it can describe a scalar-tensor Weyl geometry without a Riemannian frame. Still, as this connection enters the action algebraically, the theory admits the dynamically equivalent (pseudo)-Riemannian formulation in the form of an effective metric theory with an extra K-essence term. This may have interesting phenomenological applications.
Modified Turaev-Viro invariants from quantum 𝔰𝔩(2|1)
Authors: Ana-Maria Anghel Cristina , Geer Nathan
Published: January 2020

The category of finite dimensional modules over the quantum superalgebra [Formula: see text] is not semi-simple and the quantum dimension of a generic [Formula: see text]-module vanishes. This vanishing happens for any value of [Formula: see text] (even when [Formula: see text] is not a root of unity). These properties make it difficult to create a fusion or modular category. Loosely speaking, the standard way to obtain such a category from a quantum group is: (1) specialize [Formula: see text] to a root of unity; this forces some modules to have zero quantum dimension, (2) quotient by morphisms of modules with zero quantum dimension, (3) show the resulting category is finite and semi-simple. In this paper, we show an analogous construction works in the context of [Formula: see text] by replacing the vanishing quantum dimension with a modified quantum dimension. In particular, we specialize [Formula: see text] to a root of unity, quotient by morphisms of modules with zero modified quantum dimension and show the resulting category is generically finite semi-simple. Moreover, we show the categories of this paper are relative [Formula: see text]-spherical categories. As a consequence, we obtain invariants of 3-manifold with additional structures.
The breakdown of superconductivity in the presence of magnetic steps
Authors: Assaad Wafaa
Published: January 2020

Many earlier works were devoted to the study of the breakdown of superconductivity in type-II superconducting bounded planar domains, submitted to smooth magnetic fields. In the present contribution, we consider a new situation where the applied magnetic field is piecewise-constant, and the discontinuity jump occurs along a smooth curve meeting the boundary transversely. To handle this situation, we perform a detailed spectral analysis of a new effective model. Consequently, we establish the monotonicity of the transition from a superconducting to a normal state. Moreover, we determine the location of superconductivity in the sample just before it disappears completely. Interestingly, the study shows similarities with the case of corner domains subjected to constant fields.
Multiple solutions for parametric double phase Dirichlet problems
Authors: Papageorgiou N. S. , Vetro C. , Vetro F.
Published: January 2020

We consider a parametric double phase Dirichlet problem. Using variational tools together with suitable truncation and comparison techniques, we show that for all parametric values [Formula: see text] the problem has at least three nontrivial solutions, two of which have constant sign. Also, we identify the critical parameter [Formula: see text] precisely in terms of the spectrum of the [Formula: see text]-Laplacian.
Global existence and blow-up solutions of the radial Schrödinger maps
Authors: Zhai Jian , Zheng Bo-Wen
Published: January 2020

This paper studies the Cauchy problem of radial inhomogeneous Schrödinger maps (ISM) which arises from the integrable model of the inhomogeneous spherically symmetric Heisenberg ferromagnetic spin system. Through a complex transformation the radial ISM is equivalent to an integro-differential Schrödinger equation. A new weighted Sobolev space [Formula: see text] is introduced and the well-posedness of integro-differential Schrödinger equations, including the integral radial IMS, with small spherically symmetric initial data in one-dimensional energy space [Formula: see text] is established. Furthermore, for [Formula: see text], we prove the existence of blow-up solutions for the integral radial ISM.
Nucleosides as organizing agents
Authors: Solladié Nathalie , Rein Régis , Bouatra Souhaila , Merkas Sonja , Sooambar Chloé , Piantanida Ivo , Žinić Mladen
Published: January 2020

In the present review, we discuss the results of the research we have done over the last decade on multi-porphyrinic architectures bearing a nucleotidic backbone, compare all the data, offer a novel overview, and emphasize common capabilities of nucleosides appearing in various systems, providing a new insight on the pre-organizing capabilities of nucleosidic backbones. The efficiency of nucleosides as pre-organizing agents was investigated through the synthesis and study of various bis-porphyrins bearing nucleosidic linkers, as well as through the investigation of the conformation of linear and arborescent multi-porphyrins constructed on a nucleosidic backbone. The capacity of these molecules to complex guests with a high association constant was used as a tool to evaluate their degree of pre-organization, as well as the investigation of the electronic coupling existing between their chromophores and their photo-chemical capacities. Such an overview of one decade of scientific investigations documents the fact that rigid linkers between chromophores are not necessary for their spatial pre-organization, opening new routes to the faster synthesis of flexible highly pre-organized molecular architectures avoiding the long and tedious synthesis of rigid tweezers, especially for the preparation of rigid linkers which may bring solubility and stability problems.
Study on Fracture Mode Mixity Under Impact Loading Based on SHTB
Authors: Zou Guangping , Chen He , Chang Zhongliang
Published: January 2020

Mode mixity plays an essential role in the criteria of mixed mode fracture. In this paper, a novel approach for precisely controlling mode mixity under dynamic loading is proposed. Numerical simulation of all fracture mode (AFM) specimen and modified compact tension shear (MCTS) specimen loaded by split Hopkinson tension bar (SHTB) apparatus is carried out. With a constraint on MCTS specimen on the direction perpendicular to the incident bar, the dynamic stress intensity factor (DSIF) ratio of mode I to mode II remains constant during the loading process. When the constraint is absent, the DSIF ratio varies due to the vibration of clamps and specimen. The DSIF of MCTS specimen under different loading angles is also studied, and the ratio [Formula: see text] approximately equals the tangent of loading angle, which is also proven in experiments. Moreover, numerical results indicate that the influence of the shape of clamps is significantly reduced by applying a constraint on the specimen. It is concluded that AFM specimen is not suitable for dynamic fracture tests owing to over complicated clamps.
Precise Integration Symplectic Analytical Singular Element for Cracks Analysis Under Transient Thermal Conduction
Authors: Hu Xiaofei , Ding Xing , Bui Tinh Quoc , Yao Weian
Published: January 2020

Numerical modeling of mechanical behavior of cracks under transient thermal conduction involves solving an initial value problem (IVP) and two boundary value problems (BVPs). Both of the BVPs have a singularity issue. Drawbacks such as numerical error accumulation and high computational expense of existing numerical approaches should be overcome. This contribution intends to build a unified framework with highly efficiency and accuracy for the numerical modeling of cracks under thermal shock. The precise integration method (PIM) and the symplectic analytical singular element (SASE) have been demonstrated to be favorable alternatives for each problem, i.e., the PIM for solving the IVP and SASE for the BVP. However, it is found that these two methods cannot be combined directly. In order to incorporate the SASEs into the PIM, the existing SASEs are reformulated for the thermal shock cracks analysis. Details of the mathematical derivations are provided. The validity of the proposed method is demonstrated through numerical examples.
SWI/SNF Complex Mutations in Gynecologic Cancers: Molecular Mechanisms and Models
Authors: Wang Yemin , Hoang Lien , Ji Jennifer X. , Huntsman David G.
Published: January 2020

The SWI/SNF (mating type SWItch/Sucrose NonFermentable) chromatin remodeling complexes interact with histones and transcription factors to modulate chromatin structure and control gene expression. These evolutionarily conserved multisubunit protein complexes are involved in regulating many biological functions, such as differentiation and cell proliferation. Genomic studies have revealed frequent mutations of genes encoding multiple subunits of the SWI/SNF complexes in a wide spectrum of cancer types, including gynecologic cancers. These SWI/SNF mutations occur at different stages of tumor development and are restricted to unique histologic types of gynecologic cancers. Thus, SWI/SNF mutations have to function in the appropriate tissue and cell context to promote gynecologic cancer initiation and progression. In this review, we summarize the current knowledge of SWI/SNF mutations in the development of gynecologic cancers to provide insights into both molecular pathogenesis and possible treatment implications for these diseases.
Characteristics of Corrosion Related to Ash Deposition on Boiler Heating Surface during Cofiring of Coal and Biomass
Authors: Wang Yongzheng , Sun Yu , Jiang Lei , Liu Lu , Li Yungang
Published: January 2020

In order to investigate the regularity and mechanism of corrosion related to ash deposition on the boiler heating surface during cofiring of coal and biomass, the influence of fuel property, type of metal tubes (heating surface), proportion of blended biomass, and atmosphere in the furnace was studied by using the static corrosion mass gain method with the high-temperature tube furnace system. The results indicated that the effect of biomass property on ash corrosion is greater than that of coal, which was mainly due to high content of alkali metals and chlorine in biomass fuels. The corrosion resistance of metal pipes is T91 > 12CrMoVG > 20G. T91 is the most appropriate one, and it can effectively inhibit chlorine corrosion and can be used as the ideal material for the biomass-fired boiler and the biomass and coal cofired boiler. In addition, ash deposition can significantly aggravate the corrosion of metal tubes, and the degree of corrosion tends to become significant with increasing proportion of blended biomass fuels. HCl can aggravate metal corrosion, which can be inhibited by SO2.
Novel Criteria of ISS Analysis for Delayed Memristive Simplified Cohen–Grossberg BAM Neural Networks
Authors: Zhao Yong , Ren Shanshan
Published: January 2020

The memristor as the fourth circuit element, it can capture some key aspects of biological synaptic plasticity. So, it is significant that the characteristic of memristors is considered in neural networks. This paper investigates input-to-state stability (ISS) of a class of memristive simplified Cohen–Grossberg bidirectional associative memory (BAM) neural networks with variable time delays. In the sense of Filippov solution, some novel sufficient criteria for ISS are obtained based on differential inclusions and differential inequalities; when the input is zero, the stability of the total system is state stable. Furthermore, numerical simulations are illustrated to show the feasibility of our results.
The Role of Intraarterial Chemotherapy in the Management of Retinoblastoma
Authors: Pekacka Aleksandra
Published: January 2020

Introduction. Retinoblastoma is the most common primary intraocular neoplasm in children. With the advances in medicine, the armamentarium of available treatment modalities has grown. Intraarterial chemotherapy is a relatively new treatment method with promising outcomes. The purpose of this literature review is to evaluate its role in the management of retinoblastoma. Methods. A systematic online search was conducted using Ovid Embase and Ovid Medline. The final results included 23 studies. The studies were published between 2011 and 2019. The studies evaluated the technical success rate of IAC, globe salvage rate, and ocular and systemic complications, as well as the occurrence of deaths, metastasis, and secondary neoplasms. In total, 1827 eyes with retinoblastoma were analysed. The follow-up was between 0 and 252 months. Results. Overall globe retention rate ranged from 30% to 100%. Sixteen out of 23 studies reported ocular salvage between 60 and 80%. Eyelid oedema and erythema were the most commonly reported ocular complications following IAC. The most common systemic complications included nausea, vomiting, and neutropenia. Metastases and deaths were reported in 6 out of 23 studies. Three studies reported the development of secondary neoplasms. The technical success rate of IAC procedure ranged from 91% to 100%. Discussion. The studies have shown that IAC is a safe and effective treatment for advanced retinoblastoma, especially group D. It allows to save the globe without compromising patients’ survival. Local and systemic complications are acceptable. The role of IAC in less advanced tumours is yet to be established. Future work should focus on conducting larger prospective studies with longer follow-up. Multiple novel therapies for the management of retinoblastoma are currently being tested, including angiogenic inhibitors and targeted agents. The results seem to be promising. Future advances require a further in-depth understanding of unique genetics of retinoblastoma and complex interactions between tumour cells and their microenvironment.
Incidence and Associated Factors of Laryngospasm among Pediatric Patients Who Underwent Surgery under General Anesthesia, in University of Gondar Compressive Specialized Hospital, Northwest Ethiopia, 2019: A Cross-Sectional Study
Authors: Birlie Chekol Wubie , Yaregal Melesse Debas
Published: January 2020

Introduction. Laryngospasm is a glottis closure due to reflex constriction of the laryngeal muscles. It can occur at any phase of the anesthetic. Different studies have been done previously with various results and indicative values which initiated us to do this research. This study aimed to assess the incidence and associated factors of laryngospasm among pediatric patients who underwent surgery under general anesthesia (GA). Methods. Institution-based, cross-sectional study was conducted on pediatric patients from February to August, 2019, in University of Gondar Comprehensive Specialized Hospital (UOGCSH). Data were entered and analyzed with SPSS version 20. Variables with P value less than <0.2 in bivariate analysis were fitted into the multivariable logistic regression analysis to identify factors associated with laryngospasm. Both crude and adjusted odds ratio with 95% CI were calculated to show strength of association. In multivariable analysis, P value of <0.05 was considered as statistically significant. Results. The incidence of laryngospasm among pediatric patients who underwent surgery under GA was 57 (18.4%). Of this, 34 (59.6%), 12 (21.1%), and 11 (19.3%) happened during emergence, maintenance, and induction phases of GA, respectively. In multivariable analysis, airway anomalies (AOR: 14.64, 95% CI: 1.71, 125.04), secretion (AOR: 2.45, 95% CI: 1.19, 5.06), attempts of airway devices (AOR: 2.47, 95% CI: 1.16, 5.22), upper respiratory tract infection (AOR: 2.91, 95% CI: 1.008, 8.41), and inadequate depth of anesthesia (AOR: 7.92, 95% CI: 2.7, 23.22) were significantly associated with incidence of laryngospasm. Conclusions. Laryngospasm can occur at any phase of the anesthetic. At UOGCSH, the overall rate of laryngospasm was 18.4%, with the vast majority of episodes occurring on emergence. Inadequate depth of anesthesia, URTI, airway anomalies, multiple attempts of airway devices, and oropharyngeal secretion were predictors of laryngospasm. So, added vigilance is needed in patients with URTI, airway anomalies, or those who require multiple attempts at airway device insertion. Prompt clearing of airway secretions and adequate depth of anesthesia may help to prevent laryngospasm. Since the majority of our patients received an IV induction, endotracheal intubation, and maintenance with halothane, caution must be taken in extrapolating these results to other patient populations.
Multicenter Computer-Aided Diagnosis for Lymph Nodes Using Unsupervised Domain-Adaptation Networks Based on Cross-Domain Confounding Representations
Authors: Qin RuoXi , Zhang Huike , Jiang LingYun , Qiao Kai , Hai Jinjin , Chen Jian , Xu Junling , Shi Dapeng , Yan Bin
Published: January 2020

To achieve the robust high-performance computer-aided diagnosis systems for lymph nodes, CT images may be typically collected from multicenter data, which cause the isolated performance of the model based on different data source centers. The variability adaptation problem of lymph node data which is related to the problem of domain adaptation in deep learning differs from the general domain adaptation problem because of the typically larger CT image size and more complex data distributions. Therefore, domain adaptation for this problem needs to consider the shared feature representation and even the conditioning information of each domain so that the adaptation network can capture significant discriminative representations in a domain-invariant space. This paper extracts domain-invariant features based on a cross-domain confounding representation and proposes a cycle-consistency learning framework to encourage the network to preserve class-conditioning information through cross-domain image translations. Compared with the performance of different domain adaptation methods, the accurate rate of our method achieves at least 4.4% points higher under multicenter lymph node data. The pixel-level cross-domain image mapping and the semantic-level cycle consistency provided a stable confounding representation with class-conditioning information to achieve effective domain adaptation under complex feature distribution.
Elliptical FRP-Concrete-Steel Double-Skin Tubular Columns under Monotonic Axial Compression
Authors: Zhang Bing , Feng Gui-Sen , Wang Yan-Lei , Lai Cong-Cong , Wang Chen-Chen , Hu Xia-Min
Published: January 2020

Hybrid FRP-concrete-steel double-skin tubular columns (hybrid DSTCs) are a novel form of hollow columns consisting of an outer FRP tube, an inner steel tube, and an annular layer of concrete between the two tubes. Due to the effective confinement of the two tubes, the concrete in hybrid DSTCs is well confined, leading to excellent ductility and strength enhancement. Hybrid DSTCs also have excellent corrosion resistence due to the effective protection of the outer FRP tube. However, existing studies mainly focused on hybrid DSTCs with a circular cross-section. When subjecting to different loads in the two horizontal directions, elliptical columns are preferred as they can provide different bending stiffness and moment capacity around two axes of symmetry without significantly reducing the confining effect of the FRP tube. This paper extends the existing work on circular DSTCs to elliptical DSTCs with a particular focus on four issues: the effect of elliptical aspect ratio (i.e., the ratio of the major axis to the minor axis of the outer elliptical cross-section), the effect of the FRP tube thickness, the effect of void area ratio (i.e., the ratio of the area of concrete void to the area of the outer elliptical section), and the effect of the cross-section of the inner steel tube (i.e., both rectangular and elliptical steel tubes were used). Experimental results show that, the averaged peak stress of the confined concrete in elliptical DSTCs increases with the increase in the elliptical aspect ratio, whereas the elliptical aspect ratio has no obvious effect on the ultimate axial strain; the cross-section shape of the inner steel tube has significant effect on the axial stress-strain behavior of the confined concrete in elliptical DSTCs; elliptical DSTCs with an elliptical steel tube exhibit much better ductility and strength enhancement than those specimens with a rectangular steel tube. A simple stress-strain model of confined concrete was proposed for elliptical DSTCs to account for the effects of the elliptical aspect ratio, the inner void, and the shape of the inner steel tube, which can provide reasonably accurate but conservative predictions.
Power Management Problem for Civil Aircraft under More Electric Environment
Authors: Yang Yuanchao , Gao Zichen
Published: January 2020

The civil aviation industry is moving toward the more electric aircraft (MEA) which is to use electrical power to meet the load demands on multiple aircraft subsystems which are conventionally driven by other power resources. Thus, there will be introduced a large amount of new electrical power demands which are safety-critical for aircraft’s flight and this may lead the challenge for a reliable and efficient power management problem (PMP): the balance between the aircraft power supply and demands while minimizing the operation costs. To cope with the PMP for civil aircraft under more electric environment, in this paper, we explicitly give a detailed and complete modeling of all power supply resources (fuel and battery) and safety-critical electrical loads and cast the PMP as a mixed-integer nonlinear programming problem; we develop a practical solution methodology for the application on the real civil MEA. The proposed formulation and solution algorithm can give an efficient power schedule result with the minimal fuel and battery operation cost through a smart codispatch between the gas turbine generator, storage devices, and all electrical loads of MEA. Numerical testing results based on one real civil aircraft case demonstrate the economic and operational effectiveness.
A Phlegm Stagnation Monitoring Based on VDS Algorithm
Authors: Gao Zhiguo , Yu Xin
Published: January 2020

In the nonmedical sputum monitoring system, a practical solution for phlegm stagnation care of patients was proposed. Through the camera, the video images of patients’ laryngeal area were obtained in real time. After processing and analysis on these video frame images, the throat movement area was found out. A three-frame differential method was used to detect the throat moving targets. Anomalies were identified according to the information of moving targets and the proposed algorithm. Warning on the abnormal situation can help nursing personnel to deal with sputum blocking problem more effectively. To monitor the patients’ situation in real time, this paper proposed a VDS algorithm, which extracted the speed characteristics of moving objects and combined with the DTW algorithm and SVM algorithm for sequence image classification. Phlegm stagnation symptoms of patients were identified timely for further medical care. In order to evaluate the effectiveness, our method was compared with the DTW, SVM, CTM, and HMM methods. The experimental results showed that this method had a higher recognition rate and was more practical in a nonmedical monitoring system.
A Case Report of Mixed Osteomalacia and Low Bone Density from Vitamin D Deficiency as a Cause of Bilateral Tibial Stress Fractures in a Young Male Military Recruit from Singapore
Authors: Loh Wann Jia , Hughes Louise , Chua David Thai Chong , Gani Linsey
Published: January 2020

Despite being a tropical country, vitamin D deficiency is common in Singapore. All young Singaporean males between the age of 18 and 21 years have to undergo mandatory military service. Stress fractures occur in military recruits, and risk factors include a sudden increase in physical activity and vitamin D deficiency. We report the bone histomorphometry findings from a case of bilateral tibial stress fractures in an 18-year-old military recruit who had vitamin D deficiency. The histomorphometry showed a mixed osteomalacia and osteoporosis pattern. This case is unique as it shows that stress fractures from a marching exercise can occur in apparently healthy well young man with vitamin D deficiency despite living in a tropical country.
Enablers and Challenges in the Implementation of Active Case Findings in a Selected District of Karnataka, South India: A Qualitative Study
Authors: Shamanewadi Amrita N. , Naik Poonam R. , Thekkur Pruthu , Madhukumar Suwarna , Nirgude Abhay Subhashrao , Pavithra M. B. , Poojar Basavaraj , Sharma Vivek , Urs Arnav Prashanth , Nisarga B. V. , Shakila N. , Nagaraja Sharath Burugina
Published: January 2020

Background. Active case finding (ACF) for tuberculosis (TB) is a promising tool to enhance early case detection among marginalized populations. As opposed to passive case finding, it involves systematically searching for TB in individuals who would not spontaneously present for care. The National TB Program (NTP) of India has initiated ACF for TB through the existing general health system since the end of 2017. However, prior to scale-up, there is need for exploring the implementation challenges and solutions to improve the efficiency of this program. Objectives. (1) To explore the enablers and challenges in the implementation of ACF for TB by NTP in the Bengaluru rural district of Karnataka, South India, and (2) to explore the perceived solutions to improve the efficiency of ACF activity. Methods. A qualitative descriptive study was conducted in the Bengaluru rural district during July 2018. In-depth interviews using purposively selected health care providers involved in active case finding (n=9) and presumptive TB patients (n=8) were conducted. Manual content analysis was conducted by two independent researchers to generate categories and themes. Results. The challenges in conduct of ACF were as follows: inadequate training of health care workers, shortage of staff, indifferent attitude of community due to stigma, lack of awareness about TB, illiteracy, inability to convince patients for sputum test, and delay in getting CBNAAT results. The field staff recommended the installation of mobile CBNAAT machine, involvement of general health staff in activity, training of health workers on counseling of patients, and issue of identity cards for community health workers/volunteers so that people recognize them. Conclusion. The health system challenges in conduct of ACF need to be addressed by training the health staff involved in activity and also improving the access to TB diagnostics.
Unplanned Cesarean Delivery in the Second Stage of Labor Holds Higher Odds of Complications than in the First Stage, while Similar in Primiparas and Multiparas
Authors: Lipschuetz Michal , Guedalia Joshua , Cohen Sarah M. , Lewkowicz Aya A. , Amsalem Hagai , Karavani Gilad , Yagel Simcha , Unger Ron
Published: January 2020

Background: While endeavors to reduce cesarean delivery (CD) rates are given priority worldwide, it is important to evaluate if these efforts place parturients and neonates at risk. CD performed in the second stage of labor carries higher risks of maternal and fetal complications and is a more challenging surgical procedure than that performed in the first stage or before labor. In a population with a low CD rate, we sought to evaluate the rate of maternal and fetal complications associated with unplanned CD (UCD) performed in the second vs. the first stage of labor, in primiparas and multiparas, as well as the risk factors leading to and the complications associated with UCD in the second stage of labor in this low-CD rate setting. Methods: This was a retrospective, electronic medical record-based study of 7,635 term and preterm singletons born via UCD in the period 2003–2015. Maternal and neonatal background and outcome parameters were compared between groups. Logistic regression modeling was applied to adjust for clinically and statistically significant risk factors. Results: UCD was more likely to be performed in the second stage of labor in mothers delivering larger fetuses (head circumference and body weight ≥90 centile) and those with persistent occiput posterior (POP) presentation. UCD in the second stage was strongly associated with serious maternal complications (excessive hemorrhage and fever) compared to UCD performed in the first stage, in both primiparas and multiparas. Conclusions: UCD performed in the second stage of labor, while less frequent than first-stage UCD, is more likely with larger neonates and POP presentation, and is associated with a higher rate of maternal complications in primiparas and multiparas. Complication rates in our low-CD-rate population did not exceed those reported in the literature from high-CD-rate areas.