bluuebunny/crossref_metadata_2025 huggingface dataset:
A Practical Approach to Interpretation and Consideration of Tool Tolerance for In-Situ Strength Testing
Authors: Mittelstadt Benjamin C. , Nicholson Matthew , Delong Terry , Jimenez Brian , Zmud Robert
Published: December 2024

This paper outlines a methodology for employing in-situ test results, considering measurement tolerances, to reliably validate material grades as part of the Material Verification Program for MAOP reconfirmation. It addresses the recent amendments in 49 CFR 192 and the accompanying FAQs by the Pipeline and Hazardous Materials Safety Administration (PHMSA). These revisions mandate material testing, as stipulated in 49 CFR 192.607, in certain scenarios where U.S. pipeline operators do not have complete, traceable, and verifiable records of physical pipeline characteristics, including diameter, wall thickness, seam type, and grade. The proposed methodology, which aligns with the requirements of 49 CFR 192.607(d), ensures conservative accounting for measurement inaccuracies and uncertainties, providing a practical approach to comply with regulatory standards to verify pipe grade.

To meet the material testing requirement, pipeline operators are using recently developed in-situ and nondestructive testing in lieu of destructive methods whenever possible. The results provide a measurement of the yield strength of the steel and may then be used as an input to determine pipe grade. Pipe grade is considered one of the most challenging material attributes to determine using non-destructive methods for strength measurement due to measurement variability and overlap of actual material strengths between different grades that is allowable in API Specification 5L.

The purpose of the material verification as related to §192.624 MAOP reconfirmation is not to identify the actual yield strength of the pipe but instead to use estimates of yield strength based on established test methods to identify the grade. Pipeline engineering methods rely upon conservative models (i.e., equations) for design and defect assessment. Inputs to these models (e.g., yield strength, wall thickness, diameter) have known variability that is already accounted for by the inherent conservatism of the models. The conservatism of these models is discussed to demonstrate that the precise identification of yield strength is not necessary if the pipe can be demonstrated to be consistent with an expected grade.
Advanced Assessment of Pipeline Subjected to Downslope Movements at River Crossing: Effect of Concrete Coating
Authors: Fredj Abdelfettah
Published: December 2024

The long linear nature of buried pipelines results in the risk of interaction with a range of geotechnical hazards including downslope movements at pipeline stream and river crossings. Ground movement induced by these geotechnical hazards can subject a pipeline to displacement controlled axial, lateral, vertical and bending loading. These geotechnical hazards can result in the accumulation of axial tensile and compressive strains in the pipe. Therefore, calculation of pipe strain demand and strain capacity considering the site condition and the appropriate slope movement mechanism is necessary in assessing the pipeline integrity to support maintenance management.

It is a common practice to use weight concrete coating to provide negative buoyancy for river crossing application. The pipeline concrete coating design may extend to the toe of the slope and end adjacent to the pipeline location experiencing displacement (bending deformations). The discontinuity of the concrete coating may result in strain concentration at the end of the concrete coating when the pipeline is subject to plastic deformation. To address this without exaggerating the stiffening effect of the concrete, it is necessary to account for pipe concrete coating properties and for the slip between the concrete-pipe interface.

This paper presents a case study analyses of slope movement using a novel 3D continuum model to illustrate the detailed information that can be derived from geotechnical hazard simulation. The model was calibrated and validated for the assessment of pipe-soil interaction modeling of geotechnical events.

The analyses presented in this paper provide insights into the effects of ground movement on pipeline integrity near river crossing. The analyses highlight the effects of the pipe concrete weight coating on the pipeline response at the crossing that may affect the remedial action decisions.
An acoustic metamaterial with space-time modulated density
Authors: Zhu Xiaohui , Shen Chen
Published: December 2024

Space-time modulation opens the door for unprecedented wave behavior control, such as nonreciprocal wave manipulation. Here is proposed a one-dimensional space-time modulated membrane system aiming to realize a kind of acoustic metamaterial with space-time modulated effective density. Three different approaches, namely, the effective medium method, transfer matrix method, and time-domain simulation, are applied to analyze the acoustic response of the system under a monochromatic incidence. Results show that the proposed metamaterial can support two different nonreciprocal acoustic functionalities, namely, unidirectional parametric amplification and parametric frequency conversion, when different modulation profiles are enforced.
Topologically protected zero-directional refraction of elastic waves in a pillared phononic crystal plate
Authors: Li Hong-kang , Chen Rong-Hua , Huo Shao-yong , Fu Chun-ming
Published: December 2024

Zero-directional refraction phenomenon refers to the capability where waves do not undergo refraction at a material interface under specific conditions, which has broad potential applications, particularly in the fields of optics, acoustics, and phononics. Previous research of zero-directional refraction rely on the zero or equivalent-zero index of the material parameters, which is quite challenging to manipulate the zero-directional transport of waves. In this paper, based on the topological theory, we have constructed a pillared phononic crystal (PnC) plate structure with pseudospin topologically protected transport, enabling zero-directional refraction of elastic waves without using zero or equivalent-zero index of the material parameters. By initially adjusting the contraction and expansion of the pillared unit cell, a band inversion effect between pseudospin dipoles and quadrupoles is induced, thus leading to a topological phase transition of elastic wave. Combining the phase matching between topological interface and terminal medias, the elastic waves in pillared PnC plate can exhibit zero-directional refraction behavior. Finally, it was demonstrated that the phenomenon of zero-directional refraction exhibits robustness in the presence of cavities and bends, and different incident angles. This research result provides new insights for designing and manipulating the emission and directional antennas of elastic waves.
The Creation of a New Charity Sport Event: The Case of the Canadian Cancer Society
Authors: Wood Laura , Snelgrove Ryan
Published: December 2024

The manager of fundraising events at the Canadian Cancer Society, Hali Burton, is considering the addition of a new fundraising event for the charitable organization. Prior to making a decision, Hali evaluates the organization’s existing event portfolio, the charity fundraising landscape, and the met, and unmet motivations of event stakeholders. The case also draws attention to important factors such as organizational capacity and control over events. In developing a new event, Hali and her team need to consider the organization’s overall goals, position the event relative to its existing event portfolio and other charitable events, identify potential sponsors and host communities, and set event goals for all stakeholders, including Canadian Cancer Society. In making a recommendation for a new event, Hali and her team are tasked with following a Balanced Scorecard approach to setting event goals, including long-, medium-, and short-term goals.
Ex vivo expansion and hydrogel-mediated in vivo delivery of tissue-resident memory T cells for immunotherapy
Authors: Li Shuyi , Yao Zhi-Cheng , Wang Hanzhi , Ecker Jonathan A. , Omotoso Mary O. , Lee Jaechan , Kong Jiayuan , Feng Hexiang , Chaisawangwong Worarat , Kang Si-Sim , Shannon Sydney R. , Livingston Natalie K. , Bieler Joan G. , Singh Shweta , Zhang Maya L. , O’Neal Pilar , Ariail Emily , Biggs Benjamin , Hickey John W. , Mao Hai-Quan , Schneck Jonathan P.
Published: December 2024

Tissue-resident memory T (T
RM
) cells preferentially reside in peripheral tissues, serving as key players in tumor immunity and immunotherapy. The lack of effective approaches for expanding T
RM
cells and delivering these cells in vivo hinders the exploration of T
RM
cell–mediated cancer immunotherapy. Here, we report a nanoparticle artificial antigen-presenting cell (nano-aAPC) ex vivo expansion approach and an in vivo delivery system for T
RM
cells. Using the nano-aAPC platform, we expanded functional antigen-specific murine and human T
RM
-like CD8
+
T cells ex vivo. We also developed an injectable macroporous hyaluronic acid (HA) hydrogel to deliver T
RM
-like cells. T
RM
-like cells delivered in the optimized HA hydrogel trigger robust local and systemic antitumor immunity and show synergistic effects with anti–PD-1 treatment. Our findings suggest that nano-aAPC–induced T
RM
-like cells, coupled with a hydrogel delivery system, offer an efficient way to advance the understanding of T
RM
cell–mediated cancer therapy.
The recombination efficiency of the bacterial integron depends on the mechanical stability of the synaptic complex
Authors: Vorobevskaia Ekaterina , Loot Céline , Mazel Didier , Schlierf Michael
Published: December 2024

Multiple antibiotic resistances are a major global health threat. The predominant tool for adaptation in Gram-negative bacteria is the integron. Under stress, it rearranges gene cassettes to offer an escape using the tyrosine recombinase IntI, recognizing folded DNA hairpins, the
attC
sites. Four recombinases and two
attC
sites form the synaptic complex. Yet, for unclear reasons, the recombination efficiency varies greatly. Here, we established an optical tweezers force spectroscopy assay to probe the synaptic complex stability and revealed, for seven combinations of
attC
sites, significant variability in the mechanical stability. We found a strong correlation between mechanical stability and recombination efficiency of
attC
sites in vivo, indicating a regulatory mechanism from the DNA structure to the macromolecular complex stability. Taking into account known forces during DNA metabolism, we propose that the variation of the integron in vivo recombination efficiency is mediated by the synaptic complex stability. We anticipate that further recombination processes are also affected by their corresponding mechanical stability.
Transcription processes compete with loop extrusion to homogenize promoter and enhancer dynamics
Authors: Platania Angeliki , Erb Cathie , Barbieri Mariano , Molcrette Bastien , Grandgirard Erwan , de Kort Marit A. C. , Pomp Wim , Meaburn Karen , Taylor Tiegh , Shchuka Virlana M. , Kocanova Silvia , Nazarova Mariia , Oliveira Guilherme Monteiro , Mitchell Jennifer A. , Soutoglou Evi , Lenstra Tineke L. , Molina Nacho , Papantonis Argyris , Bystricky Kerstin , Sexton Tom
Published: December 2024

The spatiotemporal configuration of genes with distal regulatory elements is believed to be crucial for transcriptional control, but full mechanistic understanding is lacking. We combine simultaneous live tracking of pairs of genomic loci and nascent transcripts with molecular dynamics simulations to assess the
Sox2
gene and its enhancer. We find that both loci exhibit more constrained mobility than control sequences due to stalled cohesin at CCCTC-binding factor sites. Strikingly, enhancer mobility becomes constrained on transcriptional firing, homogenizing its dynamics with the gene promoter, suggestive of their cotranscriptional sharing of a nuclear microenvironment. Furthermore, we find transcription and loop extrusion to be antagonistic processes constraining regulatory loci. These findings indicate that modulating chromatin mobility can be an additional, underestimated means for effective gene regulation.
Insights of fault activities through 3-D shape preferred orientation and illite age analysis
Authors: Sim Ho , Song Yungoo , Hong Seongsik
Published: December 2024

Combining the absolute age of illite in fault rocks with microstructure analysis plays a significant role in inferring the deformation processes of fault zones that have undergone multiple complex fault activities. We aim to propose a new approach to reconstruct fault activation history by conducting systematic fabric observations, X-ray diffraction analysis, 3-D shape preferred orientation (SPO) analysis, and illite age analysis (IAA) on fault gouge affected by brittle deformation in the Yeonghae area of the Yangsan fault in the southeastern part of the Korean Peninsula, where the tectonic environment has been continuously changing since the Cretaceous. We inferred the early fault activation process from large carbonate fragments, aggregates, and chlorite in the fault gouge, and the late fault activation process from the composition of matrix-filling clay minerals, the presence and foliation of clay-bearing layers, and the SPO of rigid clasts. The outcrop in the Yeonghae area of the Yangsan fault initially experienced fault activation at relatively high temperatures and depths, and finally underwent left-lateral strike-slip fault motion due to slip inferred as aseismic creep at relatively low temperatures and shallower depths. Comparing the K-Ar IAA results with previous studies analyzing paleostress fields, it is estimated that the multiple early fault activations in the Yeonghae area of the Yangsan fault occurred between 67 Ma and 38 Ma, and the late aseismic creep occurred at ca. 17−10 Ma. Integrating quantitative 3-D SPO analysis and IAA with in-depth fabric observations will provide evidence to elucidate the developmental history of fault rocks based on highly reliable data.
Molecular-Beam Epitaxy of Metamorphic InAs/InGaAs Quantum-Dot Heterostructures Emitting in the Telecom Wavelength Range
Authors: Sorokin S. V. , Klimko G. V. , Sedova I. V. , Galimov A. I. , Serov Yu. M. , Kirilenko D. A. , Prasolov N. D. , Toropov A. A.
Published: December 2024

Heterostructures with InAs/InGaAs quantum dots grown by molecular beam epitaxy on the surface of InGaAs metamorphic buffer layers with a linearly graded composition profile on GaAs(001) substrates have been studied by X-ray diffraction, transmission electron microscopy, and, upon the growth of an additional quantum-dot layer on the surface of the structure, by atomic force microscopy. The tendency to the formation of quantum objects elongated along the [1–10] direction (so-called quantum dashes), caused by asymmetry in the surface migration of In along different crystallographic directions, is confirmed. It is established that the surface density of both quantum dots and quantum dashes is as high as (2‒4) × 1010 cm–2. At the same time, narrow lines associated with emission from individual quantum dots are observed in the spectra of low-temperature (T = 10 K) microphotoluminescence in a wide wavelength range (1.30–1.55 µm). The size and shape of quantum dots have been estimated from atomic-force microscopy and transmission electron microscopy data and good agreement with the previously reported parameters is demonstrated.
Paediatric trauma and hypocalcaemia: a systematic review
Authors: Toner Mary-Beth , Coffey Michael , Nurmatov Ulugbek , Mullen Stephen
Published: December 2024

Background

Trauma is a leading cause of mortality and morbidity in children worldwide. While adult studies have demonstrated hypocalcaemia’s association with adverse outcomes, its impact on paediatric trauma patients remains understudied. This systematic review aims to investigate current evidence into the prevalence, clinical implications and associations of hypocalcaemia in paediatric trauma.

Methods

A comprehensive literature search was conducted searching four databases, grey literature and additional sources for original studies looking at outcomes for paediatric trauma patients with ionised calcium measurements before blood product administration. Exclusion criteria comprised studies which included patients with blood product administration prior to calcium measurement, case reports, case series, reviews and papers not available in English. The review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO): CRD42023432473. Data extraction was performed on included papers and quality assessment performed using Newcastle-Ottawa Scale.

Results

Of 779 initial studies, two studies met inclusion criteria for detailed analysis. Both retrospective cohort studies originated in Israel and collectively included 568 patients. Hypocalcaemia incidence ranged from 5.3% to 19.8%. Although trends towards increased mortality, blood transfusion requirements and prolonged hospital stays were observed in patients with hypocalcaemia, statistical significance was not consistently achieved.

Conclusion

Hypocalcaemia in paediatric trauma appears reduced in incidence compared with adult populations. Limited available studies suggest potential associations with adverse outcomes, although most were not statistically significant. Studies had small patient numbers, necessitating further prospective research to facilitate a clearer understanding. Insights from such studies can guide patient management and improve outcomes in this vulnerable population.

PROSPERO registration number

CRD42023432473.
Largest reported lipoma in the United States of America
Authors: Subramaniam Sneha , Sardinha T Cristina
Published: December 2024

A woman in her early 60s presented for evaluation of an asymptomatic left groin mass. CT imaging noted a large fatty tumour replacing the majority of the abdominal and pelvic cavities. The patient underwent an uneventful resection of a 53×36×9 cm mass of the retroperitoneal (RP) space. The pathology report was compatible with a lipoma. This is the largest noted RP lipoma in the US literature. In this case report, we also offer a literature review of the diagnosis and management of fat-containing retroperitoneal masses.
Effectiveness of tofacitinib in patients with ulcerative colitis: an updated systematic review and meta-analysis of real-world studies
Authors: Lin Chien-Hung , Liu Wen-Sheng , Wan Chuan , Wang Hsin-Hui
Published: December 2024

Objectives

This study aimed to evaluate the real-world effectiveness of tofacitinib for treating moderate-to-severe ulcerative colitis (UC).

Design

Systematic review and meta-analysis.

Data sources

PubMed, EMBASE and Cochrane CENTRAL databases were searched from inception up to 18 July 2023. Reference lists of included studies were manually searched to identify potentially relevant studies not found in the databases.

Eligibility criteria

Eligible studies included real-world observational studies, reported in English, on patients with moderate-to-severe UC treated with tofacitinib, defined by the Partial Mayo Score. Excluded were clinical trials, reviews, letters, conference abstracts, case reports and studies involving patients with mixed Crohn’s disease.

Data extraction and synthesis

Two independent reviewers extracted data and recorded it in Excel. Quality assessment was performed using the Newcastle-Ottawa scale. Meta-analysis was performed using random-effects models due to high heterogeneity across studies.

Results

19 studies containing a total of 2612 patients were included. Meta-analysis revealed that clinical response rates were 58% at week 8, 61% at weeks 12–16, 51% at weeks 24–26 and 51% at week 52. Clinical remission rates were 39% at week 8, 43% at weeks 12–16, 40% at weeks 24–26 and 43% at week 52. Corticosteroid-free clinical remission rates were 33% at week 8, 37% at weeks 12–16, 32% at weeks 24–26 and 40% at week 52.

Conclusion

This meta-analysis of real-world studies indicates that treatment of UC with tofacitinib is associated with favourable clinical response and remission rates in the induction and maintenance phases.
Research capacity strengthening methods and meanings: negotiating power in a global health programme on violence against women
Authors: Tilouche Nerissa , Kalichman Beatriz , Dheensa Sandi , Rossi Evelina , Hawcroft Claire , d'Oliveira Ana Flavia , Owda Heba , Bacchus Loraine J
Published: December 2024

Background

There has been much critical reflection among global health researchers about how power imbalances between high-income countries and low- and middle-income country collaborators are perpetuated through research programmes. Research capacity strengthening (RCS) is considered both a mechanism through which to redress structural power imbalances in global health research and a vehicle for their perpetuation. This paper examines the RCS programme of a multi-county study on violence against women, focussing on how it addressed power imbalances between countries and the challenges involved in doing so. It provides specific examples and lessons learnt.

Methods

18 semi-structured interviews were conducted online with group members from all five countries involved in the collaboration between April and June 2020. Reflexive thematic analysis, with inductive and deductive approaches was adopted.

Findings

Participants articulated their understandings of RCS as an opportunity for (1) mutual learning, understanding and collaboration and (2) personal and team career development. Participants perceived the RCS programme activities to simultaneously reinforce and challenge power asymmetries within global health research. Power dynamics within the RCS programme operated across three levels; the global health research environment, the research group level and within individual country teams. Participants described structural barriers at all three levels, but felt there were more opportunities to challenge power imbalances at the research group level.

Conclusion

Despite a strong commitment to addressing power imbalances through the RCS programme, progress was often hampered by the fact that these inequalities reflected broader structural issues in global health, as seen within Healthcare Responding to Violence and Abuse. The programme faced tensions between enhancing researchers’ careers while building capacity under the current model, which sometimes conflicted with creating social value or challenging epistemic and normative structures. Participants clearly expressed concerns about power imbalances within the partnership and were keen to address them through the RCS programme. This led to a steep learning curve and significant adaptations within the RCS programme to navigate these issues within existing structural limitations.
Performance of automated machine learning in detecting fundus diseases based on ophthalmologic B-scan ultrasound images
Authors: Wei Qiaoling , Chen Qian , Zhao Chen , Jiang Rui
Published: December 2024

Aim

To evaluate the efficacy of automated machine learning (AutoML) models in detecting fundus diseases using ocular B-scan ultrasound images.

Methods

Ophthalmologists annotated two B-scan ultrasound image datasets to develop three AutoML models—single-label, multi-class single-label and multi-label—on the Vertex artificial intelligence (AI) platform. Performance of these models was compared among themselves and against existing bespoke models for binary classification tasks.

Results

The training set involved 3938 images from 1378 patients, while batch predictions used an additional set of 336 images from 180 patients. The single-label AutoML model, trained on normal and abnormal fundus images, achieved an area under the precision-recall curve (AUPRC) of 0.9943. The multi-class single-label model, focused on single-pathology images, recorded an AUPRC of 0.9617, with performance metrics of these two single-label models proving comparable to those of previously published models. The multi-label model, designed to detect both single and multiple pathologies, posted an AUPRC of 0.9650. Pathology classification AUPRCs for the multi-class single-label model ranged from 0.9277 to 1.0000 and from 0.8780 to 0.9980 for the multi-label model. Batch prediction accuracies ranged from 86.57% to 97.65% for various fundus conditions in the multi-label AutoML model. Statistical analysis demonstrated that the single-label model significantly outperformed the other two models in all evaluated metrics (p<0.05).

Conclusion

AutoML models, developed by clinicians, effectively detected multiple fundus lesions with performance on par with that of deep-learning models crafted by AI specialists. This underscores AutoML’s potential to revolutionise ophthalmologic diagnostics, facilitating broader accessibility and application of sophisticated diagnostic technologies.
Sociodemographic and clinical predictors of quality-of-life outcome in children and young people with primary brain tumour in Karachi, Pakistan: a prospective cohort study
Authors: Zahid Nida , Enam Syed Ather , Mårtensson Thomas , Azam Iqbal , Mushtaq Naureen , Moochhala Mariya , Hassan Aneesa , Kausar Faiza , Bakhshi Saqib , Rehman Lal , Javeed Farrukh , Mughal Muhammad Nouman , Altaf Sadaf , Kirmani Salman , Brown Nick
Published: December 2024

Background

Children and young people (CYP) with primary brain tumour (PBT) are at high risk for developing late effects, potentially affecting long-term quality of life (QoL). In low-income and middle-income countries, QoL has not been studied in depth in CYP. In the present study, CYP treated for PBTs in Pakistan were evaluated regarding (A) mean change in QoL scores pretreatment and 12 months post-treatment and (B) predictors of change in QoL scores 12 months post-treatment.

Methods

A prospective cohort study was conducted from November 2020 to July 2023. CYP aged 5–21 years, with newly diagnosed PBTs, were recruited from tertiary care centres in Karachi, Pakistan. QoL was assessed using the Paediatric Quality of Life Inventory 4 generic and brain tumour module, pretreatment and at 12 months post-treatment, by a trained psychologist.

Results

A total of 48 patients diagnosed with PBTs were enrolled in the study. At the 12-month post-treatment, 25 (52%) of the patients were reassessed, while 23 (48%) were lost to follow-up. There was no significant difference in mean global QoL scores of patients at 12 months post-treatment. On multivariable analysis, there was a statistically significant improvement in mean global QoL scores among those who underwent total surgical tumour resection (beta 7.7; 95% CI 0.9, 14.5) and maximum safe surgical tumour resection (beta 10.6; 95% CI 4.7, 16.6). However, there was a significant decline in mean global QoL scores among those who had hydrocephalous at diagnosis managed with a shunt and/or external ventricular drain (EVD) (beta −10.0; 95% CI −14.5, –5.5).

Conclusion

This study found a decline in mean global QoL scores among those with hydrocephalous at diagnosis who were managed with a shunt and/or EVD but an improvement in those who underwent total or maximum safe surgical tumour resection. Larger-scale studies are needed to comprehensively evaluate and validate these outcomes.
Comparison of 1-hour floatation-REST versus conventional napping on heart rate variability in active individuals
Authors: Besson Cyril , De Stefani Gianluca , Baggish Aaron Leigh , Schmitt Laurent , Millet Gregoire , Gremeaux Vincent
Published: December 2024

Objectives

This study aimed to investigate the short-term effects of a 1-hour floatation-resting environmental therapy (FLO) versus conventional napping (NAP) on heart rate variability (HRV) in highly trained individuals.

Methods

20 non-fatigued participants underwent a prospective randomised interventional study comparing the impacts of FLO and NAP on both supine and standing HRV. Measurements were taken before and after each intervention under controlled conditions, and subjective experiences were assessed through questionnaires.

Results

FLO and NAP were associated with changes in HRV parameters but did so differently. NAP significantly enhanced supine parasympathetic activity, as evidenced by increased log-transformed root mean square of successive differences (p=0.02) and power spectral density (p=0.03) relative to heart rate (HR) values, confirming its effectiveness in promoting autonomic recovery. In contrast, despite being better perceived regarding subjective well-being (p=0.04), FLO conferred no significant changes in supine root mean square of successive differences and decreased power spectral density relative to HR (p=0.02). However, post-intervention comparisons were not statistically different. While supine HR decreased significantly following both interventions, standing HR measurements showed a non-significant increase for FLO compared with NAP (p=0.056).

Conclusion

In highly trained individuals, FLO and NAP demonstrated minimal impact on acute autonomic function. NAP appears more effective for enhancing short-term parasympathetic activity, while FLO provides a more enjoyable experience. These findings underscore the importance of personalised recovery strategies and emphasise the need for further research into individual responses and the long-term effects of these interventions.
Dual antiplatelet versus alteplase in anterior and posterior circulation minor stroke
Authors: Cui Yu , Chen Hui-Sheng
Published: December 2024

Objective

The Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy (DAPT) to alteplase in minor non-disabling stroke. This prespecified secondary analysis aimed to investigate whether the treatment effects were similar across stroke territories.

Methods

Participants were divided according to stroke territory, which were subdivided into DAPT and alteplase. An excellent functional outcome at 90 days defined as modified Rankin Scale scoring 0–1 was primary outcome. National Institutes of Health Stroke Scale (NIHSS) score change and early neurological improvement measured by a 2-point decline in NIHSS score at 24 hours were secondary outcomes. Symptomatic intracerebral haemorrhage (sICH) and bleeding events were safety outcomes. Primary analyses adjusted unbalanced baseline characteristics between treatments by multivariate logistic regression.

Results

A total of 719 patients were included: 566 in anterior circulation stroke (ACS) and 153 in posterior circulation stroke (PCS). Primary outcome was 94.1% in DAPT and 91.7% in alteplase among ACS patients (adjusted risk difference (RD) and 95% CI, 1.5% (−1.5% to 4.6%), p=0.32), while 91.2% in DAPT and 91.8% in alteplase among PCS patients (adjusted RD and 95% CI, −2.1% (−8.5% to 4.4%), p=0.53). Compared with alteplase, DAPT was associated with lower risk of sICH (p=0.03) and bleeding events (p<0.001) in ACS, but only lower risk of bleeding events (p=0.007) in PCS. Additionally, among ACS patients, the alteplase was superior to DAPT in terms of decrease in NIHSS score at 24 hours compared with admission (adjusted geometric mean ratio and 95% CI, −0.09 (−0.16 to −0.03), p=0.005) and early neurological improvement (adjusted RD and 95% CI, −7.2% (−11.6% to −2.7%), p=0.001).

Conclusion

Among ischaemic stroke with minor non-disabling symptoms, DAPT was similar with intravenous alteplase regarding long-term functional outcome and better safety regardless of ACS or PCS. The potential benefit of intravenous alteplase regarding early neurological improvement in patients with ACS warrants further investigation.

Trial registration number

NCT03661411.
Chinese Stroke Association guidelines on emergency stroke unit
Authors: Jing Jing , Xie Xuewei , Leng Xinyi , Wang David , Wang Yongjun
Published: December 2024

Organised stroke care has become a keystone in delivering efficient and effective treatment to patients with stroke with improved outcomes. Delivering timely acute reperfusion therapy to those with acute ischaemic strokes is key to good recovery. Emergency stroke unit (ESU) is a novel organised stroke care system developed in China. It centralises all necessary procedures for the diagnosis and treatment of acute stroke into one unit that can perform clinical assessment, imaging examination and acute treatments. In ESU, artificial intelligence algorithms are used to aid in reading brain images and making clinical decisions. Therefore, ESU can significantly enhance the efficiency of emergent stroke care. In this guideline, we aim to clarify the concept, construction standards and personnel requirements of an ESU, standardise ESU-based acute stroke triage and treatment workflow, establish metrics of quality control, facilitate the construction and promotion of ESU and continue the improvement of the quality of stroke care.
Confidential VMs Explained: An Empirical Analysis of AMD SEV-SNP and Intel TDX
Authors: Misono Masanori , Stavrakakis Dimitrios , Santos Nuno , Bhatotia Pramod
Published: December 2024

Confidential computing is gaining traction in the cloud, driven by the increasing security and privacy concerns across various industries. Recent trusted hardware advancements introduce Confidential Virtual Machines (CVMs) to alleviate the programmability and usability challenges of the previously proposed enclave-based trusted computing technologies. CVM hardware extensions facilitate secure, hardware-isolated encrypted VMs, promoting programmability and easier deployment in cloud infrastructures. However, differing microarchitectural features, interfaces, and security properties among hardware vendors complicate the evaluation of CVMs for different use cases. Understanding the performance implications, functional limitations, and security guarantees of CVMs is a crucial step toward their adoption.

This paper presents a detailed empirical analysis of two leading CVM technologies: AMD Secure Encrypted Virtualization-Secure Nested Paging (SEV-SNP) and Intel Trust Domain Extensions (TDX). We review their microarchitectural components and conduct a thorough performance evaluation across various aspects, including memory management, computational performance, storage and network stacks, and attestation primitives. We further present a security analysis through a trusted computing base (TCB) evaluation and Common Vulnerabilities and Exposures (CVE) analysis. Our key findings demonstrate, among others, the effect of CVMs on boot time, memory management and I/O, and identify inefficiencies in their context switch mechanisms. We further provide insights into the performance implications of CVMs and highlight potential room for improvement.
Learning-Augmented Decentralized Online Convex Optimization in Networks
Authors: Li Pengfei , Yang Jianyi , Wierman Adam , Ren Shaolei
Published: December 2024

This paper studies learning-augmented decentralized online convex optimization in a networked multi-agent system, a challenging setting that has remained under-explored. We first consider a linear learning-augmented decentralized online algorithm (LADO-Lin) that combines a machine learning (ML) policy with a baseline expert policy in a linear manner. We show that, while LADO-Lin can exploit the potential of ML predictions to improve the average cost performance, it cannot have guaranteed worst-case performance. To address this limitation, we propose a novel online algorithm (LADO) that adaptively combines the ML policy and expert policy to safeguard the ML predictions to achieve strong competitiveness guarantees. We also prove the average cost bound for LADO, revealing the tradeoff between average performance and worst-case robustness and demonstrating the advantage of training the ML policy by explicitly considering the robustness requirement. Finally, we run an experiment on decentralized battery management. Our results highlight the potential of ML augmentation to improve the average performance as well as the guaranteed worst-case performance of LADO.
Beyond App Markets: Demystifying Underground Mobile App Distribution Via Telegram
Authors: Guo Yanhui , Wang Dong , Wang Liu , Fang Yongsheng , Wang Chao , Yang Minghui , Liu Tianming , Wang Haoyu
Published: December 2024

The thriving mobile app ecosystem encompasses a wide range of functionalities. However, within this ecosystem, a subset of apps provides illicit services such as gambling and pornography to pursue economic gains, collectively referred to as "underground economy apps". While previous studies have examined these apps' characteristics and identification methods, investigations into their distribution via platforms beyond app markets (like Telegram) remain scarce, which has emerged as a crucial channel for underground activities and cybercrime due to the robust encryption and user anonymity.

This study provides the first comprehensive exploration of the underground mobile app ecosystem on Telegram. Overcoming the complexities of the Telegram environment, we build a novel dataset and analyze the prevalence, promotional strategies, and characteristics of these apps. Our findings reveal the significant prevalence of these apps on Telegram, with the total sum of subscription user numbers across channels promoting these apps equivalent to 1% of Telegram's user base. We find these apps primarily cater to gambling and pornography services. We uncover sophisticated promotional strategies involving complex networks of apps, websites, users, and channels, and identify significant gaps in Telegram's content moderation capabilities. Our analysis also exposes the misuse of iOS features for app distribution and the prevalence of malicious behaviors in these apps. This research not only enhances our understanding of the underground app ecosystem but also provides valuable insights for developing effective regulatory measures and protecting users from potential risks associated with these covert operations. Our findings provide implications for platform regulators, app market operators, law enforcement agencies, and cybersecurity professionals in combating the proliferation of underground apps on encrypted messaging platforms.
Tight Bounds for Dynamic Bin Packing with Predictions
Authors: Liu Mozhengfu , Tang Xueyan
Published: December 2024

MinUsageTime DBP is a variant of the Dynamic Bin Packing (DBP) problem that seeks to minimize the accumulated length of time for which bins are used in packing a sequence of items. This DBP variant models job dispatching for optimizing the busy time of machines, which finds applications in cloud computing and energy-efficient computing. This paper studies the MinUsageTime DBP problem with predictions about item durations (job lengths). We establish tight competitiveness bounds over the entire spectrum of prediction errors. First, we give a lower bound Ω(min {max{ε ⋅ √ log μ, ε
2
}, μ}) on the competitive ratio of any deterministic online algorithm, where μ is the max/min duration ratio of all items and ε is the maximum multiplicative prediction error. Then, we show that the competitive ratio of a recent algorithm has strictly higher asymptotic order than the above lower bound when ε = ω(1) ∧ ε = o(√ μ). Finally, we present an enhanced algorithm and prove that it achieves a competitive ratio matching the above lower bound, closing the gap for this problem.
Unusual Presentation of Extrapulmonary Tuberculosis as Laryngeal Mass in an Atypical Patient
Authors: Agarwal Rohan Dipesh , Marino Mark David , Whalen Matthew Joseph , Walker Ronald J.
Published: December 2024

Spread of Mycobacterium tuberculosis (MTB) to the larynx is exceedingly rare and can be obscured by more common conditions such as laryngeal cancer or oropharyngeal candidiasis, complicating an accurate diagnosis. Risk factors for chronic laryngeal disease, such as smoking and toxin exposure, place TB infection comparatively lower for consideration on a physician’s differential. However, identifying these lesions is crucial from a medical and public health perspective to prevent community spread. We report the case of a 60‐year‐old male who presented with dysphonia, pharyngitis, aphasia, and significant unintentional weight loss. X‐rays demonstrated focal opacities in the upper lung lobes. Laryngoscope biopsy revealed caseating granulomas and a positive culture for MTB. Laryngeal TB presents as a suspicious throat mass with nonspecific symptoms and should be thoroughly investigated by clinicians.
“We Don’t Have Any Clue What Will Happen to Them”: Perspectives of Women Who Had Gestational Diabetes About Long‐Term Child Outcomes
Authors: Oladimeji Oluwatoyin I. , Ohene-Agyei Phyllis , Lin Luling , Franke Nike , Rogers Jenny , Crowther Caroline A. , Harding Jane E.
Published: December 2024

In utero exposure to gestational diabetes mellitus (GDM) is associated with adverse long‐term outcomes. Little is known about how mothers perceive these outcomes and the support they need for optimal outcomes for their children. We aimed to explore how women perceive the risk of adverse outcomes for their children exposed to GDM and the support they require for their optimal health. We conducted semistructured interviews with women who experienced GDM in at least one previous pregnancy. Data collection continued until saturation, and analysis followed an iterative thematic approach. Twenty‐five mothers participated, and their perceptions about later outcomes for children exposed to GDM varied. Five themes were identified: relating GDM to the offspring’s later health; reactions to the potential for poor later outcomes; impact on child growth, development, and behavior; maintaining optimal health from childhood to adulthood; and recommendations for long‐term care. Most mothers received no information about potential later child outcomes; some based their views on assumptions. Some mothers who believed their children were at increased risk of poor outcomes expressed fear and worry, while others proactively ensured their children engaged in healthy lifestyle choices. Mothers emphasized the need for support within health facilities (information provision, linking antenatal with child records, and risk assessment) and in the community (social groups, home visits) to ensure optimal health of their children. These findings have potential implications for policy and practice changes to optimize later health outcomes for children exposed to GDM.
Hysteresis current control for single-phase transformerless inverter
Authors: Mohd Azhar Aina Suhailah , Azri Maaspaliza , Abd Halim Wahidah , Talib Md Hairul Nizam , Rasin Zulhani , Mohammed Mohd Fayzul
Published: December 2024

The total harmonic distortion (THD) of grid current and leakage current are significant for transformerless inverters, as they impact power quality, efficiency, and compliance with grid codes. Monitoring and minimizing these currents ensure safe and reliable grid integration of photovoltaic (PV) systems while reducing electromagnetic interference. Therefore, in this paper, the analysis THD of grid current and leakage current is described. The bipolar pulse width modulation (BPWM) technology provides a stable common-mode voltage (200 V), fewer leakage currents (< 30 mA), and better system efficiency, compared to the unipolar pulse width modulation (UPWM) technique. To ensure the inverter complies with the IEC 61000-3-2 class C (THDi < 5%), the current control strategy should be considered during the design of the transformerless inverter. Therefore, this paper presents an implementation and evaluation of the bipolar hysteresis current control (BHCC) technique. In comparison to the BPWM technique, the BHCC technique delivers lower leakage current (0.007274 A), reduced grid current harmonic distortion (1.81%), and increased efficiency.
Analysis and simulation of 7-level and 9-level cascaded H-bridge multi-level inverters
Authors: Banka Sujatha , Sunil Kumar Chava , Salkuti Surender Reddy , Bhupathiraju Sai Sruthi , Balakishan Kasoju Pragathi , Chaturya Paipoti Pooja , Namineni Rishitha
Published: December 2024

Multi-level inverters (MLIs) have created a new revolution in high-power and medium-voltage applications in industry and research. In recent years, cascaded multi-level inverters have gained significant interest due to their ability to generate high-quality output waveforms with reduced total harmonic distortion (THD). This paper discusses the analysis and simulation of 7-level and 9-level cascaded H-bridge multi-level inverters using mathematical models and simulation tools. The proposed research puts emphasis on evaluating the performance and control strategies of these inverters. The control strategies, including pulse width modulation (PWM) techniques, are discussed in depth, with a focus on their effect on output waveform quality and reduction of THD. The simulation results are compared to showcase the advantages offered by the cascaded multi-level inverters in terms of waveform quality. The findings demonstrate the superior performance and power quality advantages offered by these multi-level inverters compared to traditional two-level inverters. Additionally, a passive LC filter is designed and implemented along with a multi-level inverter configuration that helps to keep the THD within the limits specified by IEEE standards.
Multi-objective hunter prey optimizer technique for distributed generation placement
Authors: Duraisamy Kesavan , Ponnuru Sudhakiran , Deglus Jovin , Arulprakasam Sakthidasan , Palanisamy Rajakumar , Peter Raja Soosaimarian
Published: December 2024

Accommodation of distributed generation (DG) units in the distribution power network (DPN) reduces the power losses (PL), improves the voltage profile (VP), and enhances the stability. The size and site for distribution generations have to be optimized to avail favorable results. Otherwise, the DPN may experience greater power losses, higher voltage deviation, and voltage instability issues. This article implements an optimization technique using a hunter-prey optimizer (HPO) algorithm to optimize single and multiple (two) DG units in the radial DPN to minimize total real power losses (RPL) and total voltage deviation (TVD). The effectiveness of the HPO algorithm is assessed on the IEEE benchmark 69-bus radial DPN and a real-world Cairo-59 bus RDS. The simulation outcome after the optimized inclusion of DGs shown significant RPL reduction and considerable voltage enhancement. Furthermore, the optimized results of HPO algorithm were compared to the different algorithms and the comparison proved that the HPO can provide a more promising and authentic outcome than other algorithms.
An optimal energy management strategy for a stand-alone PV/wind/battery hybrid energy system
Authors: Zebraoui Otmane , Bouzi Mostafa , Nasiri Badr
Published: December 2024

This paper presents an optimization study of a stand-alone hybrid energy system that includes a photovoltaic energy generator, a wind energy generator, and lithium-ion storage batteries. In the proposed system architecture, solar, and wind sources are utilized as the primary power generators, while batteries serve as a secondary storage to ensure system autonomy across varying weather conditions. The aim is to improve system performance through an optimal energy management strategy that addresses operational constraints and electrical load needs while managing energy flow between sources and controlling the storage system. To manage energy flow between sources and load, an intelligent approach using a hierarchical algorithm is proposed to configure the optimal operating mode based on the power from both sources, load power, and battery state of charge. Additionally, a controller is developed to manage battery operating modes, ensuring state of charge (SOC) limits and maintaining a constant direct current (DC) bus voltage. Under varying operating conditions, the simulation results show the efficiency of the proposed management strategy in maintaining the power balance between supply and demand, providing a stable and continuous power supply, and keeping the batteries SOC within its limits and the DC bus voltage at its reference value.