bluuebunny/crossref_metadata_2025 huggingface dataset:
Issues limiting the evaluation of post implemented enterprise architecture
Authors: Darvish Rouhani Babak , Nikpay Fatemeh , Binti Ahmad Rodina
Published: March 2020

Evaluation in enterprise architecture (EA) project is crucial to provide comprehensive information of the developed EA artefacts. It may assist in accurate evaluation of implemented Information Systems (ISs) in order to realize the achievement of EA’s goals and support EA decision makers. This research aims to identify and elaborate the existing issues of EA evaluation models. One of the crucial identified issues is to understand, capture and represent core aspects of EA artefacts. Most existing evaluation models do not provide structured approach which cover comprehensive aspect of EA implementation and some do not provide good practices to be applied. Hence, this research intends to cover the gap by exploring critical issues in EA implementation evaluation and elaborating main shortcomings of the reviewed EA models and methods through a systematic literature review
A novel approach to big data analysis using deep belief network for the detection of android malware
Authors: Narayanan Uma , Paul Varghese , Joseph Shelbi
Published: March 2020

Mobile and tablets are rapidly getting the chance to be basic device in the everyday life. Android has been the most well-known versatile working structure. Regardless, inferable from the open thought of Android, amount of malware is concealed in a broad number of kind applications in Android exhibits that really undermine Android security. Deep learning is another domain of AI explore that has expanded extending thought in artiﬁcial information. In this examination, we propose to relate the features from the static examination with features from the dynamic examination of Android applications and depict malware using Deep learning systems. What's more, besides distinguishing sensitive customer data sources is fundamental for security protection in portable applications. So we propose a Novel way to deal with overseeing tremendous information examination utilizing Deep learning for the affirmation of Android malware.
Implementation flow control to improve quality of service on computer networks
Authors: Khafidin Ahmad , Andrasto Tatyantoro , Suryono Suryono
Published: March 2020

Quality of Service (QoS) is the collective effect of service performances, which determine the degree of satisfaction of a user of the service. In addition, QoS defined as the ability of a network to provide good service. QoS aims to provide different quality of services for various needs in the IP network. QoS parameters that can be used to analyze the data communication services are jitter, packet loss, throughput, and delay. The quality of QoS parameters in the network is affected by congestion. Congestion occurs because there is an excessive queue in the network. Congestion can be prevented by implementing flow control on network. Flow control is a method to control the data packet flow in a network. By controlling of the data packet flow, it can improve of QoS. This study intends to find out value of QoS on the internet network at Faculty Engineering, State University of Semarang by measuring network performance using QoS parameters. Then, in this research will be implemented the token bucket method as a flow control mechanism at the network to improve the QoS. After research and data analysis, internet network at Faculty Engineering State University of Semarang has QoS value was 3,5 with 87,5 % of percentage and classified in satisfying of category. When measuring the network performance, there are decreases of performance at access point that having data rates 150 Mbps with many users connected. It has 9,0 ms of delay value, 0.046 ms of jitter, 16,6% of packet loss and, 1293407 bps of throughput. After token bucket was applied as flow control mechanism that be simulated on Graphical Network Simulator 3, the internet network has QoS values 3,75 with 93,75 % of percentage and classified as “satisfying” category. Furthermore, the percentage of the throughput value obtained on network by implementing flow control is 62%, while on the existing network is 41%.
A novel key exchange algorithm for security in internet of things
Authors: Koduru Suresh , Prasad Reddy PVGD , Preethi Padala
Published: March 2020

Today Internet of things (IoT) interconnects any object possessing sensing and computing capabilities to the internet. In this era, increasing number of electronic devices and applications in Internet of Things (IoT) requires secured communication with low power consumption capabilities. As security is a major challenge in internet of things, it is important to design a key management solution that considers resource constrained nodes and hence key management in public key cryptography is a crucial issue. In this paper, a novel key exchange algorithm was developed and implemented on a low powered “Raspberry pi machine” to realize the overall impact it creates on the device. The performance of the proposed algorithm had shown a great improvement over the popular Diffie Hellman key exchange algorithm and a two-level security for data exchange between the parties is implemented.
A simulation based performance evaluation of optical ethernet switch
Authors: Hailu Dawit Hadush , Lema Gebrehiwet Gebrekrstos , Tesfamariam Gebremichael T. , Sutikno Tole
Published: March 2020

With the advent of several new cloud radio access network (C-RAN) technologies, today’s networking environment is dramatically altered and is experiencing a rapid transformation. One of the most important is ethernet based C-RAN, in support of which many products such as optical Ethernet switches have recently appeared on the market. This paper presents the performance analysis of such switches with respect to packet loss ratio (PLR), latency and packet delay variation (PDV). We employed the Simula based on discrete event modelling on Simula (DEMOS), a context class for discrete event simulation to simulate a cut-through optical ethernet switch under two types of traffics: high priority (HP) traffic and low priority (LP) traffic. In this way, the paper evaluates the optical Ethernet switch performance quantitatively. The results obtained from the simulator showed that the high quality of service was reflected on HP traffic and the low quality of service in LP traffic. Hence, HP traffic can be used for transporting radio over ethernet (RoE) traffic while LP traffic can used for transporting time insensitive application. It is also found that HP traffic experiences a PDV equals to the duration of maximum sized LP traffic in Optical Ethernet switch.
Opportunities and Challenges of Claims-Based Quality Assessment: The Case of Postdischarge β-Blocker Treatment in Patients With Heart Failure With Reduced Ejection Fraction
Authors: Gilstrap Lauren , Skinner Jonathan S. , Gladders Barbara , O’Malley, A. James , Barnato Amber E. , Tosteson Anna N. A. , Austin Andrea M.
Published: March 2020

Background:

To combat the high cost and increasing burden of quality reporting, the Medicare Payment Advisory (MedPAC) has recommended using claims data wherever possible to measure clinical quality. In this article, we use a cohort of Medicare beneficiaries with heart failure with reduced ejection fraction and existing quality metrics to explore the impact of changes in quality metric methodology on measured quality performance, the association with patient outcomes, and hospital rankings.

Methods and Results:

We used 100% Medicare Parts A and B and a random 40% sample of Part D from 2008 to 2015 to create (1) a cohort of 295 494 fee-for-service beneficiaries with ≥1 hospitalization for heart failure with reduced ejection fraction and (2) a cohort of 1079 hospitals with ≥11 heart failure with reduced ejection fraction admissions in 2014 and 2015. We used Part D data to calculate β-blocker use after discharge and β-blocker use over time. We then varied the quality metric methodologies to explore the impact on measured performance. We then used multivariable time-to-event analyses to explore the impact of metric methodology on the association between quality performance and patient outcomes and Kendall’s Tau to describe impact of quality metric methodology on hospital rankings. We found that quality metric methodology had a significant impact on measured quality performance. The association between quality performance and readmissions was sensitive to changes in methodology but the association with 1-year mortality was not. Changes in quality metric methodology also had a substantial impact on hospital quality rankings.

Conclusions:

This article highlights how small changes in quality metric methodology can have a significant impact on measured quality performance, the association between quality performance and utilization-based outcomes, and hospital rankings. These findings highlight the need for standardized quality metric methodologies, better case-mix adjustment and cast further doubt on the use of utilization-based outcomes as quality metrics in chronic diseases.
A new species of Myrceugenia (Myrtaceae) from Southern Brazil

Authors: VIEIRA FÁBIO CHRISTIANO SPECK
Published: March 2020

Myrceugenia joinvillensis, a new species from the Brazilian Atlantic Forest is described and compared with related species. This taxon seems to be restricted to the Serra do Mar range in the Southern Brazilian state of Santa Catarina in the municipalities of Joinville and Schroeder. Additionally, there are provided information on its phenology, distribution and conservation status.
Phylogenetic relationships and systematics of a subclade of Mesoamerican
emerald hummingbirds (Aves: Trochilidae: Trochilini)
Authors: HERNÁNDEZ-BAÑOS BLANCA E. , ZAMUDIO-BELTRÁN LUZ E. , MILÁ BORJA
Published: March 2020

Phylogenetic relationships among major hummingbird clades are relatively well resolved, yet due to the lack of morphological synapomorphies and relative phenotypic homogeneity, the systematics of several hummingbird groups remain unresolved. Here, we present the results of a multilocus study of a clade of emerald hummingbirds composed of Cynanthus, Chlorostilbon, Riccordia and Phaeoptila (sensu Stiles et al. 2017). We include taxa not analyzed in previous studies (C. lawrencei, C. auriceps and C. forficatus, from Tres Marías Islands, Western Mexico, and Cozumel Island, respectively), and this allows us to develop a new hypothesis for the phylogenetic relationships within this group. We found that this clade originated in Mesoamerica about 12 million years ago, and comprises four geographically congruent clades: (a) the most basal clade, Phaeoptila sordida, of the Balsas River basin, Mexico; (b) Riccordia bicolor, R. maugaeus, R. ricordii and R. swainsonii of the West Indies; (c) Chlorostilbon assimilis, C. aureoventris, C. melanorhynchus, C. mellisugus, C. poortmani and C. pucherani, all of South America, except C. assimilis of Central America; and (d) a Mesoamerican clade with two Cynanthus subclades: a widespread Mexican clade that includes species formerly belonging to the genus Chlorostilbon: Cynanthus auriceps, C. canivetii, C. doubledayi and C. forficatus; and a clade restricted to the west coast of Mexico and the Tres Marías Islands and composed of C. latirostris and C. lawrencei. Our results help clarify the systematics of this group of emeralds, reconstruct its true evolutionary history, and advance understanding of phenotypic evolution in hummingbirds.
The Change in the ENSO Teleconnection under a Low Global Warming Scenario and the Uncertainty due to Internal Variability
Authors: Michel Clio , Li Camille , Simpson Isla R. , Bethke Ingo , King Martin P. , Sobolowski Stefan
Published: March 2020

El Niño–Southern Oscillation (ENSO) is a main driver of climate variability worldwide, but the presence of atmospheric internal variability makes accurate assessments of its atmospheric teleconnections a challenge. Here, we use a multimodel large ensemble of simulations to investigate the ENSO teleconnection response to a low global warming scenario that represents Paris Agreement targets. The ensemble comprises five atmospheric general circulation models with two experiments (present-day and +2°C) in which the same set of ENSO events is prescribed, which allows for quantification of the uncertainty in the ENSO response due to internal variability. In winter, the teleconnection during the positive ENSO phase features a strong negative anomaly in sea level pressure over the northeast Pacific (and vice versa for the negative phase); this anomaly shifts northeastward and strengthens in the warming experiment ensemble. At least 50–75 ENSO events are required to detect a significant shift or strengthening, emphasizing the need to adequately sample the internal variability to isolate the forced response of the ENSO teleconnection under a low warming scenario. Even more events may be needed if one includes other sources of uncertainty not considered in our experimental setup, such as changes in ENSO itself. Over North America, precipitation changes are generally more robust than temperature changes for the regions considered, despite large internal variability, and are shaped primarily by changes in atmospheric circulation. These results suggest that the observational period is likely too short for assessing changes in the ENSO teleconnection under Paris Agreement warming targets.
Local Quantitative Precipitation Forecast with Minimal Data Requirement—An Ensemble Approach
Authors: Mendez Turrubiates Raul Fernando , Gross Markus , Magar Vanesa
Published: March 2020

Operational weather forecasts are routinely performed at convection-allowing resolutions, and thus these forecasts generate weather features that appear to be realistic. However, at times the comparison of the forecast to observations is less favorable, particularly at grid scales. This lack of skill is partly due to the chaotic system underlying the weather. Another problem is that it is impossible to evaluate the risk of making decisions based on deterministic forecasts. However, running global high-resolution ensembles involves substantial computational resources. A 555-m resolution WRF ensemble based on stochastic perturbations of a deterministic forecast of the North American Mesoscale model was created. Observations are used to constrain the ensemble and improve the skill. This method increases the skill for forecasting 60-h accumulated precipitation in five standard, statistical metrics: bias, false alarm ratio, threat score, probability of detection, and success ratio. Furthermore, the ensemble continuous ranked probability score (CRPS) will be compared to a poor man’s ensemble. The forecast error is generally smaller in more than 70% of the case studies performed when compared to nine deterministic model forecasts. The ensemble-enhanced mesoscale system presented can help to determine the most likely scenario without the significant computational requirement of global ensembles and is expected to be useful when global high-resolution ensembles are not available.
Truck Platooning Under Real Traffic Conditions: First Insights on Behavioral Adaptations and Gap Preference of Professional Drivers
Authors: Castritius Sarah-Maria , Dietz Christoph Johannes , Schubert Patric , Moeller Johanna , Morvilius Simone , Hammer Sabine , Tran Chung Anh , Haas Christian T.
Published: March 2020

Objective

The aim of the study was to investigate (1) how different gap sizes are perceived by professional truck drivers under real traffic conditions and (2) whether semi-automated platoon driving leads to changes in driving behavior of subsequent manual driving.

Background

Platoon driving is a current branch in the development of automated driving in which two or more vehicles build a convoy. The lead vehicle is controlled manually while following vehicles are electronically coupled to it and drive semi-automated with small gaps in order to achieve a better traffic flow and potential fuel savings.

Method

In a real road experiment, 10 trained professional truck drivers completed a total of 33 test drives with a two-truck platoon on the German highway A9 with a gap size of either 15 or 21 m, in the leading and the following vehicle.

Results

(1) The drivers experienced both gap sizes as comfortable and preferred the smaller gap size of 15 m. (2) Both gap sizes led to significantly higher standard deviation of lane position in post- compared to pre-platoon driving. No significant difference in distance keepings in post- compared to pre-platoon driving occurred. Qualitative data give hints on difficulties, when switching back to regular truck driving.

Conclusion

The results implicate that small gap sizes are perceived as comfortable by drivers and that platoon driving has an influence on subsequent manual driving.

Application

Countermeasures to behavioral adaptations should be considered in order to ensure a safe conduction of platoon driving.
Biological Regeneration of Articular Cartilage in an Early Stage of Compartmentalized Osteoarthritis: 12-Month Results
Authors: Schinhan Martina , Toegel Stefan , Weinmann Daniela , Schneider Eleonora , Chiari Catharina , Gruber Martin , Nehrer Stefan , Windhager Reinhard
Published: March 2020

Background:

Biological regeneration in an early stage of osteoarthritis (OA) is an important clinical challenge. An early-stage compartmentalized OA model was used to evaluate different biological regeneration techniques.

Hypothesis:

Biological regeneration in an early stage of compartmentalized OA is possible.

Study Design:

Controlled laboratory study.

Methods:

A 7-mm cartilage defect was surgically created in 24 sheep. After 3 months, by which time early OA had set in, the sheep were randomized into 4 different treatment groups and operated for the second time. One group (CONTROL) served as a long-term follow-up group for the further development of OA. The other 3 groups (regeneration groups) each underwent a different regeneration procedure after abrasion of the subchondral bone (defect size: 20 × 10 mm with a depth of 2.5 mm): spongialization alone (SPONGIO), spongialization followed by implantation of an unseeded hyaluronan matrix (MATRIX), or spongialization followed by implantation of a hyaluronan matrix seeded with autologous chondrocytes (MACT). Then, 12 months after the second operative procedure, the animals were euthanized and the defects subjected to macroscopic and histological grading. Historical 4-month data were compared with the 12-month results.

Results:

After 12 months of follow-up, advanced cartilage degeneration was observed in the CONTROL group. On the other hand, all regeneration groups improved significantly compared with the 4-month results using the Mankin score. Cartilage quality in the MACT group was significantly better than in the MATRIX group, as determined by the Mankin and the O’Driscoll scores.

Conclusion:

There are no existing clinical options for preventing early OA from progressing to a severe disease. This study provides important information on how a surgical intervention can forestall the development of OA.

Clinical Relevance:

OA of the knee is very common. Total joint replacement is not an acceptable option for active patients. Biological regeneration in OA is successful for focal cartilage defects; however, a long-term follow-up for biological regeneration in OA is missing. It is essential to have long-term results for a regenerative procedure involving cartilage, which is a tissue with a very slow turnover.
Ultrasound-Assisted Liposuction and Helium-Activated Radiofrequency Skin Tightening for Treatment of Paradoxical Adipose Hyperplasia After Cryolipolysis
Authors: Mowlavi Arian , Farrell Jason , Talle Armin , Berri Mariam , Hamlet Grant
Published: March 2020

Paradoxical adipose hyperplasia (PAH) following cryolipolysis is a rare but deforming complication. This likely underreported adverse event has been described as being refractory to both traditional tumescent liposuction and repeated cryolipolysis treatments. Here, we present 3 isolated cases with PAH deformity created by cryolipolysis. Management of PAH on the abdomen and flanks involved 2 key elements: ultrasound-assisted liposuction (UAL) technology and helium-activated radiofrequency (RF) energy subdermal coagulation. We observed complete resolution and definitive correction of PAH deformities at 2 weeks, 1 month, and 3 months postoperatively. UAL combined with helium-activated RF subdermal coagulation is a viable surgical modality to correct contour irregularities seen in PAH following cryolipolysis.
Exploring soundscaping options for the cognitive environment in an open-plan office
Authors: Lee Young , Nelson Elizabeth C , Flynn Mark J , Jackman Joshua S
Published: March 2020

A major source of noise complaints in open-plan offices has consistently been co-workers talking nearby or talking on the phone. Various masking sounds such as white noise and pink noise have been explored to reduce the intelligibility level of speech from adjacent co-workers in open-plan offices. Recently, nature soundscapes such as water, rainfall or birdsong have been introduced instead of conventional white or pink noises. Water sounds with limited acoustic variation have shown more effectiveness than nature sounds with high acoustic variation such as birdsong. This study examined four types of background sounds in a controlled lab environment that simulated a typical open-plan office in a large pharmaceutical company in the United Kingdom. The purpose was to understand cognitive performance, satisfaction and preference, and physiological responses among the four types of background sounds: no external acoustic noise, typical daily office noise, white noise and spring water sound. The study employed three methods: an assessment of cognitive performance to measure memory, distractibility and decision-making; a survey to understand subjective satisfaction and preference; and use of wearable devices to monitor physiological responses. Two different types of wearable devices were used: pulse oximeter and electrodermal activity sensor to compare physiological responses to the four types of sounds. This article discusses discrepancies found between participants’ satisfaction/preference and their cognitive performance under the four background sounds and potential future implications of masking sounds in open-plan offices.
A network analysis of culturally relevant anxiety sensitivity and posttraumatic stress disorder symptoms in Cambodians
Authors: Hinton Devon E , McNally Richard J , Fairfax Regina C E , Harachi Tracy W
Published: March 2020

The Anxiety Sensitivity Index (ASI) measures fears of anxiety-related symptoms based on respondent beliefs about their harmfulness. This is the first network analysis of anxiety sensitivity and PTSD, and the first to explore an addendum of culturally salient fears in such an analysis. The purpose of our study was to test whether relations among PTSD symptoms and facets of anxiety sensitivity, observed clinically, can be visualized by this approach. Using network analysis, we examined in a Cambodian population the relationship of PTSD symptoms to the standard Anxiety Sensitivity Index (ASI) and to an ASI Cambodian Addendum (ASICA) that taps culturally salient fears of somatic symptoms among Cambodians not assessed in the standard ASI. Computing relative importance networks, we found that the ASI subscales, ASICA, and PTSD subscales were strongly interconnected, with the ASICA having the strongest outstrength centrality. In the network analysis of the ASI subscales, disaggregated ASICA, and PTSD subscales, several of the ASICA items had very high outstrength. The results show that fear of mental and physical symptoms of anxiety should be a key part of the evaluation of trauma-related disorder, and that those fears should be targeted. It also suggests the need for ASI addenda to assess concerns about anxiety symptoms salient for certain cultures that are not assessed by the standard ASI: among Cambodian populations, fear of cold hands and feet, “out of energy in the arms and legs,” neck soreness, tinnitus, and dizziness on standing.
Profiling foreign policy leaders in their own language: New insights into the stability and formation of leadership traits
Authors: Rabini Christian , Brummer Klaus , Dimmroth Katharina , Hansel Mischa
Published: March 2020

Leaders matter in international politics. One of the main tools for assessing at-a-distance psychological characteristics of political leaders is Leadership Trait Analysis. To facilitate empirical studies, a Leadership Trait Analysis coding scheme for automated text analysis was developed to replace hand-coding. However, the coding scheme has been available only for English-language texts. To broaden research opportunities, this article presents a novel Leadership Trait Analysis coding scheme for the German language. This coding scheme allows engaging in empirical analysis based on original German language sources, thereby shedding new or different light on German foreign policy. At the same time, it contributes to moving automated content analysis beyond the English language more generally.
Insights into hospital readmission patterns of atrial fibrillation patients
Authors: Bumpus Sherry , Krallman Rachel , McMahon Colin , Gupta Ashwin , Montgomery Daniel , Kline-Rogers Eva , Vaishnava Prashant
Published: March 2020

Introduction:

Patients admitted to the hospital with atrial fibrillation have associated morbidity and mortality and incur significant costs. Data characterizing atrial fibrillation patients at high risk for readmission are scarce. We sought to inform this area by characterizing and categorizing unplanned readmissions of atrial fibrillation patients.

Methods:

Retrospective data were abstracted from the charts of patients discharged from 2008 to 2012 after an index hospitalization for atrial fibrillation and referred to the nurse practitioner-led transitional care program, Bridging the Discharge Gap Effectively. Unplanned readmissions were dichotomized as early (⩽30 days) or late (31–180 days) and further classified as either “atrial fibrillation/atrial fibrillation-related” (AF/AF-related), “Cardiac; not AF/AF-related,” or “Not cardiac-related.” Case classifications were adjudicated by a senior cardiologist. Patient demographics and readmission characteristics were then compared.

Results:

Of 255 patients, 97 (38.0%) had unplanned readmissions within 180 days of discharge; 45 (46.4%) were early and 52 (53.6%) were late. Atrial fibrillation and cardiac causes accounted for 68.9% ( n=31) of early readmissions and 65.4% ( n=34) of late. Patients with late readmissions were more likely to have diabetes (32.7% vs. 17.7%, p=.022) and higher CHA2DS2VASc scores (3.63 vs. 2.98, p=0.026) than those not readmitted. No other differences in baseline characteristics were seen within or between groups. The 30-day all-cause readmission rate in this sample was 17.6% ( n=45).

Conclusion:

Readmissions following hospital discharge for atrial fibrillation are common; approximately 50% of these readmissions are for reasons unrelated to atrial fibrillation. In order to reduce atrial fibrillation-related readmissions, further research is needed to characterize predictors of readmission and to develop effective transitional care interventions.
Pin1 plays a key role in the response to treatment and clinical outcome in triple negative breast cancer
Authors: Knowlson Catherine , Haddock Paula , Bingham Victoria , McQuaid Stephen , Mullan Paul B. , Buckley Niamh E.
Published: March 2020

Background:

Triple negative breast cancer (TNBC) is the subset of breast cancer associated with the poorest outcome, and currently lacks targeted treatments. Standard of care (SoC) chemotherapy often consists of DNA damaging chemotherapies ± taxanes, with a range of responses observed. However, we currently lack biomarkers to predict this response and lack alternate treatment options.

Methods:

Pin1 expression was modulated in vitro and proliferation and treatment response was studied. Pin1 expression was analysed in patient samples and correlated with clinical outcome.

Results:

In this study, we have shown that the prolyl isomerase, Pin1, which is highly expressed in TNBC, plays a key role in pathogenesis of the disease. Knockdown of Pin1 in TNBC resulted in cell death while the opposite is seen in normal cells. We revealed for the first time that loss of Pin1 leads to increased sensitivity to Taxol but only in the absence of functional BRCA1. Conversely, loss of Pin1 results in decreased sensitivity to DNA-damaging agents independent of BRCA1 status. Analysis of Pin1 gene or IHC-based expression in over 200 TNBC patient samples revealed a novel role for Pin1 as a TNBC-specific biomarker, with high expression associated with improved outcome in the context of SoC chemotherapy. Preliminary data indicated this may be extended to other treatment options (e.g. Cisplatin/Parp Inhibitors) that are gaining traction for the treatment of TNBC.

Conclusions:

This study highlights the important role played by Pin1 in TNBC and highlights the context-dependent functions in modulating cell growth and response to treatment.
Cough reflex sensitivity and urge-to-cough deterioration in dementia with Lewy bodies
Authors: Ebihara Takae , Gui Peijun , Ooyama Chika , Kozaki Koichi , Ebihara Satoru
Published: March 2020

Cough, an important respiratory symptom, predominantly involves the brainstem and the urge-to-cough (UTC) is modulated by the cerebral cortex. Lewy body disease is associated with decreased cough reflex sensitivity and central respiratory chemosensitivity. Additionally, the insula, associated with the UTC, shows decreased activation and atrophy in dementia with Lewy bodies (DLB). We investigated the relationships between cognition and cough reflex and the UTC and compared the differences in responses of patients with DLB and other dementia subtypes.

We conducted a cross-sectional study within a geriatric ward of a university hospital involving elderly patients diagnosed with Alzheimer's disease (AD), DLB, or non-dementia (controls). The cough reflex sensitivities were estimated based on the lowest concentrations of inhaled citric acid that could induce ≥2 coughs (C2) or ≥5 coughs (C5). Subjects were asked to rate the UTC based on the threshold concentrations (Cu) using the modified Borg scale.

C2, C5and Cuwere negatively correlated with cognitive function in female participants but not in males (p<0.01). The cough reflex sensitivities expressed as C2and C5were significantly higher in the DLB group than in the AD and control groups (p<0.01 adjusted for gender). The UTC threshold expressed as Cuwas also significantly higher in the DLB group, while the UTC log–log slope was less responsive in the DLB group than in the other groups.

The cough reflex sensitivity and perceived UTC deteriorated in the DLB group more than in the other groups. This result might be valuable in treating patients with DLB.
Comparative genomics analysis of c-di-GMP metabolism and regulation in Microcystis aeruginosa
Authors: Chen Meng , Xu Chun-Yang , Wang Xu , Ren Chong-Yang , Ding Jiao , Li Li
Published: March 2020

Background

Cyanobacteria are of special concern because they proliferate in eutrophic water bodies worldwide and affect water quality. As an ancient photosynthetic microorganism, cyanobacteria can survive in ecologically diverse habitats because of their capacity to rapidly respond to environmental changes through a web of complex signaling networks, including using second messengers to regulate physiology or metabolism. A ubiquitous second messenger, bis-(3′,5′)-cyclic-dimeric-guanosine monophosphate (c-di-GMP), has been found to regulate essential behaviors in a few cyanobacteria but not Microcystis, which are the most dominant species in cyanobacterial blooms. In this study, comparative genomics analysis was performed to explore the genomic basis of c-di-GMP signaling in Microcystis aeruginosa.

Results

Proteins involved in c-di-GMP metabolism and regulation, such as diguanylate cyclases, phosphodiesterases, and PilZ-containing proteins, were encoded in M. aeruginosa genomes. However, the number of identified protein domains involved in c-di-GMP signaling was not proportional to the size of M. aeruginosa genomes (4.97 Mb in average). Pan-genome analysis showed that genes involved in c-di-GMP metabolism and regulation are conservative in M. aeruginosa strains. Phylogenetic analysis showed good congruence between the two types of phylogenetic trees based on 31 highly conserved protein-coding genes and sensor domain-coding genes. Propensity for gene loss analysis revealed that most of genes involved in c-di-GMP signaling are stable in M. aeruginosa strains. Moreover, bioinformatics and structure analysis of c-di-GMP signal-related GGDEF and EAL domains revealed that they all possess essential conserved amino acid residues that bind the substrate. In addition, it was also found that all selected M. aeruginosa genomes encode PilZ domain containing proteins.

Conclusions

Comparative genomics analysis of c-di-GMP metabolism and regulation in M. aeruginosa strains helped elucidating the genetic basis of c-di-GMP signaling pathways in M. aeruginosa. Knowledge of c-di-GMP metabolism and relevant signal regulatory processes in cyanobacteria can enhance our understanding of their adaptability to various environments and bloom-forming mechanism.
Developing evidence-based guidance for assessment of suspected infections in care home residents
Authors: Hughes Carmel , Ellard David R. , Campbell Anne , Potter Rachel , Shaw Catherine , Gardner Evie , Agus Ashley , O’Reilly Dermot , Underwood Martin , Loeb Mark , Stafford Bob , Tunney Michael
Published: March 2020

Background

The aim of this study was to update and refine an algorithm, originally developed in Canada, to assist care home staff to manage residents with suspected infection in the United Kingdom care home setting. The infections of interest were urinary tract infections, respiratory tract infections and skin and soft tissue infection.

Method

We used a multi-faceted process involving a literature review, consensus meeting [nominal group technique involving general practitioners (GPs) and specialists in geriatric medicine and clinical microbiology], focus groups (care home staff and resident family members) and interviews (GPs), alongside continual iterative internal review and analysis within the research team.

Results

Six publications were identified in the literature which met inclusion criteria. These were used to update the algorithm which was presented to a consensus meeting (four participants all with a medical background) which discussed and agreed to inclusion of signs and symptoms, and the algorithm format. Focus groups and interview participants could see the value in the algorithm, and staff often reported that it reflected their usual practice. There were also interesting contrasts between evidence and usual practice informed by experience. Through continual iterative review and analysis, the final algorithm was finally presented in a format which described management of the three infections in terms of initial assessment of the resident, observation of the resident and action by the care home staff.

Conclusions

This study has resulted in an updated algorithm targeting key infections in care home residents which should be considered for implementation into everyday practice.
ANACONDA: a new tool to improve mortality and cause of death data
Authors: Mikkelsen Lene , Moesgaard Kim , Hegnauer Michael , Lopez Alan D.
Published: March 2020

Background

The need to monitor the Sustainable Development Goals (SDGs) and to have access to reliable and timely mortality data has created a strong demand in countries for tools that can assist them in this. ANACONDA (Analysis of National Causes of Death for Action) is a new tool developed for this purpose which allows countries to assess how accurate their mortality and cause of death are. Applying ANACONDA will increase confidence and capacity among data custodians in countries about their mortality data and will give them insight into quality problems that will assist the improvement process.

Methods

ANACONDA builds on established epidemiological and demographic concepts to operationalise a series of 10 steps and numerous sub-steps to perform data checks. Extensive use is made of comparators to assess the plausibility of national mortality and cause of death statistics. The tool calculates a composite Vital Statistics Performance Index for Quality (VSPI(Q)) to measure how fit for purpose the data are. Extracts from analyses of country data are presented to show the types of outputs.

Results

Each of the 10 steps provides insight into how well the current data is describing different aspects of the mortality situation in the country, e.g. who dies of what, the completeness of the reporting, and the amount and types of unusable cause of death codes. It further identifies the exact codes that should not be used by the certifying physicians and their frequency, which makes it possible to institute a focused correction procedure. Finally, the VSPI(Q) allows periodic monitoring of data quality improvements and identifies priorities for action to strengthen the Civil Registration and Vital Statistics (CRVS) system.

Conclusions

ANACONDA has demonstrated the potential to dramatically improve knowledge about disease patterns as well as the functioning of CRVS systems and has served as a platform for galvanising wider CRVS reforms in countries.
Efficacy of the interpersonal and social rhythm therapy (IPSRT) in patients with bipolar disorder: results from a real-world, controlled trial
Authors: Steardo Luca , Luciano Mario , Sampogna Gaia , Zinno Francesca , Saviano Pasquale , Staltari Filippo , Segura Garcia Cristina , De Fazio Pasquale , Fiorillo Andrea
Published: March 2020

Background

Bipolar disorder (BD) is one of the most burdensome mental disorder, with a lifetime prevalence of 2.4%, with a prevalence of 0.6% for bipolar type I and 0.4% for bipolar type II. Several interventions have been developed to implement the treatment strategy of bipolar disorder, including the Interpersonal and Social Rhythm Therapy (IPSRT). This intervention has been specifically developed to manage patients’ stressful life events, improve the disruptions of social and circadian rhythms and increase adherence to medications. The aim of the present study is to assess the efficacy of IPSRT on affective and anxiety psychopathology, social functioning, response to pharmacological treatment and affective morbidity index (AMI) in BD patients.

Methods

BD patients were consecutively recruited at the Mood Disorder Unit of the University of Campania “Luigi Vanvitelli” and randomly assigned to the experimental group receiving the IPSRT or to the Treatment as Usual (TAU) group. Patients were assessed at baseline, after 3 and 6 months with several validated assessment tools and with the affective morbidity index.

Results

At the end of the intervention, compared to controls, patients from the experimental group reported a significant improvement in anxious depressive and manic symptomatology, global functioning; and response to mood stabilizers. Patients in the IPSRT group reported a reduction at the AMI score.

Conclusions

IPSRT has been confirmed to be effective in improving the clinical symptomology of BD patients and in improving the affective morbidity index. Further studies with longer follow-up are needed in order to assess the stability of the results.

Trial registration The study was approved by the local ethical review board (N001567/28.01.2018)
The dosimetric impact of replacing the TG-43 algorithm by model based dose calculation for liver brachytherapy
Authors: Duque Anna Sophie , Corradini Stefanie , Kamp Florian , Seidensticker Max , Streitparth Florian , Kurz Christopher , Walter Franziska , Parodi Katia , Verhaegen Frank , Ricke Jens , Belka Claus , Fonseca Gabriel Paiva , Landry Guillaume
Published: March 2020

Purpose

To compare treatment plans for interstitial high dose rate (HDR) liver brachytherapy with 192Ir calculated according to current-standard TG-43U1 protocol with model-based dose calculation following TG-186 protocol.

Methods

We retrospectively evaluated dose volume histogram (DVH) parameters for liver, organs at risk (OARs) and clinical target volumes (CTVs) of 20 patient cases diagnosed with hepatocellular carcinoma (HCC) or metastatic colorectal cancer (mCRC). Dose calculations on a homogeneous water geometry (TG-43U1 surrogate) and on a computed tomography (CT) based geometry (TG-186) were performed using Monte Carlo (MC) simulations. The CTs were segmented based on a combination of assigning TG-186 recommended tissues to fixed Hounsfield Unit (HU) ranges and using organ contours delineated by physicians. For the liver, V5Gy and V10Gy were analysed, and for OARs the dose to 1 cubic centimeter (D1cc). Target coverage was assessed by calculating V150, V100, V95 and V90 as well as D95 and D90. For every DVH parameter, median, minimum and maximum values of the deviations of TG-186 from TG-43U1 were analysed.

Results

TG-186-calculated dose was found to be on average lower than dose calculated with TG-43U1. The deviation of highest magnitude for liver parameters was -6.2% of the total liver volume. For OARs, the deviations were all smaller than or equal to -0.5 Gy. Target coverage deviations were as high as -1.5% of the total CTV volume and -3.5% of the prescribed dose.

Conclusions

In this study we found that TG-43U1 overestimates dose to liver tissue compared to TG-186. This finding may be of clinical importance for cases where dose to the whole liver is the limiting factor.
Platelets count and platelets indices; mean platelet volume and plateletcrit in pediatric chronic lung disease
Authors: Draz Iman H. , Shaheen Iman A. , Youssef Eman A.
Published: March 2020

Background

The lungs contribute in the final maturation of the circulating platelets, and some studies suggested that chronic lung disease (CLD) could impair circulating platelets maturation or count. Our aim was to study the validity of platelet count (PLT), mean platelet volume (MPV), and plateletcrit (PCT) as simple tools to assess chronic lung disease severity or predict its course.

Results

In 39 pediatric patients with CLD, we showed a significant rise in PLTs and PCT and a significant lower MPV when compared to normal controls (Pvalues 0.003, 0.010, 0.004, respectively). Also, a significant positive correlation was detected between the C reactive protein (CRP) level and both the PLTs and PCT (r0.327, 0.363 respectively) in addition to a significant reduction in MPV level in relation to the age of disease onset (Pvalue 0.031).

Conclusion

This study disagrees with the postulation that chronic lung disease could lead to the reduction of circulating platelets and emphasizes the role of increased platelets count and decreased MPV in reflecting the inflammatory condition underlying the chronic lung disease in the pediatric age group.
Long-term subjective memory after electroconvulsive therapy
Authors: Sigström Robert , Nordenskjöld Axel , Juréus Anders , Clements Caitlin , Joas Erik , Pålsson Erik , Landén Mikael
Published: March 2020

Background

There have been reports of long-term subjective memory worsening after electroconvulsive therapy (ECT).

Aims

To study the prevalence and risk factors of long-term subjective memory worsening among patients receiving ECT in routine clinical practice.

Method

Patients (n = 535, of whom 277 were included in the final analysis) were recruited from eight Swedish hospitals. Participants' subjective memory impairment was assessed before ECT and a median of 73 days after ECT using the memory item from the Comprehensive Psychopathological Rating Scale. Participants also rated their pre-ECT expectations and post-ECT evaluations of the effect of ECT on memory on a 7-point scale. We used ordinal regression to identify variables associated with subjective memory worsening and negative evaluations of the effect of ECT on memory.

Results

Comparisons of pre- and post-ECT assessments showed that subjective memory worsened in 16.2% of participants, remained unchanged in 52.3% and improved in 31.4%. By contrast, when asked to evaluate the effect of ECT on memory after treatment 54.6% reported a negative effect. Subjective memory worsening was associated with negative expectations before ECT, younger age and shorter duration of follow-up.

Conclusions

Although subjective memory improved more often than it worsened when assessed before and after ECT, a majority of patients reported that ECT had negative effects on their memory when retrospectively asked how ECT had affected it. This might suggest that some patients attribute pre-existing subjective memory impairment to ECT. Clinicians should be aware that negative expectations are associated with subjective worsening of memory after ECT.
Updated Analysis From KEYNOTE-189: Pembrolizumab or Placebo Plus Pemetrexed and Platinum for Previously Untreated Metastatic Nonsquamous Non–Small-Cell Lung Cancer
Authors: Gadgeel Shirish , Rodríguez-Abreu Delvys , Speranza Giovanna , Esteban Emilio , Felip Enriqueta , Dómine Manuel , Hui Rina , Hochmair Maximilian J. , Clingan Philip , Powell Steven F. , Cheng Susanna Yee-Shan , Bischoff Helge G. , Peled Nir , Grossi Francesco , Jennens Ross R. , Reck Martin , Garon Edward B. , Novello Silvia , Rubio-Viqueira Belén , Boyer Michael , Kurata Takayasu , Gray Jhanelle E. , Yang Jing , Bas Tuba , Pietanza M. Catherine , Garassino Marina C.
Published: March 2020

PURPOSE

In KEYNOTE-189, first-line pembrolizumab plus pemetrexed-platinum significantly improved overall survival (OS) and progression-free survival (PFS) compared with placebo plus pemetrexed-platinum in patients with metastatic nonsquamous non‒small-cell lung cancer (NSCLC), irrespective of tumor programmed death-ligand 1 (PD-L1) expression. We report an updated analysis from KEYNOTE-189 (ClinicalTrials.gov: NCT02578680 ).

METHODS

Patients were randomly assigned (2:1) to receive pemetrexed and platinum plus pembrolizumab (n = 410) or placebo (n = 206) every 3 weeks for 4 cycles, then pemetrexed maintenance plus pembrolizumab or placebo for up to a total of 35 cycles. Eligible patients with disease progression in the placebo-combination group could cross over to pembrolizumab monotherapy. Response was assessed per RECIST (version 1.1) by central review. No alpha was assigned to this updated analysis.

RESULTS

As of September 21, 2018 (median follow-up, 23.1 months), the updated median (95% CI) OS was 22.0 (19.5 to 25.2) months in the pembrolizumab-combination group versus 10.7 (8.7 to 13.6) months in the placebo-combination group (hazard ratio [HR], 0.56; 95% CI, 0.45 to 0.70]). Median (95% CI) PFS was 9.0 (8.1 to 9.9) months and 4.9 (4.7 to 5.5) months, respectively (HR, 0.48; 95% CI, 0.40 to 0.58). Median (95% CI) time from randomization to objective tumor progression on next-line treatment or death from any cause, whichever occurred first (progression-free-survival-2; PFS-2) was 17.0 (15.1 to 19.4) months and 9.0 (7.6 to 10.4) months, respectively (HR, 0.49; 95% CI, 0.40 to 0.59). OS and PFS benefits with pembrolizumab were observed regardless of PD-L1 expression or presence of liver/brain metastases. Incidence of grade 3-5 adverse events was similar in the pembrolizumab-combination (71.9%) and placebo-combination (66.8%) groups.

CONCLUSION

First-line pembrolizumab plus pemetrexed-platinum continued to demonstrate substantially improved OS and PFS in metastatic nonsquamous NSCLC, regardless of PD-L1 expression or liver/brain metastases, with manageable safety and tolerability.