bluuebunny/crossref_metadata_2025 huggingface dataset:
Unsupervised cluster‐based method for segmenting biological tumour volume of laryngeal tumours in 18F‐FDG‐PET images
Authors: Tafsast Abdelghani , Hadjili Mohamed Laid , Bouakaz Ayache , Benoudjit Nabil
Published: March 2017

In radiotherapy using 18‐fluorodeoxyglucose positron emission tomography (18F‐FDG‐PET), the accurate delineation of the biological tumour volume (BTV) is a crucial step. In this study, the authors suggest a new approach to segment the BTV in 18F‐FDG‐PET images. The technique is based on the k‐means clustering algorithm incorporating automatic optimal cluster number estimation, using intrinsic positron emission tomography image information. Clinical dataset of seven patients have a laryngeal tumour with the actual BTV defined by histology serves as a reference, were included in this study for the evaluation of results. Promising results obtained by the proposed approach with a mean error equal to (0.7%) compared with other existing methods in clinical routine, including fuzzy c‐means with (35.58%), gradient‐based method with (19.14%) and threshold‐based methods.
Accurate object distance estimation based on frequency‐domain analysis with a stereo camera
Authors: Yoo In‐Sub , Seo Seung‐Woo
Published: March 2017

Precise and robust distance measurement is one of the most important requirements for driving assistance systems and automated driving systems. In this study, the authors propose a new method for providing accurate distance measurements through frequency‐domain analysis based on a stereo camera by exploiting key information obtained from the analysis of captured images. Moreover, the proposed method was extensively tested and evaluated on a real urban road, highway and tunnel. Based on these results, the authors show that the proposed method provides more precise distance information in real time compared with conventional algorithms. By applying the authors' methodology to measure the distances of various objects, it can be demonstrated that their algorithm offers an improvement of up to 10%.
Design of distributed cooperative observer for heavy‐haul train with unknown displacement
Authors: Liu Wei‐Rong , Wang Dong‐Yang , Gao Kai , Huang Zhi‐Wu
Published: March 2017

Acquiring the relative displacement of adjacent vehicles when designing a distributed controller for a heavy‐haul train is a critical issue. As heavy‐haul trains run in complex, varying environments, the relative displacement of adjacent vehicles may not be measured accurately. To address this issue, this study proposes a distributed cooperative observer to estimate the relative displacement among train vehicles. First, a mass‐point elastic‐coupled dynamic model is constructed to capture the relative displacement of a heavy‐haul train, and the complex model is further decomposed into a series of reduced double integrators. Then, a distributed cooperative dynamic observer is designed for each reduced double integrator. State information is shared via communication among neighbouring observers to accurately estimate the relative displacements of the vehicles under system noise. The convergence of the cooperative observer error is analysed using a Riccati equation. Finally, the performance of the closed‐loop heavy‐haul train control system combined with the cooperative observer is rigorously evaluated using real parameter settings of Shuohuang Railway in China.
Colouring vehicle threat and minimising threat avoidance trajectory cost for adaptive vehicle collision defence system in active safe driving
Authors: Chang Ben‐Jye , Yu Bo‐Han , Liang Ying‐Hsin
Published: March 2017

The Advanced Driver Assistance Systems (ADASs) have been proposed to avoid vehicular accidents by using the inter‐vehicle cooperation mechanism, the real‐time‐based sharing of the road and traffic information, automatic controls of braking and acceleration and so on. Several critical challenges in ADAS are seldom discussed in related studies, including unstable driving in velocity or the road lane, driving assistance without driving path prediction, suddenly happening of human abnormal driving or mechanical vehicle accident and so on. Thus, this study proposes the Adaptive vehicle Collision Defence (ACD) system to minimise the driving threat under critical driving threats. The proposed ACD consists of three phases: the adaptive time‐to‐collision (TTC) determination phase, the threat probability analysis with colouring phase, and the threat avoidance phase. The main objectives are to minimise the driving threat probability and to achieve active safe driving for the advanced driver assistance systems. Numerical results indicate that the proposed ACD outperforms the compared approaches in TTC probability, driving threat probability, and region boundary.
Real‐time drowsiness detection using wearable, lightweight brain sensing headbands
Authors: Rohit Fnu , Kulathumani Vinod , Kavi Rahul , Elwarfalli Ibrahim , Kecojevic Vlad , Nimbarte Ashish
Published: March 2017

The feasibility of real‐time drowsiness detection using commercially available, off‐the‐shelf, lightweight, wearable electroencephalogram (EEG) sensors is explored. While EEG signals are known to be reliable indicators of fatigue and drowsiness, they have not been used widely due to their size and form factor. However, the use of lightweight wearable EEGs alleviates this concern. Spectral analysis of EEG signals from these sensors using support vector machines (SVMs) is shown to classify drowsy states with high accuracy. The system is validated using data collected on 23 subjects in fresh and drowsy states. An accuracy of 81% is obtained at a per‐subject level and 74% in cross‐subject validation using SVM with radial basis kernel. Using a temporal aggregation strategy, the cross‐subject validation accuracy is shown to improve to 87%. The EEG signals are also used to characterise the blink duration and frequency of subjects. However, classification of drowsy states using blink analysis is shown to have lower accuracy than that using spectral analysis.
Wearable computing for railway environments: proposal and evaluation of a safety solution
Authors: Ferreira Bruno V. , Serejo Gerson , Ferreira Mylena R. , Ferreira Danilo F. , Cardoso Leon , Yoshidome Ewelton , Arruda Helder , Lira Wallace , Ferreira Jair , Carvalho Eduardo , Pessin Gustavo , Souza Cleidson R.B.
Published: March 2017

Railways provide a transport system which is regarded as efficient but which is not immune of risks. The railway environment is also subject to extreme weather conditions including high temperatures, constant exposure to the sun, rainfall and wind. In addition, since it traverses several regions where there is no mobile phone coverage, communication is not possible between trains and people through a central system. Thus, it is worth considering if the development of technological solutions to increase the safety of employees who do maintenance work on the railways, might be a research area of potential value. This is the context in which this study has been undertaken, where an attempt is made to describe a solution based on wearable components for the safety of maintenance staff on the railways. This study outlines some of the challenges that should be taken into account for the solution put forward with regard to aspects of usability linked to people's perceptions of tactile, visual and sound alerts. In addition, there is a description of the solution set out and an assessment of communication devices that are aimed at allowing independence for the network data providers and maintaining the operating system of the whole railway network.
Global optimal energy management control strategies for connected four‐wheel‐drive hybrid electric vehicles
Authors: Qiu Lihong , Qian Lijun , Zomorodi Hesam , Pisu Pierluigi
Published: March 2017

This study presents a novel decentralised hierarchical global energy management control strategy for a group of connected four‐wheel‐drive hybrid electric vehicles (HEVs) in urban road conditions. In the higher level controller, signal phase and timing information and the optimal cruising velocity are combined to generate the target velocities for the HEVs. A model predictive control framework that focuses on the tracking of the target velocity and the associated desired control variable for every individual vehicle is proposed for the prediction of the optimal velocity that compromises fuel economy, mobility and safety. In the lower level controller, a dynamic programming problem is formulated that utilises the predicted velocity for the global energy management optimisation of every individual HEV. Simulation results validate the advantages of the proposed higher and lower level controllers.
Field test of train trajectory optimisation on a metro line
Authors: Zhao Ning , Chen Lei , Tian Zhongbei , Roberts Clive , Hillmansen Stuart , Lv Jidong
Published: March 2017

Train trajectory optimisation plays a key role in improving energy saving performance and it is currently receiving increasing attention in railway research because of rising energy prices and environmental concerns. There have been many studies looking for optimal train trajectories with various different approaches. However, very few of the results have been evaluated and tested in practice. This study presents a field test of an optimal train trajectory on a metro line to evaluate the performance and the practicability of the trajectory with respect to operational energy computation. A train trajectory optimisation algorithm has been developed specifically for this purpose, and a field test of the obtained trajectory has been carried out on a metro line. In the field test, the driver controls the train in accordance with the information given by a driving advisory system, which contains the results of the train trajectory optimisation. The field test results show that, by implementing the optimal train trajectory, the actual energy consumption of the train can be significantly reduced, thereby improving the operational performance. Moreover, the field test results are very similar to the simulation results, proving that the developed train kinematics model is effective and accurate.
Investigation on photonic crystal based all‐optical clocked D‐flip flop
Authors: Shaik Enaul haq , Rangaswamy Nakkeeran
Published: March 2017

In this study, the authors propose a photonic crystal‐based clocked D‐flip flop using multi‐mode interference (MMI). A central MMI waveguide is created for the interference of the input light and ports are placed at both input and output ends of it. The proposed structure is resulted with a contrast ratio (CR) of 9.63 and 5.84 dB at the outputs Q and with a response time or delay of less than 0.29 ps. Furthermore, the input and output waveguides are extended with sharp and smooth bend waveguides, respectively, in order to increase the delay of the structure as the delayed output is one of the main objectives of D‐flip flop. The modified D‐flip flop structure is operated with a delay of more than twofold of the basic structure by maintaining nearly the same CR at the output. The compactness and the fair simulation results of the proposed structure show that it is quite suitable to be a part of photonic integrated circuit.
Experimental design of the adaptive backstepping control technique for single‐phase shunt active power filters
Authors: Salimi Mahdi , Soltani Jafar , Zakipour Adel
Published: March 2017

In this study, a cascade two‐loop non‐linear controller is developed for single‐phase shunt active power filters which is robust and stable in a wide range of output current and DC‐link voltage changes. A variable structure proportional–integral controller is designed to regulate DC‐link voltage in the outer loop. Also filter output current is controlled in the inner loop using adaptive backstepping approach. All of the model uncertain parameters are estimated using designed estimation rules. By introduction of suitable Lyapunov functions, proposed controller stability is investigated using Barbalat lemma. Grid reference current is calculated indirectly using a phase‐locked loop circuit according to DC‐link voltage error. Designed active power filter has been implemented using TMS320F28335 digital signal processor and practical response of the developed controller is studied in some tests. It is shown that the proposed controller is able to eliminate harmonic components of the local load current with a fast dynamic response. Also, compensation capability of the designed non‐linear approach is compared with sliding mode controller in similar conditions.
Analysis of operating reserve demand curves in power system operations in the presence of variable generation
Authors: Krad Ibrahim , Gao David Wenzhong , Ela Erik , Ibanez Eduardo , Wu Hongyu
Published: March 2017

The electric power industry landscape is continually evolving. As emerging technologies such as wind and solar generating systems become more cost effective, traditional power system operating strategies will need to be re‐evaluated. The presence of wind and solar generation (commonly referred to as variable generation or VG) can increase variability and uncertainty in the net‐load profile. One mechanism to mitigate this issue is to schedule and dispatch additional operating reserves. These operating reserves aim to ensure that there is enough capacity online in the system to account for the increased variability and uncertainty occurring at finer temporal resolutions. A new operating reserve strategy, referred to as flexibility reserve, has been introduced in some regions. A similar implementation is explored in this study, and its implications on power system operations are analysed. Results show that flexibility reserve products can improve economic metrics, particularly in significantly reducing the number of scarcity pricing events, with minimal impacts on reliability metrics and production costs. The production costs increased due to increased VG curtailment – i.e. including the flexible ramping product in the commitment of excess thermal capacity that needed to remain online at the expense of VG output.
Techno‐economic evaluation of load frequency control systems for electric vehicle fleet integration
Authors: Bokhari Hamza , Westermann Dirk
Published: March 2017

Environmental concerns and policy directives coupled with renewable energy penetration targets in Europe and United States are leading to a greater need for identifying technical and economic characteristics that facilitate the integration of electric vehicles (EVs) in the electricity network. An important step in mitigating instability associated with unregulated EV charging and renewable power feed‐in is the integration of EVs as providers of load frequency control (LFC). This study presents an evaluation of six European and North American LFC systems on the basis of EV characteristics to identify suitability for EV integration. The evaluation shows that the Eastern Denmark network is most feasible for frequency containment and restoration reserve using EVs.
Comparison of solar radiation and PV generation variability: system dispersion in the UK
Authors: Palmer Diane , Koubli Elena , Cole Ian , Betts Thomas , Gottschalg Ralph
Published: March 2017

This study investigates how the number and geographical distribution of solar installations may reduce aggregate irradiance variability and therefore lessen the overall impact of photovoltaic (PV) on grid distribution. The current distribution of UK solar farms is analysed. It is found that variability is linked to site clustering. Other factors may include distance and direction between sites, proximity to coast, local topography and weather patterns (i.e. wind, cloud etc.). These factors do not operate in isolation but form a complex and unpredictable system. The UK solar farm fleet currently comprises a range of system sizes which, when viewed en masse, reduces temporal variation in PV generation. The predominant southwest–northeast direction of solar farm groups is also beneficial in reducing output variability within grid supply point areas.
Power system stability analysis under increasing penetration of photovoltaic power plants with synchronous power controllers
Authors: Remon Daniel , Cantarellas Antoni M. , Mauricio Juan Manuel , Rodriguez Pedro
Published: March 2017

The utilisation of renewable sources brings many benefits to electric power systems, but also some challenges such as the impact that renewable power plants employing power electronics have on the grid, which is gaining importance as the penetration of this type of generating stations increases, driven by the construction of large wind or solar photovoltaic (PV) power plants. This study analyses the impact of large‐scale PV power plants on a transmission grid for different penetration levels. The analysis considers power plants formed by a number of power converters employing synchronous power controllers (SPCs), that allow them to have a harmonious interaction with the grid, and compares their performance with that of conventional power converter controllers, assuming in both cases that the power plants participate in frequency and voltage regulation. The study addresses both the small‐signal stability of the system and its response to large disturbances that alter the active power balance and frequency stability. The results of the analysis show that PV power plants using SPCs are able to limit frequency deviations, improve the oscillation damping, and reduce the stress of other generating units, thus having a beneficial impact on the power system.
Robust smoothed ℓ0‐norm based approach for MIMO radar target estimation
Authors: Chen Jinli , Li Wei , Li Jiaqiang , Zhu Yanping
Published: March 2017

To enable the smoothed ℓ0‐norm (SL0) algorithm to offer accurate estimates of the target parameters in three dimensions of range, angle, and Doppler, the fine discretisation of the potential target space is required for multiple‐input multiple‐output (MIMO) radars, which results in the ill‐conditioned sensing matrix. Unfortunately, the SL0 algorithm will provide unacceptable results since the large errors occur in computing initial value and performing projection onto the feasible set through the use of the pseudo‐inverse of the ill‐conditioned sensing matrix. In this study, the authors present a robust SL0 approach for MIMO radars to provide accurate angle–range–Doppler estimates. The appropriate permutation matrix, which takes the place of the pseudo‐inverse of the sensing matrix in implementing SL0 algorithm, can be pre‐computed by taking advantage of the bi‐conjugate gradient stabilised approach and the singular value decomposition (SVD) of the sensing matrix. Simulation results show that the proposed algorithm not only has lower computational cost, but provides better performance in estimation of range–angle–Doppler parameters, compared with the regularised iterative reweighted minimisation approach, SL0 algorithm and its modified versions in combination with Tikhonov and truncated SVD methods.
End-to-End versus End-to-Side Microvascular Anastomosis: A Meta-analysis of Free Flap Outcomes
Authors: Ahmadi Iraj , Herle Pradyumna , Hunter-Smith David , Leong James , Rozen Warren , Miller George
Published: March 2017

Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes.

Methods A systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure.

Results RRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1.30 (95% confidence interval [CI]: 0.53–3.21) and 1.50 (95% CI: 0.85–2.67), respectively. The RRs of thrombosis and flap failure in ETS versus ETE arterial anastomosis groups were 1.04 (95% CI: 0.32–3.35) and 1.04 (95% CI: 0.72–1.48), respectively.

Conclusion Differences in rates of thrombosis and flap failure between ETE and ETS venous and arterial anastomoses are marginal and nonsignificant. As such, the type of anastomotic technique is best decided on a case-by-case basis, dependent on anatomical, surgical, and patient factors.
Evidence-based Surgery of Aortic Regurgitation: Results of a Questionnaire in German-speaking Countries
Authors: Steindl Johannes , Hitzl Wolfgang , Kiesslich Tobias , Seitelberger Rainald , Dinges Christian
Published: March 2017

Background evidence-based medicine (EBM) approaches have reached broad acceptance, both in conservative and surgical disciplines. The aim of this study is to clarify the role of EBM in a rare condition of aortic regurgitation (AR) with surgical indication.

Methods A purpose-built Internet-based questionnaire was sent to 607 cardiovascular surgeons in Germany, Austria, and Switzerland. A virtual 64-year-old patient's medical history was presented, including two ultrasound images and one computed tomography scan, showing a 58-mm aortic root aneurysm and a severe trileaflet regurgitant aortic valve. Participants had to choose their preferred therapeutic strategy from a list. Additionally, demographics including nationality, the center size, and the frequency of similar types of patients referred to their departments were collected.

Results Of 607 questionnaires, 100 were returned (16%). One participant was excluded due to conflicting answers. Most surgeons (n = 84; 84%) chose a valve-sparing root replacement (VSRR). A Bentall procedure was preferred by 13 surgeons (13%). Two surgeons voted for aortic valve replacement combined with partial root resection. The decision-making process was not significantly influenced by center size, nationality, or frequency of patients.

Conclusion Applying the current guidelines to our virtual study patient, 84% of participants acted accordingly choosing VSRR. Remarkably, 14% of these surgeons see less than 10 and 43% see not more than 20 comparable patients per year. Since the guidelines reserve VSRR for competent centers, those numbers as well as the guidelines themselves should be further discussed.
Injury to Perineal Branch of Pudendal Nerve in Women: Outcome from Resection of the Perineal Branches
Authors: Wan Eric , Goldstein Andrew , Tolson Hillary , Dellon A.
Published: March 2017

Background This study describes outcomes from a new surgical approach to treat “anterior” pudendal nerve symptoms in women by resecting the perineal branches of the pudendal nerve (PBPN).

Methods Sixteen consecutive female patients with pain in the labia, vestibule, and perineum, who had positive diagnostic pudendal nerve blocks from 2012 through 2015, are included. The PBPN were resected and implanted into the obturator internus muscle through a paralabial incision. The mean age at surgery was 49.5 years (standard deviation [SD] = 11.6 years) and the mean body mass index was 25.7 (SD = 5.8). Out of the 16 patients, mechanisms of injury were episiotomy in 5 (31%), athletic injury in 4 (25%), vulvar vestibulectomy in 5 (31%), and falls in 2 (13%). Of these 16 patients, 4 (25%) experienced urethral symptoms. Outcome measures included Female Sexual Function Index (FSFI), Vulvar Pain Functional Questionnaire (VQ), and Numeric Pain Rating Scale (NPRS).

Results Fourteen patients reported their condition pre- and postoperatively. Mean postoperative follow-up was 15 months. The overall FSFI, and arousal, lubrication, orgasm, satisfaction, and pain domains significantly improved (p < 0.05). The VQ also significantly improved (p < 0.001) in 13 (93%) of 14 patients. The NPRS score decreased on average from 8 to 3 (p < 0.0001). All four patients with urethral symptoms were relieved of these symptoms.

Conclusion Resection of the PBPN with implantation of the nerve into the obturator internus muscle significantly reduced pain and improved sexual function in women who sustained injury to the PBPN.
Surgeon-Based 3D Printing for Microvascular Bone Flaps
Authors: Taylor Erin , Iorio Matthew
Published: March 2017

Background Three-dimensional (3D) printing has developed as a revolutionary technology with the capacity to design accurate physical models in preoperative planning. We present our experience in surgeon-based design of 3D models, using home 3D software and printing technology for use as an adjunct in vascularized bone transfer.

Methods Home 3D printing techniques were used in the design and execution of vascularized bone flap transfers to the upper extremity. Open source imaging software was used to convert preoperative computed tomography scans and create 3D models. These were printed in the surgeon's office as 3D models for the planned reconstruction. Vascularized bone flaps were designed intraoperatively based on the 3D printed models.

Results Three-dimensional models were created for intraoperative use in vascularized bone flaps, including (1) medial femoral trochlea (MFT) flap for scaphoid avascular necrosis and nonunion, (2) MFT flap for lunate avascular necrosis and nonunion, (3) medial femoral condyle (MFC) flap for wrist arthrodesis, and (4) free fibula osteocutaneous flap for distal radius septic nonunion. Templates based on the 3D models allowed for the precise and rapid contouring of well-vascularized bone flaps in situ, prior to ligating the donor pedicle.

Conclusions Surgeon-based 3D printing is a feasible, innovative technology that allows for the precise and rapid contouring of models that can be created in various configurations for pre- and intraoperative planning. The technology is easy to use, convenient, and highly economical as compared with traditional send-out manufacturing. Surgeon-based 3D printing is a useful adjunct in vascularized bone transfer.

Level of Evidence Level IV.
Recombination reactions as a possible mechanism of mass-independent fractionation of sulfur isotopes in the Archean atmosphere of Earth
Authors: Babikov Dmitri
Published: March 2017

Significance

Mass-independent fractionation of sulfur isotopes found in the Archean surface deposits (more than 2.3 billion y old) represents a “smoking gun” of anoxic atmosphere and gives a key element for determining the time of the great oxygenation event. Finding the molecular-level mechanism of these isotope enrichments is essential for understanding the environment on Earth just before, at the time of appearance, and during the evolution of early life. The theory of sulfur recombination processes proposed in this paper offers one possible explanation for the mass-independent fractionation effect, giving geochemists a useful tool for studying the atmospheric chemistry of Archean Earth, based on the rock record available to them today.
ZNF50
3/
Zpo2
drives aggressive breast cancer progression by down-regulation of GATA3 expression
Authors: Shahi Payam , Wang Chih-Yang , Lawson Devon A. , Slorach Euan M. , Lu Angela , Yu Ying , Lai Ming-Derg , Gonzalez Velozo Hugo , Werb Zena
Published: March 2017

Significance

Transcription factor
GATA3
has emerged as one of top three altered genes in mammary tumors. In breast cancer,
GATA3
expression has been associated with an estrogen receptor (ER)-positive (ER
+
/luminal) phenotype. ER
+
tumor cells resemble more differentiated cells, and affected patients are more responsive to therapy and have overall better survival outcomes. Loss of
GATA3
correlates with ER
−
, less differentiated, and more aggressive tumors with poorer prognosis. We have identified zinc-finger elbow-related proline domain protein 2 (ZPO2) as a transcriptional repressor that down-regulates
GATA3
and promotes aggressive breast cancer. Thus, ZPO2 could be an important oncogenic target for prediction of aggressive breast cancer.
Recent progress in organocatalytic asymmetric total syntheses of complex indole alkaloids
Authors: Song Jin , Chen Dian-Feng , Gong Liu-Zhu
Published: March 2017

Indole and its structural analogues have been frequently found in numerous alkaloids, pharmaceutical products and related materials. The enantioselective construction of these structures allows efficient total synthesis of optically pure indole alkaloids, and hence has received worldwide interest. In the past decade, asymmetric organocatalysis has been recognized as one of the most powerful strategies to create chiral molecules with high levels of stereoselectivity. In particular, organocatalytic asymmetric cascade reactions often occur with multiple bond-breaking and forming events simultaneously or sequentially, leading to the appearance of various straightforward approaches to access core structures for asymmetric total synthesis. This review will summarize recent applications of asymmetric organocatalysis in the enantioselective synthesis of indole alkaloids.
Rapid Emergence of a New Clone Impacts the Population at Risk and Increases the Incidence of Type emm89 Group A Streptococcus Invasive Disease
Authors: Teatero Sarah , Coleman Brenda L. , Beres Stephen B. , Olsen Randall J. , Kandel Christopher , Reynolds Olivia , Athey Taryn B. T. , Musser James M. , McGeer Allison , Fittipaldi Nahuel
Published: March 2017

Background

Invasive group A Streptococcus (iGAS) disease caused by type emm89 strains has been increasing worldwide, driven by the emergence of an epidemic clonal variant (clade 3 emm89). The clinical characteristics of patients with emm89 iGAS disease, and in particular with clade 3 emm89 iGAS disease, are poorly described.

Methods

We used population-based iGAS surveillance data collected in metropolitan Toronto, Ontario, Canada during the period 2000–2014. We sequenced the genomes of 105 emm89 isolates representing all emm89 iGAS disease cases in the area during the period and 138 temporally matched emm89 iGAS isolates collected elsewhere in Ontario.

Results

Clades 1 and 2 and clade O, a newly discovered emm89 genetic variant, caused most cases of emm89 iGAS disease in metropolitan Toronto before 2008. After rapid emergence of new clade 3, previously circulating clades were purged from the population and the incidence of emm89 iGAS disease significantly increased from 0.14 per 100000 in 2000–2007 to 0.22 per 100000 in 2008–2014. Overall, emm89 organisms caused significantly more arthritis but less necrotizing fasciitis than strains of the more common type emm1. Other clinical presentations were soft tissue and severe respiratory tract infections. Clinical outcomes did not differ significantly between emm89 clades overall. However, clade 3 emm89 iGAS disease was more common in youth and middle-aged individuals.

Conclusions

The rapid shift in emm89 iGAS strain genetics in metropolitan Toronto has resulted in a significant increase in the incidence of emm89 iGAS disease, with noticeably higher rates of clade 3 disease in younger patients.
Central Nervous System Infection Diagnosis by Next-Generation Sequencing: A Glimpse Into the Future?
Authors: Mai Nguyen Thi Hoang , Phu Nguyen Hoan , Nhu Le Nguyen Truc , Hong Nguyen Thi Thu , Hanh Nguyen Ho Hong , Nguyet Lam Anh , Phuong Tran My , McBride Angela , Ha Do Quang , Nghia Ho Dang Trung , Chau Nguyen Van Vinh , Thwaites Guy , Tan Le Van
Published: March 2017

Japanese encephalitis virus was detected by deep sequencing for the first time in urine of a 16-year-old boy with encephalitis. Seroconversion and polymerase chain reaction analysis confirmed the metagenomics finding. Urine is useful for diagnosis of flaviviral encephalitis, whereas deep sequencing can be a panpathogen assay for the diagnosis of life-threatening infectious diseases.
Return to sport activities after subtalar arthroereisis for correction of pediatric flexible flatfoot
Authors: Martinelli Nicolò , Bianchi Alberto , Martinkevich Polina , Sartorelli Elena , Romeo Giovanni , Bonifacini Carlo , Malerba Francesco
Published: March 2017

The aim of this study was to establish whether children treated with subtalar arthroereisis for flexible flatfoot were able to return to sport activities. We reviewed 49 patients with a mean age at the time of surgery of 10.7 years. The type of sport activities, the number of sessions per week, the time dedicated to each session, and the level achieved were assessed preoperatively and at the last follow-up. Overall, 45 patients returned to sports after surgery. Surgery did not alter the duration, frequency, and type of sporting activities, but the participation in physical activities as well as the emotional status and footwear issues improved.
Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery
Authors: Connolly Joseph , Javed Zulqarnain , Raji Mukaila A. , Chan Winston , Kuo Yong-Fang , Baillargeon Jacques
Published: March 2017

Study Design.

A population-based retrospective cohort study.

Objective.

The aim of this study was to examine risk factors for long-term opioid use following lumbar spinal fusion surgery in a nationally representative cohort of commercially insured adults.

Summary of Background Data.

Opioid prescription rates for the management of low back pain have more than doubled in the US over the past decade. Although opioids are commonly used for the management of pain following lumbar spinal fusion surgery, to date, no large-scale nationally representative studies have examined the risk factors for long-term opioid use following such surgical intervention.

Methods.

Using one of the nation's largest commercial insurance databases, we conducted a retrospective cohort study of 8377 adults, aged 21 to 63 years, who underwent lumbar spinal fusion surgery between January 1, 2009, and December 31, 2012. Long-term opioid use was defined as ≥365 days of filled opioid prescriptions in the 24 months following lumbar fusion. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals for the risk of long-term opioid use following lumbar fusion.

Results.

After adjusting for covariates, the following factors were associated with an increased risk of long-term opioid use following surgery: duration of opioid use in the year before lumbar surgery [Referent (0 days); Quartile 1 (1–22 days) OR = 2.27, 95% CI = 1.48–3.49; Quartile 2 (23–72 days): OR = 5.94, 95% CI = 4.00–8.83; Quartile 3: (73–250 days) OR = 25.31, 95% CI = 17.26–37.10; Quartile 4 (≥250 days) OR = 219.95, 95% CI = 148.53–325.71)], refusion surgery (OR = 1.32, 95% CI = 1.02–1.72), and diagnosis of depression (OR = 1.43, 95% CI = 1.18–1.74). Receipt of anterior fusion was associated with a modest decrease in the risk of long-term opioid use (OR = 0.79, 95% CI = 0.63–0.99).

Conclusion.

These findings may provide clinically relevant information to physicians, patients, and their families regarding the risk factors for opioid dependence following lumbar fusion surgery.

Level of Evidence:3
Who Benefits Most From Individualized Physiotherapy or Advice for Low Back Disorders? A Preplanned Effect Modifier Analysis of a Randomized Controlled Trial
Authors: Hahne Andrew J. , Ford Jon J. , Richards Matthew C. , Surkitt Luke D. , Chan Alexander Y.P. , Slater Sarah L. , Taylor Nicholas F.
Published: March 2017

Study Design.

A preplanned effect modifier analysis of the Specific Treatment of Problems of the Spine randomized controlled trial.

Objective.

To identify characteristics associated with larger or smaller treatment effects in people with low back disorders undergoing either individualized physical therapy or guideline-based advice.

Summary of Background Data.

Identifying subgroups of people who attain a larger or smaller benefit from particular treatments has been identified as a high research priority for low back disorders.

Methods.

The trial involved 300 participants with low back pain and/or referred leg pain (≥6 wk, ≤6 mo duration), who satisfied criteria to be classified into five subgroups (with 228 participants classified into three subgroups relating to disc-related disorders, and 64 classified into the zygapophyseal joint dysfunction subgroup). Participants were randomly allocated to receive either two sessions of guideline based advice (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial, and neurophysiological factors (n = 156). Univariate and multivariate linear mixed models determined the interaction between treatment group and potential effect modifiers (defined a priori) for the primary outcomes of back pain, leg pain (0–10 Numeric Rating Scale) and activity limitation (Oswestry Disability Index) over a 52-week follow-up.

Results.

Participants with higher levels of back pain, higher Örebro scores (indicative of higher risk of persistent pain) or longer duration of symptoms derived the largest benefits from individualized physical therapy relative to advice. Poorer coping also predicted larger benefits from individualized physical therapy in the univariate analysis.

Conclusion.

These findings suggest that people with low back disorders could be preferentially targeted for individualized physical therapy rather than advice if they have higher back pain levels, longer duration of symptoms, or higher Örebro scores.

Level of Evidence: 2
The Confusion Assessment Method for the ICU-7 Delirium Severity Scale: A Novel Delirium Severity Instrument for Use in the ICU
Authors: Khan Babar A. , Perkins Anthony J. , Gao Sujuan , Hui Siu L. , Campbell Noll L. , Farber Mark O. , Chlan Linda L. , Boustani Malaz A.
Published: March 2017

Objectives:

Delirium severity is independently associated with longer hospital stays, nursing home placement, and death in patients outside the ICU. Delirium severity in the ICU is not routinely measured because the available instruments are difficult to complete in critically ill patients. We designed our study to assess the reliability and validity of a new ICU delirium severity tool, the Confusion Assessment Method for the ICU-7 delirium severity scale.

Design:

Observational cohort study.

Setting:

Medical, surgical, and progressive ICUs of three academic hospitals.

Patients:

Five hundred eighteen adult (≥ 18 yr) patients.

Interventions:

None.

Measurements and Main Results:

Patients received the Confusion Assessment Method for the ICU, Richmond Agitation-Sedation Scale, and Delirium Rating Scale-Revised-98 assessments. A 7-point scale (0–7) was derived from responses to the Confusion Assessment Method for the ICU and Richmond Agitation-Sedation Scale items. Confusion Assessment Method for the ICU-7 showed high internal consistency (Cronbach’s α = 0.85) and good correlation with Delirium Rating Scale-Revised-98 scores (correlation coefficient = 0.64). Known-groups validity was supported by the separation of mechanically ventilated and nonventilated assessments. Median Confusion Assessment Method for the ICU-7 scores demonstrated good predictive validity with higher odds (odds ratio = 1.47; 95% CI = 1.30–1.66) of in-hospital mortality and lower odds (odds ratio = 0.8; 95% CI = 0.72–0.9) of being discharged home after adjusting for age, race, gender, severity of illness, and chronic comorbidities. Higher Confusion Assessment Method for the ICU-7 scores were also associated with increased length of ICU stay (p = 0.001).

Conclusions:

Our results suggest that Confusion Assessment Method for the ICU-7 is a valid and reliable delirium severity measure among ICU patients. Further research comparing it to other delirium severity measures, its use in delirium efficacy trials, and real-life implementation is needed to determine its role in research and clinical practice.
Peptide-pulsed dendritic cell vaccine in combination with carboplatin and paclitaxel chemotherapy for stage IV melanoma
Authors: Fukuda Keitaro , Funakoshi Takeru , Sakurai Toshiharu , Nakamura Yoshio , Mori Mariko , Tanese Keiji , Tanikawa Akiko , Taguchi Junichi , Fujita Tomonobu , Okamoto Masato , Amagai Masayuki , Kawakami Yutaka
Published: March 2017

In this study, we aimed to evaluate the feasibility and efficacy of peptide-pulsed dendritic cell (DC) vaccine in combination with carboplatin and paclitaxel chemotherapy (DCCP) for patients with stage IV melanoma previously treated with dacarbazine-containing regimen. Six HLA-A24+ and 3 HLA-A02+ patients were treated with carboplatin (area under the curve 5) and paclitaxel (175 mg/m2) on day 1 and DCs (2×107 cells) pulsed with Wilms tumor gene 1 (WT1), gp100, tyrosinase, and either MAGE-A3 (for HLA-A24+) or MAGE-A2 (for HLA-A02+) peptides on days 8 and 22 in 28-day cycle for up to three cycles. DCCP was well tolerated, and median progression-free survival and median overall survival were 2.3 and 12.0 months, respectively. In four of nine patients, a WT1-specific immune response (WT1-IR) was detected using the interferon-γ enzyme-linked ImmunoSpot assay and WT1/HLA tetramer assay. DCCP was more likely to elicit a WT1-IR in patients who received DCs pulsed with the HLA-A24-restricted peptide (75%) compared with patients who received DCs pulsed with the HLA-A02-restricted peptide (0%, P=0.058). Furthermore, three (75%) of four patients with a WT1-IR survived longer than 12 months, whereas only one (20%) of five patients without a WT1-IR who received the BRAF inhibitor after DCCP survived longer than 12 months. These results suggest that DCCP may be beneficial for HLA-A24+ melanoma patients with a WT1-IR.
Common predictors of nurse-reported quality of care and patient safety
Authors: Stimpfel Amy Witkoski , Djukic Maja , Brewer Carol S. , Kovner Christine T.
Published: March 2017

Background:

In the era of the Patient Protection and Affordable Care Act, quality of care and patient safety in health care have never been more visible to patients or providers. Registered nurses (nurses) are key players not only in providing direct patient care but also in evaluating the quality and safety of care provided to patients and families.

Purpose:

We had the opportunity to study a unique cohort of nurses to understand more about the common predictors of nurse-reported quality of care and patient safety across acute care settings.

Approach:

We analyzed cross-sectional survey data that were collected in 2015 from 731 nurses, as part of a national 10-year panel study of nurses. Variables selected for inclusion in regression analyses were chosen based on the Systems Engineering Initiative for Patient Safety model, which is composed of work system or structure, process, and outcomes.

Results:

Our findings indicate that factors from three components of the Systems Engineering Initiative for Patient Safety model–Work System (person, environment, and organization) are predictive of quality of care and patient safety as reported by nurses. The main results from our multiple linear and logistic regression models suggest that significant predictors common to both quality and safety were job satisfaction and organizational constraints. In addition, unit type and procedural justice were associated with patient safety, whereas better nurse-physician relations were associated with quality of care.

Conclusion:

Increasing nurses’ job satisfaction and reducing organizational constraints may be areas to focus on to improve quality of care and patient safety.

Practical Implications:

Our results provide direction for hospitals and nurse managers as to how to allocate finite resources to achieve improvements in quality of care and patient safety alike.
Job demands, job resources, and behavior in times of sickness: An analysis across German nursing homes
Authors: Schneider Daniel , Winter Vera , Schreyögg Jonas
Published: March 2017

Background:

The concept of presenteeism, that is, employees coming to work despite being sick, has recently received more attention in the literature. Presenteeism not only threatens employees' health but also substantially drains productivity and drives considerable costs. When they are sick, employees have the choice of whether to go to work or to stay at home. Therefore, determinants of (sickness) absenteeism and presenteeism should be examined simultaneously. Nursing homes are faced with a particularly high prevalence of both absenteeism and presenteeism and are therefore a relevant object of investigation.

Purpose:

The aim of our study is to analyze the effect of job demands and job resources on absenteeism, presenteeism, and the tendency to choose one behavior (being absent or being present in times of sickness) rather than the other over the last 12 months. To do so, we identify the determinants of absenteeism and/or presenteeism behavior based on theory and existing research about absenteeism, presenteeism, and job demands and job resources. After our empirical analysis, we provide explanations for our findings and offer practical suggestions for how to decrease the frequencies of absenteeism and presenteeism.

Methodology:

In this study, a sample of 212 nurses from German nursing homes was used for an ordinal logistic regression analysis.

Results:

Our results show that role overload significantly increases the frequencies of both absenteeism and presenteeism. A good team climate decreases absenteeism and increases the tendency to choose presenteeism rather than absenteeism, whereas strategic training and development opportunities decrease presenteeism and increase the tendency to choose absenteeism rather than presenteeism.
A taxonomy of hospitals participating in Medicare accountable care organizations
Authors: Bazzoli Gloria J. , Harless David W. , Chukmaitov Askar S.
Published: March 2017

Background:

Medicare was an early innovator of accountable care organizations (ACOs), establishing the Medicare Shared Savings Program (MSSP) and Pioneer programs in 2012–2013. Existing research has documented that ACOs bring together an array of health providers with hospitals serving as important participants.

Purpose:

Hospitals vary markedly in their service structure and organizational capabilities, and thus, one would expect hospital ACO participants to vary in these regards. Our research identifies hospital subgroups that share certain capabilities and competencies. Such research, in conjunction with existing ACO research, provides deeper understanding of the structure and operation of these organizations. Given that Medicare was an initiator of the ACO concept, our findings provide a baseline to track the evolution of ACO hospitals over time.

Methodology/Approach:

Hierarchical clustering methods are used in separate analyses of MSSP and Pioneer ACO hospitals. Hospitals participating in ACOs with 2012–2013 start dates are identified through multiple sources. Study data come from the Centers for Medicare and Medicaid Services, American Hospital Association, and Health Information and Management Systems Society.

Results:

Five-cluster solutions were developed separately for the MSSP and Pioneer hospital samples. Both the MSSP and Pioneer taxonomies had several clusters with high levels of health information technology capabilities. Also distinct clusters with strong physician linkages were present. We examined Pioneer ACO hospitals that subsequently left the program and found that they commonly had low levels of ambulatory care services or health information technology.

Conclusion:

Distinct subgroups of hospitals exist in both the MSSP and Pioneer programs, suggesting that individual hospitals serve different roles within an ACO. Health information technology and physician linkages appear to be particularly important features in ACO hospitals.

Practice Implications:

ACOs need to consider not only geographic and service mix when selecting hospital participants but also their vertical integration features and management competencies.