bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: A systematic literature review
Authors: Li Yahua , Wang Yuhui , Chen Jianjian , Li Zhaonan , Liu Juanfang , Zhou Xueliang , Ren Kewei , Ren Jianzhuang , Han Xinwei
Published: May 2020

Background

Thoracogastric airway fistula (TGAF) is a serious complication of esophagectomy for esophageal cancer. We conducted a systematic review of the appropriate therapeutic options for acquired TGAF.

Methods

We performed a literature search to identify relevant studies from PubMed, EMBASE, and Web of Science using the search terms “gastric airway fistula”, “gastrotracheal fistula”, “gastrobronchial fistula”, “tracheogastric fistula”, “bronchogastric fistula”, “esophageal cancer”, and “esophagectomy”.

Result

Twenty-four studies (89 patients) were selected for analysis. Cough was the main clinical presentation of TGAF. The main bronchus was the most common place for fistulas (53/89), and 29 fistulas occurred in the trachea. Almost 73% (65/89) of patients underwent non-surgical treatment of whom 87.7% (57/65) received initial fistula closure. Twenty-three patients underwent surgery, including 19 (82.6%) with initial closure. The 1-, 2-, 3-, 6-, and 9-month survival rates in patients who underwent surgical repair were 95.65%, 95.65%, 82.61%, 72.73%, and 38.10%, respectively, and the equivalent survival rates in patients with tracheal stent placement were 91.67%, 86.67%, 71.67%, 36.96%, and 13.33%, respectively.

Conclusion

TGAF should be suspected in patients with persistent cough, especially in a recumbent position or associated with food intake. Individualized treatment should be emphasized based on the general condition of each patient.
Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease
Authors: Liu Bin , Zhang Hong , Wang Rong , Qu Hongdang , Sun Yifei , Zhang Wanlong , Zhang Shuye
Published: May 2020

Objectives

To investigate the effects of early administration of tirofiban after intravenous thrombolysis on early neurological deterioration in patients with branch atheromatous disease.

Methods

We analyzed clinical data from patients with branch atheromatous disease. We enrolled seven cases into the urokinase-only (UO) control group and 10 cases into the urokinase + tirofiban (UT) treatment group. National Institutes of Health Stroke Scale (NIHSS) scores were obtained at admission and on days 3 and 5 after admission. Modified Rankin Scale (mRS) scores were obtained 3 months after admission.

Results

Significant differences between the UO and UT groups were evident on days 3 and 5 after admission. In the UT group, there was a significant difference between NIHSS scores at admission and on day 5, while there were no significant differences in scores in the UO group. The early neurological deterioration rates were not significantly different between the two groups. However, there were significant differences in these rates at 72 and 120 hours. Both the mRS scores and the prognoses at 3 months differed between the two groups.

Conclusion

Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration and improves the long-term prognosis of patients with branch atheromatous disease.
Analysis of survival of patients with metastatic malignant pleural mesothelioma
Authors: Billè Andrea , Okiror Lawrence , Harling Leanne , Pernazza Fausto , Muzio Alberto , Roveta Annalisa , Grosso Federica
Published: May 2020

Aim:

To report the outcomes and prognosis of patients with malignant pleural mesothelioma (MPM) who present with or develop metastases during treatment.

Methods:

This is a retrospective observational study of patients diagnosed with MPM over 7 years. Metastases at presentation or during follow-up were recorded. Multivariate Cox regression was used to evaluate the relationship of clinicopathologic variables and overall survival (OS). Logistic regression was used for propensity score matching of patients to assess chemotherapy treatment effect.

Results:

There were 367 patients included with a median age of 71 years (range, 29–91). A total of 69 patients (18%) had metastases: 14 at presentation and 55 during follow-up. Patients presenting with metastases had significantly worse median and 2-year OS compared to those developing metastases during follow-up: 13.3 months (95% confidence interval [CI], 2–24.6 months) and 0% versus 20.2 months (95% CI, 16.7–23.3 months) and 33%, respectively ( p = 0.029). Female sex, age >70 years, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors. There was no difference in OS of patients with locally advanced (T4) disease compared to metastatic disease (M1): median OS 10.7 months (95% CI, 5.9–15.6) versus 13.3 months (95% CI, 2–24.6) ( p = 0.18), respectively. Following propensity matching, sarcomatoid histology (hazard ratio, 7.86 [95% CI, 3.64–16.95]; p < 0.001) and multiple lines of chemotherapy (hazard ratio, 0.38 [95% CI, 0.19–0.84]; p = 0.015) were significant independent prognostic factors for OS.

Conclusions:

T4 disease carries a similar OS as metastatic MPM. Female sex, advanced age, nonepithelioid histology, and not receiving chemotherapy were independent poor prognostic factors.
“You Have to Separate the Sinner From the Sin”: Clinician’s Approaches to Psychological Assessments With Men who Have Sexually Offended
Authors: Chawke Gemma , Randall Patrick , Duff Simon C.
Published: May 2020

Men who have sexually offended are often referred for presentence psychological assessments to determine factors which contributed to offending, identify risk of recidivism, and develop treatment recommendations. The accuracy of assessments is largely reliant on the cooperation of the assessee. Despite the significant legal and emotional consequences, how clinicians approach these assessments, attempt to engage assessees, and overcome resistance have not been investigated. This research sought to develop an understanding of the clinicians’ experience of conducting the assessment. How clinicians approach interviews with men who have sexually offended and the techniques they use were explored. Six interviews were conducted with qualified psychologists, at a private practice, whose role included conducting psychological assessments across a range of forensic matters. The findings, reached using Interpretative Phenomenological Analysis, highlighted the relational/social nature of the interaction and the clinicians’ experience of a somewhat blurred line in practice between forensic assessments and therapeutic endeavours.
Minimizing Cost of Highway Maintenance Considering the Impact of Vehicle Emissions using an Artificial Bee Colony Approach
Authors: Semaan Celina , Chien Steven , Ting Ching-Jung
Published: May 2020

The increasing traffic demand has reduced the efficiency of road networks and intensified the maintenance need for mobility and safety, increasing vehicle emissions, reducing air quality, and affecting climate change. To mitigate the negative impacts of work zone activities, a reliable method that can optimize spatio-temporal work zone activities is desirable. Previous studies have aimed to minimize the total cost, including maintenance, user delay, and accident costs, yet the associated environmental impact has been neglected. This study aims to optimize work zone activities using the artificial bee colony (ABC) algorithm, considering the cost of vehicle emissions in addition to the aforementioned costs for an environmentally sustainable optimization. MOtor Vehicle Emission Simulator (MOVES) is applied to calculate emission rates. The results show that the ABC algorithm is very efficient to search for the optimal solution that yields the minimum cost taking into account the well-being of the environment.
Influence of Rain on Highway Breakdown Probability
Authors: Zechin Douglas , Caleffi Felipe , Cybis Helena Beatriz Bettella
Published: May 2020

Capacity has been used to describe a deterministic value that represents the maximum volume of traffic supported by a road. Studies have pointed out the importance of not using a single value for capacity, but rather the concept of probability of occurrence of a traffic-flow breakdown. In this paper the probabilities of breakdown for a Brazilian highway under different weather conditions are compared. Data collected from inductive loop detectors and pluviometric data from automatic rain gauges are combined. Two methodologies of breakdown identification are then compared. The most consistent methodology for identifying breakdowns is used to generate breakdown probability distributions using the product limit and maximum-likelihood methods with the Weibull distribution. The results indicate significant differences in probability of breakdown for each studied climatic condition, including a maximum difference greater than 50% between dry and heavy rain conditions under the same traffic flow.
System-Level Reliability Analysis of Cooperative Driving with V2X Communication for Intersection Collision Avoidance
Authors: Wu Zhizhou , Zeng Xin , Yang Haochun
Published: May 2020

Cooperative driving with vehicle-to-everything (V2X) communication is a promising technique to improve traffic safety and efficiency. Intersection collision avoidance (ICA) is a typical safety application of it. This paper analyzes reliability of ICA with cooperative manual driving at the system level. First, the reliability of an ICA system is defined as the probability of the ICA system avoiding collisions or near-misses at intersections without failure under conditions that collisions or near-misses are about to happen. Post-encroachment time is used in the expression of this definition. Then, components of the ICA system are classified into four types: hardware, software, maneuver, and V2X communication, and a reliability block diagram (RBD) is applied to reveal how these components contribute to system reliability. Five ICA system patterns with different V2X communication modes and strategy types are compared based on RBD analysis. This shows that centralized strategies are more reliable than decentralized ones for V2I communication if software reliability of these two strategies is the same. Furthermore, reliabilities of ICA components are analyzed in detail, and they are classified into two categories based on their different impact modes on the system. Finally, a numerical example shows how to test reliability of an ICA system using reliabilities of its components by Monte Carlo simulation. Results show that closer distances from vehicles to their conflict point when alerted, longer driver reaction time, and smaller vehicle deceleration rates are more likely to lead to system failure, whereas communication latency has little effect on it.
Precarity From a Feminist Perspective: A Note on Three Elements for the Political Struggle
Authors: Flores Garrido Natalia
Published: May 2020

Three different approaches to understand the relationship between precarity and gender relations are presented: feminization of precarity, doing gender in a precarious context, and an intersectional analysis of precarity. After briefly characterizing them, the author offers some reflections of what each theoretical approach can offer to the political struggle against precarity.
Science research regimes as architectures of knowledge in context: A ‘longue durée’ comparative historical sociology of structures and dynamics in science
Authors: Marcovich Anne , Shinn Terry
Published: May 2020

The purpose of this historical-sociological study is to identify the different intellectual and organizational structures and paths adopted by science over the ages. These forms are what we call science research regimes. Our perspective is simultaneously historical, sociological and comparative. We propose a socio-historical framework that points out transverse structures in science and their changing dynamics, in a ‘longue durée’ perspective. Historical examples of regimes embrace the following regimes: what we term the ‘polycentric research regime’ of the 17th and 18th centuries; the ‘exclusionary research regime’ (disciplinarity) that emerged during the 19th century and persists today; the ‘combinatorial research regime,’ which began around the end of the 19th century; and finally the ‘interstitial research regime’ associated with transverse research- technology, also born in the late 19th century.
Impact of Disadvantaged Neighborhoods and Lifestyle Factors on Adult Obesity: Evidence From a 5-Year Cohort Study in Australia
Authors: Keramat Syed Afroz , Alam Khorshed , Gow Jeff , Biddle Stuart J. H.
Published: May 2020

Purpose:

This study aims to investigate the impact of disadvantaged neighborhoods and lifestyle factors on obesity among Australian adults.

Design:

Quantitative, longitudinal research design.

Setting:

Cohort.

Sample:

Data for this study came from a cohort of 10 734 adults (21 468 observations) who participated in the Household, Income and Labour Dynamics in Australia survey. The participants were interviewed at baseline in 2013 and were followed up in 2017.

Measures:

Generalized Estimating Equation model with logistic link function was employed to examine within-person changes in obesity due to disadvantaged neighborhoods and lifestyle factors at 2-time points over a 4-year follow-up period.

Results:

Adults living in the most disadvantaged area were 1.22 (odds ratio [OR]: 1.22, 95% CI: 1.08-1.38) and 1.30 (OR: 1.30, 95% CI: 1.20-1.42) times, respectively, more prone to be overweight and obese compared with peers living at least disadvantaged area. Study results also revealed that adults who consume fruits regularly and perform high levels of physical activity were 6% (OR: 0.94, 95% CI: 0.91-0.98) and 12% (OR: 0.88, 95% CI: 0.85-0.92) less likely to be obese, respectively, compared to their counterparts. Current alcohol drinkers were 1.07 (OR: 1.07, 95% CI: 1.01-1.13) times more likely to be obese compared to peers not consuming alcohol. Highly psychologically distressed adults were 1.08 times (OR: 1.08, 95% CI: 1.02-1.13) more likely to be obese than their peers.

Conclusion:

This study contributes to the literature regarding disadvantaged neighborhoods and lifestyle factors, which have an influence on adult obesity rates and thus help health decision-makers to formulate effective obesity prevention strategies.
Safety and Effectiveness of Sedation With Adjunctive Ketamine Versus Nonketamine Sedation in the Medical Intensive Care Unit
Authors: Jaeger Melanie , Attridge Rebecca L. , Neff Luke A. , Gutierrez G. Christina
Published: May 2020

Background:

Ketamine, an N-methyl-d-aspartate receptor antagonist with sedative and analgesic properties, is becoming more popular as an adjunctive sedative in the critically ill patients.

Methods:

We conducted a single center, retrospective cohort study of patients admitted to the medical intensive care unit (MICU) between 2013 and 2018. Patients who received continuous infusion ketamine or nonketamine sedatives (NKS) including dexmedetomidine, fentanyl, midazolam, or propofol were identified. The primary outcome was percentage of Richmond Agitation-Sedation Scale (RASS) scores at goal in patients receiving ketamine as adjunct to NKS compared to those on NKS alone.

Results:

A total of 172 patients were included (n = 86 ketamine, n = 86 NKS). Baseline characteristics were similar with the exception of antipsychotic use, which was higher in the ketamine group ( P = .008). Percentage of RASS scores at goal was not different between groups (78.7% vs 81.4%, P = .29). Fewer patients in the ketamine group received continuous infusion fentanyl (76.7% vs 94.2%, P = .002). Patients on adjunctive ketamine required fewer days of intermittent benzodiazepines (0 [0-1] vs 1 [1-2], P < .0001). Patients receiving ketamine required less norepinephrine, receiving a median of 6.32 mg (2.4-20) versus 11.7 mg (5.2-45.2; P = .03). There was no difference in receipt of new antipsychotics or occurrence of arrhythmias.

Conclusion:

Addition of ketamine did not increase the percentage of RASS scores at goal versus NKS but was well tolerated. Ketamine was associated with reductions in norepinephrine requirements, days of intermittent benzodiazepine administration, and number of patients receiving continuous infusion fentanyl. Continuous infusion ketamine appears safe and effective for sedation in the MICU.
Sliding mode control of double-wishbone active suspension systems based on equivalent 2-degree-of-freedom model
Authors: Qin Wu , Shangguan Wen-Bin , Yin Zhihong
Published: May 2020

As a critical component of transportation vehicles, active suspension systems (ASSs) have widely attracted attention for their outstanding capability of improving the riding comfort and the maneuverability. However, due to the effects of the suspension kinematic structure and the rubber elements containing bushings and top mount, the practical double-wishbone ASS cannot achieve the desired performance resulting from the control design based on a simple 2-degree-of-freedom (DOF) model. In this paper, a sliding mode control (SMC) based on an equivalent 2-DOF model is proposed to suppress the sprung mass vibration of a double-wishbone ASS, which is to improve the riding comfort of vehicle. The SMC for a double-wishbone ASS is designed in four steps. First, an equivalent 2-DOF model of a double-wishbone ASS, which considers suspension kinematic structure and rubber properties, is established. The parameter values of an equivalent 2-DOF model are identified by using least square method. Second, an SMC is designed for an equivalent 2-DOF model, and the effect of the parameter value of the 2-DOF model on the riding comfort is investigated by experimental results. Third, a control compensator for a double-wishbone ASS is developed by considering the suspension kinematic structure. Four, the control for double-wishbone ASS is obtained by integrating the compensator into the SMC based on the equivalent 2-DOF model. The numerical simulation results show that the control can effectively suppress the sprung mass vibration of the double-wishbone ASS when the SMC design is based on an equivalent 2-DOF model.
Orthoses versus gait retraining: Immediate response in improving physical performance measures in healthy and medial knee osteoarthritic adults
Authors: Khan Saad Jawaid , Khan Soobia Saad , Usman Juliana , Mokhtar Abdul Halim , Abu Osman Noor Azuan
Published: May 2020

The conservative techniques of treating knee osteoarthritis (kOA) include wearing orthoses such as knee braces and laterally wedged insoles and applying gait modification techniques such as toe-in gait and toe-out gait. This study aimed at assessing the immediate effects of these techniques in improving physical function of healthy and kOA participants. Five Osteoarthritis Research Society International (OARSI) recommended performance-based tests were randomly applied to measure physical function: (1) 30-second chair stand test (30CST), (2) 40-m (4 × 10) fast-paced walk test (40FPW), (3) stair climb test (SCT), (4) timed up and go test (TUGT) and (5) 6-minute walk test (6MWT) during a single-visit on 20 healthy and 20 kOA patients (age: 59.5 ± 7.33 and 61.5 ± 8.63 years, BMI: 69.95 ± 9.86 and 70.45 ± 8.80 kg/m2). The interventions included natural gait, toe-out gait, toe-in gait, laterally wedged insoles and knee brace. Analysis was performed through repeated-measures ANOVA and independent sample t-test. 30CST and TUGT showed no significant differences for the five test conditions ( p > 0.05). Toe-out showed profound effects via pairwise comparison in impairing the physical function while knee brace improved it during 40FPW, SCT and 6MWT. In general, all the tested conservative techniques except laterally wedged insoles had immediate effects on physical performance measures in both healthy and medial knee osteoarthritis participants. The valgus knee brace improved the parameters the most, while toe-out gait impaired them the most. Future studies can develop strategies for improving gait retraining methods on the basis of issues identified by this study.
Research on performance of vehicle semi-active suspension applied magnetorheological damper based on linear quadratic Gaussian control
Authors: Sha Shujing , Wang Zhongnan , Du Haiping
Published: May 2020

With the development of automobile technology, the traditional passive suspension cannot meet people’s requirements for vehicle comfort and safety. For this reason, a variable damping semi-active suspension applied magnetorheological damper is proposed. By collecting various performance parameters of the front suspension, the optimal feedback control matrix is obtained by applying linear quadratic Gaussian control strategy, and the optimal damping force output is also obtained to improve comfort and vehicle safety by reducing vibration. The semi-active suspension model of a quarter vehicles was established by MATLAB/Simulink, and the simulation experiment was carried out. The results show that the semi-active suspension system with magnetorheological damper is superior to the traditional passive suspension in terms of vibration absorption; meanwhile, the root mean square values of vehicle acceleration, suspension dynamic deflection, tire dynamic travel, and tire dynamic load are reduced, which effectively improve the vehicle ride stability.
Thorndike’s Credo: Metaphysics in psychometrics
Authors: Michell Joel
Published: May 2020

Endorsing a priori the conviction that any science worthy of the name must measure the attributes it investigates, psychometricians adopted a metaphysical paradigm (without acknowledging it as such) to secure its claim that mental tests measure psychological attributes, a claim that was threatened by the inadequacy of test data to secure it. The fundamental axiom of this paradigm was Thorndike’s Credo (“All that exists, exists in some amount and can be measured”; 1918, p. 16), which entails its central lemma, the psychometrician’s fallacy (“All ordered attributes are quantitative”; Michell, 2009, p. 41), and which, in turn, supplies psychometrics’ primary methodological principle (“interval scales can be derived from ordinal data”). Logically, this framework is flawed at every level: Thorndike’s Credo is metaphysical overreach; the psychometrician’s fallacy is just that—a logical fallacy; and their primary methodological principle, a prioristic thinking.
Statistical Methodology for Medical Data: Gestational Age, Birth Weight, and Hand Characteristics
Authors: Verma Surendra P. , Sharma Shreya
Published: May 2020

We briefly review the current trend in handling the neonatal baby weight, gestational age, and other related categorical and continuous variable data, through both robust and outlier-based methods. Graphs are generally presented as smooth curves which give a wrong visual impression and totally hide the actual variability of the data, robust methods are applied without considering that they may certainly be affected by asymmetrical contamination, and the outlier-based methods are incorrectly applied without ascertaining if the individual data arrays are normally distributed, free from discordant observations.

Aim: To demonstrate our new procedure for handling of neonatal baby data from two case studies.

Methodology: The univariate data were handled through the application of discordancy tests in the light of new precise and accurate critical values, and significance tests were applied to both original and discordant outlier-free data arrays. The bivariate data were also handled from identifying and separating discordant outliers and reporting the quality of the coefficients in terms of standard errors. Finally, the supervised multivariate technique of linear discriminant and canonical analysis is successfully applied.

Results: The results of significance tests for some cases varied from the use of all data versus censored data. The identification and separation of bivariate discordant outliers drastically improved the quality of regression lines. Linear discriminant and canonical analysis provided high success values for laboratory-controlled experiments.

Conclusion: The need of obtaining both central tendency and dispersion parameters in all medical data is established. The reporting of regression coefficients with individual errors is recommended.
Role of CSF-CRP as a Diagnostic Marker in Neonatal Meningitis
Authors: Balasubramanin Prashanth , Bandiya Prathik , S. Niranjan H. , Benakappa Naveen , Shinde Rajendra
Published: May 2020

Background: Cerebrospinal fluid C-reactive protein (CSF-CRP) in adults and children has been shown to be useful for the diagnosis of bacterial meningitis; however, it has not been evaluated in neonates.

Objective: To study the role of CSF-CRP as a diagnostic marker in neonatal meningitis and determine optimal cut-offs for diagnosis.

Study Design: Prospective observational study from June 2017 to December 2017.

Methodology: Routine CSF analysis along with CSF-CRP was performed in neonates who qualified for lumbar puncture.

Results: At a cut-off value of 3.8 mg/L, CSF-CRP had a sensitivity of 0.96 and a specificity of 0.44, with positive and negative predictive values of 0.63 and 0.91, respectively.

Conclusion: CSF-CRP has higher diagnostic efficiency than other CSF markers. At a value of 3.8 mg/L, it has a high sensitivity and a negative predictive value to rule out meningitis.
Cord Blood Thyroid-Stimulating Hormone Level: Interpretation in Light of Antenatal and Perinatal Factors
Authors: Bhatia Ravi , Rajwaniya Dinesh , Paul Indira S.
Published: May 2020

Objective: To study the influence of antenatal and perinatal factors on umbilical cord blood thyroid-stimulating hormone (CB TSH) levels.

Design: Cross-sectional study.

Setting: Private Medical College.

Methods: CB TSH levels were measured in 1147 neonates using chemiluminescence immunoassay. The effect of antenatal and perinatal factors on CB TSH values was analyzed statistically.

Results: The mean TSH value was 6.811 mIu/mL. A total of 44 neonates (3.83%) had a CB TSH value greater than 20 mIu/mL and had to be recalled for a repeat workup. CB TSH was significantly raised in first-order births, those born via normal vaginal delivery, and in those whom the lower section caesarean section (LSCS) was done for fetal distress (all P value <.05). Male babies had a significantly higher CB TSH value as compared to the females. Babies having Apgar < 7 at 1 min also had a significantly higher CB TSH value. Maternal hypothyroidism did not have any significant effect. On multivariate analysis, we found a positive correlation between birth weight, Apgar, and gestational age with CB TSH values.

Conclusion: The incidence of neonates having a CB TSH greater than 20 mIu/mL was 3.83%. Male children, those delivered via normal delivery, those delivered via LSCS where fetal distress was an indication, and those requiring resuscitation, were significant factors affecting CB TSH values.
Repair of Esophageal Atresia With Trache Esophageal Fistula Through Modified Transpleural Approach by Delivering Lung Out of Main Wound
Authors: Mohanty Pramod Kumar , Majumdar Pravat Kumar , Mohanty Hiranya Kishor , Jena Pradeep Kumar , Tripathy Prasant Kumar , Mohapatra Rabindra Kumar , Dash Manas Ranjan , Sarangi Gadadhar
Published: May 2020

Objectives: To assess the morbidity, mortality, operation time, and postoperative complications in the present modified transpleural (MTP) approach with the conventional extrapleural (EP) approach in esophageal atresia (EA) with tracheoesophageal fistula (TEF).

Design: Longitudinal randomized case control study.

Setting: Pediatrics Surgery Department of a tertiary care hospital.

Study period: November 2009 to December 2011.

Participants: Neonates above 1.5 kg body weight with EA and TEF.

Results: Sex ratio is 7:3 (male and female). In total, 40% had associate anomalies. Duration of operation in MTP approach from 90 to 110 min (mean duration 98.6 min) where as in EP approach from 120 to 130 min (mean duration 121.4 min). All 3(15% wound infections were in EP group. A total of 3 develops right sided pneumothorax with 2 in MTP and 1 in EP approach group. In total, 10% (2) in MTP approach group and 5% (1) in EP group expired. Leakage in anastomotic site was seen in 2(10%) each in both the groups. Six developed stricture, out of which 4 in EP group, 2 in MTP group.

Conclusion: MTP approach is less time consuming, possess less hindrance during operation. Postoperative complications are comparable. Mortality is higher in MTP group than EP group, may be because of associated lethal co morbidity.
Antimicrobial Resistance, Politics, and Practice in India
Authors: Broom Alex , Doron Assa
Published: May 2020

India is considered the epicenter of the global antimicrobial resistance crisis, with unprecedented antimicrobial consumption, production, and “misuse.” But the story of resistance in India is complicated—emerging from intersections of industrial pharmaceutical development, rationing/purchasing of health care, policy infrastructure, and dynamics of disadvantage. What looks like rampant, escalating antimicrobial misuse and a need for tighter controls over drugs and “prescribers,” emerges as a complex social problem. These dimensions reach the bedside, although variously, with doctors in India dealing with precarious infectious disease landscapes, threats of multidrug-resistant organisms, and (pan) national imperatives for “more judicious” practices. Drawing on 24 semi-structured interviews with doctors in Hyderabad, we explore their perspectives on resistance (literal and figurative) in everyday practice, and how practices articulate intersections of power, influence, and governance. This offers broader context to reframe resistance in India as multifactorial, enacted through cultural/local practices, and irreducible to singular problems of control or regulation.
An evolutionary approach for optimal multi-objective resource allocation in distributed computing systems
Authors: Kishor Avadh , Niyogi Rajdeep
Published: May 2020

Resource allocation in a distributed computing system is the process of allocating the workload across multiple computing resources to optimize the required performance criteria. In this article, a resource allocation problem that arises in a distributed system consisting of multiple heterogeneous servers is addressed. The problem is modeled as a multi-objective problem with two conflicting objectives: (a) to minimize the users’ expected response time and (b) to reduce the utilization imbalance between servers. To satisfy these objectives simultaneously, first, both the objectives are considered in an integrated manner, and an optimization problem is formulated. Second, the optimization problem is cast into a game-theoretic setting and modeled as a non-cooperative game, called a non-cooperative resource allocation game. Finally, to solve the game, a differential evolution-based co-evolutionary framework (DECEF) is proposed. To evaluate the performance of DECEF, a rigorous simulation study is carried out. Furthermore, to assess the relative performance of DECEF, it is compared against two existing approaches, from various aspects, including system utilization, system heterogeneity, and system size. The experimental results show that DECEF provides better system-wide performance while optimizing both the objectives.
Melanotic Schwannoma, a Deceptive Misnomer for a Tumor With Relative Aggressive Behavior: A Series of 7 Cranial and Spinal Cases
Authors: Sahay Ayushi , Epari Sridhar , Gupta Priyanka , Goda JayantSastri , Shetty Prakash , Patil Vijay , Bajpai Jyoti , Moiyadi Aliasgar , Gupta Tejpal
Published: May 2020

The authors present in this article a series of 7 intracranial/spinal cases of melanotic schwannomas that highlight the aggressive nature of these tumors. The series comprises 2 males and 5 females, age range 19 to 50 years, with spinal/paraspinal location in 4/7 (57%), and intracranial (along the trigeminal nerve) location in 3/7 (43%). There was no association with Carney’s complex. All the cases showed similar histology of epithelioid to spindled cytomorphology with vesicular nuclei (including prominent nucleoli) and conspicuous intracytoplasmic melanin pigment. Mitotic activity was seen in 3/7 cases (43%), 2 of which showed atypical forms. Immunohistochemically, all the cases were positive for S100 protein, HMB-45, melan-A and p16 protein; while negative for PDL1. Ki-67 labeling index was >5% in cases with mitotic activity. Two cases were asymptomatic (after 2.5 and 5 years postsurgery), 2 cases (one was mitotically active, while the other had no mitosis) had recurrence 6 months and 3.5 years after initial surgery, respectively, probably suggesting that mitosis alone may not be a robust predictor of biological behavior. These patients were treated with various adjuvant modalities and were alive for 4 years and 3 years of post-therapy period, respectively. Three patients were offered adjuvant radiotherapy, based on presence of aggressive histological features or significant residual tumor. One showed good clinical response. This series highlights the variability of clinical behavior of these neoplasms belying a deceptively bland nomenclature and also highlights the lack of correlation between histological features and biological behavior.
Decentralized vibration control of smart constrained layer damping plate
Authors: Lu Panping , Wang Pan , Lu Jun
Published: May 2020

The traditional centralized control strategy to vibration suppression of large-scale thin plate structures may increase the design difficulty of the controller. In this article, a decentralized vibration active control method is proposed to suppress the vibration of the thin plate structure with smart constrained layer damping treatment. First, the dynamics model of the smart constrained layer damping plate is established based on the finite element method, and the characteristics of viscoelastic materials with temperature and frequency are described by Golla-Hughes-McTavish damping model. Subsequently, a decentralized subsystem control model is obtained from the balanced model reduction method and complex mode truncation method. The modal test proves that the theoretical model is accurate. Then, the particular emphasis is placed on the stability and vibration attenuation of a decentralized system, which is composed of multiple subsystems. The local state feedback stabilization, using interaction of local state feedback and output feedback, is introduced to achieve system stability. To solve the practical problem of local state feedback, a decentralized controller with an observer is developed by adopting the pole placement method. Finally, the numerical simulation and hardware-in-the-loop experiment under different excitation are performed to investigate the effectiveness of decentralized vibration active control. The results demonstrate that the decentralized controller can effectively suppress the vibration, especially under mixed periodic signal and Gauss white noise signal.
Financial Instability in the Earned Income Tax Credit Program: Can Advanced Periodic Payments Ameliorate Systemic Stressors?
Authors: Greenlee Andrew , Kramer Karen , Andrade Flavia , Bellisle Dylan , Blanks Renee , Mendenhall Ruby
Published: May 2020

The Earned Income Tax Credit (EITC) serves more than 26 million U.S. tax filers every year. The EITC is distributed annually at tax time; however, past research suggests that lump-sum disbursements leave households with a lack of funds to deal with financial emergencies throughout the year. Drawing upon the data from a pilot program conducted in 2014–2015 in Chicago, this study analyzes how advanced periodic payments help mitigate financial instability for EITC recipients. Interview participants relate that advanced periodic payments result in a reduction in perceived stress, lower levels of debt, fewer unpaid bills, and the ability to engage youth in extracurricular activities. The findings provide a unique perspective on the ways in which low-income households cope with financial instability and stress and suggest that payment frequency options can play a small but important role in the way in which the EITC operates as a support mechanism.
From Homicide to Imprisonment: Mapping and Understanding the Flow of Homicide Cases
Authors: Liem Marieke , Eisner Manuel
Published: May 2020

The likelihood that homicides lead to arrest, conviction, and incarceration of the perpetrators varies widely across world regions. To date, we lack a comprehensive framework that can explain the differences in how homicide cases are processed in different jurisdictions, and how this knowledge can be used to hold perpetrators to account, to advance the rule of law, and to promote equal access to justice. This Special Issue seeks to advance the cross-national and comparative analysis of homicide case flows, from suspicious death to imprisonment. In this Introduction, we outline some analytic priorities that may help in moving the field forward.
Evaluation of eutectic lidocaine/prilocaine cream for jugular blood sampling in cats
Authors: Crisi Paolo E , De Santis Francesca , Giordano Maria V , Cerasoli Ilaria , Colucci Fabrizio , Di Tommaso Morena , Luciani Alessia
Published: May 2020

Objectives

The study aimed to evaluate the efficacy of a eutectic lidocaine/prilocaine cream (EMLA cream; Astra Pharmaceuticals) in reducing pain and reaction to venepuncture during jugular blood sampling in cats after a 30-min topical application time.

Methods

The study was a prospective, blind, controlled clinical trial. Eighteen healthy client-owned cats were randomly allocated to two study groups. All cats were clipped on the left jugular groove region and then, depending on the study group, either the placebo (liquid paraffin) or EMLA cream was applied to the region. The area was then kept protected for the next 30 mins. Except for the operator who administered the product, all operators were blinded to the study groups. Blood sampling was performed by an experienced operator and a stress score was assigned to each cat according to the reactions observed during the venepuncture. Also, the procedure was classified as being ‘easy’ or ‘difficult’ by the same operator.

Results

A significantly reduced stress score was observed in cats that received the EMLA cream compared with those belonging to the placebo group ( P = 0.048); withdrawal movements were observed in 1/9 cats treated with the EMLA cream vs 7/9 cats of the placebo group ( P = 0.015). The jugular venepuncture was defined as easy in 1/9 cats that received the placebo and in 8/9 cats in the EMLA group ( P = 0.015).

Conclusions and relevance

The present study provides evidence for the efficacy of the EMLA cream after a 30-min application time for jugular venepuncture in cats, together with significantly reduced stress for patients. Therefore, this study supports the routine use of EMLA cream as good practice to enhance the welfare of cats and to simplify venepuncture procedures.
The effect of the ratio of Λ-shaped shear connectors on the flexural behavior of a reinforced concrete frame
Authors: Nguyen Quy Thue , Livaoğlu Ramazan
Published: May 2020

Failure in a structural system can appear because of different types of pathologies and can cause a large number of problems during seismic action. Among these pathologies are design and execution flaws, underestimation of the required capacity of cross-section or seismic demand, and use of low quality of materials. The jacketing technique for a frame element is the most common use strengthening method in the practice to remove such disadvantages in a structural system. Then, the shear stress transferability at the concrete-to-concrete interface surface is the main objective. Shear connectors application is a solution for that consideration, but the investigation in the literature focusing this point is not adequate. The effect of the ratio of steel shear connectors on the interfaces of a reinforced concrete frame constructed using reinforced concrete formworks on its flexural behavior is numerically evaluated. Initially, the same ratio of Π-shaped and Λ-shaped shear connectors, 0.312%, is applied to determine the more effective shape. It should be clear that the ratio of shear connectors on any separate surface is calculated as the fraction of the total area of the cross-section of shear connectors placed perpendicularly (Π-shaped) at the surface and the area of that surface. The same ratio is understood as after evaluating the Π-shaped shear links, each of them is replaced by a Λ-shaped link at the same location. As a result, compared to the bending capacity of the frame whose surfaces are smooth, Λ-shaped connectors enhance the bending capacity of the frame up to 9.67% while the amount of improvement brought by Π-shaped ones is modest, about 2.172%. After that, a wide variety of the ratio of Λ-shaped connectors, 9 values, are placed on concrete-to-concrete interfaces. Tremendously, due to clamping stress brought by Λ-shaped shear connectors at the concrete substrates, the nonlinear behavior is improved and the amount of enhancement rises as the number of applied connectors is augmented but not linearly. The most important observation is that the amount of improvement is insignificant after the ratio of shear connectors reaches the percentage of between 0.3% and 0.4%. On the other hand, compared with the frame whose interfaces are smooth, the displacement ductility factor of the frame strengthened using 0.4% decreases an amount of about 30%.
Aerodynamics of a two-dimensional bluff body with the cross-section of a train
Authors: Li Huan , He Xuhui , Wang Hanfeng , Peng Si , Zhou Shuwei , Hu Liang
Published: May 2020

Experiments on the aerodynamics of a two-dimensional bluff body simplified from a China high-speed train in crosswinds were carried out in a wind tunnel. Effects of wind angle of attack α varying in [−20°, 20°] were investigated at a moderate Reynolds number Re = 9.35 × 104 (based on the height of the model). Four typical behaviors of aerodynamics were identified. These behaviors are attributed to the flow structure around the upper and lower halves of the model changing from full to intermittent reattachment, and to full separation with a variation in α. An alternate transition phenomenon, characterized by an alteration between large- and small-amplitude aerodynamic fluctuations, was detected. The frequency of this alteration is about 1/10 of the predominant vortex shedding. In the intervals of the large-amplitude behavior, aerodynamic forces fluctuate periodically with a strong span-wise coherence, which are caused by the anti-symmetric vortex shedding along the stream-wise direction. On the contrary, the aerodynamic forces fluctuating at small amplitudes correspond to a weak span-wise coherence, which are ascribed to the symmetric vortex shedding from the upper and lower halves of the model. Generally, the mean amplitude of the large-amplitude mode is 3 times larger than that of the small one. Finally, the effects of Reynolds number were examined within Re = [9.35 × 104, 2.49 × 105]. Strong Reynolds number dependence was observed on the model with two rounded upper corners.
Bullying, social support and adolescents’ mental health: Results from a follow-up study
Authors: Ringdal Regine , Bjørnsen Hanne Nissen , Espnes Geir Arild , Bradley Eilertsen Mary-Elizabeth , Moksnes Unni Karin
Published: May 2020

Aims: The aim of this study was to examine the predictive roles of being bullied and perceived social support in association with adolescents’ mental health. Methods: At two time points, September 2016 and April–June 2017, questionnaires were distributed to students between 15 and 21 years of age in four upper-secondary schools in Norway, with a total sample size of 351. Random- and fixed-effects regression models were used to estimate the effects of being bullied and social support on adolescents’ mental health. Results: In the random-effects models, being bullied was associated with lower scores on mental well-being and higher scores on anxiety and depression symptoms. Social support from family and friends was associated with higher scores on mental well-being, as well as fewer anxiety and depression symptoms. However, the results from the fixed-effects model, with more realistic assumptions, indicated that being bullied was only associated with more anxiety and depression symptoms, while support from friends was associated with higher scores on mental well-being and fewer anxiety and depression symptoms. Conclusions: Based on the fixed-effects models, being bullied was associated with more anxiety and depression symptoms. However, being bullied was not significantly associated with mental well-being. Social support from family was not significantly associated with either aspects of mental health. Moreover, social support from friends was associated with higher scores on mental well-being and fewer anxiety and depression symptoms. The two sources of social support did not buffer the negative effects of being bullied on either aspect of mental health.
On the vulnerability of data-driven structural health monitoring models to adversarial attack
Authors: Champneys Max David , Green Andre , Morales John , Silva Moisés , Mascarenas David
Published: May 2020

Many approaches at the forefront of structural health monitoring rely on cutting-edge techniques from the field of machine learning. Recently, much interest has been directed towards the study of so-called adversarial examples; deliberate input perturbations that deceive machine learning models while remaining semantically identical. This article demonstrates that data-driven approaches to structural health monitoring are vulnerable to attacks of this kind. In the perfect information or ‘white-box’ scenario, a transformation is found that maps every example in the Los Alamos National Laboratory three-storey structure dataset to an adversarial example. Also presented is an adversarial threat model specific to structural health monitoring. The threat model is proposed with a view to motivate discussion into ways in which structural health monitoring approaches might be made more robust to the threat of adversarial attack.
Detecting structural damage under unknown seismic excitation by deep convolutional neural network with wavelet-based transmissibility data
Authors: Lei Ying , Zhang Yixiao , Mi Jianan , Liu Weifeng , Liu Lijun
Published: May 2020

Many research groups in the structural health monitoring community have made efforts to utilize deep learning-based approaches for damage detection on a variety of structures. Among these approaches, structural damage detection through deep convolutional neural networks using raw structural response data has received great attention. However, structural responses are affected not only by structural properties but also by excitation characteristics. For detecting of structures’ damage under seismic excitations, different seismic excitations definitely cause varied structural responses data. In practice, it is impossible to accurately predict the characteristics of future seismic excitation for pre-training the deep convolutional neural network. Therefore, it is essential to investigate the autonomous detection of structural element damage subject to unknown seismic excitation. In this article, a new approach is proposed for detecting structural damage subject to unknown seismic excitation based on a convolutional neural network with wavelet-based transmissibility of structural response data. The transmissibility functions of structural response data are used to eliminate the influence of different seismic excitations. Moreover, contrary to the traditional Fourier transform in the conventional transmissibility function, wavelet-based transmissibility function is presented using the ability in subtle information acquisition of wavelet transform. The wavelet-based transmissibility data of structural responses are used as the inputs to constructed deep convolutional neural networks. Both a numerical simulation example and an experimental test are used to validate the performance of the proposed approach based on deep convolutional neural network.