bluuebunny/crossref_metadata_2025 huggingface dataset:
Monte Carlo Tree Search and Cognitive Hierarchy Theory for Interactive-Behavior Prediction in Fast Trajectory Planning and Automated Lane Change
Authors: Karimi Shahab , Vahidi Ardalan
Published: February 2021

Predicting the states of the surrounding traffic is one of the major problems in automated driving. Maneuvers such as lane change, merge, and exit management could pose challenges in the absence of intervehicular communications and can benefit from driver behavior prediction. Predicting the motion of surrounding vehicles and trajectory planning need to be computationally efficient for real-time implementation. The main goal of this paper is to develop a fast algorithm that predicts the future states of the neighboring vehicles. The proposed workflow employs Monte Carlo Tree Search (MCTS) along with an on-policy learning technique for fast trajectory planning in multi-lane highway traffic scenarios. Also, for the inclusion of behavioral aspects, cognitive hierarchy and level-K game theories are utilized to predict the reaction and decision of the surrounding drivers. Simulation case studies demonstrate that our proposed approach is real-time implementable and can often avoid collision in difficult simulated confrontations.
Zero Moment Control for Lead-Through Teach Programming and Process Monitoring of a Collaborative Welding Robot
Authors: Canfield Stephen L. , Owens Joseph S. , Zuccaro Stephen G.
Published: February 2021

Robots are commonly used for automated welding in many industries such as automotive manufacturing. The complexity and time required for programming present an obstacle in using robotic automation in welding or other tasks for small to medium enterprises that lack resources for training or expertise in traditional robot programming strategies. It also dictates a high level of repeated parts to offset the cost of weld programming. Collaborative robots or Cobots are robots designed for more collaborative operations with humans. Cobots permit new methods of task instruction (programming) through a direct interaction between the operator and the robot. This paper presents a model and model calibration strategy for collaborative robots to aid in teaching and monitoring welding tasks. The method makes use of a torque estimation model based on robot momentum to create an observer to evaluate external forces. The torque observer is used to characterize the friction that exists within the robot joints. These data are used to define the parameters of a friction model that combines static, Coulomb, and viscous friction properties with a sigmoid function to represent a transition between motion states. With an updated friction model, the torque observer is then used for collaborative robotic welding, first to provide a mode in which the robot can be taught weld paths through physical lead through and second a mode to monitor the weld process for expected motion/force characteristics. The method is demonstrated on a commercial robot.
A Kinematic Structure Based Classification of Six-DOF Industrial Robots and a Method of Inverse Kinematic Solution
Authors: Balkan Tuna , Özgören M. Kemal , Arikan M. A. Sahir , Baykurt H. Murat
Published: February 2021

A kinematic structure based classification of six degree-of-freedom industrial robotic manipulators is introduced, and sample compact kinematic equations are given according to this classification. For the classification, one hundred industrial robots are surveyed. These robots are first classified into main groups and then into subgroups under each main group, and nine kinematic main groups, each having one to ten subgroups are obtained. The main groups are based on the end-effector rotation matrices and characterized by the twist angles. On the other hand, the subgroups are based on the wrist point positions and characterized by the link lengths and offsets. Compact kinematic equations are derived for one main group and one of its subgroups by utilizing the properties of exponential rotation matrices. In the inverse kinematic solutions, most of these simplified compact equations can be solved analytically and the remaining few of them can be solved semi-analytically through a single univariate equation. In these solutions, the singularities and the multiple configurations of the manipulators can be determined easily. Utilizing the method introduced in this study, the kinematic analysis of any manipulator or designed-to-be manipulator can be performed and using the solutions, the inverse kinematics can also be computerized by means of short and fast algorithms. As an example for, the demonstration of the presented method, Unimate 4000 industrial robot is selected which has five revolute joints and one prismatic joint and its compact forward kinematic equations are given as well as the inverse kinematic solution. To generalize the solution for the corresponding subgroup, a structural parameter related to the prismatic joint is assumed to have two different possible values leading to a closed-form or a semi-analytical solution.
Information Architecture for Design Tolerancing: From Conceptual to the Detail Design
Authors: Roy U. , Sudarsan R. , Sriram R. D. , Lyons K. W. , Duffey M. R.
Published: February 2021

Tolerance design is the process of deriving a description of geometric tolerance specifications for a product from a set of specifications on the desired properties of the product. Existing approaches to tolerance analysis and synthesis entail detailed knowledge of geometry of assemblies and are mostly applicable during advanced stages of design, leading to a less than optimal design process. During the design process of assemblies, both assembly structure and associated tolerance information evolve continuously and significant gains can be achieved by effectively using this information to influence the design of an assembly. Any pro-active approach to the assembly or tolerance analysis in the early design stages will involve decision making with incomplete information models. In order to carry out early tolerance synthesis and analysis in the conceptual stages of the product design, we need to devise techniques for representing function-behavior-assembly models that will allow analysis and synthesis of tolerances, even with the incomplete data set.

A ‘function’ (what the system is for) is associated with the transformation of an input physical entity into an output physical entity by the system. The problem or customer’s need, initially described by functional requirements on an assembly, and associated constraints on the functional requirements derives the concept of an assembly. This specification of functional requirements and constraints define a functional model for the assembly. Many researchers have studied functional representation (function based taxonomy and ontology), function to form mapping, and behavior representation (behavior means how the system/product works). However, there is no comprehensive function-assembly-behavior (FAB) integrated model.

In this paper, we discuss the integration of function, assembly, and behavior representation into a comprehensive information model (FAB models). To do this, we need to develop appropriate assembly models and tolerance models that would enable the designer to incrementally understand the build-up or propagation of tolerances (i.e., constraints) and optimize the layout, features, or assembly realizations. This will ensure ease of tolerance delivery.
A0-Wave and A-Wave in Cylindrical Shell Immersed in Water: Influence on the Acoustic Scattering
Authors: Maze Gérard , Touraine Nicolas , Baillard André , Decultot Dominique , Latard Véronique , Derbesse Laurent , Pernod Philippe , Merlen Alain
Published: February 2021

In low frequencies (ka < 200), the A-wave (Scholte-Stoneley wave) and the S0-wave (first symmetrical Lamb wave) are the subject of a particular attention in the study of the acoustic scattering from empty cylindrical shells immersed in water. If the tube is in water, the A0-wave (flexural Lamb wave) which circumnavigates in the shell in vacuum, does not originate resonances in the backscattered pressure spectrum while the two others are active. Images of the acoustic scattering from cylindrical or spherical targets obtained from the “Schlieren” visualization using a high-speed camera show the typical re-radiation of the A0+-wave in water. Moreover, the backscattered signal recorded with one emitter-receiver transducer shows one echo which cannot attributed to the A- or S0-waves. In this paper, the propagation of the A0+-wave has been especially studied to explain the experimental results. This A0+-wave has a great impact if it crosses over a structure inhomogeneity after a short propagation in the shell, before its complete attenuation.
A combinational chemo-immune therapy using an enzyme-sensitive nanoplatform for dual-drug delivery to specific sites by cascade targeting
Authors: He Yanmei , Lei Lei , Cao Jun , Yang Xiaotong , Cai Shengsheng , Tong Fan , Huang Dennis , Mei Heng , Luo Kui , Gao Huile , He Bin , Peppas Nicholas A.
Published: February 2021

Nanoparticulate-based combinatorial therapy induced robust antitumor immunity against tumor metastasis.
Novel Short-Course Therapy and Morphism Mapping for Clinical Pulmonary
Mycobacterium kansasii
Authors: Srivastava Shashikant , Wang Jann-Yuan , Magombedze Gesham , Chapagain Moti , Huang Hung-Ling , Deshpande Devyani , Heysell Scott K. , Pasipanodya Jotam G. , Gumbo Tawanda
Published: February 2021

Standard therapy (isoniazid, rifampin, and ethambutol), with or without a macrolide, for pulmonary
Mycobacterium kansasii
lasts more than a year. Therefore, shorter treatment duration regimens are required.
Deciphering an Adenovirus F41 Outbreak in Pediatric Hematopoietic Stem Cell Transplant Recipients by Whole-Genome Sequencing
Authors: Lefeuvre Caroline , Salmona Maud , Feghoul Linda , Ranger Noémie , Mercier-Delarue Séverine , Nizery Laure , Alimi Aurélia , Dalle Jean-Hugues , LeGoff Jérôme
Published: February 2021

Human adenovirus (HAdV) represents a major cause of mortality and morbidity in pediatric recipients of allogeneic hematopoietic stem cell transplants (HSCT). HAdV species F type 41 (HAdV-F41) infections in HSCT patients are scarce, whereas HAdV-F41 circulates commonly in healthy individuals. Between March and July 2018, HAdV-F41 infections were identified in four children (A, B, C, and E) who received allogeneic HSCT and one child before HSCT (D) at Robert Debré Hospital, Paris, France.
Intracellular Group A
Streptococcus
Induces Golgi Fragmentation To Impair Host Defenses through Streptolysin O and NAD-Glycohydrolase
Authors: Nozawa Takashi , Iibushi Junpei , Toh Hirotaka , Minowa-Nozawa Atsuko , Murase Kazunori , Aikawa Chihiro , Nakagawa Ichiro
Published: February 2021

Two prominent virulence factors of group A
Streptococcus
(GAS), streptolysin O (SLO) and NAD-glycohydrolase (Nga), are linked to enhanced pathogenicity of the prevalent GAS strains. Recent advances show that SLO and Nga are important for intracellular survival of GAS in epithelial cells and macrophages.
The Long and Winding Road for Symbiont and Yolk Protein to Host Oocyte
Authors: Fukatsu Takema
Published: February 2021

Many insects are intimately associated with microbial symbionts, which are passed to developing oocytes in the maternal body for ensuring vertical transmission to the next generation. Previous studies uncovered that some symbionts utilize preexisting host’s molecular and cellular machineries for targeting oocytes.
Monoclonal Antibodies against Zika Virus NS1 Protein Confer Protection via FcγReceptor-Dependent and -Independent Pathways
Authors: Yu Lei , Liu Xinglong , Ye Xianmiao , Su Wan , Zhang Xiaoyan , Deng Weiqi , Luo Jia , Xiang Mengrong , Guo Wenjing , Zhang Shengnan , Xu Wei , Yan Qihong , Wang Qian , Cui Yilan , Wu Caixia , Guo Wenjing , Niu Xuefeng , Zhang Fuchun , Lei Chunliang , Qu Linbing , Chen Ling , Feng Liqiang
Published: February 2021

Zika virus (ZIKV) is a mosquito-borne flavivirus that has been linked to congenital microcephaly during recent epidemics. No licensed antiviral drug or vaccine is available.
Characterization of SARS-CoV-2 RNA, Antibodies, and Neutralizing Capacity in Milk Produced by Women with COVID-19
Authors: Pace Ryan M. , Williams Janet E. , Järvinen Kirsi M. , Belfort Mandy B. , Pace Christina D. W. , Lackey Kimberly A. , Gogel Alexandra C. , Nguyen-Contant Phuong , Kanagaiah Preshetha , Fitzgerald Theresa , Ferri Rita , Young Bridget , Rosen-Carole Casey , Diaz Nichole , Meehan Courtney L. , Caffé Beatrice , Sangster Mark Y. , Topham David , McGuire Mark A. , Seppo Antti , McGuire Michelle K.
Published: February 2021

Results from prior studies assaying human milk for the presence of SARS-CoV-2, the causative virus of COVID-19, have suggested milk may act as a potential vehicle for mother-to-child transmission. Most previous studies are limited because they followed only a few participants, were cross-sectional, and/or failed to report how milk was collected and/or analyzed.
An Indispensable Role for the MavE Effector of Legionella pneumophila in Lysosomal Evasion
Authors: Vaughn Bethany , Voth Kevin , Price Christopher T. , Jones Snake , Ozanic Mateja , Santic Marina , Cygler Miroslaw , Abu Kwaik Yousef
Published: February 2021

Intracellular proliferation of
Legionella pneumophila
within a vacuole in human alveolar macrophages is essential for manifestation of Legionnaires’ pneumonia. Intravacuolar growth of the pathogen is totally dependent on remodeling the
L. pneumophila
-containing vacuole (LCV) by the ER and on its evasion of the endosomal-lysosomal degradation pathway.
Evolution of Antibiotic Tolerance Shapes Resistance Development in Chronic Pseudomonas aeruginosa Infections
Authors: Santi Isabella , Manfredi Pablo , Maffei Enea , Egli Adrian , Jenal Urs
Published: February 2021

Over the past decades, pan-resistant strains of major bacterial pathogens have emerged and have rendered clinically available antibiotics ineffective, putting at risk many of the major achievements of modern medicine, including surgery, cancer therapy, and organ transplantation. A thorough understanding of processes leading to the development of antibiotic resistance in human patients is thus urgently needed.
Is It Time To Kill the Survival Curve? A Case for Disease Progression Factors in Microbial Pathogenesis and Host Defense Research
Authors: Cramer Robert A. , Kowalski Caitlin H.
Published: February 2021

The molecular mechanisms of microbial virulence and host defense are most often studied using animal models and Koch’s molecular postulates. A common rationale for these types of experiments is to identify therapeutic targets based on the assumption that microbial or host factors that confer extreme animal model survival phenotypes represent critical virulence and host defense factors.
Herpes Simplex Virus 1 Manipulates Host Cell Antiviral and Proviral DNA Damage Responses
Authors: Mertens Max E. , Knipe David M.
Published: February 2021

We investigated the relationship between the DNA damage response, a collection of vital cellular pathways that repair potentially lethal damage to the genome, and the DNA virus herpes simplex virus 1. We found that infection by the virus triggers the DNA damage response and key proteins that mediate this response have opposing effects on the replication and production of progeny viruses.
Comorbidities in SARS-CoV-2 Patients: a Systematic Review and Meta-Analysis
Authors: Ng Wern Hann , Tipih Thomas , Makoah Nigel A. , Vermeulen Jan-G , Goedhals Dominique , Sempa Joseph B. , Burt Felicity J. , Taylor Adam , Mahalingam Suresh
Published: February 2021

COVID-19 has plagued the world since it was first identified in December 2019. Previous systematic reviews and meta-analysis were limited by various factors such as the usage of non-peer reviewed data and were also limited by the lack of clinical data on a global scale.
Assessing Biodegradability of Chemical Compounds from Microbial Community Growth Using Flow Cytometry
Authors: Özel Duygan B. D. , Rey S. , Leocata S. , Baroux L. , Seyfried M. , van der Meer J. R.
Published: February 2021

The manifold effects of potentially toxic compounds on microbial communities are often difficult to discern. Some compounds may be transformed or completely degraded by few or multiple strains in the community, whereas others may present inhibitory effects.
High-precision U-Pb age constraints on the Permian floral turnovers, paleoclimate change, and tectonics of the North China block
Authors: Wu Qiong , Ramezani Jahandar , Zhang Hua , Wang Jun , Zeng Fangui , Zhang Yichun , Liu Feng , Chen Jun , Cai Yaofeng , Hou Zhangshuai , Liu Chao , Yang Wan , Henderson Charles M. , Shen Shu-zhong
Published: February 2021

The Permian marine-terrestrial system of the North China block provides an exceptional window into the evolution of northern temperate ecosystems during the critical transition from icehouse to greenhouse following the late Paleozoic ice age (LPIA). Despite many studies on its rich hydrocarbon reserves and climate-sensitive fossil flora, uncertain temporal constraints and correlations have hampered a thorough understanding of the records of geologic, biologic, and climatic change from the North China block. We present a new chronostratigraphy based on high-precision U-Pb chemical abrasion–isotope dilution–thermal ionization mass spectrometry (CA-ID-TIMS) geochronology of tuffs from a near-complete latest Carboniferous–Permian succession in North China. The results indicate that the predominance of continental red beds, climate aridification, and the disappearance of coals and characteristic tropical flora were well under way during the Cisuralian (Early Permian) in the North China block, significantly earlier than previously thought. A nearly 20 m.y. hiatus spanning the early Kungurian to the mid-Guadalupian (or later) is revealed in the northern North China block to have close temporal and spatial associations with the closure and/or subduction of the Paleo-Asian Ocean and its related tectonic convergence. This long hiatus was concomitant with the prominent loss of the highly diverse and abundant Cathaysian floras and the widespread invasion of the monotonous Angaran floras under arid climate conditions in the North China block. Similarities in the floral and climate shift histories between Euramerica and North China suggest that aside from the regional tectonic controls and continental movement, extensive volcanism during the Cisuralian may have played a major role in the global warming and aridification in the aftermath of the LPIA.
From Ordovician nascent to early Permian mature arc in the southern Altaids: Insights from the Kalatage inlier in the Eastern Tianshan, NW China
Authors: Mao Qigui , Wang Jingbin , Xiao Wenjiao , Windley Brian F. , Schulmann Karel , Ao Songjian , Yu Mingjing , Zhang Ji’en , Fang Tonghui
Published: February 2021

The Kalatage inlier in the Dananhu-Haerlik arc is one of the most important arcs in the Eastern Tianshan, southern Altaids (or Central Asian orogenic belt). Based on outcrop maps and core logs, we report 16 new U-Pb dates in order to reconstruct the stratigraphic framework of the Dananhu-Haerlik arc. The new U-Pb ages reveal that the volcanic and intrusive rocks formed in the interval from the Ordovician to early Permian (445–299 Ma), with the oldest diorite dike at 445 ± 3 Ma and the youngest rhyolite at 299 ± 2 Ma. These results constrain the ages of the oldest basaltic and volcaniclastic rocks of the Ordovician Huangchaopo Group, which were intruded by granite-granodiorite-diorite plutons in the Late Ordovician to middle Silurian (445–426 Ma). The second oldest components are intermediate volcanic and volcaniclastic rocks of the early Silurian Hongliuxia Formation (S1h), which lies unconformably on the Huangchaopo Group and is unconformably overlain by Early Devonian volcanic rocks (416 Ma). From the mid- to late Silurian (S2-3), all the rocks were exhumed, eroded, and overlain by polymictic pyroclastic deposits. Following subaerial to shallow subaqueous burial at 416–300 Ma by intermediate to felsic volcanic and volcaniclastics rocks, the succession was intruded by diorites, granodiorites, and granites (390–314 Ma). The arc volcanic and intrusive rocks are characterized by potassium enrichment, when they evolved from mafic to felsic and from tholeiitic via transitional and calc-alkaline to final high-K calc-alkaline compositions with relatively low initial Sr values, (87Sr/86Sr)i = 0.70391–0.70567, and positive εNd(t) values, +4.1 to +9.2. These new data suggest that the Dananhu-Haerlik arc is a long-lived arc that consequently requires a new evolutionary model. It began as a nascent (immature) intra-oceanic arc in the Ordovician to early Silurian, and it evolved into a mature island arc in the middle Silurian to early Permian. The results suggest that the construction of a juvenile-to-mature arc, in combination with its lateral attachment to an incoming arc or continent, was an important crustal growth mechanism in the southern Altaids.
Suprasubduction zone ophiolite fragments in the central Appalachian orogen: Evidence for mantle and Moho in the Baltimore Mafic Complex (Maryland, USA)
Authors: Guice George L. , Ackerson Michael R. , Holder Robert M. , George Freya R. , Browning-Hanson Joseph F. , Burgess Jerry L. , Foustoukos Dionysis I. , Becker Naomi A. , Nelson Wendy R. , Viete Daniel R.
Published: February 2021

Suprasubduction zone (SSZ) ophiolites of the northern Appalachians (eastern North America) have provided key constraints on the fundamental tectonic processes responsible for the evolution of the Appalachian orogen. The central and southern Appalachians, which extend from southern New York to Alabama (USA), also contain numerous ultramafic-mafic bodies that have been interpreted as ophiolite fragments; however, this interpretation is a matter of debate, with the origin(s) of such occurrences also attributed to layered intrusions. These disparate proposed origins, alongside the range of possible magmatic affinities, have varied potential implications for the magmatic and tectonic evolution of the central and southern Appalachian orogen and its relationship with the northern Appalachian orogen. We present the results of field observations, petrography, bulk-rock geochemistry, and spinel mineral chemistry for ultramafic portions of the Baltimore Mafic Complex, which refers to a series of ultramafic-mafic bodies that are discontinuously exposed in Maryland and southern Pennsylvania (USA). Our data indicate that the Baltimore Mafic Complex comprises SSZ ophiolite fragments. The Soldiers Delight Ultramafite displays geochemical characteristics—including highly depleted bulk-rock trace element patterns and high Cr# of spinel—characteristic of subduction-related mantle peridotites and serpentinites. The Hollofield Ultramafite likely represents the “layered ultramafics” that form the Moho. Interpretation of the Baltimore Mafic Complex as an Iapetus Ocean–derived SSZ ophiolite in the central Appalachian orogen raises the possibility that a broadly coeval suite of ophiolites is preserved along thousands of kilometers of orogenic strike.
Repurposing denosumab for recalcitrant bone healing
Authors: Agarwala Sanjay , Vijayvargiya Mayank
Published: February 2021

Fracture healing has four phases: haematoma formation, soft callus, hard callus and remodelling. Often, non-healing fractures have an arrest of one of these phases, which need resurgery. We have repurposed denosumab for impaired fracture healing cases to avoid surgical intervention. Here, we report a series of three cases of impaired fracture healing where denosumab was given 120 mg subcutaneous dosages for 3 months to enhance healing. All the three cases have shown complete bone union at a mean follow-up of 6.7 months (5–9 months) as assessed clinically and radiologically, and have observed no adverse effect of the therapy. Denosumab given in this dose aids fracture healing by increasing callus volume, density and bridges the fracture gap in recalcitrant fracture healing cases where the callus fails to consolidate.
Study protocol of a randomised controlled trial on SISU, a software agent providing a brief self-help intervention for adults with low psychological well-being
Authors: Bendig Eileen , Meißner Echo , Erb Benjamin , Weger Lena , Küchler Ann-Marie , Bauereiss Natalie , Ebert David , Baumeister Harald
Published: February 2021

Introduction

Only a minority of people living with mental health problems are getting professional help. As digitalisation moves on, the possibility of providing internet/mobile-based interventions (IMIs) arises. One type of IMIs are fully automated conversational software agents (chatbots). Software agents are computer programs that can hold conversations with a human by mimicking a human conversational style. Software agents could deliver low-threshold and cost-effective interventions aiming at promoting psychological well-being in a large number of individuals. The aim of this trial is to evaluate the clinical effectiveness and acceptance of the brief software agent-based IMI SISU in comparison with a waitlist control group.

Methods and analysis

Within a two-group randomised controlled trial, a total of 120 adult participants living with low well-being (Well-being Scale/WHO-5) will be recruited in Germany, Austria and Switzerland. SISU is based on therapeutic writing and acceptance and commitment therapy-based principles. The brief intervention consists of three modules. Participants work through the intervention on 3 consecutive days. Assessment takes place before (t1), during (t2) and after (t3) the interaction with SISU, as well as 4 weeks after randomisation (t4). Primary outcome is psychological well-being (WHO-5). Secondary outcomes are emotional well-being (Flourishing Scale), psychological flexibility (Acceptance and Action Questionnaire-II), quality of life (Assessment of Quality of Life -8D), satisfaction with the intervention (Client Satisfaction Questionnaire-8) and side effects (Inventory for the assessment of negative effectsof psychotherapy). Examined mediators and moderators are sociodemographic variables, personality (Big Five Inventory-10), emotion regulation (Emotion Regulation Questionnaire), alexithymia (Toronto Alexithymia Scale-20), centrality of events (Centrality of Events Scale), treatment expectancies (Credibility Expectancy Questionnaire) and technology alliance (Inventory of Technology Alliance–Online Therapy). Data analysis will be based on intention-to-treat principles. SISU guides participants through a 3-day intervention.

Ethics and dissemination

This trial has been approved by the ethics committee of the Ulm University (No. 448/18, 18.02.2019). Results will be submitted for publication in a peer-reviewed journal and presented at conferences.

Trial registration

The trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (DRKS): DRKS00016799 (date of registration: 25 April 2019). In case of important protocol modifications, trial registration will be updated. This is protocol version number 1.
Strategies used by emergency care professionals to handle interpersonal difficulties with patients: a qualitative study
Authors: Charrier Philippe , Occelli Pauline , Buchet-Poyau Karine , Douplat Marion , Delaroche-Gaudin Marine , Fayard-Gonon Florence , Jacquin Laurent , Potinet Véronique , Sigal Alain , Tazarourte Karim , Touzet Sandrine
Published: February 2021

Objectives

Identify the strategies implemented by emergency care professionals when facing tension and interpersonal violence from patients and their friends and family.

Design

Descriptive qualitative study based on 38 semidirective interviews.

Participants

Doctors, nurses, nursing assistants and administrative staff.

Setting

Four emergency departments (EDs) from three French university hospitals.

Results

According to the medical professionals interviewed, the difficulties that they encounter with patients or their accompanying family members can be explained by a lack of understanding of the functioning of EDs, by a general increase in individualistic behaviours leading to a lack of civility or by deviant behaviours (related to toxic substance abuse or mental illness). While managing deviant behaviours may sometimes require a collective intervention, ED staff also implement what are essentially individual communication strategies (with the use of rational explanation, seduction and empathy), confrontation or flight to deal with interpersonal difficulties.

Conclusions

Strategies used by staff members tend to be individualised for the most part, and some, such as confrontational or escape strategies, may not be adapted to all situations. In the face of difficulties between staff and patients, mediators, specialised in resolving conflict, could entrust some cases to professionals.

Trial registration number

ClinicalTrials.gov Registry (NCT03139110).
Protocol for an observational study to identify potential predictors of an acute exacerbation in patients with chronic obstructive pulmonary disease (the PACE Study)
Authors: Kenn Klaus , Gloeckl Rainer , Leitl Daniela , Schneeberger Tessa , Jarosch Inga , Hitzl Wolfgang , Alter Peter , Sczepanski Bernd , Winterkamp Sandra , Boensch Martina , Schade-Brittinger Carmen , Skevaki Chrysanthi , Holz Olaf , Jones Paul W , Vogelmeier Claus F , Koczulla Andreas R
Published: February 2021

Introduction

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are the most critical events for patients with COPD that have a negative impact on patients’ quality of life, accelerate disease progression, and can result in hospital admissions and death. Although there is no distinct definition or detailed knowledge about AECOPD, it is commonly used as primary outcome in clinical studies. Furthermore, it may be difficult in clinical practice to differentiate the worsening of symptoms due to an AECOPD or to the development of heart failure. Therefore, it is of major clinical importance to investigate the underlying pathophysiology, and if possible, predictors of an AECOPD and thus to identify patients who are at high risk for developing an acute exacerbation.

Methods and analysis

In total, 355 patients with COPD will be included prospectively to this study during a 3-week inpatient pulmonary rehabilitation programme at the Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee (Germany). All patients will be closely monitored from admission to discharge. Lung function, exercise tests, clinical parameters, quality of life, physical activity and symptoms will be recorded, and blood samples and exhaled air will be collected. If a patient develops an AECOPD, there will be additional comprehensive diagnostic assessments to differentiate between cardiac, pulmonary or cardiopulmonary causes of worsening. Follow-up measures will be performed at 6, 12 and 24 months.

Exploratory data analyses methods will be used for the primary research question (screening and identification of possible factors to predict an AECOPD). Regression analyses and a generalised linear model with a binomial outcome (AECOPD) will be applied to test if predictors are significant.

Ethics and dissemination

This study has been approved by the Ethical Committee of the Philipps University Marburg, Germany (No. 61/19). The results will be presented in conferences and published in a peer-reviewed journal.

Trial registration number

NCT04140097.
Use of routine death and illness surveillance data to provide insight for UK pandemic planning: lessons from COVID-19
Authors: Clough Helen E , McIntyre K Marie , Patterson Grace E , Harris John P , Rushton Jonathan
Published: February 2021

Objectives

Reporting of COVID-19 cases, deaths and testing has often lacked context for appropriate assessment of disease burden within risk groups. The research considers how routine surveillance data might provide initial insights and identify risk factors, setting COVID-19 deaths early in the pandemic into context. This will facilitate the understanding of wider consequences of a pandemic from the earliest stage, reducing fear, aiding in accurately assessing disease burden and ensuring appropriate disease mitigation.

Setting

UK, 2020.

Participants

The study is a secondary analysis of routine, public domain, surveillance data and information from Office for National Statistics (ONS), National Health Service (NHS) 111 and Public Health England (PHE) on deaths and disease.

Primary and secondary outcome measures

Our principal focus is ONS data on deaths mentioning COVID-19 on the death certificate. We also consider information provided in NHS 111 and PHE data summaries.

Results

Deaths with COVID-19 significantly contributed to, yet do not entirely explain, abnormally elevated all-cause mortality in the UK from weeks 12–18 of 2020. Early in the UK epidemic, COVID-19 was the greatest threat to those with underlying illness, rarely endangering people aged under 40 years. COVID-19-related death rates differed by region, possibly reflecting underlying population structure. Risk of COVID-19-related death was greater for healthcare and social care staff and black, Asian and minority ethnic individuals, having allowed for documented risk factors.

Conclusion

Early contextualisation of public health data is critical to recognising who gets sick, when and why. Understanding at-risk groups facilitates a targeted response considering indirect consequences of society’s reaction to a pandemic alongside disease-related impacts. COVID-19-related deaths mainly mirror historical patterns, and excess non-COVID-19-related deaths partly reflect reduced access to and uptake of healthcare during lockdown. Future outbreak response will improve through better understanding of connectivity between disease monitoring systems to aid interpretation of disease risk patterns, facilitating nuanced mitigation measures.
Protocol for a randomised, double-blinded, placebo-controlled, double-dummy 6-week clinical trial comparing the treatment effects of the glucagon-like peptide 1 receptor agonist liraglutide versus the bile acid sequestrant colesevelam on bile acid malabsorption
Authors: Kårhus Martin Lund , Brønden Andreas , Lyng Forman Julie , Haaber Anne , Vilsbøll Tina , Sonne David Peick , Knop Filip Krag
Published: February 2021

Introduction

Bile acid malabsorption (BAM) is a socially debilitating disease characterised by high stool frequency and urgency caused by a spillover of bile acids into the colon. Bile acid sequestrants (BASs) have limited therapeutic effect but represent the only available treatment option. Cases reporting total remission of BAM-related symptoms after treatment with liraglutide, a glucagon-like peptide 1 analogue, prompted us to design a clinical trial investigating the therapeutic effect of this compound in patients with BAM.

Methods and analysis

Fifty adult individuals with moderate or severe BAM as assessed by the75selenium-homotaurocholic acid test (SeHCAT) will, after a run-in period of 10 days with no BAM treatment, be randomised to either treatment with the BAS colesevelam or liraglutide (double blinded) for 6 weeks. Daily symptom diaries and questionnaires will be filled in. Blood and faecal samples will be collected and SeHCAT will be performed at baseline, after week 3 and at end of trial. The primary endpoint is change in daily stool frequency. Secondary endpoints include changes from baseline in questionnaires, biochemistry, SeHCAT and faecal bile acid content and microbial composition.

Ethics and dissemination

The study complies with Danish and European Union legislation and is approved by the Danish Medicines Agency, the Regional Scientific Ethics Committee of the Capital Region of Denmark and the Danish Data Protection Agency. The study is monitored by the Capital Region of Denmark’s good clinical practice unit. All results, positive, negative and inconclusive, will be disseminated at national and/or international scientific meetings and in peer-reviewed scientific journals.

Trial registration number

EudraCA: 2018-003575-34; Pre-results.
Palliative Medicine Specialist Trainee Research experience, interest and opportunities: a national survey
Authors: Wakefield Donna , Dewhurst Felicity , Koffman Jonathan , Chamberlain Charlotte
Published: February 2021

Objectives

Despite the acknowledged benefits of research, Palliative Medicine receives minimal research funding and has few dedicated research training posts. This study investigated the opportunities and barriers to participating in research for the current cohort of UK Palliative Medicine Specialist Trainees (PMSTs), to better understand the opportunities to improve evidence-based practice within the specialty.

Methods

Two surveys, one for PMSTs and a second for training programme directors (TPDs), were developed. Surveys were piloted and then reviewed by the UK Palliative trainee Research Collaborative and the Palliative Medicine Specialty Advisory Committee (SAC) before distribution. All current PMSTs and TPDs representing all of the UK training regions (n=13) were invited to complete the appropriate survey.

Results

Overall, 85% (11/13) and 45% (102/225) of TPDs and PMSTs responded, respectively. Almost all (92%) PMSTs reported that they were either ‘very interested’ or ‘quite interested’ in taking part in clinical research. PMSTs generally felt that educationaland clinical supervisors were supportive of them taking part in research; however, few (35%) believed they had access to personnel with adequate research experience to provide practical support. Opportunity for appropriate research supervision varied considerably by training region. Where research was being conducted, it was often conducted in trainees’ personal time due to the wide regional variation in dedicated research time.

Conclusion

Despite significant interest in clinical research and support by TPDs and clinical supervisors, access to experienced researchers and equitable protected research time by region needs urgent attention to enhance progress in evidence-based palliative medicine.
Short-term response to immune-chemotherapy and immune features of a ceritinib-resistant patient withROS1-rearranged lung adenocarcinoma
Authors: Yue Dongsheng , Qian Juanjuan , Chen Zhipeng , Zhang Bin , Chen Peng , Zhang Lei , Li Jingjing , Zhang Henghui , Wang Changli
Published: February 2021

Patients withROS1-rearranged non-small cell lung cancer (NSCLC) inevitably relapse after first-line targeted therapy with tyrosine kinase inhibitors. Efficacy of checkpoint inhibitor-based therapy onROS1-positive NSCLC in second-line setting and change of immune factors during treatment are rarely studied. We report aROS1-rearranged stage ⅢB lung adenocarcinoma patient who was resistant to ceritinib after developing a secondaryROS1F2004L mutation. He received eight cycles of nivolumab plus chemotherapy and had an initial partial response, but brain metastases appeared in the seventh cycle. Lorlatinib was confirmed to have activity againstCD74–ROS1with F2004L in vitro, and was administered to this patient as the third-line therapy. The patient responded well to lorlatinib and had no relapse. We explored the tumor immune microenvironment (TIME) during immune-chemotherapy by multiplex immunohistochemistry, RNA sequencing, and multiplex plasma protein immunoassay. The results show that the TIME was active and plasma inflammatory factors were increased when the patient responded to immune-chemotherapy, while the plasma inhibitory checkpoint proteins, lymphocyte-activation gene 3, B and T lymphocyte attenuator, programmed cell death ligand 1 (PD-L1), and PD-1, were increased when the disease progressed. Moreover, the PD-L1 expression on tumor tissue was upregulated during treatment, predicting the limited benefit from immune-chemotherapy. This case report suggests that lorlatinib is a better choice than immune-chemotherapy in second-line setting for patients with similar genomic characteristics, and that monitoring the immune components during immunotherapy may help to predict disease response.
Performance of the 2019 EULAR/ACR systemic lupus erythematosus classification criteria in a cohort of patients with biopsy-confirmed lupus nephritis
Authors: Wang Huijing , Gao Yunjie , Ma Yanhong , Cai Fanghao , Huang Xiaohan , Lan Lan , Ren Pingping , Wang Yaomin , Chen Jianghua , Han Fei
Published: February 2021

Objective

To evaluate the performance of the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) SLE classification criteria in a cohort of patients with biopsy-confirmed lupus nephritis (LN) and their renal prognosis.

Methods

Patients with newly diagnosed SLE attending and followed up for >12 months were included. A retrospective review of all patients with renal biopsy fulfilling a consensus expert opinion during 2014 and 2018. Clinical, serological and pathological data were collected and each patient was assigned a high/low criteria scores (HS/LS) group. Survival curves for flare adjusted for multiplicity on renal flares, was applied to the two groups.

Results

Applying EULAR/ACR criteria in our cohort of 126 patients, 6 (4.76%) did not meet the criterion, resulting in a sensitivity of 95.24%. The EULAR/ACR criteria scores was positively correlated with SLE disease activity index scores. Additionally, we noticed that a significant difference in clinical and immunological manifestations between HS and LS group. We observed a higher proportions of class Ⅲ or Ⅳ LN and lower proportions of class Ⅱ or V LN (p=0.034) and pathological higher activity index in HS group (p=0.007). Compared with LS groups, patients involved more severe renal damage and achieved higher rate of complete remission in the HS group. The Kaplan-Meier exploratory analyses, adjusted for LN classification, estimated glomerular filtration rate, activity index and chronicity index and induction and maintenance treatments, showed that patients in the HS group had a tendency of higher renal flare risk than that in the LS group (HR=0.21, p=0.04).

Conclusions

The EULAR/ACR criteria performed high sensitivity in identifying SLE in this cohort of biopsy-confirmed LN. Patients with LN with high criteria scores had more extrarenal manifestations, and worse renal prognosis in the short and long terms.
Association of asymptomatic hemorrhage after endovascular stroke treatment with outcomes
Authors: Feldman Michael J , Roth Steven , Fusco Matthew R , Mehta Tapan , Arora Niraj , Siegler James E , Schrag Matthew , Mittal Shilpi , Kirshner Howard , Mistry Akshitkumar M. , Yaghi Shadi , Chitale Rohan V , Khatri Pooja , Mistry Eva A
Published: February 2021

Background

Intracerebral hemorrhage (ICH) occurs in ~20%–30% of stroke patients undergoing endovascular therapy (EVT). However, there is conflicting evidence regarding the effect of asymptomatic ICH (aICH) on post-EVT outcomes. We sought to evaluate the effect of aICH on immediate and 90-day post-EVT neurological outcomes.

Methods

In this post-hoc analysis of the multicenter, prospective Blood Pressure after Endovascular Therapy (BEST) study we identified subjects with ICH following EVT. This population was divided into no ICH, aICH, and symptomatic ICH (sICH). Associations with 90-day modified Rankin Scale (mRS) dichotomized by functional independence (0–2 vs 3–6) and early neurological recovery (ENR) were determined using univariate/multivariate logistic regression models.

Results

Of 485 patients enrolled in BEST, 446 had 90-day follow-up data available. 92 (20.6%) developed aICH, and 18 (4%) developed sICH. Compared with those without ICH, aICH was not associated with worse 90-day outcome or lower ENR (OR 0.84 [0.53–1.35], P=0.55, aOR 0.84 [0.48–1.44], P=0.53 for 90-day mRS 0–2; OR 0.77 [0.48–1.23], P=0.34, aOR 0.72 [0.43–1.22] for ENR). aICH was not associated with 90-day outcome or ENR in patients with mTICI ≥2 b (OR 0.78 [0.48–1.26], P=0.33 for 90-day mRS 0–2; OR 0.89 [0.69–1.12], P=0.15 for ENR). A higher proportion of patients with aICH had mTICI ≥2 b than those without ICH (97%vs 87%, P=0.01).

Conclusions

aICH was not associated with worse outcomes in patients with large-vessel stroke treated with EVT. aICH was more frequent in patients with successful recanalization. Further validation of our findings in large cohort studies of EVT-treated patients is warranted.
Effect of alkali activator dosage on compressive and tensile strength of ground granulated blast furnace slag based geopolymer concrete
Authors: Singh Ashita , Bhadauria Sudhir Singh , Mudgal Manish , Kushwah Suresh Singh
Published: February 2021

Use of ordinary portland cement contributes to environmental deterioration by releasing enormous quantities of CO2. To reduce use of cement, this research focuses on preparation of solely ground granulated blast-furnace-slag-based geopolymer binder, activated by a combination of sodium hydroxide and sodium metasilicate cured under ambient temperature at 27 °C. Engineering properties of geopolymer binder are evaluated and compared with conventional cement to assess its suitability as a binder for making geopolymer concrete. Compressive strength, flexure strength, and split tensile strength are determined for geopolymer concrete. Microstructural analysis of geopolymer is performed by X-ray diffraction (XRD), field emission scanning electron microscope (FESEM) with energy dispersive X-ray analysis (EDAX), and Fourier-transform infrared spectroscopy (FTIR) tests. The concentration of alkali activators is optimized by laboratory trials and maximum compressive, flexural, and split tensile strengths of 44.07, 5.60, and 4.39 MPa, respectively, are obtained for geopolymer concrete at 2 mol/L concentration of sodium hydroxide solution with the ratio of sodium metasilicate to sodium hydroxide taken as 2.0.
ESTIMATING ROLE OF GREEN FINANCING ON ENERGY SECURITY, ECONOMIC AND ENVIRONMENTAL INTEGRATION OF BRI MEMBER COUNTRIES
Authors: TU CHUC ANH , CHIEN FENGSHENG , HUSSEIN MUAWYA AHMED , RAMLI MM YANTO , S. PSI MOCHAMAD SOELTON , IQBAL SAJID , BILAL AHMAD RAZA
Published: February 2021

China’s Belt and Road Initiative (BRI) developed a system of interaction with the member countries to uplift economic and environmental integration. Through BRI, these countries are now developing in the field of financial management, energy and environment. This raised the importance to test nexus between energy, finance and environment-related constructs to present the empirical significance with policy suggestions. Therefore, considering the SDG number 7 for sustainable and reliable energy system, recent investigation attempted to determine that how green financing raise energy efficiency, and, to what extent economic and environmental integration act as a catalyst to enhance sustainability and reliability in energy systems of BRI member countries. For empirical analysis, study used the data from 2005–2018. The results have shown a significant variation in energy financing patterns, renewable energy sources consumption and carbon emission trends in BRI member nations. Moreover, the Probit regression analysis confirmed this variation between energy efficiency, financing patterns and carbon emission. Moreover, Human Development Index (HDI) and public financing in energy sector have shown a limited role in developing energy efficiency, which presented the room for private investment through green financing for energy efficiency maximization and this proved as significant in study context. This study also presented policy guidelines for key stakeholders.