bluuebunny/crossref_metadata_2025 huggingface dataset:
Erfahrungen auf dem Gebiet der Entölung von Kraftwerksabwässern
Authors: Schuster H.
Published: July 2021

Je nach Brennstoffbasis und Technologie der Kraftwerke entstehen Abwässer mit unterschiedlichen Mengen und verschiedenen Konzentrationen an Öl und Feststoffen. Hiernach orientieren sich der Umfang und die Methoden der Emulsionsbrechung, Entölung sowie Feststoffabtrennung. Die gegenwärtig üblichen Verfahren werden an mehreren schematischen Darstellungen erläutert. Abschließend werden Vorschläge für künftige Forschungsaufgaben gebracht, wobei der Schwerpunkt der Untersuchungen auf die Wiedergewinnung von Wertstoffen wie Öl, Vanadinpentoxid u. a. zu orientieren ist. Durch wasserwirtschaftliche Prozeßanalysen in den Kraftwerken sind Ansatzpunkte zur Intensivierung bzw. Rationalisierung vorhandener oder neuartiger Technologien zu entwickeln.
Modellierung der Zwickauer Mulde ‐ Beschreibungsmodelle
Authors: Gnauck A. , Reissig H. , Wernstedt J. , Winkler W. , Beyer J.
Published: July 2021

Für die Fließstrecke der Zwickauer Mulde zwischen den Pegeln Zwickau‐Pölbitz und Göhren werden statische und dynamische Beschreibungsmodelle angegeben, die anhand kontinuierlich gewonnener Meßwerte von Einflußgrößen der Wasserbeschaffenheit mit einem Diskretisierungsabstand von Δt = 2 h gebildet wurden. Neben den statistischen Auswertungen werden rekursiv geschätzte Sauerstoffmodelle für den Pegel Göhren und für die gesamte Fließstrecke dargestellt.
The Cost of Discrimination: A Study of Major League Baseball
Authors: Hanssen Andrew
Published: July 2021

This article seeks to determine whether discriminators perform differently than nondiscriminators, whether that performance difference serves to inhibit discrimination, and, if so, how the process works. It investigates an area with abundant data on both the racial mix of participants and firm performance—major league baseball. A sizeable and statistically significant relationship between winning and the presence of black players in the starting lineup is found to hold for the early years of the 1950s and to decline, as expected, as the average number of black ballplayers on major league rosters increased. However, a puzzle emerges in the fact that a significantly slower rate of integration was pursued in the American League (AL) than in the National League (NL) despite there being nearly identical associations between black players and winning in each. The most likely solution to that puzzle is that fan preferences differed—each black player on an AL team appears to have reduced attendance by significantly more than he would have on a NL team. Examination also reveals that when substitute players are considered separately, the positive association between the number of blacks employed and winning is much weaker, whereas the negative association between black ballplayers and attendance is the same. Not coincidentally, black players made up a significantly smaller proportion of substitutes than they did of starters throughout the entire period.
Marginal and Average Tax Rates and the Incentive for Self‐Employment
Authors: Robson Martin T. , Wren Colin
Published: July 2021

The paper examines how the incentives for individuals to take up self‐employment, rather than paid employment, are influenced by the marginal and average income tax rate. A model is developed in which an individual optimally chooses the supply of labor effort and the amount of tax to evade. Assuming that remuneration is more responsive to effort but that the opportunities for evasion are greater in self‐employment, we find a negative relationship between self‐employment and the marginal tax rate but a positive relationship with the average rate. This is supported by empirical evidence for 15 OECD countries over the 1980s.
A Theoretical and Empirical Comparison of Free Agent and Arbitration‐Eligible Salaries Negotiated in Major League Baseball
Authors: Miller Phillip A.
Published: July 2021

This paper presents a theoretical and empirical comparison of determination of negotiated salaries in baseball's free agent market to that in its final‐offer arbitration (FOA) system. The theoretical bargaining model of each system is based on Nash (1950). It is argued that Farber's (1980) model of FOA is not fully applicable in explaining baseball's FOA process. The free agent market and the arbitration system each determine negotiated salaries that are dependent on the different disagreement outcomes of the negotiators in the respective systems. It is thus concluded theoretically that the two systems will determine salaries differently. The theoretical analysis also suggests that there may be selection bias present when one empirically analyzes only negotiated settlements. Using a straightforward regression model that controls for productivity, playing experience, and the potential selection bias, the empirical analysis substantiates the theory's results. A method is then developed to estimate the effect that free agent salaries have on salaries for arbitration‐eligible players. It is found that there is a significant positive relationship between them, but the systems do not determine equal salaries for comparable players.
The Dynamic Behavior of Wages and Prices: Cointegration Tests within a Large Macroeconomic System
Authors: Schmidt Martin B.
Published: July 2021

The dynamic relationship between wages and prices has long held a central place within the economic literature. Most macroeconomic models make assumptions as to the causal relationship between the two variables. Unfortunately, empirical investigations have produced widely divergent results. In particular, the present paper examines the results of time‐series studies and argues that the lack of a consensus is due to improperly specified models. Once the wage‐price relationship is embedded within a multiple vector system, identification of a wage‐price cointegrating relationship is significantly improved. In addition, the increased efficiency yields evidence in favor of the dual feedback between wages and prices.
Exchange Rate Shocks and the Speed of Trade Price Adjustment
Authors: Ran Jimmy , Balvers Ronald
Published: July 2021

A quantity adjustment cost model is developed in the context of international trade along the lines proposed by Krugman (1987). The model implies that prices adjust dynamically to exchange rate fluctuations. The price adjustment speed is determined as a function of foreign demand responsiveness, the appropriate discount rate, and an adjustment cost parameter. Pass‐through is incomplete and increases over time and with the speed of price adjustment. A preliminary empirical analysis finds that the speed of price adjustment from the time series by industry and then in a cross‐sectional regression tentatively relates the obtained adjustment speeds to their theoretical determinants.
Hospital Cost Containment and Length of Stay: An Econometric Analysis
Authors: Carey Kathleen
Published: July 2021

In recent years, concern in the United States over rising health care costs has led to precipitous reductions in the lengths of hospitalizations. While perceptions of compromised medical care quality following this practice and others have prompted policy makers to consider stricter regulation of health insurance organizations, little attention has been given to the extent to which length of stay reductions are responsible for decreasing hospital costs. This paper provides empirical evidence on that point. The method utilizes a hospital total operating cost function estimated on 2792 U.S. hospitals for the period 1987‐1992. Three different panel data estimating techniques are applied, including a random effects model that is distinctive in allowing for correlation between hospital effects and observable regressors, circumventing inconsistency problems following from standard generalized least‐squares estimations. The cost elasticity of length of stay is calculated from the regression results. This measure is low, falling in the range 0.09‐0.12. It suggests that common perceptions regarding the extent of cost savings resulting from length of stay reductions have been overestimated.
Adam Smith's Lost Legacy
Authors: Evensky Jerry
Published: July 2021

This piece outlines Adam Smith's moral philosophical vision. It traces the central role he ascribed to civic ethics as an antidote to the incentives for rent‐seeking and thus as a key element in the successful development of a constructive, cohesive liberal society. The case is made that standard neoclassical analysis, as represented by the work of Gary Becker, identifies no such antidote and thus cannot model the constructive liberal case. The best modern work on the issue is that of Amartya Sen and of James Buchanan. Sen's work and its relation to Smith's vision are examined.
Market Efficiency and Profitable Wagering in the National Hockey League: Can Bettors Score on Longshots?
Authors: Woodland Linda M. , Woodland Bill M.
Published: July 2021

Sports betting and racetrack markets continue to provide researchers with opportunities to test the efficient market hypothesis. This paper investigates the efficiency of a relatively new sports betting market, the National Hockey League, for 1990‐1996. The market is found to be somewhat inefficient and simple wagering strategies are identified that result in profitable returns. Consistent with previous research for football and baseball, bettors in hockey are inclined to overbet favorites relative to their observed chance of winning. Interestingly, the market does not appear to be converging to efficiency.
Are Real GDP Levels Nonstationary? Evidence from Panel Data Tests
Authors: Rapach David E.
Published: July 2021

Ever since the seminal paper of Nelson and Plosser (1982), researchers have focused on the potential nonstationarity of important macroeconomic variables, and unit root tests are now a standard procedure in empirical analyses. While there are many findings of unit roots in macroeconomic variables using the popular augmented Dickey and Fuller (1979) test, this test has low power against near‐unit‐root alternatives. Recently, panel data procedures have been proposed as an avenue to increased power. This paper applies panel unit root tests to international real GDP and real GDP per capita data. The results overwhelmingly indicate that international real GDP and real GDP per capita levels are nonstationary.
Shall the Northern Optimal R&D Subsidy Rate Inversely Respond to Southern Intellectual Property Protection?
Authors: Lin Hwan C.
Published: July 2021

Empirical studies have found that decentralized economies typically underinvest in research and development (R&D). This paper shows that to promote R&D investment, the innovating North's optimal subsidy rate may not necessarily fall in response to the imitating South's strengthening intellectual property protection (IPP), depending on the elasticity of demand for innovative goods. As numerical simulations indicate, if the demand is less elastic, a tightening of Southern IPP (increase in patent life) tends to allow the self‐interested North a smaller optimal subsidy rate. Yet, this relation is overturned if the demand is elastic enough. I also find that worldwide welfare maximization requires a regime of Southern IPP that is neither as stringent as the North favors nor as lax as the South prefers.
Spillovers, Complementarities, and Sorting in Labor Markets with an Application to Professional Sports
Authors: Kendall Todd D.
Published: July 2021

Spillovers to productivity across workers may exist when workers produce in teams. Under certain conditions, these spillovers may cause a worker's marginal product to differ across different firms. Empirical examination of professional basketball finds significant spillovers to offensive productivity but finds relatively little evidence for market sorting based on spillovers. Thus, while teammate composition is important to a player's success, there is no evidence for complementarity.
Does Allowing the Bells to Offer InterLATA Long‐Distance Service Affect Entry into Local Telephony?
Authors: Flaherty Susan M. V. , Zimmerman Paul R.
Published: July 2021

Following the 1984 divestiture of AT&T, local telephone service was provided by several Regional Bell Operating Companies (RBOCs). The RBOCs served as monopoly providers of local telephone service in their respective territories but were prohibited from offering long‐distance service to their in‐region subscribers. Section 271 of the landmark Telecommunications Act of 1996 allows an RBOC to offer in‐region long‐distance service if it demonstrates that the local telephone exchange market is open to competitive entry. This study empirically evaluates the efficacy of this policy by considering the impact of RBOC entry into long‐distance on the development of competitive entry into local telephony. The results suggest that section 271 has been successful in promoting entry into local telephony. However, aggregate price data suggest that this entry has not been realized with lower rates for residential telephone subscribers.
Entry in Foreign Markets under Asymmetric Information and Demand Uncertainty
Authors: Moner‐Colonques Rafael , Orts Vicente , Sempere‐Monerris José J.
Published: July 2021

This paper examines the mode of entry of a multinational firm that has less information about the host market stochastic demand than the local firm. The foreign firm can enter the market either through direct investment or exports. Each entry mode entails different costs and has different informational implications. Entry through foreign direct investment (FDI) is favored by greater variability in demand. Interestingly enough, strategic behavior by the incumbent firm, which deviates from its first period monopoly output, might be aimed at increasing the probability of foreign entry through FDI despite having to compete against an equally informed and efficient entrant; this never happens in a symmetric information environment. Such host firm behavior is aimed at reducing the strategic uncertainty derived from the foreign firm's beliefs. Compared with the symmetric information setting, entry via direct investment may occur in more cases.
A comparison of two teaching procedures to establish generalized intraverbal‐tacting in children with autism
Authors: degli Espinosa Francesca , Wolff Kate , Hewett Sophie
Published: July 2021

Previous research has investigated generalized intraverbal‐tacting by teaching children with autism to respond using autoclitic frames. The present study compared the effectiveness and efficiency of a Frame and a No Frame procedure across counterbalanced stimulus sets with 4 children with autism. In the Frame condition, children were taught to respond using autoclitic frames (e.g., “Shape square,” “Number two,” “Color green,” “It's mummy,” “S/he is drinking”) corresponding to the verbal antecedent (“What shape?”, “What number?”, “What color?”, “Who is it?”, “What is s/he doing?”). In the No Frame condition, intraverbal‐tacting was established without the autoclitic frame. Irrespective of stimuli employed, 2 children acquired intraverbal‐tacting only in the Frame condition. The other 2 children acquired intraverbal‐tacting in both conditions, with the Frame procedure requiring fewer teaching trials for 1 child and producing greater generalization for the other. Implications for clinical practice and the role of additive intraverbal stimulus control of autoclitic frames are discussed.
Cognitive decline is associated with an accelerated rate of bone loss and increased fracture risk in women: a prospective study from the Canadian Multicentre Osteoporosis Study
Authors: Bliuc Dana , Tran Thach , Adachi Jonathan D. , Atkins Gerald J. , Berger Claudie , van den Bergh Joop , Cappai Roberto , Eisman John A. , van Geel Tineke , Geusens Piet , Goltzman David , Hanley David A. , Josse Robert , Kaiser Stephanie , Kovacs Christopher S. , Langsetmo Lisa , Prior Jerilynn C. , Nguyen Tuan V. , Solomon Lucian B. , Stapledon Catherine , Center Jacqueline R. ,   For the Canadian Multicentre Osteoporosis Study (CaMos) Research Group
Published: July 2021

Cognitive decline and osteoporosis often coexist and some evidence suggests a causal link. However, there are no data on the longitudinal relationship between cognitive decline, bone loss and fracture risk, independent of aging. This study aimed to determine the association between: (i) cognitive decline and bone loss; and (ii) clinically significant cognitive decline (≥3 points) on Mini Mental State Examination (MMSE) over the first 5 years and subsequent fracture risk over the following 10 years. A total of 1741 women and 620 men aged ≥65 years from the population-based Canadian Multicentre Osteoporosis Study were followed from 1997 to 2013. Association between cognitive decline and (i) bone loss was estimated using mixed-effects models; and (ii) fracture risk was estimated using adjusted Cox models. Over 95% of participants had normal cognition at baseline (MMSE ≥ 24). The annual % change in MMSE was similar for both genders (women −0.33, interquartile range [IQR] −0.70 to +0.00; and men −0.34, IQR: −0.99 to 0.01). After multivariable adjustment, cognitive decline was associated with bone loss in women (6.5%; 95% confidence interval [CI], 3.2% to 9.9% for each percent decline in MMSE from baseline) but not men. Approximately 13% of participants experienced significant cognitive decline by year 5. In women, fracture risk was increased significantly (multivariable hazard ratio [HR], 1.61; 95% CI, 1.11 to 2.34). There were too few men to analyze. There was a significant association between cognitive decline and both bone loss and fracture risk, independent of aging, in women. Further studies are needed to determine mechanisms that link these common conditions. © 2021 American Society for Bone and Mineral Research (ASBMR).
Epilepsy, violence, and crime. A historical analysis
Authors: Gyimesi Júlia
Published: July 2021

In the 19th and early 20th century, epilepsy was one of the most investigated disorders in forensic psychiatry and psychology. The possible subsidiary symptoms of epilepsy (such as temporal confusion, alterations of consciousness, or increased aggression) played pivotal roles in early forensic and criminal psychological theories that aimed to underscore the problematic medical, social and legal status of epileptic criminals. These criminals were considered extremely violent and capable of committing sudden, brutal acts. Although the theory of “epileptic criminality” was refuted due to 20th‐century developments in medicine, forensic psychiatry, and criminal psychology, some suppositions related to the concept of epileptic personality have lingered. This paper explores the lasting influence of the theory of epileptic personality by examining the evolution of the theories of epileptic criminality both in the international and the Hungarian context. Specifically, it calls attention to the twentieth‐century revival of the theory of epileptic personality in the works of Leopold Szondi, István Benedek and Norman Geschwind. The paper shows that the issue of epileptic personality still lingers in neuropsychology. In doing so, biological reductionist trends in medical‐psychological thinking are traced, and attention is drawn to questions that arise due to changing cultural and medical representations.
What is the optimum time to start antiretroviral therapy in people with HIV and tuberculosis coinfection? A systematic review and meta‐analysis
Authors: Burke Rachael M , Rickman Hannah M , Singh Vindi , Corbett Elizabeth L , Ayles Helen , Jahn Andreas , Hosseinipour Mina C , Wilkinson Robert J , MacPherson Peter
Published: July 2021

Background

HIV and tuberculosis are frequently diagnosed concurrently. In March 2021, World Health Organization recommended that antiretroviral therapy (ART) should be started within two weeks of tuberculosis treatment start, at any CD4 count. We assessed whether earlier ART improved outcomes in people with newly diagnosed HIV and tuberculosis.

Methods

We did a systematic review by searching nine databases for trials that compared earlier ART to later ART initiation in people with HIV and tuberculosis. We included studies published from database inception to 12 March 2021. We compared ART within four weeks versus ART more than four weeks after TB treatment, and ART within two weeks versus ART between two and eight weeks, and stratified analysis by CD4 count. The main outcome was death; secondary outcomes included IRIS and AIDS‐defining events. We pooled effect estimates using random effects meta‐analysis.

Results and discussion

We screened 2468 abstracts, and identified nine trials. Among people with all CD4 counts, there was no difference in mortality by earlier ART (≤4 week) versus later ART (>4 week) (risk difference [RD] 0%, 95% confidence interval [CI] −2% to +1%). Among people with CD4 count ≤50 cells/mm3, earlier ART (≤4 weeks) reduced risk of death (RD −6%, −10% to −1%). Among people with all CD4 counts earlier ART (≤4 weeks) increased the risk of IRIS (RD +6%, 95% CI +2% to +10%) and reduced the incidence of AIDS‐defining events (RD −2%, 95% CI −4% to 0%). Results were similar when trials were restricted to the four trials which permitted comparison of ART within two weeks to ART between two and eight weeks. Trials were conducted between 2004 and 2014, before recommendations to treat HIV at any CD4 count or to rapidly start ART in people without TB. No trials included children or pregnant women. No trials included integrase inhibitors in ART regimens.

Discussion

Earlier ART did not alter risk of death overall among people living with HIV who had TB disease. For logistical and patient preference reasons, earlier ART initiation for everyone with TB and HIV may be preferred to later ART.
Seroprevalence of SARS‐CoV‐2 antibodies among rural healthcare workers
Authors: Neises Jordan Z. , Hossain Md. Saddam , Sultana Rifat , Wanniarachchi Kevin N. , Wollman Jared W. , Nelson Eric , Specker Bonny L. , Hoppe Adam D. , Lawson Steven R. , Thiex Natalie W.
Published: July 2021

The objective of this longitudinal cohort study was to determine the seroprevalence of antibodies to severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) in healthcare workers employed at healthcare settings in three rural counties in eastern South Dakota and western Minnesota from May 13, 2020, through December 22, 2020. Three blood draws were performed at five clinical sites and tested for the presence of antibodies against the SARS‐CoV‐2. Serum samples were tested for the presence of antibodies using a fluorescent microsphere immunoassay (FMIA), neutralization of SARS‐CoV‐2 spike‐pseudotyped particles (SARS‐CoV‐2pp) assay, and serum virus neutralization (SVN) assay. The seroprevalence was determined to be 1/336 (0.29%) for samples collected from 5/13/20 to 7/13/20, 5/260 (1.92%) for samples collected from 8/13/20 to 9/25/20, and 35/235 (14.89%) for samples collected from 10/16/20 to 12/22/20. Eight of the 35 (22.8%) seropositive individuals identified in the final draw did not report a previous diagnosis with COVID‐19. There was a high correlation (>90%) between the FMIA and virus neutralization assays. Each clinical site's seroprevalence was higher than the cumulative incidence for the general public in the respective county as reported by state public health agencies. As of December 2020, there was a high percentage (85%) of seronegative individuals in the study population.
Graph‐based local climate classification in Iran
Authors: Akrami Neda , Ziarati Koorush , Dev Soumyabrata
Published: July 2021

In this paper, we introduce a novel graph‐based method to classify the regions with similar climate in a local area. We refer our proposed method as graph partition based method (GPBM). Our proposed method attempts to overcome the shortcomings of the current state‐of‐the‐art methods in the literature. It has no limit on the number of variables that can be used and also preserves the nature of climate data. To illustrate the capability of our proposed algorithm, we benchmark its performance with other state‐of‐the‐art climate classification techniques. The climate data are collected from 24 synoptic stations in Fars province in southern Iran. The data include seven climate variables stored as time series from 1951 to 2017. Our results exhibit that our proposed method performs a more realistic climate classification with less computational time. It can save more information during the climate classification process and is therefore efficient in further data analysis. Furthermore, using our method, we can introduce seasonal graphs to better investigate seasonal climate changes. To the best of our knowledge, our proposed method is the first graph‐based climate classification system.
Handgrip strength stratifies the risk of covert and overt hepatic encephalopathy in patients with cirrhosis
Authors: Miwa Takao , Hanai Tatsunori , Nishimura Kayoko , Maeda Toshihide , Ogiso Yui , Imai Kenji , Suetsugu Atsushi , Takai Koji , Shiraki Makoto , Shimizu Masahito
Published: July 2021

Background

Handgrip strength (HGS) is a simple and convenient method to assess nutrition status in patients with cirrhosis. This retrospective study aimed to investigate the utility of HGS for predicting patients with covert hepatic encephalopathy (CHE) and patients at high risk of overt hepatic encephalopathy (OHE).

Methods

We reviewed 963 patients with cirrhosis and consequently enrolled eligible 270 patients. HGS was measured using a digital grip dynamometer. CHE was diagnosed using a computer‐aided neuropsychiatric test. Factors associated with CHE were estimated using the logistic regression model. Predictors associated with OHE occurrence were analyzed using the Fine‐Gray competing risk regression model.

Results

Of the 270 eligible patients, reduced HGS was observed in 102 (38%), reduced muscle mass in 107 (40%), and CHE in 53 (20%). Multivariate analysis showed that serum ammonia levels (odds ratio [OR], 2.23; 95% CI, 1.14–4.36; P = 0.014) and reduced HGS (OR, 3.68; 95% CI, 1.93–7.03; P < 0.001) were independently associated with CHE. During the median follow‐up period of 24.5 months, 43 (16%) patients experienced OHE. After adjusting for possible confounding factors, multivariate analysis showed that reduced HGS (subdistribution hazard ratio, 2.36; 95% CI, 1.27–4.38; P = 0.007) was a significant predictor in the development of OHE.

Conclusion

Patients with reduced HGS had a higher prevalence of CHE and a higher risk for OHE occurrence than those with normal HGS. The measurement of HGS could be a simple bedside modality to stratify the patients’ risk for CHE and OHE.
Bile acid–farnesoid X receptor–fibroblast growth factor 19 axis in patients with short bowel syndrome: The randomized, glepaglutide phase 2 trial
Authors: Hvistendahl Mark Krogh , Naimi Rahim Mohammad , Hansen Svend Høime , Rehfeld Jens Frederik , Kissow Hannelouise , Pedersen Jens , Dragsted Lars Ove , Sonne David Peick , Knop Filip Krag , Jeppesen Palle Bekker
Published: July 2021

Background

The gut‐liver axis and enterohepatic circulation have gained increasing attention lately. Patients with short bowel syndrome (SBS) are, in fact, human knock‐out models that may assist in the understanding of bile acid synthesis and regulation.

We evaluated effect of glepaglutide (a long‐acting glucagon‐like peptide‐2 analog) on bile acid synthesis (the enterohepatic circulation of bile acids and liver biochemistry in patients with SBS).

Method

In a single‐center, double‐blinded, dose‐finding, crossover phase 2 trial, 18 patients with SBS were randomly assigned to 2 of 3 treatment arms (0.1, 1, and 10 mg) with daily subcutaneous injections of glepaglutide for 3 weeks. The washout period between the 2 treatment periods was 4–8 weeks. Measurements were performed at baseline and at the end of each treatment period and included postprandial plasma samples for fibroblast growth factor 19 (FGF19), 7α‐hydroxy‐4‐cholesten‐3‐one (C4), total excretion of fecal bile acids, gene expression of farnesoid X receptor (FXR) in intestinal mucosal biopsies, total plasma bile acids, and liver biochemistry.

Results

Compared with baseline, the median (interquartile range) postprandial response (area under the curve 0–2h) of FGF19 increased by 150 h × ng/L (41, 195; P = 0.001) and C4 decreased by 82 h × µg/L (−169, −28; p = 0.010) in the 10‐mg dose. FXR gene expression did not change in any of the groups. Alkaline phosphatase significantly decreased.

Conclusion

Glepaglutide may stimulate the bile acid/FXR/FGF19 axis, leading to increased plasma concentrations of FGF19. Thereby, glepaglutide may ameliorate the accelerated de novo bile acid synthesis and play a role in the prevention and/or treatment of intestinal failure–associated liver disease.
Catheter‐related infection rates in patients receiving customized home parenteral nutrition compared with multichamber bags
Authors: Crooks Benjamin , Harrison Simon , Millward Graham , Hall Kirsty , Taylor Michael , Farrer Kirstine , Abraham Arun , Teubner Antje , Lal Simon
Published: July 2021

Background

The risk of bloodstream infections may be increased in hospitalized patients receiving ready‐made parenteral nutrition (PN) multichamber bags (MCBs) compared with customized PN; however, as highlighted in recent international guidelines, there are no comparable data relating to home PN (HPN).

Methods

Data from a prospectively maintained database were analyzed to compare incidence rates of catheter‐related bloodstream infections (CRBSIs) between patients receiving customized HPN compared with MCB HPN at a national UK referral center between May 2018 and August 2020.

Results

Sixty patients with chronic intestinal failure were commenced on MCBs and 45 received customized HPN for a total of 5914 and 7641 catheter days, respectively. No difference in CRBSI incidence was found (0.51/1000 catheter days for MCBs, 0.39/1000 catheter days for customized HPN; incidence rate ratio, 1.29; 95% CI, 0.26–6.37). Eighteen patients were switched from customized HPN to MCB HPN. The study period covered 7401 catheter days receiving customized HPN and 4834 days on MCBs. No significant change was noted in the CRBSI rates following this switch (0.27/1000 catheter days receiving customized HPN vs 0.21/1000 catheter days on MCBs; incidence rate ratio, 1.31; 95% CI, 0.12–14.3).

Conclusion

The use of MCBs for HPN patients is not associated with an increased risk of CRBSI. This study will inform international guidelines and provide reassurance for the continued, safe use of MCB HPN.
Efficacy of a harvest graft substitute for recession coverage and soft tissue volume augmentation: A randomized controlled trial
Authors: McGuire Michael K. , Janakievski Jim , Scheyer E. Todd , Velásquez Diego , Gunsolley John C. , Heard Rick H. , Morelli Thiago
Published: July 2021

Background

The autogenous connective tissue graft (CTG) with coronally advanced flap (CTG+CAF) is the "gold standard" for recession defect coverage; however, researchers continue to pursue lower morbidity, more convenient and unlimited supply harvest graft substitutes, including those that could provide soft tissue volume augmentation.

Methods

A randomized, controlled, double‐masked comparison of a volume‐stable collagen matrix (VCMX) versus CTG was conducted at four clinical investigation sites. Single, contralateral, within patient matched‐pair, RT1 recession defects were treated with VCMX+CAF (test) and CTG+CAF (control). The primary efficacy end point was percent root coverage at 6 months. Secondary efficacy end points included clinical measures such as soft tissue volume, attachment level, and keratinized tissue width. Patient‐reported outcomes included measures such as discomfort, esthetics, and overall satisfaction; 6‐month end point results were followed for 1 year.

Results

Thirty patients received control and test therapies, and all patients were available for follow‐up measures. Average percent root coverage for CTG+CAF was 90.5% ± 14.87% versus 70.7% ± 28.26% for VCMX+CAF, P <0.0001. Both therapies produced significant soft tissue volume increases (84.8 ± 47.43 mm3 control versus 48.90 ± 35.58 mm3 test, P = 0.0006). The test, harvest graft substitute produced less postoperative pain and was preferred by patients at the 6‐month end point. All other end point measures were not significantly different.

Conclusions

VCMX+CAF root coverage was inferior to CTG+CAF but produced less morbidity and was preferred by patients. Case/patient selection and surgical technique appear key to achieving successful results with the harvest graft alternative.
An evaluation of pharmacist activity in hospital outpatient clinics
Authors: Snoswell Centaine L. , Draper Megan J. , Barras Michael
Published: July 2021

Multidisciplinary healthcare teams embedded into outpatient clinics enhance patient outcomes; it is therefore important that when medications are a focus of treatment in these clinics that clinical pharmacists are included in the team. At the start of the 2019/2020 financial year, the Princess Alexandra Hospital added 13 clinic pharmacist positions to their outpatient services. The aim of this study is to describe the results of a retrospective appraisal of the contents of clinical notes written by pharmacists in these outpatient clinics during the first two months. This appraisal is a preliminary investigation into the activities undertaken in these new clinic roles. A sample of notes was randomly selected from each clinic. Data included the number and type of activities undertaken by the pharmacists and the recommendations they recorded in their notes. It was found that of the 249 clinic pharmacist notes that were assessed, new patients made up 75.5% of the cohort. Recommendations were documented in 91 (37%) notes and included both dose adjustments to promote the judicious use of medicines and advice on how to withhold medications prior to surgical procedures. Although the results are preliminary, it is expected that the patients and hospital will benefit from embedding these pharmacists in these outpatient clinics; however, further research is required. Additionally, further standardisation of clinic pharmacist notes will improve future evaluation of these roles and allow for clearer conclusions to be drawn regarding the clinical benefits for patients and the hospital from the addition of clinical pharmacists in outpatient clinics.
Structural insights into the distinctive RNA recognition and therapeutic potentials of RIG‐I‐like receptors
Authors: Batool Maria , Kim Moon Suk , Choi Sangdun
Published: July 2021

RNA viruses, including the coronavirus, develop a unique strategy to evade the host immune response by interrupting the normal function of cytosolic retinoic acid‐inducible gene‐I (RIG‐I)‐like receptors (RLRs). RLRs rapidly detect atypical nucleic acids, thereby triggering the antiviral innate immune signaling cascade and subsequently activates the interferons transcription and induction of other proinflammatory cytokines and chemokines. Nonetheless, these receptors are manipulated by viral proteins to subvert the host immune system and sustain the infectivity and replication potential of the virus. RIG‐I senses the single‐stranded, double‐stranded, and short double‐stranded RNAs and recognizes the key signature, a 5′‐triphosphate moiety, at the blunt end of the viral RNA. Meanwhile, the melanoma differentiation‐associated gene 5 (MDA5) is triggered by longer double stranded RNAs, messenger RNAs lacking 2′‐O‐methylation in their 5′‐cap, and RNA aggregates. Therefore, structural insights into the nucleic‐acid‐sensing and downstream signaling mechanisms of these receptors hold great promise for developing effective antiviral therapeutic interventions. This review highlights the critical roles played by RLRs in viral infections as well as their ligand recognition mechanisms. In addition, we highlight the crosstalk between the toll‐like receptors and RLRs and provide a comprehensive overview of RLR‐associated diseases as well as the therapeutic potential of RLRs for the development of antiviral‐drugs. Moreover, we believe that these RLR‐based antivirals will serve as a step toward countering the recent coronavirus disease 2019 pandemic.
Sensor interrogation technique with multi‐wavelength laser based microwave photonic filter
Authors: Dai Weiyu , Wang Haoran , Fu Hongyan
Published: July 2021

In this article, we have proposed and demonstrated a sensing interrogation scheme of microwave photonic filter (MPF) based on multi‐wavelength fiber laser (MWFL). A Mach‐Zehnder interferometer (FMZI) acts as the wavelength selective component in the laser cavity as well as the sensing element. An erbium doped fiber amplifier (EDFA) and a semiconductor optical amplifier (SOA) are employed as hybrid gain medium to suppress the homogeneous broadening of erbium doped fiber. The MWFL is employed as the optical source to implement the MPF together with a dispersive medium. The free spectrum range of interference pattern of the FMZI changes with the temperature variation, thus changing the central frequency of MPF's passbands. The sensitivities are −12.23 and 6.11 MHz/°C, respectively, when the sensing optical fiber with the length of 2.2 and 1.1 m are used.
Study on 13.56‐MHz out‐to‐in body channel and its coexistence with human body communication for capsule endoscope
Authors: Jung Jaehyo , Li Meina , Kim Youn Tae
Published: July 2021

A capsule endoscope transmits images of the digestive organs from the inside to the outside of the body. For in‐to‐out body transmission, a capsule endoscope can use human body communication (HBC) instead of radio frequency (RF). However, an HBC endoscope does not transmit in the opposite direction (i.e., out‐to‐in body transmission). In this study, out‐to‐in body transmission using HBC at 13.56 MHz was investigated, and the results are presented herein. The coexistence between the 13.56‐MHz out‐to‐in body transmission and HBC was investigated through channel measurement and bit error rate (BER) analysis. The use of 13.56 MHz is advantageous because out‐to‐in body transmission can be easily implemented using various existing chip solutions that have been developed for 13.56‐MHz radio‐frequency identification (RFID).
Compact combined antenna for high‐power ultrawideband radiation sources with subnanosecond pulse duration
Authors: Balzovsky Evgeny , Buyanov Yury , Koshelev Vladimir , Nekrasov Eduard
Published: July 2021

The paper presents the design of a combined antenna, optimized in numerical calculations to radiate high‐power bipolar pulses with a duration of 0.5 ns. According to the results of the calculations, a compact antenna with the dimensions of 60 × 65 × 55 mm3 (width × height × length) was made. The influence of a high‐voltage insulator position relative to the antenna input on the matching band of the antenna with the coaxial feeder is shown. In the absence of an isolator, the matching band is in the range of 0.98–9.33 GHz. The antenna efficiency by the peak electric field strength and the energy efficiency are equal to 0.75–0.8 and 0.9, respectively.
Comparison of convolutional neural networks for detecting large vessel occlusion on computed tomography angiography
Authors: Remedios Lucas W. , Lingam Sneha , Remedios Samuel W. , Gao Riqiang , Clark Stephen W. , Davis Larry T. , Landman Bennett A.
Published: July 2021

Purpose

Artificial intelligence diagnosis and triage of large vessel occlusion may quicken clinical response for a subset of time‐sensitive acute ischemic stroke patients, improving outcomes. Differences in architectural elements within data‐driven convolutional neural network (CNN) models impact performance. Foreknowledge of effective model architectural elements for domain‐specific problems can narrow the search for candidate models and inform strategic model design and adaptation to optimize performance on available data. Here, we study CNN architectures with a range of learnable parameters and which span the inclusion of architectural elements, such as parallel processing branches and residual connections with varying methods of recombining residual information.

Methods

We compare five CNNs: ResNet‐50, DenseNet‐121, EfficientNet‐B0, PhiNet, and an Inception module‐based network, on a computed tomography angiography large vessel occlusion detection task. The models were trained and preliminarily evaluated with 10‐fold cross‐validation on preprocessed scans (n = 240). An ablation study was performed on PhiNet due to superior cross‐validated test performance across accuracy, precision, recall, specificity, and F1 score. The final evaluation of all models was performed on a withheld external validation set (n = 60) and these predictions were subsequently calibrated with sigmoid curves.

Results

Uncalibrated results on the withheld external validation set show that DenseNet‐121 had the best average performance on accuracy, precision, recall, specificity, and F1 score. After calibration DenseNet‐121 maintained superior performance on all metrics except recall.

Conclusions

The number of learnable parameters in our five models and best‐ablated PhiNet directly related to cross‐validated test performance—the smaller the model the better. However, this pattern did not hold when looking at generalization on the withheld external validation set. DenseNet‐121 generalized the best; we posit this was due to its heavy use of residual connections utilizing concatenation, which causes feature maps from earlier layers to be used deeper in the network, while aiding in gradient flow and regularization.
Acupuncture in addition to standard conservative treatment for overactive bladder; a feasibility trial for a randomized controlled study
Authors: Hargreaves Emma , Harding Chris , Clarkson Carl
Published: July 2021

Aims

This study aims to assess the feasibility of an randomized controlled trial (RCT) to test treatment efficacy of acupuncture for symptoms of overactive bladder syndrome (OAB), a common long‐term condition with physical, psychological, social and sexual consequences.

Methods

A total of 30 participants were recruited and randomized to either standard conservative management for OAB or standard conservative management plus acupuncture. Standard care consisted of individually tailored advice regarding bladder health, pelvic floor exercises and lifestyle adjustments. The intervention group received 6 sessions of acupuncture over an 8‐week period. Outcomes measured included adherence to the study protocol, recruitment rate, participant attrition rate and adverse events. A 3‐day bladder diary and Incontinence Questionnaire—short form questionnaire were used to assess symptoms. The ICEpop CAPability measure for Adults measure was used to assess well‐being. Outcomes were collected at baseline, after 8 weeks of intervention and 6 weeks after completing intervention. An exit questionnaire captured participant experience data.

Results

Comparison of the two groups at baseline did not detect statistically significant differences in demographics and symptom profile. A total of 23 participants completed all study proceedures. Recruitment was completed in 11 months, quicker than anticipated. No serious adverse events occurred; minor adverse events were recorded in 11/114 (9.6%) treatments. A total of seven participants failed to complete one or more study proceedures with an overall attrition rate of 23.3%.

Conclusions

Most participants completed all aspects of the study and found the protocol acceptable. The interventions appear safe and well tolerated. The concept of a large‐scale RCT with a similar protocol was proven and appears feasible based on this pilot work.
“Novice nurse and novel coronavirus”—experiences of novice nurses caring for patients diagnosed with COVID‐19 in Thailand
Authors: Sarnkhaowkhom Chawapon , Promkanya Anucha , Pomisrikeaw Siriluk , Ritthapanya Nutchaporn
Published: July 2021

Aims

To explore the experiences of novice nurses caring for patients diagnosed with COVID‐19 in Thailand.

Design

A qualitative descriptive research.

Methods

The experiences of twelve novice nurses were explored through in‐depth interviews, telephone and video conferencing interviews. All interviews were recorded, verbatim transcribed and analysed by thematic content analysis.

Results

The findings fell into five main themes as follows: from novice nurses to nurse who care for COVID‐19 patients; various learning methods focused on providing care to COVID‐19 patients; work experiences and confrontations with COVID‐19; various feelings that arise when being a nurse caring for patients with COVID‐19; the power of novice nurse to bring along positive changes.

Conclusions

The study provides an understanding of novice nurses’ experiences when caring for COVID‐19 patients. It also highlights the stress, fear and anxiety of novice nurses during the pandemic and suggests novice nursing practice training systems to enhance their familiarity and confidence when dealing with situations during the pandemic. The novice nurses were found to demonstrate a large amount of self‐determination and possess several technological skills and innovative abilities to improve the nursing practice and quality of care.
Multierror stochastic gradient algorithm for identification of a Hammerstein system with random noise and its application in the modeling of a continuous stirring tank reactor
Authors: Jing Shaoxue
Published: July 2021

In this article, a stochastic gradient algorithm based on the minimum Shannon entropy is proposed to identify a type of Hammerstein system with random noise. Firstly, the probability density function is estimated by a parzen window based on the Gaussian kernel. Then, the traditional stochastic gradient algorithm is adopted to estimate the parameters. However, the traditional stochastic gradient algorithm converges quite slowly. To fasten the algorithm, a multierror method is integrated into the algorithm. In this multierror gradient algorithm, the scalar error is replaced by a vector error. This vector error can accelerate the algorithm greatly and give a more accurate estimate by using the same data set. Finally, the proposed algorithm is validated by a numerical example and an industrial process. The estimation results indicate that the proposed algorithm can obtain more accurate estimates than the traditional gradient algorithm and has a faster convergence speed.
Notions of (In)Dependence at a Papua New Guinean University
Authors: Syndicus Ivo
Published: July 2021

This article explores notions of interpersonal dependence and personal independence voiced by university students, graduates, and staff in Papua New Guinea (PNG). It discusses how those obtaining a university education to become regular wage earners reflect on navigating the financial requests of less privileged kin. Wage earners often ascribe dependence to these kin and former sponsors who subsequently may rely on them in times of need. As the number of putatively dependent kin are often large, the process of social stratification that university‐educated wage earners experience also gives rise to reflections about social welfare systems that underlie or could potentially alleviate specific constellations of perceived dependence. Ascriptions of dependence as discussed in this article highlight the combination of the dynamic circumstances of ongoing social stratification and nation‐making with increased levels of connectivity through transport and mobile phone infrastructure, leading an emerging middle class to reconsider some of their social connections.