bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigations with Various Inner Shielding Distance Tests for a Novel Coupler-based CPT System Applied for Electric Vehicles Using Electromagnetic Resonant Coupling and Aluminium Shielding Material
Authors: Duan J , Wang W
Published: May 2020

Contactless power transfer (CPT) technology development has been driven rapidly over the past decade by the world-wide trends towards new energy explorations, and numerous reports have been presented in this area. This paper focuses on passive magnetic shielding, which acts as one of the major factors mainly determining the overall CPT system performance when discussing electromagnetic field flux distribution and its real-time effects on magnetic resonant coupling. As a well performance conductive metallic material, aluminium has been adopted to be a passive shielding material in the designed novel H-shape coupler CPT system in this paper, in order to evaluate and find out the optimal inner shielding distance in between the coil and the inner shielding shell. Three inner shielding distances are applied and analyzed across a critical range of system operating frequency, by which the actual CPT system performance differences from perspectives of electromagnetics and power electronics have been illustrated and compared. As a result, it can be noticed that the 15-mm inner shielding gap CPT model is able to yield an optimal system performance with a maximum system efficiency, peak system output RMS power of over 36% and 22 kW, respectively, which also shows an optimal capability to address major concerns over electric vehicle contactless charging. Besides, along with the electromagnetic field parameters generated in the model, such as actual real-time values of flux linkage, magnetic flux density and field strength, it can be found that the 15-mm inner shielding gap prototype is able to achieve better overall magnetic field performance than 5-mm and 25-mm inner shielding distance CPT models.
Research and modeling of wrinkles and control of rectangular membrane structures with high-class modeling in on-orbit conditions
Authors: Kumar S , Upadhyay S H , Koryanov V V
Published: May 2020

In the previous paper, the authors described a mathematical model of the process, this paper is devoted to the issues of modeling and analysis. The effects of different parameters such as temperature gradients, membrane’s aspect ratio, pre-stress, thickness, anchor points, and elastic properties of the membrane and the multilayer on the characteristic wrinkling behavior (wavelength, size, critical load and location) have been examined. It is found that the critical buckling condition of the membrane is dependent on the compressibility, anchor points, aspect ratio and the thickness of the membrane, and it’s out of plane displacement depends on the magnitude of the applied in-plane tension. The number of wrinkles decreased with increasing the number of anchor points of the membrane. An effective active flatness control method is used to minimize the surface error (RMS error). Also, it is seen that the multilayer geometry helps in reducing the surface error of the membrane structure.
A wrinkling analysis and control of rectangular membrane structures with upscale modelling under on-orbit conditions
Authors: Kumar S , Upadhyay S H , Koryanov V V
Published: May 2020

This paper presents detailed analysis of a novel concept on the formation and evolution of wrinkle pattern on a multilayer shell-membrane under the action of mechanical and thermal-mechanical loading. The double scale Fourier series is used to deduce the wrinkling equation of membrane structure. In this paper discusses the theoretical aspects of this process and carried out part of the numerical calculations. In particular: wrinkling analysis of square membrane with corner tensile loading. It contains: schematic loading condition on square membrane, membrane with shell elements and experimental analysis of square membrane with tensile loading. Also held stress analysis. In the next paper, the authors will consider a detailed analysis of the research.
Structural and Random Vibration Analysis of LEDs Conductive Polymer Interconnections
Authors: Zulfiqar S , Saad AA , Chek MA Wan , Sharif MFM , Samsudin Z , Ali MYT
Published: May 2020

Many devices consist of electronic parts and can be operated in a certain vibration environment for some instant without undergoing failure. Interconnection or joint plays a very important role in electronic devices to connect various electrical and mechanical parts altogether. The main objective of this study is to investigate the effect of interconnection performance under vibration loading in terms of natural frequency, mode shapes and transfer function. Four different models of LEDs are built for pull strength and vibration tests. The structural analysis of these models are carried out by using universal testing machine. The dynamic responses of four build matrices under certain random frequency are observed by random vibration analysis. In structural analysis, the samples are subjected to vertical displacement loading while in random vibration analysis, the models run in a frequency range of 3 Hz to 500 Hz. It is observed that the structure of the adhesive joints affect the strength of interconnection between circuit pad and LED joints. Furthermore, FEA analysis is also carried out to determine the stresses at solder joint under vibration condition. The models are excited from natural frequency and good comparison of the experimental results and FEA analysis are observed.
Sound Absorption Characteristics of Sandwich Panel Made from Double Leaf Micro-perforated Panel And Natural Fiber
Authors: Rusli Meifal , Nanda Ronal Satria , Dahlan Hendery , Bur Mulyadi
Published: May 2020

One of sound-absorbent developed nowadays, micro-perforated panel (MPP), effectively reduce reflected acoustic energy after approach the panel based on a Helmholtz-type resonance absorber. Some MPPs modifications have been applied to increase its performance, like the application of double-leaf MPP. Furthermore, the implementation of sound absorption materials made of natural fibers recently has invited more attention to some researcher because it is biodegradable, environmentally friendly, and economical. In this paper, a sandwich panel made of double MPP and natural fiber as sound absorptive material is investigated. The MPPs are made of a transparent acrylic board 1.5 mm thickness, 0.8 mm hole’s diameter with five mm hole distance in front panel, and five mm in the backing panel. Two different types of natural fibers panel; pineapple leaf fiber and oil palm fiber from empty fruit bunches are used in this sandwich. a low-cost impedance tube with double channel microphone is used to measure the sound absorption coefficients. It is found that the sandwich model changes the sound absorption characteristics of MPP by shifting the maximum absorption coefficient into the lower frequency and raising the absorption coefficient of the double MPP following its natural fiber panel absorption coefficient. The total impedance of sandwich gives the effect of decreasing the frequency peak of the absorption, and higher resistance of the fiber panel will increase the absorption coefficient and broaden the frequency peak.
Investigation of Fatigue Failure Performance of Ankle Implant Mobile Bearing using Finite Element Method
Authors: Daud Rosdi , Jantan M Z H , Ayu H M , Shah A
Published: May 2020

The Fatigue of the mobile bearing component of ankle implant became one of the main causes of failure in ankle implant. This paper deal with the investigation of fatigue failure performance of mobile bearing for different gait cycles (normal, dorsiflexion and plantarflexion) using finite element method. The finite element analysis is one of the method to predict fatigue and identify the critical area that have highest contact stress on mobile bearing design of ankle implant. The three-dimensional solid modelling of STAR and BOX ankle implants are constructed using SolidWorks software. The finite element analyses are performed by using ANSYS software. The finite element model of the mobile bearing was analysed using static structural analysis approach. The most critical area on the mobile bearing of ankle implant was found on its middle bottom area. The obtained results also showed that the STAR mobile bearing has the higher life cycle than BOX before fatigue failure occurs. This finding is similar with experimental and clinical result done by previous researcher. Therefore, our Finite Element Model has potential to improve the mobile bearing at the designing stage to be better in future in term of fatigue failure resistance and has longer life span.
Effect of Femur Geometry on Hip Protectors Testing System
Authors: Yahaya S A , Ahmad Iqbal A A S , Ripin Z M , Ridzwan M I Z
Published: May 2020

There have been different types of simplified femoral geometry incorporated into test systems for testing the biomechanical effectiveness of hip protectors. However, the effect of the simplification of femoral geometry in simulated sideways impact experiment has not been reported. In this study, an actual femoral geometry was fabricated and examined along with a simplified femoral geometry in a surrogate hip arrangement to mimic the fracture-causing situation in a sideways fall. A pendulum impact testing machine was used to evaluate the impact force response of both the femoral geometries at various velocity and constant residual impact energy for both geometries. The result showed that the peak impact force varied only 9% between actual and simplified geometries after normalizing the weight for both femurs in testing without a hip protector. However, a higher distinction of the impact force responses of both femurs was observed when testing with a hip protector. This findings at this moment suggest that the femur geometry affects the performance of a testing system. Therefore, the simplified femur geometry may not accurately substitute for the actual femur geometry in comparison of the impact attenuation of a hip protector in a simulated sideways fall.
Numerical Study of the Flow-Induced Vibration During Tunnel Surging at the Intake Section of Chenderoh Dam
Authors: Mazlan AZA , Zawawi MH , Arbain A , Ghazali MHM , Satar MHA , Abas MA , Hassan NH , Radzi MRM
Published: May 2020

Chenderoh Dam that located in Malaysia is one of renewable energy power plant that beneficial to mankind. However, in some cases, the dam suffers from the vibration effect during the water spilling from upstream to downstream. This study focused on major part of the dam which is the intake section during the tunnel surging condition. A detail 3D model of the intake section was constructed and used in the prediction of flow-induced vibration response. The results of frequency domain response and operational defection shapes (ODS) from the effect of flow-induced vibration are compared with the natural frequencies and mode shapes of the dam. From the results, the transient vibration responses due to the flow of water occurred at the frequency of 8.63 Hz with the maximum deformation of 8.24 x 10−1 m, meanwhile, the modal analysis obtained at 2.76 Hz of natural frequency with deformation of 9.1 x 10−4 m. The deformation of ODS is high because of the water flow and tunnel surging condition. However, there is no resonance phenomenon occurred, yet a safety precaution must still be considered by the operator based on this result.
Kalahari skinks eavesdrop on sociable weavers to manage predation by pygmy falcons and expand their realized niche
Authors: Lowney Anthony M , Flower Tom P , Thomson Robert L
Published: May 2020

Eavesdropping on community members has immediate and clear benefits. However, little is known regarding its importance for the organization of cross-taxa community structure. Furthermore, the possibility that eavesdropping could allow species to coexist with a predator and access risky foraging habitat, thereby expanding their realized niche, has been little considered. Kalahari tree skinks (Trachylepis spilogaster) associate with sociable weaver (Philetairus socius) colonies as do African pygmy falcons (Polihierax semitorquatus), a predator of skinks and weavers. We undertook observational and experimental tests to determine if skinks eavesdrop on sociable weavers to mitigate any increase in predation threat that associating with weaver colonies may bring. Observations reveal that skinks use information from weavers to determine when predators are nearby; skinks were more active, more likely to forage in riskier habitats, and initiated flight from predators earlier in the presence of weavers compared with when weavers were absent. Playback of weaver alarm calls caused skinks to increase vigilance and flee, confirming that skinks eavesdrop on weavers. Furthermore, skinks at sociable weaver colonies were more likely to flee than skinks at noncolony trees, suggesting that learning is mechanistically important for eavesdropping behavior. Overall, it appears that eavesdropping allows skinks at colony trees to gain an early warning signal of potential predators, expand their realized niche, and join communities, whose predators may otherwise exclude them.
Is there a definite relationship between placental mTOR signaling and fetal growth?
Authors: Dong Jie , Shin Na , Chen Shuqiang , Lei Jun , Burd Irina , Wang Xiaohong
Published: May 2020

Fetal growth restriction and overgrowth are common obstetrical complications that result in adverse perinatal outcomes and long-term health risks later in life, including neurodevelopmental dysfunction and adult metabolic syndrome. The placenta plays a critical role in the nutrition transfer from mother to fetus and even exerts adaptive mechanism when the fetus is under poor developmental conditions. The mammalian/mechanistic target of rapamycin (mTOR) signaling serves as a critical hub of cell growth, survival, and metabolism in response to nutrients, growth factors, energy, and stress signals. Placental mTOR signaling regulates placental function, including oxygen and nutrient transport. Therefore, placental mTOR signaling is hypothesized to have a positive relationship with fetal growth. In this review, we summarize that most studies support the current evidence that there is connection between placental mTOR signaling and abnormal fetal growth; however, but more studies should be performed following a vigorous and unanimous method for assessment to determine placental mTOR activity.
Management of facial burns
Authors: Greenhalgh David G
Published: May 2020

Burns to the face affect a part of the body that cannot be hidden and thus exposes potentially major changes in appearance to society. Therefore, it is incumbent upon the caregiver to optimize healing and minimize scarring. The goal for partial-thickness burns is to have them heal within 2–3 weeks to minimize healing time. For full-thickness burns there needs to be strategies to optimize the outcomes for skin grafting and minimize scarring. The goal of this review is to discuss the best way to improve the outcomes of these devastating injuries.
Differential flora in the microenvironment of lung tumor and paired adjacent normal tissues
Authors: Mao Qixing , Ma Weidong , Wang Zhongqiu , Liang Yingkuan , Zhang Te , Yang Yao , Xia Wenjie , Jiang Feng , Hu Jianzhong , Xu Lin
Published: May 2020

Recent evidence demonstrates the existence of diversified microbiota in the lung. However, the effect of lung carcinogenesis on the flora in lung microenvironment has yet not been well investigated. In this study, we surveyed the microbial composition and diversity in lung tumor and paired adjacent normal tissues obtained from 55 lung cancer patients to test whether any specific tumor-associated microbial features in lung microenvironment can be identified. Compared with non-malignant adjacent tissues, the tumor samples showed significantly lower community richness (α diversity), but no significant difference in overall microbiome dissimilarity (β diversity). Strong intrasubject correlations were observed between tumor sample and its paired non-malignant adjacent tissues. In addition, correlation network analysis found more significant taxa–taxa correlations (adjusted q-value < 0.05) in tumor microenvironment than non-malignant adjacent tissues. At taxa level, we found Propionibacterium genus were significantly reduced in tumor tissues compared with non-malignant adjacent tissues. In summary, the microbiota in tumor tissues showed the lower richness, higher taxa–taxa interaction, and reduction of potential pro-inflammatory microbial genera compared with non-malignant tissues, suggesting the potential link between the tumor microbiota and the altered tumor microenvironment for the further investigation.
Penicillin Allergy Evaluation Access: A National Survey
Authors: Mancini Christian M , Fu Xiaoqing , Zhang Yuqing , Kuper Kristi , Schulz Lucas T , Bhowmick Tanaya , Postelnick Michael , Lee Francesca , Walensky Rochelle P , Blumenthal Kimberly G
Published: May 2020

In a study of 121 hospitals from 38 US states, 44% had access to an allergist for inpatient consultations and 39% had access to inpatient penicillin skin testing, indicating that the majority of US hospitals lack sufficient resources to address inpatient penicillin allergies.
Emergence, time and sociality: comparing conceptions of process ontology
Authors: Baggio Guido
Published: May 2020

The paper focuses on a comparison between Lawson’s and Mead’s processual ontologies and more specifically on their conceptions of emergence. The first aim of the article is to highlight elements of similarity between their conceptions of social reality. It also aims to show, on the one hand, that Mead’s bio-social account of the emergent can help to interpret the dynamic process of emergence of both the social realm and agents’ identities (as described by Lawson) from a dynamic non-reductive naturalistic perspective; on the other hand, it shows how Lawson’s category of ‘social positioning’ can complement Mead’s ontogenetic explanation of changing social positions and the definition of ‘multiple selves’. By carefully considering the key elements of Lawson’s and Mead’s projects, it is, in fact, possible to understand better the meaning of a commitment to an updated processual ontology. In considering connections with classical pragmatic authors, it can be demonstrated that there are significant overlaps regarding the respective ways of considering the emergent. This offers a chance to understand more deeply how both pragmatism and Cambridge social ontology can together become part of the wider contemporary philosophical debate. In fact, Mead’s attempted synthesis between social and physical theories would help to highlight the common and complementary aspects linking what can be defined as his and Lawson’s ‘processual ontologies’.
Puberty and oestral cycle length in captive female jaguars Panthera onca
Authors: Viau Priscila , Rodini Débora Cattaruzzi , Sobral Gisela , Martins Gabriela Siqueira , Morato Ronaldo Gonçalves , de Oliveira Claudio Alvarenga
Published: May 2020

Habitat loss and fragmentation have been leading jaguars to constant conflicts with humans, and as a result, jaguar populations have been declining over the last decades. Captive breeding is often a tool for species conservation, and it is not different for jaguars. However, success is far from optimal due to the lack of basic knowledge about species’ reproductive biology. In the present study, we assessed gonadal hormonal profiles of natural oestral cycles and puberty and compared our data to those of other wild felids. We collected faecal samples from two to seven times per week for 18 months from two adults and three pre-pubertal females. We defined baseline levels for progestins and oestrogens in order to estimate oestrous cycle length and age at puberty. We compared our data with 16 other species through generalized linear model, using weight and genus as two explanatory variables. Cycle length was 38.28 ± 2.52 days, ranging from 25 to 44 days, while sexual maturity was attained within 22 months. Due to our analysis of both hormonal and behavioural data, there is a variation between this research from other studies that employed only behavioural observations. Such difference may be caused by the absence of behavioural oestrous at the peri-pubertal period. When compared to wild felids of similar size, puberty and oestral cycle durations of the jaguar females fell within the same range. Our modelling showed that age at maturity was influenced mostly by size and only Leopardus partially explained the observed variation. Conversely, oestral cycle length did not differ among genera or size categories. Our study adds to the body literature in the reproductive endocrinology of wild felids, and because female gametes are more challenging to collect and preserve, a strong understanding on the female reproductive physiology is essential to assisted reproduction and wild population viability assessment.
Impact of arterio–ventricular interaction on first-phase ejection fraction in aortic stenosis
Authors: Einarsen Eigir , Hjertaas Johannes J , Gu Haotian , Matre Knut , Chowienczyk Philip J , Gerdts Eva , Chambers John B , Saeed Sahrai
Published: May 2020

Aims 

First-phase ejection fraction (EF1), the EF at the time to peak aortic jet velocity, has been proposed as a novel marker of peak systolic function in aortic stenosis (AS). This study aimed to explore the association of myocardial contractility and arterial load with EF1 in AS patients.

Methods and results 

Data from a prospective, cross-sectional study of 114 patients with mild, moderate, and severe AS with preserved left ventricular EF (>50%) were analysed. EF1 was measured as the volume change from end-diastole to the time that corresponded to peak aortic jet velocity. Myocardial contractility was assessed by strain rate measured by speckle tracking echocardiography. Arterial stiffness was assessed by central pulse pressure/stroke volume index ratio (PP/SVi). The total study population included 48% women, median age was 73 years, and mean peak aortic jet velocity was 3.47 m/s. In univariable linear regression analyses, lower EF1 was associated with higher age, higher peak aortic jet velocity, lower global EF, lower global longitudinal strain, lower strain rate, and higher PP/SVi. There was no significant association between EF1 and heart rate or sex. In multivariable linear regression analysis, EF1 was associated with lower strain rate and higher PP/SVi, independent of AS severity. Replacing PP/SVi by valvular impedance did not change the results.

Conclusion 

In patients with AS, reduced myocardial contractility and increased arterial load were associated with lower EF1 independent of the severity of valve stenosis.
Sex-specific relationships between patterns of ventricular remodelling and clinical outcomes
Authors: Miller Robert J H , Mikami Yoko , Heydari Bobak , Wilton Stephen B , James Matthew T , Howarth Andrew G , White James A , Lydell Carmen P
Published: May 2020

Aims

Left ventricular hypertrophy (LVH) is the most common form of myocardial remodelling and predicts adverse outcomes in patients with coronary artery disease (CAD). However, sex-specific prevalence and prognostic significance of LVH patterns are poorly understood. We investigated the sex-specific influence of LVH pattern on clinical outcomes in patients undergoing cardiovascular magnetic resonance (CMR) and coronary angiography following adjustment for co-morbidities including CAD burden.

Methods and results

Patients undergoing CMR and coronary angiography between 2005 and 2013 were included. Volumetric measurements of left ventricular (LV) mass with classification of concentric vs. eccentric remodelling patterns were determined from CMR cine images. Multivariable Cox analysis was performed to assess independent associations with the primary outcome of all-cause mortality. In total, 3754 patients were studied (mean age 59.3 ± 13.1 years), including 1039 (27.7%) women. Women were more likely to have concentric remodelling (8.1% vs. 2.1%, P < 0.001), less likely to have eccentric hypertrophy (15.1% vs. 26.8%, P < 0.001) and had a similar prevalence of concentric hypertrophy (6.1 vs. 5.2%, P = 0.296) compared to men. At a median follow-up of 3.7 years, 315 (8.4%) patients died. Following adjustment including CAD burden, concentric hypertrophy was associated with increased all-cause mortality in women [adjusted hazard ratio (HR) 3.48, P < 0.001] and men (adjusted HR 2.57, P < 0.001). Eccentric hypertrophy was associated with all-cause mortality only in women (adjusted HR 1.78, P = 0.047).

Conclusion

Patterns of LV remodelling differ by sex and LVH and provides prognostic information in both men and women. Our findings support the presence of sex-specific factors influencing LV remodelling.
Jobs, News and Reoffending after Incarceration
Authors: Galbiati Roberto , Ouss Aurélie , Philippe Arnaud
Published: May 2020

We study how local labour market conditions and information about job availability affect recidivism after incarceration. We exploit daily variations in the quality of the labour market at the time of release from prison. We combine individual-level administrative data on former inmates in France to county-level daily data on new job vacancies, and on newspaper coverage of job creation and destruction. Our analysis provides two new findings. First, media coverage of job creation reduces recidivism, suggesting that policies promoting access to information about employment opportunities can contribute to reducing recidivism. Second, we show that there is heterogeneity in what kinds of jobs affect recidivism: in France, former inmates do not respond to overall job creation, but better opportunities in manufacturing jobs at release reduce recidivism rates.
Uncertainty quantification in time-lapse seismic imaging: a full-waveform approach
Authors: Kotsi M , Malcolm A , Ely G
Published: May 2020

Time-lapse seismic monitoring using full-wavefield methods aims to accurately and robustly image rock and fluid changes within a reservoir. These changes are typically small and localized. Quantifying the uncertainty related to these changes is crucial for decision making, but traditional methods that use pixel by pixel uncertainty quantification with large models are computationally infeasible. We exploit the structure of the time-lapse seismic problem for fast wavefield computations using a numerically exact local acoustic solver. This allows us to perform a Bayesian inversion using a Metropolis–Hastings algorithm to sample our posterior distribution. We address the well-known dimensionality problem in global optimization using an image compression technique. We run our numerical experiments using a single shot and a single frequency, however we show that various frequencies converge to different local minima. In addition, we test our framework for both uncorrelated and correlated noise, and we retrieve different histograms for each noise type. Through our numerical examples we show the importance of defining quantities of interest in order to setup an appropriate uncertainty quantification framework involving choosing the number of degrees of freedom and model parametrization that best approximate the problem. To our knowledge, there is no work in the literature studying the time-lapse problem using stochastic full-waveform inversion.
Whole exome sequencing in patients with Williams–Beuren syndrome followed by disease modeling in mice points to four novel pathways that may modify stenosis risk
Authors: Parrish Phoebe C R , Liu Delong , Knutsen Russell H , Billington Charles J , Mecham Robert P , Fu Yi-Ping , Kozel Beth A
Published: May 2020

Supravalvular aortic stenosis (SVAS) is a narrowing of the aorta caused by elastin (ELN) haploinsufficiency. SVAS severity varies among patients with Williams–Beuren syndrome (WBS), a rare disorder that removes one copy of ELN and 25–27 other genes. Twenty percent of children with WBS require one or more invasive and often risky procedures to correct the defect while 30% have no appreciable stenosis, despite sharing the same basic genetic lesion. There is no known medical therapy. Consequently, identifying genes that modify SVAS offers the potential for novel modifier-based therapeutics. To improve statistical power in our rare-disease cohort (N = 104 exomes), we utilized extreme-phenotype cohorting, functional variant filtration and pathway-based analysis. Gene set enrichment analysis of exome-wide association data identified increased adaptive immune system variant burden among genes associated with SVAS severity. Additional enrichment, using only potentially pathogenic variants known to differ in frequency between the extreme phenotype subsets, identified significant association of SVAS severity with not only immune pathway genes, but also genes involved with the extracellular matrix, G protein-coupled receptor signaling and lipid metabolism using both SKAT-O and RQTest. Complementary studies in Eln+/−; Rag1−/− mice, which lack a functional adaptive immune system, showed improvement in cardiovascular features of ELN insufficiency. Similarly, studies in mixed background Eln+/− mice confirmed that variations in genes that increase elastic fiber deposition also had positive impact on aortic caliber. By using tools to improve statistical power in combination with orthogonal analyses in mice, we detected four main pathways that contribute to SVAS risk.
Modelling of energy and exergy analysis of ORC integrated systems in terms of sustainability by applying artificial neural network
Authors: Utlu Zafer , Tolon Mert , Karabuga Arif
Published: May 2020

The present study focuses on the organic Rankine cycle (ORC) integrated into an evacuated tube heat pipe (ETHP), whose systems are an alternative solar energy system to low-efficiency planary collectors. In this work, a detailed thermodynamic and artificial neural network (ANN) analysis was conducted to evaluate the solar energy system. One of the key parameters of sustainable approaches focused on exergy efficiency is application of thermal engineering. In addition to this, sustainable engineering approaches nowadays are a necessity for improving the efficiency of all of the engineering research areas. For this reason, the ANN model is used to forecast different types of energy efficiency problems in thermodynamic literature. The examined system consists of two main parts such as the ETHP system and the ORC system used for thermal energy production. With this system, it is aimed to evaluate energy and exergy analysis results by the ANN method in the case of integrating the ORC system to ETHP, which is one of the planar collectors suitable for the roofs of the buildings. Within the scope of this study, the exergy efficiency was evaluated on the developed ANN algorithm. The effect rates of parameters such as pressure, temperature and ambient temperature affecting the exergy efficiency of ORC integrated ETHP were calculated. Ambient temperature was found to be the most influential parameter on exergy efficiency. The exergy efficiency of the whole system has been calculated as ~23.39%. The most suitable BPNN architecture for this case study is recurrent networks with dampened feedback (Jordan–Elman nets). The success rate of the developed BPNN model is 95.4%.
Principles of Large-scale Evidence Generation and Evaluation across a Network of Databases (LEGEND)
Authors: Schuemie Martijn J , Ryan Patrick B , Pratt Nicole , Chen RuiJun , You Seng Chan , Krumholz Harlan M , Madigan David , Hripcsak George , Suchard Marc A
Published: May 2020

Evidence derived from existing health-care data, such as administrative claims and electronic health records, can fill evidence gaps in medicine. However, many claim such data cannot be used to estimate causal treatment effects because of the potential for observational study bias; for example, due to residual confounding. Other concerns include P hacking and publication bias.

In response, the Observational Health Data Sciences and Informatics international collaborative launched the Large-scale Evidence Generation and Evaluation across a Network of Databases (LEGEND) research initiative. Its mission is to generate evidence on the effects of medical interventions using observational health-care databases while addressing the aforementioned concerns by following a recently proposed paradigm. We define 10 principles of LEGEND that enshrine this new paradigm, prescribing the generation and dissemination of evidence on many research questions at once; for example, comparing all treatments for a disease for many outcomes, thus preventing publication bias. These questions are answered using a prespecified and systematic approach, avoiding P hacking. Best-practice statistical methods address measured confounding, and control questions (research questions where the answer is known) quantify potential residual bias. Finally, the evidence is generated in a network of databases to assess consistency by sharing open-source analytics code to enhance transparency and reproducibility, but without sharing patient-level information.

Here we detail the LEGEND principles and provide a generic overview of a LEGEND study. Our companion paper highlights an example study on the effects of hypertension treatments, and evaluates the internal and external validity of the evidence we generate.
Role ofN-Acetylcysteine in the Treatment of Acute Nonacetaminophen, Nonalcoholic and Nonviral Hepatitis: A Meta-analysis
Authors: Aljohani Waleed , Chan Brian Pak Ho , Yaghoobi Mohammad
Published: May 2020

Introduction

N-acetylcysteine (NAC) has been extensively investigated for the use in acetaminophen and alcoholic hepatitis and is indicated in acetaminophen overdose. Studies assessing the effect of NAC on other forms of acute hepatitis in adult patients are limited and therefore here we aimed at evaluating the effect of NAC on survival in nonacetaminophen, nonalcoholic and nonviral hepatitis in adults.

Methods

A comprehensive literature search up to September 2019 was completed for randomized controlled trials (RCTs) comparing NAC to placebo in the management of acute nonacetaminophen, nonalcoholic and nonviral hepatitis. Studies with insufficient data, non-RCT or nonprospective design, paediatric studies and studies with no comparator were excluded. Study selection, quality assessment and data extraction were independently performed by two co-authors. Primary outcome was survival. Secondary outcomes were an increase in infection rate. We used random model Mantel–Haenszel meta-analysis with Cochrane risk of bias to assess the quality of included studies. The recommendation was presented using the GRADE framework.

Results

Seven out of 42 retrieved studies were included. Study population included patients with post-liver transplant, postsurgical, hypoxia-induced, ischemic and other nonalcoholic hepatitis. There was no difference in overall survival between NAC and placebo (odds ratio [OR] 0.95 [0.55 to 1.62]) in seven studies including 1033 patients. Furthermore, there was no difference in the rate of infection between NAC and placebo (OR 0.87 [0.43 to 1.79]). Random model analysis was used to adjust the effect of statistically significant heterogeneity in both analyses (P = 0.02). Lack of blinding in one study was found as a possible source of heterogeneity.

Conclusions

NAC does not improve overall survival or the rate of infection in patients with acute nonacetaminophen, nonalcoholic and nonviral hepatitis as compared to placebo and should not be recommended in such setting which may even delay a transplant evaluation (level of evidence: 2a, GRADE of recommendation: B).
Laboratory Methods for Rearing Horn Flies (Diptera: Muscidae)
Authors: Holderman Chris J , Sanchez-Sandoval Ulises A , Ramirez Jovannah , Smythe Brandon G
Published: May 2020

The horn fly, Haematobia irritans (L.), is an obligate hematophagous ectoparasite of cattle, and one of the most important pests of cattle causing unrealized gains or losses in meat and milk production. The present study describes the difficulties that arise when research programs have attempted to maintain this pest, both on-host and off-host, in a laboratory environment. Suggestions aimed at assisting future researchers in successfully colonizing horn flies in the laboratory are provided.
Wolbachia (Rickettsiales: Alphaproteobacteria) Infection in the Leafhopper Vector of Sugarcane White Leaf Disease
Authors: Wangkeeree Jureemart , Tewaruxsa Panida , Roddee Jariya , Hanboonsong Yupa
Published: May 2020

Wolbachia is a maternally inherited bacterium ubiquitous in insects that has attracted interest as a prospective insect pest-control agent. Here, we detected and characterized Wolbachia in the leafhoppers Matsumuratettix hiroglyphicus (Matsumura) (Cicadellidae: Hemiptera) and Yamatotettix flavovittatus Matsumura (Cicadellidae: Hemiptera), insect vectors of the phytoplasma that cause white leaf disease in sugarcane. The 16S rRNA and wsp gene markers revealed that Wolbachia was not present in the M. hiroglyphicus but naturally occurs in Y. flavovittatus. Additionally, the infection rates in adult leafhoppers ranged from 0 to 100% depending on geographic location. Moreover, Wolbachia was detected in the eggs and first- to fifth-instar nymphs of Y. flavovittatus. A phylogenic tree of Wolbachia indicated that it resided in the monophyletic supergroup B clade and clustered in the Ori subgroup. Furthermore, fluorescence in situ hybridization revealed that Wolbachia localized to the egg apices, randomly distributed in the egg cytoplasm, and was concentrated in the nymph and adult bacteriomes, as well as occasional detection in the thorax and abdomen. To the best of our knowledge, the present study is the first to demonstrate the prevalence of Wolbachia in the leafhopper Y. flavovittatus. The obtained results would provide useful information for the future development of Wolbachia as a biological control agent for the leafhopper vectors.
Clinical and Epidemiological Features of a Family Cluster of Symptomatic and Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infection
Authors: Wolf Gerhard K , Glueck Thomas , Huebner Johannes , Muenchhoff Maximilian , Hoffmann Dieter , French Lars E , Keppler Oliver T , Protzer Ulrike
Published: May 2020

In a family experiencing coronavirus disease 2019, the parents and 2 children aged 2 and 5 years became infected but the youngest child was not infected. Both children initially shed infectious virus, but cleared the virus after 5 to 6 days in the nasopharynx. However, viral RNA was continuously detected in the children’s stool for more than 4 weeks.
“Thanks, But No Thanks!” Patient Refusal of ED Diagnosis and Treatment
Authors: Derse Arthur R.
Published: May 2020

Patient refusal of medical treatment that appears to be in the patient’s best interest is a common challenge for emergency physicians. In the United States, adults have the right to refuse treatment, including life-sustaining medical treatment. The patient must both possess the capacity to make the decision and be offered an opportunity to understand the potential consequences of refusal. The determination of capacity is necessary in deciding when to honor a patient’s refusal. Parents and guardians generally have the right to make health care decisions for their children, but those decisions need to align with the best interests of the child. Documentation of the patient’s refusal of treatment against medical advice may be of some evidentiary value but does not ensure legal protection from liability. Patients who have the capacity to refuse medical treatment should be offered the opportunity to learn and consider the potential consequences before physicians respect their autonomous refusal.
Who Decides?
Authors: Iserson Kenneth V.
Published: May 2020

To make a health care decision, individuals (whether it be the patient or an adult surrogate) must have decision-making capacity. Based on the principle of patient autonomy (respect for persons), such adults can make their own health care decisions, even if they contradict what their health care provider recommends. However, if a patient lacks decision-making capacity, his or her previously completed health care directive(s) take effect. These can be a living will, durable power of attorney for health care, Physician Orders for Life-Sustaining Treatment (POLST) form, or a similar document. In a similar manner, if an adult patient wishes to orally designate another adult to make his or her health care decisions (as in the case in this chapter), they may do that. These surrogates’ decisions carry the same weight as and replace any previously named surrogate. When no surrogate has been named, most hospital policies and many state statutes list the general hierarchy of people to be the patient’s surrogates.
The Drunken Drug Lord
Authors: Simon Jeremy R.
Published: May 2020

This chapter discusses the appropriate response of emergency physicians to requests to collect evidence, in particular, blood alcohol tests and ingested drugs, from patients for police and other law enforcement officers. The relevant ethical principles, legislation, and case law are reviewed. Recommendations are made regarding when and how it may be ethically appropriate to respond to such requests.
Very Important Patients
Authors: Nestor Kelsey , Wolfe Carmen
Published: May 2020

Emergency medicine physicians often are faced with administrative requests to provide preferential care for special patients. Based on a patient’s celebrity status or simply their status within a specific hospital system, accommodations often are made for deviations in triage, alternate care teams, or treatment plans. How should we balance the additional needs of the VIP to maintain a level of privacy afforded to the general patient population, with the ethical calling to treat all patients equally regardless of status?
Frequent Flyer
Authors: Marco Catherine A.
Published: May 2020

Stewardship of health care resources is an important bioethical tenet of the practice of medicine. Physicians should act as stewards of resources and ensure that they are appropriately used to provide the best possible medical care for individual patients and for society as a whole. As in all cases of the physician-patient relationship, goals of therapy should be delineated, and appropriate diagnostic and therapeutic interventions to achieve that goal should be undertaken. Emergency physicians should advocate for the best treatment of the individual patient. In most cases, physician and patients agree, with the same goal of improving patient comfort and health. However, at times, there may be discordance between patient and physician. Shared decision-making should be undertaken to elicit the patient’s goals and values and then to educate and inform the patient about the physician’s recommendations. The goal is to reach a mutually agreeable course of action based on the patient’s goals and values. If unable to reach agreement, the physician should offer the tests and therapy that offer the best good to the patient.
Little Secrets, Big Lies
Authors: Li-Sauerwine Simiao , Gorgas Diane L.
Published: May 2020

This chapter addresses the ethical issues surrounding provision of emergency care to minor patients. The highlighted case illustrates a scenario in which a 12-year-old boy is diagnosed with acute leukemia. Recommendations by national organizations are reviewed regarding care of minors. First discussed is the concept of assent by a minor that acknowledges the decision-making abilities and rights of the child, tailored to an appropriate developmental level. This is in juxtaposition to the concept of parental dissent, which also is addressed. Finally, the focus is on care of minors in special situations, including the ethics of emergent conditions when care without parental consent is necessary. Additionally, criteria for emancipated minor and mature minor designations are reviewed.
Like, Comment, Post . . . Lawsuit?!
Authors: McGrath Jillian L. , Sahlani Lydia M.
Published: May 2020

Social media (SM) and electronic communication (EC) use in emergency practice settings has offered patients and health care providers expansive options in accessing and utilizing information that affects medical decision-making. This widespread use has created opportunities and challenges for the health care community. This chapter discusses some of the ethical and legal ramifications of utilizing electronic communication, social media, and internet forums in patient care. The chapter seeks to prime emergency physicians and other providers to better inform themselves in order to ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) and other privacy standards. This will facilitate better patient outcomes via collaborative diagnosis while protecting against legal risks associated with the use of SM, EC, and recording for medical purposes.
An Industrial Accident
Authors: Kraus Chadd K.
Published: May 2020

Emergency physicians and emergency departments serve critical public health functions at all times and particularly during public health emergencies or disasters. Public health emergencies and disasters transform standards of care into crisis standards of care. In addition to traditional tenets of bioethics, during events requiring crisis standards of care, the emergency physician faces the dilemmas of balancing responsibilities of how to allocate scarce resources to individual patients with obligations to the community and with personal and professional autonomy. Crisis standards of care permit emergency physicians to allocate scarce resources to provide necessary treatments to patients most likely to benefit. In crisis standard-of-care situations, emergency physicians must adhere to ethical and professional norms. The emergency physician should focus on how to best use the available resources with the recognition that not all patients might be able to be treated.
Doctors Police Your Own Expert Witness Testimony
Authors: Solomon Robert C.
Published: May 2020

Experienced emergency physicians with involvement in teaching and writing about clinical topics may be approached about a case of alleged medical negligence. The physician must decide whether to get involved as a potential expert witness, subjecting oneself to the requirement for diligent and thorough review of the case in all its particulars. If one agrees to do this, one must interact with attorneys, prepare opinions, and likely give testimony in deposition, and possibly at trial if the case is not settled. Accepting the responsibility for judging whether a colleague has fallen short of the standard of care, and harmed a patient through negligence, cannot be taken lightly. Guidelines for ethical conduct by an expert witness in a medical negligence tort have been developed and promulgated by the American College of Emergency Physicians and should guide physicians’ actions.
Clinical Presentation
Authors: Maj Mario
Published: May 2020

This chapter reviews the clinical presentation of bipolar I and bipolar II disorders, and in particular of manic, hypomanic, depressive, and mixed episodes. The DSM-5 operational criteria and the ICD-11 clinical descriptions and diagnostic guidelines are summarized, but several aspects that emerge from the literature and are not considered by those diagnostic systems are also covered. The divergences between those systems and the issues that remain controversial are pointed out, and the limitations of “specifiers” (or “qualifiers”) in accounting for the heterogeneity of depressive episodes are emphasized. Different clinical presentations of manic and depressive episodes in children and adolescents are also briefly described. It is concluded that the familiarity with the DSM-5 and/or the ICD-11 is not sufficient to ensure an appropriate approach to the diagnosis of mood episodes and disorders, in the absence of adequate training and clinical expertise.