bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental analysis of passivity‐based control theory for permanent magnet synchronous motor drive fed by grid power
Authors: Belkhier Youcef , Abdelyazid Achour , Oubelaid Adel , Khosravi Nima , Bajaj Mohit , Vishnuram Pradeep , Zaitsev Ievgen
Published: October 2023

Controlling the Permanent Magnet Synchronous Motor (PMSM) can be challenging due to the nonlinearity of its dynamics, which makes it difficult to design control strategies that are both robust and effective. To address this challenge, this paper presents a novel control strategy rooted in the concept of passivity that combines field‐oriented control (FOC). This strategy compels the PMSM to accurately follow velocity and electrical torque trajectories. The approach, known as passivity‐based control (PBC), entails reshaping the inherent system energy while introducing the necessary damping to attain the desired objectives. A crucial aspect involves identifying workless force terms within the process model. Despite their presence, these terms do not impact the energy balance and stability properties. As a result, eliminating these terms is unnecessary. This simplicity in control architecture not only preserves system stability but also bolsters overall robustness. The system's overall stability and the current tracking error's exponential convergence have both been demonstrated analytically. In order to maintain stability, the controller accounts for the nonlinearities of the plant and approximates the unstructured dynamics of the PMSM. The proposed control is designed using the dq model of the PMSM, which avoids the model's structure destruction due to singularities, since the dq model does not depend explicitly on the rotor angular position. Experimental results shown further, illustrate speed and position control with a desired pair calculated by a filter or a proportional‐integral (PI) controller for speed control and a proportional‐integral‐derivative (PID) controller for position control. Also the correlation between practical and theoretical results is given as well as the robustness test in relation to the uncertainties of the PMSM's inertia moment. The results demonstrates the effectiveness of the proposed strategy in controlling the PMSM under different operating conditions, highlighting its potential for industrial applications.
Self‐triggered consensus of multi‐agent systems with quantized relative state measurements
Authors: Wakaiki Masashi
Published: October 2023

This paper addresses the consensus problem of first‐order continuous‐time multi‐agent systems over undirected graphs. Each agent samples relative state measurements in a self‐triggered fashion and transmits the sum of the measurements to its neighbours. Moreover, we use finite‐level dynamic quantizers and apply the zooming‐in technique. The proposed joint design method for quantization and self‐triggered sampling achieves asymptotic consensus, and inter‐event times are strictly positive. Sampling times are determined explicitly with iterative procedures including the computation of the Lambert W‐function. A simulation example is provided to illustrate the effectiveness of the proposed method.
A subsystem‐based fault location method in distribution grids by sparse measurement
Authors: Lv Xiaodong , Yuan Lifen , Cheng Zhen , Yin Baiqiang , He Yigang , Ding Chengwei
Published: October 2023

With the development of smart meters and other intelligent electronic devices, more and more data‐driven fault location methods based on wide area measurement are emerging. However, these diagnostic methods for dealing with the whole tested system often appear complex. This paper presents an innovative subsystems‐based fault location strategy in distribution grid by the sparsity promoted Bayesian learning algorithm. To avoid taking measurement for the whole distribution system, the fault‐included subsystem is selected according to the distribution characteristics of negative sequence voltage. Then the data for fault location is measured by allocating meters in subsystem, which can reduce the number of required meters. For accurately estimating the fault location, a sparse prior is proposed for the Bayesian learning, which could improve the accuracy of the fault location algorithm by about 4%. The performance is tested on a 12.66‐kV, 69‐bus distribution system in response to various fault scenarios. The results show that the accuracy of the proposed method for the fault section location can reach 90%. It also verifies the robustness and accuracy for fault line location, faced different fault types, fault resistance, noise, etc.
Adaptive interference mitigation space‐time array reconfiguration by joint selection of antenna and delay tap
Authors: Sun Yandong , Xie Jian , Gong Yanyun , Zhang Zhaolin , Wang Ling
Published: October 2023

Space‐time adaptive processing (STAP) array has found extensive use in the global navigation satellite system for interference suppression. Nevertheless, the conventional space‐time array necessitates multiple antennas and time delay taps, resulting in a heavy burden on both hardware and computation resources. Thus, lowering the cost and complexity of STAP becomes a considerable problem demanding prompt solutions. This work designs a space‐time array reconfiguration scheme based on the joint selection strategy of the antenna and delay tap to address this problem. The reconstructed array can induce a high signal to interference plus noise power ratio (SINR) when using fewer antennas and delay taps. The space‐time correlation coefficient (STCC) is first presented to manifest the influence of reconfiguration on output SINR. Then, we formulate the space‐time array reconfiguration mathematical model, aiming to minimise STCC. Two reconfiguration methods are provided to solve the optimal array configuration of antennas and delay taps that can reach the minimum STCC and maximum SINR. The optimal antenna‐delay tap pairs are finally selected to comprise the reconstructed array. Substantial simulation experiments verify that the presented scheme and strategy are effective and reliable in space‐time array reconfiguration.
Effective fault module localization in substation critical equipment: an improved ant colony optimization and back propagation neural network approach
Authors: Wang Wei , Zhang Jianfei , Wang Sai , Chen Xuewei
Published: October 2023

The rapid development of substations has increased the demand for accurate and fast fault prediction systems. In order to achieve rapid localization and autonomous decision‐making of fault modules and types in substations, the article proposes a fault autonomous localization algorithm based on improved ant colony optimization (IACO) and back propagation neural network (BPNN). The fault data of the substation secondary equipment for training and testing the BPNN model is based on the actual operating equipment of the substation, which can significantly improve the reliability of the model results. In addition, the IACO is used to globally optimize the weights and thresholds of BPNN, and the number of hidden layer nodes in BPNN was analyzed to further improve the accuracy of the established fault prediction algorithm. The test results show that the fault prediction accuracy of the BPNN model optimized by IACO is 93.67%, which is significantly improved compared to the traditional BPNN and BPNN with ant colony optimization method (with an accuracy of 82.98% and 91.04%). The above results effectively demonstrate the high accuracy and effectiveness of the established prediction algorithm in processing data and locating faults, which can improve the maintenance and operational efficiency of substations.
Adaptive neuro‐fuzzy inference systems controller design on Buck converter
Authors: Nejad Mohsen Baniasadi , Ghamari Seyyed Morteza , Mollaee Hasan
Published: October 2023

Adaptive neuro‐fuzzy inference system (ANFIS) approach is designed for a Buck converter. Because DC–DC converters are under the negative impact of different disturbances, a need for a well‐behaved technique is felt to provide higher robustness in various scenarios, including parametric variations, load uncertainty, supply voltage variation, and noise. Therefore, the fuzzy logic‐based controller is adopted for this structure that provides better error detection and correction, more comprehensive range of operating conditions, and is more readily customizable. However, the fuzzy technique suffers from slow dynamics, lack of reliability against broader range of disturbances, and has a huge computational burden. To overcome the weaknesses addressed before, this technique combined with an artificial neural network (ANN) system that can tune the fuzzy part resulting in an adaptive and robust structure. ANFIS method is a promising approach that has two soft‐computing control structures, including a fuzzy logic‐based part consisting of ANN. This combination has provided many significant benefits over fuzzy logic, such as low computational burden with faster dynamics, higher flexibility with adaptable rules, and a simple structure providing ease of practical implantation; also, it does not need a mathematical moulding of the system since the whole system has been considered as a Black‐box system. To better show the superiority of this method, two other control schemes are designed as fuzzy‐based PID technique and PID controller optimized by PSO algorithm. Finally, the ANFIS control strategy is tested in various working cases through simulation and experiment results as a beneficial alternative for practical applications.
SoloHI observations of coronal mass ejections observed by multiple spacecraft
Authors: Hess P. , Colaninno R. C. , Vourlidas A. , Howard R. A. , Stenborg G.
Published: October 2023

Context. The Solar Orbiter Heliospheric Imager (SoloHI) instrument of the Solar Orbiter mission is a next-generation heliospheric imager. New observations from SoloHI demonstrate the improved spatial and temporal resolution compared to previous observations of the heliosphere and corona. At perihelion, the field of view (FoV) of SoloHI covers the transition between the coronagraph (COR2) and heliospheric imager (HI1) Sun-Earth Connection Coronal and Heliospheric Investigation (SECCHI) suite. In this paper, we focus on an active solar period following the first Solar Orbiter science perihelion that resulted in a number of well-observed large coronal mass ejections (CMEs) in SoloHI data in March and April 2022. Specifically, we highlight a series of events produced by AR12795 between 28 March and 2 April and show overlapping observations with SECCHI/COR2 and HI1 and LASCO/C3.

Aims. We compare the performance of the SoloHI instrument against similar observations from 1 au imagers. We describe CME observations, highlighting the unique structural features captured within the SoloHI FoV. These observations demonstrate that SoloHI will provide new insights into CME morphology and evolution from a unique vantage point.

Methods. To provide a direct and relevant comparison, images from all the telescopes we used in the paper are presented in FoVs common to each and with minimal processing applied. The J-maps we used to highlight outflowing features are also presented to show that the CME kinematics can be tracked through the SoloHI FoV, and also to report how the rest of the Heliophysics Systems Observatory (HSO) can be used to support the SoloHI data.

Results. The high-resolution SoloHI images of these eruptions, taken from ∼0.3 au, reveal a number of detailed structural CME features, including internal cavities or cores of the CME flux rope(s). They also show the surrounding material and associated sheath region of the compressed upstream solar wind plasma. Many features that could not have been observed by other instruments are highlighted and discussed.

Conclusions. The SoloHI instrument is performing well and has already provided detailed observations of CMEs that can help us understand the details of the internal structure and magnetic field of CMEs. These new observations in combination with synoptic observations from 1 au offer new opportunities for CME propagation from the corona to the heliosphere.
Study on screw turbine of the micro hydroelectric power plant working in low pressure water flows
Authors: Davirov Alisher , Kodirov Dilshod , Mamadiyev Xumoyun
Published: October 2023

Nowadays, the demand for electricity is becoming more and more important, so finding new, safe and renewable energy is considered an important issue. Micro hydroelectric power plants with screw turbines are ecologically clean, renewable and efficient operation in low-pressure water flows is presented in the article. This article examines the transmission of 2 parallel screw turbines to one generator through a chain drive and increasing the output power by controlling the part connected to the generator in obtaining electricity from low-pressure water flows.
Study on a generator and turbine designed for an efficient wind power plant in low speed wind currents
Authors: Toshev Sherzod , Tosheva Shaxnoza , Sadullaev Abror , Vokhidov Akmal
Published: October 2023

This article presents the advantages of improving and developing new types of turbines and generators designed for the production of electricity from low-speed wind and free-flowing water, at a time when the environment is deteriorating and there is a shortage of electricity. It has been analyzed that low-speed micro-hydroelectric power plants and wind power plants bring great benefits to the environment and economy through their mass use in meeting the needs of the population and businessmen for electricity. For this purpose, the effective structure of low-speed generators, micro-hydroelectric power plants and wind power plants were considered, and the issues of improving them so that they work efficiently at low speeds were considered. Mathematical equations of a low-speed generator designed to obtain electricity from low-speed wind and free-flowing water are presented. At the same time, scientific research was conducted to study, improve, and develop new types of micro-hydroelectric and wind power plants suitable for low-speed generators. As a result of scientific research, an improved wind power device designed for small speed was developed and the results of research were analyzed.
Express diagnostics of power oil transformers by vibroacoustics and partial discharges
Authors: Yusupov Dilmurod , Ismoilov Ibroximjon , Rakhmatov Abdugani , Kilichov Orifjon , Toshpulatov Nusratillo , Babayev Aziz , Matchonov Oybek
Published: October 2023

This article presents the results of Express Diagnostics conducted in the working state of the autotransformer ATDTN-125000/220/110-U1. Three measurement pribors were used in the research process to determine the vibroacutic, partial discharge, and current strength values in the working state of the oil power transformer. Experimental studies and their analysis have shown that by evaluating the technical condition of the oil power transformer at a short opportunity, it is possible to give a conclusion to its ecpluation or release into repair.
Increasing the efficiency of the use of oil fuel in thermal power stations and boilers
Authors: Normuminov Jakhongir , Tursunov Muhiddin , Unarov Abdurauf , Kuchkarov Abdullo
Published: October 2023

An organization can achieve good results by properly managing the supply of fuel, ensuring the desired intensity of combustion, and optimizing the volume of the combustion process to promote complete combustion. Additionally, the mixing of fuel with secondary air, provided by combustion devices, is crucial for achieving efficient combustion. Experimental studies conducted on boilers in thermal power plants have demonstrated that heating the secondary air can enhance energy efficiency. This improvement is particularly relevant for fuel oil and gas burning. To optimize the combustion of fuel oil, steam-mechanical nozzles are commonly utilized. These nozzles excel in prolonging the combustion process, leading to more efficient fuel oil burning. When burning gas and fuel oil, a two-stage arrangement of burners in the boiler is more effective than a single-stage configuration, regardless of whether the burners are positioned in opposite directions or in a one-sided frontal arrangement. To mitigate the emission of nitrogen oxides, several measures can be taken. It has been observed that recirculating flue gases from the heat is more effective than solely utilizing flue gas. Additionally, the strategic placement of boilers with furnace gases and the optimization of turning parameters can also contribute to reducing harmful nitrogen oxide emissions.
Structural Damage Identification Methods in Truss Bridge Structures Using Vibration Analysis: A Review
Authors: Fitriyah Dita Kamarul , Irawan D , Suswanto Budi , Habieb AB
Published: October 2023

Developing countries will always engage in infrastructure development in various regions, and one notable aspect of this development is the construction of steel frame bridges. Bridges are complex structures with a myriad of challenges. The increasing number of cases of steel frame bridge collapses has prompted humans to become more conscious of Structural Health Monitoring (SHM) activities. In order to implement this, the development of a straightforward structural damage detection method has been pursued, suitable for both simple and highly complex structures, commonly referred to as Vibration-Based Damage Detection (VBDD). Various algorithms have been proposed to achieve the goal of identifying structural damage, enabling prompt and accurate decision-making in handling such situations. This article delves into the discussion of several proposed algorithms for achieving this objective.
Sodium Nitroprusside As An Adjunct To Pediatric Perfusion
Authors: Kurusz Mark , Christman Earle W. , Arens James F. , Tyson Kenneth R. T.
Published: October 2023

Sodium nitroprusside (N) has been administered to pediatric patients undergoing cardiopulmonary bypass with hypothermia for surgical repair of congenital heart defects. The rationale is to limit peripheral constriction due to cooling while maintaining a high flow perfusion (3.0 to 3.5 L/min/m2). Patients ranging in size from 4.0 to 33.6 kg ( 18.2 mean) and in age from 0.25 to 15 years ( 6.9 mean) have been treated during the past year. While the patients were being cooled to 23°C on pump, N (50 mg/500 cc) was administered into the arterial reservoir of the oxygenator with a minidrip set connected to an infusion pump. Rate of infusion was 2.5 to 10.8 μgm/kg/min (5.4 , μgm/kg/mean). The mean arterial pressure was maintained at 40 to 50 mmHg. Once the patients were at 23°C, N infusion was discontinued. Hypothermic potassium arrest of the heart was used in conjunction with this technique following aortic cross-clamping. N was administered again during rewarming at a slightly higher rate of infusion than when cooling. Advantages of the technique are increased tissue perfusion as evidenced by increased urine output on bypass, decreased fluid replacement in the postoperative period, and uniform body cooling/rewarming.
Fifth-time redo mitral valve replacement via right thoracotomy under systemic hyperkalemia cardiopulmonary bypass without aortic cross-clamp
Authors: Takeichi Tomohisa , Morimoto Yoshihisa , Yamada Akitoshi , Tanaka Takanori
Published: October 2023

The surgical management of prosthetic valvular endocarditis (PVE) can be challenging. We report a case of a 46-year-old female patient who had a history of four cardiac operations. We chose a mitral valve replacement via right thoracotomy to enable optimal exposure of the mitral valve (MV). Because of multi-reoperations, we employed systemic hyperkalemia for cardiac arrest to protect the heart during cardiopulmonary bypass (CPB) without aortic cross-clamping. Here, we present a complex operation that performed management of CPB under hyperkalemia and the patient had a good postoperative recovery.
The self-coordination mean-variance strategy in continuous time
Authors: Shi Yun , Li Duan , Cui Xiangyu
Published: October 2023

The dynamic mean-variance portfolio selection problem is time inconsistent. In the literature, scholars try to derive the pre-committed strategy, the time consistent strategy and the self-coordination strategy. The pre-committed strategy only concern the global investment interest of the investor. The time consistent strategy only concerns the local investment interests of the investor, while the self-coordination strategy balances between the global investment interest and local investment interests of the investor. However, the self-coordination strategy is only studied for the discrete time mean-variance setting. We study the self-coordination strategy for the continuous time mean-variance setting in this paper. With the help of mean-field reformulation, we derive the analytical self-coordination mean-variance strategy and show that the pre-committed strategy and time consistent strategy are special cases of the self-coordination strategy.
Ein kritischer DRG-Blick auf Fälle mit chronisch entzündlichen Darmerkrankungen
Authors: Moll-von der Wettern Maria , Heinlein Wolfgang , Rathmayer Markus , Koller Lisa , Albert Jörg G. , Siegmund Britta
Published: October 2023

Einleitung Ob stationäre Behandlungsfälle mit
chronisch-entzündlichen Darmerkrankungen (CED) in deutschen Krankenhäusern kostendeckend
vergütet werden, wurde bislang nicht untersucht. Vor diesem Hintergrund befasst sich die
vorliegende Arbeit mit der Vergütungssituation (Kosten-Erlös-Vergleich) von CED in deutschen
Krankenhäusern in Abhängigkeit von der Erkrankungskomplexität sowie den
Versorgungstypen.

Methodik Für diese retrospektive Studie standen anonymisierte
Falldaten inkl. Kostendaten aus der InEK-Kalkulation (§ 21–4 KHEntgG) des DRG-Projektes der
Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS)
aus dem Jahr 2019 zur Verfügung. Analysiert wurden 3385 Fälle mit CED als Hauptdiagnose aus 49
Krankenhäusern. Um die Auswirkungen der Krankheitskomplexität auf die Vergütungssituation zu
untersuchen, wurden verschiedene Variablen analysiert, darunter gastroenterologische
Komplikationen, Infektionen, Aufnahmeanlass und Zusatzentgelte. Zur Untersuchung möglicher
Zentrumseffekte wurden die Krankenhäuser nach Versorgungstyp, im Wesentlichen definiert durch
Bettenanzahl, gruppiert.

Ergebnisse Die vorliegende Arbeit zeigt, dass sämtliche
Versorgungstypen im Durchschnitt als nicht kostendeckend einzustufen sind. Die Unterdeckung
liegt durchschnittlich bei 10 % (296 € absolute Unterdeckung) und variiert zwischen den
Versorgungstypen. Fälle mit höherer Komplexität weisen eine höhere Kostenunterdeckung auf als
Fälle mit geringerer Komplexität. Auf DRG-Ebene sind die analysierten Fallkosten der 3
häufigsten CED-DRGs für Normallieger höher als die InEK-Kosten; jedoch ist das Delta nicht
signifikant. Jedoch tragen Fälle mit dem Aufnahmegrund Verlegung
spezifischer DRGs signifikant höhere Kosten.

Diskussion Unsere Ergebnisse zeigen, dass CED nicht kostendeckend
vergütet werden. Dies ist auf die unzureichende Vergütung von gastroenterologischen
Komplikationen, Infektionen, spezifischen Prozeduren und Notfall- und Verlegungsfällen
zurückzuführen. Verlegungsfälle tragen signifikant höhere Kosten.
Symptoms and Management of Aseptic Liver Abscesses
Authors: Hafner Susanne , Seufferlein Thomas , Kleger Alexander , Müller Martin
Published: October 2023

Aseptic liver abscesses occur very rarely. Clinical guidelines on the management of the disease do not exist, and the diagnosis is challenging.

We screen MEDLINE and PUBMED databases for relevant case reports from inception to November 2022. Information on patient age, sex, initial symptoms, the extent of abscess formation, further diagnoses, treatment, and course of the disease is analyzed.

Thirty cases with sterile hepatic abscess formation are identified. In most patients (n=18), the spleen is affected as well. Patients typically present with fever, abdominal pain, and increased inflammatory values. Comorbidity with inflammatory bowel disease is very common (n=18) and is associated with a significantly younger age at the time of hepatic abscess development. In addition, many patients show autoimmune-mediated cutaneous, ocular, or arthritic rheumatoid manifestations. Histological examination of abscess material reveals neutrophilic infiltration. The majority of patients initially receive corticosteroid therapy. Furthermore, response to azathioprine, anti-TNF-α antibodies, and other immunomodulatory drugs is reported. Ten out of fourteen patients with a long-term follow-up (≥ 36 months) have at least one relapse of hepatic abscess formation.

Aseptic hepatic abscesses should be considered in the case of sterile punctures and non-response to antibiotics. Patients with aseptic liver abscesses have a high risk of recurrence warranting immunomodulatory maintenance therapy.
Früherkennung des sporadischen Pankreasadenokarzinoms
Authors: Scherübl Hans
Published: October 2023

Das Pankreasadenokarzinom (PK) nimmt stetig an Häufigkeit zu und stellt bereits die dritthäufigste tumorbedingte Todesursache in Deutschland dar. Voraussichtlich rückt es bis 2030 auf den 2. Platz und bis 2050 gar auf den 1. Platz der krebsbedingten Todesfälle vor. Das Pankreaskarzinom wird generell spät diagnostiziert und die 5-Jahre-Überlebensrate liegt bei nur 10%. Wird das PK aber im Tumorstadium IA diagnostiziert und therapiert, so beträgt das 5-Jahresüberleben rund 80%. Früherkennungsinitiativen verfolgen deshalb das Ziel, Hochrisikopersonen zu identifizieren und das sporadische Pankreaskarzinom frühzeitig festzustellen. Personen über 50 mit neu diagnostiziertem Diabetes stehen dabei im Mittelpunkt des Interesses. Aktuelle Entwicklungen und Früherkennungsstrategien werden angesprochen.
Umgang mit best-verfügbarer Evidenz in der Nutzenbewertung
von Arzneimitteln: Eine Analyse von Verfahren ohne Vorliegen einer
randomisiert-kontrollierten Studie
Authors: Julian Elaine , Rasch Andrej , Bussilliat Paul , Ruof Jörg
Published: October 2023

Hintergrund/Fragestellung Neue wissenschaftliche Erkenntnisse aus
der Grundlagenforschung prägen zuletzt einen Paradigmenwechsel in der
klinischen Forschung hin zu mehr gezielten Therapieansätzen. Zusammen
mit dem vom Gesetzgeber ausdrücklich gewünschten Forschungsfokus
auf seltene Krankheitsbilder führt dies zu einer Herausforderung
für die Durchführbarkeit von randomisiert-kontrollierten Studien
(RCTs). Diese Untersuchung befasst sich mit dem Umgang des Gemeinsamen
Bundesausschuss (G-BA) mit der best-verfügbaren Evidenz bei
Nutzenbewertungen von Arzneimitteln ohne RCT.

Methoden Es wurden die im Zeitraum 1.1.2017 bis 1.4.2022 begonnenen
AMNOG-Verfahren für neue Arzneimittel nach dem erstmaligen
Inverkehrbringen und ohne Vorliegen einer RCT aus der
vfa-AMNOG-Verfahrensdatenbank selektiert. Die in den Verfahren vorgelegten
Studien wurden identifiziert und die Akzeptanz dieser Evidenz seitens des G-BA
anhand der Beschlussunterlagen wurde untersucht.

Ergebnisse Im Untersuchungszeitraum wurden 536 abgeschlossene
AMNOG-Verfahren identifiziert, davon waren 215 Erstbewertungen nach dem
erstmaligen Inverkehrbringen. Bei 42 Verfahren zu insgesamt 37 Arzneimitteln lag
für die Bewertung keine RCT vor. In allen 42 Verfahren wurde seitens des
pharmazeutischen Unternehmers mind. eine einarmige Studie (SAT) vorgelegt.
Darunter wurden in 19 Verfahren≥2 SATs, in 27 Verfahren ein oder mehr
indirekte Vergleiche (ITC) und in vier Verfahren weitere Daten unter
Einbeziehung von Real World Evidence (RWE) vorgelegt. Diese Evidenz wurde durch
den G-BA in 20 (47.6%) Verfahren herangezogen, wobei es sich hierbei in
allen Fällen um Orphan Drugs handelt. In 6 dieser Verfahren
(14.3%) wird die best-verfügbare Evidenz für
vergleichende Aussagen seitens des G-BA herangezogen. In weiteren 7
(16.7%) der Verfahren erfolgt der Hinweis, dass das Medikament in
Einzelfällen eine relevante Therapieoption darstellen kann. Bei 16
Verfahren (38.1%) wurde eine Befristung ausgesprochen. Für 22
der 42 Verfahren lagen zusätzlich Information für das
Arztinformationssystem vor. Eine darin erkennbare Berücksichtigung der
Daten erfolgte nur bei 3 OD-Verfahren.

Schlussfolgerung Die Untersuchung zeigt einen vorwiegend ablehnenden
Umgang des G-BA mit best-verfügbarer Evidenz aus nicht-randomisierten
Studienergebnissen. Eine explizite Berücksichtigung solcher Daten durch
den G-BA für die Bewertung und Quantifizierung des Zusatznutzen erfolgt
nur in sehr seltenen Ausnahmefällen. Angesichts der
medizinisch-wissenschaftlichen Entwicklung besteht Bedarf Kriterien zu
erarbeiten, wann ein RCT im Rahmen eines klinischen Entwicklungsprogramms nicht
anwendbar ist und wie bei Nutzenbewertungen von Arzneimitteln ohne RCT auf Basis
der best-verfügbaren Evidenz vergleichende Aussagen zum Zusatznutzen
möglich sind.
Ein schwieriges Feld: Betriebliche Gesundheitsförderung in
der stationären Altenpflege
Authors: Huber Gerhard , Peters Stefan , Weiß Klaus
Published: October 2023

Das Aufsuchen in Betrieb und Arbeitsplatz ist für viele Menschen die
einzige Option, um sie mit dem Thema
„Gesundheitsförderung“ zu erreichen. Dies gilt besonders
für das Arbeitsfeld der stationären Altenpflege, da wir
denjenigen, die für die Gesundheit und Pflege anderer Menschen sorgen,
besondere Aufmerksamkeit widmen sollten. Die hohen Arbeitsbeanspruchungen und
die hohen Arbeitsunfähigkeitszahlen wurden im Rahmen des Projekts POLKA
ausführlich analysiert und an anderer Stelle publiziert.

Das POLKA-Projekt ist durch den Einsatz professioneller Lotsen und Experten zur
Implementation gekennzeichnet. In Ergänzung zu den quantitativen
Forschungsansätzen wurden deren konkrete Erfahrungen und Erkenntnisse
qualitativ durch semi-strukturierte Interviews erschlossen. Die
computergestützte Auswertung der Interviews ergab einen substantiierten
Einblick in die Förderfaktoren und Barrieren der Projektumsetzung. Die
Adhärenz der Mitarbeiter sowie die Heimleitung konnten als relevante
übergeordnete Kategorien, für die Handlungsbedarf besteht,
identifiziert werden. Dies wird differenziert dargestellt.
Morbidity in Patients with Chronic Adrenal Insufficiency –
Cardiovascular Risk Factors and Hospitalization Rate Compared to Population
Based Controls
Authors: Burger-Stritt Stephanie , Hahner Stefanie , Chifu Irina , Quinkler Marcus , Altieri Barbara , Hannemann Anke , Völzke Henry , Lang Katharina , Reisch Nicole , Pamporaki Christina , Willenberg Holger Sven , Beuschlein Felix
Published: October 2023

Patients with adrenal insufficiency (AI) have been found to have increased
cardiovascular morbidity, partly associated with nonphysiologic glucocorticoid
replacement. We included two separate cohorts (cohort 1 n=384 patients,
cohort 2 n=180 patients) of patients with chronic primary and secondary
AI under standard replacement therapy and compared them to two age- and
sex-matched population-based studies (SHIP-TREND/DEGS). Odds ratios with
95% CI for hypertension, hyperlipidemia/HLP, type 2
diabetes/T2DM, obesity, and hospitalization with adjustment for
confounders were evaluated by logistic regression. Patient cohort 1 had
significantly lower ORs for obesity [0.4 (0.3–0.6), p<0.001] and
hypertension [0.5 (0.3–0.6), p<0.001] compared to SHIP-TREND and
for obesity [0.7 (0.5–0.9), p=0.01], hypertension [0.4
(0.3–0.5), p<0.001] and HLP [0.4 (0.3–0.6),
p<0.001] compared to DEGS. In cohort 2, ORs were significantly lower for
HLP compared to both SHIP-TREND [0.4 (0.2–0.7), p=0.001] and
DEGS [0.3 (0.2–0.5), p<0.001] and for hypertension [0.7
(0.4–0.9), p=0.04] compared to SHIP-TREND. In patients with SAI
from cohort 2, ORs for DM2 [2.5 (1.3–4.9) p=0.009], hypertension
[2.5 (1.4–4.5), p=0.002] and obesity [1.9 (1.1–3.1),
p=0.02] were significantly higher compared to DEGS, whereas ORs for HLP
were significantly lower compared to both SHIP [0.3 (0.1–0.6),
p=0.002] and DEGS [0.3 (0.1–0.6), p<0.001]. In most of
our AI patients treated with conventional glucocorticoid doses, the risk for
T2DM, obesity, hypertension, and HLP was not increased. The number of
hospitalizations was significantly higher in AI patients compared to controls,
which might reflect increased susceptibility but also a more proactive
management of concomitant diseases by physicians and patients.
Effect of Health Insurance Status and Visitation Restrictions on Virtual Visitation Technology in the Neonatal Intensive Care Unit
Authors: Henderson-Sears Susan E. , Stefanescu Andrei R. , Stefanescu Beatrice M. , Allen Jayme D.
Published: October 2023

Objective This study aimed to examine the relationship between virtual technology system utilization and insurance status or type of visitation restrictions in a single-center neonatal intensive care unit.

Study Design Prospective cohort study with separate analyses performed based on insurance status (public vs. nonpublic) and “in effect” unit visitation restrictions. The three study epochs based on patient visitation restrictions were Epoch 1 (July to October 2019) with standard visitation restrictions, Epoch 2 (November 2019 to February 2020) with respiratory syncytial virus/influenza visitation restrictions, and Epoch 3 (March to June 2020) with coronavirus disease 2019 (COVID-19) visitation restrictions, respectively.

Results Families of 357 infants used web-based cameras through most of the infant's hospitalization (median: 86.05%, Q3: 97.9%) with 165,795 total camera logins, indicating consistent utilization. There was a trend for fewer logins per infant and significantly longer time to consent (p = 0.03) in the Public Insurance group. Unit visitation restrictions impacted the time to consent, the shortest being in Epoch 3 during the COVID-19 pandemic (p = 0.03).

Conclusion Virtual visitation technology is well embraced by neonatal instensive care unit families; however, gaps in access and use among subgroups signals a form of social inequality that needs to be explored further.

Key Points
Platelet Activation is Upregulated in Cirrhotic Patients with Portal Vein Thrombosis
Authors: Zhao Fazhi , Ding Jingnuo , Cui Juanjuan , Zhu Mingqing , Zhao Weifeng
Published: October 2023

Objective Platelet plays a key role in thrombosis formation, especially that the alteration of platelet function may influence the thrombosis development. This study aimed to investigate platelet function alterations in the formation of portal vein thrombosis (PVT) in cirrhosis.

Methods Cirrhotic patients admitted to The First Affiliated Hospital of Soochow University between October 2021 and April 2023 were recruited and divided into PVT and non-PVT groups according to radiological results. Clinical parameters and prognosis were also collected and assessed to identify potential risk factors. Flow cytometry was used to detect the expression of CD62p, CD63, monocyte–platelet aggregates (MPAs), neutrophil–platelet aggregates (NPAs), and von Willebrand factor antigen (vWF-Ag) to evaluate platelet activation and adhesion function.

Results A total of 145 subjects were enrolled in our study including 60 cirrhotic PVT patients, 60 cirrhotic non-PVT patients, and 25 healthy volunteers. Multivariate analysis suggested that esophageal gastric varices, splenectomy, and D-dimer were independent risk factors for PVT pathogenesis in cirrhosis. The vWF-Ag expression level was reduced in the PVT group compared with the non-PVT group (p = 0.046) but was not an independent risk factor for PVT formation pathogenesis. The expression of CD41+CD62p+ and CD41+CD63+ platelets in the PVT group was significantly elevated compared with that in the non-PVT group (p < 0.05). There were no significant differences in MPAs and NPAs between the two cirrhotic groups. Subgroup analysis showed that the mean fluorescence intensity (MFI) of CD62p and CD63 was associated with portal hypertension-related complications (p = 0.008, p < 0.001), and CD63 MFI was significantly associated with thrombosis burden (p = 0.019). CD41+CD62p+ and CD41+CD63+ platelets as well as MPAs and NPAs were highly expressed in the splenectomy group compared with those in the nonsplenectomy group in cirrhotic patients (p < 0.05). Positive correlations were found between CD62p MFI and CD63 MFI, MPAs and NPAs (r = 0.642, p < 0.001; r = 0.378, p = 0.003; r = 0.430, p < 0.001). In addition, platelet counts were also correlated with MPAs (r = 0.556, p < 0.001) and NPAs (r = 0.467, p < 0.001). Cirrhotic patients with PVT had higher mortality and were more likely to experience portal hypertension-related complications in the prognostic analysis (p < 0.05).

Conclusion Highly activated platelet function exists in patients with cirrhosis, and platelet activation was elevated during PVT formation, suggesting that activated platelets may participate in the formation of PVT in patients with cirrhosis.
Distinctive Amplitude-Integrated EEG Ictal Pattern and Targeted Therapy with Carbamazepine in KCNQ2 and KCNQ3 Neonatal Epilepsy: A Case Series
Authors: Vilan Ana , Grangeia Ana , Ribeiro José Mendes , Cilio Maria Roberta , de Vries Linda S.
Published: October 2023

Background Carbamazepine (CBZ) is effective in treating KCNQ2/3-related seizures, which may present with a distinctive amplitude-integrated electroencephalography (aEEG) pattern.

Objective To assess how improved recognition of the distinctive aEEG ictal pattern associated with KCNQ2/3 variants has enabled early and effective targeted therapy with CBZ.

Methods Retrospective descriptive study of five neonates with KCNQ2/3 pathogenic gene variants admitted at a level 3 neonatal intensive care unit (NICU) over an 8-year period.

Results The distinctive ictal aEEG pattern was recognized in four neonates after an average of 61.5 hours (minimum 12 hours, maximum 120 hours) from the first electroclinical seizure and prompted the use of CBZ that was effective in all. The two most recently diagnosed patients could avoid polytherapy as they received CBZ as the first and second antiseizure medication, respectively. Three out of five patients with continuous normal voltage (CNV), sleep–wake cycling (SWC), and shorter postictal suppression had normal neurodevelopmental outcome. Regarding the remaining two infants, one was not trialed with CBZ and had a high seizure burden, both presented with a prolonged postictal suppression, no SWC, and had moderate-to-severe developmental delay. Genetic results became available after the neonatal period in all but one of the infants, who had a prenatal diagnosis.

Conclusion Recognition of the distinctive ictal aEEG pattern in the NICU allowed early and effective targeted therapy with CBZ in four neonates, well before genetic results became available. Furthermore, a CNV background pattern with SWC and short postictal suppression were associated with normal developmental outcomes.
The Assessment and Management of Childhood Masturbation: An Analysis of 90 Cases
Authors: Güleç Ayten , Öztürk Selcan , Acer Hamit , Canpolat Mehmet , Gümüş Hakan , Per Hüseyin
Published: October 2023

Aim The child's self-stimulating pleasure behavior is defined as childhood masturbation (CM). Diagnosis of CM is mainly based on behavior and analysis of video recordings. This study aims to investigate etiological factors, movement patterns, and treatment options.

Medical records and video recordings of CM in our clinic between 2015 and 2020 were retrospectively reviewed.

Results Ninety patients aged 8 months to 9 years were included in our study. The male-to-female ratio was 23/67. The mean age at onset of masturbation (mean ± standard deviation) was 21.42 ± 18.44 (6–107) months. Note that 27.7% (32) of the patients were taking antiepileptic drugs before admission.

Eight of the 90 patients had abnormal electroencephalograms. The time of onset of CM was related to cessation of breast milk in 24.4%, separation from the mother in 43.3%, new siblings in 16.6%, initiation of toilet training in 7.7%, and parental divorce in 6.6%. Behavioral therapy was sufficient in 71.1%. Hydroxyzine hydrochloride in 19 (21.1%) and risperidone in 9 (10%) were given in the remaining cases. Overall, 23/28 of the cases receiving medication improved during follow-up.

Conclusion Physicians may have difficulty identifying repetitive movements in CM. Misdiagnosis or delayed diagnosis may lead to unnecessary use of antiepileptic drugs, delayed initiation of treatment, and prolonged treatment duration. Video recordings are important in the differential diagnosis of CM. CM may have psychosocial causes and can often be effectively treated with behavioral therapy. Pharmacological treatment (hydroxyzine hydrochloride and risperidone) may be considered in cases that do not respond to behavioral treatment.
Profile of Enteric Fever in Children Admitted to a Tertiary Care Center in North India
Authors: Joshi Disha , Gupta Veenu , Bhat Deepak , Gupta Menal , Dhooria Gurdeep Singh
Published: October 2023

Background Enteric fever is a community-acquired systemic infection which is more common in resource-limited overcrowded communities with poor access to sanitation and its management is compounded by the increasing antimicrobial resistance to the first-line antibiotics used.

Materials and Methods This descriptive study reports the clinical profile of children with enteric fever managed at the departments of pediatrics and microbiology of a tertiary care hospital from February 2020 to August 2021. All inpatients who were confirmed (blood culture positive) or probable cases (clinical and serological evidence by Widal test) of enteric fever were included. Profile of all cases and antibiotic sensitivity pattern in culture positive cases were studied.

Results Of the 70 cases enrolled, 40% were females and 60% males, and majority (52.9%) was in the age group of > 5 years. At admission, fever was the most common presentation along with abdominal symptoms. Widal test was positive in 84.6% cases and was found to be 80% sensitive when compared to the gold-standard blood culture. Both Salmonella Typhi (74.3%) and S. Paratyphi (12.9%) isolates were 100% sensitive to azithromycin, cotrimoxazole, and ceftriaxone. Quinolones and second-generation cephalosporin cefuroxime showed high resistance in comparison. None of the isolates was multidrug resistant. All cases were discharged after successful treatment.

Conclusion The burden of disease and antibiotic susceptibility of enteric fever needs to be monitored to guide clinicians in selection of antibiotics.
Existence and stability of traveling waves for semi-relativistic Schrödinger equations with van der Waals-type potentials
Authors: Lu Hui , Wu Dan
Published: October 2023

In this paper, we prove the existence and stability of traveling waves for semi-relativistic Schrödinger equations with van der Waals-type potentials. Using the concentration-compactness principle, we study the corresponding constraint minimization problem of equations and obtain the existence of traveling waves with subcritical arbitrarily small mass. Moreover, we show that the set of boosted ground states is a stable set. Our results contribute to the study of traveling wave solutions and the dynamics of semi-relativistic Schrödinger equations with van der Waals-type potentials.
Mid-infrared photocurrent nano-spectroscopy exploiting the thermoelectric effect in graphene
Authors: Venanzi T. , Giliberti V. , Temperini M. E. , Sotgiu S. , Polito R. , Mattioli F. , Pitanti A. , Mišeikis V. , Coletti C. , Roddaro S. , Baldassarre L. , Ortolani M.
Published: October 2023

We develop a conductive-atomic force microscope coupled to a mid-infrared (IR) quantum cascade laser that allows to measure mid-IR photocurrent maps and spectra with nanometric spatial resolution. Here, we exploit the photo-induced thermoelectric effect of graphene to obtain the mid-IR local absorption spectra of nanoscale devices and materials. By scanning the probe in AFM-contact mode, the thermoelectric photocurrent can be mapped throughout the graphene layer, which acts as a semitransparent transducer. At zero voltage bias applied to the probe tip, we observe very low noise (about 25 pA/Hz), which makes our technique competitive with others in measuring the local IR absorption in nanomaterials with insufficient thermal expansion coefficient, or to characterize nanoscale devices that significantly absorb IR radiation, such as mid-infrared photodetectors.
Deep-learning assisted reduced order model for high-dimensional flow prediction from sparse data
Authors: Wu Jiaxin , Xiao Dunhui , Luo Min
Published: October 2023

The reconstruction and prediction of full-state flows from sparse data are of great scientific and engineering significance yet remain challenging, especially in applications where data are sparse and/or subjected to noise. To this end, this study proposes a deep-learning assisted non-intrusive reduced order model (named DCDMD) for high-dimensional flow prediction from sparse data. Based on the compressed sensing (CS)-dynamic mode decomposition (DMD), the DCDMD model is distinguished by two novelties. First, a sparse matrix is defined to overcome the strict random distribution condition of sensor locations in CS, thus allowing flexible sensor deployments and requiring very few sensors. Second, a deep-learning-based proxy is invoked to acquire coherent flow modes from the sparse data of high-dimensional flows, thereby addressing the issue of defining sparsity and the stringent incoherence condition in the conventional CSDMD. The two advantageous features, combined with the fact that the model retains flow physics in the online stage, lead to significant enhancements in accuracy and efficiency, as well as superior insensitivity to data noises (i.e., robustness), in both reconstruction and prediction of full-state flows. These are demonstrated by three benchmark examples, i.e., cylinder wake, weekly mean sea surface temperature, and isotropic turbulence in a periodic square area.
An open loop 0D-3D modeling of pulsatile hemodynamics for the diagnosis of a suspected coronary arterial disease with patient data
Authors: Kumar Sumit , Kumar B. V. Rathish , Rai Sanjay Kumar , Shankar Om
Published: October 2023

Due to the high degree of curvature of the coronary arteries, normal blood flow patterns are disrupted, making them susceptible sites for stenosis and atherosclerosis, leading to decrease in flow. Myocardial ischemia and infarction are the results of this reduced myocardial flow perfusion. Therefore, we conducted an extensive hemodynamic analysis on a patient suspected to have chest pain because of coronary artery disease in order to recognize the processes behind behaviors instigated by intricate geometry of the coronary artery. First, using coronary computed tomography angiography data, which were obtained from an ethically approved data provider, a patient-specific model was reconstructed. Open-circuit resemblance lumped parameter network coupled with zero-three dimensional (0D-3D) model was built to mimic coronary pressure and flow. Hemodynamic parameters such as the flow streamlines, time-average wall shear stress, oscillatory shear index, flow rate, and relative resilience time were investigated using computational fluid dynamics. It is critical for cardiac specialists to adequately care for their patients and provide corrective therapies at early onset of coronary problems caused by myocardial infarctions and demand coronary bypass surgery and stenting. The open loop modeling approach with lumped parameter-based physiologically and geometrically realistic outflow pressures will assist cardiologists in analyzing blood dynamics using the medically imaged coronary arteries of their patients and computing the magnitude of the hemodynamic parameters to provide them with a reliable assessment of the risk of coronary arterial disease for their patients.