bluuebunny/crossref_metadata_2025 huggingface dataset:
Testing and evaluation paradigms for assistive hearing devices
Authors: Chandra Shekar Ram Charan M. , Ali Hussnain , Hansen John H. L.
Published: October 2018

Research interfaces and assistive hearing devices (RI/AHD) enable investigators to perform perceptual studies and develop effective sound processing strategies for cochlear implant (CI) and hearing aid (HA) devices. Several concerns exist regarding safe and reliable operation of RI/AHDs, for example, safety, reliability, possible hazards, accuracy, and their long-term consistency. Recently, CRSS-CILab at UTDallas has developed a mobile RI (CCi-MOBILE) for unilateral and bilateral HA/CI devices. In this study, a comprehensive testing and evaluation strategy is proposed to investigate the behavior of RI/AHDs that addresses safety concerns, reliability of hardware/firmware design, hearing-comfort, subjective sound-quality, and range of human-driven settings, as well as diverse types of acoustic exposure. Furthermore, a characteristic risk-hazard analysis is performed including diagnosis and categorization of the severity level of the associated safety concerns by probing pulse characteristics from each electrode, e.g., current-level, pulse-width, charge per phase, frame-period (for stimulation-rate), inter-phase gap (IPG), and several other parameters. The CCi-MOBILE RI is employed in this study to demonstrate the utility of the proposed testing and evaluation paradigm. The described practices could potentially serve as a blue-print to characterize future RI for AHDs and several other personalized listening devices based on safety, reliability, listening comfort/perception, and subjective sound quality.
Using coherence to improve calculation of active acoustic intensity
Authors: Cook Mylan R. , Lawrence Joseph S. , Gee Kent L. , Sommerfeldt Scott D. , Neilsen Tracianne B. , Mortenson Michael C.
Published: October 2018

The Phase and Amplitude Gradient Estimator (PAGE) method was developed as an alternative to the traditional method for calculating energy-based acoustic measures such as active acoustic intensity [E. B. Whiting et al. J. Acoust. Soc. Am. 142, 2208–2218 (2017)]. While this method shows many marked improvements over the traditional method, such as a higher valid frequency bandwidth for broadband sources, contaminating noise can lead to inaccurate results. Both the traditional method and the PAGE method can perform poorly when microphone pairs exhibit low coherence, whether caused by noise or by imprecise measurements. By using a coherence weighting in the least-squares pressure gradient calculations, where the weighting can vary across frequency, better estimates of the pressure gradient can be obtained, which in turn yield more accurate results for intensity. Additionally, a coherence-based approach may be used to mitigate the negative impact of contaminating noise, most especially for uncorrelated contaminating noise. These improvements, though requiring a greater amount of computation time, can be integrated into the PAGE method processing procedures to create a more stable method for calculating acoustic intensity. [Work supported by NSF.]
Characterization of bottom parameters in the New England Mud Patch using geophone and hydrophone measurements
Authors: Potty Gopu R. , Miller James , Lin Ying-Tsong , Bonnel Julien , Newhall Arthur , Knobles David P. , Wilson Preston S.
Published: October 2018

Measurements of acoustic pressure and particle velocity were made during the Seabed Characterization Experiment (SCEx) in the New England Mud Patch south of Cape Cod in about 70 meters of water. The University of Rhode Island and Woods Hole Oceanographic Institution deployed the “geosled” with a four-element geophone array, a tetrahedral array of four hydrophones, and several hydrophone receive units (SHRUs). In addition, a new low frequency source, interface Wave Sediment Profiler (iWaSP) was deployed to excite interface waves (Scholte waves). The iWaSP system consists of a source to generate the interface wave and a four-element accelerometer receive array. Modal arrivals from broadband sources (SUS and CSS) on geophones and hydrophones will be presented and compared. The individual arrivals on the sensors will be identified though seismo-acoustic modeling. Based on the propagation paths of the various waves (compressional, shear and Scholte waves), geoacoustic parameters will be estimated. Seismic data collected at the location will be used to constrain the model parameters in the inversion. Sediment data from cores, other in-situ measurements and inversions using other types of data will be used to compare and validate our inversions. [Work supported by Office of Naval Research.]
Sequential bottom parameter estimation using blind deconvolution of sources of opportunity in ocean waveguide
Authors: Zhang Xuedong , Durofchalk Nicholas C. , Wu Lixin , Sabra Karim G.
Published: October 2018

This paper investigates the performance of sequential bottom parameter estimation based on ray-based blind deconvolution (RBD) of sources of opportunity using both numerical simulations and the 2016 Santa Barbara Channel (SBC) experimental recordings of shipping noise for ranges up to several kilometers. The RBD algorithm relies on estimating the unknown phase of the random sources to approximate the source-to-array channel impulse responses (CIR) by wideband beamforming along a well-resolved ray path [Sabra et al., JASA, 2010, EL42-7]. The power ratio of the direct and bottom-bounced arrivals is processed to infer the bottom reflection loss and is utilized to invert for the bottom parameters. Usually, the estimated bottom reflection loss is not accurate enough as the estimated CIR is noisy. Sequential parameter estimation uses a state space model for predicting and correcting the bottom parameters as the estimated bottom reflection loss values become available. This approach is a robust estimation tool employing predictions from previous estimates and corrects stemming from models that relate bottom parameters to the bottom reflection loss. Inversions results for the SBC experiment were also performed with conventional active sources to validate the inversion obtained with RBD of sources of opportunity.
Research trajectories in classroom acoustics: Investigating children perception beyond accuracy
Authors: Prodi Nicola
Published: October 2018

In a prospective discussion with Murray Hodgson earlier in 2003 in Ferrara, we agreed that much further insight should be gained in the perception of room acoustics for speech, and classrooms were the main area of common interest. In fact several metrics have been in use since long to assess listeners’ accuracy, either objectively or subjectively. Unfortunately, these tools are not effective in tracking the listening effort, which may occur even if accuracy is high. Thus, an extension of the analysis beyond acoustically and accuracy-oriented indicators is required to grasp information on the multi-faceted construct of listening effort. In the field of audiology a framework for listening effort was developed and several psycho-physiological and behavioral quantities have been proposed. None of them is considered exhaustive, and different quantities are sensitive to peculiar aspects: for instance, the slowing down of response time in adverse conditions is thought to trace an increase of processing load. Applying this knowledge in the field of room acoustics may fill the gap in the evaluation and design of rooms for speech communication. In this work, the results achieved so far will be presented and applications in the field of classroom acoustics will be outlined too.
Learning and interacting in noisy classrooms: what background noise measures and subjective teacher perceptions tell us about the challenges for students who are hard of hearing
Authors: Jamieson Janet R. , Poon Brenda , Zaidman-Zait Anat
Published: October 2018

The negative impact of noisy classrooms can impede academic performance for even typically hearing children. The purpose of this qualitative study was to investigate the impact of noisy classrooms on the social and academic experiences of deaf and hard-of-hearing students, who are increasingly educated alongside their hearing peers. First, background noise levels were measured in 11 kindergarten-Grade 7 classrooms in which children with hearing loss were placed, during the first 1½ hours of one school day. Based on the ongoing activities and background noise levels, predictions were made as to when the children would likely experience the most and least adverse listening conditions. Second, teachers were interviewed to obtain their perspectives of the learning and socialization experiences of the children with hearing loss. Overall, there was striking consistency between the predicted difficulties based on objective acoustic measures and perceived difficulties based on teachers’ subjective perspectives. Thematic analysis of the interviews revealed the following major themes concerning the students with hearing loss: difficulty hearing instruction; missing out on social communication with peers; and difficulty recognizing and managing transitions. Overall, these findings suggest that background noise in elementary school classrooms negatively impacts listening, learning, and social interaction for students with hearing loss.
Investigation of the context of humpback whale non-song calls in the North Atlantic
Authors: Epp Mikala , Davoren Gail
Published: October 2018

Humpback whales display behavioural plasticity in their foraging behaviours and non-song calling behaviours. Prey type appears to be associated with some of the variation in foraging behaviours and, thus, may also be related to variation in use of non-song calls related to foraging. Our goal was to compare non-song calls from two regions and identify any call types that occur in only one of the regions. We used recordings from stationary hydrophones within two foraging grounds: from the northeast Newfoundland coast, where capelin is the main prey; and the Gulf of Maine, where herring and sand lance dominate the diet. These areas are sympatric and foraging groups are thought to be from the same breeding aggregation, suggesting that call type differences would not have a genetic-basis. Most of the call types were the same across both areas, as has been found across many foraging grounds, but a small number of call types and call sequences were heard in only one of the two regions. We hope to use multi-sensor tag data and video recordings to help identify the contexts of these calls to further determine whether non-song call variation can be linked to prey type.
A micro-mechanical model for the Biot theory of acoustic waves in a fully saturated granular material
Authors: La Ragione Luigi , Recchia Giuseppina , Jenkins James T.
Published: October 2018

In the context of the classical Biot theory for acoustic waves in a fully saturated granular material, we improve upon the constitutive relation of the solid phase by means of micro-mechanical modeling. This is needed to explain discrepancies on the dependency of the frequency with the sound speed attenuation and dispersion between present models and experiment. The micro-mechanical provides a more detailed description of the interaction between the particles and water and gives an expression for the stress of the entire aggregate based upon micro mechanical parameters such as coordination number (average number of contacts per particle), porosity, material properties. The aggregate is modeled as a collection of particles that are stiffer than the water; so in the particle fluid interaction, idealized by a Standard Linear Solid model, only the compressibility of the water is taken in account. The possibility to include a deviation of the particle motion from the classical affine deformation is explored. Predictions of the sound speed attenuation and dispersion are provided in the context of a uniaxial deformation.
Simulated cavitation noise from strong nonlinear coupling in a multi-bubble system
Authors: Pandey Vikash
Published: October 2018

The mutual nonlinear coupling between cavitation bubbles in a bubble cloud has often been blamed for the complex nature of the cavitation noise. This noise is undesirable for two reasons. First, it affects the source air-gun signature which is crucial in later stages of seismic signal processing. Second, the generated noise may fall in the same frequency regime which is used by some types of whales for communication, and therefore interfere. The complete nonlinear theory of bubble interaction is used to solve the governing Keller-Miksis equation (KME) to simulate the experimentally observed cavitation noise. A qualitative comparison is made with the results from other scientific investigations and interesting inferences are drawn. It is believed that the findings reported here may have implications in the air-gun array design in seismic exploration industry since air-guns are the indirect source of cavitation noise. It may also have an impact on the study of communication systems in marine mammals.
Acoustic streaming in a channel a moderate streaming Reynolds number
Authors: Thompson Charles , Chandra Kavitha , Pierce Allan D.
Published: October 2018

In this work, the generation of acoustic streaming in a rigid walled channel is examined. At low values of the streaming Reynolds number, the time-averaged fluid motion in the channel follows that given by Rayleigh. However, departure from the aforementioned result ensues as the magnitude of the streaming Reynolds number increases. Higher order nonlinear corrections to the Rayleigh streaming solution is given and are expressed in terms of a regular perturbation sequence in nondimensional particle amplitude. It is shown that the reduction in the amplitude of the axially directed streaming velocity is a function of the streaming Reynolds number.
Thickness measurement of rigid porous material through reflected acoustic waves at Darcy's regime
Authors: Sadouki Mustapha
Published: October 2018

In this work, an inverse method is proposed for measuring the thickness of air-saturated of rigid porous material using the reflected acoustic waves at Darcy’s regime. The equivalent fluid model is considered. The interactions between the structure and the fluid are taken into account in two frequency response factors; the dynamic tortuosity of the medium introduced by Johnson et al. and the dynamic compressibility of the air introduced by Allard. A simplified expression of the reflection coefficient is obtained at the Darcy’s regime (very low frequencies), this expression is independent of the frequency and depends only on the thickness and the flow resistivity of the porous medium. The inverse problem is solved numerically by minimizing between the simulated and experimental reflected signals; the reconstructed values found of the thickness of porous samples with different resistivity are in good agreement to those obtained using direct measurements.
Acoustic wave propagation in orthotropic porous silicon with specific pore shapes
Authors: Gong Xiaoyue , Bustillo Julien , Blanc Laurianne , Gautier Gaël
Published: October 2018

In the literature, porous materials are normally treated as isotropic media. In this case, analytical solutions for wave velocities and attenuations as a function of frequency have been given by M. A. Biot. Nevertheless, porous silicon (PSi) synthesized using electrochemical manufacturing is generally highly anisotropic. Then, it can be considered as orthotropic. In order to optimize acoustic applications using PSi, it is necessary to take account to this anisotropy. In early works, by using FEM simulations, skeleton elastic constants have been computed for five PSi pore shapes and different porosities. In this work, the "Gedanken experiments" have been implemented and compliance tensors have been calculated. By inverting the compliance tensor, the elastic parameters of fluid-saturated PSi have been calculated. Moreover, geometrical parameters such as tortuosity, permeability and characteristic length of pores have been simulated. The wave equations can be deduced by combining Biot's theory and Christoffel's equations, and have been solved by using the simulation results. Then, the phase velocity and attenuation variations, according to frequency, were studied. The results for five different pore shapes have been compared and the differences show that the shape strongly influences wave propagation.
Ultrasonic phased array total focusing method based on sparse deconvolution
Authors: Yu Bei , Mei Yujian , Jin Haoran , Wu Eryong , Yang Keji
Published: October 2018

Ultrasonic phased array total focusing method (TFM) has been widely used in the field of non-destructive testing (NDT) as an advances post-processing imaging algorithm. It shows great potential in defect detection and characterization. However, due to the small number of excitation elements and large amount of collecting data, its temporal resolution and imaging efficiency need to be improved. To overcome these disadvantages, an ultrasonic phased array total focusing method based on sparse deconvolution has been proposed in this paper. Based on the actual situation of ultrasonic testing, a regularized sparse deconvolution model has been established. The Bayesian theory is used to add low-probability prior information to the deconvolution model. At the same time, the sparse deconvolution optimization algorithm proposed in this paper is used to solve the sparse deconvolution model. Compared with ordinary phased array total focusing method, this algorithm reduced the calculation amount and improved the temporal resolution. The performance of the proposed method is proved by simulation and experimental comparison. The results verify that the proposed method has higher resolution and imaging efficiency.
Estimating the flight parameters of a moving airborne source using one hydrophone
Authors: Zhang Boxuan , Yang Yixin , Guo Xijing , Liang Ningning
Published: October 2018

The low frequency tone noise of the turboprop aircrafts can be discovered more easily under water than the broadband continuum spectrum noise due to its higher intensity. Ferguson and Lo provided a method based on a single hydrophone for estimating the four flight parameters, including the source frequency, velocity, altitude and CPA time (the time when the source passes the closet point of approach), using the variation of the instantaneous frequency (IF) of a single tone over time [Ferguson and Lo, IEEE J. Oceanic Eng., 24(4):424–435 (1999)]. Therefore, the performance of their method is largely determined by the precision of the IF estimates, which were obtained by using the short-time Fourier transform (STFT). In this paper, the polynomial chirplet transform (PCT), which models the change of the IF over time as a polynomial, is used instead of STFT to provide more accurate IF estimates. Moreover, multiple tones are used to improve the precision of the flight parameter estimates. The performance improvement is demonstrated by simulations and an experiment carried out near the Sanya coast in May, 2018.
Exertional Dyspnea in Childhood: Is There an Iceberg Beneath the Apex?
Authors: Pianosi Paolo T.
Published: October 2018

This essay expounds on fundamental, quantitative elements of the exercise ventilation in children, which was the subject of the Tom Rowland Lecture given at the NASPEM 2018 Conference. Our knowledge about how much ventilation rises during aerobic exercise is reasonably solid; our understanding of its governance is a work in progress, but our grasp of dyspnea and ventilatory limitation in children (if it occurs) remains embryonic. This manuscript summarizes ventilatory mechanics during dynamic exercise, then proceeds to outline our current understanding of mechanisms of dyspnea, particularly during exercise (exertional dyspnea). Most research in this field has been done in adults, and the vast majority of these studies in patients with chronic obstructive pulmonary disease. To what extent conclusions drawn from this literature apply to children and adolescents—both healthy and those with cardiopulmonary disease—will be discussed. The few, recent, pertinent, pediatric studies will be reviewed in an attempt to provide an empirical basis for proposing a hypothetical model to study exertional dyspnea in youth. Just as somatic growth will have consequences for ventilatory and exercise capacity, so too will neural developmental plasticity and experience affect perception of dyspnea. Our path to understand how these evolving inputs and influences summate during a child’s life will be Columbus’ India.
NASA's asteroid explorer Dawn soon to go dark
Authors: Voosen Paul
Published: October 2018

Mission was first to orbit two planetary bodies, Vesta and Ceres.
China narrows U.S. lead in R&D spending
Authors: Normile Dennis
Published: October 2018

But lagging support for basic research may hinder ambitions to become a science superpower.
Toxin or treatment?
Authors: Couzin-Frankel Jennifer
Published: October 2018

Ingesting small doses of peanut products guards against allergic reactions—but an undercurrent of anxiety persists.
Chiral Lewis acids integrated with single-walled carbon nanotubes for asymmetric catalysis in water
Authors: Kitanosono Taku , Xu Pengyu , Kobayashi Shū
Published: October 2018

Carbon nanotubes help nickel work in water

Most synthetic chemistry takes place in hydrocarbon-derived solvents. By contrast, enzymes manage to perform exquisitely selective reactions in water, often by surrounding reactants with hydrophobic pockets. Kitanosono
et al.
show that single-walled carbon nanotubes can similarly render simple nickel catalysts effective in water. Integration of the nickel ions with chiral ligands and surfactants at the nanotube surface produces a highly enantioselective catalyst for nitrone formation from aldoximes and unsaturated ketones. Spectroscopy suggests that the nanotubes enhance electron density at the nickel center as well as provide a hydrophobic milieu.

Science
, this issue p.
311
Quantum advantage with shallow circuits
Authors: Bravyi Sergey , Gosset David , König Robert
Published: October 2018

Quantum outperforms classical

Quantum computers are expected to be better at solving certain computational problems than classical computers. This expectation is based on (well-founded) conjectures in computational complexity theory, but rigorous comparisons between the capabilities of quantum and classical algorithms are difficult to perform. Bravyi
et al.
proved theoretically that whereas the number of “steps” needed by parallel quantum circuits to solve certain linear algebra problems was independent of the problem size, this number grew logarithmically with size for analogous classical circuits (see the Perspective by Montanaro). This so-called quantum advantage stems from the quantum correlations present in quantum circuits that cannot be reproduced in analogous classical circuits.

Science
, this issue p.
308
; see also p.
289
Landscapes that work for biodiversity and people
Authors: Kremen C. , Merenlender A. M.
Published: October 2018

A nature-friendly matrix

As the human population has grown, we have taken and modified more and more land, leaving less and less for nonhuman species. This is clearly unsustainable, and the amount of land we protect for nature needs to be increased and preserved. However, this still leaves vast regions of the world unprotected and modified. Such landscapes do not have to be a lost cause. Kremen and Merenlender review how biodiversity-based techniques can be used to manage most human-modified lands as “working landscapes.” These can provide for human needs and maintain biodiversity not just for ecosystem services but also for maintenance and persistence of nonhuman species.

Science
, this issue p.
eaau6020
Shear properties of Earth’s inner core constrained by a detection of
J
waves in global correlation wavefield
Authors: Tkalčić Hrvoje , Phạm Thanh-Son
Published: October 2018

A solid and squishy inner core

Earth's inner core is thought to be solid, which means it should support shear waves. However, the small size of the inner core makes detecting shear waves very difficult. Tkalčić and Phạm correlated different types of seismic phases to finally determine the speed of shear waves in Earth's inner core (see the Perspective by Irving). The detection of the waves closes an 80-year quest to find them and confirms a solid, but soft, inner core.

Science
, this issue p.
329
; see also p.
294
The familiar politics of the final frontier
Moon
Kim Stanley Robinson
, Orbit, 2018. 464 pp.
Authors: Trapani Josh
Published: October 2018

Earth's economic woes haunt the first lunar colony in a fictional near future
Recognizing the role of skilled immigration
The Gift of Global Talent: How Migration Shapes Business, Economy & Society
William R. Kerr
Stanford University Press, 2018. 256 pp.
Authors: Shih Kevin
Published: October 2018

A scholar examines the rewards and shortcomings of global talent in the United States
Response to Comment on “The plateau of human mortality: Demography of longevity pioneers”
Authors: Barbi Elisabetta , Lagona Francesco , Marsili Marco , Vaupel James W. , Wachter Kenneth W.
Published: October 2018

Beltrán-Sánchez
et al
. based their comment on misleading calculations of the maximum survival age. With realistic numbers of people attaining age 105 and the estimated plateau, the Jeanne Calment record is indeed plausible.
A friendly danger
Authors: Salazar Fabián , Brown Gordon D.
Published: October 2018

Immune cell receptor DNGR-1 limits inflammatory tissue damage
Influenza A: another cause of SIADH?
Authors: Mifsud Simon , Zammit Maria Alessandra , Casha Ramon , Fsadni Claudia
Published: October 2018

The syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a frequent cause of hyponatraemia. It is a dilutional hyponatraemia secondary to impaired urinary dilution in the absence of renal disease or any identifiable non-osmotic stimulus known to induce antidiuretic hormone secretion. SIADH can arise secondary to various respiratory tract infections; however, the association between SIADH and influenza A infection is described in only a few cases in the literature. The authors present a case report of influenza A that may have caused a profound SIADH-related hyponatraemia.
Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis
Authors: Davenport Margie H , Ruchat Stephanie-May , Poitras Veronica J , Jaramillo Garcia Alejandra , Gray Casey E , Barrowman Nick , Skow Rachel J , Meah Victoria L , Riske Laurel , Sobierajski Frances , James Marina , Kathol Amariah J , Nuspl Megan , Marchand Andree-Anne , Nagpal Taniya S , Slater Linda G , Weeks Ashley , Adamo Kristi B , Davies Gregory A , Barakat Ruben , Mottola Michelle F
Published: October 2018

Objective

Gestational diabetes mellitus (GDM), gestational hypertension (GH) and pre-eclampsia (PE) are associated with short and long-term health issues for mother and child; prevention of these complications is critically important. This study aimed to perform a systematic review and meta-analysis of the relationships between prenatal exercise and GDM, GH and PE.

Design

Systematic review with random effects meta-analysis and meta-regression.

Data sources

Online databases were searched up to 6 January 2017.

Study eligibility criteria

Studies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcomes (GDM, GH, PE).

Results

A total of 106 studies (n=273 182) were included. ‘Moderate’ to ‘high’-quality evidence from randomised controlled trials revealed that exercise-only interventions, but not exercise+cointerventions, reduced odds of GDM (n=6934; OR 0.62, 95% CI 0.52 to 0.75), GH (n=5316; OR 0.61, 95% CI 0.43 to 0.85) and PE (n=3322; OR 0.59, 95% CI 0.37 to 0.9) compared with no exercise. To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140 min of brisk walking, water aerobics, stationary cycling or resistance training).

Summary/conclusions

In conclusion, exercise-only interventions were effective at lowering the odds of developing GDM, GH and PE.
Association between patient outcomes and accreditation in US hospitals: observational study
Authors: Lam Miranda B , Figueroa Jose F , Feyman Yevgeniy , Reimold Kimberly E , Orav E John , Jha Ashish K
Published: October 2018

Objectives

To determine whether patients admitted to US hospitals that are accredited have better outcomes than those admitted to hospitals reviewed through state surveys, and whether accreditation by The Joint Commission (the largest and most well known accrediting body with an international presence) confers any additional benefits for patients compared with other independent accrediting organizations.

Design

Observational study.

Setting

4400 hospitals in the United States, of which 3337 were accredited (2847 by The Joint Commission) and 1063 underwent state based review between 2014 and 2017.

Participants

4 242 684 patients aged 65 years and older admitted for 15 common medical and six common surgical conditions and survey respondents of the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS).

Main outcome measures

Risk adjusted mortality and readmission rates at 30 days and HCAHPS patient experience scores. Hospital admissions were identified from Medicare inpatient files for 2014, and accreditation information was obtained from the Centers for Medicare and Medicaid Services and The Joint Commission.

Results

Patients treated at accredited hospitals had lower 30 day mortality rates (although not statistically significant lower rates, based on the prespecified P value threshold) than those at hospitals that were reviewed by a state survey agency (10.2% v 10.6%, difference 0.4% (95% confidence interval 0.1% to 0.8%), P=0.03), but nearly identical rates of mortality for the six surgical conditions (2.4% v 2.4%, 0.0% (−0.3% to 0.3%), P=0.99). Readmissions for the 15 medical conditions at 30 days were significantly lower at accredited hospitals than at state survey hospitals (22.4% v 23.2%, 0.8% (0.4% to 1.3%), P<0.001) but did not differ for the surgical conditions (15.9% v 15.6%, 0.3% (−1.2% to 1.6%), P=0.75). No statistically significant differences were seen in 30 day mortality or readmission rates (for both the medical or surgical conditions) between hospitals accredited by The Joint Commission and those accredited by other independent organizations. Patient experience scores were modestly better at state survey hospitals than at accredited hospitals (summary star rating 3.4 v 3.2, 0.2 (0.1 to 0.3), P<0.001). Among accredited hospitals, The Joint Commission did not have significantly different patient experience scores compared to other independent organizations (3.1 v 3.2, 0.1 (−0.003 to 0.2), P=0.06).

Conclusions

US hospital accreditation by independent organizations is not associated with lower mortality, and is only slightly associated with reduced readmission rates for the 15 common medical conditions selected in this study. There was no evidence in this study to indicate that patients choosing a hospital accredited by The Joint Commission confer any healthcare benefits over choosing a hospital accredited by another independent accrediting organization.
Is body mass index associated with symptom severity and health-related quality of life in irritable bowel syndrome? A cross-sectional study
Authors: Dong Yuanjun , Berens Sabrina , Eich Wolfgang , Schaefert Rainer , Tesarz Jonas
Published: October 2018

Objective

The aim of this study was to describe the body mass index (BMI) distribution in patients with irritable bowel syndrome (IBS) based on the Rome III criteria and to evaluate the association of BMI with symptom severity and quality of life (QOL).

Methods

A cross-sectional study was carried out in patients visiting our outpatient functional gastrointestinal disorders specialty clinic. IBS diagnosis was made based on Rome III criteria. IBS symptom severity was investigated using the IBS severity score system. QOL was assessed using the Short Form 36 Health Survey, which consists of physical health and mental health.

Results

366 patients (252 women) who fulfilled Rome III criteria and provided complete BMI data (23.90±5.22 kg/m2) were included. Overall, 59.0% of patients with IBS were in the normal weight range, 30.3% were overweight or obese, and 10.7% were underweight. Both physical and mental health decreased significantly with the severity of symptoms (all p<0.01), while controlling for several covariates (age, gender, family status, education status and IBS subtypes). Obesity and symptom severity (β=−0.177,△R2=0.037, p<0.01; β=−0.387,△R2=0.147, p<0.01) were significant negative factors that influencing physical health. Symptom severity (β=−0.301,△R2=0.084, p<0.01) was significant negative factor that influencing mental health. However, BMI didn’t account for additional variance in mental health (p>0.05).

Conclusion

Being overweight is a common phenomenon in patients with IBS regardless of IBS subtype. The association between QOL and symptom severity followed a negative dose-response pattern. Patients with higher BMI, especially obese patients, were more frequently in poor physical health. However, this kind of relationship was not found in BMI and mental health.
Environmental exposure to triclosan and polycystic ovary syndrome: a cross-sectional study in China
Authors: Ye Jiangfeng , Zhu Wenting , Liu Han , Mao Yuchan , Jin Fan , Zhang Jun
Published: October 2018

Objectives

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of women at reproductive age. Although the aetiology of PCOS remains unclear, potential effects of environmental endocrine-disrupting compounds on the development of PCOS have drawn increasing attention. The aim of the current study was to examine the association between triclosan (TCS) and PCOS, and explore possible mechanisms on how TCS may contribute to the development of clinical manifestations of PCOS.

Design

Cross-sectional study.

Setting

This study was conducted in one tertiary-level hospital located in Zhejiang, China.

Participants

A total of 674 infertile women at 18–45 years of age were recruited in 2014–2015. Participants with (n=84) and without (n=212) PCOS with urinary TCS concentration available were included in the analyses.

Methods

Urinary TCS concentration was measured using a high-performance liquid chromatography–electrospray ionisation tandem mass spectrometry. Logistic regression model was used to examine the association between TCS and PCOS. Fractional polynomial regression models were built to fit the potential non-linear relationship between TCS concentrations and luteinising hormone (LH) and LH/follicle stimulate hormone (FSH).

Results

The PCOS group had significantly higher level of TCS concentration than the non-PCOS group (the median of TCS (IQR), μg/g creatinine: 1.49 (0.68–3.80) vs 1.06 (0.52–3.02), p=0.0407). Compared with the lowest tertile, the highest tertile of TCS concentration was associated with an increased odd of PCOS (OR 2.12, 95% CI 1.12 to 3.99). After adjusting for potential confounders, the significant association remained (OR 1.99, 95% CI 1.05 to 3.79). Positive relationships were found between TCS levels and LH and LH/FSH ratio in non-PCOS participants.

Conclusions

TCS exposure at a relatively low level is associated with PCOS in Chinese women. Further epidemiological studies are needed to confirm our finding, which may have important public health implications.
Relationship between leisure time physical activity, sedentary behaviour and symptoms of depression and anxiety: evidence from a population-based sample of Canadian adolescents
Authors: Bélair Marc-André , Kohen Dafna E , Kingsbury Mila , Colman Ian
Published: October 2018

Background

Physical and sedentary activities have been identified as potentially modifiable risk factors for many diseases, including mental illness, and may be effective targets for public health policy and intervention. However, the relative contribution of physical activity versus sedentary behaviour to mental health is less clear. This study investigated the cross-sectional association between physical activity, sedentary activity and symptoms of depression and anxiety at age 14–15 in the National Longitudinal Survey of Children and Youth (NLSCY).

Methods

Respondents aged 14–15 years between 1996 and 2009 who reported on symptoms of depression in the NLSCY were included (n=9702). Multinomial logistic regression was used to assess the relationship between physical and sedentary activity and symptoms of depression and anxiety. Joint models including both physical and sedentary activity were also explored. Models were adjusted for sex, ethnicity, immigration status, family income, parental education, recent major stressful life events and chronic health conditions.

Results

The odds of having moderate and severe symptoms of depression and anxiety compared with no symptoms was 1.43 (1.11 to 1.84) and 1.88 (1.45 to 2.45) times higher, respectively, in physically inactive youth relative to physically active youth. The odds of having moderate and severe symptoms of depression and anxiety compared with no symptoms was 1.38 (1.13 to 1.69) and 1.31 (1.02 to 1.69) times higher, respectively, in sedentary youth relative to non-sedentary youth. In joint models including both physical and sedentary activity, sedentary activity was not consistently associated with symptoms of depression and anxiety.

Conclusions

Both physical inactivity and sedentary activity appear to be significantly related to symptoms of depression and anxiety. The importance of distinguishing these two behaviours has relevance for research as well as policies targeting physical activity and mental health in youth.
Patient engagement, treatment preferences and shared decision-making in the treatment of opioid use disorder in adults: a scoping review protocol
Authors: Marshall Tyler , Kinnard Elizabeth N , Hancock Myles , King-Jones Susanne , Olson Karin , Abba-Aji Adam , Rittenbach Katherine , Vohra Sunita
Published: October 2018

Introduction

Opioid use disorder (OUD) is characterised by the fifth Edition of the Diagnostic and Statistics Manual as a problematic pattern of opioid use (eg, fentanyl, heroin, oxycodone) that leads to clinically significant impairment. OUD diagnoses have risen substantially over the last decade, and treatment services have struggled to meet the demand. Evidence suggests when patients with chronic illnesses are matched with their treatment preferences and engaged in shared decision-making (SDM), health outcomes may improve. However, it is not known whether SDM could impact outcomes in specific substance use disorders such as OUD.

Methods and analysis

A scoping review will be conducted according to Arksey and O’Malley’s framework and by recommendations from Levacet al. The search strategy was developed to retrieve relevant publications from database inception and June 2017. MEDLINE, EMBASE, PsycINFO, Cochrane Database for Controlled Trials, Cochrane Database for Systematic Reviews and reference lists of relevant articles and Google Scholar will be searched. Included studies must be composed of adults with a diagnosis of OUD, and investigate SDM or its constituent components. Experimental, quasi-experimental, qualitative, case–control, cohort studies and cross-sectional surveys will be included. Articles will be screened for final eligibility according to title and abstract, and then by full text. Two independent reviewers will screen excluded articles at each stage. A consultation phase with expert clinicians and policy-makers will be added to set the scope of the work, refine research questions, review the search strategy and identify additional relevant literature. Results will summarise whether SDM impacts health and patient-centred outcomes in OUD.

Ethics and dissemination

Scoping review methodology is considered secondary analysis and does not require ethics approval. The final review will be submitted to a peer-reviewed journal, disseminated at relevant academic conferences and will be shared with policy-makers, patients and clinicians.
B-type natriuretic peptide reference interval of newborns from healthy and pre-eclamptic women: a prospective, multicentre, cross-sectional study
Authors: Rodriguez David , Garcia-Rivas Gerardo , Laresgoiti-Servitje Estibalitz , Yañez Jesus , Torre-Amione Guillermo , Jerjes-Sanchez Carlos
Published: October 2018

Objective

To define and compare the reference interval of B-type natriuretic peptide (BNP) in healthy newborns (HN) from healthy mothers and with severe pre-eclampsia.

Design

Prospective, multicentre, cross-sectional study.

Setting

Four obstetric wards of second-level academic hospitals.

Participants

167 HN, from 146 healthy and 21 severe pre-eclamptic women. We included newborns from healthy mothers with full-term pregnancies (38 to 42 gestational weeks), who received adequate prenatal care and who had Apgar scores ≥7 at 0 and 5 min. Newborns with chromosomopathies identified during prenatal consultations, those with respiratory distress and those with cardiac or pulmonary disease detected in the first paediatric evaluation were excluded from this study. In the group of pre-eclamptic women, we considered the same inclusion criteria, but the patients also had to meet the diagnostic criteria for pre-eclampsia with severity features, according to the American College of Obstetricians and Gynaecologists guidelines. The same exclusion criteria used for the healthy group were applied to the pre-eclampsia-associated newborn.

Interventions

A single blood sample from the umbilical cord artery after delivery (vaginal or caesarean section).

Primary outcome

Reference level of BNP in HN.

Results

In the HN group, the median BNP was 12.15 pg/mL (IQR 7.7–16.8 pg/mL) and in the pre-eclamptic group 20.8 pg/mL (IQR 5.8–46.5 pg/mL). The reference interval for BNP in HN was 5pg/mL (95% CI 5 to 5) to 34 pg/mL (95% CI 28.4 to 38.8). We identified higher expression of BNP in newborns from pre-eclamptic women overall (p=0.037, r=0.16) and in newborns exposed to stress conditions, such as complications during labour and delivery (p=0.004, r=0.33).

Conclusions

In HN, BNP concentrations at birth were lower than reported in other similar populations. In neonates with stress conditions, the higher expression of this biomarker establishes another possible link between stress and the cardiovascular response.

Trial registration number

NCT02574806; Pre-results.
Public, medical professionals’ and patients’ preferences for the allocation of donor organs for transplantation: study protocol for discrete choice experiments
Authors: Oedingen Carina , Bartling Tim , Krauth Christian
Published: October 2018

Introduction

Organ transplantation is the treatment of choice for patients with severe organ failure. Nevertheless, donor organs are a scarce resource resulting in a large mismatch between supply and demand. Therefore, priority-setting leads to the dilemma of how these scarce organs should be allocated and who should be considered eligible to receive a suitable organ. In order to improve the supply–demand mismatch in transplantation medicine, this study explores preferences of different stakeholders (general public, medical professionals and patients) for the allocation of donor organs for transplantation in Germany. The aims are (1) to determine criteria and preferences, which are relevant for the allocation of scarce donor organs and (2) to compare the results between the three target groups to derive strategies for health policy.

Methods and analysis

We outline the study protocol for discrete choice experiments, where respondents are presented with different choices including attributes with varied attribute levels. They were asked to choose between these choice sets. First, systematic reviews will be conducted to identify the state of art. Subsequently, focus group discussions with the public and patients as well as expert interviews with medical professionals will follow to establish the attributes that are going to be included in the experiments and to verify the results of the systematic reviews. Using this qualitative exploratory work, discrete choice studies will be designed to quantitatively assess preferences. We will use a D-efficient fractional factorial design to survey a total sample of 600 respondents according to the public, medical professionals and patients each. Multinomial conditional logit model and latent class model will be analysed to estimate the final results.

Ethics and dissemination

This study has received Ethics Approval from the Hannover Medical School Human Ethics Committee (Vote number: 7921_BO_K_2018). Findings will be disseminated through conference presentations, workshops with stakeholders and peer-reviewed journal articles.
Haploinsufficiency of A20 impairs protein–protein interactome and leads into caspase-8-dependent enhancement of NLRP3 inflammasome activation
Authors: Rajamäki Kristiina , Keskitalo Salla , Seppänen Mikko , Kuismin Outi , Vähäsalo Paula , Trotta Luca , Väänänen Antti , Glumoff Virpi , Keskitalo Paula , Kaarteenaho Riitta , Jartti Airi , Hautala Nina , Jackson Päivi , Nordström Dan C , Saarela Janna , Hautala Timo , Eklund Kari K , Varjosalo Markku
Published: October 2018

Objectives

TNFAIP3encodes A20 that negatively regulates nuclear factor kappa light chain enhancer of activated B cells (NF-κB), the major transcription factor coordinating inflammatory gene expression.TNFAIP3polymorphisms have been linked with a spectrum of inflammatory and autoimmune diseases and, recently, loss-of-function mutations in A20 were found to cause a novel inflammatory disease ‘haploinsufficiency of A20’ (HA20). Here we describe a family with HA20 caused by a novelTNFAIP3loss-of-function mutation and elucidate the upstream molecular mechanisms linking HA20 to dysregulation of NF-κB and the related inflammasome pathway.

Methods

NF-κB activation was studied in a mutation-expressing cell line using luciferase reporter assay. Physical and close-proximity protein–protein interactions of wild-type andTNFAIP3p.(Lys91*) mutant A20 were analysed using mass spectrometry. NF-κB -dependent transcription, cytokine secretion and inflammasome activation were compared in immune cells of the HA20 patients and control subjects.

Results

The protein–protein interactome of p.(Lys91*) mutant A20 was severely impaired, including interactions with proteins regulating NF-κB activation, DNA repair responses and the NLR family pyrin domain containing 3 (NLRP3) inflammasome. The p.(Lys91*) mutant A20 failed to suppress NF-κB signalling, which led to increased NF-κB -dependent proinflammatory cytokine transcription. Functional experiments in the HA20 patients’ immune cells uncovered a novel caspase-8-dependent mechanism of NLRP3 inflammasome hyperresponsiveness that mediated the excessive secretion of interleukin-1β and interleukin-18.

Conclusions

The current findings significantly deepen our understanding of the molecular mechanisms underlying HA20 and other diseases associated with reduced A20 expression or function, paving the way for future therapeutic targeting of the pathway.