bluuebunny/crossref_metadata_2025 huggingface dataset:
PP17 Verbalisation of plans during out-of-hospital cardiac arrest resuscitation
Authors: Marzuki Ernisa , Crawford Anna , Cummins Chris , Rohde Hannah , Branigan Holly , Clegg Gareth
Published: April 2019

Background

Planning and communication are pivotal in achieving team goals. Studies have shown that teams with effective planning and sharing of mental models display better performance in resuscitation. The Advanced Life Support (ALS) algorithm serves as an overall script regarding specific stages during resuscitation, but it does not explicitly specify how tasks should be delegated or synchronised. Team members therefore need to rely on ongoing, context-specific shared plans for effective team coordination.

Methods

In our research, we explore paramedic resuscitation teams’ verbal communication from a discourse-analytic perspective. We analysed out-of-hospital cardiac arrest (OHCA) resuscitation videos, recorded using body cameras in the field, for plan verbalisation patterns and possible association with successful or unsuccessful outcomes. For the current study, the first five minutes of 10 OHCA resuscitations were transcribed and annotated using a bespoke coding scheme. We focused on how paramedics use language to coordinate their goals and manage the transitions between stages of the OHCA treatment process, and whether this is associated with the deployment of the mechanical compression device, AutoPulse.

Results

All 10 videos showed similar patterns of plan verbalisation in the first five minutes. The amount of verbalised plans took up nearly half the spoken utterances of all teams, suggesting that paramedics actively shared plans with their team members. Early in the resuscitation, paramedics tended to concentrate on immediate, single-task goals (e.g. moving patient to ideal position) rather than long-term, multi-task goals (e.g. accessing airway). We found little communication of the team leader’s overall mental model or script. Instead, plans were shared moment by moment. Based on the 10 videos, the timing of AutoPulse deployment seemed unaffected by the way plans were shared.

Conclusion

This study enriches our understanding of real-life planning and sharing of mental models during resuscitation. Through these, we can contribute to the betterment of professional interaction in this critical domain.
PP24 Time: take-home naloxone in multicentre emergency settings: protocol for a feasibility study
Authors: Jones Matthew , Snooks Helen , Bulger Jenna , Watkins Alan , Moore Chris , Edwards Adrian , Evans Bridie , Fuller Gordon , John Ann , Benger Jonathan , Buykx Penny , Hoskins Rebecca , Dixon Simon , Goodacre Steve , Black Sarah , Parry Emma , Lawrence Barbara , Bell Fiona
Published: April 2019

Background

Opioids such as heroin kill more people worldwide than any other drug. Death rates associated with opioid poisoning in the UK are at record levels. Naloxone is an opioid agonist which can be distributed in take home ‘kits’. This intervention is known as Take Home Naloxone (THN).

Methods

We propose to carry out a randomised controlled feasibility trial (RCT) of THN distributed in emergency settings clustered by Emergency Department (ED) catchment area, and local ambulance service; with anonymised linked data outcomes. This will include distribution of THN by paramedics and ED staff to patients at risk of opioid overdose. Existing linked data will be used to develop a discriminant function to retrospectively identify people at high risk of overdose death based on observable predictors of overdose to include in outcome follow up.

Results

We will gather outcomes up to one year including; deaths (and drug related); emergency admissions; intensive care admissions; ED attendances (and overdose related); 999 attendances (and for overdose); THN kits issued; and NHS resource usage. We will agree progression criteria following consultation with research team members related to sign up of sites; successful identification and provision of THN to eligible participants; successful follow up of eligible participants and opioid decedents; adverse event rate; successful data matching and data linkage; and retrieval of outcomes within three months of projected timeline.

Conclusions

THN programmes are currently run by some drug services in the UK. However, saturation is low. There has been a lack of experimental research in to THN, and so questions remain: Does THN reduce deaths? Are there unforeseen harms associated with THN? Is THN cost effective? This feasibility study will establish whether a fully powered cluster RCT can be used to answer these questions.
PP26 Convey or not convey? Does crew skill level predict hospital conveyance rate in a UK regional NHS ambulance service trust?
Authors: Black Sarah , Frampton Ian
Published: April 2019

Background

This study aimed to explore how demographic, temporal and patient characteristics influenced the decision to convey in a large dataset of nearly half a million consecutive calls to an NHS Ambulance Service Trust in the course of a single year.

Methods

The retrospective dataset combined information from patient clinical records and Control system data. Thirty variables were examined using a variety of techniques, including Pearson χ2, Mantel-Haenszel test for trend and Binomial logistic regression. Challenges and benefits to combining large datasets from different sources were explored.

Results

The binomial logistic regression model was statistically significant, χ2(21)=90409, p<0.0005, and showed that crew skill level independently predicted decision to convey. The model explained 24.3% (NagelkerkeR2) of the variance in conveyance and correctly classified 68.2% of cases. Sensitivity was 86.4%, specificity was 44.4%, positive predictive value was 33.1% and negative predictive value was 71.6%. All five predictor variables were statistically significant. Controlling for all the other variables; increasing crew skill level was independently associated with a significantly reduced likelihood of being conveyed.

Conclusions

The potential implications of this finding for ambulance services, Emergency Departments and the wider NHS are profound. Investment in community services in more rural areas may reduce ambulance conveyance, resulting in fewer avoidable admissions and easing pressure on the system. A striking difference in conveyance rates due to the time of day the 999 call was made is evident. During the ‘in hours’ period ambulance clinicians were able to discharge more patients at scene without the requirement for an ED conveyance. Conversely access to alternative health and social care providers is limited ‘out of hours’; making these services available over a longer operating period may similarly reduce ambulance conveyance rates during the evening and overnight.
PP28 Tia prehospital referral feasibility trial (TIER): recruitment and intervention usage
Authors: Rees Nigel , Hampton Chelsey , Bulger Jenna , Ali Khalid , Quinn Tom , Ford Gary , Akbari Ashley , Ward Matthew , Porter Alison , Jones Charlene , Snooks Helen
Published: April 2019

Background

Early specialist assessment of Transient Ischaemic Attack (TIA) can reduce the risk of stroke and death. This study assessed feasibility of undertaking a multi-centre randomised trial to evaluate clinical and cost effectiveness of referral of patients attended by emergency ambulance paramedic with low-risk TIA directly to specialist TIA clinic for early review.

Methods

We developed a protocol and referral pathway for paramedics to assess and refer patients directly to TIA clinic, including provision of aspirin. We randomly allocated volunteer paramedics to intervention or control group. Intervention paramedics were trained to deliver the intervention during the patient recruitment period. Control paramedics continued to deliver care as usual. Patients with TIA were identified from hospital records. We aimed to recruit 86 patients and pre-defined progression criteria related to feasibility of intervention delivery and trial methods.

Results

Development and recruitment phases are complete, with outcome follow up ongoing. Eighty nine of 134 (66%) paramedics participated in TIER. Of 1377 patients attended by trial paramedics during the patient recruitment period, 53 (3.8%) were identified as eligible for trial inclusion. Three of 36 (8%) patients attended by intervention paramedics were referred to the TIA clinic. Of the others, only one appeared to be a missed referral; in one case there was no prehospital record of TIA; one was attended by a paramedic who was not TIER trained; one patient record was missing; all others were recorded with contraindications: FAST positive (n=13); ABCD2 score >3 (n=5); already taking warfarin (n=2); crescendo TIA (n=1) other clinical factors (n=8).

Conclusions

Preliminary Results indicate challenges in recruitment and low referral rates. The low-risk 999 TIA population suitable for Emergency Department avoidance may be smaller than previously thought. Further analyses will focus on whether progression criteria for a definitive trial were met, and clinical outcomes from this feasibility trial.
PP7 Perceptions and experiences of being a community first responder: interview study
Authors: Phung Viet-Hai , Trueman Ian , Togher Fiona , Ørner Roderick , Siriwardena Niroshan
Published: April 2019

Background

Community First Responder (CFR) schemes work with ambulance services, supporting volunteers to respond to medical emergencies. The CFR’s primary role is to stabilise a patient’s condition and perform basic clinical procedures before handing over to statutory ambulance service staff. By early 2014, there were 2,431 CFR schemes, with over 12 000 volunteers in the UK. Despite expansion in numbers and role, little is known about perspectives of CFRs. We aimed to explore the perceptions and experiences of CFRs about their role.

Methods

We used a qualitative design conducting semi-structured interviews with a purposive sample of CFRs from one scheme in one English county. Interviews were transcribed verbatim and coded thematically in NVivo 10 using the Framework approach.

Results

We interviewed four female and 12 male adult CFRs between June and July 2016. The interviews identified five overarching themes,: ‘getting started and keeping going’; ‘the reality of being a CFR’; ‘recognition and relationships’; ‘learning to be a CFR’; and ‘the way forward’ for CFRs and schemes. Participants were keen to enhance their skills and progress. CFRs felt that the public confused them with ambulance staff, although patients felt reassured by the presence of someone who could help them regardless of who they were. CFRs were keen to raise their profile within the communities they served and to establish a distinct identity. The relationship between CFRs and ambulance staff was ambivalent: sometimes they worked well together while at other times they perceived a poor relationship with ambulance staff.

Conclusion

The complex relationship between CFRs, patients and the ambulance service has implications for how such schemes develop in the future. As such, further research is required on public and ambulance staff perceptions of what they do to see how these complex relationships can be harnessed effectively to benefit the communities they serve.
Greater analgesic effect with intermittent compared with continuous mode of lumbar plexus block for total hip arthroplasty: a randomized controlled trial
Authors: Ueshima Hironobu , Tanaka Noriko , Otake Hiroshi
Published: April 2019

This article has been retracted
Assessing the association between bronchiolitis in infancy and recurrent wheeze: a whole English birth cohort case–control study
Authors: Marlow Robin , Finn Adam , Henderson John
Published: April 2019

The precise association between bronchiolitis and predisposition to childhood wheeze is unclear. We assessed bronchiolitis aetiology and later wheeze phenotypes in the entire 2007 English birth cohort. All infants admitted to hospital in England during their first year of life with bronchiolitis or urinary tract infection (UTI) were followed using Hospital Episode Statistics to determine risk and characteristics of wheeze admission over the subsequent 8 years. In our cohort of 21 272 children compared with UTI, the risk of wheeze admission was higher with previous bronchiolitis (risk ratio (RR) 2.4), even higher in those with non-respiratory syncytial virus bronchiolitis (RR 3.1) and persisted into late-onset wheeze (RR 1.7).
Sub-fourier quantum metrology through bright solitary trains in Bose–Einstein condensate
Authors: Ghosh Suranjana , Bera Jayanta , Panigrahi Prasanta K. , Roy Utpal
Published: April 2019

We propose to utilize the Bose–Einstein condensate (BEC) for precision phase sensitive measurement of position and momentum displacements. The controlled two-soliton dynamics can be turned into a quantum probe to measure these parameters with high precision in an experimentally verified system of bright solitary trains. A careful phase space analysis of the dynamics of the mesoscopic wave packet is carried out through Wigner phase space picture for finding out the parameter domain exhibiting sub-Planck structures, required for precision quantum metrology. We propose two experimentally feasible scenarios, one involving the overall phase and the other through the relative phase between the two-solitons when they are oscillating inside the trap. In both the cases, detailed analytical studies are carried out through the overlap functions which reveal the sensitivity issue. A careful analysis is also performed to find the parametric domain relevant for the use of BEC for weak value estimation.
Vibration characteristics simulation and comparison of traditional cab system model and seat–cab coupled model for trucks
Authors: Zhao Leilei , Yu Yuewei , Zhou Changcheng , Feng Simon
Published: April 2019

To define the application fields of the traditional cab system model and the seat–cab coupled model, this paper mainly aims to investigate the differences of the vibration characteristics of the two models. First, the two models and their motion equations were introduced. Then, based on the mechanical parameters of the seat and cab system for a truck, the transmissibility characteristics of the two models were analyzed. The results show that the traditional model can relatively accurately predict the pitch and roll vibration characteristics of the real seat–cab system. However, it overvalues the vertical vibration transmitted from the front suspensions of the cab. Third, the typical excitation conditions and the measuring points were selected. Finally, under the typical excitation conditions, the dynamic responses of the measuring points were calculated. The results show that under the vertical excitation condition, the dynamic responses of the two models have obvious differences. Under the roll excitation condition and the pitch excitation condition, the roll responses and the pitch responses of the cab between the two models show almost no obvious difference. Under the random excitation condition, the vertical acceleration responses have relatively larger deviations between the two models, however, the angular acceleration responses are almost the same. For the preliminary design of the cab system, the traditional cab system model can be used. However, for the accurate design and the optimization of the seat–cab system, the seat–cab coupled model is recommended.
ContextAiDe
Authors: Pore Madhurima , Chakati Vinaya , Banerjee Ayan , Gupta Sandeep K. S.
Published: April 2019

Mobile crowd-sensing (MCS) enables development of context-aware applications by mining relevant information from a large set of devices selected in an ad hoc manner. For example, MCS has been used for real-time monitoring such as Vehicle ad hoc Networks-based traffic updates as well as offline data mining and tagging for future use in applications with location-based services. However, MCS could be potentially used for much more demanding applications such as real-time perpetrator tracking by online mining of images from nearby mobile users. A recent example is tracking the miscreant responsible for the Boston bombing. We present a new design approach for tracking using MCS for such complex processing in real time. Since MCS applications assume an unreliable underlying computational platform, most typically sample size for recruited devices is guided by concerns such as fault tolerance and reliability of information. As the real-time requirements get stricter coupled with increasing complexity of data-mining approaches, the communication and computation overheads can impose a very tight constraint on the sample size of devices needed for realizing real-time operation. This results in trade-off in acquiring context-relevant data and resource usage incurred while the real-time operation requirements get updated dynamically. Such effects have not been properly studied and optimized to enable real-time MCS applications such as perpetrator tracking. In this article, we propose ContextAiDe architecture, a combination of API, middleware, and optimization engine. The key innovation in ContextAiDe is context-optimized recruitment for execution of computation- and communication-heavy MCS applications in edge environment.

ContextAiDe uses a notion of two types of contexts, exact (hard constraints), which have to be satisfied, and preferred (soft constraints), which may be satisfied to a certain degree. By adjusting the preferred contexts, ContextAiDe can optimize the operational overheads to enable real-time operation. ContextAiDe provides an API to specify contexts requirements and the code of MCS app, offload execution environment, a middleware that enables context-optimized and a fault-tolerant distributed execution. ContextAiDe evaluation using a real-time perpetrator tracking application shows reduced energy consumption of 37.8%, decrease in data transfer of 24.8%, and 43% less time compared to existing strategy. In spite of a small increase in the minimum distance from the perpetrator, iterations of optimization tracks the perpetrator successfully. Pro-actively learning the context and using stochastic optimization strategy minimizes the performance degradation caused due to uncertainty (<20%) in usage-dependent contexts.
The FechDeck
Authors: Ferwerda James
Published: April 2019

Learning the methods of psychophysics is an essential part of training for perceptual experimentation, and hands-on experience is vital, but gaining this experience is difficult because good tools for learning are not available. The FechDeck is an ordinary deck of playing cards that has been modified to support learning the methods of psychophysics. Card backs are printed with noise patterns that span a range of densities. Faces are augmented with line segments arranged in “L” patterns. Jokers are printed with ruled faces and with backs that serve as standards. Instructions provided with the FechDeck allow users to perform threshold experiments using Fechner's methods of adjustment, limits, and constant stimuli; scaling experiments using Thurstone's ranking, paired comparison, and successive categories methods; and Stevens's magnitude estimation method. Spreadsheets provided with the deck support easy data entry and meaningful data analysis. An online repository supporting the FechDeck has been established to facilitate dissemination and to encourage open source development of the deck.
Analysis of the Complete Genome Sequence of a Novel, Pseudorabies Virus Strain Isolated in Southeast Europe
Authors: Csabai Zsolt , Tombácz Dóra , Deim Zoltán , Snyder Michael , Boldogkői Zsolt
Published: April 2019

Background. Pseudorabies virus (PRV) is the causative agent of Aujeszky’s disease giving rise to significant economic losses worldwide. Many countries have implemented national programs for the eradication of this virus. In this study, long-read sequencing was used to determine the nucleotide sequence of the genome of a novel PRV strain (PRV-MdBio) isolated in Serbia.Results. In this study, a novel PRV strain was isolated and characterized. PRV-MdBio was found to exhibit similar growth properties to those of another wild-type PRV, the strain Kaplan. Single-molecule real-time (SMRT) sequencing has revealed that the new strain differs significantly in base composition even from strain Kaplan, to which it otherwise exhibits the highest similarity. We compared the genetic composition of PRV-MdBio to strain Kaplan and the China reference strain Ea and obtained that radical base replacements were the most common point mutations preceding conservative and silent mutations. We also found that the adaptation of PRV to cell culture does not lead to any tendentious genetic alteration in the viral genome.Conclusion. PRV-MdBio is a wild-type virus, which differs in base composition from other PRV strains to a relatively large extent.
Replication-Based Data Dissemination in Connected Internet of Vehicles
Authors: Fan Xiying , Huang Chuanhe , Zhu Junyu , Fu Bin
Published: April 2019

Due to the dynamically changing topology of Internet of Vehicles (IoV), it is a challenging issue to achieve efficient data dissemination in IoV. This paper considers strongly connected IoV with a number of heterogenous vehicular nodes to disseminate information and studies distributed replication-based data dissemination algorithms to improve the performance of data dissemination. Accordingly, two data replication algorithms, a deterministic algorithm and a distributed randomised algorithm, are proposed. In the proposed algorithms, the number of message copies spread in the network is limited and the network will be balanced after a series of average operations among the nodes. The number of communication stages needed for network balance shows the complexity of network convergence as well as network convergence speed. It is proved that the network can achieve a balanced status after a finite number of communication stages. Meanwhile, the upper and lower bounds of the time complexity are derived when the distributed randomised algorithm is applied. Detailed mathematical results show that the network can be balanced quickly in complete graph; thus highly efficient data dissemination can be guaranteed in dense IoV. Simulation results present that the proposed randomised algorithm outperforms the present schemes in terms of transmissions and dissemination delay.
Modeling and Analysis of Wireless Cyberphysical Systems Using Stochastic Methods
Authors: Liu Jing , Yao Yixu
Published: April 2019

Wireless mesh network control systems (WMNCSs) are typical Cyberphysical Systems (CPSs) widely used in industries that need to meet stringent performance requirements. These WMNCSs are characteristic of stochasticity at different levels as system behavior, network performance, and wireless signal propagation, which grievously increases the difficulties of system modeling and analysis. In this paper, we propose a three-layered modeling framework to capture the stochastic properties of WMNCSs at different levels with stochastic hybrid system (SHS), stochastic network calculus (SNC), and physical layer models. We also bridge the gaps between these methods with an upper bound approach. All the efforts give us a methodology of modeling and analysis WMNCSs with stochastic methods, so we can know how the factors as channel conditions, network topology, etc. affect the stability and performance of the system. To the best of our knowledge, it is the first work that provides such a unified and flexible framework to model and analyze WMNCSs with stochastic methods.
Brown Bowel Syndrome in a Middle-Aged Woman with Chronic Idiopathic Malabsorption
Authors: Parente Renato , Pinamonti Maurizio , Martina Stefania
Published: April 2019

Brown bowel syndrome (BBS) is an extremely unusual condition characterized by an orange-brown discoloration of the bowel and intestinal motility disorders secondary to fat-soluble vitamin deficiency and malabsorption from many different causes. We present the case of a middle-aged woman suffering for years of chronic constipation with recurrent intestinal subocclusion, who was diagnosed BBS on surgical biopsy material. Nutritional supplementary treatment was tried, but her symptoms did not improve, and a decision was finally made in favor of a surgical approach. After subtotal colectomy and continual vitamin nutritional supplementation, she has now regular transit without the use of laxatives. BBS is a rare complication of long-term malabsorption manifesting as intestinal motility disorders, which can lead to severe complications. This condition is only partially responsive to vitamin supplementation, and most cases require surgery.
Methods to Estimate Surface Roughness Length for Offshore Wind Energy
Authors: Golbazi Maryam , Archer Cristina L.
Published: April 2019

The northeastern coast of the U.S. is projected to expand its offshore wind capacity from the existing 30 MW to over 22 GW in the next decade, yet, only a few wind measurements are available in the region and none at hub height (around 100 m today); thus, extrapolations are needed to estimate wind speed as a function of height. A common method is the log-law, which is based on surface roughness length (z0). No reliable estimates of z0 for the region have been presented in the literature. Here, we fill this knowledge gap using two field campaigns that were conducted in the Nantucket Sound at the Cape Wind (CW) platform: the 2003–2009 “CW Historical”, which collected wind measurements on a meteorological tower at three levels (20, 41, and 60 m AMSL) with sonic and cup/vane anemometers, and the 2013–2014 IMPOWR (Improving the Mapping and Prediction of Offshore Wind Resources), which collected high-frequency wind and flux measurements at 12 m AMSL. We tested three different methods to calculate z0: (1) analytical method, dependent on friction velocity u∗ and a stability function ψ; (2) the Charnock relationship between z0 and u∗; and (3) a statistical method based on wind speed observed at the three levels. The first two methods are physical, whereas the statistical method is purely mathematical. Comparing mean and median of z0, we find that the median is a more robust statistics because the mean varies by over four orders of magnitude across the three methods and the two campaigns. In general, the median z0 exhibits little seasonal variability and a weak dependency on atmospheric stability, which was predominantly unstable (54–67%). With the goal of providing the most accurate estimates of wind speed near the hub height of modern turbines, the statistical method, despite delivering unrealistic z0 values at times, gives the best estimates of 60 m winds, even when the 5 m wind speed from a nearby buoy is used as the reference. The unrealistic z0 values are caused by nonmonotonic wind speed profiles, occurring about 41% of the time, and should not be rejected because they produce realistic fits. Furthermore, the statistical method outperforms the other two even though it does not need any stability information. In summary, if wind speed data from multiple levels are available, as is the case with vertically pointing floating lidar and meteorological towers, the statistical method is recommended, regardless of the seemingly unrealistic z0 values at times. If multilevel wind speeds are not available but advanced sonic anemometry is available at one level, the analytical method is recommended over Charnock’s. Lastly, if a single, constant value of z0 is sought after to characterize the region, we recommend the median from the statistical method, i.e., 6.09×10−3 m, which is typical of rough seas.
Inadequate Protein Intake at Specific Meals Is Associated with Higher Risk of Impaired Functionality in Middle to Older Aged Mexican Adults
Authors: Gaytán-González Alejandro , Ocampo-Alfaro María de Jesús , Arroniz-Rivera Maritza , Torres-Naranjo Francisco , González-Mendoza Roberto Gabriel , Gil-Barreiro Martha , López-Taylor Juan Ricardo
Published: April 2019

Purpose. To describe the proportions of inadequate protein intake (IPI) per day and per meal and their association with functionality in middle to older aged Mexican adults. Materials and Methods. In a cross-sectional design, we evaluated the protein intake and functionality of instrumental activities of daily living (IADL) and activities of daily living (ADL) of 190 middle to older aged Mexican adults. IPI was considered as any protein intake: <1.2 g/kg/day, <30 g/meal, or <0.4 g/kg/meal. Functionality was organized into three groups: high, middle, and low scores. The first was set as the reference, and the other was considered as impaired functionality. With a multinomial logistic regression, we analyzed the association between IPI per day and per meal with impaired functionality. Results. A high proportion of participants showed IPI per day. The meal with the highest proportion of IPI was dinner, followed by breakfast and lunch for both criteria. IPI at lunch was a significant risk factor for impaired functionality in ADL when assessed with the 30 g/meal criterion (low scores, OR 3.82 (95% CI, 1.15–12.65); middle scores, OR 2.40 [1.03–5.62]). For the 0.4 g/kg/meal criterion, IPI at dinner was a significant risk factor for IADL middle scores only (OR 7.64, [1.27–45.85]). Conclusion. IPI per meal is high in middle to older aged Mexican adults, and at specific meals, it is a significant risk factor for impaired functionality in activities of daily living.
Smart-RED: A Novel Congestion Control Mechanism for High Throughput and Low Queuing Delay
Authors: Bujari Armir , Marin Andrea , Palazzi Claudio E. , Rossi Sabina
Published: April 2019

We consider the scenario in which several TCP connections share the same access point (AP) and a congestion avoidance/control mechanism is adopted with the aim of assigning the available bandwidth to the clients with a certain fairness. When UDP traffic with real-time requirements is present, the problem becomes even more challenging. Very well-known congestion avoidance mechanisms are the Random Early Detection (RED) and the Explicit Congestion Notification (ECN). More recently, the Smart Access Point with Limited Advertised Window (SAP-LAW) has been proposed. Its main idea is that of computing the maximum TCP rate for each connection at the bottleneck, taking into account the UDP traffic to keep a low queue size combined with a reasonable bandwidth utilization. In this paper, we propose a new congestion control mechanism, namely, Smart-RED, inspired by SAP-LAW heuristic formula. We study its performance by using mean field models and compare the behaviours of ECN/RED, SAP-LAW, and Smart-RED under different scenarios. We show that while Smart-RED maintains some of the desirable properties of the SAP-LAW, it solves the problems it may have in case of bursty UDP traffic or TCP connections with very different needs of bandwidth.
Study on the Degradation of Sodium Diethyldithiocarbamate (DDTC) in Artificially Prepared Beneficiation Wastewater with Sodium Hypochlorite
Authors: Cui Baoyu , Wang Xuetao , Zhao Qiang , Liu Wengang
Published: April 2019

The degradation of DDTC in beneficiation wastewater has become an increasingly concerned issue due to the serious effects on the environment. In this study, the degradation characteristics of DDTC in artificially prepared beneficiation wastewater were investigated by adding sodium hypochlorite as an oxidant, and the influences of different degradation conditions on removal efficiency of DDTC were analyzed systematically. The results indicated that the degradation rate of DDTC without sodium hypochlorite added can reach 88.4% in a stewing time of 6 h. When the dosage of sodium hypochlorite was 400 mg·L−1, the degradation rate of DDTC can reach 91.28% for 1 min reaction time under the natural condition of pH value 5.98 and reaction temperature 25°C. The DDTC in the wastewater was firstly degraded into carbon disulfide and diethylamine, and then carbon disulfide was further degraded into CO2, S, or SO42−, while diethylamine was degraded into N2 and CO2. The research results can provide a technical basis for the treatment of beneficiation wastewater containing DDTC.
Sensitivity and Performance Evaluation of Multiple-Model State Estimation Algorithms for Autonomous Vehicle Functions
Authors: Törő Olivér , Bécsi Tamás , Aradi Szilárd , Gáspár Péter
Published: April 2019

Robust object tracking and maneuver estimation methods play significant role in the design of advanced driver assistant systems and self-driving cars. As an input to situation understanding and awareness, the performance of such algorithms influences the overall effectiveness of motion planning and plays high role in safety. The paper examines the suitability of different probabilistic state estimation methods, namely, the Extended Kalman Filter (EKF) and the more general Particle Filter (PF) with the addition of the Interacting Multiple Model (IMM) approach. These algorithms are not capable of predicting motion for long term in road traffic conditions, though their robustness and model classification capability are essential for the overall system. The performance is evaluated in road traffic scenarios where the tracked object imitates the motion characteristics of a road vehicle and is observed from a stationary sensor. The measurements are generated according to standard automotive radar models. The analysis conducted along two aspects emphasizes the different performance and scaling properties of the examined state estimation algorithms. The presented evaluation framework serves as a customizable method to test and develop advanced autonomous functions.
Designated Verifier Proxy Blind Signature Scheme for Unmanned Aerial Vehicle Network Based on Mobile Edge Computing
Authors: He Lei , Ma Jianfeng , Mo Ruo , Wei Dawei
Published: April 2019

Unmanned Aerial Vehicle (UAV) has enormous potential in many domains. According to the characteristics of UAV, it is important for UAV network to assure low latency and integrity and authentication of commands sent by command center or command stations to UAV. In this paper, we proposed a UAV network architecture based on mobile edge computing (MEC) which helps guarantee low latency in the UAV network. Afterwards, we proposed a designated verifier proxy blind signature (DVPBS) scheme for UAV network and proved that it is existentially unforgeable under an adaptive chosen message attack in the random oracle model. We compared the efficiency of our DVPBS scheme with other signature schemes by implementing them in jPBC and theoretically analyzing their signature length. The experiment results indicate that our DVPBS scheme is efficient. The signature length of our DVPBS is longer, but it is still short enough compared with the transmission capacity of UAV.
Supporting the Management of Patients with Heart Failure within Asia-Pacific, Middle East, and African Countries: A Toolbox for Healthcare Providers
Authors: Kabbani Samer , Al Habeeb Waleed , Liew Houng-Bang , Mohan Jagdish C. , Ogola Elijah , Sim David , Tsabedze Nqoba
Published: April 2019

Objectives: The management of heart failure (HF) is most effective when established treatment guidelines and recommendations are followed. We aimed to develop a “Toolbox” of resources to facilitate the care of patients with acute HF and chronic HF with reduced ejection fraction delivered by healthcare professionals across Asia-Pacific, the Middle East and Africa (henceforth referred to as the “Region”). Methods: We convened a group of cardiologists from across the Region to develop a set of checklists, algorithms, and other practical resources. These resources are based on our experiences, current evidence, and international guidelines. Results: The HF Toolbox comprises three simplified sets of resources for use in the Emergency Room (ER), hospital and outpatient settings. Resources include admission and discharge checklists, treatment algorithms, recommendations for forming a multidisciplinary team, patient education, and self-management materials, and key performance indicators to monitor whether standards of care are met or maintained, or should be improved. Conclusions: The HF Toolbox provides practical resources to simplify the management of patients with HF and to support the formation of HF programs in the Region. The Toolbox is aligned with current guideline recommendations and can support the management of patients from presentation in the ER, through hospital admission to outpatient care.
Unexpected Daily Changes in Tumor Volume during Fractionated Gamma Knife Radiosurgery for Solitary Intraventricular Metastatic Renal Cell Carcinoma: A Case Report
Authors: Roh Haewon , Kim Junwon , Chong Kyuha , Yoon Won Ki , Kwon Taek-Hyun , Kim Jong Hyun
Published: April 2019

For most fractionated stereotactic radiosurgery treatment plans, daily imaging is not routinely performed, because there is little expectation that lesions will change significantly in the short term. However, here, we present the case of an abrupt increase and decrease in tumor volume during fractionated gamma knife radiosurgery (GKRS) for metastatic brain cancer. A 65-year-old man with a history of nephrectomy due to renal cell carcinoma was admitted to our hospital because of mild cognitive disorder and gait disturbance. An initial MRI of the brain demonstrated a 5 × 3 × 4.5 cm-sized, heterogeneously well-enhanced tumor with a large cystic component compressing the left thalamus and corpus callosum near the lateral ventricle. Owing to its large size and proximity to critical structures, we decided to perform 3 fractionated GKRSs over 3 consecutive days. After the first fraction of 9 Gy with 50% isodose, follow-up MRI the next day revealed an unexpected increase in tumor volume up to 30%. Therefore, the radiosurgical plan was adjusted, and GKRS was performed again using the same dose for the second fraction. The image taken on the third day showed rapid shrinkage of the tumor volume. This case shows that a tumor may change its shape and volume unexpectedly even during the short period of a fractionated GKRS session. Hence, for optimal fractionated GKRS treatment of tumors with the likelihood of an abrupt change in the short term, interval imaging should be considered.
How Early Can a Seizure Happen? Pathophysiological Considerations of Extremely Premature Infant Brain Development
Authors: Carrasco Melisa , Stafstrom Carl E.
Published: April 2019

Seizures in neonates represent a neurologic emergency requiring prompt recognition, determination of etiology, and treatment. Yet, the definition and identification of neonatal seizures remain challenging and controversial, in part due to the unique physiology of brain development at this life stage. These issues are compounded when considering seizures in premature infants, in whom the complexities of brain development may engender different clinical and electrographic seizure features at different points in neuronal maturation. In extremely premature infants (< 28 weeks gestational age), seizure pathophysiology has not been explored in detail. This review discusses the physiological and structural development of the brain in this developmental window, focusing on factors that may lead to seizures and their consequences at this early time point. We hypothesize that the clinical and electrographic phenomenology of seizures in extremely preterm infants reflects the specific pathophysiology of brain development in that age window.
Risk Factors for Late-Onset Sepsis in Preterm Infants: A Multicenter Case-Control Study
Authors: el Manouni el Hassani Sofia , Berkhout Daniel J.C.  , Niemarkt Hendrik J. , Mann Sarah , de Boode Willem P. , Cossey Veerle , Hulzebos Christian V. , van Kaam Anton H. , Kramer Boris W. , van Lingen Richard A. , van Goudoever Johannes B. , Vijlbrief Daniel C. , van Weissenbruch Mirjam M. , Benninga Marc A. , de Boer Nanne K.H. , de Meij Tim G.J.
Published: April 2019

Background: Late-onset sepsis (LOS) in preterm infants is a leading cause of mortality and morbidity. Timely recognition and initiation of antibiotics are important factors for improved outcomes. Identification of risk factors could allow selection of infants at an increased risk for LOS. Objectives: The aim was to identify risk factors for LOS. Methods: In this multicenter case-control study, preterm infants born at ≤30 weeks of gestation were included at 9 neonatal intensive care units. Detailed demographical and clinical data were collected daily up to day 28 postnatally. Clinical and demographic risk factors were identified using univariate and multivariate regression analyses in a 1: 1 matched case-control cohort. Results: In total, 755 infants were included, including 194 LOS cases (41 gram-negative cases, 152 gram-positive cases, and 1 fungus). In the case-control cohort, every additional day of parenteral feeding increased the risk for LOS (adjusted OR = 1.29; 95% CI 1.07–1.55; p = 0.006), whereas antibiotics administration decreased this risk (OR = 0.08; 95% CI 0.01–0.88; p = 0.039). These findings could largely be attributed to specific LOS-causative pathogens, since these predictive factors could be identified for gram-positive, but not for gram-negative, LOS cases. Specifically cephalosporins administration prior to clinical onset was inversely related to coagulase-negative staphylococcus LOS (CoNS-LOS) development. Formula feeding was an independent risk factor for development of CoNS-LOS (OR = 3.779; 95% CI 1.257–11.363; p = 0.018). Conclusion: The length of parenteral feeding was associated with LOS, whereas breastmilk administration was protective against CoNS-LOS. A rapid advancement of enteral feeding, preferably with breastmilk, may proportionally reduce the number of parenteral feeding days and consequently the risk for LOS.
Making the Most of Innovation in Personalised Medicine: An EU Strategy for a Faster Bench to Bedside and Beyond Process
Authors: Horgan Denis , Lal Jonathan A.
Published: April 2019

Personalised medicine promises to revolutionise healthcare, with its key goal of providing the right treatment to the right patient at the right time, and thus the potential of improving quality of life and helping to bring down healthcare costs. However, a major problem with broader implementation of personalised medicine is patient access to new drugs, devices and treatments. The fact that a new medicine or innovative product can sometimes take as long as 20 years to get from bench to bedside is not only clearly undesirable but is arguably unacceptable in the 21st century. This paper looks in detail at the issues surrounding development, continued investment, risk factors, testing and approval from both the industry perspective as well as that of the assessor and the decision maker/payer. It becomes clear that there is a lack of working in tandem that results in a double time frame (two times 10 years). This is simply because the key stakeholders, surprisingly, do not synergise their assessments of a new product. As well as causing delays in patient access, this can also affect investment confidence as industry waits too long for approval for its product to reach the market and its subsequent implementation into healthcare. Such a slow process undermines continued investment and contributes to a risk-averse environment, which in turn can have an impact on innovation. The solution appears to be uncomplicated, involving better coordination and collaboration between the different stakeholders working at various stages within the bench-to-bedside timeframe. We take the example of the network of the European Alliance for Personalised Medicine (EAPM) to demonstrate possible solutions using an innovative approach.
A Systematic Review of the Effect of Probiotic Supplementation on Schizophrenia Symptoms
Authors: Ng Qin Xiang , Soh Alex Yu Sen , Venkatanarayanan Nandini , Ho Collin Yih Xian , Lim Donovan Yutong , Yeo Wee-Song
Published: April 2019

Background: Derangements of the gut microbiome have been linked to increased systemic inflammation and central nervous system disorders, including schizophrenia. This systematic review thus aimed to investigate the hypothesis that probiotic supplementation improves schizophrenia symptoms. Methods: By using the keywords (probiotic OR gut OR microbiota OR microbiome OR yogurt OR yoghurt OR lactobacillus OR bifidobacterium) AND (schizophrenia OR psychosis), a preliminary search of the PubMed, Medline, Embase, Google Scholar, ClinicalTrials.gov, Clinical Trials Register of the Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDANTR), and Cochrane Field for Complementary Medicine databases yielded 329 papers published in English between January 1, 1960 and May 1, 2018. Attempts were made to search grey literature as well. Results: Three clinical studies were reviewed, comparing the use of probiotics to placebo controls. Applying per-protocol analysis and a fixed-effects model, there was no significant difference in schizophrenia symptoms between the group that received probiotic supplementation and the placebo group post-intervention as the standardized mean difference was –0.0884 (95% CI –0.380 to 0.204, p = 0.551). Separate analyses were performed to investigate the effect of probiotic supplementation on positive or negative symptoms of schizophrenia alone. In both instances, no significant difference was observed as well. Conclusion: Based on current evidence, limited inferences can be made regarding the efficacy of probiotics in schizophrenia. Although probiotics may have other benefits, for example to regulate bowel movement and ameliorate the metabolic effects of antipsychotic medications, the clinical utility of probiotics in the treatment of schizophrenia patients remains to be validated by future clinical studies.
Renovascular Hypertension Aggravates Atherosclerosis in Cholesterol-Fed Rabbits
Authors: Chen Yajie , Waqar Ahmed Bilal , Yan Haizhao , Wang Yanli , Liang Jingyan , Fan Jianglin
Published: April 2019

Background: Hypertension is a major risk factor for atherosclerotic disease. However, it is still not clear whether mechanical stress caused by hypertension directly affects the atherosclerotic development in the aorta and coronary arteries. Objectives and Methods: We generated a hypertensive (HTN) rabbit model by surgical removal of the left kidney and partial ligation of the right renal artery. After a 16-week cholesterol diet, we compared aortic and coronary atherosclerosis of HTN rabbits with those of normotensive rabbits. Results: Hypertension did not affect lipid and apolipoprotein levels in plasma but led to a 3.0-fold increase in aortic atherosclerosis and a 1.7-fold increase in coronary atherosclerosis compared with control rabbits. Enhanced atherosclerosis in HTN rabbits was caused by significant increases in macrophages and smooth muscle cells in the lesions. Furthermore, oxidized LDL contents in the lesions were significantly increased in HTN rabbits. In addition, HTN rabbits exhibited prominent hyaline arteriolosclerosis in coronary arterioles. Conclusions: These results indicate that hyper tension not only enhances atherosclerosis in large arteries including the aorta and coronary arteries but also affects hyaline arteriolosclerosis in small arteries.