bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of plasma-enhanced atomic layer deposition AlN films prepared with different plasma sources
Authors: Kot Małgorzata , Henkel Karsten , Naumann Franziska , Gargouri Hassan , Lupina Lidia , Wilker Viola , Kus Peter , Poz´arowska Emilia , Garain Samiran , Rouissi Zied , Schmeißer Dieter
Published: January 2019

A comparative study of thin aluminum nitride (AlN) films deposited by plasma-enhanced atomic layer deposition in the SENTECH SI ALD LL system applying either a direct inductively coupled plasma (ICP) or an indirect capacitively coupled plasma (CCP) source is presented. The films prepared with the ICP source (based on a planar triple spiral antenna) exhibit improved properties concerning the growth rate per cycle, total cycle duration, homogeneity, refractive index, fixed and mobile electrical charges, and residual oxygen content compared to the CCP source, where the comparison is based on the applied plasma power of 200 W. The increase of the plasma power to 600 W in the ICP process significantly reduces the residual oxygen content and enhances the electrical breakdown field. The AlN layers grown under these conditions, with a growth rate per cycle of 1.54 Å/cycle, contain residual oxygen and carbon concentrations of about 10% and 4%, respectively, and possess a refractive index of 2.07 (at 632.8 nm).
Psychoacoustic evidence for stronger discrimination suppression of spatial information conveyed by lag-click interaural time than interaural level differences
Authors: Nilsson Mats E. , Tirado Carlos , Szychowska Malina
Published: January 2019

Listeners have limited access to spatial information in lagging sound, a phenomenon known as discrimination suppression. It is unclear whether discrimination suppression works differently for interaural time differences (ITDs) and interaural level differences (ILDs). To explore this, three listeners assessed the lateralization (left or right) and detection (present or not) of lag clicks with a large fixed ITD (350 μs) or ILD (10 dB) following a diotic lead click, with inter-click intervals (ICIs) of 0.125–256 ms. Performance was measured on a common scale for both cues: the lag–lead amplitude ratio [dB] at 75% correct answers. The main finding was that the lateralization thresholds, but not detection thresholds, were more strongly elevated for ITD-only than ILD-only clicks at intermediate ICIs (1–8 ms) in which previous research has found the strongest discrimination suppression effects. Altogether, these findings suggest that discrimination suppression involves mechanisms that make spatial information conveyed by lag-click ITDs less accessible to listeners than spatial information conveyed by lag-click ILDs.
ACOUSTICAL STANDARDS NEWS
Authors: Struck Christopher J.
Published: January 2019

American National Standards (ANSI Standards) developed by Accredited Standards Committees S1, S2, S3, S3/SC 1, and S12 in the areas of acoustics, mechanical vibration and shock, bioacoustics, animal bioacoustics, and noise, respectively, are published by the Acoustical Society of America (ASA). In addition to these standards, ASA publishes a catalog of Acoustical American National Standards. To receive a copy of the latest Standards catalog, please contact asastds@acousticalsociety.org.

Comments are welcomed on all material in Acoustical Standards News.

This Acoustical Standards News section in JASA and other information on the Standards Program of the Acoustical Society of America are available via the ASA home page: http://acousticalsociety.org.
Design and experimental investigation of V-folded beams with acoustic black hole indentations
Authors: Gao Nansha , Wei Zhengyu , Hou Hong , Krushynska Anastasiia O.
Published: January 2019

This paper proposes a strategy to broaden complete bandgap attenuating flexural and longitudinal modes, and to shift them to lower frequencies by spatially folding designs. Numerical simulations show that the V-folded acoustic black hole beam exhibits an ultra-wide complete bandgap below 1 kHz due to longitudinal-flexural waveform transformation, and experimental results verify this finding. The proposed folded beams are easy-to-fabricate, of compact dimensions, and exhibit excellent wave attenuation functionality that makes them promising for low-frequency vibration reduction and wave attenuation applications.
Acute blue finger syndrome: a rare benign cause of acute digit discolouration
Authors: Dhaliwal Kiran , Brewster Colin Thomas , Pakeerathan Sivarajasingham
Published: January 2019

Acute blue finger syndrome is a rare benign condition that mimics digital ischaemia. We discuss the case of a 32-year-old woman who presented with a 6hour history of blue discolouration of the middle finger of the right hand, associated with pain and swelling. There was no history of trauma and this was the first time that the patient had experienced these symptoms. Examination found blue discolouration of the digit primarily on the volar aspect with associated swelling. All investigations, including blood tests, X-rays and Doppler scanning, were normal. The symptoms resolved spontaneously within 48 hours. There were no recurrent episodes or long-term sequelae. Patients presenting with an acutely blue finger need rapid assessment to exclude digit ischaemia. Knowledge of this rare benign condition may prevent unnecessary distress, invasive investigations and potentially harmful treatment of a healthy patient.
Pseudomonas meningoencephalitis masquerading as a stroke in a patient on tocilizumab
Authors: Williams Cameron J , Foote Andrew , Choi Philip
Published: January 2019

A previously high-functioning woman presents with clinical and CT features of a subacute ischaemic stroke. Her medical history is relevant for refractory giant cell arteritis on long-term high-dose prednisolone and recent commencement of tocilizumab (interleukin-6 monoclonal antibody). The potential for stroke mimic is considered and a magnetic resonance brain scan is requested. She rapidly deteriorates within 24 hours of admission and unexpectantly dies. An autopsy reveals that she has bilateral pulmonary emboli with lower limb deep vein thrombosis and Pseudomonas meningoencephalitis with frank pus on the brain. We discuss the potential risks of immunosuppression and the role of imaging in the diagnosis of stroke.
Intestinal obstruction caused by small bowel adenocarcinoma misdiagnosed as psychogenic disorder
Authors: Nishie Hirotada , Suzuki Taketo , Ichikawa Hiroshi , Kataoka Hiromi
Published: January 2019

We describe a case of intestinal obstruction caused by a small bowel adenocarcinoma misdiagnosed as psychogenic disorder. A woman in her 40s was admitted to Nagoya City University Hospital with fatigue, anorexia, nausea and vomiting. CT, oesophagogastroduodenoscopy and colonoscopy revealed no signs of organic abnormality in her gastrointestinal tract. As the patient had previously been diagnosed with and treated for depression, her symptoms were suspected to be due to psychogenic disorder. Therefore, she was diagnosed with severe depression and was administered antidepressant agents. Despite intense psychiatric treatment, her symptoms worsened and she was later diagnosed with ileus due to adenocarcinoma in the jejunum. After drainage by insertion of a transnasal decompression tube, a partial jejunum resection was performed. After the resection, the patient’s symptoms including fatigue and depression resolved without the use of antidepressant agents.
Peroneal artery entrapment syndrome (PRAES): a rare cause of ischaemic toes
Authors: Tan Alfred Bingchao , Stuart Wesley , Roditi Giles
Published: January 2019

A 75-year-old man presenting with intermittent discolouration of his left toes was referred to vascular surgery with suspicion of embolic vascular disease. A contrast-enhanced MR angiogram was performed which revealed bilateral dominant peroneal arteries (PRAs). There was evidence of short atherosclerotic stenosis directly at the point where the left PRA passes through the tibiofibular interosseous membrane which we postulate to be the source of the emboli. We present what is believed to be the first reported case of PRA entrapment complicated by distal toe emboli.
Double axillary vein variation diagnosed with ultrasound guidance during infraclavicular nerve block intervention
Authors: Altıparmak Başak , Korkmaz Toker Melike , Uysal Ali İhsan , Gümüş Demirbilek Semra
Published: January 2019

The use of ultrasound guidance increases the safety of peripheral block interventions by allowing anaesthesiologists to simultaneously see the position of block needle, the targeted nerves and surrounding vessels. In this report, we represented three patients diagnosed with double axillary vein variation with ultrasound guidance during infraclavicular nerve block intervention. The patients were scheduled for different types of upper limb surgeries. All patients received infraclavicular nerve block for anaesthetic management. A double axillary vein variation was diagnosed with ultrasound during block interventions. Hydro-location technique was used in all cases and the procedures were completed uneventfully. In the current literature, there is limited number of reports concerning double axillary vein variation. Detailed knowledge of the axillary anatomy is important to avoid complications such as intravascular injection during peripheral nerve block interventions. The use of ultrasound guidance and hydro-location technique should be considered for nerve blocks, especially in the axillary area.
Simultaneous presentation of thyroid storm and diabetic ketoacidosis in a previously healthy 21-year-old man
Authors: Wallington David , Schauer Mark , Bauler Laura D
Published: January 2019

A 21-year-old young man with no history of diabetes or thyroid disease presented to the emergency department with simultaneous thyroid storm and diabetic ketoacidosis. Notable findings on admission were a ventricular rate of 235 beats/min, tachypnoea, tremors, polydipsia and a lack of fever. Due to the unusual constellation of symptoms, diagnosis was only possible after initial laboratory results came back. While the lack of fever is unusual in thyroid storm, diabetic ketoacidosis has previously been reported to suppress fever, and this case supports the occurrence of this phenomenon. This case was highly unusual because the patient had not previously been diagnosed with either type 1 diabetes or Graves’ disease.
Actinomycosis of the omentum with invasion of the abdominal wall, small bowel and transverse colon mimicking malignancy
Authors: Caplan Edward , Deputy Mohammed , Arul Dhili , Wilson Jonathan
Published: January 2019

We report the case of a 59-year-old Russian man who presented with a painless, slow-growing, epigastric mass. CT revealed a large heterogeneous mass within the omentum infiltrating into adjacent tissues. During diagnostic laparoscopy, the omental mass was noted to be firm, raising the suspicion of malignancy. Surgical en-bloc resection of the mass, including the posterior rectus sheath, transverse colon and small bowel, was performed with primary anastomoses at laparotomy. Histological examination was inconsistent with malignancy and revealed the mass to be actinomycosis, confirmed by microscopy and gram staining. Surgical resection was followed by an 8-week course of penicillin and doxycycline antibiotic therapy. This treatment resulted in full clinical and radiological recovery with no complications. Although the clinical and radiological findings, in this case, were highly suspicious of malignancy, abdominal actinomycosis should be considered a differential diagnosis in patients with infiltrative abdominal masses and mild constitutional symptoms.
An updated roadmap for MERS-CoV research and product development: focus on diagnostics
Authors: Kelly-Cirino Cassandra , Mazzola Laura T , Chua Arlene , Oxenford Christopher J , Van Kerkhove Maria D
Published: February 2019

Diagnostics play a central role in the early detection and control of outbreaks and can enable a more nuanced understanding of the disease kinetics and risk factors for the Middle East respiratory syndrome-coronavirus (MERS-CoV), one of the high-priority pathogens identified by the WHO. In this review we identified sources for molecular and serological diagnostic tests used in MERS-CoV detection, case management and outbreak investigations, as well as surveillance for humans and animals (camels), and summarised the performance of currently available tests, diagnostic needs, and associated challenges for diagnostic test development and implementation. A more detailed understanding of the kinetics of infection of MERS-CoV is needed in order to optimise the use of existing assays. Notably, MERS-CoV point-of-care tests are needed in order to optimise supportive care and to minimise transmission risk. However, for new test development, sourcing clinical material continues to be a major challenge to achieving assay validation. Harmonisation and standardisation of laboratory methods are essential for surveillance and for a rapid and effective international response to emerging diseases. Routine external quality assessment, along with well-characterised and up-to-date proficiency panels, would provide insight into MERS-CoV diagnostic performance worldwide. A defined set of Target Product Profiles for diagnostic technologies will be developed by WHO to address these gaps in MERS-CoV outbreak management.
Under-reporting of diagnosed tuberculosis to the national surveillance system in China: an inventory study in nine counties in 2015
Authors: Li Tao , Shewade Hemant Deepak , Soe Kyaw Thu , Rainey Jeanette J. , Zhang Hui , Du Xin , Wang Lixia
Published: January 2019

Objective

The WHO estimates that almost 40% of patients diagnosed with tuberculosis (TB) are not reported. We implemented this study to assess TB under-reporting and delayed treatment registration in nine counties in China.

Design

A retrospective inventory study (record review).

Setting

Counties were selected using purposive sampling from nine provinces distributed across eastern, central and western regions of China in 2015.

Primary and secondary outcome measures

Under-reporting was calculated as the percentage of patients with TB not reported to TB Information Management System (TBIMS) within 6 months of diagnosis. Delayed registration was estimated as the percentage of reported cases initiating treatment 7 or more days after diagnosis. Multivariable logistic regression and an alpha level of 0.05 were used to examine factors associated with these outcomes.

Results

Of the 5606 patients with TB identified from project health facilities and social insurance systems, 1082 (19.3%) were not reported to TBIMS. Of the 4524 patients successfully reported, 1416 (31.3%) were not registered for treatment within 7 days of diagnosis. Children, TB pleurisy, patients diagnosed in the eastern and central regions and patients with a TB diagnosis recorded in either health facilities or social insurance system—but not both—were statistically more likely to be unreported. Delayed treatment registration was more likely for previously treated patients with TB, patients with negative or unknown sputum results and for patients diagnosed in the eastern region.

Conclusion

Almost one in every five patients diagnosed with TB in this study was unknown to local or national TB control programmes. We recommend strengthening TB data management practices, particularly in the eastern and central regions, and developing specific guidelines for reporting paediatric TB and TB pleurisy. Patient education and follow-up by diagnosing facilities could improve timely treatment registration. Additional studies are needed to assess under-reporting elsewhere in China.
Development of a binational thyroid cancer clinical quality registry: a protocol paper
Authors: Ioannou Liane J , Serpell Jonathan , Dean Joanne , Bendinelli Cino , Gough Jenny , Lisewski Dean , Miller Julie A , Meyer-Rochow Win , Sidhu Stan , Topliss Duncan , Walters David , Zalcberg John , Ahern Susannah
Published: January 2019

Introduction

The occurrence of thyroid cancer is increasing throughout the developed world and since the 1990s has become the fastest increasing malignancy. In 2014, a total of 2693 Australians and 302 New Zealanders were diagnosed with thyroid cancer, with this number projected to rise to 3650 in 2018. The purpose of this protocol is to establish a binational population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand.

Methods and analysis

The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) aims to capture clinical data for all patients over the age of 16 years with thyroid cancer, confirmed by histopathology report, who have been diagnosed, assessed or treated at a contributing hospital. A multidisciplinary steering committee was formed which, with operational support from Monash University, established the ANZTCR in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 20 sites expected to come on board across Australia in 2018. A modified Delphi process was undertaken to determine the clinical quality indicators to be reported by the registry, and a minimum data set was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery and 90-day follow-up.

Future plans

The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand current practice in the treatment of thyroid cancer and identify variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer term outcome data particularly for patients with poor prognostic disease will add significant further value to the registry.
Hypersegmented airway neutrophils and its association with reduced lung function in adults with obstructive airway disease: an exploratory study
Authors: Lokwani Ravi , Wark Peter A B , Baines Katherine J , Barker Daniel , Simpson Jodie L
Published: January 2019

Objectives

The significance of neutrophilic inflammation in obstructive airway disease remains controversial. Recent studies have demonstrated presence of an active neutrophil population in systemic circulation, featuring hypersegmented morphology, with high oxidative burst and functional plasticity in inflammatory conditions. The aim of this study was to characterise neutrophil subsets in bronchial lavage (BL) of obstructive airway disease participants (asthma, chronic obstructive pulmonary disease (COPD) and bronchiectasis) and healthy controls on the basis of nuclear morphology and to assess the association between neutrophil subsets and the clinical parameters of the obstructive airway disease participants.

Design

A cross-sectional exploratory study.

Setting

John Hunter Hospital and Hunter Medical Research Institute, Australia.

Participants

Seventy-eight adults with obstructive airway disease comprised those with stable asthma (n=39), COPD (n=20) and bronchiectasis (n=19) and 20 healthy controls.

Materials and methods

Cytospins were prepared and neutrophil subsets were classified based on nuclear morphology into hypersegmented (>4 lobes), normal (2–4 lobes) and banded (1 lobe) neutrophils and enumerated.

Results

Neutrophils from each subset were identified in all participants. Numbers of hypersegmented neutrophils were elevated in participants with airway disease compared with healthy controls (p<0.001). Both the number and the proportion of hypersegmented neutrophils were highest in COPD participants (median (Q1–Q3) of 1073.6 (258.8–2742) × 102/mL and 24.5 (14.0–46.5)%, respectively). An increased proportion of hypersegmented neutrophils in airway disease participants was significantly associated with lower forced expiratory volume in 1 s/forced vital capacity per cent (Spearman’s r=−0.322, p=0.004).

Conclusion

Neutrophil heterogeneity is common in BL and is associated with more severe airflow obstruction in adults with airway disease. Further work is required to elucidate the functional consequences of hypersegmented neutrophils in the pathogenesis of disease.
Exploring obstetricians’, midwives’ and general practitioners’ approach to weight management in pregnant women with a BMI ≥25 kg/m2: a qualitative study
Authors: Flannery Caragh , McHugh Sheena , Kenny Louise C , O’Riordan Mairead N , McAuliffe Fionnuala M , Bradley Colin , Kearney Patricia M , Byrne Molly
Published: January 2019

Objective

The aim of this study was to explore healthcare professionals’ (HCPs) beliefs and attitudes towards weight management for pregnant women with a body mass index (BMI) ≥25 kg/m2.

Design

Qualitative study.

Setting

A public antenatal clinic in a large academic maternity hospital in Cork, Ireland, and general practice clinics in the same region.

Participants

HCPs such as hospital-based midwives and consultant obstetricians and general practitioners (GPs).

Method

Semistructured interviews were conducted with a purposive sample of hospital-based HCPs and a sample of GPs working in the same region. Interviews were recorded, transcribed and thematically analysed using NVivo software.

Results

Seventeen HCPs were interviewed (hospital based=10; GPs=7). Four themes identified the complexity of weight management in pregnancy and the challenges HCPs faced when trying to balance the medical and psychosocial needs of the women. HCPs acknowledged weight as a sensitive conversation topic, leading to a ‘softly-softly approach’to weight management. HCPs tried to strike a balance between being woman centred and empathetic and medicalising the conversation. HCPs described ‘doing what you can with what you have’ andshifting the focus to managing obstetric complications. Furthermore, there wereunclear roles and responsibilitiesin terms of weight management.

Conclusion

HCPs need to have standardised approaches and evidence-based guidelines that support the consistent monitoring and management of weight during pregnancy.
Factors associated with adverse childhood experiences in Scottish children: a prospective cohort study
Authors: Marryat Louise , Frank John
Published: February 2019

Background and objectives

Adverse childhood experiences (ACEs) have been associated with a range of poorer health and social outcomes throughout the life course; however, to date they have primarily been conducted retrospectively in adulthood. This paper sets out to determine the prevalence of ACEs at age 8 in a recent prospective birth cohort and examine associations between risk factors in the first year and cumulative ACEs.

Design

This study uses the Growing Up in Scotland Birth Cohort 1, in which children born in Scotland in 2004/5 were identified using Child Benefit Records and followed up for 7 years (n.3119). ACE scores and sample characteristics were calculated and described. Logistic regression models were fitted to explore associations between risk factors (sex, mother’s age and education, household income, area level deprivation and urban/rural indicator) and ACE scores.

Results

Seven ACEs (or proxies) were assessed: physical abuse, domestic violence, substance abuse, mental illness, parental separation, parental incarceration and emotional neglect. Instances of sexual abuse were too few to be reported. Emotional abuse and physical neglect could not be gathered. Around two-thirds of children had experienced one or more ACE, with 10% experiencing three or more in their lifetime. Higher ACE scores were associated with being male, having a young mother, low income and urban areas.

Conclusions

Using prospective data, the majority of children born in 2004/2005 in Scotland experienced at least one ACE by age 8, although three ACEs could not be assessed in this cohort. ACEs were highly correlated with socioeconomic disadvantage in the first year of life.
Children on the move in Europe: a narrative review of the evidence on the health risks, health needs and health policy for asylum seeking, refugee and undocumented children
Authors: Kadir Ayesha , Battersby Anna , Spencer Nick , Hjern Anders
Published: February 2019

Background

Europe has experienced a marked increase in the number of children on the move. The evidence on the health risks and needs of migrant children is primarily from North America and Australia.

Objective

To summarise the literature and identify the major knowledge gaps on the health risks and needs of asylum seeking, refugee and undocumented children in Europe in the early period after arrival, and the ways in which European health policies respond to these risks and needs.

Design

Literature searches were undertaken in PubMed and EMBASE for studies on migrant child health in Europe from 1 January 2007 to 8 August 2017. The database searches were complemented by hand searches for peer-reviewed papers and grey literature reports.

Results

The health needs of children on the move in Europe are highly heterogeneous and depend on the conditions before travel, during the journey and after arrival in the country of destination. Although the bulk of the recent evidence from Europe is on communicable diseases, the major health risks for this group are in the domain of mental health, where evidence regarding effective interventions is scarce. Health policies across EU and EES member states vary widely, and children on the move in Europe continue to face structural, financial, language and cultural barriers in access to care that affect child healthcare and outcomes.

Conclusions

Asylum seeking, refugee and undocumented children in Europe have significant health risks and needs that differ from children in the local population. Major knowledge gaps were identified regarding interventions and policies to treat and to promote the health and well-being of children on the move.
What is the timeliness and extent of health service use of Victorian (Australia) children in the year after entry to out-of-home care? Protocol for a retrospective cohort study using linked administrative data
Authors: McLean Karen , Hiscock Harriet , Scott Dorothy , Goldfeld Sharon
Published: February 2019

Introduction

Children entering out-of-home care have high rates of health needs across all domains of health. To identify these needs early and optimise long-term outcomes, routine health assessment on entry to care is recommended by child health experts and included in policy in many jurisdictions. If effective, this ought to lead to high rates of health service use as needs are addressed. Victoria (Australia) has no state-wide approach to deliver routine health assessments and no data to describe the timing and use of health service visits for children in out-of-home care. This retrospective cohort data linkage study aims to describe the extent and timeliness of health service use by Victorian children (aged 0–12 years) who entered out-of-home care for the first time between 1 April 2010 and 31 December 2015, in the first 12 months of care.

Methods and analysis

The sample will be identified in the Victorian Child Protection database. Child and placement variables will be extracted. Linked health databases will provide additional data: six state databases that collate data about hospital admissions, emergency department presentations and attendances at dental, mental and community health services and public hospital outpatients. The federal Medicare Benefits Schedule claims dataset will provide information on visits to general practitioners, specialist physicians (including paediatricians), optometrists, audiologists and dentists. The number, type and timing of visits to different health services will be determined and benchmarked to national standards. Multivariable logistic regression will examine the effects of child and system variables on the odds of timely health visits, and proportional-hazards regression will explore the effects on time to first health visits.

Ethics and dissemination

Ethical and data custodian approval has been obtained for this study. Dissemination will include presentation of findings to policy and service stakeholders in addition to scientific papers.
Compliance with hand hygiene in emergency medical services: an international observational study
Authors: Vikke Heidi Storm , Vittinghus Svend , Giebner Matthias , Kolmos Hans Jørn , Smith Karen , Castrén Maaret , Lindström Veronica
Published: January 2019

Introduction

Healthcare-associated infection caused by insufficient hygiene is associated with mortality, economic burden, and suffering for the patient. Emergency medical service (EMS) providers encounter many patients in different surroundings and are thus at risk of posing a source of microbial transmission. Hand hygiene (HH), a proven infection control intervention, has rarely been studied in the EMS.

Methods

A multicentre prospective observational study was conducted from December 2016 to May 2017 in ambulance services from Finland, Sweden, Australia and Denmark. Two observers recorded the following parameters: HH compliance according to WHO guidelines (before patient contact, before clean/aseptic procedures, after risk of body fluids, after patient contact and after contact with patient surroundings). Glove use and basic parameters such as nails, hair and use of jewellery were also recorded.

Results

Sixty hours of observation occurred in each country, for a total of 87 patient encounters. In total, there were 1344 indications for HH. Use of hand rub or hand wash was observed: before patient contact, 3%; before clean/aseptic procedures, 2%; after the risk of body fluids, 8%; after patient contact, 29%; and after contact with patient-related surroundings, 38%. Gloves were worn in 54% of all HH indications. Adherence to short or up done hair, short, clean nails without polish and no jewellery was 99%, 84% and 62%, respectively. HH compliance was associated with wearing gloves (OR 45; 95% CI 10.8 to 187.8; p=0.000) and provider level (OR 1.7; 95% CI 1.1 to 2.4; p=0.007), but not associated with gender (OR 1.3; 95% CI 0.9 to 1.9; p=0.107).

Conclusion

HH compliance among EMS providers was remarkably low, with higher compliance after patient contacts compared with before patient contacts, and an over-reliance on gloves. We recommend further research on contextual challenges and hygiene perceptions among EMS providers to clarify future improvement strategies.
Delayed febrile response with bloodstream infections in patients with continuous-flow left ventricular assist devices
Authors: Wrobel Christopher A , Drazner Mark H , Ayers Colby R , Pham David D , La Hoz Ricardo M , Grodin Justin L , Garg Sonia , Mammen Pradeep P A , Morlend Robert M , Araj Faris , Amin Alpesh A , Cornwell William K , Thibodeau Jennifer T
Published: January 2019

Bloodstream infections (BSIs) are common in patients with continuous-flow left ventricular assist devices (CF-LVADs). Whether CF-LVADs modulate the febrile response to BSIs is unknown. We retrospectively compared the febrile response to BSIs in patients with heart failure (HF) with CF-LVADs versus a control population of patients with HF receiving inotropic infusions. BSIs were adjudicated using the Centers for Disease Control and Prevention and the National Healthcare Safety Network criteria. Febrile status (temperature ≥38°C, 100.4 °F), temperature at presentation with BSI, and the highest temperature within 72 hours (Tmax) were collected. We observed 59 BSIs in LVAD patients and 45 BSIs in controls. LVAD patients were more likely to be afebrile and to have a lower temperature at presentation than control (88% vs 58%, p=0.002, and 37°C ±0.7 vs 37.7°C ±1.0, p=0.0009, respectively). By 72 hours, the difference in afebrile status diminished (53% vs 44%, p=0.42), and the Tmax was similar between the LVAD and control groups (37.9°C±0.9 vs 38.2°C±0.8, respectively, p=0.10). In conclusion, at presentation with a BSI, the vast majority of CF-LVAD patients were afebrile, an event which occurred at a higher frequency when compared with patients with advanced HF on chronic inotropes via an indwelling venous catheter. These data alert clinicians to have a very low threshold to obtain blood cultures in CF-LVAD patients even in the absence of fever. Further study is needed to determine whether a delayed or diminished febrile response represents another pathophysiological consequence of CF-LVADs.
Protected–permissive left turn phasing with flashing yellow arrow signal: study of red intervals for an effective phase transition
Authors: Mahbub Muqtasid , Kang Min-Wook , Lee Joyoung
Published: January 2019

Protected–permissive left turn (PPLT) phasing has been popular and widely used in many urban intersections in North America because of its operational benefits. A significant number of intersections have recently been upgraded with four-section signal heads with flashing yellow arrow (FYA) indication for an effective protected–permissive left turn operation. The present study seeks to find appropriate length of two red intervals whose roles are important, but different during the transition period of FYA-PPLT phasing. One is a red interval for delayed-start of permissive left turn movements; the other is additional red interval for delayed-start of opposing through movements. Micro-traffic simulation and conflict analysis are explored to assess the effects of the red intervals on intersection efficiency and safety. A useful reference, which describes the balanced length of the two red intervals under varying traffic levels, is developed as a result.
Life-history variation of two inland salmonids revealed through otolith microchemistry analysis
Authors: Ciepiela Lindsy R. , Walters Annika W.
Published: January 2019

Increasingly, otolith microchemistry analysis is used as a tool to trace fish migrations, especially migrations of diadromous fishes. Yet, few studies have used otolith microchemistry to trace migrations in small inland watersheds, leaving major knowledge gaps in our understanding of inland fish spatial ecology. Here, we evaluate the use of tributary habitat for spawning and describe and compare fluvial brown trout (Salmo trutta) and rainbow trout (Oncorhynchus mykiss) natal origin distribution, time spent in natal streams, and spawning site fidelity. 63% of rainbow trout and 57% of brown trout migrated after hatching. Brown trout showed greater variation in time spent in natal tributaries, suggesting that individuals are temporally distributing risk among offspring. By contrast, rainbow trout showed greater variation in natal origin, suggesting that individuals are spatially distributing risk among offspring. Our results indicate there is high inter- and intraspecific migration variation in inland salmonid populations, which may be linked to access to a mosaic of spawning and rearing habitat types.
Genome-wide identification, phylogeny, and expression profile of the sucrose transporter multigene family in tobacco
Authors: Wang Shanshan , Yang Jun , Xie Xiaodong , Li Feng , Wu Mingzhu , Lin Fucheng , Wang Zhong
Published: January 2019

The transportation and distribution of sucrose in plants is mediated by sucrose transporters (SUTs), which also participate in various plant developmental and resistance processes. However, no such study of the tobacco SUT family has been reported yet. In the present study, 11, 5, and 4 SUT genes were identified from the genomes of Nicotiana tabacum, Nicotiana sylvestris, and Nicotiana tomentosiformis, respectively. The exon–intron structures of the tobacco SUT genes were highly conserved in the three tobacco species. Gene loss, duplication, and chromosome exchange occurred in the NtSUT family during the formation of allotetraploid common tobacco. Expression profiling analysis revealed that the expression patterns of the NtSUT genes in common tobacco were closer to those in N. sylvestris plants. The NtSUT2s and NtSUT4 genes were ubiquitously expressed in various tobacco tissues, while the NtSUT1s gene was highly expressed in the maturing leaves, indicating their functional conservation and differentiation. The transcriptions of the NtSUT2t, NtSUT3s, NtSUT4, and NtSUT5s genes in tobacco plants were dramatically induced under Pi starvation, drought, and salinity stresses, but their highest expression levels occurred in different tissues, suggesting the multiple roles of NtSUTs in plant resistance to various abiotic stresses. This study provides useful information for the further functional characterization of SUT genes in tobacco.
A Miniaturized High-Gain (MHG) Ultra-Wideband Unidirectional Monopole Antenna for UWB Applications
Authors: Vijayalakshmi J. , Murugesan G.
Published: January 2019

A miniaturized high-gain (MHG) ultra-wideband (UWB) unidirectional monopole antenna with defected ground structure (DGS) is designed for ultra-wideband applications. The MHG antenna is printed on the FR4 substrate material with an overall size of 26.6-mm [Formula: see text] 29.3-mm [Formula: see text] 1.6-mm, which operates over the UWB frequency range and achieves the bandwidth between 3.1[Formula: see text]GHz and 10.6[Formula: see text]GHz. This high-gain unidirectional antenna exhibits a peak gain of 7.20[Formula: see text]dB with an efficiency of 95%. The compact antenna is a simple overlay design of circular and rectangular patches with the partial ground plane exhibiting high gain and better directivity. The overlay patch antenna acts as the radiator for wider bandwidth compared to the fundamental design of patch antenna and is matched to an SMA connector via 50[Formula: see text][Formula: see text] microstrip feed line. These simulated results are presented using HFSS software package. The designed antennas are fabricated and validated by using Agilent Vector Analyzer.
The Effect of “Collective” Regional Intergovernmental Organizations (RIGOs) on Global Security
Authors: Kim Hae S.
Published: January 2019

The purpose of this paper is to assess the effect of “collective” regional intergovernmental organizations (RIGOs) on global security, national (traditional) and human (non-traditional), of the member states. A total of 12 RIGOs across 222 countries were selected. It has been argued whether the “collective” RIGOs, military or economic, regional or sub-regional, have been effective in enhancing the global security of their respective “individual” sovereign member states. The following 10 variables were chosen as human security: poverty, corruption, unemployment, global food security, income inequality, population growth, human development index (HDI), political freedom, quality of life, and economic freedom. For the national security variables, conflict, military expenditure, and global peace were selected. Based on factor analysis, two global security patterns were found: predominant and peripheral. RIGOs, despite their institutional collectivism, were found not to affect the predominant global security, while their effects on the peripheral global security were found to be spotty. In affecting global security, national or human, RIGO with its collectivism was found not to prevail over individual sovereign member states.
Formation of bitumen in the Elgin–Franklin complex, Central Graben, North Sea: implications for hydrocarbon charging
Authors: Meredith W. , Uguna C. N. , Snape C. E. , Carr A. D. , Scotchman I. C.
Published: January 2019

The Elgin–Franklin complex contains gas condensates in Upper Jurassic reservoirs in the North Sea Central Graben. Upper parts of the reservoirs contain bitumens, which previous studies have suggested were formed by the thermal cracking of oil as the reservoirs experienced temperatures of >150°C during rapid Plio-Pleistocene subsidence. Bitumen-stained cores contaminated by oil-based drilling muds have been analysed by hydropyrolysis. Asphaltene-bound aliphatic hydrocarbon fractions were dominated by
n
-hexadecane and
n
-octadecane originating from fatty acid additives in the muds. Uncontaminated asphaltene-bound aromatic hydrocarbon fractions, however, contained a PAH distribution very similar to normal North Sea oils, suggesting that the bitumens may not have been derived from oil cracking.

1D basin models of well 29/5b-6 and a pseudo-well east of the Elgin–Franklin complex utilize a thermal history derived from the basin's rifting and subsidence histories, combined with the conservation of energy currently not contained in the thermal histories. Vitrinite reflectance values predicted by the conventional kinetic models do not match the measured data. Using the pressure-dependent PresRo
®
model, however, a good match was achieved between observed and measured data. The predicted petroleum generation is combined with published diagenetic cement data from the Elgin and Franklin fields to produce a composite model for petroleum generation, diagenetic cement and bitumen formation.
SONYC
Authors: Bello Juan P. , Silva Claudio , Nov Oded , Dubois R. Luke , Arora Anish , Salamon Justin , Mydlarz Charles , Doraiswamy Harish
Published: January 2019

SONYC integrates sensors, machine listening, data analytics, and citizen science to address noise pollution in New York City.
Representations and Optimizations for Embedded Parallel Dataflow Languages
Authors: Alexandrov Alexander , Krastev Georgi , Markl Volker
Published: January 2019

Parallel dataflow engines such as Apache Hadoop, Apache Spark, and Apache Flink are an established alternative to relational databases for modern data analysis applications. A characteristic of these systems is a scalable programming model based on distributed collections and parallel transformations expressed by means of second-order functions such as map and reduce. Notable examples are Flink’s DataSet and Spark’s RDD programming abstractions. These programming models are realized as EDSLs—domain specific languages embedded in a general-purpose host language such as Java, Scala, or Python. This approach has several advantages over traditional external DSLs such as SQL or XQuery. First, syntactic constructs from the host language (e.g., anonymous functions syntax, value definitions, and fluent syntax via method chaining) can be reused in the EDSL. This eases the learning curve for developers already familiar with the host language. Second, it allows for seamless integration of library methods written in the host language via the function parameters passed to the parallel dataflow operators. This reduces the effort for developing analytics dataflows that go beyond pure SQL and require domain-specific logic.

At the same time, however, state-of-the-art parallel dataflow EDSLs exhibit a number of shortcomings. First, one of the main advantages of an external DSL such as SQL—the high-level, declarative Select-From-Where syntax—is either lost completely or mimicked in a non-standard way. Second, execution aspects such as caching, join order, and partial aggregation have to be decided by the programmer. Optimizing them automatically is very difficult due to the limited program context available in the intermediate representation of the DSL.

In this article, we argue that the limitations listed above are a side effect of the adopted type-based embedding approach. As a solution, we propose an alternative EDSL design based on quotations. We present a DSL embedded in Scala and discuss its compiler pipeline, intermediate representation, and some of the enabled optimizations. We promote the algebraic type of bags in union representation as a model for distributed collections and its associated structural recursion scheme and monad as a model for parallel collection processing. At the source code level, Scala’s comprehension syntax over a bag monad can be used to encode Select-From-Where expressions in a standard way. At the intermediate representation level, maintaining comprehensions as a first-class citizen can be used to simplify the design and implementation of holistic dataflow optimizations that accommodate for nesting and control-flow. The proposed DSL design therefore reconciles the benefits of embedded parallel dataflow DSLs with the declarativity and optimization potential of external DSLs like SQL.
Wander Join and XDB
Authors: Li Feifei , Wu Bin , Yi Ke , Zhao Zhuoyue
Published: January 2019

Joins are expensive, and online aggregation over joins was proposed to mitigate the cost, which offers users a nice and flexible tradeoff between query efficiency and accuracy in a continuous, online fashion. However, the state-of-the-art approach, in both internal and external memory, is based on ripple join, which is still very expensive and even needs unrealistic assumptions (e.g., tuples in a table are stored in random order). This article proposes a new approach, the
wander join
algorithm, to the online aggregation problem by performing random walks over the underlying join graph. We also design an optimizer that chooses the optimal plan for conducting the random walks without having to collect any statistics
a priori
. Compared with ripple join, wander join is particularly efficient for equality joins involving multiple tables, but also supports θ-joins. Selection predicates and group-by clauses can be handled as well. To demonstrate the usefulness of wander join, we have designed and implemented XDB (approXimate DB) by integrating wander join into various systems including PostgreSQL, Spark, and a stand-alone plug-in version using PL/SQL. The design and implementation of XDB has demonstrated wander join’s practicality in a full-fledged database system. Extensive experiments using the TPC-H benchmark have demonstrated the superior performance of wander join over ripple join.
Seeking digital humanities, IT tech support
Authors: Bruderer Herbert , Hill Robin K.
Published: January 2019

The
Communications
Web site, http://cacm.acm.org, features more than a dozen bloggers in the BLOG@CACM community. In each issue of
Communications
, we'll publish selected posts or excerpts.

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Follow us on Twitter at http://twitter.com/blogCACM

http://cacm.acm.org/blogs/blog-cacm

Herbert Bruderer explains why the opposite of digital is not analog; Robin K. Hill describes how the challenges of user support are aggravated by indeterminate client responsibility.
Being recognized everywhere
Authors: Kugler Logan
Published: January 2019

How facial and voice recognition are reshaping society.
Chameleon 2
Authors: Barton Tomas , Bruna Tomas , Kordik Pavel
Published: January 2019

Traditional clustering algorithms fail to produce human-like results when confronted with data of variable density, complex distributions, or in the presence of noise. We propose an improved graph-based clustering algorithm called Chameleon 2, which overcomes several drawbacks of state-of-the-art clustering approaches. We modified the internal cluster quality measure and added an extra step to ensure algorithm robustness. Our results reveal a significant positive impact on the clustering quality measured by Normalized Mutual Information on 32 artificial datasets used in the clustering literature. This significant improvement is also confirmed on real-world datasets.

The performance of clustering algorithms such as DBSCAN is extremely parameter sensitive, and exhaustive manual parameter tuning is necessary to obtain a meaningful result. All hierarchical clustering methods are very sensitive to cutoff selection, and a human expert is often required to find the true cutoff for each clustering result. We present an automated cutoff selection method that enables the Chameleon 2 algorithm to generate high-quality clustering in autonomous mode.