bluuebunny/crossref_metadata_2025 huggingface dataset:
Proof of Concept for a Grounded Theory Approach to Understanding Interactions Occurring on Bicycle Facilities
Authors: Silva Cat , Moeckel Rolf , Clifton Kelly
Published: August 2020

Protected bicycle lanes are held up as the end-all of bicycle infrastructure, with unprotected bicycle lanes being widely considered unsafe and inferior. This perspective is supported by existing research showing people’s preference for protected versus unprotected bicycle lanes. Scant research, however, has explored this topic area using an observational research method. If an observational method is used, the research is typically count-based and focused on a predetermined sets of variables identified before the observation period and this hinders the research from advancing findings beyond frequencies and the already known variables. Without a clearer understanding of how people are using and interacting on streets with either type of bicycle lane, it is difficult, if not impossible, to adequately assess whether, and which, facility type best accommodates safe bicycle mobility. This paper introduces a new qualitative-quantitative method for conducting observational research which takes a grounded theory approach to gain new insights into how people behave and interact while using street segments, intersections, and other public places. This method follows a four-step process which involves qualitatively identifying interactions recorded on video, using deductive and inductive logic to document independent variables associated with interactions, and concludes in a quantitative analysis of the qualitatively produced data. As a display of the applications of this method, a case study is presented here which uses the new method to investigate the interactions of bicyclists with other road users on a street segment with an unprotected bicycle lane in Munich, Germany.
Deep Learning Framework for Freeway Speed Prediction in Adverse Weather
Authors: Shabarek Abdullah , Chien Steven , Hadri Soubhi
Published: August 2020

The introduction of deep learning (DL) models and data analysis may significantly elevate the performance of traffic speed prediction. Adverse weather causes mobility and safety concerns because of varying traffic speeds with poor visibility and road conditions. Most previous modeling approaches have not considered the heterogeneity of temporal and spatial data, such as traffic and weather conditions. This paper presents a framework, consisting of two DL models, to predict traffic speed under normal conditions and during adverse weather, considering prevailing traffic speed, wind speed, traffic volume, road capacity, wind bearing, precipitation intensity, and visibility. To ensure the accuracy of speed prediction, different DL models were assessed. The results indicated that the proposed one-dimensional convolutional neural network model outperformed others in relation to the least root mean square error and the least mean absolute error. Considering real-time weather data feeds on a 15-min basis, a tool was also developed for displaying predicted traffic speeds on New Jersey freeways. Application of the proposed framework models for predicting spatio-temporal hot-spot congestion caused by adverse weather is discussed.
Deterrence and the Moral Context: Is the Impact of Perceived Sanction Risk Dependent on Best Friends’ Moral Beliefs?
Authors: Hirtenlehner Helmut , Schulz Sonja
Published: August 2020

Research on differential deterrability suggests increasingly that the size of a potential sanction risk effect is conditional on characteristics of the person and properties of the setting. Whether the moral context of young people’s action settings shapes adolescents’ responsiveness to deterrent cues has been a neglected issue, however. Since youths spend much time in the company of their peers, close friends’ stance toward crime may serve as a measure of the moral makeup of the immediate environment in which young people make behavioral choices. Based on a longitudinal adolescent self-report survey, we test whether the impact of an individual’s sanction certainty perceptions varies according to the level of his or her best friends’ moral beliefs regarding selected acts of rule-breaking. Lagged negative binomial regression analyses provide mixed support for the hypothesis that perceived sanction risk matters more for adolescents whose close friends encourage criminal activity. These findings have wider implications for perceptual deterrence research: They suggest that efforts to specify the conditions under which sanction certainty perceptions are related to offending should concentrate on the presence of criminogenic factors.
Initial Development and Validation of the Social Skills Improvement System—Social and Emotional Learning Brief Scales-Teacher Form
Authors: Anthony Christopher J. , Elliott Stephen N. , DiPerna James C. , Lei Pui‐Wa
Published: August 2020

Despite the need for assessments targeting social and emotional learning (SEL) skills within multitiered systems of support, there are few brief SEL measures available. To address this need, this article describes the development of the Social Skills Improvement System—Social and Emotional Learning Brief Scales-Teacher Form (SSIS SEL b-T), a significantly shorter version of the Social Skills Improvement System—Social and Emotional Learning Edition Rating Form-Teacher (SSIS SEL RF-T). Using the SSIS SEL standardization sample and item response theory, we identified efficient sets of items for each SSIS SEL RF-T scale and examined psychometric evidence for resulting scores. In general, SSIS SEL b-T scales functioned well and very similarly to scores from corresponding SSIS SEL RF-T scales. One exception was the Self-Awareness scale which, similar to its long-form counterpart, exhibited several content and psychometric limitations. Results provide initial psychometric evidence for a time-efficient teacher-informant measure of SEL competencies with promise for use within multitiered systems of support.
A keratin-based microparticle for cell delivery
Authors: Thompson Marc , Giuffre Aaron , McClenny Claire , Van Dyke Mark
Published: August 2020

Keratin-based biomaterials represent an attractive opportunity in the fields of wound healing and tissue regeneration, not only for their chemical and physical properties, but also for their ability to act as a delivery system for a variety of payloads. Importantly, keratins are the only natural biomaterial that is not targeted by specific tissue turnover-related enzymes, giving it potential stability advantages and greater control over degradation after implantation. However, in-situ polymerization chemistry in some keratin systems are not compatible with cells, and incorporation within constructs such as hydrogels may lead to hypoxia and cell death. To address these challenges, we envisioned a pre-formed keratin microparticle on which cells could be seeded, while other payloads (e.g. drugs, growth factors or other biologic compounds) could be contained within, although studies investigating the potential partitioning between phases during emulsion polymerization would need to be conducted. This study employs well-established water-in-oil emulsion procedures as well as a suspension culture method to load keratin-based microparticles with bone marrow-derived mesenchymal stem cells. Fabricated microparticles were characterized for size, porosity and surface structure and further analyzed to investigate their ability to form gels upon hydration. The suspension culture technique was validated based on the ability for loaded cells to maintain their viability and express actin and vinculin proteins, which are key indicators of cell attachment and growth. Maintenance of expression of markers associated with cell plasticity was also investigated. As a comparative model, a collagen-coated microparticle (Sigma) of similar size was used. Results showed that an oxidized form of keratin (“keratose” or “KOS”) formed unique microparticle structures of various size that appeared to contain a fibrous sub-structure. Cell adhesion and viability was greater on keratin microparticles compared to collagen-coated microparticles, while marker expression was retained on both.
Respectful operationalism
Authors: Vessonen Elina
Published: August 2020

I first argue that there are three major currents in the contemporary debate on operationalism. These are: (a) methodologists who criticize operationalism qua philosophy, (b) psychologists who practice operationalization that is allegedly philosophically noncommittal, and (c) critics who claim that psychologists’ validation practices commit them to stronger operationalism than psychologists realize. I then outline respectful operationalism and argue that it avoids the main criticisms of operationalism while incorporating some of the epistemic benefits of operational definitions. I show how respectful operationalism aligns with other operationalism-friendly theories, such as generalizability theory and Michael T. Kane’s argument-based approach to validity.
Epidemic prevention for coronavirus disease 2019 in Taiwan: A new perspective in emergency department
Authors: Lin Yang‐Tse , Cheng Wan‐Ling , Lin Chaou‐Shune , Hsu Chan‐Peng
Published: August 2020

Introduction:

Coronavirus disease 2019 (COVID‐19) has become a pandemic with millions of contagions all over the world. However, as of June 2020, relatively few indigenous cases have been identified in Taiwan.

Case Presentation:

A 34‐year‐old man presented to our emergency department with progressive rhinorrhoea, a sore throat, and recent travel to the United States (Texas) and Mexico. He was diagnosed with COVID‐19 after a positive throat swab test. Even though he was not initially isolated, there was no cluster of infection identified after epidemiological investigation.

Discussion:

This case demonstrates Taiwan's unique epidemic prevention strategy, including the utilization of face masks, compact screening indications, quarantine arrangements, and the effective disposition of confirmed cases.

Conclusion:

In addition to managing various emergent conditions, emergency physicians should prepare epidemic prevention strategies as soon as possible and provide frontline suggestions.
Consensus on Indications for Isolated Subtalar Joint Fusion and Naviculocuneiform Fusions for Progressive Collapsing Foot Deformity
Authors: Hintermann Beat , Deland Jonathan T. , de Cesar Netto Cesar , Ellis Scott J. , Johnson Jeffrey E. , Myerson Mark S. , Sangeorzan Bruce J. , Thordarson David B. , Schon Lew C.
Published: August 2020

Recommendation:

Peritalar subluxation represents an important hindfoot component of progressive collapsing foot deformity, which can be associated with a breakdown of the medial longitudinal arch. It results in a complex 3-dimensional deformity with varying degrees of hindfoot valgus, forefoot abduction, and pronation. Loss of peritalar stability allows the talus to rotate and translate on the calcaneal and navicular bone surfaces, typically moving medially and anteriorly, which may result in sinus tarsi and subfibular impingement. The onset of degenerative disease can manifest with stiffening of the subtalar (ST) joint and subsequent fixed and possibly arthritic deformity. While ST joint fusion may permit repositioning and stabilization of the talus on top of the calcaneus, it may not fully correct forefoot abduction and it does not correct forefoot varus. Such varus may be addressed by a talonavicular (TN) fusion or a plantar flexion osteotomy of the first ray, but, if too pronounced, it may be more effectively corrected with a naviculocuneiform (NC) fusion. The NC joint has a curvature in the sagittal plane. Thus, preserving the shape of the joint is the key to permitting plantarflexion correction by rotating the midfoot along the debrided surfaces and to fix it. Intraoperatively, care must be also taken to not overcorrect the talocalcaneal angle in the horizontal plane during the ST fusion (eg, to exceed the external rotation of the talus and inadvertently put the midfoot in a supinated position). Such overcorrection can lead to lateral column overload with persistent lateral midfoot pain and discomfort. A contraindication for an isolated ST fusion may be a rupture of posterior tibial tendon because of the resultant loss of the internal rotation force at the TN joint. In these cases, a flexor digitorum longus tendon transfer is added to the procedure.

Level of Evidence:

Level V, consensus, expert opinion.
Permeation measurement of 27 chemotherapy drugs after simulated dynamic testing on 15 surgical and examination gloves: A knowledge update
Authors: Nalin Marie , Hug Guillaume , Boeckmans Eric , Machon Christelle , Favier Bertrand , Guitton Jérôme
Published: August 2020

Purpose

Exposure to anticancer drugs is one of the known risks for people working in specialist oncology units. Wearing gloves is a vital form of personal protection. The aim of this study was to assess, in close to real use dynamic conditions, the permeability of 15 surgical and examination gloves made from different materials when exposed to 27 anticancer drugs included in the list from international Guides and Recommendations.

Methods

Gloves were tested by using controlled dynamic conditions replicating flexion and extension movements that mimic typical clinical applications. Tests were performed at 37°C or at 43°C for 30 min and anticancer drugs were tested at the highest concentration used in clinical practice. To determine the permeation rate, the quantification of anticancer drugs was performed with selective and sensitive analytical methods such as inductively coupled plasma-mass spectroscopy and liquid chromatography-mass spectrometry.

Results

All the gloves met the EN 16523-1 European standard (1000 ng/(min.cm2)). The penetration rate of busulfan, carmustine and thiotepa exceeded the ASTM D-6978-05 American standard (10 ng/(min.cm2)) with several surgical and/or examination gloves. This standard was met in all of cases when double gloving was used. Breakage of several nitrile gloves was observed in relation with the excipient used by drugs suppliers.

Conclusions

Permeation is a complex multifactorial phenomenon. However, we have suggested that the thickness of the glove and three physicochemical parameters (molecular weight, topological polar surface area and hydrogen bond donor) of the drug were the main parameters affecting permeation.
Exploring Peace in the Midst of War: Rojava as a Zone of Peace?
Authors: Nordhag Anders
Published: August 2020

War and peace are often depicted as mutually exclusive phenomena; where there is violent conflict, peace is absent. This assumption is problematic because it obscures cases where groups, networks, or communities create peaceful situations for themselves in the midst of, or in close proximity to, war. This article focuses on Rojava, a predominantly Syrian Kurdish area in northern Syria. Since the start of the Syrian war, Rojava was for a long time an island of relative security in an otherwise violent context. This article explores Rojava between 2011 and 2014 through theories and empirical examples of zones of peace where local communities in violent conflicts create spaces that are off limits to violence. The article concludes that because violence is not prohibited in Rojava, it cannot be considered a peace zone. Yet the case shows that peacebuilding is possible beyond minimising effects of violence even during a violent conflict.
The Work of Hermeneutic Phenomenology
Authors: Suddick Kitty Maria , Cross Vinette , Vuoskoski Pirjo , Galvin Kathleen T. , Stew Graham
Published: August 2020

This paper is an illustration of the application of a hermeneutic phenomenological study. The theory of meaning and interpretation, drawing on philosophical hermeneutics and the work of Gadamer and Heidegger, and its alignment with phenomenological thought is presented. The paper explains and aims to make visible how key concerns in relation to the fusion of horizons, hermeneutic understanding, hermeneutic circle and hermeneutic phenomenological attitude were implemented. The purpose is to provide practical guidance and illustrate a fully worked up example of hermeneutic phenomenological work as research praxis. This present paper makes a case that hermeneutic phenomenological work is detailed, lengthy, rigorous and systematic in its own philosophical and theoretical frame. It articulates the philosophical and methodological alignment of hermeneutics in a specific hermeneutic phenomenological study and makes visible the work of hermeneutic phenomenology. It concludes by sharing key reflections and insights on the hermeneutic phenomenological process.
Problems in Audiovisual Filtering for Children with Special Educational Needs
Authors: Armstrong-Gallegos Stephanie , Nicolson Roderick I.
Published: August 2020

There is pervasive evidence that problems in sensory processing occur across a range of developmental disorders, but their aetiology and clinical significance remain unclear. The present study investigated the relation between sensory processing and literacy skills in children with and without a background of special educational needs (SEN). Twenty-six children aged between 7 and 12 years old, from both regular classes and SEN programmes, participated. Following baseline tests of literacy, fine motor skills and naming speed, two sets of instruments were administered: the carer-assessed Child Sensory Profile-2 and a novel Audiovisual Animal Stroop (AVAS) test. The SEN group showed significantly higher ratings on three Child Sensory Profile-2 quadrants, together with body position ratings. The SEN participants also showed a specific deficit when required to ignore an accompanying incongruent auditory stimulus on the AVAS. Interestingly, AVAS performance correlated significantly with literacy scores and with the sensory profile scores. It is proposed that the children with SEN showed a specific deficit in “filtering out” irrelevant auditory input. The results highlight the importance of including analysis of sensory processes within theoretical and applied approaches to developmental differences and suggest promising new approaches to the understanding, assessment, and support of children with SEN.
Heart rate fragmentation gives novel insights into non-autonomic mechanisms governing beat-to-beat control of the heart’s rhythm
Authors: Lensen Irene S , Monfredi Oliver J , Andris Robert T , Lake Douglas E , Moorman J Randall
Published: August 2020

Objectives

To demonstrate how heart rate fragmentation gives novel insights into non-autonomic mechanisms of beat-to-beat variability in cycle length, and predicts survival of cardiology clinic patients, over and above traditional clinical risk factors and measures of heart rate variability. Approach: We studied 2893 patients seen by cardiologists with clinical data including 24-hour Holter monitoring. Novel measures of heart rate fragmentation alongside canonical time and frequency domain measures of heart rate variability, as well as an existing local dynamics score were calculated. A proportional hazards model was utilized to relate the results to survival. Main results: The novel heart rate fragmentation measures were validated and characterized with respect to the effects of age, ectopy and atrial fibrillation. Correlations between parameters were determined. Critically, heart rate fragmentation results could not be accounted for by undersampling respiratory sinus arrhythmia. Increased heart rate fragmentation was associated with poorer survival (p ≪ 0.01 in the univariate model). In multivariable analyses, increased heart rate fragmentation and more abnormal local dynamics (p 0.045), along with increased clinical risk factors (age (p ≪ 0.01), tobacco use (p ≪ 0.01) and history of heart failure (p 0.019)) and lower low- to high-frequency ratio (p 0.022) were all independent predictors of 2-year mortality. Significance: Analysis of continuous ECG data with heart rate fragmentation indices yields information regarding non-autonomic control of beat-to-beat variability in cycle length that is independent of and additive to established parameters for investigating heart rate variability, and predicts mortality in concert with measures of local dynamics, frequency content of heart rate, and clinical risk factors.
Platforming Intersectionality: Networked Solidarity and the Limits of Corporate Social Media
Authors: Christian Aymar Jean , Day Faithe , Díaz Mark , Peterson-Salahuddin Chelsea
Published: August 2020

How do historically marginalized narratives spread on social media platforms? Developing research in collaboration with intersectional artists and community, or what we call “platforming intersectionality,” can reveal the promise and limitations of social media for bridging disparate, segregated communities, or “networked solidarity.” Using case studies of indie TV series about historically marginalized communities, we show that intersectionality can spread on corporate social media platforms, but the causes are largely visible outside of platforms, both online and offline. Basic conditions for spreading intersectional narratives may be met when the language used to describe them are simply communicated in ways algorithms and users can quickly understand. However, community members, including artists and publishers who produce for specific communities online and offline, serve as critical, under-appreciated nodes platforms leverage to spread intersectionality. We argue that reconceptualizing platforms as community-based media provides a better framework for understanding the power and limits of social media.
Myocarditis Associated With Enteric Amebiasis in an Adolescent
Authors: Keleş Alp Esma , Alp Hayrullah , Keçeli Merter
Published: August 2020

Parasitic diseases may occasionally affect the cardiovascular system while it is rarely seen in childhood. Parasites may directly or indirectly affect the heart in the form of myocarditis, pericarditis, pancarditis, or pulmonary hypertension. Therefore, it should be kept in mind that parasites may be responsible for myocardial and pericardial disease anywhere around the globe. Herein, we report an adolescent boy with myocarditis associated with enteric amebiasis.
The Apical View Sign for Easier Identification of Left Juxtaposition of the Right Atrial Appendage
Authors: Madan Nitin , Parthiban Anitha , Lorber Richard
Published: August 2020

Left juxtaposition of the right atrial appendage (RAA) is a rare congenital cardiac malformation, where both atrial appendages are located leftward of the great arteries. Despite well-described echocardiographic markers, this diagnosis remains challenging to establish, especially for the novice imager. We describe the apical view sign in three patients with juxtaposed RAA. We noted that the normal left atrial appendage was visualized from the apical four-chamber or equivalent coronal view at the level of the atrioventricular valves.
Diagnostic Accuracy of Fine‐Needle Biopsy for Salivary Gland Neoplasms in a Community Otolaryngology Practice
Authors: Harb Jennifer L. , Bakar Dara , Dhingra Jagdish K.
Published: August 2020

Objective

To assess the diagnostic accuracy of fine‐needle biopsy (FNB) of salivary gland neoplasms via ultrasound (US) or palpation guidance by an otolaryngologist in a community practice.

Study Design

Retrospective chart review.

Setting

Community otolaryngology practice.

Methods

Retrospective analysis was conducted for all office‐based salivary gland FNBs from a community practice from 2005 through 2018. There were 433 FNBs performed among 370 patients. The likelihood of achieving a diagnostic result based on method (US vs palpation guidance) was calculated. Of this cohort, 196 cases had surgical follow‐up (parotid gland, n = 168; submandibular gland, n = 28). Correlation of preoperative FNB results to final surgical pathology was performed and measures of diagnostic accuracy computed.

Results

US‐guided FNBs were more likely to achieve a diagnostic result than FNBs obtained via palpation guidance (P =. 00002). Parotid gland FNBs demonstrated a sensitivity and specificity of 78.57% and 92.44%, respectively. Submandibular FNBs demonstrated a sensitivity and specificity of 57.14% and 93.74%.

Conclusion

FNBs performed under US guidance are more likely to achieve a diagnostic specimen than those performed under palpation guidance. FNBs of parotid gland tumors may be assessed with diagnostic accuracy in the community setting that is similar to that achieved at tertiary care centers. Further research is needed to ascertain whether this finding extends to FNBs of submandibular gland tumors. Offering this procedure at point of care in the community may improve compliance and reduce wait time.
Environmental imaginaries and the environmental sciences of antimicrobial resistance
Authors: Helliwell Richard , Raman Sujatha , Morris Carol
Published: August 2020

The environmental dimension of antimicrobial resistance has expanded the scope and scale of policy concern and research interest in antimicrobial resistance to include not just clinical and agricultural settings but a wide variety of environmental spaces and places. This article examines the ways in which environmental scientists researching the environmental dimension of antimicrobial resistance produce culturally specific forms of environmental imaginaries as a means of stabilising complex, uneven and open-ended environmental, human and microbial relations. These imaginaries work to structure the gaze of scientific enquiry towards particular places, objects and scales, and justify particular decisions and practices over others. Drawing on the imaginaries literature from Science and Technology Studies and Cultural Geography, our analysis examines the spatial and temporal dimensions of environmental imaginaries. In doing so, we identify four imaginaries, the environmental hotspot, the pristine environment, the fluid environment and the environmental reservoir. These distinct but interconnected imaginaries produce a constellation of ideas and assumptions that shape scientific practices, the ways and places in which the environmental dimension of antimicrobial resistance becomes known, and the types of interventions and actions that are made apprehensible as a result. In opening these imaginaries to interrogation at this relatively formative stage, we aim to identify ways in which social science contributions can complement and enhance the ways in which the figure of ‘the environment’ is brought to bear on responses to antimicrobial resistance.
Effectiveness and safety of rivaroxaban compared with low-molecular-weight heparin in cancer-associated thromboembolism
Authors: Costa Olivia S. , Kohn Christine G. , Kuderer Nicole M. , Lyman Gary H. , Bunz Thomas J. , Coleman Craig I.
Published: August 2020

Guidelines provide differing recommendations regarding direct-acting oral anticoagulants vs low-molecular-weight heparin (LMWH) for treatment of cancer-associated thrombosis (CAT). This study was undertaken to evaluate the effectiveness and safety of rivaroxaban vs LMWH for treatment of CAT. Using US Surveillance, Epidemiology and End Results-Medicare–linked data from 2013 through 2016, we evaluated adults with active breast, lung, ovarian, or pancreatic cancer, who were admitted to the hospital or treated in the emergency department for CAT and were prescribed rivaroxaban or LMWH for outpatient anticoagulation. Patients with luminal gastrointestinal or genitourinary cancers were excluded. Rivaroxaban and LMWH users were 1:1 propensity score matched. Outcomes included the composite of recurrent thrombosis or major bleeding, each outcome separately, and mortality at 6 months, using an intent-to-treat approach. On-treatment analysis after 12 months was also performed. Proportional hazards models for the subdistribution of competing risk were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). We included 529 rivaroxaban- and 529 LMWH-treated patients with CAT. Rivaroxaban was not associated with differences in risk of the composite outcome (HR, 0.71; 95% CI, 0.41-1.22), major bleeding (HR, 1.01; 95% CI, 0.50-2.01), or mortality (HR, 0.87; 95% CI, 0.70-1.07) vs LMWH, but it reduced recurrent thrombosis (HR, 0.37; 95% CI, 0.15-0.95). On-treatment analysis at 12 months showed similar results. Rivaroxaban may be a reasonable alternative to LMWH for patients with CAT without gastrointestinal or genitourinary cancer.
Automated closed-loopversusstandard manual oxygen administration after major abdominal or thoracic surgery: an international multicentre randomised controlled study
Authors: L'Her Erwan , Jaber Samir , Verzilli Daniel , Jacob Christophe , Huiban Brigitte , Futier Emmanuel , Kerforne Thomas , Pateau Victoire , Bouchard Pierre-Alexandre , Consigny Maëlys , Lellouche François
Published: August 2020

Introduction

Hypoxaemia and hyperoxaemia may occur after surgery, with related complications. This multicentre randomised trial evaluated the impact of automated closed-loop oxygen administration after high-risk abdominal or thoracic surgeries in terms of optimising the oxygen saturation measured by pulse oximetry time within target range.

Methods

After extubation, patients with an intermediate to high risk of post-operative pulmonary complications were randomised to “standard” or “automated” closed-loop oxygen administration. The primary outcome was the percentage of time within the oxygenation range, during a 3-day frame. The secondary outcomes were the time with hypoxaemia and hyperoxaemia under oxygen.

Results

Among the 200 patients, time within range was higher in the automated group, both initially (≤3 h; 91.4±13.7%versus40.2±35.1% of time, difference +51.0% (95% CI −42.8–59.2%); p<0.0001) and during the 3-day period (94.0±11.3%versus62.1±23.3% of time, difference +31.9% (95% CI 26.3–37.4%); p<0.0001). Periods of hypoxaemia were reduced in the automated group (≤3 days; 32.6±57.8 min (1.2±1.9%)versus370.5±594.3 min (5.0±11.2%), difference −10.2% (95% CI −13.9–−6.6%); p<0.0001), as well as hyperoxaemia under oxygen (≤3 days; 5.1±10.9 min (4.8±11.2%)versus177.9±277.2 min (27.0±23.8%), difference −22.0% (95% CI −27.6–−16.4%); p<0.0001). Kaplan–Meier analysis depicted a significant difference in terms of hypoxaemia (p=0.01) and severe hypoxaemia (p=0.0003) occurrence between groups in favour of the automated group. 25 patients experienced hypoxaemia for >10% of the entire monitoring time during the 3 days within the standard group, as compared to the automated group (p<0.0001).

Conclusion

Automated closed-loop oxygen administration promotes greater time within the oxygenation target, as compared to standard manual administration, thus reducing the occurrence of hypoxaemia and hyperoxaemia.
Should the number of acute exacerbations in the previous year be used to guide treatments in COPD?
Authors: Sadatsafavi Mohsen , McCormack James , Petkau John , Lynd Larry D. , Lee Tae Yoon , Sin Don D.
Published: August 2020

Background

In contemporary management of chronic obstructive pulmonary disease (COPD), the frequent exacerbator phenotype, based on a 12-month history of acute exacerbation of COPD (AECOPD), is a major determinant of therapeutic recommendations. However, there is considerable debate as to the stability of this phenotype over time.

Methods

We used fundamental principles in time-to-event analysis to demonstrate that variation in the frequent exacerbator phenotype has two major sources: variability in the underlying AECOPD rate and randomness in the occurrence of individual AECOPDs. We re-analysed data from two large cohorts, the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study and the SubPopulations and InteRmediate OutcoMes In COPD Study (SPIROMICS), using a Bayesian model that separated these sources of variability. We then evaluated the stability of the frequent exacerbator phenotype based on these results.

Results

In both cohorts, the pattern of AECOPDs strongly supported the presence of an individual-specific underlying AECOPD rate which is stable over time (Bayes Factor less than 0.001). Despite this, the observed AECOPD rate can vary markedly year-to-year within individual patients. For those with an underlying rate of 0.8–3.1 events·year−1, the frequent exacerbator classification, based on the observed rate, changes more than 30% of the time over two consecutive years due to chance alone. This value increases to more than 45% for those with an underlying rate of 1.2–2.2 events·year−1.

Conclusions

While the underlying AECOPD rate is a stable trait, the frequent exacerbator phenotype based on observed AECOPD patterns is unstable, so much so that its suitability for informing treatment decisions should be questioned. Whether evaluating AECOPD history over longer durations or using multivariate prediction models can result in more stable phenotyping needs to be evaluated.
Compound Impedance Control of a Hydraulic Driven Parallel 3UPS/S Manipulator
Authors: Wang Lihang , Cui Shaofei , Ma Chong , Zhang Lijie
Published: August 2020

The hydraulic parallel manipulator combines the high-power density of the hydraulic system and high rigidity of the parallel mechanism with excellent load-carrying capacity. However, the high-precision trajectory tracking control of the hydraulic parallel manipulator is challenged by the coupling dynamics of the parallel mechanism and the high nonlinearities of the hydraulic system. In this study, the trajectory control of a 3-DOF symmetric spherical parallel 3UPS/S manipulator is evaluated. Focusing on the highly coupling and nonlinear system dynamics, a compound impedance control method for a hydraulic driven parallel manipulator is proposed, which combines impedance control with the spatial motion characteristics of a parallel manipulator. The control strategy is divided into the inner and outer loops. The inner loop controls the impedance of the actuator in the joint space, and the outer loop controls the impedance of the entire platform in the task space to compensate the coupling of the actuators and improve the tracking accuracy of the moving platform. Compound impedance control does not require force or pressure sensors and is less dependent on modeling precision. The experimental results show that the compound impedance control effectively improves the tracking accuracy of the moving platform. This research proposes a compound impedance control strategy for a 3-DOF hydraulic parallel manipulator, which has high tracking precision with a simple and cheap system configuration.
Nitrogen soil surface budgets for districts in Germany 1995 to 2017
Authors: Häußermann Uwe , Klement Laura , Breuer Lutz , Ullrich Antje , Wechsung Gabriele , Bach Martin
Published: August 2020

Background

Nitrogen (N) as a key input for crop production has adverse effects on the environment through emissions of reactive nitrogen. Less than 20% of the fertiliser nitrogen applied to agricultural land is actually consumed by humans in meat. Given this situation, nitrogen budgets have been introduced to quantify potential losses into the environment, to raise awareness in nutrient management, and to enforce and monitor nutrient mitigation measures. The surplus of the N soil surface budget has been used for many years for the assessment of potentially water pollution with nitrate from agriculture.

Results

For the 402 districts in Germany, nitrogen soil surface budgets were calculated for the time series 1995 to 2017. For the first time, biogas production in agriculture and the transfer of manure between districts were included in the budget. Averaged for all districts, the recent N supply to the utilised agricultural area (UAA) totals 227 kg N ha−1 UAA (mean 2015–2017), among them 104 kg N ha−1 UAA mineral fertiliser, 59 kg N ha−1 UAA manure, 33 kg N ha−1 UAA digestate, 14 kg N ha−1 UAA from gross atmospheric deposition, 13 kg N ha−1 UAA biological N fixation, and 1 kg N ha−1 UAA from seed and planting material. The withdrawal with harvested products accounts for 149 kg N ha−1 UAA, resulting in an N soil surface budget surplus of 77 kg N ha−1 UAA. The N surpluses per district (mean 2015–2017) vary considerably between 26 and 162 kg N ha−1 UAA and the nitrogen use efficiency of crop production ranges from 0.53 to 0.79 in the districts. The N surplus in Germany as a whole has remained nearly constant since 1995, but the regional distribution has changed significantly. The N surplus has decreased in the arable farming regions, but increased in the districts with high livestock density. Some of this surplus, however, is relocated to other districts through the transfer of manure.

Conclusions

The 23-year time series forms a reliable basis for further interpretation of N soil surface surplus in Germany. Agri-environmental programmes such as the limitation of the N surplus through the Fertiliser Ordinance and the promotion of biogas production have a clear effect on the N surplus in Germany as a whole and its regional distribution.
Dynamic RMST curves for survival analysis in clinical trials
Authors: Liao Jason J. Z. , Liu G. Frank , Wu Wen-Chi
Published: August 2020

Background

The data from immuno-oncology (IO) therapy trials often show delayed effects, cure rate, crossing hazards, or some mixture of these phenomena. Thus, the proportional hazards (PH) assumption is often violated such that the commonly used log-rank test can be very underpowered. In these trials, the conventional hazard ratio for describing the treatment effect may not be a good estimand due to the lack of an easily understandable interpretation. To overcome this challenge, restricted mean survival time (RMST) has been strongly recommended for survival analysis in clinical literature due to its independence of the PH assumption as well as a more clinically meaningful interpretation. The RMST also aligns well with the estimand associated with the analysis from the recommendation in ICH E-9 (R1), and the test/estimation coherency. Currently, the Kaplan Meier (KM) curve is commonly applied to RMST related analyses. Due to some drawbacks of the KM approach such as the limitation in extrapolating to time points beyond the follow-up time, and the large variance at time points with small numbers of events, the RMST may be hindered.

Methods

The dynamic RMST curve using a mixture model is proposed in this paper to fully enhance the RMST method for survival analysis in clinical trials. It is constructed that the RMST difference or ratio is computed over a range of values to the restriction time τ which traces out an evolving treatment effect profile over time.

Results

This new dynamic RMST curve overcomes the drawbacks from the KM approach. The good performance of this proposal is illustrated through three real examples.

Conclusions

The RMST provides a clinically meaningful and easily interpretable measure for survival clinical trials. The proposed dynamic RMST approach provides a useful tool for assessing treatment effect over different time frames for survival clinical trials. This dynamic RMST curve also allows ones for checking whether the follow-up time for a study is long enough to demonstrate a treatment difference. The prediction feature of the dynamic RMST analysis may be used for determining an appropriate time point for an interim analysis, and the data monitoring committee (DMC) can use this evaluation tool for study recommendation.
The quality of primary care in community health centers: comparison among urban, suburban and rural users in Shanghai, China
Authors: Shi Jianwei , Jin Hua , Shi Leiyu , Chen Chen , Ge Xuhua , Lu Yuan , Zhang Hanzhi , Wang Zhaoxin , Yu Dehua
Published: August 2020

Objective

Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.

Methods

Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.

Findings

A total of 2404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß = 1.57, P <  0.001) compared with those from urban CHCs.

Conclusion

That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).
Highly proliferative anal neuroendocrine carcinoma: molecular and clinical features of a rare, recurrent case in complete remission
Authors: Juhlin Carl Christofer , Falhammar Henrik , Kjellman Magnus , Åhlén Jan , Welin Staffan , Calissendorff Jan
Published: August 2020

Background

Poorly differentiated anal neuroendocrine carcinomas (ANECs) are rare lesions with poor prognosis, and the molecular etiology is only partially understood.

Case presentation

At our institution, we have treated and followed a patient with such a rare ANEC. He had primarily surgery followed by three rounds of repeated surgery for loco-regional recurrences. He also received three different combinations of chemotherapy and external beam radiation. At last follow-up 13 years since the primary diagnosis, the patient had been in complete remission for nine years.

The patient’s medical files were re-examined, including laboratory, radiology and clinical examinations. Histopathology was re-assessed, and expanded immunohistochemistry was performed from tissue specimens from the four surgical procedures. In addition, the molecular genetic status was evaluated through next-generation sequencing.

The initial tumor was consistent with a 59 mm small cell neuroendocrine cancer with a Ki-67 index of 80%. Regional lymph node metastases were evident, and immunohistochemistry supported a neuroendocrine origin. A PCR screening detected human papilloma virus type 45 DNA (high-risk subtype), and focused next-generation sequencing found a missense mutation in the Phosphatidylinositol-4,5-Bisphosphate 3-Kinase Catalytic Subunit Alpha (PIK3CA) gene. In tissues representing subsequent recurrences, the Chromogranin A expression was lost, and the Ki-67 index increased to 90%.

Conclusions

For the first time, we report the detection of HPV45 in a case of ANEC. To our belief, PIK3CA mutations have also not been previously demonstrated in this tumor entity. In highly malignant ANECs, cure can in rare cases be achieved. Although speculative, expression of HPV45 and/or the PIK3CA mutation may have contributed to the favorable outcome.
A cohort study investigating the relationship between patient reported outcome measures and pre-operative frailty in patients with operable, non-palliative colorectal cancer
Authors: Knight J. , Ayyash K. , Colling K. , Dhesi J. , Ewan V. , Danjoux G. , Kothmann E. , Mill A. , Taylor S. , Yates D. , Ayyash Reema
Published: August 2020

Background

Frailty refers to the reduction in homeostatic reserve resulting from an accumulation of physiological deficits over a lifetime. Frailty is common in older patients undergoing surgery and is an independent risk factor for post-operative mortality, morbidity and increased length of hospital stay. In frail individuals, stressors, such as surgery, can precipitate an acute deterioration in health, manifesting as delirium, falls, reduction in mobility or continence, rendering these individuals at an increased risk of adverse perioperative outcomes. However, little is known about how frailty affects the patient experience, functional ability and quality of life (QoL) after surgery. In addition, the distribution of frailty in this population is unknown.

Methods

We will conduct a multi-centre observational trial to investigate the relationship between patient reported outcome measures and preoperative frailty. We aim to recruit approximately two-hundred patients with operable, potentially curative colorectal cancer. Eligible patients will be identified at three hospital sites. QoL and functional ability (measured using EORTC QLQ-C30 and WHO-DAS 2.0 respectively) will be recorded at the pre-operative assessment clinic, and at 6 and 12 weeks postoperatively. Frailty scores including the Edmonton Frail Scale (EFS) and Rockwood clinical frailty scale (CFS) will be calculated both preoperatively, and at 12 weeks post-operatively. Secondary outcome measures including post-operative morbidity and mortality will be measured using Clavien Dindo classification and 90-day mortality.

Discussion

This observational feasibility study seeks to define the prevalence of frailty in older (> 65 years) colorectal cancer patients and understand how frailty impacts on patient reported outcome measures. This information will help to inform larger studies relating to treatment decision algorithms and promote shared decision making in this population.
Increased physiological dead space in mechanically ventilated COVID-19 patients recovering from severe acute respiratory distress syndrome: a case report
Authors: Xia Jingen , Feng Yingying , Li Min , Yu Xin , Zhang Yi , Duan Jun , Zhan Qingyuan
Published: August 2020

Background

An ongoing outbreak of coronavirus disease 2019 (COVID-19) is spreading globally. Recently, several articles have mentioned that the early acute respiratory distress syndrome (ARDS) caused by COVID-19 significantly differ from those of ARDS due to other causes. Actually, we newly observed that some mechanically ventilated COVID-19 patients recovering from severe ARDS (more than 14 days after invasive ventilation) often experienced evidently gradual increases in CO2 retention and minute ventilation. However, the underlying mechanics remain unclear.

Case presentation

To explain these pathophysiological features and discuss the ventilatory strategy during the late phase of severe ARDS in COVID-19 patients, we first used a metabolic module on a General Electric R860 ventilator (Engstrom Carestation; GE Healthcare, USA) to monitor parameters related to gas metabolism, lung mechanics and physiological dead space in two COVID-19 patients. We found that remarkably decreased ventilatory efficiency (e.g., the ratio of dead space to tidal volume 70–80%, arterial to end-tidal CO2 difference 18–23 mmHg and ventilatory ratio 3–4) and hypermetabolism (oxygen consumption 300–400 ml/min, CO2 elimination 200–300 ml/min) may explain why these patients experienced more severe respiratory distress and CO2 retention in the late phase of ARDS caused by COVID-19.

Conclusion

During the recovery period of ARDS among mechanically-ventilated COVID-19 patients, attention should be paid to the monitoring of physiological dead space and metabolism. Tidal volume (8–9 ml/kg) could be increased appropriately under the limited plateau pressure; however, barotrauma should still be kept in mind.