bluuebunny/crossref_metadata_2025 huggingface dataset:
Antilock braking control system for electric vehicles
Authors: Lin Chun‐Liang , Yang Meng‐Yao , Chen En‐Ping , Chen Yu‐Chan , Yu Wen‐Cheng
Published: November 2017

In recent years, brushless DC motors (BLDCMs) have replaced brushed DC motors in the design of electric scooters (ESs). This study proposes a new antilock braking system (ABS) based on a slip ratio estimator for ES utilising the braking force generated by the BLDCM when electrical energy is released to the virtual load, yielding an effect analogous to the ABS control in gas‐powered vehicles. Compared with mechanical ABS, the proposed design possesses the advantage of rapid torque responses because no mechanical parts needed. Current control design is used to adjust the braking torque, and the sliding‐mode control strategy is adopted to regulate the slip ratio to attain the optimal road adhesion during emergency braking. A variety of experiments are conducted for functional and performance verification.
Image gradient histogram's fitting and calculation
Authors: Ding Chang , Dong Lili , Xu Wenhai
Published: November 2017

The gradient is an important property in an image. According to the characteristics of image gradient histogram (image gradient magnitude distribution), Gamma distribution model is near to the actual distribution, so Gamma mixture model is used to fit natural image gradient distribution. First, an image can be divided into edge region and non‐edge region on the aspect of the gradient; the authors assume that each region obeys sub‐Gamma distribution with different parameters. Then, expectation maximisation (EM) algorithm is used to estimate the parameters of each part. Finally, the accuracy of the fitting result of the entire gradient distribution is verified by the correlation coefficient and the validity of the estimated gradient magnitude distribution of non‐edge region and edge region is verified by the edge‐detection experiment with different threshold. This work can select Canny edge‐detector high threshold adaptively, which can improve algorithm automatic level.
Research on self‐starting strategy of variable speed pumped storage units based on model predictive control
Authors: Ji Li , Shao Yixiang , Sun Jing , Shi Lei
Published: November 2017

This study focuses on the self‐starting strategy of variable speed pumped storage units (VSPSU) by shorting machine stator. First, the mathematical model and characteristics of VSPSU are proposed, while the machine stator is short‐circuited. Then, a closed‐loop self‐starting system based on model predictive control is presented in order to accelerate the rotor for synchronisation. For verification, a VSPSU model is built in MATLAB/Simulink, and the simulations regarding the start‐up and synchronisation procedure are carried out. The results show that with the proposed self‐starting strategy, it is possible to obtain good starting performance and robustness.
AC excitation control strategy of variable speed pumped storage units based on active disturbance rejection control
Authors: Ji Li , Sun Jing , Zhou Min , Tian Wei
Published: November 2017

This study focuses on the AC excitation control system of variable speed pumped storage units (VSPSU) based on active disturbance rejection control (ADRC). First, the mathematical model of VSPSU is proposed considering the effects of the inverter. Then a second‐order ADRC is presented as well as an AC excitation control system based on the stator flux oriented control in order to control the active and reactive power of the VSPSU. For verification, a simulation system of VSPSU with the proposed ADRC is built in real‐time digital simulator. The simulation results show that the proposed control system can achieve the control of the output power of VSPSU both in generating mode and pumping mode and the controller takes on good dynamic performance and robustness.
PPSO method for distribution network reconfiguration considering the stochastic uncertainty of wind turbine, photovoltaic and load
Authors: Wu Huayi , Dong Ping
Published: November 2017

This study presents a new algorithm to solve distribution network reconfiguration for power loss reduction considering the stochastic uncertain of the wind, photovoltaic generation and load demand. At first, the stochastic power output models of distributed generation and load are built. Then, in order to get the minimum power loss under the optimal network topology, Prim's particle swarm optimisation (PPSO) algorithm, is firstly introduced to determine the optimal plan under different conditions of network power injected. The proposed algorithm utilises the Prim's algorithm to generate a radial network topology without checking the loop and island at each iteration. To obtain the stochastic expected value of the power loss, a probabilistic power flow calculation based on Monte‐Carlo simulation is employed to handle the stochastic feature of distributed generations (DG) and load. Finally, the proposed method is applied to 33‐bus radial distribution system. The PPSO have a good performance to solve distribution network reconfiguration problem.
Impact on SSR of wind farms connected to series‐compensated lines from the different structures of power grid
Authors: Yunhong Li , Hui Liu , Wenyuan Ning , Xiaorong Xie
Published: November 2017

The interaction between controllers of doubly fed induction generators and fixed series compensation would induce sub‐synchronous resonance (SSR) problem. The literatures are mainly based on the practical cases in Texas and North China, and no other case has been reported so far. Recently, the grid structure of the case in North China has been changed and the characteristics of SSR phenomena are different from the past. This brings up some new problems and the damping ratio under different grid structures need to be investigated. This particular case was analysed in detail in this study. The impact on SSR from different structures of power grid is the combined result of multiple factors. This study is aimed to find out the key factors and how the factors affect SSR phenomenon.
Impact of PMSG on SSR of DFIGs connected to series‐compensated lines based on the impedance characteristics
Authors: Yunhong Li , Hui Liu , Xiaowei Chen , Jing Hao , Li Yu
Published: November 2017

Doubly‐fed induction generators (DFIGs) connected to series‐compensated transmission system is facing the risk of sub‐synchronous resonance (SSR). In recent years, SSR events have occurred many times in the area with large‐scale wind power plants in Guyuan, Zhangjiakou. Previous studies have shown that DFIGs exhibit negative damping at sub‐synchronous frequencies, thus leading to the SSR phenomenon. The permanent magnet synchronous generator (PMSG) is decoupled from the grid by a full‐power converter, so it does not participate in the SSR process. In this study, the impact of PMSG on SSR will be analysed based on the impedance characteristics. The results show that PMSG enhances system damping in some frequency bands and deteriorates the system damping in other frequency bands.
Luminosities and mass-loss rates of Local Group AGB stars and red supergiants
Authors: Groenewegen M. A. T. , Sloan G. C.
Published: November 2017

Context. Mass loss is one of the fundamental properties of asymptotic giant branch (AGB) stars, and through the enrichment of the interstellar medium, AGB stars are key players in the life cycle of dust and gas in the universe. However, a quantitative understanding of the mass-loss process is still largely lacking.

Aims. We aim to investigate mass loss and luminosity in a large sample of evolved stars in several Local Group galaxies with a variety of metalliticies and star-formation histories: the Small and Large Magellanic Cloud, and the Fornax, Carina, and Sculptor dwarf spheroidal galaxies (dSphs).

Methods. Dust radiative transfer models are presented for 225 carbon stars and 171 oxygen-rich evolved stars in several Local Group galaxies for which spectra from the Infrared Spectrograph on Spitzer are available. The spectra are complemented with available optical and infrared photometry to construct spectral energy distributions. A minimization procedure was used to determine luminosity and mass-loss rate (MLR). Pulsation periods were derived for a large fraction of the sample based on a re-analysis of existing data.

Results. New deep K-band photometry from the VMC survey and multi-epoch data from IRAC (at 4.5 μm) and AllWISE and NEOWISE have allowed us to derive pulsation periods longer than 1000 days for some of the most heavily obscured and reddened objects. We derive (dust) MLRs and luminosities for the entire sample. The estimated MLRs can differ significantly from estimates for the same objects in the literature due to differences in adopted optical constants (up to factors of several) and details in the radiative transfer modelling. Updated parameters for the super-AGB candidate MSX SMC 055 (IRAS 00483−7347) are presented. Its current mass is estimated to be 8.5 ± 1.6 M⊙, suggesting an initial mass well above 8 M⊙ in agreement with estimates based on its large Rubidium abundance. Using synthetic photometry, we present and discuss colour-colour and colour-magnitude diagrams which can be expected from the James Webb Space Telescope.
Transient events in bright debris discs: Collisional avalanches revisited
Authors: Thebault P. , Kral Q.
Published: November 2017

Context. A collisional avalanche is set off by the breakup of a large planetesimal, releasing vast amounts of small unbound grains that enter a debris disc located further away from the star, triggering there a collisional chain reaction that could potentially create detectable transient structures.

Aims. We investigate this mechanism, using for the first time a fully self-consistent code coupling dynamical and collisional evolutions. We also quantify for the first time the photometric evolution of the system and investigate whether or not avalanches could explain the short-term luminosity variations recently observed in some extremely bright debris discs.

Methods. We use the state-of-the-art LIDT-DD code. We consider an avalanche-favoring A6V star, and two set-ups: a “cold disc” case, with a dust release at 10 au and an outer disc extending from 50 to 120 au, and a “warm disc” case with the release at 1 au and a 5−12 au outer disc. We explore, in addition, two key parameters: the density (parameterized by its optical depth τ) of the main outer disc and the amount of dust released by the initial breakup.

Results. We find that avalanches could leave detectable structures on resolved images, for both “cold” and “warm” disc cases, in discs with τ of a few 10-3, provided that large dust masses (≳1020−5 × 1022 g) are initially released. The integrated photometric excess due to an avalanche is relatively limited, less than 10% for these released dust masses, peaking in the λ ~ 10−20 μm domain and becoming insignificant beyond ~40–50 μm. Contrary to earlier studies, we do not obtain stronger avalanches when increasing τ to higher values. Likewise, we do not observe a significant luminosity deficit, as compared to the pre-avalanche level, after the passage of the avalanche. These two results concur to make avalanches an unlikely explanation for the sharp luminosity drops observed in some extremely bright debris discs. The ideal configuration for observing an avalanche would be a two-belt structure, with an inner belt (at ~1 or ~10 au for the “warm” and “cold” disc cases, respectively) of fractional luminosity f ≳ 10-4 where breakups of massive planetesimals occur, and a more massive outer belt, with τ of a few 10-3, into which the avalanche chain reaction develops and propagates.
Low-temperature β-SiC interlayer for diamond film on cemented carbide
Authors: Ren Yi , Yu Xiang , Liu Fei , Wang Yong-Hui
Published: November 2017

The adhesion of protective diamond films to cemented carbide substrates used in fabrication of space drilling tools can be improved by the inclusion of β-SiC interlayers. Conventional CVD methods for depositing the SiC interlayers lead to interface coarsening and heat stress resulting from high temperatures of deposition. In this work, a mid-frequency magnetron sputtering technique is used to deposit the β-SiC interlayer at lower temperatures, and the effects of deposition temperature on the microstructure and properties of the interlayer and final diamond film are assessed. The results show that the β-SiC interlayers deposited at temperatures exceeding 300°C possess high compactness and crystallinity. Increasing crystal β-SiC phase has beneficial effects on the nucleation and growth of diamond film. Based on the experimental data, a six-step reaction model is proposed to show the mechanism by which the β-SiC interlayer promotes the nucleation and growth of diamond films.
Multi-model ensemble projections of European river floods and high flows
at 1.5, 2, and 3 degrees global warming
Authors: Thober Stephan , Kumar Rohini , Wanders Niko , Marx Andreas , Pan Ming , Rakovec Oldrich , Samaniego Luis , Sheffield Justin , Wood Eric F , Zink Matthias
Published: November 2017

Severe river floods often result in huge economic losses and fatalities. Since 1980,
almost 1500 such events have been reported in Europe. This study investigates climate
change impacts on European floods under 1.5, 2, and 3 K global warming. The impacts
are assessed employing a multi-model ensemble containing three hydrologic models
(HMs: mHM, Noah-MP, PCR-GLOBWB) forced by five CMIP5 general circulation models
(GCMs) under three Representative Concentration Pathways (RCPs 2.6, 6.0, and 8.5).
This multi-model ensemble is unprecedented with respect to the combination of its
size (45 realisations) and its spatial resolution, which is 5 km over the entirety of
Europe. Climate change impacts are quantified for high flows and flood events,
represented by 10% exceedance probability and annual maxima of daily streamflow,
respectively. The multi-model ensemble points to the Mediterranean region as a
hotspot of changes with significant decrements in high flows from −11% at 1.5 K up to
−30% at 3 K global warming mainly resulting from reduced precipitation. Small changes
(< ±10%) are observed for river basins in Central Europe and the British Isles
under different levels of warming. Projected higher annual precipitation increases
high flows in Scandinavia, but reduced snow melt equivalent decreases flood events in
this region. Neglecting uncertainties originating from internal climate variability,
downscaling technique, and hydrologic model parameters, the contribution by the GCMs
to the overall uncertainties of the ensemble is in general higher than that by the
HMs. The latter, however, have a substantial share in the Mediterranean and
Scandinavia. Adaptation measures for limiting the impacts of global warming could be
similar under 1.5 K and 2 K global warming, but have to account for significantly
higher changes under 3 K global warming.
Designing Climate Policy: Lessons from the Renewable Fuel Standard and the Blend Wall
Authors: Lade Gabriel E , Cynthia Lin Lawell C‐Y , Smith Aaron
Published: November 2017

Many policies mandate renewable energy production to combat global climate change. These policies often differ significantly from first‐best policy prescriptions. Among the largest renewable energy mandates enacted to date is the Renewable Fuel Standard (RFS), which mandates biofuel consumption far beyond what is feasible with current technology and infrastructure. We critically review the methods used by the Environmental Protection Agency to project near‐ and long‐term compliance costs under the RFS, and draw lessons from the RFS experience to date that would improve the program's efficiency. The lessons are meant to inform both future RFS rulemaking and the design of future climate policies. We draw two lessons specific to the RFS. First, incorporate uncertainty into rulemaking; second, implement multi‐year rules. Multi‐year rulemaking allows for longer periods between major regulatory decisions and sends greater certainty to markets. We also provide two more general recommendations: tie waiver authority to compliance costs or include cost containment provisions, and fund research and development of new technologies directly rather than mandating them. Future technological advancement is uncertain, and mandating new technologies has proven to be largely ineffective to date, particularly in fuel markets.
SimulaTE: simulating complex landscapes of transposable elements of populations
Authors: Kofler Robert
Published: November 2017

Motivation

Estimating the abundance of transposable elements (TEs) in populations (or tissues) promises to answer many open research questions. However, progress is hampered by the lack of concordance between different approaches for TE identification and thus potentially unreliable results.

Results

To address this problem, we developed SimulaTE a tool that generates TE landscapes for populations using a newly developed domain specific language (DSL). The simple syntax of our DSL allows for easily building even complex TE landscapes that have, for example, nested, truncated and highly diverged TE insertions. Reads may be simulated for the populations using different sequencing technologies (PacBio, Illumina paired-ends) and strategies (sequencing individuals and pooled populations). The comparison between the expected (i.e. simulated) and the observed results will guide researchers in finding the most suitable approach for a particular research question.

Availability and implementation

SimulaTE is implemented in Python and available at https://sourceforge.net/projects/simulates/. Manual https://sourceforge.net/p/simulates/wiki/Home/#manual; Test data and tutorials https://sourceforge.net/p/simulates/wiki/Home/#walkthrough; Validation https://sourceforge.net/p/simulates/wiki/Home/#validation.
Assessing Viral Transfer During Doffing of Ebola-Level Personal Protective Equipment in a Biocontainment Unit
Authors: Casanova Lisa M , Erukunuakpor Kimberly , Kraft Colleen S , Mumma Joel M , Durso Francis T , Ferguson Ashley N , Gipson Christina L , Walsh Victoria L , Zimring Craig , DuBose Jennifer , Jacob Jesse T ,   Centers for Disease Control and Prevention Epicenters Program, Division of Healthcare Quality Promotion
Published: November 2017

In simulations of Ebola-level personal protective equipment doffing with experienced healthcare workers, hands, inner gloves, and scrubs are contaminated with nonenveloped viruses and, infrequently, with enveloped viruses.
Vascular peroxidase 1 mediates hypoxia-induced pulmonary artery smooth muscle cell proliferation, apoptosis resistance and migration
Authors: You Baiyang , Liu Yanbo , Chen Jia , Huang Xiao , Peng Huihui , Liu Zhaoya , Tang Yixin , Zhang Kai , Xu Qian , Li Xiaohui , Cheng Guangjie , Shi Ruizheng , Zhang Guogang
Published: November 2017

Aims

Reactive oxygen species (ROS) play essential roles in the pulmonary vascular remodelling associated with hypoxia-induced pulmonary hypertension (PH). Vascular peroxidase 1 (VPO1) is a newly identified haeme-containing peroxidase that accelerates oxidative stress development in the vasculature. This study aimed to determine the potential role of VPO1 in hypoxia-induced PH-related vascular remodelling.

Methods and results

The vascular morphology and VPO1 expression were assessed in the pulmonary arteries of Sprague–Dawley (SD) rats. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 4 (NOX4) and VPO1 expression and HOCl production were significantly increased in hypoxic rats, which also exhibited obvious vascular remodelling. Furthermore, a hypoxia-induced PH model was generated by exposing primary rat pulmonary artery smooth muscle cells (PASMCs) to hypoxic conditions (3% O2, 48 h), which significantly increased the expression of NOX4 and VPO1 and the production of HOCl. These hypoxic changes were accompanied by enhanced proliferation, apoptosis resistance, and migration. In PASMCs, hypoxia-induced changes, including effects on the expression of cell cycle regulators (cyclin B1 and cyclin D1), apoptosis-related proteins (bax, bcl-2, and cleaved caspase-3), migration promoters (matrix metalloproteinases 2 and 9), and NF-κB expression, as well as the production of HOCl, were all inhibited by silencing VPO1 with small interfering RNAs. Moreover, treatment with HOCl under hypoxic conditions upregulated NF-κB expression and enhanced proliferation, apoptosis resistance, and migration in PASMCs, whereas BAY 11-7082 (an inhibitor of NF-κB) significantly inhibited these effects.

Conclusion

Collectively, these results demonstrate that VPO1 promotes hypoxia-induced proliferation, apoptosis resistance, and migration in PASMCs via the NOX4/VPO1/HOCl/NF-κB signalling pathway.
How to convene an international health or development commission: ten key steps
Authors: Yamey Gavin , Summers Lawrence H , Jamison Dean T , Brinton Jessica
Published: November 2017

The Commission on Investing in Health (CIH), an international group of 25 economists and global health experts, published its Global Health 2035 report in The Lancet in December 2013. The report laid out an ambitious investment framework for achieving a “grand convergence” in health—a universal reduction in deaths from infectious diseases and maternal and child health conditions—within a generation. This article captures ten key elements that the CIH found important to its process and successful outcomes. The elements are presented in chronological order, from inception to post-publication activities. The starting point is to identify the gap that a new commission could help to narrow. A critical early step is to choose a chair who can help to set the agenda, motivate the commissioners, frame the commission’s analytic work, and run the commission meetings in an effective way. In selecting commissioners, important considerations are their technical expertise, ensuring diversity of people and viewpoints, and the connections that commissioners have with the intended policy audience. Financial and human resources need to be secured, typically from universities, foundations, and development agencies. It is important to set a clear end date, so that the commission’s work program, the timing of its meetings and its interim deadlines can be established. In-person meetings are usually a more effective mechanism than conference calls for gaining commissioners’ inputs, surfacing important debates, and ‘reality testing’ the commission’s key findings and messages. To have policy impact, the commission report should ideally say something new and unexpected and should have simple messages. Generating new empirical data and including forward-looking recommendations can also help galvanize policy action. Finally, the lifespan of a commission can be extended if it lays the foundation for a research agenda that is then taken up after the commission report is published.
Golod–Shafarevich-Type Theorems and Potential Algebras
Authors: Iyudu Natalia , Smoktunowicz Agata
Published: November 2017

Potential algebras feature in the minimal model program and noncommutative resolution of singularities, and the important cases are when they are finite dimensional, or of linear growth. We develop techniques, involving Gröbner basis theory and generalized Golod–Shafarevich-type theorems for potential algebras, to determine finiteness conditions in terms of the potential. We consider two-generated potential algebras. Using Gröbner bases techniques and arguing in terms of associated truncated algebra we prove that they cannot have dimension smaller than 8. This answers a question of Wemyss [21], related to the geometric argument of Toda [17]. We derive from the improved version of the Golod–Shafarevich theorem, that if the potential has only terms of degree 5 or higher, then the potential algebra is infinite dimensional. We prove that potential algebra for any homogeneous potential of degree $n\geqslant 3$ is infinite dimensional. The proof includes a complete classification of all potentials of degree 3. Then we introduce a certain version of Koszul complex, and prove that in the class $\mathcal {P}_{n}$ of potential algebras with homogeneous potential of degree $n+1\geqslant 4$, the minimal Hilbert series is $H_{n}=\frac {1}{1-2t+2t^{n}-t^{n+1}}$, so they are all infinite dimensional. Moreover, growth could be polynomial (but nonlinear) for the potential of degree 4, and is always exponential for potential of degree starting from 5. For one particular type of potential we prove a conjecture by Wemyss, which relates the difference of dimensions of potential algebra and its abelianization with Gopakumar–Vafa invariants.
Beauty, Effort, and Misrepresentation: How Beauty Work Affects Judgments of Moral Character and Consumer Preferences
Authors: Samper Adriana , Yang Linyun W , Daniels Michelle E
Published: November 2017

Women engage in a variety of beauty practices, or “beauty work,” to enhance their physical appearance, such as applying cosmetics, tanning, or exercising. Although the rewards of physical attractiveness are well documented, perceptions of both the women who engage in efforts to enhance their appearance and the high-effort beauty products marketed to them are not well understood. Across seven studies, we demonstrate that consumers judge women who engage in certain types of extensive beauty work as possessing poorer moral character. These judgments occur only for effortful beauty work perceived as transformative (significantly altering appearance) and transient (lasting a relatively short time), such that they emerge within cosmetics and tanning, yet not skincare or exercise. This effect is mediated by the perception that putting high effort into one’s appearance signals a willingness to misrepresent one’s true self, and translates into lower purchase intentions for higher-effort cosmetics. We identify several boundary conditions, including the attractiveness of the woman performing the beauty work and whether the effort is attributed to external norms or causes. In examining how beauty work elicits moral judgments, we also shed light on why effortful cosmetic use is viewed negatively, yet effortful products continue to be commercially successful.
Pattern of Methamphetamine Use and the Time Lag to Methamphetamine Dependence
Authors: Yimsaard Pongkwan , Maes Michael M. , Verachai Viroj , Kalayasiri Rasmon
Published: November 2017

Objectives:

Use of methamphetamine (MA) commonly co-occurs with the use of other substances. The present study aims to examine substance initiation patterns of other substances, including alcohol, nicotine, inhalants, and cannabis (OTH), in MA users and its consequence on the time lag of MA dependence.

Methods:

Sociodemographic, environmental, and clinical data were obtained from MA users at a Thai substance treatment center. The Semi-Structured Assessment for Drug Dependence and Alcoholism was employed to diagnose drug dependence.

Results:

Of 991 MA users, 52.6% were males, and the average age was 26.8 ± 7.1 years. The mean age of first MA use (18 years) was greater than the mean age of first use of alcohol (17 years), nicotine (16 years), and inhalants (15 years) (P < 0.001), but was comparable with the mean age at the first use of cannabis (P > 0.05). Family history of MA use and nicotine dependence were associated with early MA onset. Participants who used MA as their first drug (MA>OTH) were more likely to be female and less likely to smoke intensely and to be exposed to severe traumatic events than those who used MA later than other substances (OTH>MA). The time lag from age at onset of MA use to MA dependence was shorter in OTH>MA than in MA>OTH (3 vs 5 years; χ2 = 5.7, P = 0.02, log-rank test).

Conclusions:

A higher proportion of women was observed in MA>OTH than in OTH>MA. The use of other substances before MA increases the individual's vulnerability in shortening the interval between age at onset of MA use and MA dependence in a substance treatment cohort.
Patients’ Experiences of Using a Cellular Photo Digital Breathalyzer for Treatment Purposes
Authors: Nehlin Christina , Carlsson Kristina , Öster Caisa
Published: November 2017

Objectives:

The field of eHealth systems is rapidly developing and is now expanding into alcohol treatment settings. Despite a growing public and professional interest, cellular photo digital breathalyzers (CPDBs) have not been investigated in a clinical context so far. In this study, we aimed to investigate the experiences of patients in alcohol treatment who had been using a CPDB—TripleA- for a minimum of three months. What are their personal experiences of using the CPDB? Do the patients think it supports them to change their drinking habits, and if so, in what way?

Methods:

A qualitative interview study with individuals who had been using the CPDB TripleA, for at least 3 months as complement to treatment (12-step program or hospital-based outpatient care). A thematic analysis with an inductive approach was used to identify, analyze, and interpret patterns within data.

Results:

In all, 12 interviews were conducted with 8 men and 4 women. Participants were generally enthusiastic about the CPDB and found it convenient and useful, even though it created a need for privacy when using the device. Although technical problems were substantial, participants were tolerant to those. The system was perceived to support self-control and to restore relations, but did not replace the need for close contact with caregivers. Self-motivation to change drinking habits was essential, and could not be reached by solely using the CPDB.

Conclusions:

Participants perceived the CPDB as a convenient and useful tool that was supportive under the circumstances that it was used in a context that included personal contact with a caregiver; and the user felt more than just a minimum of motivation to reduce drinking. Technical stability needs to be achieved to secure long-term use.
Foreword: Proceedings From the First Annual Lumbar Total Disc Replacement Summit
Authors: Blumenthal Scott , Buttermann Glenn , Garcia Rolando , Gornet Matthew , Grunch Betsy , Guyer Richard , Janssen Michael , Kimball Brent , Lewis Adam , Mesiwala Ali , Miller Lynn , Morreale Joseph , Reed William , Sandhu Faheem , Shackleford Ian , Yue James , Zigler Jack , OConnell Brent , Ferko Nicole , Hollmann Sarah
Published: November 2017

This publication focuses on proceedings from the First Annual Lumbar Total Disc Replacement Summit, held October 25, 2016 in Boston, MA. The Summit brought together 17 thought leading surgeons who employed a modified-Delphi method to determine where consensus existed pertaining to the utilization of lumbar total disc replacement as a standard of care for a subpopulation of patients suffering from degenerative disc disease.
Defining the Ideal Lumbar Total Disc Replacement Patient and Standard of Care
Authors: Gornet Matthew , Buttermann Glenn , Guyer Richard , Yue James , Ferko Nicole , Hollmann Sarah
Published: November 2017

Lumbar total disc replacement, now in use since 2004, was determined by the panel to be a standard of care for the treatment of symptomatic single-level lumbar degenerative disc disease in the active patient subpopulation as outlined by the investigational device exemption study criteria. The large body of evidence supporting this statement, including surgeons’ experiences, was presented and discussed. Consensus statements focusing on decision-making criteria reflected that efficacy, long-term safety, clinical outcomes with validated measures, and cost-effectiveness should form the basis of decision-making by payers. Diagnostic challenges with lumbar degenerative disc disease patients were discussed among the panel, and it was concluded that although variably used among surgeons, reliable tools exist to appropriately diagnose discogenic back pain.
Challenges and Solutions for Lumbar Total Disc Replacement Implantation
Authors: Janssen Michael , Garcia Rolando , Miller Lynn , Reed William , Zigler Jack , Ferko Nicole , Hollmann Sarah
Published: November 2017

Long-term data are now available to support the safety and efficacy of lumbar total disc replacement (TDR). Five-year randomized and controlled trials, meta-analyses, and observational studies support a similar or lower risk of complications with lumbar TDR compared with fusion. The panel concluded that published data on commercially available lumbar TDR devices demonstrate minimal concerns with late-onset complications, and that the risk of adjacent segment degeneration and reoperations can be reduced with lumbar TDR versus fusion. Survey results of surgeon practice experiences supported the evidence, revealing a low rate of complications with TDR. Panelists acknowledged the importance of adhering to selection criteria to help minimize patient complications.
Barriers to and Budget Impact of Lumbar Total Disc Replacement Utilization
Authors: Sandhu Faheem , Blumenthal Scott , Grunch Betsy , Kimball Bent , Ferko Nicole , Hollmann Sarah
Published: November 2017

Evidence on the favorable efficacy, safety, and cost effectiveness of lumbar total disc replacement (TDR) compared with fusion for lumbar degenerative disc disease is mounting; however, a key barrier identified for TDR utilization is lack of coverage by US health insurers. Although economic considerations in a fee-for-service model should not be a determining factor in patient access, concerns regarding the budget impact of lumbar TDR surgery may unfortunately underlie coverage decisions. On the basis of the data available and economic modeling, the panel agreed that there is no indication that there would be a dramatic increase in patients seeking lumbar TDR. Considering several possible scenarios on potential growth in TDR utilization with coverage, as well as growth in the overall surgical pool of patients, economic modeling demonstrated that adoption of lumbar TDR would result in minimal or no budget impact for commercial insurance plans. Considering these model results and the economic literature, the panel concluded that adopting lumbar TDR within a coverage policy is expected to remain cost neutral for the insurer.
Low participation in organized colorectal cancer screening in France: underlying ethical issues
Authors: Moutel Grégoire , Duchange Nathalie , Lièvre Astrid , Orgerie Marie Brigitte , Jullian Odile , Sancho-Garnier Hélène , Darquy Sylviane
Published: November 2017

International studies have shown a significant reduction in colorectal cancer (CRC) mortality following the implementation of organized screening programs, given a sufficient participation rate and adequate follow-up. The French national CRC screening program has been generalized since 2008 and targets 18 million men and women aged 50–74 years. Despite broad recommendations, the participation rate remains low (29.8%), questioning the efficiency of the program. A panel of experts was appointed by the French National Cancer Institute to critically examine the place of autonomy and efficiency in CRC screening and propose recommendations. In this paper, we explore the ethical significance of a public health intervention that falls short of its objectives owing to low take-up by the population targeted. First, we analyze the reasons for the low CRC screening participation. Second, we examine the models that can be proposed for public health actions, reconciling respect for the individual and the collective good. Our expert panel explored possible ways to enhance take-up of CRC screening within the bounds of individual autonomy, adapting awareness campaigns, and new educational approaches that take into account knowledge and analysis of sociocultural hurdles. Although public health actions must be universal, target actions should nonetheless be developed for nonparticipating population subgroups.
Rare NaV1.7 variants associated with painful diabetic peripheral neuropathy
Authors: Blesneac Iulia , Themistocleous Andreas C. , Fratter Carl , Conrad Linus J. , Ramirez Juan D. , Cox James J. , Tesfaye Solomon , Shillo Pallai R. , Rice Andrew S.C. , Tucker Stephen J. , Bennett David L.H.
Published: November 2017

Diabetic peripheral neuropathy (DPN) is a common disabling complication of diabetes. Almost half of the patients with DPN develop neuropathic pain (NeuP) for which current analgesic treatments are inadequate. Understanding the role of genetic variability in the development of painful DPN is needed for improved understanding of pain pathogenesis for better patient stratification in clinical trials and to target therapy more appropriately. Here, we examined the relationship between variants in the voltage-gated sodium channel NaV1.7 and NeuP in a deeply phenotyped cohort of patients with DPN. Although no rare variants were found in 78 participants with painless DPN, we identified 12 rare NaV1.7 variants in 10 (out of 111) study participants with painful DPN. Five of these variants had previously been described in the context of other NeuP disorders and 7 have not previously been linked to NeuP. Those patients with rare variants reported more severe pain and greater sensitivity to pressure stimuli on quantitative sensory testing. Electrophysiological characterization of 2 of the novel variants (M1852T and T1596I) demonstrated that gain of function changes as a consequence of markedly impaired channel fast inactivation. Using a structural model of NaV1.7, we were also able to provide further insight into the structural mechanisms underlying fast inactivation and the role of the C-terminal domain in this process. Our observations suggest that rare NaV1.7 variants contribute to the development NeuP in patients with DPN. Their identification should aid understanding of sensory phenotype, patient stratification, and help target treatments effectively.
Bacteremia in Patients With Liver Cirrhosis
Authors: Addo Smith Jennifer N. , Yau Raymond , Russo Hannah P. , Putney Kimberly , Restrepo Alejandro , Garey Kevin W. , Sofjan Amelia K.
Published: November 2017

Goals:

The objective of this study was to assess the prevalence and predictors of multidrug resistant organisms (MDRO) in cirrhotic patients with bacteremia at a large tertiary center in the United States.

Background:

The epidemiology of bacteremia in patients with liver cirrhosis has not been well studied in the United States.

Study:

This case-case control study included 180 adults with liver cirrhosis hospitalized from 2011 to 2015. Case group 1 were patients with bacteremia due to a MDRO (n=30). Case group 2 were patients with bacteremia due to a non-MDRO (n=60). Control group comprised patients without bacteremia (n=90). MDRO was defined as bacteria that was nonsusceptible to ≥1 agent in ≥3 antimicrobial categories.

Results:

Of the 90 bacteremia episodes, 44% were because of gram-positive bacteria, 50% were because of gram-negative bacteria, and 6% were polymicrobial. MDROs caused 30 of 90 (33%) bacteremia episodes, including methicillin-resistant Staphylococcus species [12% (11/90)], fluoroquinolone-resistant Enterobacteriaceae [10% (9/90)], and Enterococcus faecium [3% (3/90)]. Eight percent of Enterobacteriaceae produced extended-spectrum β-lactamases. Four independent predictors of MDROs were identified: nonwhite race [adjusted odds ratio (aOR), 3.35; 95% confidence interval (CI), 1.19-9.38], biliary cirrhosis (aOR, 11.75; 95% CI, 2.08-66.32), blood cultures obtained >48 hours after hospital admission (aOR, 6.02; 95% CI, 1.70-21.40), and recent health care exposure (aOR, 9.81; 95% CI, 2.15-44.88).

Conclusions:

A significant proportion of bacteremia in cirrhotic patients was due to MDROs at a large US tertiary care center. Local epidemiology data and identification of risk factors associated with MDROs may help with optimal empiric antibiotic selection.
Impact of Hydroxyurea on Anthropometry and Serum 25-Hydroxyvitamin D Among Children With Sickle Cell Disease
Authors: Adegoke Samuel A. , Braga Josefina A.P. , D. Adekile Adekunle , Figueiredo Maria S.
Published: November 2017

Objective:

To evaluate the impact of hydroxyurea (HU) on nutritional status and serum 25-hydroxyvitamin D (25-OHD) of children with sickle cell disease (SCD).

Design:

Anthropometry and serum 25-OHD were determined in 98 children with SCD, comprising of 68 in HU-group and 30 in HU-naive group.

Results:

Underweight was more common among HU-naive group (33.3% vs. 10.3%,P=0.009), while 79.4% of HU-group against 56.7% HU-naive had normal body mass index percentile for age and sex,P=0.028. None of the HU-group compared with 13.3% of the HU-naive had severe vitamin D deficiency,P=0.002. The mean 25-OHD of the HU-group was also higher (24.1±1.2 vs. 19.1±9.8 ng/mL,P=0.007).

Conclusions:

HU possibly ameliorate growth retardation and vitamin D deficiency in children with SCD.
The Challenge of Next Generation Sequencing in a Boy With Severe Mononucleosis and EBV-related Lymphoma
Authors: Verzegnassi Federico , Valencic Erica , Kiren Valentina , Giurici Nagua , Bianco Anna Monica , Marcuzzi Annalisa , Vozzi Diego , Tommasini Alberto , Faletra Flavio
Published: November 2017

A severe course of infectious mononucleosis should always lead up to the suspicion of a primary immunodeficiency. We describe the case of a boy with severe mononucleosis accompanied by the development of hemophagocytic lymphohistiocytosis and lymphoma. By whole exome sequencing, we identified a mutation of uncertain significance in CTPS2, a gene closely related to CTPS1, which is involved in a primary immune deficiency with susceptibility to herpesviruses. We discuss the challenge of a correct interpretation of data from whole exome sequencing, questioning whether the CTPS2 variant found in our patient is just an incidental finding or a mutation with variable penetrance.
Primary Ewing Sarcoma of the Mastoid: A Novel Case Mimicking Acute Mastoiditis
Authors: Egan Grace , Pierro Joanna , Madhusoodhan Pillai Pallavi , Ilyas Ghulam , Cohen Benjamin , Bhatla Teena
Published: November 2017

Ewing sarcoma (EWS) is a primitive neuroectodermal tumor arising in bone or soft tissue. It is the second most common primary bone malignancy of children and adolescents, with a peak incidence in the second decade of life. It most often arises in the long bones of the extremities and pelvis. Here, we present a novel case of EWS arising from the mastoid bone in a 5-year-old African American male who presented with symptoms of acute mastoiditis. This unique presentation highlights the importance of considering EWS in a patient who presents with atypical mastoiditis or a rapidly growing mass in the postauricular region.
Feasibility and Acceptability of Internet-delivered Cognitive Behavioral Therapy for Chronic Pain in Adolescents With Sickle Cell Disease and Their Parents
Authors: Palermo Tonya M. , Dudeney Joanne , Santanelli James P. , Carletti Alexie , Zempsky William T.
Published: November 2017

Pain is a clinical hallmark of sickle cell disease (SCD), and is rarely optimally managed. Cognitive-behavioral therapy (CBT) for pain has been effectively delivered through the Internet in other pediatric populations. We tested feasibility and acceptability of an Internet-delivered CBT intervention in 25 adolescents with SCD (64% female, mean age=14.8 y) and their parents randomized to Internet CBT (n=15) or Internet Pain Education (n=10). Participants completed pretreatment/posttreatment measures. Eight dyads completed semistructured interviews to evaluate treatment acceptability. Feasibility indicators included recruitment and participation rates, engagement and adherence to intervention, and completion of outcome measures. In total, 87 referrals were received from 9 study sites; our recruitment rate was 60% from those families approached for screening. Among participants, high levels of initial intervention engagement (>90%), and adherence (>70%) were demonstrated. Most participants completed posttreatment outcome and diary measures (>75%). Retention at posttreatment was 80%. High treatment acceptability was reported in interviews. Our findings suggest that Internet-delivered CBT for SCD pain is feasible and acceptable to adolescents with SCD and their parents. Engagement and adherence were good. Next steps are to modify recruitment plans to enhance enrollment and determine efficacy of Internet CBT for SCD pain in a large multisite randomized controlled trial.
A Giant Ear!
Authors: Bakshi Satvinder S.
Published: November 2017

A 17 year old female presented with a progressive swelling on the left pinna for 2 years. On examination the left pinna was enlarged and a pulsatile swelling was felt with an audible bruit. A diagnosis of arteriovenous malformation was confirmed by an angiography which revealed primary feeding vessel from the post auricular artery. The vessel was embolized and the mass excised.
Can Pediatric Risk of Mortality Score (PRISM III) Be Used Effectively in Initial Evaluation and Follow-up of Critically Ill Cancer Patients Admitted to Pediatric Oncology Intensive Care Unit (POICU)? A Prospective Study, in a Tertiary Cancer Center in Egypt
Authors: Sayed Heba A. , Ali Amany M. , Elzembely Mahmoud M.
Published: November 2017

Pediatric Risk of Mortality Score (PRISM III-12) is a physiology-based predictor for risk of mortality. We conducted prospective study from January 1, 2014 to 2015 in pediatric oncology intensive care unit (POICU) at South Egypt Cancer Institute, Egypt to explore the ability of 1st PRISM III-12 to predict the risk of mortality in critically ill cancer patients and the ability of serial PRISM III measured every 72 hours to follow-up the patients’ clinical condition during POICU stay. In total, 123 (78 males) children were included. Median age was 5 years (1 to 15 y). Death rate was 20%. 1st PRISM III-12 mean was 19 (0 to 61). The mean 1st PRISM III-12 for survivors was significantly higher compared with nonsurvivors (15 vs. 37 respectively; P<0.001). 1st PRISM III-12 mean was significantly correlated to the reasons for admission and organ failures’ number (P<0.001 and <0.001). 1st PRISM III-12 correlated weakly positive with the length of stay (r=0.2; P=0.024). Receiver operator curve for 1st PRISM III-12 was 0.913 (95% confidence interval, 0.85-0.98; P<0.001). Decline in serial PRISM III was significantly correlated with favorable (survivor) outcome (P<0.001). We concluded that PRISM III-12 can be used effectively in predicting the risk of mortality and following the clinical condition of patients during POICU stay.