bluuebunny/crossref_metadata_2025 huggingface dataset:
The side effects of deemed consent: changing defaults in organ donation
Authors: Shaw David M
Published: June 2019

In this Current Controversy article, I describe and analyse the imminent move to a system of deemed consent for deceased organ donation in England and similar planned changes in Scotland, in light of evidence from Wales, where the system changed in 2015. Although the media has tended to focus on the potential benefits and ethical issues relating to the main change from an opt-in default to an opt-out one, other defaults will also change, while some will remain the same. Interaction of these other defaults with the principal one raise several ethical issues that may complicate efforts to use deemed consent to increase donation rates. Most significantly, changing the main default will have the effect of changing the default for patients' families, who play a vital role in the consent process.
Hormone replacement therapy: informed consent without assessment?
Authors: Saad Toni C , Blackshaw Bruce Philip , Rodger Daniel
Published: June 2019

Florence Ashley has argued that requiring patients with gender dysphoria to undergo an assessment and referral from a mental health professional before undergoing hormone replacement therapy (HRT) is unethical and may represent an unconscious hostility towards transgender people. We respond, first, by showing that Ashley has conflated the self-reporting of symptoms with self-diagnosis, and that this is not consistent with the standard model of informed consent to medical treatment. Second, we note that the model of informed consent involved in cosmetic surgery resembles the model Ashley defends, and that psychological assessment and referral is recognised as an important aspect of such a model. Third, we suggest that the increased prevalence of psychiatric morbidity in the transgender population arguably supports the requirement of assessment and referral from a mental health professional prior to undergoing HRT.
Derivation and validation of a risk score for predicting mortality among inpatients following rapid response team activation
Authors: White Kyle , Bernard Anne , Scott Ian
Published: June 2019

Purpose of the study

Despite mature rapid response systems (RRS) for clinical deterioration, individuals activating RRS have poor outcomes, with up to one in four dying in hospital. We aimed to derive and validate a risk prediction tool for estimating risk of 28-day mortality among hospitalised patients following rapid response team (RRT) activation.

Study design

Analysis of prospectively collected data on 1151 consecutive RRT activations involving 800 inpatients at a tertiary adult hospital. Patient characteristics, RRT triggers and actions, and mortality were ascertained from medical records and death registries. A multivariable risk prediction regression model, derived from 600 randomly selected patients, was validated in the remaining 200 patients. Main outcome was accuracy of weighted risk score (measured by area under receiver operator curve (AUC)) and performance characteristics for various cut-off scores.

Results

At 28 days, 150 (18.8%) patients had died. Increasing age, emergency admission, chronic liver disease, chronic kidney disease, malignancy, after-hours RRT activation, increasing National Early Warning Score, major/intense RRT intervention and multiple RRT activations were predictors of mortality. The risk score (0–105) in derivation and validation cohorts had AUCs 0.86 (95% CI 0.82 to 0.89) and 0.82 (95% CI 0.75 to 0.90), respectively. In the validation cohort, cut-off score of 32.5 or higher maximised sensitivity: 81.6% (95% CI 68.4% to 92.1%), specificity: 56.2% (95% CI 49.4% to 63.6%), positive likelihood ratio (LR): 1.9 (95% CI 1.5 to 2.3) and negative LR: 0.3 (95% CI 0.2 to 0.6).

Conclusion

A validated risk score predicted risk of post-RRT death with more than 80% accuracy, helping to identify patients for whom targeted rescue care may improve survival.
Efficient biodegradation of 3-phenoxybenzoic acid and pyrethroid pesticides by the novel strain Klebsiella pneumoniae BPBA052
Authors: Tang Jie , Hu Qiong , Liu Bo , Lei Dan , Chen Tingting , Sun Qing , Zeng Chaoyi , Zhang Qing
Published: June 2019

A novel Klebsiella pneumoniae strain (BPBA052) capable of degrading 3-phenoxybenzoic acid (3-PBA) was isolated from soybean rhizosphere soil. The strain was obtained by screening after enrichment, isolation, and purification using 3-PBA as the sole carbon and energy source. It could degrade 96.37% of 3-PBA (100 mg/L) within 72 h, and its growth and 3-PBA degradation followed kinetics models of logistic growth (XBPBA052 = 0.0883 × e0.0947t / [1 − 0.0792 × (1 − 0.0883 × e0.0947t)]; μm = 0.0947 h–1, X0 = 0.0883, and Xm = 1.1145) and first-order degradation (CBPBA052 = 101.8194 × e–0.0403t, k = 0.0403, t1/2 = 17.22 h), respectively. Based on Box–Behnken response surface analysis, the optimal temperature, pH, and 3-PBA concentration for K. pneumoniae BPBA052 were 35.01 °C, 7.77, and 150 mg/L, respectively. Moreover, pyrethroid pesticides (PPs) (such as β-cypermethrin, permethrin, bifenthrin, deltamethrin, and fenvalerate) and 3-PBA metabolites (including phenol, catechol, and protocatechuate) were efficiently utilized by BPBA052. We propose a novel microbial metabolic pathway for 3-PBA, based on metabolite identification; enzyme-degrading activity; and cloning of the phenol hydroxylase, catechol 1,2-dioxygenase, and protocatechuate 3,4-dioxygenase genes. This study provides a fundamental platform for further studies to reveal the mechanism of biodegradation of 3-BPA and show K. pneumoniae BPBA052 as a potential microbial resource for bioremediation of environments polluted with 3-PBA or PPs.
Decreased liver triglyceride content in adult rats exposed to protein restriction during gestation and lactation: roles of hepatic lipogenesis and lipid utilization in muscle and adipose tissue
Authors: Mendez-Garcia Claudia , Trini Afsana , Browne Veron , Kochansky Christopher J. , Pontiggia Laura , D’mello Anil P.
Published: June 2019

Protein restriction throughout pregnancy and lactation reduces liver triglyceride (TG) content in adult male rat offspring. The study determined the contribution of hepatic lipogenesis to the reduction in liver TG content. Rats received either control or protein-restricted diets throughout pregnancy and lactation. Offspring were sacrificed on day 65. Hepatic fatty acid uptake and de novo fatty acid and TG biosynthesis were similar between control and low-protein (LP) offspring. These results indicate that hepatic lipogenesis cannot mediate the decrease in liver TG content in LP offspring. We then determined whether increased lipid utilization in adipose tissue and muscle was responsible for the decrease in liver TG content. There was suggestive evidence of increased sympathetic nervous system tone in epididymal adipose tissue of LP offspring that increased fatty acid uptake, TG lipolysis, and utilization of fatty acids in mitochondrial thermogenesis. Measurement of similar parameters demonstrated that such alterations do not occur in gastrocnemius muscle, another major lipid-utilizing tissue. Our results suggest that the decrease in liver TG content in LP offspring is likely due to increased diversion of fatty acids to white and brown adipose tissue depots and their enhanced utilization to fuel mitochondrial thermogenesis.
Effect of Al Doping on the Structural, Electrical, Gas Sensing Properties of ZnO Nanorods Synthesized by Hydrothermal Growth
Authors: Srivastava V. , Eadi S. B. , Hong S.-K.
Published: June 2019

The effect of Al doping on the morphology and sensing properties of ZnO nanorods have been shown. Undoped and Al-doped well-aligned ZnO nanorods have been grown on sputtered ZnO/SiO2/Si (100) pre-grown seed layer substrate by the hydrothermal method. The molar ratio of dopant (aluminum nitrate) in the solution, [Al/Zn], was varied from 0.1% to 3%. The prepared ZnO nanorods showed preferred orientation [Formula: see text]0001[Formula: see text] and were well aligned vertically. We observed that for 0.5% Al doping the diameter and resistivity of the nanorods became the least, carrier concentration became large. Sensing behavior of the doped samples tested for H2 gas shows the sensitivity of [Formula: see text] at [Formula: see text]C and [Formula: see text] at [Formula: see text]C, respectively.
Deposition of Gold Nanostructures into Porous SiO2∕Si Templates from the Electrolyte Based on Au(I) Sulfite Complex
Authors: Bundyukova V. D. , Yakimchuk D. V. , Shlimas D. I. , Khubezhov S. A.
Published: June 2019

Gold nanostructures were fabricated in porous SiO2/Si ion-track templates by the wet chemical deposition from a solution of Au(I) sulfite complex. Their morphological features were analyzed, and features of the deposition processes were determined. A mechanism describing the selective formation of gold nanostructures in the pores of SiO2 was proposed. The present approach allows us to control shape and size of Au nanostructures those which can be used as plasmonic active surfaces for SERS detecting of small amounts of biological and chemical substances.
Autonomous Object Pick-and-Sort Procedure for Industrial Robotics Application
Authors: Li Lianjun , Zhang Yizhe , Ripperger Michael , Nicho Jorge , Veeraraghavan Malathi , Fumagalli Andrea
Published: June 2019

This paper describes an industrial robotics application, named Gilbreth, for autonomously picking up objects of different types from a moving conveyor belt and sorting the objects into bins according to their type. The environment, which consists of a moving conveyor belt, a break beam sensor, a 3D camera Kinect sensor, a UR10 industrial robot arm with a vacuum gripper, and different object types such as pulleys, disks, gears, and piston rods, is inspired by the NIST ARIAC competition. A first version of the Gilbreth application is implemented leveraging a number of Robot Operating System (ROS) and ROS-Industrial (ROS-I) packages. The Gazebo package is used to simulate the environment, and six external ROS nodes have been implemented to execute the required functions. Experimental measurements of CPU usage and processing times of the ROS nodes are discussed. In particular, the object recognition ROS package requires the highest processing times and offers an opportunity for designing an iterative method with the aim to fasten completion time. Its processing time is found to be on par with the time required by the robot arm to execute its movement between four poses: pick approach, pick, pick retreat and place.
Gait Pattern Recognition Using a Smartwatch Assisting Postoperative Physiotherapy
Authors: Kyritsis Athanasios I. , Willems Geoffrey , Deriaz Michel , Konstantas Dimitri
Published: June 2019

Postoperative rehabilitation is led by physiotherapists and is a vital program that re-establishes joint motion and strengthens the muscles around the joint after an orthopedic surgery. Modern smart devices have affected every aspect of human life. Newly developed technologies have disrupted the way various industries operate, including the healthcare one. Extensive research has been carried out on how smartphone inertial sensors can be used for activity recognition. However, there are very few studies on systems that monitor patients and detect different gait patterns in order to assist the work of physiotherapists during the said rehabilitation phase, even outside the time-limited physiotherapy sessions. In this paper, we are presenting a gait recognition system that was developed to detect different gait patterns. The proposed system was trained, tested and validated with data of people who have undergone lower body orthopedic surgery, recorded by Hirslanden Clinique La Colline, an orthopedic clinic in Geneva, Switzerland. Nine different gait classes were labeled by professional physiotherapists. After extracting both time and frequency domain features from the time series data, several machine learning models were tested including a fully connected neural network. Raw time series data were also fed into a convolutional neural network.
Access controls and healthcare records
Authors: CACM Staff
Published: June 2019

A discussion with David Evans, Richard McDonald, and Terry Coatta.
Study on Deformation and Permeation Properties of Gas-Containing Fractured Rock
Authors: Yang Yushun , Zhang Dongming , Li Shujian
Published: June 2019

In this paper, we investigated the gas permeation properties of fractured rock during the process of stage load axial stress and cyclic load and unload confining pressure and come to some conclusions as follows: (1) the relationship between radial strain and deviatoric stress satisfied the quadratic polynomial function, and the relationship between permeability and deviatoric stress satisfied the exponential function under different axial stress levels; (2) in the staged load axial stress process, the axial strain-deviatoric curves of specimens conform to the quadratic polynomial function. The axial strain-deviatoric curves of specimens conform to linear function when confining pressure is 8.6 MPa or 2.0 MPa at different axial stress levels; (3) we used the permeability damage rate and maximum permeability damage rate to evaluate the recovery degree and reduction extent of permeability; (4) we used the volume expansion ratio and the maximum volume expansion ratio to evaluate the expansion degree and increase extent of rock samples’ volume.
An Effective Approach to Input Variable Selection for Preliminary Cost Estimation of Construction Projects
Authors: Meharie Meseret Getnet , Gariy Zachary C. Abiero , Ndisya Mutuku Raphael Ngumbau , Mengesha Wubshet Jekale
Published: June 2019

Accurate cost estimates are vital to the effective realisation of construction projects. Extended knowledge, wide‐ranging information, substantial expertise, and continuous improvement are required to attain accurate cost estimation. Cost estimation at the preliminary phase of the project is always a challenge as only limited information is available. Hence, rational selection of input variables for preliminary cost estimation could be imperative. A systematic input variable selection approach for preliminary estimating using an integrated methodology of factor analysis and fuzzy AHP is presented in this paper. First, the factor analysis is used to classify and reduce the input variables and their variable coefficients are determined. Second, fuzzy AHP based on the geometric mean method is employed to determine the weights of input variables in a fuzzy environment where the subjectivity and vagueness are handled with natural language expressions parameterized by triangular fuzzy numbers. Then, the input variables are suggested to be selected starting with those having high coefficient and high importance weight. A set of three variables, one from each group, can be added to the estimating model at a time so that the problem of collinearity can vanish and good accuracy of the estimate can be ensured. The proposed approach enables cost estimators to better understand the complete input variable selection process at the early stage of project development and provide a more accurate, rational, and systematic decision support tool.
Jiedu Granule Combined with Transcatheter Arterial Chemoembolization and Gamma Knife Radiosurgery in Treating Hepatocellular Carcinoma with Portal Vein Tumor Thrombus
Authors: Wang Jianchu , Luo Jinhong , Yin Xiaolan , Huang Wei , Cao Huangming , Wang Guilin , Wang Jincheng , Zhou Jun
Published: June 2019

Background. The potential advantages of Jiedu granule (a compound Chinese herbal medicine) combined therapeutic strategies compared with non-Jiedu granule therapeutic strategies for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) remain unclear. Thus, the purpose of the study was to investigate the safety and efficacy of Jiedu granule for HCC with PVTT. Methods. We retrospectively reviewed the clinical data of 190 patients (94 for non-Jiedu and 96 for Jiedu) with HCC and PVTT from March 2012 to October 2016. Patients were followed up by outpatient examination and telephone till November 2018. Results. It was statistically insignificant between the two groups in baseline characteristics. Procedure-related adverse events (AEs) were observed and compared and most of them were not serious which were easily controlled or subsided naturally. No AE-induced death happened. The median overall survival (OS) rates in the single TACE plus GKR and Jiedu granule combined group were 11.3 months (95% CI: 9.168-13.435) and 15.8 months (95% CI: 13.244-18.339), respectively (p = 0.00047). Conclusions. Jiedu granule combined with TACE plus GKR is safe in HCC patients with PVTT and this Chinese herbal medicine is worthy to be promoted because of better prognosis which needs further research.
Health Benefits of Endurance Training: Implications of the Brain-Derived Neurotrophic Factor—A Systematic Review
Authors: Mrówczyński Włodzimierz
Published: June 2019

This article presents a concept that wide expression of brain-derived neurotrophic factor (BDNF) and its receptors (TrkB) in the nervous tissue, evoked by regular endurance training (ET), can cause numerous motor and metabolic adaptations, which are beneficial for human health. The relationships between the training-evoked increase of endogenous BDNF and molecular and/or physiological adaptations in the nervous structures controlling both motor performance and homeostasis of the whole organism have been presented. Due to a very wide range of plastic changes that ET has exerted on various systems of the body, the improvement of motor skills and counteraction of the development of civilization diseases resulting from the posttraining increase of BDNF/TrkB levels have been discussed, as important for people, who undertake ET. Thus, this report presents the influence of endurance exercises on the (1) transformation of motoneuron properties, which are a final element of the motor pathways, (2) reduction of motor deficits evoked by Parkinson disease, and (3) prevention of the metabolic syndrome (MetS). This review suggests that the increase of posttraining levels of BDNF and its TrkB receptors causes simultaneous changes in the activity of the spinal cord, the substantia nigra, and the hypothalamic nuclei neurons, which are responsible for the alteration of the functional properties of motoneurons innervating the skeletal muscles, for the enhancement of dopamine release in the brain, and for the modulation of hormone levels involved in regulating the metabolic processes, responsively. Finally, training-evoked increase of the BDNF/TrkB leads to a change in a manner of regulation of skeletal muscles, causes a reduction of motor deficits observed in the Parkinson disease, and lowers weight, glucose level, and blood pressure, which accompany the MetS. Therefore, BDNF seems to be the molecular factor of pleiotropic activity, important in the modulation processes, underlying adaptations, which result from ET.
Lamb Wave Directional Sensing with Piezoelectric Fiber Rosette in Structure Health Monitoring
Authors: Wang Songlai , Wu Wanrong , Shen Yiping , Li Hui , Tang Binlong
Published: June 2019

Directional piezoelectric sensors can detect the Lamb wave propagation direction to locate damage in structural health monitoring (SHM). The directivity of the round piezoelectric fiber is exploited with a 0°/45°/90° rosette configuration to acquire flexural Lamb wave signals. The directional response of the piezoelectric fiber under narrowband tone‐burst excitation is theoretically deduced. Experimental tests are conducted to demonstrate the directivity and the frequency response property of the piezoelectric fiber under different excitation central frequencies in comparison with the MFC, rectangular piezoelectric sheet, and circular piezoelectric disc. Continuous wavelet transform (CWT) is applied to extract the maximum response amplitude information of the acquired Lamb wave signal at a central frequency. Experimental test results indicate that the piezoelectric fiber is capable to be used as a Lamb wave directional sensor than other piezoelectric sensors. A numerical estimation method for the Lamb wave propagation direction is proposed by defining an error function between the theoretical and experimental normalized response amplitude. The proposed method is generally applicable for different rosette configurations. Experimental results validate the accuracy of the proposed estimation method. The research results are significant to design or select the piezoelectric sensor to measure Lamb wave signals.
Numerical and Experimental Investigation of the Sealing Effect of a Specific Labyrinth Seal Structure
Authors: Yang Shiping , Tan Bosi , Deng Xiaofen
Published: June 2019

A numerical simulation and experimental study were performed to investigate the sealing effect of the labyrinth seal used in a wheel‐side reducer. A three‐dimensional computational fluid dynamics model was established based on the labyrinth structure. The effects of the temperature and viscosity of lubricant, rotor speed, pressure ratio, clearance, and cavity size of the sealing structure on the sealing were analyzed, and the leakage amount under the corresponding values of different factors was also analyzed. The results indicated that increase in the lubricating oil temperature, viscosity, pressure ratio, and seal clearance lead to decrease in the sealing effect and increases in the leakage. And the effect of rotational speed on the seal is low. To verify numerical simulation, the results of numerical analysis, a test bench was set up to simulate the work of the reducer, and the sealing effect of the sealing structure was examined. The simulation result was compared with the actual results. Both the numerical simulation and experiment indicate that the labyrinth seal achieves the desired sealing effect.
Dolichocebus gaimanensis Is Not a Stem Platyrrhine
Authors: Rosenberger Alfred L.
Published: June 2019

The lower molars of the early Miocene New World monkey Dolichocebus gaimanensis from Patagonia, considered by some to be a stem platyrrhine, are for all intents and purposes indistinguishable from the same teeth preserved in the type specimen of the middle Miocene Laventiana annectens from Colombia. Canine morphology further indicates that Dolichocebus is a cebine, closely related to living Saimiri. The phenetic and phyletic continuity of these extinct species, here classified as congeners, means they are the first fossil platyrrhines that link South America’s southern and northern Miocene monkey faunas, possibly as vicariant communities or with ancestral-descendant species that evolved by phyletic evolution. These findings further refute the hypothesis that early Miocene platyrrhines are (1) monophyletic and (2) outside the so-called crown platyrrhine radiation. The connection between these species is additional evidence supporting the hypothesis that the pattern of platyrrhine evolution is notably distinct for the predominance of low-level taxonomic clades (genera, tribes, subfamilies) of prolonged ecophylogenetic stability, which is the essence of the Long-Lineage Hypothesis.
Variantes del ensayo en revistas digitales de Argentina. Coyunturas, escrituras, experiencias
Authors: Vigna Diego Germán
Published: June 2019

Este artículo aborda formas textuales que son consideradas como ensayísticas y que se distinguen, en su condición de publicaciones digitales, por objetivos, indagaciones y estéticas dispares, lo que obliga a revisar la tradición del ensayo construida sobre la cultura impresa. El análisis no parte de los textos, ni de sus autores ni de los temas que abordan, aunque desemboca en estos aspectos. La mirada surge de la reflexión sobre el soporte digital y los formatos de publicación web, partiendo del reconocimiento específico de la revista cultural y literaria como el “artefacto mediador” que en Argentina dio densidad y dinamismo a la producción ensayística. El objetivo del trabajo es mostrar registros ensayísticos firmados por escritores que se publican en revistas digitales y que dan cuenta del trabajo actual de instituciones y formaciones en el campo literario nacional.
Modos de resistencia en Fruta Podrida de Lina Meruane
Authors: Novelli Julieta
Published: June 2019

Este trabajo propone una lectura de Fruta podrida de Lina Meruane que se despliega a partir de la pregunta por las tensiones entre discursos (im)productivos, por el lugar que ocupan los cuerpos y la poesía en relación con los discursos del saber y de lo útil. Para pensar en estas tensiones, utilizamos dos figuras teóricas: exforma (Bourriaud) y resto (Cragnolini). La pesquisa gira en torno a los distintos modos de resistencia presentes en la novela–el silencio, la poesía, la desubjetivación- frente al discurso de la institución médica y del mercado. La tensión entre el poder estabilizador de la Institución y la impugnación de este discurso propicia una resistencia en ese devenir de descomposición del discurso que permite que sobrevivan otros modos, lenguas o subjetividades como resto o exforma.
Coleccionista, artista, monstruo: El Duque de Bomarzo en La Boca del Infierno de María Negroni
Authors: Pozzi Rayén Daiana
Published: June 2019

Ante el pronunciado vínculo entre Bomarzo (1962) de Manuel Mujica Láinez y La Boca del Infierno (2009) de María Negroni, este artículo propone una lectura atenta a las significaciones actualizadas por la reescritura que realiza Negroni, quien ya había realizado una rescritura de alguna zona de la tradición en otras obras anteriores. Esta sostenida estrategia de reelaboración habilita una lectura atenta a los caracteres que definen una estética radicante. En este trabajo, el examen de la correspondencia del sujeto hablante de ambas obras pone en relieve tanto los rasgos sobresalientes de la singularidad de este sujeto (huérfano, coleccionista, artista y “monstruo”) como algunas diferencias en la figuración que cada texto construye. Así, la boca/gruta/cripta del infierno creada por Negroni se abre a las tensiones singularidad/otredad y prolifera a partir de la historia de Bomarzo prestándose a nuevos arraigos que desenvuelven una poética radicante.
Rheum moorcroftianum (Polygonaceae) in Kashmir Himalaya
Authors: KHAN MOHD. ISHFAQ , PANDITH SHAHZAD A. , RAMAZAN SALIKA , SHAH MANZOOR A. , MALIK AKHTAR H. , RESHI ZAFAR A.
Published: June 2019

Rheum moorcroftianum (Polygonaceae) was recorded for the first time in Kashmir Himalayas region. The species was identified using morphological and molecular (DNA-barcode) data. R. moorcroftianum can be distinguished from the other Rheum species on the basis of absence of stem, 3‒7 or more basal leaves, inflorescence in branched panicle, rachis papilliferous, perianth yellow-white, anthers pinkish-red, and seeds red, 3-winged.
Phytotaxa Begonia Special Issue: Part II (Table of contents)
Authors: TIAN DAI-KE , SHUI YU-MIN , HUGHES MARK , KIEW RUTH , TEBBITT MARK , MOONLIGHT PETER W.
Published: June 2019

N/A
Revision of Ilyocryptus Sars, 1862 (Cladocera: Ilyocryptidae) of Brazil with description of two new subspecies
Authors: KOTOV ALEXEY A. , ELMOOR-LOUREIRO LOURDES M. A.
Published: June 2019

Analyzing numerous samples from Brazil, we found only three previously described species of Ilyocryptus (Cladocera: Anomopoda: Ilyocryptidae): I. paranaensis paranaensis Paggi, 1989, I. sarsi Stingelin, 1913 and I. spinifer Herrick, 1882. Two new taxa, being Neotropical subspecies of the species previously described from Palaearctic, I. cuneatus brasiliensis subsp. nov. and I. silvaeducensis paraensis subsp. nov., are described. Maps of Brazilian records are provided for each species using both original and literature data. Most part of records of Brazilian ilyocryptids concerns I. spinifer, which is among the most common cladocerans in the Neotropics, while other taxa occur significantly rare. I. spinifer has a wide distributional range. “I. sarsi” seems to be a group of close topical congeners, quite possible that I. sarsi s. str. is an exclusively Neotropical taxon. Three other recorded species are Neotropical endemics. We believe that previous records of I. sordidus (Lévin, 1848) from Brazil were misidentifications, probably of two newly described taxa, or I. sarsi.
Classification of Driver Distraction: A Comprehensive Analysis of Feature Generation, Machine Learning, and Input Measures
Authors: McDonald Anthony D. , Ferris Thomas K. , Wiener Tyler A.
Published: June 2019

Objective

The objective of this study was to analyze a set of driver performance and physiological data using advanced machine learning approaches, including feature generation, to determine the best-performing algorithms for detecting driver distraction and predicting the source of distraction.

Background

Distracted driving is a causal factor in many vehicle crashes, often resulting in injuries and deaths. As mobile devices and in-vehicle information systems become more prevalent, the ability to detect and mitigate driver distraction becomes more important.

Method

This study trained 21 algorithms to identify when drivers were distracted by secondary cognitive and texting tasks. The algorithms included physiological and driving behavioral input processed with a comprehensive feature generation package, Time Series Feature Extraction based on Scalable Hypothesis tests.

Results

Results showed that a Random Forest algorithm, trained using only driving behavior measures and excluding driver physiological data, was the highest-performing algorithm for accurately classifying driver distraction. The most important input measures identified were lane offset, speed, and steering, whereas the most important feature types were standard deviation, quantiles, and nonlinear transforms.

Conclusion

This work suggests that distraction detection algorithms may be improved by considering ensemble machine learning algorithms that are trained with driving behavior measures and nonstandard features. In addition, the study presents several new indicators of distraction derived from speed and steering measures.

Application

Future development of distraction mitigation systems should focus on driver behavior–based algorithms that use complex feature generation techniques.
Occupational Licensing of Social Services and Nursing Home Quality: A Regression Discontinuity Approach
Authors: Bowblis John R. , Smith Austin C.
Published: June 2019

Occupational licensing has grown dramatically in recent years, with more than 25% of the US workforce having a license as of 2008, up from 5% in 1950. Has licensing improved quality or is it simply rent-seeking behavior by incumbent workers? To estimate the impact of increased licensure of social workers in skilled nursing facilities (SNFs) on service quality, the authors exploit a federal staffing provision that requires SNFs of a certain size to employ licensed social workers. Using a regression discontinuity design, the authors find that qualified social worker staffing increases by approximately 10%. However, the overall increase in social services staffing is negligible because SNFs primarily meet this requirement in the lowest cost way—substituting qualified social workers for unlicensed social services staff. The authors find no evidence that the increase in licensure improves patient care quality, patient quality of life, or quality of social services provided.
Rebutting Distortions of How the Sanctity of Life Doctrine Applies to the Periviable
Authors: Pierucci Robin
Published: June 2019

In the September article “Should Parents of Neonates with Bleak Prognosis Be Encouraged to Opt for Another Child with Better Odds? On the Notion of Moral Replaceability,” (Tännsjö 2018, S552-57), the author contrasts how three different moral philosophies can be applied to medical decision-making for periviable babies. Unfortunately, the sanctity of life doctrine is critically misrepresented. Unlike what is stated in the article, this doctrine is not a framework that unconditionally advises the resuscitation of all extremely premature babies at all costs under any circumstances. Instead, by considering the degree of usefulness and burdensomeness of medical treatments, the sanctity of life doctrine exercises a prudent stewardship over finite resources while simultaneously honoring the inherent dignity in every human being.
A Critical Analysis of Medicare Claims for Otolaryngology Procedures
Authors: Youssef Stephanie J. , Vyas Krishna S.
Published: June 2019

Objective

This study was performed to outline and analyze the overall Medicare landscape with respect to otolaryngologists and beneficiaries, services, and reimbursements.

Methods

This is a retrospective analysis of publicly available Medicare utilization and payment data for all otolaryngologists in facility and nonfacility practice settings who provided services to Medicare beneficiaries between January 1, 2012, and December 31, 2016.

Results

In 2016, a total of $701,195,375 was distributed to 8572 otolaryngology physician providers for 815 unique Healthcare Common Procedure Coding System codes for 13,942,536 procedure claims. Of specialty care, otolaryngology ranks 20th among 54 subspecialties for total Medicare payments. The average number of services coded per provider was 1627. The average otolaryngologist was paid $81,800.67. Thirty‐two percent of otolaryngologists did not receive reimbursement for services from Medicare in 2016.

Discussion

In 2016, the most significant contributors to Medicare payments to otolaryngologists were large‐scale, low‐cost events that are relatively short procedures done in clinic. Utilization of nasal endoscopy was up trending from 2012 to 2016. Some of the Current Procedural Terminology codes with the greatest discrepancies between submitted charge and Medicare payment among nonfacility otolaryngology providers are more involved than simple office procedures.

Implications for Practice

It is increasingly valuable for physicians to know factors that affect reimbursement for procedures and operations in different settings and to be aware of the trends in variation in their specialty. Otolaryngologists should communicate with policy makers in efforts toward sustainable reimbursement models.
Impact of stroke co-morbidities on cortical collateral flow following ischaemic stroke
Authors: Biose Ifechukwude J , Dewar Deborah , Macrae I Mhairi , McCabe Christopher
Published: June 2019

Acute hyperglycaemia and chronic hypertension worsen stroke outcome but their impact on collateral perfusion, a determinant of penumbral life span, is poorly understood. Laser-speckle contrast imaging (LSCI) was used to determine the influence of these stroke comorbidities on cortical perfusion after permanent middle cerebral artery occlusion (pMCAO) in spontaneously hypertensive stroke prone rats (SHRSP) and normotensive Wistar rats. Four independent studies were conducted. In animals without pMCAO, cortical perfusion remained stable over 180 min. Following pMCAO, cortical perfusion was markedly reduced at 30 min then gradually increased, via cortical collaterals, over the subsequent 3.5 h. In the contralateral non-ischaemic hemisphere, perfusion did not change over time. Acute hyperglycaemia (in normotensive Wistar) and chronic hypertension (SHRSP) attenuated the restoration of cortical perfusion after pMCAO. Inhaled nitric oxide did not influence cortical perfusion in SHRSP following pMCAO. Thus, hyperglycaemia at the time of arterial occlusion or pre-existing hypertension impaired the dynamic recruitment of cortical collaterals after pMCAO. The impairment of collateral recruitment may contribute to the detrimental effects these comorbidities have on stroke outcome.
Minimizing the surgical approach for a rare disease: transanal endoscopic microsurgery for rectal schwannoma
Authors: Guaglio Marcello , Belli Filiberto , Cesa Bianchi Alessandro , Sorrentino Luca , Battaglia Luigi
Published: June 2019

Objective:

Rectal schwannomas are extremely rare tumors and their surgical treatment is widely variable in literature. Transanal endoscopic microsurgery (TEM) approach could be a reasonable option for such lesions, offering an organ-sparing strategy, but evidence is scarce.

Methods:

We report a 69-year-old man with a rectal submucosal lesion at 10 cm from the anal verge, treated by TEM. A systematic literature review on surgical approaches in rectal schwannoma was performed.

Results:

The patient was successfully treated by TEM, with adequate excision of the submucosal lesion. Histopathology revealed a rectal schwannoma. No recurrence was found at 1-year endoscopic follow-up. Previous studies reported 23 cases of rectal schwannoma and several treatment options, but only 2 cases were treated by TEM. Anterior rectal resection was generally adopted in cases of large, symptomatic masses with inconclusive preoperative biopsy, while lesions with features suggestive of stromal tumors were preferentially treated by endoscopy or, if located in distal rectum, by transanal approaches.

Conclusions:

An organ-sparing minimally invasive approach should be the standard of care for rectal schwannomas. TEM could extend the indication for their endoscopic treatment, providing adequate excision even for larger schwannomas of the middle–upper rectum.
Eptinezumab for prevention of chronic migraine: A randomized phase 2b clinical trial
Authors: Dodick David W , Lipton Richard B , Silberstein Stephen , Goadsby Peter J , Biondi David , Hirman Joe , Cady Roger , Smith Jeff
Published: June 2019

Background

Calcitonin gene-related peptide plays an important role in migraine pathophysiology. We evaluated eptinezumab, an intravenous (IV) anti-calcitonin gene-related peptide monoclonal antibody, for the prevention of chronic migraine.

Objective

To determine the safety, tolerability, and effectiveness of four dose levels of eptinezumab and to inform the phase 3 development program.

Methods

This was a phase 2b, parallel-group, double-blind, randomized, placebo-controlled, dose-ranging clinical trial. Men and women (N = 616) aged 18–55 years were included if they had a diagnosis of chronic migraine, with onset at age ≤35 years and history of chronic migraine ≥1 year. During the 28-day screening period, patients must have had ≥15 headache days, including ≥8 migraine days, with ≥5 migraine attacks as recorded in the electronic diary. Patients were assigned in a 1:1:1:1:1 ratio to eptinezumab 300, 100, 30, 10 mg or placebo, administered as a single IV infusion. The primary endpoint was the percentage of patients with a ≥75% decrease in monthly migraine days over weeks 1–12 compared with the 28-day screening period.

Results

The ≥75% migraine responder rates over weeks 1–12 for eptinezumab 300, 100, 30, and 10 mg were 33.3%, 31.4%, 28.2%, and 26.8%, respectively, versus 20.7% for placebo ( p = 0.033, 0.072, 0.201, 0.294 vs. placebo). Secondary efficacy endpoints (e.g. ≥50% responder rate, change from baseline in frequency of migraine/headache days, and percentage of severe migraines) had results favoring the three higher eptinezumab doses versus placebo. Eptinezumab was well tolerated and adverse event rates were similar to placebo.

Conclusions

The results of this trial demonstrate that eptinezumab appears effective and well-tolerated for the preventive treatment of chronic migraine and justifies the conduct of pivotal phase 3 trials for migraine prevention.

Trial Registration

ClinicalTrials.gov identifier: NCT02275117.
Biomechanical Assessment of a Distally Fixed Lateral Extra-articular Augmentation Procedure in the Treatment of Anterolateral Rotational Laxity of the Knee
Authors: Devitt Brian M. , Lord Breck R. , Williams Andy , Amis Andrew A. , Feller Julian A.
Published: June 2019

Background:

Most lateral extra-articular tenodesis (LET) procedures rely on passing a strip of the iliotibial band (ITB) under the fibular (lateral) collateral ligament and fixing it proximally to the femur. The Ellison procedure is a distally fixed lateral extra-articular augmentation procedure with no proximal fixation of the ITB. It has the potential advantages of maintaining a dynamic element of control of knee rotation and avoiding the possibility of overconstraint.

Hypothesis:

The modified Ellison procedure would restore native knee kinematics after sectioning of the anterolateral capsule, and closure of the ITB defect would decrease rotational laxity of the knee.

Study Design:

Controlled laboratory study.

Methods:

Twelve fresh-frozen cadaveric knees were tested in a 6 degrees of freedom robotic system through 0° to 90° of knee flexion to assess anteroposterior, internal rotation (IR), and external rotation laxities. A simulated pivot shift (SPS) was performed at 0°, 15°, 30°, and 45° of flexion. Kinematic testing was performed in the intact knee and anterolateral capsule–injured knee and after the modified Ellison procedure, with and without closure of the ITB defect. A novel pulley system was used to load the ITB at 30 N for all testing states. Statistical analysis used repeated measures analyses of variance and paired t tests with Bonferroni adjustments.

Results:

Sectioning of the anterolateral capsule increased anterior drawer and IR during isolated displacement and with the SPS (mean increase, 2° of IR; P < .05). The modified Ellison procedure reduced both isolated and coupled IR as compared with the sectioned state ( P < .05). During isolated testing, IR was reduced close to that of the intact state with the modified Ellison procedure, except at 30° of knee flexion, when it was slightly overconstrained. During the SPS, IR with the closed modified Ellison was less than that in the intact state at 15° and 30° of flexion. No significant differences in knee kinematics were seen between the ITB defect open and closed.

Conclusion:

A distally fixed lateral augmentation procedure can closely restore knee laxities to native values in an anterolateral capsule–sectioned knee. Although the modified Ellison did result in overconstraint to isolated IR and coupled IR during SPS, this occurred only in the early range of knee flexion. Closure of the ITB defect had no effect on knee kinematics.

Clinical Relevance:

A distally fixed lateral extra-articular augmentation procedure provides an alternative to a proximally fixed LET and can reduce anterolateral laxity in the anterolateral capsule–injured knee and restore kinematics close to the intact state.
Adaptive sliding mode fault tolerant control design for uncertain nonlinear systems with multiplicative faults: Takagi–Sugeno fuzzy approach
Authors: Ben Brahim Ali , Dhahri Slim , Ben Hmida Fayçal , Sellami Anis
Published: June 2019

The present article deals with adaptive sliding mode fault tolerant control design for uncertain nonlinear systems, affected by multiplicative faults, that is described under Takagi–Sugeno fuzzy representation. First, we propose to conceive robust adaptive observer in order to achieve states and multiplicative faults estimation in the presence of nonlinear system uncertainties. Under the nonlinear Lipschitz condition, the observer gains are attained by solving the multi-objective optimization problem. Second, sliding mode controller is suggested to offer a solution of the closed-loop system stability even the occurrence of real fault effects. The main objective is to compensate multiplicative fault effects based on output feedback information. Sufficient conditions are developed with [Formula: see text] performances and expressed as a set of linear matrix inequalities subject to compute controller gains. Finally, simulation results, using the nonlinear model of a single-link flexible joint robot system, are given to illustrate the capability of the suggested fault tolerant control strategy to treat multiplicative faults.
Robust optimisation of dynamic and NVH characteristics for compound power-split hybrid transmission
Authors: Guo Han , Zhang Jianwu , Yu Haisheng
Published: June 2019

In this paper, vibro-acoustic characteristics of a power-split hybrid transmission including a compound planetary gear set are investigated by numerical procedure and refined system dynamics modelling. For validation of the numerical predictions, bench tests are performed for dynamic and acoustic responses of the hybrid transmission, contribution rates of acoustic radiation power induced due to the planetary gears, support bearings, transmission shafts and the gearbox housing are estimated. In improving the noise, vibration and harshness (NVH) performance of the transmission during hybrid vehicle acceleration, traction torques of the motors against the planetary gear parametric resonance are formulated and an optimal control strategy is proposed. By real road NVH test results acquired on board of the midsize hybrid car, it is demonstrated that a significant reduction of the planetary gear whine noise is achieved. As a result, numerical approaches applied to establish relationships between torques of the two traction motors and parametric excitations of the compound planetary gear train are experimentally validated.
Surgical Diabetic Foot Debridement: Improving Training and Practice Utilizing the Traffic Light Principle
Authors: Ahluwalia Raju , Vainieri Erika , Tam Joseph , Sait Saif , Sinha Aaditya , Manu Chris Adusei , Reichert Ines , Kavarthapu Venu , Edmonds Michael , Vas Prashant
Published: June 2019

Comprehensive management of a severe diabetic foot infection focus on clear treatment pathways. Including rapid, radical debridement of all infection in addition to intravenous antibiotics and supportive measures. However, inexperienced surgeons can often underestimate the extent of infection, risking inadequate debridement, repeated theatre episodes, higher hospital morbidity, and hospital length of stay (LOS). This study aims to assess protocolized diabetic-foot-debridement: Red-Amber-Green (RAG) model as part of a value-based driven intervention. The model highlights necrotic/infected tissue (red-zone, nonviable), followed by areas of moderate damage (amber-zone), healthy tissue (green-zone, viable). Sequential training of orthopedic surgeons supporting our emergency service was undertaken prior to introduction. We compared outcomes before/after RAG introduction (pre-RAG, n = 48; post- RAG, n = 35). Outcomes measured included: impact on number of debridement/individual admission, percentage of individuals requiring multiple debridement, and length-of-hospital-stay as a function-of-cost. All-patients fulfilled grade 2/3, stage-B, of the Texas-Wound-Classification. Those with evidence of ischemia were excluded. The pre-RAG-group were younger (53.8 ± 11.0 years vs 60.3 ± 9.2 years, P = .01); otherwise the 2-groups were matched: HbA1c, white blood cell count, and C-reactive protein. The post-RAG-group underwent significantly lower numbers of debridement’s (1.1 ± 0.3 vs 1.5 ± 0.6/individual admission, P = .003); equired fewer visits to theatre (8.6% vs 38%, P = .003), their LOS was reduced (median LOS pre-RAG 36.0 vs post-RAG 21.5 days, P = .02). RAG facilitates infection clearance, fewer theatre-episodes, and shorter LOS. This protocolized-management-tools in acute severely infected diabetic foot infection offers benefits to patients and health-care-gain.
Time Use and Happiness of Millionaires: Evidence From the Netherlands
Authors: Smeets Paul , Whillans Ashley , Bekkers Rene , Norton Michael I.
Published: June 2019

How do the very wealthy spend their time, and how does time use relate to well-being? In two studies in the Netherlands, the affluent ( N = 863; N = 690) and the general population ( N = 1,232; N = 306) spent time in surprisingly similar ways such as by spending the same amount of time working. Yet the nature of their time use differed in critical ways that are related to life satisfaction. In Study 1, millionaires spent more time engaged in active leisure (e.g., exercising and volunteering) rather than passive leisure (e.g., watching television and relaxing). In Study 2, millionaires spent more time engaged in tasks at work over which they had more control. The affluent sample belongs to the top of the income and wealth distribution, representing a significantly wealthier sample than in previous studies. These results further our understanding of when and how wealth may translate into greater well-being. All materials for this article are available at https://osf.io/vndmt/