bluuebunny/crossref_metadata_2025 huggingface dataset:
Smartphone Confrontational Applications and Security Issues
Authors: Kumar Abhishek , Chatterjee Jyotir Moy , Rathore Pramod Singh
Published: January 2020

In today's society, there is a high volume of smartphones, with Android being the most popular and most commonly used smartphones. In the last few years, the Android market has been booming, making lots of developers join the industry so as to create various mobile applications that are a benefit to people's lives. However, its over-popularity has brought many crime issues, including security. One of the major common incidents to mobile users is having their mobile phones lost or stolen. Since most mobile users want to find their lost phones, they are looking for the most reliable features that can help them locate their smartphones. Luckily, there are some developed applications and services that have been designed to track down and locate lost or stolen smartphones. In this work, the authors tried to identify a collection of these applications and the information they send to the user in aiding them to find their phone. Since some applications are able to send location information or a photo, this work will look at what metadata is usually sent with the message.
Reducing the Risk of Failure by Deliberate Weaknesses
Authors: Todinov Michael Todorov
Published: January 2020

The deliberate weaknesses are points of weakness towards which a potential failure is channeled in order to limit the magnitude of the consequences from failure. The article shows that reducing risk by deliberate weaknesses is a powerful domain-independent method which transcends mechanical engineering and works in various unrelated areas of human activity. A classification has been proposed of categories and classes of deliberate weaknesses reducing risk as well as discussion related to the underlying mechanisms of risk reduction. It is shown that introducing and repositioning existing weaknesses is an effective risk-reduction strategy which transcends engineering and can be applied in many unrelated domains. The article shows that in the case where the cost of failure of the separate components in a system varies significantly, an approach based on deliberate weaknesses has a significant advantage to the equal-reliability/equal-strength design approach.
Technical Report White Paper
Authors: Abitew Endalsasa Belay
Published: January 2020

This study focuses on the risks of passenger overloading in urban public transports in Bahir Dar City, Ethiopia. The main purpose of this study was to communicate the problem of passenger overloading in urban public transport in Bahir Dar City and thereby to show the possibility of negative impacts associated with overloading of passengers in urban public transportation. The author of this study has not employed the data collected by questionnaire, interview, and focus group discussion, rather the researcher's personal observation was used. The study encompasses contents like reviewing of related literature on the area under discussion, description of the situation of urban public transportation in Bahir Dar City, the possibility of negative impacts of passengers overloading in urban public transport and the possible suggestions or recommendations to curb the risks of excess passengers on public transport vehicles.
O uso do modelo COSO na administração pública: um estudo nos municípios catarinenses
Authors: Gattringer João Luiz , Marinho Sidnei Vieira
Published: January 2020

O objetivo deste estudo foi avaliar os Controles Internos que estão em operação nos municípios Catarinenses para constatar se os componentes e princípios de Controles Internos do modelo COSO Framework 2013, relacionados à eficiência operacional: ambiente de controle, avaliação de risco, atividades de controle, informação e comunicação e monitoramento, estão substancialmente presentes. A pesquisa molda-se à abordagem quantitativa, na estratégia de levantamento survey, de caráter descritivo com corte transversal. Os dados foram coletados por meio de questionário estruturado, com 80 perguntas diretas do tipo Likert de 5 pontos, atingindo todos os responsáveis pelos Controles Internos dos 295 municípios pesquisados, consolidando-se o censo. Avaliou-se a confiabilidade interna das escalas pelo alfa de Cronbach, que apresentou valores acima de 0,7 para todas as variáveis. Para medir as características dos componentes que impactam na eficiência operacional, usou-se a análise descritiva, com cálculo da média e desvio-padrão, agrupados por componentes e princípios do modelo COSO Framework 2013.O resultado da pesquisa evidenciou que os municípios catarinenses, no seu conjunto, utilizam satisfatoriamente os 5 componentes do modelo COSO Framework 2013, contribuindo para a efetividade do Sistema de Controle Interno, considerando que atingiu o índice médio geral de 3,7421. A pesquisa também revelou a necessidade de aprimoramento dos componentes Ambiente de Controle (índice médio de 3,4991) e Informação e Comunicação (índice médio de 3,5454).
Legibilidade das notas explicativas das empresas brasileiras de capital aberto
Authors: Holtz Luciana , Santos Odilanei Morais dos
Published: January 2020

Com o objetivo de identificar os determinantes da legibilidade das notas explicativas (NEs) das empresas brasileiras listadas na B3, observado o período pré e pós adoção de normas internacionais de contabilidade, desenvolveu-se um estudo quantitativo, utilizando-os dados dos anos de 2005, 2010 e 2015. A amostra compreendeu entre 205 e 164 empresas, variando de acordo com os testes estatísticos aplicados. A motivação do estudo pauta-se no fato de que a adoção das normas internacionais de contabilidade fornece um contexto interessante para que sejam realizados estudos comparativos e considera-se que a legibilidade impacta nas atividades e nas decisões dos usuários da informação contábil. Pode-se verificar que as NEs em 2010 e 2015 possuem menor nível de legibilidade em comparação com 2005, indicando que a adoção das normas internacionais provocou uma redução na legibilidade das NEs. Constatou-se ainda que as NEs, quando avaliadas pelo índice de Flesch, são consideradas de difícil leitura resultado este condizente com os estudos internacionais. Em relação aos determinantes, obteve-se evidências de que o tamanho e o desempenho impactam nas métricas de legibilidade das NEs das empresas brasileiras de capital aberto, sendo que o tamanho está relacionado com o fato de que a complexidade do negócio leva a relatórios maiores e menos legíveis, enquanto que o desempenho se relaciona com a hipótese de ofuscação, em que empresas com desempenho ruim tendem a ofuscar seu resultado, elaborando relatórios menos legíveis.
Celulares a postos? Estudo sobre a percepção de alunos de ciências contábeis acerca do sistema de resposta de audiência (SRA)
Authors: Nasu Vitor Hideo , Nogueira Daniel Ramos
Published: January 2020

O Sistema de Resposta da Audiência (SRA) é uma tecnologia educacional que promove atividades de quiz. Sua utilização visa promover mais participação e motivação discente, podendo ser considerada por professores de contabilidade. Desta forma, este estudo objetiva analisar as percepções dos alunos de Ciências Contábeis acerca dos modelos Plickers e Kahoot!.O estudo é caracterizado como pesquisa de surveye foi desenvolvido em uma instituição de ensino superior localizada no Paraná durante o 3º e 4º bimestre de 2017 com três turmas (n = 68). Para a coleta dos dados, foram aplicados, in loco, questionários ao final do período da pesquisa para obter informações sócio demográficas e a percepção discente sobre o uso do SRAs. As estatísticas descritivas indicaram que os SRAs fornecem feedback rapidamente, tornam as aulas divertidas e criam maior interatividade em sala de aula. Os testes pareados de Wilcoxon apontaram que, de forma geral, os alunos preferem o modelo Kahoot! ao Plickers. Dentre os modelos Kahoot!, Plickers e às Questões Impressas em Papel para atividade de quiz, as estatísticas descritivas sustentaram que os estudantes preferiram o primeiro. Além disso, os testes de proporção apontaram que há diferença significativa de preferência entre alunos mais jovens e mais velhos. As evidências fornecem suporte à ideia de que o emprego de tecnologias é percebido positivamente pelos alunos. Destacam-se as seguintes implicações: (i) reforça-se que os SRAs podem trazer benefícios ao processo de ensino-aprendizagem; (ii) os achados podem ajudar professores e instituições a tomarem decisões sobre qual modelo de SRA adotar.
Improvement of Mechanical Properties of Concrete by Using Polyproplene Fibers and Admixure
Authors: Mezher Thaer Matlab , Hiswa Ashraf A.M.R. , Shubber Mustafa Salman
Published: January 2020

Concrete is considered a low tensile resistance material and a weak material against cracking. The weak properties of concrete has been enhanced by utilizing fibers to reinforce it. In this research, the effects of the polypropylene fibers on several properties of plain concrete have been studied. It was found that the polypropylene fibers has enhanced the concrete ductility and the concrete crack control. The compressive strength of plain concrete has been increased by adding polypropylene fibers to it and also the flexural and splitting strengths. The best results were at fibers ratio of 1%. When the polypropylene fibers ratio has changed different effects on concrete properties have been obtained.
Structural and Morphological Properties of Nano Photonic Silicon Structure for Photonics Applications
Authors: Hassan Mariam M. , Fakhri Makram A. , Adnan Salah Aldeen
Published: January 2020

Porous silicon (n-PS) with diverse morphologies was prepared on silicon (Si) substrate via photo-electrochemical etching technique. We studies the structure, surface morphology, pore diameter, roughness, based on (XRD), (AFM), (SEM) at different etching time (5, 10 min) and current (10mA/cm2).
Use of Simulation to Enhance the Performance of Sustainable Bio-Based Polyurethan Fome
Authors: Raouf Raouf Mahmood , Abdalgane Hadeel A. , Al-Jadiri Rand Salih
Published: January 2020

The needs to replace petroleum-based polyol by bio-source polyol in polyurethane industry were increased dramatically in the last few decades. The main obstacles associating with using bio-based polyol where the change in foam density and foam shrinkage. The reacting monomer was preheated to achieve a higher maximum reaction temperature that allows more setting of the cell structure and more stable foam matrix to overcome the vacuum forces and prevent density change and foam shrinkage. A simulation code for polyurethane reaction was used to find the optimum recipes with low catalyst loading to achieve a polyurethane foam with good properties.
The Optical, Structural and Thermal Properties of Transparent Poly (Methylmethacrylate)/Cellulose Acetate Phthalate Blend
Authors: Al-Moameri Harith Hasoon , Abdulrehman Mohammed Ali , Marhoon Ismail Ibrahim
Published: January 2020

Miscible transparent blend consist of poly (methylmethacrylate) with cellulose acetate phthalate was prepared in order to get more transparent blend for ultraviolet rays. The blend was prepared by melt-blending and examined using UV-VIS spectroscopy. The structural, mechanical and thermal properties of selected samples were studied using X-ray diffraction, scanning electron microscopy, dynamic mechanical analysis, and thermos-gravimetric analysis. The UV-VIS spectrum exhibited the best blend ratio which has low absorbency to ultraviolet rays, On the other hand, high optical transparency within visible region. The results also showed that the blend has an amorphous structure as X-ray diffraction diffractogram. Moreover, thermal stability happened with the presence of cellulose acetate phthalate in the blend.
Continuous Versus Bolus Gastric Feeding in Children Receiving Mechanical Ventilation: A Systematic Review
Authors: Brown Ann-Marie , Madsen Erik C. , Leonard Charlene P. , Leslie Sharon L. , Allen Christine , Srinivasan Vijay , Irving Sharon Y.
Published: January 2020

Background

Nutrition guidelines recommend enteral nutrition in the form of gastric feedings for critically ill children and acknowledge a lack of evidence describing an optimal method for providing these feedings.

Objective

To determine the state of the science regarding the efficacy of bolus (intermittent) or continuous gastric feedings to improve nutrition delivery in critically ill children receiving mechanical ventilation.

Methods

Five hundred seventy-nine abstracts met the inclusion criteria and were screened by 2 reviewers according to prespecified criteria. Full-text reviews were performed on 28 articles; 11 studies were selected for detailed analysis. Because of the small number of eligible studies, broader searches were conducted.

Results

Only 5 studies with a collective enrollment of fewer than 200 children closely addressed the specific research question. These 5 studies did not report any similarity in feeding regimens, nor did they report nutritional outcomes. Two of the articles described findings from the same study population. Although 4 of the 5 studies randomized children to bolus versus continuous feedings, only 3 studies described attainment of nutrient delivery goals in both the intervention and the control groups; the remaining study did not report this outcome. The heterogeneity in methodology and outcomes among the 5 studies did not allow for a meta-analysis.

Conclusions

The dearth of evidence regarding best practices and outcomes related to bolus versus continuous gastric feedings in critically ill children receiving mechanical ventilation requires additional rigorous investigation.
IL-7R–Dependent Phosphatidylinositol 3-Kinase Competes with the STAT5 Signal to Modulate T Cell Development and Homeostasis
Authors: Cui Guangwei , Shimba Akihiro , Ma Guangyong , Takahara Kazuhiko , Tani-ichi Shizue , Zhu Yuanbo , Asahi Takuma , Abe Akifumi , Miyachi Hitoshi , Kitano Satsuki , Hara Takahiro , Yasunaga Jun-ichirou , Suwanai Hirotsugu , Yamada Hisakata , Matsuoka Masao , Ueki Kohjiro , Yoshikai Yasunobu , Ikuta Koichi
Published: January 2020

T cell development and homeostasis requires IL-7R α-chain (IL-7Rα) signaling. Tyrosine Y449 of the IL-7Rα is essential to activate STAT5 and PI3K, whereas PI3K recruitment requires IL-7Rα methionine M452. How IL-7Rα activates and regulates both signaling pathways differentially remains unclear. To characterize differential signaling, we established two lines of IL-7Rα mutant mice: IL-7R–Y449F mice and IL-7R–M452L mice. IL-7R–Y449F mice showed decreased PI3K and STAT5 signals, whereas IL-7R–M452L mice showed decreased PI3K but significantly increased STAT5 signaling, owing to a competition between PI3K and STAT5 signaling through Y449 of IL-7Rα. The number of T, B, and mature innate lymphoid cells were markedly reduced in IL-7R–Y449F mice, whereas IL-7R–M452L mice showed impaired early T cell development and memory precursor effector T cell maintenance with the downregulation of transcription factor T cell factor–1. Peripheral T cell numbers increased in IL-7R–M452L mice with enhanced survival and homeostatic proliferation. Furthermore, although wild type and IL-7R–Y449F mice showed comparable Th1/Th2 differentiation, IL-7R–M452L mice exhibited impaired Th17 differentiation. We conclude that PI3K competes with STAT5 under IL-7Rα and maintains an appropriate signal balance for modulating T cell development and homeostasis. To our knowledge, this study provides a new insight into complex regulation of IL-7Rα signaling, which supports immune development and responses.
TCR Repertoires of Thymic Conventional and Regulatory T Cells: Identification and Characterization of Both Unique and Shared TCR Sequences
Authors: Ko Annette , Watanabe Masashi , Nguyen Thomas , Shi Alvin , Achour Achouak , Zhang Baojun , Sun Xiaoping , Wang Qun , Zhuang Yuan , Weng Nan-ping , Hodes Richard J.
Published: January 2020

Thymic regulatory T cells (tTreg) are critical in the maintenance of normal T cell immunity and tolerance. The role of TCR in tTreg selection remains incompletely understood. In this study, we assessed TCRα and TCRβ sequences of mouse tTreg and thymic conventional CD4+ T cells (Tconv) by high-throughput sequencing. We identified αβ TCR sequences that were unique to either tTreg or Tconv and found that these were distinct as recognized by machine learning algorithm and by preferentially used amino acid trimers in αβ CDR3 of tTreg. In addition, a proportion of αβ TCR sequences expressed by tTreg were also found in Tconv, and machine learning classified the great majority of these shared αβ TCR sequences as characteristic of Tconv and not tTreg. These findings identify two populations of tTreg, one in which the regulatory T cell fate is associated with unique properties of the TCR and another with TCR properties characteristic of Tconv for which tTreg fate is determined by factors beyond TCR sequence.
PASTOR, ¿USTED EN QUÉ CREE? SOCIOLOGÍA DE LOS PROCESOS DE LIDERAZGO E INSTITUCIONALIZACIÓN EN IGLESIAS EVANGÉLICAS DE PEQUEÑA Y MEDIANA ESCALA
Authors: Mosqueira Mariela Analía , Algranti Joaquín
Published: January 2020

Las ciencias sociales de la religión tienden a priorizar el punto de vista de los creyentes sobre el de los especialistas a la hora de explorar la vida interna de las iglesias y sus lógicas de funcionamiento. El objetivo del artículo consiste en analizar las representaciones de pastores y líderes evangélicos, en torno a las tareas que involucra su actividad cotidiana en iglesias de pequeña y mediana escala de la Argentina. El trabajo explora analíticamente tres dimensiones dominantes en el ejercicio del liderazgo pastoral: (a) los modos de acceso a posiciones de jerarquía y sus estrategias de profesionalización (b) la construcción de las iglesias como unidades religiosas-familiares y  (c) las relaciones que se establecen con los miembros de la sociedad civil. En lo que respecta a la metodología, los resultados corresponden a una encuesta realizada durante el 2017 en uno de los principales retiros de pastores de la Argentina.
DE MIGUEL MANSILLA Y LUIS ORELLANA: EVANGÉLICOS Y POLÍTICA EN CHILE, 1960-1990. POLÍTICA, APOLITICISTMO Y ANTIPOLÍTICA.
Authors: Quiroz González Esteban
Published: January 2020

Reseña de Libro. Mansilla, M. y Orellana, L. (2019). Evangélicos y Política en Chile, 1960-1990. Política, apoliticismo y antipolítica. Santiago de Chile, RIL Editores. 201 pp.
Stackable SiC-Embedded Ceramic Packages for High-Voltage and High-Temperature Power Electronic Applications
Authors: Bach Hoang Linh , Dirksen Daniel , Blechinger Christoph , Endres Tobias Maximilian , Bayer Christoph Friedrich , Schletz Andreas , März Martin
Published: January 2020

This study encompasses the development of a high-voltage and high-temperature–capable package for power electronic applications based on the embedding of silicon carbide (SiC) semiconductor devices in the ceramic circuit carrier such as the direct bonded copper (DBC) substrate. By sealing semiconductor devices into DBC substrates, high temperature, high voltage, and high current capability as well as high corrosion resistance can be achieved compared with the state-of-the-art printed circuit board (PCB) embedding technology. The power devices are attached with high-temperature stable solder and sinter material and are surrounded by thermal conductive ceramic and high-temperature–capable potting materials that enable the complete package to operate at 250°C or above. Furthermore, the single embedded packages can be stacked together to multilevel DBC topologies with increased voltage blocking characteristics. Thus, current limits of the PCB and low-temperature cofired ceramic–based multilayer solutions are exceeded and will be confirmed in the course of this study. This package is designed to carry out the maximal performance of SiC and future wide bandgap devices. It is a promising solution not only for applications in harsh ambient environments such as aerospace and turbine, geothermal well logging, and downhole oil and gas wells but also for hybrid electric/electric vehicle and energy conversion.
Process Optimization and Implementation of Online Monitoring Process in the Transfer Molding for Electronic Packaging
Authors: Kaya Burcu , Kaiser Jan-Martin , Becker Karl-Friedrich , Braun Tanja , Lang Klaus-Dieter
Published: January 2020

The quality of molded packages heavily depends on the process parameters of the molding process and on the material characteristics of epoxy molding compounds (EMCs). When defects are introduced into the electronic packages in one of the last steps in the manufacturing process, namely, during encapsulation, it may cause high failure costs. To decrease the number of defects due to the molding process, a comprehensive understanding of the impact of process parameters and variations in the characteristics of the EMC on package quality is necessary. This study aimed at supporting a deeper understanding of the influence of process parameters and variations in the material characteristics of the EMC on package quality. A systematic approach was introduced to generate a process model describing the correlation between process parameters and package quality to obtain optimum process parameters for the transfer molding process. The influence of the alterations in material characteristics of the EMC due to prolonged storage duration and humidity on void formation and wire sweep was investigated. An online monitoring method, dielectric analysis (DEA), was implemented into the transfer molding process to monitor the variations in the cure behavior of the EMC. A second molding compound was used to analyze the similarities in the alteration behavior of the molding compounds when subjected to the same preconditioning and to generalize the characteristic information obtained from DEA.
Rapid and Localized Soldering Using Reactive Films for Electronic Applications
Authors: Khazaka Rabih , Martineau Donatien , Youssef Toni , Le Thanh Long , Azzopardi Stéphane
Published: January 2020

The rapid and localized heating techniques allow the joining of temperature-sensitive materials and components without thermal induced damage commonly encountered when high-temperature solder reflow processes are used. This is also advantageous for making assemblies with materials having a large difference in the coefficient of thermal expansion without induced bowing or cracking. The use of exothermic reactive foil sandwiched between solder preforms is a promising local and rapid soldering process because it does not require any external heat source. The reactive foil is formed from alternatively stacked nanolayers of Ni and Al until it reaches the total film thickness. Once the film is activated by using an external power source, a reaction takes place and releases such an amount of energy that is transferred to the solder preforms. If this amount of energy is high enough, solder preforms melt and insure the adhesion between the materials of the assembly. The influences of the applied pressure, the reactive film (RF) thickness as well as the solder, and the attached materials chemical composition and thickness were investigated. It was shown that the applied pressure during the process has a strong effect on the joint initial quality with voids ratio decreases from 64% to 26% for pressure values between .5 and 100 kPa, respectively. This can be explained by the improvement of the solder flow under higher pressure leading to a better surface wettability and voids elimination. Otherwise, the joint quality was found to be improved once the solder melting duration is increased. This relationship was observed when the thickness of the reactive foil is increased (additional induced energy) or the thickness of solders, Cu, and/or Si is decreased (less energy consumption). The microstructure of the AuSn joint achieved using the RFs shows very fine phase distribution compared with the one obtained using conventional solder reflow process in the oven because of high cooling rate. The mechanical properties of the joint were evaluated using shear tests performed on 350-μm-thick silicon diodes assembled on active metal brazed substrates under a pressure of 100 kPa. The RFs were 60 μm thick and sandwiched between two 25-μm-thick 96.5Sn3Ag.5Cu (SAC) preforms. The voids ratio was about 37% for the tested samples and shear strength values above 9.5 MPa were achieved which remains largely higher than MIL-STD-883H requirements. Finally, the process impact on the electrical properties of the assembled diodes was compared with a commonly used solder reflow assembly and the results show a negligible variation.
Patient, doctor, disease, and informed consent
Authors: Pela Riccardo
Published: January 2020

Lung cancer is the 10th ranking cause of death in the world: its incidence has reached a steady state in the male gender while it is still increasing in fe- males. Even if data are now available on lung can- cer screening with low-dose spiral computerized tomography [...]
Effects of indoor air pollution on respiratory symptoms of non-smoking women in Niš, Serbia
Authors: Stanković Aleksandra , Nikolić Maja , Arandjelović Mirjana
Published: January 2020

Rationale: The aim of this study was to determine the effects of indoor air pollution exposure on respiratory symptoms and illnesses in non-smoking women in Niš, Serbia.

Materials and methods: The study was carried out in 1,082 never-smoking females, aged 20-40 years, who were not occupationally exposed to indoor air pollution. The prevalence of respiratory symptoms and illnesses was assessed using the American Thoracic Society questionnaires. Multivariate methods were used in the analysis.

Results: A strong association was found between respiratory symptoms and indoor air pollution. The associations between home dampness and sinusitis and bronchitis were also found to be statistically significant.

Conclusions: Indoor air pollution exposure is an important risk factor for respiratory symptoms and illnesses in nonsmoking women in Niš, Serbia.
A new tuning fork with different vibration frequencies as an aid to bronchopulmonary hygiene physiotherapy
Authors: De Alcântara José Roberto , Munhoz Manzano Roberta , Gonçalves Maicon Gabriel , Dos Santos Rodrigo Leonel , Donaire Albino Daniel , Apostólico Nadua , Teixeira Fonseca Nina , Julioti Urbano Jéssica , Lombardi Daibem Célio Guilherme , Donner Claudio F. , Gimenes Camila , Pepe Ambrozin Alexandre Ricardo , Franco de Oliveira Luis Vicente
Published: January 2020

Background: The main function of the mucociliary system is the removal of particles or substances that are potentially harmful to the respiratory tract. The tuning fork therapeutic for the purpose of bronchial hygiene has still not been described in the literature. The optimal vibration frequency to mobilize secretions is widely debated and varies between 3 and 25 Hz. It is expected that a tuning fork is able to generate vibrations in the thorax, facilitating bronchial hygiene. The aim of the present study is to develop tuning forks with different frequencies, for use in bronchopulmonary hygiene therapy.

Methods: The first tuning fork was made with a fixed frequency of 25 Hz and it was recorded in the Brazilian institution of patent registration. This device generated a frequency of 25 Hz and had a weight of 521 g, with dimensions of 600 mm in total length. The device is characterized by a bottom end containing a transducer with a diameter of 62 mm and a thickness of 5/16 mm (8''), a rod removable 148 mm, fork length of 362 mm and an extension at the upper end of sinuous shape bilaterally.The tuning forks must be applied at an angle of 90° directly on the chest wall of the patient after pulmonary auscultation for location of secretions. The tuning fork is activated by squeezing the tips of the extensions together and releasing them in a sudden movement.

Results: This study shows the result of the development of others three tuning forks of different dimensions to generate different frequencies. Each equipment reaches a fixed frequency preset of 12, 15 and 20 Hz measured by digital oscilloscope.

Conclusions: The tuning fork models developed in this study generated different frequencies proposed by the scientific literature as effective in the mobilization of pulmonary secretions.
Sedation in non-invasive ventilation: do we know what to do (and why)?
Authors: Longrois Dan , Conti Giorgio , Mantz Jean , Faltlhauser Andreas , Aantaa Riku , Tonner Peter
Published: January 2020

This review examines some of the issues encountered in the use of sedation in patients receiving respiratory support from non-invasive ventilation (NIV). This is an area of critical and intensive care medicine where there are limited (if any) robust data to guide the development of best practice and where local custom appears to exert a strong influence on patterns of care. We examine aspects of sedation for NIV where the current lack of structure may be contributing to missed opportunities to improve standards of care and examine the existing sedative armamentarium. No single sedative agent is currently available that fulfils the criteria for an ideal agent but we offer some observations on the relative merits of different agents as they relate to considerations such as effects on respiratory drive and timing, and airways patency. The significance of agitation and delirium and the affective aspect(s) of dyspnoea are also considered.We outline an agenda for placing the use of sedation in NIV on a more systematic footing, including clearly expressed criteria and conditions for terminating NIV and structural and organizational conditions for prospective multicentre trials.
COPD: adherence to therapy
Authors: Sanduzzi Alessandro , Balbo Piero , Candoli Piero , Catapano Giosuè A. , Contini Paola , Mattei Alessio , Puglisi Giovanni , Santoiemma Luigi , Stanziola Anna A.
Published: January 2020

Adherence to medical therapies is a growing issue, so much so that the World Health Organization defined it as “a new pharmacological problem”. The main factors affecting compliance are: frequency of administration, rapid onset of action, role of device. The most severe consequence of non-adherence is the increased risk of poor clinical outcome, associated with worsening of the quality of life and increase in health-care expenditure. It appears crucial to identify those COPD patients who are “poorly or not at all compliant with their treatment”. In order to evaluate adherence to the medical therapy, several methods were proposed, the most effective of which turned out to be self-reports, i.e. simple, brief questionnaires (e.g. Morisky test). To increase the likelihood of quickly identifying non-compliant patients, it may be useful to administer a simple questionnaire to naïve subjects (for example, in the waiting room before an examination) including six specific items allowing to identify the patient’s key characteristics. Depending on the answers, patients who do not comply with their pharmacological treatment may be classified as belonging to 6 phenotypes. For patients who are already under treatment it might be useful to administer another short questionnaire during follow up examination. Once the risk of non-compliance is identified, four possible types of measures can be taken: prescription-related, educational, behavioral and complex combined measures (combination of two or more actions).

Therefore, while it is clear that adherence in COPD is a critical issue, it is also obvious that raising awareness on the disease and improving cooperation among specialists, general practitioners, health-care professionals, and patients is the starting point at which this evolution should immediately begin. Each medication is able to foster good compliance with the therapy, and consequently to maximize the efficacy, by virtue of its specific inhaler and its own active ingredient.
Idiopathic pulmonary fibrosis and coronary artery disease
Authors: Cicchitto Gaetano , Musella Valentina , Acitorio Mario , Capuano Nicola , Fiorenzano Giuseppe , Owen Caroline A. , Polverino Mario , Polverino Francesca
Published: January 2020

Idiopathic pulmonary fibrosis (IPF) is defined as a chronic fibrosing interstitial disease of unknown cause, limited to the lungs, and associated with the histopathologic and/or radiologic pattern of usual interstitial pneumonia (UIP); it generally progresses into respiratory failure and death. Although progression of the disease is the most common cause of death, there are increasing reports of its association with other pathologies has been reported: e.g., IPF patients seem more susceptible to cardiovascular diseases. Therefore, other pathologies might also influence the natural course. In this paper, we describe a case of IPF and coronary artery disease (CAD). We emphasize the importance of cardiopulmonary exercise test (CPET) as a useful procedure to monitor disease progression in IPF patients. We also stress the importance of a careful analysis of variables measured for an accurate interpretation of the clinical picture and an improvement of the clinical management of patients. Moreover, we suggest that a careful assessment of CPET parameters may additionally help in the early detection of high cardiovascular ischemic risk.
Effects of vitamin D supplementation on alveolar macrophage gene expression: preliminary results of a randomized, controlled trial
Authors: Gerke Alicia K. , Pezzulo Alejandro A. , Tang Fan , Cavanaugh Joseph E. , Bair Thomas B. , Phillips Emily , Powers Linda S. , Monick Martha M.
Published: January 2020

Background: Vitamin D deficiency has been implicated as a factor in a number of infectious and inflammatory lung diseases. In the lung, alveolar macrophages play a key role in inflammation and defense of infection, but there are little data exploring the immunomodulatory effects of vitamin D on innate lung immunity in humans. The objective of this study was to determine the effects of vitamin D supplementation on gene expression of alveolar macrophages.

Methods: We performed a parallel, double-blind, placebo-controlled, randomized trial to determine the effects of vitamin D on alveolar macrophage gene expression. Vitamin D3 (1000 international units/day) or placebo was administered to adults for three months. Bronchoscopy was performed pre- and post-intervention to obtain alveolar macrophages. Messenger RNA was isolated from the macrophages and subjected to whole genome exon array analysis. The primary outcome was differential gene expression of the alveolar macrophage in response to vitamin D supplementation. Specific genes underwent validation by polymerase chain reaction methods.

Results: Fifty-eight subjects were randomized to vitamin D (n = 28) or placebo (n = 30). There was a marginal overall difference between treatment group and placebo group in the change of 25-hydroxyvitaminD levels(4.43 ng/ml vs. 0.2 ng/ml, p = 0.10). Whole genome exon array analysis revealed differential gene expression associated with change in serum vitamin D levels in the treated group. CCL8/MCP-2 was the top-regulated cytokine gene and was further validated.

Conclusions: Although only a non-significant increased trend was seen in serum vitamin D levels, subjects treated with vitamin D supplementation had immune-related differential gene expression in alveolar macrophages.

Trial registration: ClinicalTrials.org: NCT01967628.
Sensitivity of the COPD assessment test (CAT questionnaire) investigated in a population of 681 consecutive patients referring to a lung clinic: the first Italian specific study
Authors: Dal Negro Roberto W. , Bonadiman Luca , Turco Paola
Published: January 2020

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality at global level even if still underestimated. The insufficient use of specific tools for an objective definition and staging, the inadequate awareness of COPD, but also a difficult patient-to-doctor communication, can contribute to the poor management of COPD. A very simple, short and sensitive questionnaire (the “COPD Assessment Test” - CAT questionnaire) is now available for assessing the impact of COPD on the patient’s health. The present study was designed to provide such evidence using data generated throughout Italy.

Methods: The Italian validated version of the CAT questionnaire was distributed to 681 consecutive COPD patients of different severity (males = 480), well matched for age, gender, smoking habit, geographical distribution, BMI, dyspnoea score and educational level. The CAT score variability was investigated vs all anagraphic, and clinical variables, and spirometric indices of lung function (regression). No Italian data are available to our knowledge on the CAT use, neither in General Medicine, nor in the specialist setting.

Results: Data of this study confirmed that the CAT questionnaire is a sensitive, simple, and quick tool for assessing the respiratory status of COPD patients. The CAT score proved not conditioned by the patient’s age, gender, body size, geographical origin, and educational level. It was inversely correlated with the spirometric values, even if not uniquely linked to them.

Conclusions: The CAT score does not represent a surrogate measurement of lung function: it is an instrument which focuses on different areas of respiratory health in COPD patients, thus providing an useful and objective tool for the long-term clinical and therapeutic monitoring of COPD patients in the specialist outpatient setting.
Limitation of the therapeutic effort: ethical and legal justification for withholding and/or withdrawing life sustaining treatments
Authors: Borsellino Patrizia
Published: January 2020

Withholding and withdrawing a treatment already established are two forms of limitation of the therapeutic effort (LTE). The question of undergoing or not undergoing lifesaving medical treatments is not restricted to a specific health care context, as it refers to a variety of treatments, and it does not concern a restricted group of diseases. LTE has become part of the options compatible with the good clinical practice, in accordance with a deep change in modern medicine’s ‘mission’ along with the increased importance attributed to the patient’s general, personal condition, and to the quality of his/her life. However, LTE remains a controversial issue, and it still has many opponents, in particular, but not exclusively, in those cases in which the question is the withdrawal of treatments, which a widespread conventional wisdom considers ethically and legally different from not initiating treatments. But is it justified to address LTE as a totally controversial issue, especially in case of withdrawal of treatments? The paper answers negatively by arguing that there are criteria both in medical ethics and in law often adequate enough to remove doubts, and to guide decisions and actions.
Cognitive dysfunction in severe chronic obstructive pulmonary disease (COPD) with or without Long-Term Oxygen Therapy (LTOT)
Authors: Dal Negro Roberto W. , Bonadiman Luca , Bricolo Fernanda P. , Tognella Silvia , Turco Paola
Published: January 2020

Background: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition which can lead to comorbidities of variable severity, cognitive dysfunction included. The role of supplemental oxygen in preventing COPD-induced cognitive deterioration is still debated, but only episodically investigated. The aim of this study was to compare the cognitive pattern of hypoxemic COPD subjects treated with long-term oxygen (LTOT) to that of patients of comparable severity assuming oxygen on irregular basis, and to normal reference values.

Methods: Lung function, arterial blood gases, health status, and cognitive function measured by means of four psychometric tests focusing different domains of cognition (such as: MMSE, Clock test; TMT-A; TMT-B) were assessed in 146 well matched hypoxemic COPD patients (males n = 96, 66%; mean age = 70.5 ± 12.9). Seventy-three patients were assuming long-term oxygen (LTOT), while the remaining seventy-three were only using oxygen as needed (AN). Regarding statistics, t test and ANOVA (Duncan test) were used to analyze data, assuming a p < 0.05 as the lowest limit of significance.

Results: Even though all COPD patients showed a poorer psychometric profile vs corresponding normal reference values, LTOT patients showed a lower prevalence of severe deterioration in cognition. Also the extent of impairment was significantly lower in these patients when assessed by TMT-A and TMT-B (p < 0.012 and 0.001, respectively), but not when measured by MMSE and Clock test (both p = ns). Several domains of cognition are variably affected by persistent hypoxemia in COPD patients. A panel of psychometric tools is needed for identifying the pattern of cognitive dysfunctions in these patients. Memory and attention (functions assessed by MMSE and Clock test) are only mildly-moderately affected, while visual processing, reproduction of numeric sequences, cognition flexibility, and shifting capacity (functions assessed by TMT-A and TMT-B) are much more deteriorated (p < 0.012 and p < 0.001, respectively).

Conclusions: Only LTOT allows to preserve significantly (p < 0.022) cognitive functions from the COPD-induced deterioration. This assumption is of strategic value for COPD patients who are prescribed long-term oxygen because they frequently are not aware of the cognitive risks related to their condition.
Venous thromboembolism and lung cancer: a review
Authors: Vitale Carolina , D’Amato Mario , Calabrò Paolo , Stanziola Anna Agnese , Mornile Mauro , Molino Anotnio
Published: January 2020

Venous thromboembolism (VTE) is a common complication of malignancies and epidemiological studies suggest that lung cancer belonged to the group of malignancies with the highest incidence rates of VTE. Risk factors for VTE in lung cancer patients are adenocarcinoma, NSCLC in comparison with SCLC, advanced disease, pneumonectomy, chemotherapy including antiangiogenic therapy. Other risk factors are pretreatment platelet counts and increased release of TF-positive microparticles. Elevated D-dimer levels do not necessarily indicate an increased risk of VTE but have been shown to be predictive for a worse clinical outcome in lung cancer patients. Mechanisms responsible for the increase in venous thrombosis in patients with lung cancer are not understood. Currently no biomarker is recognized as a predictor for VTE in lung cancer patients. Although several clinical trials have reported the efficacy of antithrombotic prophylaxis in patients with lung cancer who are receiving chemotherapy, further trials are needed to assess the clinical benefit since these patients are at an increased risk of developing a thromboembolism.
Anti-RSV prophylaxis efficacy for infants and young children with cystic fibrosis in Ireland
Authors: Linnane Barry , Kiernan Miranda G. , O’Connell Nuala H. , Kearse Linda , Dunne Colum P.
Published: January 2020

Rationale: There is limited evidence supporting the routine use of palivizumab in paediatric cystic fibrosis (CF) patients to reduce respiratory syncytial virus (RSV) infection and related hospitalisation. Despite this, anti-RSV prophylaxis is increasingly common. This is the first report from Ireland regarding palivizumab outcomes for children with CF, under 2 years old, despite the greatest prevalence of CF globally.

Methods: An audit was performed at a tertiary hospital in Ireland’s mid-West to document all children with CF, <24 months old, who received palivizumab over a five year period and comparision made with all eligible children for the prior five year period who had not received the product (also CF patients). Palivizumab was administered to both cohorts in their first year of life. Hospitalisation rates were compared using Fisher’s exact test. Incidence of RSV and Pseudomonas aeruginosa infection was recorded.

Results: A total of 19 patients who received palivizumab were included in the study; comparision was made with a retrospective control group of 30 patients. Prophylactic palivizumab did not prevent hospitalisation for 10/19 patients, 3 of whom were affected by RSV. This was significantly greater than in the control group, where no hospitalisations were recorded (p < 0.0001). P. aeruginosa was isolated in one case from the study cohort, while no P. aeruginosa was detected in the control group.

Conclusions: This study, the first of its kind from Ireland where CF prevalence is highest, does not provide unequivocal support for prophylactic use of palivizumab in CF patients under 2 years. Despite being derived from a small sample size, based on these data and complementary clinical observation, we have discontinued such prophylaxis. However, should reported incidence of RSV-related hospitalisation increase, there is scientific plausibility for appropriately powered, randomised, controlled trials of palivizumab.
8th International Conference on Management and Rehabilitation of Chronic Respiratory Failure: the Long Summaries
Authors: Ambrosino Nicolino , Casaburi Richard , Chetta Alfredo , Clini Enrico , Donner Claudio F. , Dreher Michael , Goldstein Roger , Jubran Amal , Nici Linda , Owen Caroline A. , Rochester Carolyn , Tobin Martin J. , Vagheggini Guido , Vitacca Michele , ZuWallack Richard
Published: January 2020

This paper summarizes Part 1 of the proceedings of the 8th International Conference on Management and Rehabilitation of Chronic Respiratory Failure, held in Pescara, Italy, on 7 and 8 May, 2015. It summarizes the contributions from numerous experts in the field of chronic respiratory disease and chronic respiratory failure. The outline follows the temporal sequence of presentations. This paper (Part 1) includes sections regarding: Advances in Asthma and COPD Therapy (Novel Therapeutic Targets for Asthma: Proteinases, Blood Biomarker Changes in COPD Patients); The problem of Hospital Re-Admission following Discharge after the COPD Exacerbation (Characteristics of the Hospitalized COPD Patient, Reducing Hospital Readmissions Following COPD Exacerbation).

This paper summarizes Part 2 of the proceedings of the 8th International Conference on Management and Rehabilitation of Chronic Respiratory Failure, held in Pescara, Italy, on 7 and 8 May, 2015. It summarizes the contributions from numerous experts in the field of chronic respiratory disease and chronic respiratory failure. The outline follows the temporal sequence of presentations. This paper (Part 2) includes sections regarding: Promoting Physical Activity across the Spectrum of COPD (Physical activity: definitions, measurements, and significance; Increasing Physical Activity through Pharmacotherapy in COPD); Pulmonary Rehabilitation in Critical Illness (Complex COPD with comorbidities and its impact during acute exacerbation; Collaborative Self-Management in COPD: A Double-Edged Sword?; and Pulmonary Rehabilitation in Critical Illness.

This paper summarizes Part 3 of the proceedings of the 8th International Conference on Management and Rehabilitation of Chronic Respiratory Failure, held in Pescara, Italy, on 7 and 8 May, 2015. It summarizes the contributions from numerous experts in the field of chronic respiratory disease and chronic respiratory failure. The outline follows the temporal sequence of presentations. This paper (Part 3) presents a section regarding Moving Across the Spectrum of Care for Long-Term Ventilation (Moving Across the Spectrum of Care for Long-Term Ventilation, New Indications for Non-Invasive Ventilation, Elective Ventilation in Respiratory Failure - Can you Prevent ICU Care in Patients with COPD?, Weaning in Long-Term Acute Care Hospitals in the United States, The Difficult-to-Wean Patient: Comprehensive management, Telemonitoring in Ventilator-Dependent Patients, Ethics and Palliative Care in Critically-Ill Respiratory Patients, and Ethics and Palliative Care in Ventilator-Dependent Patients).