bluuebunny/crossref_metadata_2025 huggingface dataset:
Doctors' response to queues: Evidence from a Portuguese emergency department
Authors: Martins Bruno , Filipe Luís
Published: December 2019

We evaluate how doctors in an emergency department react to the number of patients waiting for treatment. Our outcomes reflect the time spent with the patient, the intensity of treatment, and discharge destination. Using visit‐level data in a Lisbon‐area hospital, we use a fixed effects model to exploit variation in the queue size while addressing endogeneity using the number of arrivals to the hospital in the previous 60 min as an instrumental variable. Furthermore, we estimate doctors' reactions separately for patients with different degrees of urgency, as measured by the Manchester triage system. Results show that doctors discharge patients more rapidly as queues become longer, and this effect is stronger for patients that do not have life‐threatening conditions. We also find that the intensity of diagnosis/treatment procedures decreases when patients face longer queues, driven by the extensive margin. Finally, doctors are less likely to admit patients to inpatient care. We interpret the results in the light of the doctors' incentives literature, explaining how these agents behave in the context of a National Health Service, with no financial incentives.
Applying Quantitative Microbial Risk Assessment Model in Developing Appropriate Standards for Irrigation Water
Authors: Ezzat Safaa M
Published: December 2019

This study aimed to apply a quantitative microbial risk assessment (QMRA) model to estimate the annual risk probability of Salmonella infection associated with the consumption of crops, which were irrigated with raw wastewater abstracted by farmers without official permission. Data generated from the model were used to propose realistic standards for Salmonella in irrigation water needed for safe crop production. Results demonstrated the presence of total coliforms, fecal coliforms, fecal streptococci, and Salmonella in wastewater samples. Salmonella was recorded on lettuce and spinach in 3 different harvesting events, although it was not found in data obtained for parsley plant. The QMRA scenario included surface irrigation, consumption of raw crops, and 1-day withholding period before harvest. The annual risk probability of Salmonella infection for consumers exceeded the target tolerable risk (7.7 × 10−4) for investigated crops. The Pearson's correlation coefficient between different annual risk probabilities showed significant correlation (p < 0.05). The levels of risk posed from spinach and lettuce were roughly similar, although they tended to be higher for lettuce. The optimum concentrations of Salmonella in irrigation water needed to satisfy the World Health Organization guidelines of disease burden (disability-adjusted life years 10−6) per person per year ranged from 34 to 119 via multiple-tube fermentation technique/100 mL, for spinach and lettuce plants, respectively. The study concluded that unofficial reuse of wastewater in irrigation is a principle route for crop contamination. Water quality monitoring programs should be integrated with QMRA investigations for better estimation of risk level. The fit parameters used could be tailored to cover a wide array of local situations in different countries. Models applied for viruses, helminths, and bacteria other than Salmonella are encouraged in future studies. Integr Environ Assess Manag 2020;16:353–361. © 2019 SETAC

KEY POINTS

Raw wastewater irrigation is a principle route for crop contamination with pathogens such as Salmonella. QMRA data indicated that the annual risk probability of Salmonella infection for consumers exceeded the target tolerable risk for investigated crops. The model could estimate the reduction levels of Salmonella needed in irrigation water to provide adequate guidance to regulatory agencies and food crop managers. To verify and maximize the value of the present model for decision makers, a wider range of exposure scenarios, including farmers and consumers, could be added in future studies as well as models for viruses, helminths, and bacteria other than Salmonella.
The Contribution of Economic Science to Brownfield Redevelopment: A Review
Authors: Ameller Joaquin , Rinaudo Jean-Daniel , Merly Corinne
Published: December 2019

Urban planners increasingly perceive Brownfield redevelopment (BFR) as a strategic priority. BFR not only allows suppressing some of the nuisances caused by derelict and contaminated lands, it also contributes to revitalizing dense urban areas and preventing the undesired effects of urban sprawl. This literature review analyzes how economists have contributed to removing some of the barriers that prevent or restrict BFR. A first contribution was to demonstrate the economic benefits of BFR. Economists also contributed to the development of multidisciplinary decision support tools used to rank BFR projects in terms of long-term sustainability and social welfare. They contributed to the design of institutional arrangements, including regulatory and economic instruments, that can facilitate the engagement of stakeholders in BFR projects. Our literature search combines the use of a standard and a systematic literature review to identify relevant papers scattered in very diverse publications. We show that there is significant scope for better integration of economic analysis within the multidisciplinary mainstream of BFR literature and provide pathways for future research. Integr Environ Assess Manag 2020;16:184–196. © 2019 SETAC
Not only assholes drive Mercedes. Besides disagreeable men, also conscientious people drive high‐status cars
Authors: Lönnqvist Jan Erik , Ilmarinen Ville‐Juhani , Leikas Sointu
Published: December 2019

In a representative sample of Finnish car owners (N = 1892) we connected the Five‐Factor Model personality dimensions to driving a high‐status car. Regardless of whether income was included in the logistic model, disagreeable men and conscientious people in general were particularly likely to drive high‐status cars. The results regarding agreeableness are consistent with prior work that has argued for the role of narcissism in status consumption. Regarding conscientiousness, the results can be interpreted from the perspective of self‐congruity theory, according to which consumers purchase brands that best reflect their actual or ideal personalities. An important implication is that the association between driving a high‐status car and unethical driving behaviour may not, as is commonly argued, be due to the corruptive effects of wealth. Rather, certain personality traits, such as low agreeableness, may be associated with both unethical driving behaviour and with driving a high‐status car.
Physical sensors for skin‐inspired electronics
Authors: Li Shuo , Zhang Yong , Wang Yiliang , Xia Kailun , Yin Zhe , Wang Huimin , Zhang Mingchao , Liang Xiaoping , Lu Haojie , Zhu Mengjia , Wang Haomin , Shen Xinyi , Zhang Yingying
Published: December 2019

Skin, the largest organ in the human body, is sensitive to external stimuli. In recent years, an increasing number of skin‐inspired electronics, including wearable electronics, implantable electronics, and electronic skin, have been developed because of their broad applications in healthcare and robotics. Physical sensors are one of the key building blocks of skin‐inspired electronics. Typical physical sensors include mechanical sensors, temperature sensors, humidity sensors, electrophysiological sensors, and so on. In this review, we systematically review the latest advances of skin‐inspired mechanical sensors, temperature sensors, and humidity sensors. The working mechanisms, key materials, device structures, and performance of various physical sensors are summarized and discussed in detail. Their applications in health monitoring, human disease diagnosis and treatment, and intelligent robots are reviewed. In addition, several novel properties of skin‐inspired physical sensors such as versatility, self‐healability, and implantability are introduced. Finally, the existing challenges and future perspectives of physical sensors for practical applications are discussed and proposed.

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The recent advances in self‐powered medical information sensors
Authors: Zhao Luming , Li Hu , Meng Jianping , Li Zhou
Published: December 2019

Monitoring various medical information distributed throughout the body is of great importance in early clinic diagnosis and treatment of disease. To discover abnormal medical signals and find their causes in good time, the human body should be monitored continuously and accurately. To meet the requirements, various battery‐less and self‐powered information acquisition techniques are invented. In this review, the recent advances in self‐powered medical information sensors (SMIS) with different functions, structure design, and electric performance are summarized and discussed. The SMIS mainly involves triboelectric nanogenerator (TENG), piezoelectric nanogenerator (PENG), pyroelectric nanogenerator (PyNG)/ thermoelectric generator (TEG) and solar cell. Additionally, this review also analyzed the remaining challenges and prospected the development direction of SMIS in future.

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Approach to Designing Systems for Delivering Value
Authors: Kumar Anand , Goruganthula Edwin Anand , Lokku Doji Samson , Natarajan Swaminathan , Nori Kesav V
Published: December 2019

How value emerges from the interactions between different classes of stakeholders (like customers, service providers, suppliers, acquirers and so on) and the ways and means to enhance the interactions is a phenomenon that is increasingly becoming a significant game changer in any human endeavor. Increasingly, stakeholders expect something of interest to emanate for them whenever they participate in an endeavor. This thing that the stakeholders wish to create or experience is subjective and every stakeholder has their own perception of what this thing is. It is often the case that the thing that enthuses a stakeholder is the perceived value that they feel they can obtain; and the thing that they experience or create when participating in the endeavor is the actual value. In this situation, stakeholders often try to minimize the gap between their perceptions and actuals. This is often difficult to achieve as the notion of what is of value is time and stakeholder dependent. In order to address these issues, in this paper, a systematic approach to facilitate stakeholder value creation is presented and the underlying rationale for the approach discussed. This approach is based on the premise that in all human endeavors, goal or purpose of the endeavor, human centric processes, quality of these human‐centric processes, outcomes and the quality of the outcomes determine the value that different stakeholders create or experience. It is essential to understand, establish and articulate the right value influencing factors and criteria so that value is created for all stakeholders. This is further substantiated by the system value cycle wherein value created by the stakeholder by utilizing one or more systems. A set of eight different processes to institutionalize the stakeholder value creation dynamics is also presented to aid in the value co‐creation, sustenance and transformation.
Systems Complexity In Conceiving An Optical Payload For Remote Sensing Spacecraft – A Case Study
Authors: Avinash M , Ravi Chandra Babu G , Nagesh S. K
Published: December 2019

Remote sensing satellites have become indispensable tool, offering various applications for the economic development of the country. There is an increasing demand for new generation of remote sensing satellites, which can offer better resolution with wider swath. Optical payloads for such an advanced satellite require bigger optics, tighter fabrication tolerances and better thermal management to give their best performance. It is advantageous to configure these payloads on a standard spacecraft bus. At the same time the standard bus imposes some limitations on the mechanical and electrical parameters of the payload like mass, volume, power, data rate etc., besides the harsh launch environment.

Optical payload realization involves multi‐disciplinary teams working in geographically distributed places. Any variation in one parameter/process during the realization phase impacts the system performance and hence may lead to degradation of mission. In addition to this increase in demand for multiple satellites in short period of time, mandates sharing of manpower and facilities among multiple projects at each work centre. Therefore, systems engineering approach and project management tools have become crucial for realization of such a complex system.

In this paper, authors have explained the process involved in evolving the Opto‐mechanical design of such a complex optical payload for a remote sensing satellite. It is intended to bring out system complexity involved and the system engineering concepts adapted in the process.
Multi‐objective modeling and analysis of an electric pickup vehicle for range, performance, drivability, handling and ride comfort attributes
Authors: Dharumaseelan Elavarasan , Pitchaikani Anand , Tamilselvam Elanchezhian , Sundstrom Peter , Malik Sidharth
Published: December 2019

In today's electric vehicle arena, range, performance, drivability, handling safety and ride comfort are few important attributes an OEM would like to improve on a vehicle. However, they are almost mutually exclusive like greater range & extreme handling safety would need to compromise on drivability & ride comfort and vice versa respectively. Automotive engineers constantly focus on to find the right balance among these attributes by optimum design of the vehicle components. Often these components are multi‐disciplinary involving different engineering domains like mechanical, thermal, electrical, hydraulic & electronics, etc. These complexities demand for model based and systems engineering approach from the start of the development. This emphasizes the need for high fidelity, dynamic vehicle system models suitable for co‐development of different components and controls. In this study, detailed vehicle model representing an electric pickup truck including battery, traction motors, driveline, chassis (suspension, brakes, wheels & mounts) is created in Modelica platform using which multiple vehicle level attributes like range, performance, drivability, handling and ride comfort are studied. Further, it is shown that the simulation speed can be increased by varying fidelity of the subsystems based on study intended within the same model framework.
Safety Assurance Case Description Method for Systems Incorporating Off‐Operational Machine Learning and Safety Device
Authors: Fujino Hirotaka , Kobayashi Nobuyuki , Shirasaka Seiko
Published: December 2019

Technology in the field of machine learning (ML) has been advanced in recent years. There have been discussions for applying ML technology especially toward safety critical systems such as automated driving. One of the issues is about the safety assurance of the system utilizing ML. Conventional safety assurance methods are not able to assure the system incorporating ML because “it is difficult to estimate its performance in advance, and it is not possible to grasp the boundaries between what can be done and what cannot be done.”(Ishikawa, 2019) Therefore, the purpose of this study is to assure the safety of systems incorporating ML. This study proposes the safety assurance case description method with seven layers for the system incorporating both off‐operational ML and the safety device. Based on the thought of systems engineering, the seven layers utilize the seven viewpoints decomposed with 1) internal and external system, 2) different states of the system, 3) the factors of the accidents in the system, 4) operating conditions of the system, 5) ML and safety device operation process, 6) output rules of the safety devices, and 7) output restriction method of the safety device. The evaluation method for this proposal indicates whether the subjects could describe using both the proposed description method and an example of the train brake system that incorporates off‐operational ML and safety device. The future study topic is the proposal of the description method for the higher layer of the safety device operation process. Moreover, we plan to work on the proposal of the safety assurance case of a system incorporating on‐operational ML.
Systems Engineering Challenges in Realizations of Spinning Satellite Versus Rotating Payload to Improve Systems Reliability
Authors: Mahto Brindaban , Meena G. , Gupta Abhilash , Khened Amareshwar
Published: December 2019

Satellites are playing vital role in the astronomical study by scientific community. Whereas making a bigger satellite, catering complex mission requirement for scientific study is not viable due to huge realization duration and launch cost. Configurations of astronomical study satellites are quite different compared to earth observation satellites, in such a way that payloads of former may demand rotating mechanisms. A cost effective spinning satellite configuration is studied to meet the payload rotation requirement for space astronomy exploration. On the other hand, accomplishing the essential requirements is a challenge viz. power generation, stringent payload pointing, attitude updates, telecommand establishment, telemetry links, visibility to data reception ground station for a spinning satellite. This paper is intended to bring out the complexity involved and the systems engineering concepts adopted to achieve the mission goal, mainframe elements redundancy, positive energy balance and high systems reliability to build a cost effective spinning small satellite.
Challenges in the Automation of Eddy Current Evaluation for Aerospace‐Spacecraft Propellant Tanks
Authors: Poornima S , Ramprasad B , Ingersol S , Narayan R , Narayanan G
Published: December 2019

An automated system is designed for Eddy current evaluation of spacecraft components with a proven multi‐axis industrial robot interfaced with dynamic electromechanical distance compensation device (EMDC), automated probe exchange, array eddy current probe, precision component fixtures and turntables, eddy current equipments, centralized control system to control robot and eddy current system with seamless handshake capability. Accuracy of the probe guidance system for the entire test period is ensured by the repeatable probe positioning within ±0.05mm by the robot and a minimal lift off error of ± 50μ, achieved by deploying an automated device with a high precision component turntable with positioning accuracy of £0.005°. The component is aligned initially by LASER and fine alignment is established by Infrared based touch‐tool.

Automation of eddy current based evaluation technique has made the system state of the art with high probability of defect detection capability at a lesser evaluation time. Also the system has enhanced process confidence level due to the high positional accuracy of the system in comparison with manual methods, with defect detection capabilities up to depth of 0.12mm on a shell of 0.8 mm thickness. The challenges in automation of the system include intricacies due to component's thickness and also due to the complex hemispherical profile of the component. Fixtures were designed to provide enough support for the fragile components with soft pads at the contact area, and alignment of component in turntable to avoid surface run‐out errors, synchronization between turntable and the robot scanning speed, precision maintenance of lift‐off distance between eddy current probe and component surface, array eddy current probe design with multiple elements ensuring defect detection in any orientation are some of the challenges overcome in the automation of eddy current evaluation technique.

The challenges in designing an automated eddy current system for evaluation of propellant tanks were systematically overcome with automation to get better defect characterization capability with reduced test time aiding in design optimization of thin walled metallic structures like propellant tanks.
Ameliorating the Methodology to Chill Rocket Fuels for Launch Vehicle
Authors: Lamba Ankit Kumar , Chandramouly Vishwas Banavara , Naidu R Krishna Murthy , Damodaram J
Published: December 2019

Current Launch vehicles of ISRO uses Earth storable propellant such as UH25/MMH and N2O4/MON3 as fuel and oxidizer respectively for their liquid engines. Chilling of these rocket fuels is necessary before loading them in Launch Vehicles to meet the liquid engine requirements so as to meet the desired net positive suction head for the turbo pumps of rocket engines (like VIKAS engines). Pressure fed engine is cooled using regenerative cooling technique. To compensate for the pressure drops in the piping when fuel flows, the chilled propellant makes it heavy in density and helps to maintain greater injection pressure. In ISRO spiral plate heat exchanger is used or chilling the propellants. The chilling activity requires around 10 to 12 hours to chill propellants from ambient to 10° C for given flow rate and effective reynolds number. Reducing this time will be very helpful in reducing the time required for overall system readiness for launch activities. Existing chilling process involves circulating propellant through one heat exchanger using a pump. The storage facility has two heat exchangers and two pumps and out of which only one heat exchanger and one pump is being used and the other act as standby. The paper aims to find possible alternate configurations using the idle heat exchanger and pump and also to study the effect of mass flow rate of propellant on chilling time. Study in this paper is done considering N2O4 propellant. A theoretical model is developed using basic heat transfer equations in MATLAB, it is evaluated by comparing the results with previous mission data. This is later applied on different configurations possible and chilling time for each configuration is calculated. The results obtained suggested that by operating two heat exchanger in parallel and one pump, time required for chilling of propellants can be reduced significantly.
System Design Approach For Service Oriented Communication Using Autosar Methodology
Authors: Chaudhari Nayana P , Isac Sinu J
Published: December 2019

Automotive radars and cameras form the backbone of self‐driving cars, Active safety and Advanced Driver Assistant Systems (ADASs). Streaming sensor, camera and audio data between sensors and Electronic control units (ECUs) requires huge data exchange. Traditionally data communication happens in a signal‐oriented approach where the sender transmits data irrespective of receiver's consumption needs on the network. With introduction of Scalable Service‐Oriented MiddlewarE over Internet Protocol ‐Service Discovery (SOME/IP‐SD), which is a Service oriented communication, the sender transmits the data only when the receiver on network needs the data. The advantage is that the network and connected nodes are not loaded by unnecessary data. This paper describes the system level design approach for the serialization of large data (>1500 bytes) over SOME/IP‐Service Discovery protocol using Autosar methodology in automotive Ethernet in‐vehicle networks. The system design is done using PREEVision tool and the bench evaluation is performed using Freescale hardware and Vector Autosar Basic Software stack. The outcome of this paper is to measure the end to end subscription latency between Client and Server ECUs.
Systems Approach for Integration of Medicine and Therapy to Alleviate Pain of Human Musculoskeletal System
Authors: Ohkami Yoshiaki , Kayo Munehiro
Published: December 2019

Chronic pain and general physical discomfort are common symptoms for those seeking medical or physiotherapy treatment, as this relates to disorders found within the Human Musculoskeletal System (HMS). Since this system is highly complex and large in scale, clinical pain research has been confounded by many complex factors. To help alleviate chronic pain and other symptoms, Asian countries such as Japan, India and China have developed various traditional medicine‐based exercise techniques over many years. Although some are critical of these non‐orthodox medical approaches, others support the ‘overwhelming effort towards integrating alternative medicine into the mainstream’. In addition, these traditional techniques have been enhanced by recent scientific research into the HMS, undertaken by biomedical and mechanical engineers. The goal of our research is to establish a multidisciplinary approach integrating Systems Engineering, traditional oriental techniques, conventional medicine and related science. To pursue such an integrated approach this paper examines the therapist‐guided exercise for restoring human musculoskeletal balance called the Somatic Balance Restoration Therapy (SBRT). The SBRT is a simple but effective self‐exercise therapy with minimal assistance by a trained therapist. This therapy is analyzed by a Systems Engineering Approach using a mechanical engineering method by modeling the human body as a multi‐body subject to a static equilibrium condition. In addition, the wording has been rewritten in functional anatomical terms, enabling smooth communication between specialists of three different disciplines: therapy, conventional medicine and Systems Engineering. Examples will be given to demonstrate an integrated and systematic approach for identifying and remedying malfunctions within the HMS.
Designing An On‐board Macro Executor For Payload (MEP) For Optimized Payload Operations Of Earth Observation Satellites
Authors: Rao Chaitra , Nagesh S K
Published: December 2019

Earth Observation (EO) from Space has proved to be an indispensable tool for providing valuable information on natural resources and environment on various spatial and temporal scales. These satellites have been used in various applications viz., agriculture & soils, land form and land use/ land cover studies, water resources, forestry, agricultural drought assessment & flood monitoring, cartography, town planning and coastal zone monitoring. The Resourcesat series of satellites not only caters to the National users but also for other global resource applications. The Resourcesat series payload platform incorporates three optical remote sensing cameras, viz., Linear Imaging Self Scanner (LISS‐3/L3), Advanced Wide Field of view Sensor (AWIFS/AW) and LISS‐4/L4. LISS‐4 provided 5.8m resolution imageries in three VNIR bands (B2, B3 & B4) with 70km swath, LISS‐3 provides 23.5m resolution in four bands (3 VNIR and 1 SWIR) with 140 km swath. AWIFS provides spatial resolution of 56 m in four bands with 740 km swath. The three cameras can be independently operated based on the demand from various user agencies. It is necessary to optimally use the on‐board resources within the boundaries of Mission constraints yet achieve the maximum throughput in terms of imageries from the payload. The satellites are equipped with payload operation sequencers which can be ground programmed based on the payload operation plan arrived at. The on‐board sequencers have to cater to the varying ground requirements of various payload, download and record modes of operations, which involves sequencing of various sub events to achieve one payload operation session.

This paper brings out the evolution of the design of the on‐board sequencer of Resourcesat‐2A from Resourcesat‐1 and Resourcesat‐2. The MEP, a macro based programmable sequencer was designed, developed and implemented on‐board Resourecesat‐2A which provided total flexibility in programming the sub‐events, sequencing and also reduced the commanding load. The system is so built such that it can be configured for any satellite to perform any payload operation.
Effect of Aerobic or Resistance Exercise, or Both, on Bone Mineral Density and Bone Metabolism in Obese Older Adults While Dieting: A Randomized Controlled Trial
Authors: Armamento-Villareal Reina , Aguirre Lina , Waters Debra L , Napoli Nicola , Qualls Clifford , Villareal Dennis T
Published: December 2019

Weight loss therapy of older adults with obesity is limited by weight loss–induced decrease in bone mineral density (BMD), which could exacerbate ongoing age-related bone loss and increase the risk for fractures. Therefore, it is recommended that weight loss therapy of older adults with obesity should include an intervention such as regular exercise to reduce the concomitant bone loss. However, the most appropriate exercise types to combine with weight loss therapy in this older population is unknown. In a randomized controlled trial, we performed a head-to-head comparison of aerobic or resistance exercise, or both, during matched ~10% weight loss in 160 older adults with obesity. We measured changes in BMD (total hip, femoral neck, trochanter, intertrochanter, one-third radius, lumbar spine) and bone markers. Changes between groups were analyzed using mixed-model repeated measures analyses of variance. After 6 months of intensive lifestyle interventions, BMD decreased less in the resistance group (−0.006 g/cm2 [−0.7%]) and combination group (−0.012 g/cm2 [−1.1%]) than in the aerobic group (−0.027 g/cm2 [−2.6%]) (p = 0.001 for between-group comparisons). Serum C-telopeptide, procollagen type 1 N-propeptide, and osteocalcin concentrations increased more in the aerobic group (33%, 16%, and 16%, respectively) than in the resistance group (7%, 2%, and 0%, respectively) and combination group (11%, 2%, and 5%, respectively) (p = 0.004 to 0.048 for between-group comparisons). Multiple regression analyses revealed that the decline in whole body mass and serum leptin were the independent predictors of the decline in hip BMD (multiple R = 0.45 [p < .001]). These findings indicate that compared with aerobic exercise, resistance and combined aerobic and resistance exercise are associated with less weight loss–induced decrease in hip BMD and less weight loss–induced increase in bone turnover. Therefore, both resistance and combined aerobic and resistance exercise can be recommended to protect against bone loss during weight loss therapy of older adults with obesity. (LITOE ClinicalTrials.gov number NCT01065636.) © 2019 American Society for Bone and Mineral Research. Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
There is no (95, 40, 12, 20) strongly regular graph
Authors: Azarija Jernej , Marc Tilen
Published: December 2019

We show that there is no (95, 40, 12, 20) strongly regular graph and, consequently, there is no (96, 45, 24, 18) strongly regular graph, no nontrivial regular two‐graph on 96 vertices, and no partial geometry pg(4, 9, 2). The main idea of the result is based on the star complement technique and requires a moderate amount of computation.
Genetic polymorphisms of rs9313422 G>C and rs41297579 G>A at the promoter of TIM‐1 gene contribute to the risk of community‐acquired pneumonia in children
Authors: Liu Yang , Xu Hong‐Bo
Published: December 2019

Objective

To investigate the association of genetic polymorphisms of rs9313422 G>C and rs41297579 G>A at the promoter of TIM‐1 gene with the risk of community‐acquired pneumonia (CAP) in children.

Methods

A total of 112 children with CAP were included as the case group. Another 120 healthy children were enrolled as the control group. Polymerase chain reaction‐restriction fragment length polymorphism (PCR‐RFLP) was applied for the genotyping of rs9313422 G>C and rs41297579 G>A in the promoter region of TIM‐1.

Results

rs9313422 G>C was related to the risk of CAP in children under codominant model, dominant model, recessive model, and allele model. Besides, the A allele of rs41297579 G>A could increase the risk of CAP in children. Besides, the haplotype GA (rs9313422‐rs41297579) and GG reduced the risk of children CAP, while haplotype CA had an elevated risk. rs9313422 G>C and rs41297579 G>A polymorphisms were both associated with the severity of CAP in children, and the rs9313422 G>C was also related to the ICU admission rate. In addition, patients carried with the mutant homozygotes of rs9313422 G>C and rs41297579 G>A showed higher levels of white blood cell (WBC), procalcitonin (PCT), and C‐reactive protein (CRP) than the wild type and heterozygous genotypes carriers.

Conclusion

rs9313422 G>C and rs41297579 G>A polymorphisms in the promoter region of TIM‐1 could increase the risk of CAP in children and showed a relation with inflammatory responses and severity.
Decreased native renal T1 up to one week after gadobutrol administration in healthy volunteers
Authors: de Boer Anneloes , Harteveld Anita A. , Pieters Tobias T. , Blankestijn Peter J. , Bos Clemens , Froeling Martijn , Joles Jaap A. , Verhaar Marianne C. , Leiner Tim , Hoogduin Hans
Published: December 2019

Background

Gadolinium‐based contrast agents (GBCAs) are widely used in MRI, despite safety concerns regarding deposition in brain and other organs. In animal studies gadolinium was detected for weeks after administration in the kidneys, but this has not yet been demonstrated in humans.

Purpose

To find evidence for the prolonged presence of gadobutrol in the kidneys in healthy volunteers.

Study Type

Combined retrospective and prospective analysis of a repeatability study.

Population

Twenty‐three healthy volunteers with normal renal function (12 women, age range 40–76 years), of whom 21 were used for analysis.

Field Strength/Sequence

Inversion recovery‐based T1 map at 3T.

Assessment

T1 maps were obtained twice with a median interval of 7 (range: 4–16) days. The T1 difference (ΔT1) between both scans was compared between the gadolinium group (n = 16, 0.05 mmol/kg gadobutrol administered after T1 mapping during both scan sessions) and the control group (n = 5, no gadobutrol). T1 maps were analyzed separately for cortex and medulla.

Statistical Tests

Mann–Whitney U‐tests to detect differences in ΔT1 between groups and linear regression to relate time between scans and estimated glomerular filtration rate (eGFR) to ΔT1.

Results

ΔT1 differed significantly between the gadolinium and control group: median ΔT1 cortex –98 vs. 7 msec (P < 0.001) and medulla –68 msec vs. 19 msec (P = 0.001), respectively. The bias corresponds to renal gadobutrol concentrations of 8 nmol/g tissue (cortex) and 4 nmol/g tissue (medulla), ie, ~2.4 μmol for both kidneys (0.05% of original dose). ΔT1 correlated in the gadolinium group with duration between acquisitions for both cortex (regression coefficient (β) 16.5 msec/day, R2 0.50, P < 0.001) and medulla (β 11.5 msec/day, R2 0.32, P < 0.001). Medullary ΔT1 correlated with eGFR (β 1.13 msec/(ml/min) R2 0.25, P = 0.008).

Data Conclusion

We found evidence of delayed renal gadobutrol excretion after a single contrast agent administration in subjects with normal renal function. Even within this healthy population, elimination delay increased with decreasing kidney function.

Level of Evidence: 3

Technical Efficacy: Stage 3

J. Magn. Reson. Imaging 2020;52:622–631.
Recurrent ischemic stroke in patients with atrial fibrillation ablation and prior stroke: A study based on etiological classification
Authors: Fukamizu Seiji , Hojo Rintaro , Kitamura Takeshi , Kawamura Iwanari , Miyazawa Satoshi , Karashima Jun , Nakamura Shin , Takeda Kosuke , Yamaoka Koichiro , Arai Tomoyuki , Kawajiri Kohei , Tanabe Sho , Koyano Yasuki , Miyahara Daisuke , Tokioka Sayuri , Arai Marina , Inagaki Dai , Miyabe Tomonori , Sakurada Harumizu , Hiraoka Masayasu
Published: December 2019

Background

Different subtypes of ischemic stroke may have different risk factors, clinical features, and prognoses. This study investigated the incidence and mode of stroke recurrence in patients with a history of stroke who underwent atrial fibrillation (AF) ablation.

Methods

Of 825 patients who underwent AF ablation from 2006 to 2016, 77 patients (9.3%, median age 69 years) with a prior ischemic stroke were identified. Patients were classified as those with prior cardioembolic (CE) stroke (n = 55) and those with prior non‐CE stroke (n = 22). The incidence and pattern of stroke recurrence were investigated.

Results

The incidence of asymptomatic AF (54.5% vs 22.7%; P = .011) and left atrial volume (135.8 mL vs 109.3 mL; P = .024) was greater in the CE group than in the non‐CE group. Anticoagulation treatment was discontinued at an average of 28.1 months following the initial ablation in 34 (44.2%) patients. None of the patients developed CE stroke during a median 4.1‐year follow‐up. In the non‐CE group, 2 patients experienced recurrent non‐CE stroke (lacunar infarction in 1 and atherosclerotic stroke in 1); however, AF was not observed at the onset of recurrent ischemic stroke.

Conclusions

In patients with a history of stroke who underwent catheter ablation for AF, the incidence of recurrent stroke was 0.54/100 patient‐years. The previous stroke in these patients may not have been due to AF in some cases; therefore, a large‐scale prospective study is warranted to identify the appro priate antithrombotic therapy for the prevention of potentially recurrent stroke.
Computational Model Validation of Contact Mechanics in Total Ankle Arthroplasty
Authors: Dharia Mehul A. , Snyder Sandra , Bischoff Jeffrey E.
Published: December 2019

Revision rates in total ankle arthroplasty (TAA) are nearly double compared with hip or knee arthroplasty procedures. Contact mechanics for metal–polyethylene articulation in TAA is critical due to the reduced size of the implant and higher expected load, compared with a hip or knee joint. This study was focused on developing a validated computational model to predict contact area in a polyethylene tibial bearing articulating with a metallic talar component in a bicondylar TAA design. Contact area was evaluated at five different flexion angles in an experimental test and in a computational model, per ASTM F2665. The overall contact area values predicted in the computational model matched closely (within 8%) with that measured in the comparator; well within the range reported in the literature. The credibility of the model to sufficiently predict the outputs relative to the experimental data was discussed using the guidelines provided by the recently published ASME V&V 40‐2018 standard. Various sensitivities associated with both the model and the comparator, were explored. It was concluded that the validated modeling approach presented in this study demonstrated sufficient accuracy to support the use of modeling for evaluation of contact area of TAA designs. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:1063‐1069, 2020
Effect of an integrated clinical pharmacy service with the general medical units on patient flow and medical staff satisfaction: a pre‐ and postintervention study
Authors: Tran Tim , Johnson Douglas Forsyth , Balassone Jacqueline , Tanner Francine , Chan Vincent , Garrett Kent
Published: December 2019

Background

Health services are under pressure to accommodate increasing numbers of emergency department presentations. This can contribute to prescribing errors. Integration of a pharmacist into the general medical team may reduce the incidence of prescribing errors on discharge and improve patient flow and medical staff satisfaction.

Aim

This study evaluated the effect of an integrated pharmacy service provided to the general medical units (GMUs) on patient flow and medical staff satisfaction.

Method

This study was a 4‐week pre‐ and postintervention study involving GMUs at a major metropolitan hospital in Australia. During the intervention period, an integrated clinical pharmacy service, which included attending medical ward rounds and assisting with the preparation of discharge prescriptions, was provided to medical units. The primary endpoint was the median time (min) past 9am that patients were discharged from the ward. Secondary outcomes included the proportion of prescriptions requiring an amendment and medical staff satisfaction with the service.

Results

There were 87 and 84 patients discharged from the medical units before and after the intervention. During the intervention period, pharmacists prepared 79% of prescriptions, which reduced the proportion requiring an amendment from 65% to 17% (p < 0.01). Patients were discharged 77 min earlier during the postintervention period (median 380 vs 303 min after 9am; p = 0.03). Medical staff felt the integrated clinical pharmacy service improved patient flow and should be incorporated into standard practice.

Conclusions

An integrated clinical pharmacy service with proactive pharmacist intervention within the GMUs improved patient flow and medical staff satisfaction, and decreased prescriptions requiring an amendment.
Management of Benign Paroxysmal Positional Vertigo in an Adult With Severe Osteogenesis Imperfecta
Authors: Hoppes Carrie W. , Klatt Brooke N. , Dunlap Pamela M. , Jacks Beth , Whitney Susan L.
Published: December 2019

The purpose of this case report was to describe the evaluation and management of atypical benign paroxysmal positional vertigo (BPPV) in an adult with severe osteogenesis imperfecta. A 29‐year‐old male was referred to a physical therapist with extensive experience in vestibular rehabilitation who provided horizontal canal BPPV treatment with a canalith repositioning maneuver over two treatment sessions. The individual's symptoms had reduced by 65% and his nystagmus during the roll test was reduced. Extreme care is needed to safely reposition individuals living with severe osteogenesis imperfecta, but the repositioning can reduce symptoms and improve quality of life. Laryngoscope, 130:2241–2244, 2020
Oral Squamous Cell Carcinoma as a Complication of Treatment for Recurrent High‐Grade Serous Cancer
Authors: Moses Lindsey E. , Rotsides Janine M. , Balogun Fiyinfolu O. , Persky Mark S. , Muggia Franco M. , Persky Michael J.
Published: December 2019

Objectives/Hypothesis

Advances in cancer treatment have increased survival for many patients, prompting a need for greater recognition of the long‐term complications of treatment. Chemotherapy agents have the potential to induce carcinogenesis and can increase the risk of secondary malignancy. Pegylated liposomal doxorubicin (PLD) used for maintenance treatment of recurrent high‐grade serous cancers has been associated with the development of oral cavity squamous cell carcinoma (SCC).

Study Design

Retrospective review.

Methods

Cases of oral cavity SCC in patients with recurrent high‐grade serous cancer treated with PLD between 1997 and 2017 at a single institution were reviewed.

Results

Eight of 16 patients treated with PLD developed oral cavity SCC. The duration of PLD use ranged from 1.3 to 15 years (mean = 5.8 years) and cumulative dose ranged from 405 to 3,000 mg/m2 (mean = 1,542 mg/m2). Seven patients tested positive for BRCA mutations (four BRCA 1+, three BRCA 2+). No patients had a history of alcohol or tobacco use. All had early‐stage oral cavity disease; five were T1N0, two were T2N0, and one had carcinoma in situ. All patients underwent surgery, and two received adjuvant radiation. Four developed locoregional recurrence requiring additional treatment. Of these, one patient died from complications of oral SCC, one developed recurrent ovarian cancer, and two had no evidence of disease of the oral cavity or ovarian cancer at the last follow‐up.

Conclusions

Long‐term PLD therapy may be associated with the development of oral cavity SCC. A high index of suspicion and routine head and neck examination should be included in follow‐up for exposed patients.

Level of Evidence

4 Laryngoscope, 130:2607–2610, 2020
Cellular Uptake of Gold Nanoparticles and Their Movement in 3D Multicellular Tumor Spheroids: Effect of Molecular Weight and Grafting Density of Poly(2‐hydroxyl ethyl acrylate)
Authors: Lu Hongxu , Su Jiaying , Mamdooh Russul , Li Yimeng , Stenzel Martina H.
Published: December 2019

It is known that the size of gold nanoparticles (GNPs) is not the only determining factor in the uptake by cells such as cancer cells. The surface functionalization plays a crucial role, in particular the nature of the ligand as well as the molecular weight and the grafting density. Here, poly(2‐hydroxy ethyl) acrylate (pHEA) with molecular weights ranging from 10, 20 to 39 g mol−1via reversible addition–fragmentation chain transfer polymerization is synthesized. These polymers are used directly to coat GNPs with sizes of 20, 40, and 70 nm as the trithiocarbonate functionality can strongly bind to the gold surface. The library of nine GNP is found to be nontoxic against lung carcinoma cells A549 and has negligible albumin protein absorption as determined by quartz crystal microbalance. Laser scanning confocal microscopy and flow cytometry reveal that GNP coated with medium length pHEA displays the highest cellular uptake while the effect of the size is not statistically significant. In contrast, multicellular tumor spheroids, which is a 3D model that simulates the tissue, enable the penetration of GNP coated with the longest pHEA chain while it also appears that smaller GNPs have now a clear advantage.
Progress in Articular Cartilage Tissue Engineering: A Review on Therapeutic Cells and Macromolecular Scaffolds
Authors: Zhao Zhongyi , Fan Changjiang , Chen Feng , Sun Yutai , Xia Yujun , Ji Aiyu , Wang Dong‐An
Published: December 2019

Repair and regeneration of articular cartilage lesions have always been a major challenge in the medical field due to its peculiar structure (e.g., sparsely distributed chondrocytes, no blood supply, no nerves). Articular cartilage tissue engineering is considered as one promising strategy to achieve reconstruction of cartilage. With this perspective, the articular cartilage tissue engineering has been widely studied. Here, the recent progress of articular cartilage tissue engineering is reviewed. The ad hoc therapeutic cells and growth factors for cartilage regeneration are summarized and discussed. Various types of bio/macromolecular scaffolds together with their pros and cons are also reviewed and elaborated.
Breastmilk Lipids and Oligosaccharides Influence Branched Short‐Chain Fatty Acid Concentrations in Infants with Excessive Weight Gain
Authors: Pekmez Ceyda Tugba , Larsson Melanie Wange , Lind Mads Vendelbo , Vazquez Manjarrez Natalia , Yonemitsu Chloe , Larnkjær Anni , Bode Lars , Mølgaard Christian , Michaelsen Kim F. , Dragsted Lars Ove
Published: December 2019

Scope

The aim is to identify breastmilk components associated with fecal concentration of SCFAs and to investigate whether they differ between infants with high weight gain (HW) and normal weight gain (NW).

Methods and results

Breastmilk and fecal samples are collected from mother–infant dyads with HW (n = 11) and NW (n = 15) at 5 and 9 months of age. Breastmilk is profiled on ultra‐performance LC‐quadrupole TOF‐MS platform. Fecal SCFAs are quantified using an isotope‐labeled chemical derivatization method. Human milk oligosaccharides (HMOs) are quantified using HPLC after fluorescent derivatization. Lower levels of α‐linolenic acid, oleic acid, 3‐oxohexadecanoic acid, LPE (P‐16:0), LPC (16:0), LPC (18:0), PC (36:2) in breastmilk from mothers from the HW‐group at 5 months of age is found. Fecal SCFA concentrations are increased during the transition period from breastfeeding to complementary feeding. Fecal butyrate concentration is higher in the NW‐group at 9 months of age. Fecal branched SCFAs are positively associated with breastmilk phospholipid levels, free‐fatty acid levels, HMO‐diversity, sialylated‐HMOs, 6′‐sialyllactose, and disialyl‐lacto‐N‐hexaose.

Conclusion

Fecal branched SCFA concentrations seem to be affected by breastmilk lipid and HMO composition. These differences in breastmilk metabolites may partially explain the excessive weight gain in early life.