bluuebunny/crossref_metadata_2025 huggingface dataset:
Visual privacy behaviour recognition for social robots based on an improved generative adversarial network
Authors: Yang Guanci , Lin Jiacheng , Su Zhidong , Li Yang
Published: August 2023

Although social robots equipped with visual devices may leak user information, countermeasures for ensuring privacy are not readily available, making visual privacy protection problematic. In this article, a semi‐supervised learning algorithm is proposed for visual privacy behaviour recognition based on an improved generative adversarial network for social robots; it is called PBR‐GAN. A 9‐layer residual generator network enhances the data quality, and a 10‐layer discriminator network strengthens the feature extraction. A tailored objective function, loss function, and strategy are proposed to dynamically adjust the learning rate to guarantee high performance. A social robot platform and architecture for visual privacy recognition and protection are implemented. The recognition accuracy of the proposed PBR‐GAN is compared with Inception_v3, SS‐GAN, and SF‐GAN. The average recognition accuracy of the proposed PBR‐GAN is 85.91%, which is improved by 3.93%, 9.91%, and 1.73% compared with the performance of Inception_v3, SS‐GAN, and SF‐GAN respectively. Through a case study, seven situations are considered related to privacy at home, and develop training and test datasets with 8,720 and 1,280 images, respectively, are developed. The proposed PBR‐GAN recognises the designed visual privacy information with an average accuracy of 89.91%.
K‐band CMOS low‐noise amplifier with 180° phase shift function using cascode structure
Authors: Jang Seongjin , Lee Jaeyong , Park Changkun
Published: August 2023

In this study, a K‐band CMOS low‐noise amplifier (LNA) with a 180° phase shift function is presented to reduce the chip area of the beamforming system. The proposed LNA is composed of three stages, and the last stage is designed with a differential cascode structure for 180° phase shift function. The 180° phase shift function was implemented by dividing one cascode transistor into two transistors. As a result, it is possible to equip the 180° phase shift function without an additional chip area. The LNA was designed with a 65‐nm CMOS process to verify the feasibility of the proposed technique. The core size was 0.66 × 0.41 mm2. The measured phase difference between 0° and 180° phase shift modes was approximately 178° in the operating frequency of 22.0 GHz. The measured noise figure and gain were 3.8 and 12.7 dB, respectively.
Two algorithms of geodesic line length calculation considering elevation in eLoran systems
Authors: Chang Sisi , Ji Bing , Hu Qiongfang , Bian Shaofeng , Li Houpu , Li Wenkui , Liu Bei
Published: August 2023

The existing LOng RAnge Naviating System stations are mostly used by marine users and are situated at offshore, low‐altitude locations. As a result, the impact of height on the system's positioning accuracy is usually ignored. However, the direct transplantation of low‐altitude calculation methods to high‐altitude areas will bring errors in the positioning results due to the lack of elevation consideration. In order to improve the accuracy of the new enhanced Loran system and reduce the error caused by the calculation of the geodetic line length without considering elevation in high altitude areas, this paper proposes two different algorithms to establish new reference ellipsoids to reduce the height‐caused error, namely the direct algorithm and the expansion ellipsoid algorithm. Experiments show that the error of the calculation results by direct algorithm is smaller, except that it is not applicable when the azimuth is 90° or 270°. The new ellipsoid created by expansion ellipsoid algorithm has smaller changes, and the elevation and geographical coordinates can be considered independent, which is more in line with the Loran system's application requirements.
The Role of Metabolic Syndrome Components in Sensorineural Hearing Loss in Adolescents: A Case-Control Study
Authors: Jalali Mir Mohammad , Dalili Setila , Koohmanaee Shahin , Rad Samira
Published: August 2023

Introduction Metabolic syndrome (MetS) and its associated components were reported as a possible cause of inner ear dysfunction. However, research about the influence of cardiovascular risk factors on hearing thresholds are conducted mainly in adult patients.

Objective The aim of the present study was to investigate auditory function in adolescents with MetS compared with healthy controls.

Methods One hundred adolescents with metabolic syndrome and 200 sex- and age-matched controls were recruited from a university pediatric endocrine clinic from May 2018 to July 2020. Hearing loss was defined as hearing level ≥ 15 dB at speech frequency (SFHL) or high frequency (HFHL) in one or both ears. A multivariable conditional logistic regression analysis examined the correlation between MetS components and several important demographic characteristics, and hearing loss.

Results A total of 165 (55.0%) boys and 135 (45.0%) girls participated in this study. The rates of SFHL and HFHL in adolescents with MetS were 32.0% and 51.0%, respectively. Those values for controls were 5.0% and 15.5%, respectively. The regression analysis showed high triglycerides as a significant predictor for SFHL (odds ratio 10.87; 95% confidence interval: 1.98, 59.74). Neither predictor of interest was significant for HFHL.

Conclusion Hypertriglyceridemia may be an important factor in the pathogenesis of SFHL. However, the strength of the association was not significant with a wide confidence interval. Also, we were unable to find an association between predictors and HFHL with the current sample size. Larger and prospective studies are recommended.
Postauricular Transcanal Posterior Tympanectomy (PT2) Approach – A Modified Surgical Technique for Jugulotympanic Paragangliomas
Authors: Panda Naresh K. , Nayak Gyanranjan
Published: August 2023

Introduction The surgical management of jugulotympanic paragangliomas has remained challenging. They are the second most common type of tumor of the temporal bone after acoustic neuroma. It has been noticed by the authors that the jugulotympanic paragangliomas may have extensions to the epitympanum and aditus in addition to the mesotympanum and hypotympanum. The modified technique could be an alternative to the conventional facial recess technique for complete removal of the tumors.

Objective To highlight the modified surgical technique for the surgical treatment of jugulotympanic paragangliomas.

Methods This is a retrospective review of 34 cases of jugulotympanic paragangliomas treated in a tertiary center with respect to clinical presentation, diagnosis, and surgical treatment. Tinnitus and hearing loss were predominant symptoms. A modified technique of postauricular transcanal posterior tympanectomy with extended hypotympanic access was performed in 29 patients. Only two cases were operated with a classical transcanal approach. A canal wall down the mastoidectomy was required in three patients.

Results The patients operated on with the modified technique had complete excision evident by absence of any lesion in computed tomography and the disappearance of tinnitus. However, two patients had recurrence of symptoms and presence of tumor in the follow-up period. These two patients underwent revision surgery. None of the patients required postoperative radiotherapy or gamma knife therapy.

Conclusions Jugulotympanic paragangliomas can be effectively managed with the modified technique to ensure complete removal of the lesions. This technique has not been reported earlier in the literature.
Outcomes of Endoscopic Sinus Surgery for Chronic Rhinosinusitis in Adults with Primary Ciliary Dyskinesia
Authors: Plantier Diogo Barreto , Pinna Fábio de Rezende , Olm Mary Anne Kowal , Athanázio Rodrigo , Pilan Renata Ribeiro de Mendonça , Voegels Richard Louis
Published: August 2023

Introduction Primary ciliary dyskinesia (PCD) is a rare inherited disease associated with impairment of mucociliary transport and, consequently, with a high incidence of chronic rhinosinusitis. For patients with chronic rhinosinusitis who remain symptomatic despite medical treatment, endoscopic sinus surgery is a safe and effective therapeutic option. However, to date, no studies have been found evaluating the effect of surgery on the quality of life associated with the effect on olfaction and nasal endoscopy findings of patients with primary ciliary dyskinesia and chronic rhinosinusitis.

Objective To describe the effect of endoscopic sinus surgery on the quality of life, on olfaction, and on nasal endoscopy findings of adults with PCD and chronic rhinosinusitis.

Methods Four patients who underwent endoscopic sinus surgery were included. The Sinonasal Outcome Test-22 (SNOT-22) score, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and the Lund-Kennedy score were collected preoperatively and at 3 and 6 months postoperatively. The olfaction as assessed with the University of Pennsylvania Smell Identification Test (UPSIT), which was administered preoperatively and 3 months postoperatively.

Results A total of 4 patients with a mean age of 39.3 years old (3 men and 1 woman) completed the study. All patients showed clinically significant improvement in the SNOT-22, NOSE, and Lund-Kennedy scores at 3 months postoperatively, and this improvement was sustained throughout the follow-up period. However, olfaction did not improve after surgery.

Conclusion The endoscopic sinus surgery treatment of chronic rhinosinusitis in adults with PCD was associated with improvement in quality of life and endoscopic findings. However, no improvement in olfaction was demonstrated. Studies with a larger number of patients and control groups should help confirm these findings.
Quality of Life of Parents of Children with Cancer—Single-Center, Prospective Cross-Sectional Study from South India
Authors: Innasimuthu Arockia John , Jayaraman Dhaarani , Jeyarani Gracelin , Scott Julius Xavier , Iyengar Sumedh Krishna , Subramanian Lalitha , Sneha Latha M. , Kovindan Balaji Thiruvengadam , Arul Janani
Published: August 2023

Introduction Holistic care for children with chronic diseases including cancer should include psychological support for children and their families. The impact of pediatric malignancies in regard to quality of life (QOL) of parents is poorly described.

Objectives We aim to study the QOL of parents of children diagnosed with cancer in physical, psychosocial, environmental, and social domains.

Materials and Methods A prospective, cross-sectional study was conducted with 162 parents of children diagnosed with malignancy for 3 months or more. Assessment was done by World Health Organization quality of life (WHOQOL-BREF) questionnaire that includes four domains with a total of 26 questions. Data analysis was done by using Statistical Package for Social Sciences (SPSS) version 20.0; p-value less than 0.05 was considered significant. Results on continuous measurements were presented as “Mean ± SD” and categorical measurements were presented as percentages (%). Differences in the quantitative variables between groups were assessed by unpaired-t-test; comparison between groups by nonparametric Mann–Whitney U test and chi-squared test was used to analyze categorical variables with p-value of < 0.05 using a two-tailed taken as statistically significant.

Results Mean raw scores of QOL in physical health, psychological, social, and environmental domains were 20.10, 15.28, 8.10, and 25.24, respectively, with social relationships being the lowest; inadequate or low QOL was noted in 50% study population and it was maximally affected by increased duration of treatment, multimodality treatment, socioeconomic status, rural population, education and occupation status of the parents, and increased cost of care. Type of family or place of residence, family history of psychiatric illness, or malignancy did not influence the QOL of parents of children with cancer.

Conclusion Psychological support from the beginning of the treatment along with financial, social support should be offered through a comprehensive care program to improve the QOL.
Communicative and Hearing Performance in Individuals with Cochlear Implants and Delayed Neuropsychomotor Development: A Longitudinal Analysis
Authors: Rocha Larissa Veloso , Zabeu-Fernandes Julia Speranza , Neto Rubens Vuono de Brito , Morettin-Zupelari Marina , Lourençone Luiz Fernando Manzoni
Published: August 2023

Introduction Between 15% to 30% of individuals with bilateral prelingual sensorineural hearing loss present with associated disabilities. Cochlear implant (CI) is an alternative treatment that provides consistent access to environmental and speech sounds, which results in significant benefits regarding quality of life and auditory and language development.

Objectives To study the auditory and communicative performance of individuals with CI and delayed neuropsychomotor development after a minimum of five years using the device.

Methods A total of eight patients were included in the study. We collected the multidisciplinary clinical records of participants, as well as the answers for the questionnaires applied remotely, which included the Children with Cochlear Implants: Parental Perspectives (CCIPP), International Classification of Functioning, Disability and Health: Children and Youth Version (ICF-CY), and the Gross Motor Function Classification System (GMFCS).

Results We found that throughout the years of CI use, the auditory threshold means improved significantly in all tested frequencies, as did the speech detection threshold and the language and hearing results. Regarding parental perception, parents evaluated aspects related to their children's social relations to be positive, and had worse perceptions regarding aspects related to their education.

Conclusion We observed a progression in the participants' auditory and language skills throughout the years of CI use; even in the presence of other associated disabilities. Future multicentric studies with larger samples are needed to further the advancement of rehabilitation in patients with other associated disabilities.
Tissue Perfusion and Diffusion and Cellular Respiration: Transport and Utilization of Oxygen
Authors: Hsia Connie C. W.
Published: August 2023

This article provides an overview of the journey of inspired oxygen after its uptake across the alveolar–capillary interface, and the interplay among tissue perfusion, diffusion, and cellular respiration in the transport and utilization of oxygen. The critical interactions between oxygen and its facilitative carriers (hemoglobin in red blood cells and myoglobin in muscle cells), and with other respiratory and vasoactive molecules (carbon dioxide, nitric oxide, and carbon monoxide), are emphasized to illustrate how this versatile system dynamically optimizes regional convective transport and diffusive gas exchange. The rates of reciprocal gas exchange in the lung and the periphery must be well-matched and sufficient for meeting the range of energy demands from rest to maximal stress but not excessive as to become toxic. The mobile red blood cells play a vital role in matching tissue perfusion and gas exchange by dynamically regulating the controlled uptake of oxygen and communicating regional metabolic signals across different organs. Intracellular oxygen diffusion and facilitation via myoglobin into the mitochondria, and utilization via electron transport chain and oxidative phosphorylation, are summarized. Physiological and pathophysiological adaptations are briefly described. Dysfunction of any component across this integrated system affects all other components and elicits corresponding structural and functional adaptation aimed at matching the capacities across the entire system and restoring equilibrium under normal and pathological conditions.
Importance of Diameter of Long Process of Incus in Stapedotomy-New Findings From In Vivo Study
Authors: Anand Veluswamy , Anand Aiswarya , Janarthanan Sridurga , Francis Sebina
Published: August 2023

Introduction Stapes surgery for otosclerosis is a precise surgical procedure. To achieve excellent hearing results, a firm and stable attachment of the prosthesis to the long process of incus (LPI) is necessary. The present study provides details on the attachment site in two dimensions to choose an appropriate prosthesis and to ensure firm attachment for better surgical outcomes.

Objective To study the diameter of the LPI and its relevance in determining the piston, used in stapes surgery by an in vivo method.

Methods This study was conducted in 41 patients who underwent stapedotomy, where both Anteroposterior (AP) and Mediolateral (ML) diameters of the LPI were measured at the site of attachment of the piston using specially designed instruments, intraoperatively.

Radiological data were obtained to measure the LPI diameter from the normal ears of 46 patients. It was measured from both the right and left side, hence 92 LPI diameters were obtained.

Results The most commonly used site for prosthesis attachment is between 1–1.5 mm away from the tip of the LPI. We found great variability in the diameters of LPI in the attachment site, with the AP diameter ranging between 0.6 -1.5mm and the ML diameter ranging between 0.5mm-1.2 mm.

Conclusion Pistons by design have characteristics of gripping incus that will vary between types. Based on LPI dimensions, ideal piston types with appropriate inner loop diameters are suggested in this study. HRCT before surgery should include measurements of the LPI as a guide to the choice of the prosthesis during surgery.
Robotic Plastic Surgery Education: Developing a Robotic Surgery Training Program Specific to Plastic Surgery Trainees
Authors: Yim Nicholas H. , Burns Heather R. , Davis Matthew J. , Selber Jesse C.
Published: August 2023

Over the past two decades, the surgical community has increasingly embraced robotic-assisted surgery (RAS) due to its potential to enhance accuracy and decrease surgical morbidity. Plastic surgery as a field has been historically slow to incorporate RAS, with lack of adequate training posing as one of the most commonly cited barriers. To date, robot technology has been utilized for various reconstructive procedures including flap elevation and inset, pedicle dissection, and microvascular anastomosis. As RAS continues to integrate within plastic surgery procedures, the need for a structured RAS curriculum designed for plastic surgery trainees is rising. This article delineates the essential components of a plastic surgery-specific RAS curriculum and outlines current training models and assessment tools utilized across surgical subspecialties to date.
The Benefit of YouTube Videos as a Source of Information on Tinnitus for Patients
Authors: Bakshi Satvinder Singh , Kalidoss Vinoth Kumar , Ramesh Seepana , Das Soumyajit
Published: August 2023

Introduction Tinnitus is one of the most common otological complaints encountered. Patients often use the internet, especially YouTube videos, as a source of information regarding their health condition. There is a need to analyze the standard and quality of information in these videos so that the patients receive correct information.

Objective The purpose of the present study was to evaluate the reliability and utility of YouTube videos on tinnitus.

Methods The first 100 videos on YouTube using the search terms tinnitus and ringing in the ear were identified. Three subject experts assessed the reliability using the modified five-point DISCERN score and utility using a usefulness score. Various indices like view ratio, like ratio, video power index, and interaction index were also calculated.

Results Out of the 100 videos selected, 34 were excluded; collectively the remaining 66 videos were viewed 12,797,730 times. The most common upload sources were hospital/physician (39%), paramedic health care providers (19%), and alternative medicine (19%). The discern score was the highest in hospital/physician group (mean 19.3) and lowest in patient experience group (mean 13.4). A negative correlation was observed between the number of views (correlation coefficient −0.214), number of likes (correlation coefficient −0.242), number of comments (correlation coefficient −0.242), and the usefulness score.

Conclusion Although there are multiple videos on YouTube regarding tinnitus, the overall educational content and reliability of the videos are poor. Video popularity is not associated with usefulness. Healthcare providers should counsel patients regarding videos on YouTube and try to create more comprehensive videos.
The impact of non-communicable chronic diseases on the earned income of working age Chinese residents
Authors: Zhao Pengju , Li Ke , Coyte Peter C.
Published: August 2023

This paper used two waves (2016 and 2018) of longitudinal data from the China Families Panel Survey (CFPS) to analyze the economic impact of Non-communicable chronic diseases (NCDs) on individual earned income using propensity score matching and difference in difference (PSM-DID) methods to control for potential confounding. The occurrence of a NCDs was associated with a significant decrease in earned income by 19.2% (P = 0.002, t = 3.75). The reasons for this decrease include: a lower labour force participation rate; lower weekly hours worked; and a lower average hourly wage. After holding labour market behaviours constant, different types of NCDs have different impacts on earned income. Musculoskeletal diseases have the greatest negative impact, accounting for a 21.5% decrease in individual earned income (p < 0.0001, t = −7.84), while digestive system diseases have the smallest impact accounting for a 6.9% decrease in earned income (p = 0.012, t = −2.52).
Imitating Fishtail Motion to Increase Efficiency of Flapping Foil Energy Harvesters
Authors: Liebendorfer Adam
Published: August 2023

After a 2D simulation on both single and tandem flapping foil with two types of flapping trajectories, there was a significant role in energy extraction performance.
Secondary scintillation properties of multi-layer THGEMs operated in low-pressure CF4 and Ar/5%Xe
Authors: Cortesi M. , Sims H. , Pereira J. , Ayyad Y. , Majewski P.A. , Katsioulas I.
Published: August 2023

We present a measurement of the secondary scintillation
yield produced by two-layer Thick Gas Electron Multipliers
(M-THGEMs) in pure Tetrafluoromethane (CF4) gas and in Ar mixed
with 5% Xe in low-pressures down to 20 Torr. The detector was
irradiated with 5.49 MeV alpha particles from a low-rate 241-Am
source. The secondary scintillation light generated during the gas
avalanche process was read out by a Hamamatsu photomultiplier tube
(model R8520-406), sensitive to a broad wavelength range
(160–650 nm). The avalanche charge was collected on the bottom
electrode of M-THGEM and correlated to the scintillation light on an
event-by-event basis. We observed that, for both gas types, the
value of the photon to electron production ratio (0.4 ph/el in
CF4 and 0.1 ph/el in Ar/5%Xe) increases with the thickness of
the M-THGEM electrodes and varies significantly with the pressure,
being higher at lower values. The decrease in electroluminescence
yield at higher pressures is much more pronounced in the Ar/Xe
mixture. In addition, because of a larger gas avalanche volume, the
electroluminescence light yield is larger in thicker M-THGEM
structures. Presented results are particularly useful for designing
the next generation of Optical-readout Time Projection Chambers
(O-TPCs) operated at low-pressure CF4; applications include
experimental nuclear physics with rare isotope beams, dark matter
detection with directional sensitivity and observation of the Migdal
effect in a low-pressure Optical TPC.
Complexity Theory and Child Protection and Welfare: A Tool of Hindsight and/or a Tool to Assist Improved Decision Making in Child Protection and Welfare Work
Authors: Gillen Aisling , Canavan John
Published: August 2023

Child abuse and neglect is a ‘wicked problem’ (Devaney, J. and Spratt, T. (2009) ‘Child abuse as a complex and wicked problem: Reflecting on policy developments in the United Kingdom in working with children and families with multiple problems’, Children and Youth Services Review, 31(6), pp. 635–41.). Child Protection and Welfare (CPW) systems are open systems in which a wide variety of practitioners and families themselves contribute to outcomes. Small interacting changes in one part of a CPW system can lead to unpredictable and systemic effects so linear, technocratic solutions are not sufficient in addressing this complexity. Whilst CPW systems may aim to make clear roles and responsibilities, steered by legislation and regulatory guidance, complex systems do not behave as system designers expect. Recent literature has demonstrated a turn to complexity theory and systems theory concepts for understanding and working in the world of child protection. This article suggests a practice framework based on complexity theory concepts of self-organisation/emergence/adaptation, path-dependency and bifurcation. The utility of the framework is tested by its application to a fictionalised case study built on a thematic analysis of five National Review Panel published case reviews in the Irish child protection context (2019–2020). We argue that complexity theory may be a useful tool for both post hoc analytics as well as providing a proactive tool for application to practice to assist decision making in CPW systems, services and organisations.
A Large-Scale Mobile Traffic Dataset For Mobile Application Identification
Authors: Zhao Shuang , Chen Shuhui , Wang Fei , Wei Ziling , Zhong Jincheng , Liang Jianbing
Published: August 2023

With Internet access shifting from desktop-driven to mobile-driven, application-level mobile traffic identification has become a research hotspot. Although considerable progress has been made in this research field, two obstacles are hindering its further development. Firstly, there is a lack of sharable labeled mobile traffic datasets. Although it is easy to capture mobile traffic, labeling traffic at the application level is non-trivial. Besides, researchers usually hold a conservative attitude toward publishing their datasets for privacy concerns. Secondly, most of the datasets used by existing studies are inadequate to evaluate the proposed methods, since they usually have the problems of inaccurate labels, small scale and simple collection configurations. To tackle these two obstacles, a mobile traffic collection is carried out in this paper. The collected traffic has the advantages of large-scale data size, accurate application-level labels and diverse collection configurations. Then, the collected traffic is anonymized carefully to make it public. Several mobile traffic identification methods are compared based on our anonymized dataset, which proves the applicability of our dataset.
Life cycle complexity and body mass drive erratic changes in climate vulnerability across ontogeny in a seasonally migrating butterfly
Authors: Medina-Báez Osmary A , Lenard Angie , Muzychuk Rut A , da Silva Carmen R B , Diamond Sarah E
Published: August 2023

Physiological traits are often used for vulnerability assessments of organismal responses to climate change. Trait values can change dramatically over the life cycle of organisms but are typically assessed at a single developmental stage. Reconciling ontogenetic changes in physiological traits with vulnerability assessments often reveals early life-stage vulnerabilities. The degree to which ontogenetic changes in physiological traits are due to changes in body mass over development versus stage-specific responses determines the degree to which mass can be used as a proxy for vulnerability. Here, we use the painted lady butterfly, Vanessa cardui, to test ontogenetic changes in two physiological traits, the acute thermal sensitivity of routine metabolic rate (RMR Q10) and the critical thermal maximum (CTmax). RMR Q10 generally followed ontogenetic changes in body mass, with stages characterized by smaller body mass exhibiting lower acute thermal sensitivity. However, CTmax was largely decoupled from ontogenetic changes in body mass. In contrast with trends from other studies showing increasing vulnerability among progressively earlier developmental stages, our study revealed highly erratic patterns of vulnerability across ontogeny. Specifically, we found the lowest joint-trait vulnerability (both RMR Q10 and CTmax) in the earliest developmental stage we tested (3rd instar larvae), the highest vulnerabilities in the next two developmental stages (4th and 5th instar larvae), and reduced vulnerability into the pupal and adult stages. Our study supports growing evidence of mechanistic decoupling of physiology across developmental stages and suggests that body mass is not a universal proxy for all physiological trait indicators of climate vulnerability.
Right ventricular myocardial work for the prediction of early right heart failure and long-term mortality after left ventricular assist device implant
Authors: Landra Federico , Sciaccaluga Carlotta , Pastore Maria Concetta , Gallone Guglielmo , Barilli Maria , Fusi Chiara , Focardi Marta , Cavigli Luna , D’Ascenzi Flavio , Natali Benedetta Maria , Bernazzali Sonia , Maccherini Massimo , Valente Serafina , Cameli Matteo , Mandoli Giulia Elena
Published: August 2023

Aims

Right heart failure (RHF) after left ventricular assist device (LVAD) implant is burdened by high morbidity and mortality rates and should be prevented by appropriate patient selection. Adequate right ventricular function is of paramount importance but its assessment is complex and cannot disregard afterload. Myocardial work (MW) is a non-invasive Speckle Tracking Echocardiography-derived method to estimate pressure–volume loops. The aim of this study was to evaluate the performance of right ventricular myocardial work to predict RHF and long-term mortality after LVAD implant.

Methods and results

Consecutive patients from May 2017 to February 2022 undergoing LVAD implant were retrospectively reviewed. Patients without a useful echocardiographic exam prior to LVAD implant were excluded. MW analysis was performed. The primary endpoints were early RHF (<30 days from LVAD implant) and death at latest available follow-up. We included 23 patients (mean age 64 ± 8 years, 91% men). Median follow-up was 339 days (IQR: 30–1143). Early RHF occurred in six patients (26%). A lower right ventricular global work efficiency [RVGWE, OR 0.86, 95% confidence intervals (CI) 0.76–0.97, P = 0.014] was associated with the occurrence of early RHF. Among MW indices, the performance for early RHF prediction was greatest for RVGWE [area under the curve (AUC) 0.92] and a cut-off of 77% had a 100% sensitivity and 82% specificity. At long-term follow-up, death occurred in 4 of 14 patients (28.6%) in the RVGWE > 77% group and in 6 of 9 patients (66.7%) in the RVGWE < 77% group (HR 0.25, 95% CI 0.07–0.90, P = 0.033).

Conclusion

RVGWE was a predictor of early RHF after LVAD implant and brought prognostic value in terms of long-term mortality.
Effect of protein supplementation on plasma sodium levels in the syndrome of inappropriate antidiuresis: a monocentric, open-label, proof-of-concept study—the TREASURE study
Authors: Monnerat Sophie , Atila Cihan , Baur Fabienne , Santos de Jesus Joyce , Refardt Julie , Dickenmann Michael , Christ-Crain Mirjam
Published: August 2023

Importance

The syndrome of inappropriate antidiuresis (SIAD) can be treated with oral urea; however, compliance is impaired by its poor palatability.

Objective

To investigate whether dietary proteins could increase plasma sodium levels through urea-induced osmotic diuresis.

Design

An open-label, proof-of-concept trial.

Setting

University Hospital of Basel, Switzerland, between October 2021 and February 2023.

Participants

Outpatients with chronic SIAD.

Interventions or exposures

Ninety grams of protein daily for 7 days in the form of protein powder, followed by 30 g of oral urea daily for 7 days after a wash-out period of ≥1 week.

Main outcomes and measures

The increase in sodium levels from baseline to the end of the 7-day protein supplementation.

Results

Seventeen patients were included. After 7 days of 90 g daily protein supplementation (n = 17), plasma sodium levels increased from 131 (129-133) to 133 (132-137), that is, by a median of 3 mmol L–1 (0-5) (P = .01). Plasma urea levels increased by 3 mmol L–1 (1.7-4.9) (P < .01), and urine urea to creatinine ratio increased by 21.2 mmol mmol–1 (6.2-29.1) (P < .01). After 7 days of 30 g oral urea (n = 10), plasma sodium levels increased from 132 (130-133) to 134 (131-136), that is, by a median of 2 mmol L–1 (1-3) (P = .06). Plasma urea levels increased by 5.8 mmol L–1 (2.7-9.2) (P < .01), and urine urea to creatinine ratio increased by 31.0 mmol mmol–1 (18.7-45.1) (P < .01).

Conclusions and relevance

Our findings suggest that protein powder increases plasma sodium levels in patients with chronic SIAD through protein-induced ureagenesis and osmotic diuresis. The effects are comparable with oral urea.
Private quantiles estimation in the presence of atoms
Authors: Lalanne Clément , Gastaud Clément , Grislain Nicolas , Garivier Aurélien , Gribonval Rémi
Published: August 2023

We consider the differentially private estimation of multiple quantiles (MQ) of a distribution from a dataset, a key building block in modern data analysis. We apply the recent non-smoothed Inverse Sensitivity (IS) mechanism to this specific problem. We establish that the resulting method is closely related to the recently published ad hoc algorithm JointExp. In particular, they share the same computational complexity and a similar efficiency. We prove the statistical consistency of these two algorithms for continuous distributions. Furthermore, we demonstrate both theoretically and empirically that this method suffers from an important lack of performance in the case of peaked distributions, which can degrade up to a potentially catastrophic impact in the presence of atoms. Its smoothed version (i.e. by applying a max kernel to its output density) would solve this problem, but remains an open challenge to implement. As a proxy, we propose a simple and numerically efficient method called Heuristically Smoothed JointExp (HSJointExp), which is endowed with performance guarantees for a broad class of distributions and achieves results that are orders of magnitude better on problematic datasets.
Knowledge and use of chorhexidine gel in umbilical cord care among postpartum women at Poly General Hospital, Enugu, Southeast Nigeria: a cross-sectional study
Authors: Israel Chidinma E , Attama Kareen O , Opara Hope Chizolum , Ihudiebube-Splendor Chikaodili N , Omotola Ngozi J
Published: August 2023

Background

Sepsis in the first week or two of life is a major cause of newborn deaths. People from diverse cultural backgrounds use different substances for umbilical cord care. Evidence-based umbilical cord care practices have a large potential to lower infant morbidity and mortality linked to infection. This study investigated the knowledge and use of chlorhexidine gel for umbilical cord care.

Methods

A cross-sectional descriptive survey was employed among 191 postpartum women at the Poly General Hospital Asata, Enugu, selected through simple random sampling. A researcher-developed questionnaire was used for data collection.

Results

More than one-half (n=101; 52.1%) had poor knowledge of chlorhexidine gel use in umbilical cord care. There was no significant association between educational status and knowledge of chlorhexidine gel use in umbilical cord care among the participants (p=0.072). Only 89 (46.6%) had ever used chlorhexidine gel for umbilical cord care, while 49 (25.7%) used chlorhexidine gel for their last child. Parity was not significantly associated with the use of chlorhexidine gel (p=0.736). Both educational status (p=0.019) and knowledge of chlorhexidine use for umbilical cord care (p<0.001) were found to be significantly associated with its use.

Conclusions

There was poor knowledge of chlorhexidine gel use for umbilical cord care among the participants. Use of chlorhexidine gel in this population is still suboptimal. Healthcare providers should continue to provide information on chlorhexidine gel use in umbilical cord care in order to optimise its knowledge and use. Other factors associated with the use of chlorhexidine gel for umbilical cord care should be explored.
Consumer-Led Investigation into Potential Issues That Arise When Testing Dairy Matrixes for Gluten With the NIMA Sensor
Authors: Thompson Tricia , Rogers Adrian , Perry Johnna
Published: August 2023

Background

Some consumers with celiac disease use personal, point-of-use gluten detection devices to test food. False-positive results may occur due to sampling, matrix effects, and sensor issues.

Objective

The purpose of the present study was to determine if the positive gluten results some users were obtaining when testing cream cheese and materials of similar consistency were false positives and, if so, what might be causing them to occur.

Methods

Cream cheese, soft cheese, and yogurt were tested for gluten using the Ridascreen Gliadin R7001 sandwich R5 ELISA and the Ridascreen Gliadin R7021 competitive R5 ELISA. Two test portions were taken, extracted, and tested from each homogenized material. Materials were also analyzed for gluten using a NIMA sensor, a personal, point-of-use gluten detection device. Multiple test portion weights were tested beginning at 0.13 to 0.17 g (the ideal weight of the test portion according to the NIMA sensor development team).

Results

Using the sandwich R5 ELISA and the competitive R5 ELISA, all materials tested below the lower LOD for gluten. Using a NIMA sensor, as the weight of the test portion tested increased, sensor results went from no gluten found, to gluten found, to no test result.

Conclusion

The gluten found results using the NIMA sensor are likely false positives that appear to correspond with the weight and volume of the material tested, as well as the viscosity. There is also an apparent disconnect between the gluten found result reported by the sensor and an interpretation of the lateral flow device (LFD) strip result when assessed by eye which should also be taken into account. Ideally, NIMA sensor users should be advised on the weight amount of material to analyze and test portions should be weighed before being used with the NIMA sensor. However, this is not a practical solution when testing in many environments, including restaurants.

Highlights

Slight variations in weight and volume of test materials can result in false positive results when testing dairy matrixes for gluten using the Nima sensor.
Confirmation of cannabinoids in forensic toxicology casework by isomer-selective UPLC–MS-MS analysis in urine
Authors: Rosano Thomas G , Cooper Jane A , Scholz Kiley L , Wood Michelle
Published: August 2023

Confirmation of cannabinoid use by forensic toxicology testing in urine has been traditionally focused on ∆9-tetrahydrocannabinol (∆9-THC) with analysis of its major metabolite, 11-nor-9-carboxy-∆9-THC (∆9-cTHC), in free and conjugated forms. Legalization of hemp, however, has led to the widespread production and sale of cannabidiol (CBD) derivatives with psycho-activity, including ∆8-THC and ∆10-THC isomers. The increasing availability and growing use of isomer derivatives necessitate an expanded scope of cannabinoid confirmation test protocols. We report a quantitative, isomer-selective method of cannabinoid confirmation by liquid chromatography–tandem mass spectrometry determination of parent drug isomers (∆8-THC, ∆9-THC, ∆10-THC and CBD) as well as isomeric metabolites (∆8-cTHC and ∆9-cTHC). An efficient C18 phase chromatography on 1.6-µm solid core particles was used with a step gradient for near isocratic separation of both early-eluting THC metabolite isomers and later-eluting CBD and THC isomers. A rapid method of hydrolysis, dilution and analysis was employed for the quantitative co-determination of free and conjugated analytes, using stable isotope internal standardization. Method validation is reported, along with interference assessment from a prior confirmation method. Casework experience with the isomer-selective method revealed a 14% prevalence of ∆8-cTHC positive cases with a pattern of concomitant ∆8-THC and ∆9-THC use. A comparison of ∆8-cTHC and ∆9-cTHC phase two metabolism is also reported.
Can Wealth Buy Health? A Model of Pecuniary and Non-Pecuniary Investments in Health
Authors: Margaris Panos , Wallenius Johanna
Published: August 2023

In this paper, we develop a life cycle model that features pecuniary and non-pecuniary investments in health in order to rationalize the socioeconomic gradients in health and life expectancy in the United States. Agents accumulate health capital, which affects labor productivity, utility, the distribution of medical spending shocks, and life expectancy. We find that unequal health insurance coverage plays a negligible role in generating the observed gaps in health and longevity. Universal health insurance increases preventive medical spending but not time spent in health promoting activities, as individuals are no longer worried about avoiding high curative medical expenditure shocks due to increased health insurance coverage. Our findings suggest that differences in lifetime income, preferences, and health shocks are the main determinants of inequality in life expectancy.
A Weapon is No Subordinate
Authors: Spadaro Alessandra
Published: August 2023

The doctrine of superior responsibility is occasionally presented as a potential solution to the ‘responsibility gap’ allegedly created when the employment of autonomous weapon systems (AWS) results in violations of international humanitarian law, which would amount to war crimes. This article analyses several challenges to the applicability of the doctrine of superior responsibility in these circumstances. In fact, superior responsibility is premised on the existence of a superior–subordinate relationship between individuals. The type of control required for this relationship to exist is different from the kind of control exercised over weapons, including AWS. Additionally, the doctrine requires the commission of an underlying crime in all its elements by a punishable subordinate. Nonetheless, superior responsibility remains a useful framework to demarcate the scope of the supervisory duties of the superior in relation to the prevention of war crimes. Understanding the limitations of this doctrine will be important in guiding the discussions concerning the level of human control that should be retained over AWS.
Tolstoy on the injustice of the philosophy of education
Authors: Moulin Daniel
Published: August 2023

Tolstoy had a lifelong interest in education and philosophy. However, he was suspicious of using philosophy as a foundation for educational practice or applying philosophy to the educational problems of his day, most importantly, the development of an education system in Russia around the time of the emancipation of the serfs. Tolstoy’s rejection of the philosophy of education arose from his concerns about what would be identified in contemporary terminology as ‘epistemic injustice’ or ‘epistemicide’. How could European philosophy inform a curriculum and pedagogy for the Russian peasantry when the peasants’ own forms of knowledge were more valuable to their ways of life? Tolstoy sought to answer this question by engaging with children in peasant schools. This experience informed the development of his own worldview, articulated in the latter years of his life—a vision of uniting the insights of indigenous peoples from various times and places to inform what he considered to be the pursuit of authentic knowledge. This article considers Tolstoy’s apparent rejection of the philosophy of education, exploring how this seemingly bombastic position led to the evolution of an innovative meta-philosophy that offers some contribution to thinking about contemporary educational problems.
Stability of hierarchical triples – II. The inclination ι = 140° resonance in the stability surface
Authors: Pasechnik Alexey , Mylläri Aleksandr , Valtonen Mauri , Mikkola Seppo
Published: August 2023

The stability of a hierarchical triple star may be decided by a simple criterion, which was derived in Paper I. However, there is a region in the phase space where the stability limit Qmax is raised by a factor of two in a small region of the phase space with respect to the surrounding phase space. The phase space is defined by the inner and outer eccentricities ein and eout, respectively, as well as by the inclination ιtot between the inner and outer orbits. Additional parameters of the phase space are the masses of the three bodies. We study by numerical integration the orbits of over 100 000 triple systems in the resonance region. We find that the instability that causes the high value of Qmax arises from the octupole Kozai–Lidov resonance. This resonance region has rather equal contributions from the quadrupole and octupole terms and leads to secular evolution with an amplitude larger than either of the two oscillations in isolation. The conditions for this situation are best satisfied near the relative inclination ι = 140°. Additionally, the relative orientation of the two orbits plays a decisive role: the resonance is found only at certain values of the orbit’s node line longitude Ω. An analytical approximation of the energy change in a single close encounter between the inner and outer systems suggests a cos 2Ω dependence of Qmax on Ω, which seems to be qualitatively valid. We model Qmax as a function of cos ι and ein by a Gaussian function.
BSBM-14 MOLECULAR PROFILING OF CHECKPOINT LIGANDS AND KEY NK-ACTIVATION AND SUPPRESSIVE LIGANDS BY METASTATIC MELANOMA CELLS
Authors: Anchan Akshata , Kim Hyeon Joo , Davison Will , Yu Jane , Robilliard Laverne , Graham E Scott
Published: August 2023

Melanoma is an aggressive skin cancer with high propensity for brain metastasis. For advanced melanoma, immune checkpoint blockade (ICB) drugs, like pembrolizumab, have shown remarkable promise for progression-free survival. The ICB drugs have primarily targeted melanoma suppression of cytotoxic T-lymphocytes (CTLs). Earlier studies showed positive responses in up to 40% of cases, which has improved with discovery of new inhibitory ligands and combination therapy. However, not all patients respond, likely because of the capacity of cancer cells to regulate inhibitory and activating ligands, circumventing both immunomodulatory axes currently targeted by immunotherapies. In this study, we aim to characterize additional axes, prioritizing NK cells of the innate immune system. NK cells can mediate cytotoxic killing similar to CTLs but possess the advantages of germline-encoded receptors that recognize a broad range of ligands, thus, requiring relatively little priming and circumventing antigen escape. We have acquired up to ten patient-derived New Zealand Melanoma lines in collaboration with Auckland Cancer Society Research Centre, of which three are from brain metastases. We used NanoString technology to assess melanoma gene expression of immunoregulatory ligands governing NK activation, inhibition or both (via dual-functional ligands dictated by NK-receptors). The results showed expression of several inhibitory ligands but very few activating ligands. The expression trends were largely similar but varied in a select few ligands. Flow cytometry was used to characterize cell-surface expression of the immunoregulatory proteins. These were compared with the classical inhibitory checkpoint molecules evidencing that melanoma cells expressed more NK inhibitory molecules. We hypothesize that melanoma cells both express inhibitory ligands and suppress activation ligands, to hinder NK cell activity. Here we aim to identify novel immune axes leading towards expansion of ICB therapies. This will afford clinicians a personalized approach and access to combination immunotherapies, especially in combating refractory metastatic melanoma, which have poor prognoses.