bluuebunny/crossref_metadata_2025 huggingface dataset:
Palliativmedizinisches Denken und Handeln im Notarztdienst – eine Befragung zur Strukturqualität
Authors: Tiesmeier Jens , Salomon Fred , Lehning Brigitte , Tomaszczyk Matylda , Henzler Dietrich , Jakob Thomas
Published: October 2017

Fragestellung Je nach untersuchter Region beträgt der Anteil von Patienten mit einer palliativen Grunderkrankung 3 – 10% (ca. 1% in einer Terminalphase) der Gesamteinsätze im Rettungsdienst. Dabei ist ein breites Spektrum zu bewältigen. Es reicht von Symptomkrisen und psychosozialen Belastungen des Umfelds, über erkrankungsunabhängige Notfälle bis hin zur Frage der Durchführung einer Reanimation. Hierbei besteht ein Spannungsfeld zwischen dem kurativen Ansatz der Notfallrettung und dem Ansatz einer palliativen, symptomkontrollierenden Therapie vor Ort. Unter Zeitdruck müssen die Gesamtsituation erfasst und medizinische, juristische und ethische Aspekte im Sinne des Patienten gewürdigt werden. Es wurde der Frage nachgegangen, welche Strukturen und Hilfsmittel dem Notarzt für ein palliativmedizinisches Vorgehen und Denken im Einsatz zur Verfügung stehen.

Material und Methoden Datenerhebung zur Strukturqualität bei der Versorgung von Palliativpatienten mittels Fragebogen bei den Ärztlichen Leitern Rettungsdienst der Region Ostwestfalen-Lippe und der Stadt Münster.

Ergebnisse Rücklaufquote 8/8. Gesamtzahl der regelmäßig aktiven Notärzte pro Gebietskörperschaft 71 – 80; hiervon mit Zusatzweiterbildung Palliativmedizin 0 – 10. Fragenauswahl (in Klammern Anzahl der Nennungen), Strukturdaten Leitstelle: Kontaktdaten des ambulanten Palliativmediziners (z. B. Mobilfunknummer) für Disponenten zur Verfügung: ja (7), nein (1). Spezielle Schulungen der Disponenten: ja (1), nein (7). Strukturdaten zum Advance-Care Planning: Qualitätszirkel/Treffen Rettungsdienst/Palliativnetzwerk: ja (2), nein (6), geplant (1). Regional standardisierte Notfallausweise o. Ä.: ja (4), nein (4), geplant (1). Entscheidungshilfen im Einsatz: Standard operating Procedure (SOP) als Entscheidungspfad vorhanden: ja (3), nein (5), geplant (1). Ausstattung der Rettungsmittel: Port-Nadeln: ja (7), nein (1); MAD-Systeme (Intranasal Mucosal Atomization Device): ja (8), Gesamtmenge Morphinsulfat vor Ort ≥ 40 mg: ja (7), nein (1).

Diskussion und Schlussfolgerung Optionen, die ein palliativmedizinisches Vorgehen für die Notfallmedizin bieten können, wurden bislang uneinheitlich implementiert. Dies gilt für die Weiterbildung in medizinischen, rechtlichen und ethischen Fragen, die Ausstattung und Hilfsmittel auf den Rettungsmitteln sowie für die Kooperation mit den ambulanten Partnern. Mögliche Konflikt- und Schnittmengen sollten lokal und überregional erkannt und besprochen werden. Ziel ist ein souveränes und differenziertes Vorgehen zwischen kurativer Behandlungsoption und palliativer Symptomkontrolle, um im Sinne des Patienten handeln zu können.
Hall measurements on low-mobility thin films
Authors: Werner Florian
Published: October 2017

We review the conventional measuring standard for dc Hall measurements in van der Pauw configuration with particular focus on the challenges arising from a small Hall signal compared to sizable offset voltages, which is a typical scenario for many material systems, particularly low-mobility thin films. We show that the conventional approach of using a simple field-reversal technique is often unsuited to obtain reliable results, and present an improved correction scheme to extend the accessible measurement range to mobility values well below 1 cm2/(V s). We discuss procedures to limit the impact of temperature fluctuations and long stabilization times for highly resistive materials. We further address potential sources of error due to the presence of grain boundaries in polycrystalline specimen and due to multi-carrier conduction, both of which might yield low apparent Hall mobilities significantly underestimating the actual mobility.
Support for the existence of invertible maps between electronic densities and non-analytic 1-body external potentials in non-relativistic time-dependent quantum mechanics
Authors: Mosquera Martín A.
Published: October 2017

Provided the initial state, the Runge-Gross theorem establishes that the time-dependent (TD) external potential of a system of non-relativistic electrons determines uniquely their TD electronic density, and vice versa (up to a constant in the potential). This theorem requires the TD external potential and density to be Taylor-expandable around the initial time of the propagation. This paper presents an extension without this restriction. Given the initial state of the system and evolution of the density due to some TD scalar potential, we show that a perturbative (not necessarily weak) TD potential that induces a non-zero divergence of the external force-density, inside a small spatial subset and immediately after the initial propagation time, will cause a change in the density within that subset, implying that the TD potential uniquely determines the TD density. In this proof, we assume unitary evolution of wavefunctions and first-order differentiability (which does not imply analyticity) in time of the internal and external force-densities, electronic density, current density, and their spatial derivatives over the small spatial subset and short time interval.
Design and properties of planar-type tunnel FETs using In0.53Ga0.47As/InxGa1-xAs/In0.53Ga0.47As quantum well
Authors: Ahn D.-H. , Ji S.-M. , Takenaka M. , Takagi S.
Published: October 2017

Tunnel Field Effect Transistors (tunnel FETs) have been proposed using In0.53Ga0.47As/InxGa1-xAs/In0.53Ga0.47As Quantum Well (InxGa1-xAs QW) channels which improve their performance. It is expected in this structure that the high-In-content InxGa1-xAs QW layer with the lower bandgap can increase the tunneling current and resulting on-current (Ion), while the low-In-content In0.53Ga0.47As layer, where the source junction edge is mainly formed, can suppress the increase in the junction leakage current because of the higher bandgap. Considering the strain effect and the quantum confinement effect of the InxGa1-xAs QW layers, the In content and the QW thickness are designed carefully in terms of the reduction in the effective bandgap. The proposed tunnel FETs using the QW layers grown by Metal-organic Vapor Phase Epitaxy are fabricated, and the electrical and physical properties are systematically evaluated. It is found that the InxGa1-xAs QW can significantly enhance the performance of tunnel FETs. As expected in the calculation of the effective bandgap, the higher In content and thicker QW thickness lead to higher Ion, while the thinner QW thickness makes the sub-threshold swing (S.S.) steeper through the reduction in off-current (Ioff) and enhancement of carrier confinement. The minimum sub-threshold swing (S.S.min) of 62 mV/dec is obtained at VD = 150 mV for a tunnel FET with an In0.53Ga0.47As (2.6 nm)/In0.67Ga0.33 As (3.2 nm)/In0.53Ga0.47As (96.3 nm) QW structure. Also, the highest Ion of 11 μA/μm at VD = 150 mV and VG = 1 V, which is 8.5 times higher than 1.3 μA/μm of a control In0.53Ga0.47As tunnel FET, is obtained for a tunnel FET with an In0.53Ga0.47As (2.2 nm)/InAs (6.3 nm)/In0.53Ga0.47As (94.4 nm) QW structure. It is found that the InAs QW tunnel FETs with the InAs QW thicker than 5 nm significantly degrade by high junction leakage current attributed to the lattice relaxation.
Aharonov-Bohm effect without contact with the solenoid
Authors: de Oliveira César R. , Romano Renan G.
Published: October 2017

We add a scalar potential to the 2D Aharonov-Bohm (AB) model which properly diverges both at the solenoid border and at infinity so that the resulting operator is essentially self-adjoint and has a discrete spectrum; the former property is interpreted as no contact of the particle with the solenoid border since there is no need of boundary conditions. We study gauge transformations to get the usual periodic behavior of the AB properties as a function of the magnetic flux. The presence of the AB effect is proven through the ground state energy, which is shown to be smooth in case it is simple and with a nonzero derivative if the ground state is real valued; such properties are verified in the case of circular solenoids, for which it is shown to be a nonconstant periodic function with a minimum at integer and a maximum at half-integer circulations (at half-integer circulations, it is doubly degenerated).
Depolarization current relaxation process of insulating dielectrics after corona poling under different charging conditions
Authors: Zhang J. W. , Zhou T. C. , Wang J. X. , Yang X. F. , Zhu F. , Tian L. M. , Liu R. T.
Published: October 2017

As an insulating dielectric, polyimide is favorable for the application of optoelectronics, electrical insulation system in electric power industry, insulating, and packaging materials in space aircraft, due to its excellent thermal, mechanical and electrical insulating stability. The charge storage profile of such insulating dielectric is utmost important to its application, when it is exposed to electron irradiation, high voltage corona discharge or other treatments. These treatments could induce changes in physical and chemical properties of treated samples. To investigate the charge storage mechanism of the insulating dielectrics after high-voltage corona discharge, the relaxation processes responsible for corona charged polyimide films under different poling conditions were analyzed by the Thermally Stimulated Discharge Currents method (TSDC). In the results of thermal relaxation process, the appearance of various peaks in TSDC spectra provided a deep insight into the molecular status in the dielectric material and reflected stored space charge relaxation process in the insulating polymers after corona discharge treatments. Furthermore, the different space charge distribution status under various poling temperature and different discharge voltage level were also investigated, which could partly reflect the influence of the ambiance condition on the functional dielectrics after corona poling.
Optical characterization of surface plasmon resonance of Pt nanoparticles in TiO2-SiO2 nanocomposite films
Authors: Kang T. D. , Yoon Jong-Gul
Published: October 2017

The surface plasmon resonance (SPR) of Pt nanoparticles (NPs) in TiO2-SiO2 nanocomposite films, in which Pt NPs of about 5 nm are incorporated, is investigated by using spectroscopic ellipsometry. After obtaining the dielectric functions of Pt NPs from the Pt-SiO2 nanocomposite film, Pt-TiO2-SiO2 nanocomposite films are analyzed by applying a homogenous single layer model with an effective medium approximation. The effects of Pt NPs on the optical properties of the nanocomposite films are clearly revealed in the imaginary part of the dielectric functions, showing an increase in broadband absorption near the band gap of the films with the increasing volume fraction of Pt NPs in the films. Particularly, the maximum of extinction cross-section of Pt NPs in the films coincides with the broadband absorption, indicating that the localized SPR of Pt NPs is responsible for the enhanced light absorption at the visible-light wavelengths. This work emphasizes that, although SPR absorption of Pt NPs is not so distinctive in the visible-light wavelengths, proper tuning of the dielectric environment as well as the volume fraction of Pt NPs can enhance the photoactivity of the nanocomposite films.
Mechanism of reverse current increase of vertical-type diamond Schottky diodes
Authors: Teraji T. , Fiori A. , Kiritani N. , Tanimoto S. , Gheeraert E. , Koide Y.
Published: October 2017

Current transport at p-diamond Schottky contacts under reverse bias operation was investigated. Reverse current transport modes of several types were observed depending on the bias voltage range: thermionic emission (TE) associated with the image force barrier lowering was dominant in the lower voltage range of <50 V, whereas thermionic-field emission (TFE) mechanism governed transport in the higher voltage range. The Schottky barrier height ϕb estimated from the reverse characteristics was lower than that obtained from the forward characteristic by more than 0.4 eV, which indicates that the low Schottky barrier height ϕblow area localized in the patch shape at the diamond Schottky contact. This Schottky contact inhomogeneity was found to increase the reverse current effectively even though the ϕblow area is smaller because the reverse current in TE mode flows preferentially through ϕblow patches. The current transport mode changed from TE to TFE when the maximum electric field was >1 MV cm−1, which indicates that a strong electric field concentration exists at the Schottky electrode fringe. When the high reverse voltage was biased, a sudden current increase occurred, followed by a permanent increase of reverse current, indicating that mid-gap defects were formed at the interface. These results indicate that reverse current and electric-field breakdown have different origins.
Kinetic theory for DNA melting with vibrational entropy
Authors: Sensale Sebastian , Peng Zhangli , Chang Hsueh-Chia
Published: October 2017

By treating DNA as a vibrating nonlinear lattice, an activated kinetic theory for DNA melting is developed to capture the breakage of the hydrogen bonds and subsequent softening of torsional and bending vibration modes. With a coarse-grained lattice model, we identify a key bending mode with GHz frequency that replaces the hydrogen vibration modes as the dominant out-of-phase phonon vibration at the transition state. By associating its bending modulus to a universal in-phase bending vibration modulus at equilibrium, we can hence estimate the entropic change in the out-of-phase vibration from near-equilibrium all-atom simulations. This and estimates of torsional and bending entropy changes lead to the first predictive and sequence-dependent theory with good quantitative agreement with experimental data for the activation energy of melting of short DNA molecules without intermediate hairpin structures.
Nanoscale thermal analysis for heat-assisted magnetic recording
Authors: Hu Yueqiang , Wu Haoyu , Meng Yonggang , Bogy David B.
Published: October 2017

The heat assisted magnetic recording (HAMR) technology is expected to increase the areal density of the hard disk drives up to 10 Tb/in.2 This paper presents a numerical thermal study of near field transducers (NFTs), a key component in HAMR. Both an electromagnetic and a heat transfer model are included. Instead of assuming a heat transfer model across the nanoscale gap, we performed a parameter sweep of various models and investigated all the possible results. We found that if the heat transfer coefficient across the head-disk interface (HDI) is high, the carbon overcoat on the head is critical for protecting the NFT from excess heat. The heat flux across the HDI and the thermal efficiency of the NFT are also investigated to better understand the heat transfer mechanism in the HAMR system.
Temperature dependence of band gaps and conformational disorder in PEDOT and its selenium and tellurium derivatives: Density functional calculations
Authors: Mirsakiyeva Amina , Hugosson Håkan W. , Linares Mathieu , Delin Anna
Published: October 2017

The conducting polymer poly(3,4-ethylenedioxythiophene), or PEDOT, is an attractive material for flexible electronics. We present combined molecular dynamics and quantum chemical calculations, based on density functional theory, of EDOT oligomers and isoelectronic selenium and tellurium derivatives (EDOS and EDOTe) to address the effect of temperature on the geometrical and electronic properties of these systems. With finite size scaling, we also extrapolate our results to the infinite polymers, i.e., PEDOT, PEDOS, and PEDOTe. Our computations indicate that the most favourable oligomer conformations at finite temperature are conformations around the flat trans-conformation and a non-flat conformation around 45° from the cis-conformation. Also, the dihedral stiffness increases with the atomic number of the heteroatom. We find excellent agreement with experimentally measured gaps for PEDOT and PEDOS. For PEDOT, the gap does not increase with temperature, whereas this is the case for its derivatives. The conformational disorder and the choice of the basis set both significantly affect the calculated gaps.
Some aspects of the interaction of a magnetic quadrupole moment with an electric field in a rotating frame
Authors: Fonseca I. C. , Bakke K.
Published: October 2017

From the interaction between the magnetic quadrupole moment of a neutral particle (atom or molecule) with a radial electric field, a uniform effective magnetic field perpendicular to the plane of motion of the neutral particle appears. In addition, it is considered that the presence of a scalar potential is proportional to the radial distance and noninertial effects that stem from a rotating reference frame. Then, analytical solutions to the Schrödinger equation are obtained, where it is shown that the Landau-type levels are modified, and the allowed values of the cyclotron frequency are determined by the angular velocity of the rotating frame, the parameter associated with the scalar potential proportional to the radial distance and the quantum numbers of the system.
Can large-scale oblique undulations on a solid wall reduce the turbulent drag?
Authors: Ghebali Sacha , Chernyshenko Sergei I. , Leschziner Michael A.
Published: October 2017

Direct numerical simulations of fully developed turbulent channel flows with wavy walls are undertaken. The wavy walls, skewed with respect to the mean flow direction, are introduced as a means of emulating a Spatial Stokes Layer (SSL) induced by in-plane wall motion. The transverse shear strain above the wavy wall is shown to be similar to that of a SSL, thereby affecting the turbulent flow and leading to a reduction in the turbulent skin-friction drag. However, some important differences with respect to the SSL case are brought to light too. In particular, the phase variations of the turbulent properties are accentuated and, unlike in the SSL case, there is a region of increased turbulence production over a portion of the wall, above the leeward side of the wave, thus giving rise to a local increase in dissipation. The pressure- and friction-drag levels are carefully quantified for various flow configurations, exhibiting a combined maximum overall-drag reduction of about 0.6%. The friction-drag reduction is shown to behave approximately quadratically for small wave slopes and then linearly for higher slopes, whilst the pressure-drag penalty increases quadratically. The transverse shear-strain layer is shown to be approximately Reynolds-number independent when the wave geometry is scaled in wall units.
Quasi-periodic solutions of a fractional nonlinear Schrödinger equation
Authors: Li Jing
Published: October 2017

In the present paper, it is proved that there are many quasi-periodic solutions of a class of space fractional nonlinear Schrödinger equations with the Riesz fractional derivative by means of KAM (Kolmogorov-Arnold-Moser) theorem.
Determination of the measure of size (amplitude) of perturbation and its role in the process of enforcing discrete Korteweg-de Vries solitons to modified Korteweg-de Vries solitons as means of continuum hypothesis in a multi-component dusty plasma
Authors: Kalita B. C. , Das S. , Bhattacharjee D.
Published: October 2017

The role of the order of perturbation required for establishing modified Korteweg-de Vries (mKdV) solitons and determining the corresponding measure of the size (amplitude) of perturbation ϵ in multi-component dusty plasma is investigated for the first time. Various amplitudes of mKdV solitons at critical density σc based on the respective measure of the size of perturbation generated by the corresponding number of dust charges Zd for some values of ion streaming vi0 are presented in Tables in this new pursuit. Many characteristic results of mKdV solitons connecting the totality of the newly established parameters, namely, initial ion streaming vi0, dust charge number Zd, measure of the size of perturbation ϵ, and non-thermal parameter β , are also reported. Further, a new range of non-thermal parameters β occurring in Cairns distribution is also determined in the presence of electrons with quantum effects for this dusty plasma.
Shock response of 1,3,5-trinitroperhydro-1,3,5-triazine (RDX): The C-N bond scission studied by molecular dynamics simulations
Authors: Yuan Jiao-Nan , Wei Yong-Kai , Zhang Xiu-Qing , Chen Xiang-Rong , Ji Guang-Fu , Kotni Meena Kumari , Wei Dong-Qing
Published: October 2017

The shock response has a great influence on the design, synthesis, and application of energetic materials in both industrial and military areas. Therefore, the initial decomposition mechanism of bond scission at the atomistic level of condensed-phase α-RDX under shock loading has been studied based on quantum molecular dynamics simulations in combination with a multi-scale shock technique. First, based on the frontier molecular orbital theory, our calculated result shows that the N-NO2 bond is the weakest bond in the α-RDX molecule in the ground state, which may be the initial bond for pyrolysis. Second, the changes of bonds under shock loading are investigated by the changes of structures, kinetic bond lengths, and Laplacian bond orders during the simulation. Also, the variation of thermodynamic properties with time in shocked α-RDX at 10 km/s along the lattice vector a for a timescale of up to 3.5 ps is presented. By analyzing the detailed structural changes of RDX under shock loading, we find that the shocked RDX crystal undergoes a process of compression and rotation, which leads to the C-N bond initial rupture. The time variation of dynamic bond lengths in a shocked RDX crystal is calculated, and the result indicates that the C-N bond is easier to rupture than other bonds. The Laplacian bond orders are used to predict the molecular reactivity and stability. The values of the calculated bond orders show that the C-N bonds are more sensitive than other bonds under shock loading. In a word, the C-N bond scission has been validated as the initial decomposition in a RDX crystal shocked at 10 km/s. Finally, the bond-length criterion has been used to identify individual molecules in the simulation. The distance thresholds up to which two particles are considered direct neighbors and assigned to the same cluster have been tested. The species and density numbers of the initial decomposition products are collected according to the trajectory.
Synchronization of fractional fuzzy cellular neural networks with interactions
Authors: Ma Weiyuan , Li Changpin , Wu Yujiang , Wu Yongqing
Published: October 2017

In this paper, we introduce fuzzy theory into the fractional cellular neural networks to dynamically enhance the coupling strength and propose a fractional fuzzy neural network model with interactions. Using the Lyapunov principle of fractional differential equations, we design the adaptive control schemes to realize the synchronization and obtain the synchronization criteria. Finally, we provide some numerical examples to show the effectiveness of our obtained results.
Coin trials
Authors: Smith Martin
Published: October 2017

According to the JUSTIFIED FAIR COINS principle, if I know that a coin is fair, and I lack justification for believing that it won’t be flipped, then I lack justification for believing that it won’t land tails. What this principle says, in effect, is that the only way to have justification for believing that a fair coin won’t land tails, is by having justification for believing that it won’t be flipped at all. Although this seems a plausible and innocuous principle, in a recent paper Dorr, Goodman and Hawthorne use it in devising an intriguing puzzle which places all justified beliefs about the future in jeopardy. They point out, further, that one very widespread theory of justification predicts that JUSTIFIED FAIR COINS is false, giving us additional reason to reject it. In this paper, I will attempt to turn this dialectic around. I will argue that JUSTIFIED FAIR COINS does not inevitably lead to scepticism about the future, and the fact that it is incompatible with a widespread theory of justification may give us reason to doubt the theory. I will outline an alternative theory of justification that predicts both that JUSTIFIED FAIR COINS is true and that we have justification for believing much about the future.
Friction stir scribe welding technique for dissimilar joining of aluminium and galvanised steel
Authors: Wang Tianhao , Sidhar Harpreet , Mishra Rajiv S. , Hovanski Yuri , Upadhyay Piyush , Carlson Blair
Published: October 2017

Friction stir scribe technology, a derivative of friction stir welding, was applied for the dissimilar lap welding of an aluminium alloy and galvanised mild steel sheets. During the process, the rotating tool with a cobalt steel scribe first penetrated the top material – aluminium – and then the scribe cuts the bottom material – steel. The steel was displaced into the upper material to produce a characteristic hook feature. Lap welds were shear tested, and their fracture paths were studied. Welding parameters affected the welding features, including hook height, which turned out to be highly related to fracture position. Therefore, in this paper, the relationships among welding parameters, hook height, joint strength and fracture position are presented. In addition, the influence of zinc coating on joint strength was also studied.
Benefits of computerized auditory training software for Kannada speaking children with hearing impairment – parent’s perspective
Authors: Nanjundaswamy Manohar , Prabhu Prashanth , Rajanna Revathi Kittur , Ningegowda Raghavendra Gulaganji , Firdose Husna , Sharma Madhuri
Published: October 2017

Purpose:

The present study attempted to develop computer based auditory training software focusing on Kannada speaking children with hearing impairment (HI). In addition, it was also attempted to determine if there are any improvements in listening with and without the developed software.

Materials and Methods:

This was determined based on pre and post therapy changes in the parent’s perspective, and also on questionnaires. The software consisted of five modules namely, auditory awareness, auditory identification, auditory discrimination, auditory memory and sequencing and auditory comprehension. It was administered on ten individuals with HI who also received listening training, while he control group received only listening training.

Results:

The results of the study showed that there was an improvement in listening skills based on infant toddler-meaningful auditory integration scale (IT-MAIS) and parents’ evaluation of aural/oral performance of children (PEACH) questionnaires administered on parents of children with HI. A detailed interview of parents also suggested that there was an enhanced auditory attention and improvement in overall listening skills.

Conclusions:

Thus, the present software can act as a supplement to the usual listening training in Kannada speaking children with HI.
Chromosome biorientation and APC activity remain uncoupled in oocytes with reduced volume
Authors: Lane Simon I.R. , Jones Keith T.
Published: October 2017

The spindle assembly checkpoint (SAC) prevents chromosome missegregation by coupling anaphase onset with correct chromosome attachment and tension to microtubules. It does this by generating a diffusible signal from free kinetochores into the cytoplasm, inhibiting the anaphase-promoting complex (APC). The volume in which this signal remains effective is unknown. This raises the possibility that cell volume may be the reason the SAC is weak, and chromosome segregation error-prone, in mammalian oocytes. Here, by a process of serial bisection, we analyzed the influence of oocyte volume on the ability of the SAC to inhibit bivalent segregation in meiosis I. We were able to generate oocytes with cytoplasmic volumes reduced by 86% and observed changes in APC activity consistent with increased SAC control. However, bivalent biorientation remained uncoupled from APC activity, leading to error-prone chromosome segregation. We conclude that volume is one factor contributing to SAC weakness in oocytes. However, additional factors likely uncouple chromosome biorientation with APC activity.
The infarcted myocardium solicits GM-CSF for the detrimental oversupply of inflammatory leukocytes
Authors: Anzai Atsushi , Choi Jennifer L. , He Shun , Fenn Ashley M. , Nairz Manfred , Rattik Sara , McAlpine Cameron S. , Mindur John E. , Chan Christopher T. , Iwamoto Yoshiko , Tricot Benoit , Wojtkiewicz Gregory R. , Weissleder Ralph , Libby Peter , Nahrendorf Matthias , Stone James R. , Becher Burkhard , Swirski Filip K.
Published: October 2017

Myocardial infarction (MI) elicits massive inflammatory leukocyte recruitment to the heart. Here, we hypothesized that excessive leukocyte invasion leads to heart failure and death during acute myocardial ischemia. We found that shortly and transiently after onset of ischemia, human and mouse cardiac fibroblasts produce granulocyte/macrophage colony-stimulating factor (GM-CSF) that acts locally and distally to generate and recruit inflammatory and proteolytic cells. In the heart, fibroblast-derived GM-CSF alerts its neighboring myeloid cells to attract neutrophils and monocytes. The growth factor also reaches the bone marrow, where it stimulates a distinct myeloid-biased progenitor subset. Consequently, hearts of mice deficient in either GM-CSF or its receptor recruit fewer leukocytes and function relatively well, whereas mice producing GM-CSF can succumb from left ventricular rupture, a complication mitigated by anti–GM-CSF therapy. These results identify GM-CSF as both a key contributor to the pathogenesis of MI and a potential therapeutic target, bolstering the idea that GM-CSF is a major orchestrator of the leukocyte supply chain during inflammation.
𝐾₂ of certain families of plane quartic curves
Authors: Liu Hang , Chang Shan
Published: October 2017

We construct three elements in the kernel of the tame symbol on families of quartic curves. We show that these elements are integral under certain conditions on the parameters. Moreover, we prove that these elements are in general linearly independent by calculating the limit of the regulator.
Two weight estimates with matrix measures for well localized operators
Authors: Bickel Kelly , Culiuc Amalia , Treil Sergei , Wick Brett
Published: October 2017

In this paper, we give necessary and sufficient conditions for weighted

L
2

L^2

estimates with matrix-valued measures of well localized operators. Namely, we seek estimates of the form
\[
<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" alttext="double-vertical-bar upper T left-parenthesis bold upper W f right-parenthesis double-vertical-bar Subscript upper L squared left-parenthesis bold upper V right-parenthesis Baseline less-than-or-equal-to upper C double-vertical-bar f double-vertical-bar Subscript upper L squared left-parenthesis bold upper W right-parenthesis Baseline comma">

‖
T
(

W

f
)

‖

L
2

(

V

)

≤
C
‖
f

‖

L
2

(

W

)

,

\| T(\mathbf {W} f)\|_{L^2(\mathbf {V})} \le C\|f\|_{L^2(\mathbf {W})},

\]
where

T
T

is formally an integral operator with additional structure,

W

,

V

\mathbf {W}, \mathbf {V}

are matrix measures, and the underlying measure space possesses a filtration. The characterization we obtain is of Sawyer type; in particular, we show that certain natural testing conditions obtained by studying the operator and its adjoint on indicator functions suffice to determine boundedness. Working in both the matrix-weighted setting and the setting of measure spaces with arbitrary filtrations requires novel modifications of a T1 proof strategy; a particular benefit of this level of generality is that we obtain polynomial estimates on the complexity of certain Haar shift operators.
On the law of the iterated logarithm for random exponential sums
Authors: Berkes István , Borda Bence
Published: October 2017

The asymptotic behavior of exponential sums

∑

k
=
1

N

exp
⁡
(
2
π
i

n
k

α
)

\sum _{k=1}^N \exp ( 2\pi i n_k \alpha )

for Hadamard lacunary

(

n
k

)

(n_k)

is well known, but for general

(

n
k

)

(n_k)

very few precise results exist, due to number theoretic difficulties. It is therefore natural to consider random

(

n
k

)

(n_k)

, and in this paper we prove the law of the iterated logarithm for

∑

k
=
1

N

exp
⁡
(
2
π
i

n
k

α
)

\sum _{k=1}^N \exp (2\pi i n_k \alpha )

if the gaps

n

k
+
1

−

n
k

n_{k+1}-n_k

are independent, identically distributed random variables. As a comparison, we give a lower bound for the discrepancy of

{

n
k

α
}

\{n_k \alpha \}

under the same random model, exhibiting a completely different behavior.
Prevalence of Hypertension Defined by Central Blood Pressure Measured Using a Type II Device in a Nationally Representative Cohort
Authors: Chuang Shao-Yuan , Chang Hsing-Yi , Cheng Hao-Min , Pan Wen-Harn , Chen Chen-Huan
Published: October 2017

OBJECTIVES

Central blood pressure (BP) can be used to define hypertension. A central BP approach may be more sensitive than a conventional brachial BP approach in detecting hypertension. We aimed to compare the 2 approaches in estimating the prevalence hypertension in a nationally representative population.

METHODS

A total of 2,742 adults older than 19 years participated in the 2013–2016 National Nutrition and Health Survey in Taiwan. Central and brachial BP were simultaneously measured using a cuff-based stand-alone central BP monitor purporting to measure invasive central BP (type II device). Central hypertension was defined by central systolic (SBP)/diastolic BP (DBP) ≥130 or 90 mm Hg or using antihypertensive medications, and brachial hypertension was defined by brachial SBP/DBP ≥140 or 90 mm Hg or using antihypertensive medications.

RESULTS

The World Health Organization-standardized and national weighted prevalence rates of central hypertension were 27.95% and 32.48%, respectively, and both were significantly higher than those of brachial hypertension (20.80% and 25.43%, both P < 0.001). The national weighted prevalence rates of concordant central and brachial hypertension, concordant central and brachial nonhypertension, isolated central hypertension, and isolated brachial hypertension were 25.13%, 67.22%, 7.35%, and 0.30%, respectively. Most subjects with the isolated central hypertension (97%) were within the range of brachial prehypertension, but only 38.0% of subject with brachial prehypertension had central hypertension.

CONCLUSION

Almost one-third of a nationally representative population had hypertension detected by a central BP approach. Hypertension detection using a conventional brachial BP approach may underestimate the prevalence of hypertension and result in a less effective hypertension control.
Ethical issues in the use of SMS messaging in HIV care and treatment in low- and middle-income countries: case examples from Mozambique
Authors: Ossemane Ezequiel B , Moon Troy D , Were Martin C , Heitman Elizabeth
Published: October 2017

The introduction of mobile communication technologies in health care in low- and middle-income countries offers an opportunity for increased efficiencies in provision of care, improved utilization of scarce resources, reductions in workload, and increased reach of services to a larger target population. Short message service (SMS) technologies offer promise, with several large-scale SMS-based implementations already under way. Still largely lacking in the research literature are evaluations of specific ethical issues that arise when SMS programs are implemented and studied in resource-limited settings. In this paper, we examine the ethical issues raised by the deployment of SMS messaging to support patient retention in HIV care and treatment and in the research conducted to evaluate that deployment. We use case studies that are based in Mozambique and ground our discussion in the ethical framework for international research proposed by Emanuel et al., highlighting ethical considerations needed to guide the design and implementation of future SMS-based interventions. Such guidance is increasingly needed in countries such as Mozambique, where the local capacity for ethical study design and oversight is still limited and the scale-up and study of mHealth initiatives are still driven predominantly by international collaborators. These issues can be complex and will need ongoing attention on a case-by-case basis to ensure that appropriate protections are in place, while simultaneously maximizing the potential benefit of new mHealth technologies.
SYN-004 (ribaxamase) prevents New Onset Clostridium difficile Infection by Protecting the Integrity Gut Microbiome in a Phase 2b Study
Authors: Kokai-Kun John , Roberts Tracey , Coughlin Olivia , Whalen Heidi , Le Charles , Da Costa Christopher , Sliman Joseph
Published: October 2017

Background

Clostridium difficile infections (CDI) are an “urgent threat,” but there are no approved drugs or vaccines to prevent new onset CDI. SYN-004 (ribaxamase) is a β-lactamase designed to be orally administered with IV β-lactam antibiotics and remain localized in the intestine to degrade antibiotics excreted into the intestine. This is expected to protect the gut microbiome from disruption thus preventing deleterious effects including CDI, colonization by opportunistic pathogens, and emergence of antibiotic resistance in the gut microbiome. Ribaxamase was well tolerated and not systemically absorbed in Phase 1 studies and efficiently degraded ceftriaxone excreted into the human intestine while not altering the plasma pharmacokinetics of ceftriaxone in Phase 2a studies.

Methods

A multinational Phase 2b, double-blind, placebo-controlled, study was conducted to determine whether ribaxamase could prevent new onset CDI with additional endpoints for non-CDI antibiotic-associated diarrhea, colonization by opportunistic pathogens, changes in the gut microbiome and emergence of antibiotic resistance. The 412 patient mITT population, enriched for higher risk for CDI, were admitted to the hospital for ≥5 days of IV ceftriaxone for the treatment of a lower respiratory tract infection. Patients were randomized 1:1 to receive ribaxamase or placebo during treatment and for 72h after. Fecal samples were collected at prespecified points for determination of colonization by opportunistic pathogens and to examine changes in the gut microbiome. Patients were monitored for 6 weeks for CDI (diarrhea plus the presence of C. difficile toxin). The study was powered at 80% for the reduction in CDI with 1-sided α = 0.05.

Results

The study met its primary endpoint with a 71% relative risk reduction in CDI (1-sided p = 0.045) and had a statistically significant 44% relative risk reduction in new colonization by vancomycin-resistant enterococci (1-sided p = 0.0002). Ribaxamase also protected the diversity of the gut microbiome and reduced the emergence of antibiotic resistance in ceftriaxone-treated patients.

Conclusion

These data support that ribaxamase can maintain the balance of the gut microbiome and thereby prevent opportunistic infections like CDI during IV β-lactam treatment.

Disclosures

J. Kokai-Kun, Synthetic Biologics, Inc.: Employee, Salary; T. Roberts, Synthetic Biologics, Inc.: Employee, Salary; O. Coughlin, Synthetic Biologics, Inc.: Employee, Salary; H. Whalen, Synthetic Biologics, Inc.: Employee, Salary; C. Le, Synthetic Biologics, Inc.: Employee, Salary; C. Da Costa, Synthetic Biologics, Inc.: Employee, Salary; J. Sliman, Synthetic Biologics, Inc.: Employee, Salary.
Comparison of Respiratory Pathogen Detections from Routine Hospital Testing and Expanded Systematic Testing from the Minnesota Severe Acute Respiratory Illness Surveillance Program, 2015–2016
Authors: Steffens Andrea , Friedlander Hannah , Como-Sabetti Kathryn , Boxrud Dave , Bistodeau Sarah , Strain Anna , Reed Carrie , Lynfield Ruth , Fowlkes Ashley
Published: October 2017

Background

Hospital testing for respiratory pathogens is nonsystematic, leading to potential missed detection of clinically relevant pathogens. The Minnesota Severe Acute Respiratory Illness (SARI) surveillance program monitors hospitalizations due to acute respiratory illness and conducts systematic testing for several respiratory pathogens. We assessed viruses detected by the hospital and additional detections identified by expanded testing.

Methods

Residual upper respiratory specimens collected from patients hospitalized for suspected respiratory illness for routine diagnostic testing at three hospitals, including one children’s hospital, were submitted to the Minnesota Department of Health (MDH). Specimens were tested for 18 respiratory viruses by RT-PCR. Clinical and hospital test data were collected through medical record review.

Results

From September 2015 to August 2016, 2,351 hospitalized SARI patients were reported, with the following age distribution: 57% <5 years, 13% 5–17 years, 30% ≥18 years. Among all SARI patients, 97% (2,273) had hospital-based, clinician-directed testing for viral pathogens. Viruses were detected among 47% (1,077) of tested patients, among which testing methods included PCR (85%), rapid antigen (13%), and culture (2%); 74% were tested on the day of admission. Most common viruses detected by clinical testing included respiratory syncytial virus (41%), rhinovirus/enterovirus (31%), and influenza (15%) (Figure 1). Systematic RT–PCR testing at MDH identified 1,600 (68%) patients positive for ≥1 respiratory virus, identifying previously unknown detections among 35% (820) of SARI patients (Figure 2). Of 1,272 patients with no virus identified at the hospital, 46% (586) had a viral detection at MDH. Patients aged <18 years were significantly more likely to have an additional pathogen detected by MDH testing than those aged ≥18 years (P < 0.01), including rhinovirus/enterovirus, adenovirus, human metapneumovirus, and coronaviruses.

Conclusion

Systematic, expanded testing at MDH identified a higher proportion of respiratory pathogens among SARI patients compared with clinical laboratory testing. Additional testing for clinically relevant respiratory pathogens may inform medical decision-making.

Disclosures

All authors: No reported disclosures.
Pneumococcal Urinary Antigen Testing in US Hospitals: Underutilized and Rarely Acted Upon
Authors: Haessler Sarah , Schimmel Jennifer , Yu Pei-Chun , Rothberg Michael
Published: October 2017

Background

The IDSA guideline for CAP recommends Pneumococcal urinary antigen testing (UAT) in addition to blood and sputum cultures for patients with severe CAP. In controlled settings, UAT is 50–80% sensitive and >90% specific; however, its utility and performance on a large-scale in real-world use has not been assessed. It is unclear whether UAT is clinically useful or whether the results impact prescribing behavior.

Methods

Retrospective cohort study of adult patients admitted with CAP or HCAP from 2010 to 2015 at 170 US hospitals that submit data to Premier. Date and time-stamped administrative and microbiologic data were assessed. Patients with a principal diagnosis of pneumonia, or sepsis with a secondary diagnosis of pneumonia plus a CXR and antibiotics within the first 24 hours, were included if they had a UAT plus either a blood or respiratory culture within the first 48 hours of admission.

Results

Of 159,894 eligible pneumonia patients, 24,757 (15.5%) had UAT plus either blood or respiratory cultures performed. Of 1,797 (7%) who had a positive UAT, 457 (25%) also grew S. pneumoniae (SP) from blood or respiratory cultures, 1,240 (69%) had negative cultures, and 100 (6%) an organism other than SP, with S. aureus, Pseudomonas spp., and E.coli being the most common pathogens, predominantly from respiratory cultures. Among 22,960 patients with a negative UAT, 429 (2%) had a positive blood or respiratory culture for SP and 2,653 (12%) had a culture positive for another organism. UAT was performed among 18.4% of patients admitted to the ICU, and 15.3% of those admitted to wards. Among patients empirically started on broad-spectrum antibiotics, 35% who had a positive UAT were de-escalated by Day 5, compared with 49% who grew SP in blood cultures and 24% in respiratory cultures.

Conclusion

In a large representative US inpatient database, there was poor concordance between UAT and cultures for SP. A positive UAT decreased the probability of having a non-SP pathogen. Antibiotic de-escalation occurred more often in association with a positive blood culture for SP than for UAT or positive respiratory culture, but occurred in less than half the patients with these markers of pneumococcal pneumonia. Overall, UAT is underutilized and does not appear to have a substantial impact on clinical care.

Disclosures

S. Haessler, AHRQ: Investigator, Research grant; P. C. Yu, AHRQ: Investigator, Research grant; M. Rothberg, AHRQ: Investigator, Research grant
Comparing the Outcomes of Adults with Enterobacteriaceae Bacteremia Receiving Short-Course vs Prolonged-Course Antibiotic Therapy
Authors: Chotiprasitsakul Darunee , Han Jennifer H , Conley Anna T , Cosgrove Sara E , Harris Anthony D , Lautenbach Ebbing , Tamma Pranita D
Published: October 2017

Background

The recommended duration of antibiotic treatment for Enterobacteriaceae bacteremia is between 7 and 14 days. We compared the clinical outcomes of patients receiving short-course (6–10 days) vs prolonged-course (11–15 days) antibiotic therapy for Enterobacteriaceae bacteremia.

Methods

A retrospective cohort study was conducted at The Johns Hopkins Hospital, The University of Maryland Medical Center, and The Hospital of the University of Pennsylvania including patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active antibiotic therapy in the range of 6–15 days between 2008 and 2014. 1:1 nearest neighbor propensity score matching without replacement was performed, prior to regression analysis, to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment for patients receiving short vs. prolonged durations of antibiotic therapy. Secondary outcomes included Clostridium difficile infection (CDI) and the emergence of multidrug-resistant Gram-negative (MDRGN) bacteria within 30 days after the end of antibiotic therapy.

Results

A total of 1,769 patients met eligibility criteria. There were 385 matched pairs who were well-balanced on baseline characteristics. The median duration of therapy in the short-course group and prolonged-course group was 8 days (interquartile range (IQR) 7–9 days) and 15 days (IQR 13–15 days), respectively. No difference in all-cause mortality between short- and prolonged-course treatment groups was observed (adjusted hazard ratio [aHR] 1.00; 95% CI 0.62–1.63). Rates of CDI were similar between the treatment groups (OR 1.17; 95% CI 0.39–3.51). There was a non-significant protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (OR 0.59; 95% CI 0.32–1.09 P = 0.09).

Conclusion

Short courses of antibiotic therapy yields similar clinical outcomes to prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN emergence.

Disclosures

All authors: No reported disclosures.