bluuebunny/crossref_metadata_2025_split huggingface dataset:
Data‐driven optimal PEMFC temperature control via curriculum guidance strategy‐based large‐scale deep reinforcement learning
Authors: Li Jiawen , Yang Shengchun , Yu Tao , Zhang Xiaoshun 
Published: September 2021

AbstractAs the proton exchange membrane fuel cell (PEMFC) is a nonlinear, time‐varying, multiple‐input multiple‐output system, an advanced controller with strong robustness and adaptability is required for controlling PEMFC stack temperature and achieve a high operation efficiency. In this paper, a data driven optimal controller is proposed for controlling the stack temperature, which is based on large‐scale deep reinforcement learning. In addition, a new deep reinforcement learning algorithm termed curriculum guidance strategy large‐scale dual‐delay deep deterministic policy gradient (CGS‐L4DPG) algorithm is proposed for this controller. The design of this algorithm introduces the concepts of the curriculum guidance strategy and imitation learning, and its inclusion improves the performance and robustness of the proposed controller. The simulation results show that, taking advantage of the high adaptability and robustness of CGS‐L4DPG algorithm, the proposed controller can more effectively control the PEMFC stack temperature than existing control algorithms.
Folgen einer vorderen Kreuzbandruptur – Ein systematisches Umbrella-Review
Authors: Diemer Frank , Zebisch Jochen , Saueressig Tobias 
Published: September 2021

ZusammenfassungEinleitung Die Behandlung einer vorderen Kreuzbandruptur wird nach wie vor kontrovers diskutiert. Insbesondere die Frage: Konservative oder operative Versorgung? steht dabei im Mittelpunkt. Für die Beantwortung dieser Frage werden häufig Folgeschäden wie die Entwicklung einer posttraumatischen Arthrose, Sekundärschäden am Meniskus oder Knorpel und auch die Partizipation im Sport herangezogen. Sollten zwischen den einzelnen Behandlungsoptionen bedeutsame Unterschiede bezüglich dieser Parameter bestehen, so wären die Ergebnisse für die Entwicklung evidenzbasierter Behandlungspfade von hoher Bedeutung. Ziel dieser Arbeit war es daher, die Entwicklung einer Gonarthrose nach einer Ruptur des vorderen Kreuzbandes und der entsprechenden Behandlung (konservativ oder operativ) zu evaluieren.Material und Methoden Zur Beantwortung der Fragestellung wurde eine systematische Literaturrecherche in der Medline über Pubmed, der Cochrane Library und in CINAHL durchgeführt. Die Recherche wurde im Januar 2020 durchgeführt und im Januar 2021 wiederholt. Eingeschlossen wurden ausschließlich systematische Reviews mit einem minimalen Nachuntersuchungszeitraum von 10 Jahren. Untersuchte Kohorten umfassten Patienten mit einer entweder konservativ oder operativ versorgten Ruptur des vorderen Kreuzbandes. Die Diagnose Arthrose wurde entweder radiologisch (anerkannte Scores) oder klinisch (Schmerz und Funktionseinschränkung) gestellt. Passende Übersichtsarbeiten wurden mit dem AMSTAR-2-Fragebogen einer qualitativen Bewertung unterzogen.Ergebnisse Die Literaturrecherche ermittelte zunächst n = 42 Übersichtsarbeiten, von denen 14 Arbeiten inkludiert werden konnten. Nach der Volltextprüfung und der qualitativen Bewertung verblieben zur Auswertung der Ergebnisse lediglich n = 2 systematische Reviews. Die Ergebnisse beider Arbeiten zeigen unpräzise Daten mit einer großen Variabilität. Es kann aber mit großer Wahrscheinlichkeit davon ausgegangen werden, dass das Risiko für die Entwicklung einer Gonarthrose nach einer Ruptur des vorderen Kreuzbandes erhöht ist. Eine Reduktion der Inzidenz der Gelenkdegeneration durch eine Rekonstruktion des vorderen Kreuzbandes ist nicht nachweisbar, genauso wenig wie ein Unterschied bei einem direkten Vergleich zwischen konservativer und operativer Versorgung.Schlussfolgerung Patienten mit einer vorderen Kreuzbandruptur tragen mit hoher Wahrscheinlichkeit ein größeres Risiko für eine progressive Gelenkdegeneration. Ein pauschaler protektiver Effekt einer Kreuzbandplastik ist in den ausgewerteten Arbeiten nicht nachweisbar. Aus diesem Grund sollten innerhalb der Entscheidungsfindung über operative versus konservative Versorgung andere Faktoren wie die funktionelle Instabilität noch höher bewertet werden.
Erwerbstätig mit chronisch entzündlicher
Darmerkrankung –Herausforderungen im Arbeitsleben und
unterstützende Maßnahmen zur Bewältigung
Authors: Langbrandtner Jana , Steimann Gero , Reichel Christoph , Bokemeyer Bernd , Hüppe Angelika 
Published: September 2021

Zusammenfassung
Ziel der Studie Betroffene mit chronisch entzündlicher
Darmerkrankung (CED) sind durch die spezifische Krankheitssymptomatik oftmals in
ihrer beruflichen Teilhabe und Arbeitsfähigkeit beeinträchtigt.
Ziel war eine Exploration ihrer berufsbezogenen Problemlagen und
Unterstützungswünsche sowie die Ableitung bedarfsgerechter
Unterstützungsangebote für den rehabilitativen Sektor.
Methodik 235 CED-Patienten (97 Rehabilitanden, 138 in ambulanter
fachärztlicher Betreuung) bearbeiteten einen
Selbstausauskunftsfragebogen, der krankheitsspezifische Belastungen,
arbeitsbezogene Sorgen und den Bedarf an Unterstützungsangeboten
ermittelte. Die subjektive Prognose der Erwerbsfähigkeit (SPE) wurde mit
der SPE-Skala erfasst.
Ergebnisse Die Studienteilnehmer waren im Mittel 46 Jahre alt, 60%
waren Frauen, 45% litten an Morbus Crohn, 67% waren in Vollzeit
erwerbstätig. 72% (N=170) wiesen Anzeichen einer
negativen Erwerbsprognose anhand der SPE-Skala auf. Sie berichteten im
Durchschnitt 12 krankheitsspezifische und 22 arbeitsbezogene Probleme und Sorgen
im Berufsleben. Krankheitssymptome, die das Berufsleben von etwa jedem zweiten
Befragten fast täglich belasten, waren Beeinträchtigungen durch
Müdigkeit (66%), Schwäche (55%) sowie Stuhldrang
(55%). Zu den drei häufigsten arbeitsbezogenen Problemen, von
denen mehr als jeder zweite Teilnehmer beinahe jeden Tag betroffen ist,
zählen: eine verringerte Leistungsfähigkeit (56%), die
Sorge nicht mehr voll leistungsfähig zu sein (55%) sowie
Arbeitsdruck und Stress am Arbeitsplatz (53%). Als wichtigste
arbeitsbezogene Unterstützungsangebote nannten die Befragten
Informationen, Beratungen oder Schulungen zu den Themen Krankheitswissen
(91%), Behandlungsmöglichkeiten (88%), sozialrechtliche
Leistungen (85%) sowie Bewegungsangebote zur Steigerung der
körperlichen Fitness (84%).
Schlussfolgerung Die Studienergebnisse zeigen eine große
Bandbreite von Problemen im Arbeitsleben von CED-Betroffenen und
veranschaulichen die Vielfalt körperlicher und psychosozialer
Beeinträchtigungen. Die Daten liefern wichtige Anhaltspunkte für
die Entwicklung von bedarfsgerechten Unterstützungsangeboten, die in
einem multimodalen und interdisziplinären Setting wie dem
Rehabilitationssektor gut adressiert werden können. Dazu sollte das
Spektrum bestehender Angebote in der CED-Reha erweitert, ein stärkerer
Berufsbezug während der Rehabilitation hergestellt sowie ein
standardisiertes Screening auf berufsbezogene Probleme implementiert werden.
Preterm Newborn Adaptive Responses to Daily Nursing during Neonatal Intensive Care Unit Stay, Associate with Neurodevelopment, 2 Years Later
Authors: Bembich Stefano , Risso Francesco M. , Stan Nicoleta , Lamba Domitilla , Banova Carolina , Pagnini Arianna , Bin Maura , Trappan Antonella , Sanson Gianfranco 
Published: September 2021

Objective This study aimed to evaluate if adaptive responses of very preterm newborns to neonatal intensive care unit (NICU) daily nursing, specifically bathing and weighing procedures are associated with their neurodevelopment after 2 years.
Study Design Twenty-six very preterm newborns, with a gestational age <32 weeks, were enrolled. Infants' adaptive responses to daily nursing were evaluated, at 30 to 32 to 35 postmenstrual age (PMA) weeks by an observational sheet. Neurodevelopment was assessed at 24 months of corrected age by the Bayley Scales of Infant and Toddler Development, third edition. Autonomic, motor, and self-regulatory responses to NICU nursing were analyzed by Spearman's correlation coefficient and multivariate linear regression with Bayley's cognitive, language, and motor scales.
Results Significant (p < 0.05) positive correlations of self-regulatory and autonomic responses to nursing with all Bayley's scales were found at 30- and 32-week PMA. At 35-week PMA, only self-regulatory responses had significant positive correlations with all Bayley's scales. When adjusted for birth weight and sex, the significant associations were confirmed only at 30- and 32-week PMA.
Conclusion Very preterm newborn adaptive responses to NICU daily nursing reveal to be positively related to forthcoming neurodevelopment 2 years later, as early as the 30-week PMA. Helping preterm babies to adapt to daily NICU nursing may promote their future neurobehavior.
Key Points
What Is the Role of Steroids for Septic Shock in 2021?
Authors: Nedel Wagner , Lisboa Thiago , Salluh Jorge I.F. 
Published: September 2021

AbstractCorticosteroids have been used for decades in the adjunctive treatment of severe infections in intensive care. The most frequent scenario in intensive care is in septic shock, where low doses of glucocorticoids appear to restore vascular responsiveness to norepinephrine. There is a strong body of evidence suggesting that hydrocortisone reduces time on vasopressor, and may modulate the immune response. In this review, we explore the current evidence supporting the use of corticosteroids in septic shock, its benefits, and potential harms. In addition to landmark clinical trials, we will also describe new frontiers for the use of corticosteroids in septic shock which should be explored in future studies.
What Is the Utility of Measuring Lactate Levels in Patients with Sepsis and Septic Shock?
Authors: Weinberger Jeremy , Klompas Michael , Rhee Chanu 
Published: September 2021

AbstractElevations in blood lactate concentrations have been studied in sepsis and other disease states for decades and are well known to be associated with increased mortality. Many studies have also demonstrated the prognostic accuracy of serial lactate levels, and some have suggested that lactate clearance may be a useful therapeutic target for resuscitation. Lactate measurements have therefore gained an increasingly prominent role in sepsis definitions, screening protocols, management guidelines, and quality measures over the past two decades. The heavy emphasis on lactate monitoring, however, has also generated controversy and concerns. Lactate is not specific to infection and its frequent use for sepsis screening and diagnosis may therefore trigger unnecessary broad-spectrum antibiotic use in some patients. Because hyperlactatemia does not always reflect fluid-responsive hypoperfusion, titrating resuscitation to lactate clearance can also lead to unnecessary fluid and volume overload. More broadly, there is a lack of high-quality evidence demonstrating that initial and serial lactate monitoring leads to better patient-centered outcomes. Indeed, a recent randomized controlled trial comparing resuscitation strategies based on lactate clearance versus normalizing capillary refill time showed no benefit and potential harm with lactate-guided therapy. In this article, we review the basic pathobiology of lactate metabolism and delineate why the traditional paradigm that hyperlactatemia reflects tissue hypoxia is overly simplistic and incomplete. We then review the evidence behind the diagnostic, prognostic, and therapeutic uses of lactate monitoring and place this in the context of evolving sepsis diagnosis and management guidelines.
Any Role of High-Dose Vitamin C for Septic Shock in 2021?
Authors: Agarwal Ankita , Hager David N. , Sevransky Jonathan E. 
Published: September 2021

AbstractWhile the use of vitamin C as a therapeutic agent has been investigated since the 1950s, there has been substantial recent interest in the role of vitamin C supplementation in critical illness and particularly, sepsis and septic shock. Humans cannot synthesize vitamin C and rely on exogenous intake to maintain a plasma concentration of approximately 70 to 80 μmol/L. Vitamin C, in healthy humans, is involved with antioxidant function, wound healing, endothelial function, and catecholamine synthesis. Its function in the human body informs the theoretical basis for why vitamin C supplementation may be beneficial in sepsis/septic shock.Critically ill patients can be vitamin C deficient due to low dietary intake, increased metabolic demands, inefficient recycling of vitamin C metabolites, and loss due to renal replacement therapy. Intravenous supplementation is required to achieve supraphysiologic serum levels of vitamin C. While some clinical studies of intravenous vitamin C supplementation in sepsis have shown improvements in secondary outcome measures, none of the randomized clinical trials have shown differences between vitamin C supplementation and standard of care and/or placebo in the primary outcome measures of the trials. There are some ongoing studies of high-dose vitamin C administration in patients with sepsis and coronavirus disease 2019; the majority of evidence so far does not support the routine supplementation of vitamin C in patients with sepsis or septic shock.
Which Biomarkers Can Be Used as Diagnostic Tools for Infection in Suspected Sepsis?
Authors: Póvoa Pedro , Coelho Luis 
Published: September 2021

AbstractThe diagnosis of infection in patients with suspected sepsis is frequently difficult to achieve with a reasonable degree of certainty. Currently, the diagnosis of infection still relies on a combination of systemic manifestations, manifestations of organ dysfunction, and microbiological documentation. In addition, the microbiologic confirmation of infection is obtained only after 2 to 3 days of empiric antibiotic therapy. These criteria are far from perfect being at least in part responsible for the overuse and misuse of antibiotics, in the community and in hospital, and probably the main drive for antibiotic resistance. Biomarkers have been studied and used in several clinical settings as surrogate markers of infection to improve their diagnostic accuracy as well as in the assessment of response to antibiotics and in antibiotic stewardship programs. The aim of this review is to provide a clear overview of the current evidence of usefulness of biomarkers in several clinical scenarios, namely, to diagnose infection to prescribe antibiotics, to exclude infection to withhold antibiotics, and to identify the causative pathogen to target antimicrobial treatment. In recent years, new evidence with “old” biomarkers, like C-reactive protein and procalcitonin, as well as new biomarkers and molecular tests, as breathomics or bacterial DNA identification by polymerase chain reaction, increased markedly in different areas adding useful information for clinical decision making at the bedside when adequately used. The recent evidence shows that the information given by biomarkers can support the suspicion of infection and pathogen identification but also, and not less important, can exclude its diagnosis. Although the ideal biomarker has not yet been found, there are various promising biomarkers that represent true evolutions in the diagnosis of infection in patients with suspected sepsis.
Impact of State Prioritization of Safe Infant Sleep Programs on Supine Sleep Positioning for Non-Hispanic White and Non-Hispanic Black Infants
Authors: Hwang Sunah S. , Tong Suhong , Pyle Laura , Battaglia Catherine , McManus Beth , Niermeyer Susan , Sauaia Angela 
Published: September 2021

Objective Investigate whether safe infant sleep prioritization by states through the Title V Maternal and Child Block Grant in 2010 differentially impacted maternal report of supine sleep positioning (SSP) for Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) U.S.-born infants.
Study Design We analyzed retrospective cross-sectional data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2005 to 2015 from 4 states: WV and OK (Intervention) and AR and UT (Control). PRAMS is a population-based surveillance system of maternal perinatal experiences which is linked to infant birth certificates. Piece-wise survey linear regression models were used to estimate the difference in the change in slopes of SSP percents in the pre- (2005–2009) and post- (2011–2015) periods, controlling for maternal and infant characteristics. Models were also stratified by race/ethnicity.
Results From 2005 to 2015, for NHW infants, SSP improved from 61.5% and 70.2% to 82.8% and 82.3% for intervention and control states, respectively. For NHB infants, SSP improved from 30.6% and 26.5% to 64.5% and 53.1% for intervention and control states, respectively. After adjustment for maternal characteristics, there was no difference in the rate of SSP change from the pre- to post- intervention periods for either NHW or NHB infants in intervention or control groups.
Conclusion Compared with control states that did not prioritize safe infant sleep in their 2010 Title V Block Grant needs assessment, intervention states experienced no difference in SSP improvement rates for NHW and NHB infants. While SSP increased for all infants during the study period, there was no causal relationship between states' prioritization of safe infant sleep and SSP improvement. More targeted approaches may be needed to reduce the racial/ethnic disparity in SSP and reduce the risk for sleep-associated infant death.
Key Points
Evaluation of Fistulotomy with Immediate Sphincteric Reconstruction in the Treatment of High Transsphincteric Perianal Fistula
Authors: Orban Yasser A. , Soliman Hossam Hassan , Teliti Ahmed M. El , El-Shewy Ali , Hegab Yasmine Hany , Ibrahim Amr 
Published: September 2021

Abstract
Background High perianal fistula treatment remains challenging, mainly due to the variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and complication-free surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. The present study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction regaring fistula recurrence, incontinence, and patient satisfaction.
Methods This interventional study was performed at the General Surgery Department of Zagazig University Hospital during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then, suturing muscles to muscles, including the internal and external sphincters, by transverse mattress sutures.
Results Our study showed that 2 patients develop incontinence to flatus ∼ 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%.
Conclusion Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula, with low morbidity and high healing rate with acceptable continence state.
Occurrence of Epidermal Growth Factor Receptor Expression in Squamous Cell Carcinoma of Oral Cavity and Adjacent Sites: A Retrospective Observational Study
Authors: Dasgupta Senjuti , Chakrabarti Sudipta , Deb Asit R. 
Published: September 2021

AbstractIntroduction Oral cavity squamous cell carcinomas (OCSCCs) are one of the most common malignancies encountered. They have diverse clinicopathologic profiles. Epidermal growth factor receptor (EGFR) is an important marker of OCSCC for diagnosis, prognosis, and therapy.Objective The study aimed to evaluate the distribution of clinicopathological parameters in cases of squamous cell carcinoma (SCC) of the oral cavity and adjacent sites and their EGFR expression. An attempt was made to correlate EGFR scores with different parameters.Materials and Methods An observational retrospective study was undertaken for 1 year. Patients with histologically proven SCC of the oral cavity and adjacent sites were included. Clinicopathologic and immunohistochemical features of each case were analyzed.Results A total of 59 cases of SCC were included of which 41 (69%) were males. The mean age of the patients was 56.4 ± 10.3 years. The most common location of the tumors was oral cavity (31, 53%) followed by larynx (10, 16%). Most cases were moderately differentiated tumors (31, 53%). Immunohistochemical analysis showed low EGFR score in 7 (11.9%) cases, intermediate in 6 (10.1%), and high in 46 (78%) cases. Association between gender of patients and EGFR score was statistically significant (p = 0.000159). Most lesions of the oral cavity (31 cases, 53%) had a high EGFR score (23 cases, 74.2%). A statistically significant correlation was found between tumor grade and EGFR score (p = 0.03338).Conclusion This study from eastern region of India reveals unique characteristics of EGFR expression in SCC of the oral cavity and adjacent sites.
‘The good economy’: a conceptual and empirical move for investigating how economies and versions of the good are entangled
Authors: Asdal Kristin , Cointe Béatrice , Hobæk Bård , Reinertsen Hilde , Huse Tone , Morsman Silje R. , Måløy Tommas 
Published: September 2021

AbstractAcross Europe and the OECD, the bioeconomy is promoted as that which will succeed the carbon economy: an economy based in ‘the bio’ that will be innovative, sustainable, responsible and environmentally friendly. Yet how to critically approach an economy justified not only by its accumulative potentials but also its ability to do and be good? This paper suggests the concept of ‘the good economy’ as an analytical tool for investigating how economic practice is entangled in versions of the good. Building upon the classic contributions of Weber, Thompson and Foucault in combination with valuation studies, this paper shows how the good economy concept can be employed to examine how the economic and the good are intertwined. Empirically, the paper teases out how what is made to be good in the bioeconomy is radically different than in economies of the recent past. While ‘the good economy’ of the early oil and aquaculture economy concerned how to insert this economy into society in a good manner, society is surprisingly absent in the contemporary bioeconomy. The bioeconomy is enacted as an expert issue, pursued by the tools of economic valuation, and based in the unquestioned idea that ‘the bio’ makes any economy good.
Returns of research funding are maximised in media visibility for excellent institutes
Authors: Entradas Marta , Santos João M. 
Published: September 2021

AbstractThis paper investigates public communication activity across research institutes with varying levels of excellence in research, and how competitive funding affects this activity. With competing funding trends requiring plans for public engagement in the funded research, a question arising is whether institutes capturing higher amounts of funding return the most value for public communication. Using international data from N = 1550 institutes in six countries, we first compare public communication activity among excellent and less-than-excellent institutes. We then investigate the relationship between competitive funding and public communication across levels of excellence. We find that the returns of funding are maximised in media interactions in excellent institutes when compared to the less excellent, but not in public events. This suggests that returns of research funding may not result in the expected outcomes for increased ‘public engagement in science’ if institutions are guided by instrumental goals.