Alternative Point Research Articles

Graph theoretic methods for assessing the effects of a background shear current on internal solitary waves

Internal solitary waves are a widely observed phenomenon in natural waters. Mathematically, they are fundamentally a nonlinear phenomenon that differs from the paradigm of turbulence, in that energy does not move across scales. Internal solitary waves may be computed from the Dubreil–Jacotin Long equation, which is a scalar partial differential equation that is equivalent to the stratified Euler equations. When a background shear current is present the algebraic complexity of the problem increases substantially. We present an alternative point of view for characterizing the situation with a shear current using Lagrangian (particle-like) models analysed with graph theoretic methods. We find that this yields a novel, data-centric framework for analysis that could prove useful well beyond the study of internal solitary waves.

Comparison of 2 Free Light Chain Assays: Performance of the Free Light Chain Ratio as a Risk Factor for MGUS Progression.

New immunoglobulin free light chain (FLC) assays are available. Despite analytical differences, it seems possible to use free light chain ratios (FLCr) generated by different assays and apply similar cut-points for the diagnosis of multiple myeloma. It is still unknown if we can use different assays for risk stratification of patients with monoclonal gammopathy of undetermined significance (MGUS). Patients diagnosed with MGUS (N = 923) had FLC tested using a nephelometric FreeLite (Binding Site) assay on BNII instruments (Siemens) and a Sebia FLC assay (Sebia) on a DS2 ELISA analyzer (Dynex). Patients were followed up for progression to any plasma cell dyscrasia (PCD) for several decades. The Mayo MGUS risk stratification model for progression was assessed with both assays (M-spike >1.5 g/dL; non-IgG isotype and abnormal FLCr), using package insert reference intervals (RI) and a new metric called principal component 2 (PC2). There were 94 events of progression to PCD in the cohort during a median of 38 years of follow-up. Freelite and Sebia FLC showed similar hazard ratios in the risk models for elevated FLCr. An alternative clinical decision point lower than the package insert RI was evaluated for the Sebia assay, which improved risk stratification for patients with a low FLCr. The PC2 metric showed similar performance to the FLCr in models, without superior benefit. The Sebia ELISA-based FLC assay can be employed in an MGUS risk stratification model with similar performance to the original 2005 risk stratification model using the FreeLite assay.

Community Specialist Teams: Are We Making an Impact? Insights from General Practitioners

Abstract Background Within our catchment area, General Practitioners (GPs) are the primary source of referral to community specialist teams (CSTs) for older adults and are key stakeholders in supporting the integrated care pathway. We sought to evaluate their experience to inform service development. Methods GPs across four healthcare networks were invited to complete an online questionnaire evaluating their experience of the CSTs for older adults. Results Twenty-eight GPs responded. Of these, 85.7% (24) found the referral criteria clear, and 89.3% (25) reported ease of access to the service. However, 50% (14) were uncertain about when to refer patients to primary care alone versus the CST. A significant majority, 96.5% (27), felt the service positively impacted the health and well-being of referred patients, and 92.9% (26) were satisfied with communication regarding patient care plans and progress. Identified strengths of the service included the multidisciplinary approach to providing comprehensive, patient-centered care and effective communication with both GPs and patients. Areas for improvement included enhancing access for specialist teams to community radiology and increasing staffing levels to ensure timely assessments. Regarding the impact on unscheduled and emergency care, 71.4% (20) reported a reduced need to refer to the acute medical unit, and 35.7% (10) reported a reduced need to refer to the emergency department due to the ability to refer to CSTs. Conclusion GPs value the CST service for the quality of assessment and intervention their patients receive. Targeted areas for operational and clinical improvement include provision of diagnostics and role distinction from primary care teams. This survey also suggests CSTs are providing an alternative care pathway and point of contact for older patients in crisis, resulting in a reduction in unscheduled and emergency care utilisation. The role of the CSTs should be supported and enhanced and warrants more detailed exploration.

Telehealth in Libraries: The Creation of a Novel Pre-Implementation Workbook

ABSTRACT Telehealth services are a growing aspect of the US healthcare delivery system. Some rural patients, however, lack proper internet speed in their home to access telehealth services and need alternative telehealth access points. Public libraries can be an alternative telehealth access point due to their access to high-speed internet services; however, these programs often experience limited success due to a lack of planning with community health providers and local health organizations. This article describes a novel workbook that guides public libraries to collaborate with community stakeholders when considering the implementation of telehealth services. Development of the workbook leveraged expertise of library and public health professionals. The workbook is currently free to download and updated versions will be available as more knowledge is gained in the field.

Competence in Unsustainability Resolution—A New Paradigm

Environmental unsustainability in coupled human–nature systems is accumulating. Yet, there is no accreditation requirement for unsustainability resolution competency in higher education. Thus, a new and complete representation of the pedagogy for unsustainability resolution competence has been induced, using what is already available and working. The nature of unsustainability problems points to collaboration and holism attitudes. Resolution requires social skills, namely participation, perspective taking, and the generation of social capital, and cognitive skills, namely project management, knowledge building, and modeling. Resolution is scaffolded in three successive steps during the collaborative process within a systems approach: (i) collapse complexity; (ii) select a path/trajectory; and (iii) operationalize a plan. The hierarchically cumulative abilities toward unsustainability resolution competence are to source data and information about the coupled human–nature system (SEARCH); simplify the dynamics of the human–nature system (SIMULATE); generate and test alternative paths and end points for the coupled human–nature system (STRATEGIZE); chose a favorable path among the available alternatives (SELECT); operationalize the favorable path into a plan (strategy–program–project) with measurable management and policy objectives (IMPLEMENT); and develop criteria/indicators to monitor and adjust when necessary the implementation of the plan toward system goals (STEER). For each one of these learning objectives, the Bloom’s taxonomy and a progression from behaviorist through cognitivist to constructivist tools apply. The development of mastery requires the comparison and contrast of many similar cases with the same unsustainability problem and project-based learning with specific cases for deep learning. In this way, it is the resolutions of unsustainability in human–nature systems that will be accumulating.

Immunity to Non-Dengue Flaviviruses Impacts Dengue Virus Immunoglobulin G Enzyme-Linked Immunosorbent Assay Specificity in Cambodia.

Seroprevalence studies are the standard for disease surveillance, and serology determined eligibility for the first dengue vaccine. Expanding flavivirus co-circulation and vaccination complicate testing. We evaluate the accuracy of a common dengue virus serological assay, examine immunity to non-dengue flaviviruses as a contributor to decreased performance, and assess whether alternative cut points may improve assay performance. Children (n = 770) aged 2-9 years in Kampong Speu, Cambodia were enrolled in a prospective longitudinal study, and PanBio indirect dengue virus immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA) was performed. Plaque reduction neutralization tests (PRNTs) using dengue viruses were performed on a subset to assess the accuracy of the IgG ELISA, and PRNTs with Zika, Japanese encephalitis, and West Nile viruses evaluated immunity to non-dengue flaviviruses. Receiver operating curve analysis identified an alternative cut point to improve IgG ELISA accuracy. The dengue IgG ELISA had a lower specificity than previously reported (58% vs 93%-100%). Of those with false-positive IgG results, 46% had detectable neutralizing antibodies against other flaviviruses including 14% against West Nile virus. A higher IgG cut point improved the test accuracy in this population. Physicians and public health authorities should be alert for West Nile in Cambodia. Immunity to non-dengue flaviviruses can impact dengue surveillance. NCT03534245.

Particle swarm optimization based on data driven for EV charging station siting

Charging stations are an important support facility for electric vehicles (EVs). Nowadays, the EV industry is developing rapidly, however, the imperfect construction of charging stations or the unreasonable choice of location has seriously reduced the desire of people to buy EVs and led to the problem of difficult charging of EVs in many areas. At present, the research field of EV charging station siting suffers from the inability to quickly and accurately calculate the optimal solution for charging station siting. In this regard, a particle swarm optimization based on deep neural networks modified boundaries (DNNMBPSO) is proposed for solving the problem. DNNMBPSO reduces the convergence value of the objective function by applying deep learning to modify the boundary of the particle swarm optimization. DNNMBPSO is an algorithm that combines heuristic and data driven. In this study, DNNMBPSO is applied for siting study in a system having 50 alternative points, 500 alternative points, and 1000 alternative points and a case of siting of electric vehicle charging stations in Nanning, Guangxi, China. The convergence value of the DNNMBPSO-based objective function is found to be at least 5.5 %, 1.7 %, 8.23 % and 14.7 %, lower compared to genetic algorithms, African vulture optimization algorithm, particle swarm optimization, and grey wolf optimization algorithms, respectively. Traditional heuristic optimization algorithms cannot find optimal solutions in large-scale systems, while DNNMBPSO shows feasibility in large-scale systems.

Accessing the Cloke-Wilson Rearrangement via Conjugate Addition of Phosphoranes to Michael Acceptors: A Route to Cyclopropanes and 5-Membered Ring Heterocycles Investigated by Density Functional and Ab Initio Theory.

Conjugate addition of unstabilized Wittig-type phosphonium ylides to 1,1-diacceptor- and 1-acceptor-substituted alkenes is investigated by density functional theory and high-level ab initio (DLPNO-CCSD(T)) calculations. The results indicate that the initial conjugate addition step should be facile with barriers predicted to be between 0 and 21 kcal mol-1. Potential intramolecular follow-up reactions include the formation of acceptor-substituted cyclopropanes as well as the formation of dihydrofuran derivatives via intramolecular SN2-type transition state structures. The barriers calculated for these potentially valuable cyclization reactions are substantial with Gibbs free energies of activation between 19 and 40 kcal mol-1. Competing reaction channels include Wittig olefination (for ketones and aldehydes), as well as Claisen condensation reactions. The reaction offers an alternative entry point to the nucleophile-catalyzed Cloke-Wilson rearrangement.

Enhanced minimum cost consensus model for interval type-2 fuzzy social network group decision making focusing on individual attributes and group attitude

In group decision-making scenarios, consensus reaching is a crucial factor for resolving conflicts of opinion among groups, and social network analysis plays a significant role in fostering group consensus. This paper constructs a social network-driven minimum cost consensus framework for interval type-2 fuzzy group decision-making problems involving different individual attributes. Firstly, this paper proposes a theoretical social network analysis by the implementation of propagation efficiency, propagation reliability and opinion similarity to generate comprehensive trust relationships. The aim is to obtain missing trust relationships and individual centrality. Secondly, a minimum cost consensus model is constructed to give recommendation advice for identified inconsistent decision-makers according to their adjustment willingness. The novelty of the model lies in its capability to consider decision-makers’ individual attributes and group attitude or behavior. Then, this paper proposes an interval type-2 fuzzy Alternative by Alternative Comparison (ABAC) method for ranking multiple alternatives which address the rank reversal problem. Lastly, a case study on the selection of alternative charging point operators illustrates the effectiveness of the proposed method, and comparison and sensitivity analysis show the advantages of the proposed method.

Challenging the Controversy Surrounding Percutaneous Brachial Artery Access Related Complications: A Systematic Review and Meta-Analysis.

Endovascular therapy has become increasingly preferred in the diagnosis and treatment of various conditions. The choice of arterial access usually depends on the type of procedure being performed with most via the common femoral artery and increasingly via the radial artery. Percutaneous access via the brachial artery has however been approached with caution due to the perceived increased risk for development of complications. Percutaneous brachial artery access (pBAA) has insufficient evidence when compared to femoral and radial access, with no large-scale studies available. The objective of this study is to review the literature and report the clinical and radiological complications associated with pBAA. EMBASE, EMCARE, CINAHL and Medline were searched for existing data on the complications associated with pBAA. Systematic review and meta-analysis were carried out on the data of 31 studies. The results of this systematic review and meta-analysis indicates that the probability of post procedural haematoma was 4.76%, haemorrhage 1.43%, perforation 1.11% pseudoaneurysm 1.06%, spasm 0.9%, thrombus 0.55%, neuropathy 0.53%, occlusion 0.51%, ischaemia 0.37% and infection 0.24 %. Non-target vessel puncture, stenosis and stroke had a 0% incidence among the assessed population. This study provides evidence to support clinical decision making when it comes to the utility of pBAA in endovascular diagnosis or therapy. The results demonstrate that pBAA is relatively safe with a low incidence of serious complications and thereby provide the clinician with the option of an alternate access point when planning treatment.

Metadynamics Study of Lipid-Mediated Antibacterial Toxin Binding to the EmrE Multiefflux Protein.

EmrE is a bacterial efflux protein in the small multidrug-resistant (SMR) family present in Escherichia coli. Due to its small size, 110 residues in each dimer subunit, it is an ideal model system to study ligand-protein-membrane interactions. Here in our work, we have calculated the free energy landscape of benzyltrimetylammonium (BTMA) and tetraphenyl phosphonium (TPP) binding to EmrE using the enhanced sampling method-multiple walker metadynamics. We estimate that the free energy of BTMA binding to EmrE is -21.2 ± 3.3 kJ/mol and for TPP is -43.6 ± 3.8 kJ/mol. BTMA passes through two metastable states to reach the binding pocket, while TPP has a more complex binding landscape with four metastable states and one main binding site. Our simulations show that the ligands interact with the membrane lipids at a distance 1 nm away from the binding site which forms a broad local minimum, consistent for both BTMA and TPP. This site can be an alternate entry point for ligands to partition from the membrane into the protein, especially for bulky and/or branched ligands. We also observed the membrane lipid and C-terminal 110HisA form salt-bridge interactions with the helix-1 residue 22LysB. Our free energy estimates and clusters are in close agreement with experimental data and give us an atomistic view of the ligand-protein-lipid interactions. Understanding the binding pathway of these ligands can guide us in future design of ligands that can alter or halt the function of EmrE.

Chronic illness as cultural disruption: The impact of chronic illness on religious and cultural practice.

The relationship between religion and health tends to be framed positively. Religion has been found to act as a coping mechanism and source of support in times of ill health. In this paper, we focus on the disruptive effect of chronic illness on religious practice and cultural engagement. Drawing on interviews with ethnic minority adults with end-stage kidney disease, who also identify as religious, we introduce the concept 'cultural disruption'. While religious practice and belief was found to provide strength and comfort we also found that chronic illness had a disruptive impact on religious and cultural practice that participants attempted to manage. To highlight the potential disruptive effect of chronic illness on religious faith and cultural engagement we identify three elements of cultural disruption-disruption to religious practice, disruption to sense of self and identity and disruption to wellbeing. We conclude by suggesting that understanding and accounting for the potential of cultural disruption when diagnosing, treating and supporting people with chronic illness offers an alternative entry point to the life-worlds of patients who identify as religious and the things that are important to them.

The Comparison A-Optimal and I-Optimal Design in Non-Linear Models to Increase Purity Levels Silicon Dioxide

One of the obstacles that arise in optimal design is the non-linear model. The relationship between temperature factors and the temperature increase rates with the purity of silicon dioxide (SiO2) forms a non-linear pattern. Determining the optimal design for a non-linear model is relatively more complex than a linear model because it requires additional information in its information matrix. Therefore, this issue necessitates further research on optimal design in non-linear models. This study uses the polynomial Taylor approach to approximate the non-linear equation through a linear equation using the appropriate optimal design methods, namely A-Optimal and I-Optimal criterion. The point search algorithm used was variable neighborhood search, this algorithm searches for design points by exploring several different neighborhood structures. These two methods were chosen to compare the characteristics and performance of the designs produced, aiming to obtain an optimal design to improve SiO2 purity (non-linear case) using the same algorithm, VNS. The research results showed that the design pattern produced by the A-Optimal design formed three temperature groups, namely the minimum temperature of 800°C - 820°C, the middle temperature of 850°C, 860°C, and the maximum temperature of 900°C, with varying temperature increase rates in the design area. The design pattern produced by the I-Optimal design formed a full quadratic pattern, namely the minimum temperature of 800°C and the maximum temperature of 900°C, with varying temperature increase rates in the design area. The I-Optimal design demonstrated the best performance (most optimal) in the aspect of prediction variance compared to the A-Optimal design across all alternative points in this study to improve SiO2 purity.

Применение компьютерного зрения для определения реперных точек при оценке геометрии лица

The use of computer vision to determine the geometry of a face using reference points is a relatively new approach in medicine. The relevance of this study is due not only to the need to develop new methods and approaches in determining the geometry of the face, but also to the growing interest in the development and application of artificial intelligence in medicine. The research objective. The purpose of this article is to develop mathematical and neural network algorithms that determine the geometry of a face using reference points. Material and methods. To train the neural network, a small sample of 1,000 marked-up photos in the public domain was used, which depict a full-face portrait of a man up to his shoulders. Only adult (18+) representatives of the Caucasian race were considered. The photos were marked up using the LabelImg 1.8.6 graphical image analysis tool, in which the areas of finding (classes of definition) of reference points were manually marked in the graphical interface mode. YOLO 8 was chosen as the neural network architecture. Results. It was shown that the accuracy of the point search by a neural network trained on 1000 grouped photographs reaches 98.15 %, which indicates a good definition of the boundaries of objects and their classification. Conclusion. The conducted research demonstrated the successful development and application of neural network algorithms to determine alternative reference points characterizing the geometry of the face. The results obtained confirm the effectiveness of the technique proposed by the authors in cosmetology, and also indicate its potential for use in other fields of medicine, such as dentistry, neurology and surgery.

Consumer Perceptions Matter: A Case Study of an Anomaly in English Football

Abstract In 1983 England’s fifth-tier football competition introduced a two-points-for-a-home-win and three-points-for-an-away-win reward system. This system was abolished after three seasons. The anomalous point system may have been introduced to reduce home advantage but the reasons are not fully clear and neither are the reasons for abolishing the system shortly after its introduction. We find that the new point system did not affect match outcomes but it did influence match attendance negatively. We speculate that the alternative point system was perceived as unfair to potential buyers of seasonal tickets or individual match tickets some of whom as a response decided to avoid watching the game in person. Consumer perceptions seem to matter.

Modeling the unphysical pseudomode model with physical ensembles: Simulation, mitigation, and restructuring of non-Markovian quantum noise

The influence of a Gaussian environment on a quantum system can be described by effectively replacing the continuum with a discrete set of ancillary quantum and classical degrees of freedom. This defines a pseudomode model which can be used to classically simulate the reduced system dynamics. Here we consider an alternative point of view and analyze the potential benefits of an analog or digital quantum simulation of the pseudomode model itself. Superficially, such a direct experimental implementation is, in general, impossible due to the unphysical properties of the effective degrees of freedom involved. However, we show that the effects of the unphysical pseudomode model can still be reproduced using measurement results over an ensemble of physical systems involving ancillary harmonic modes and an optional stochastic driving field. This is done by introducing an extrapolation technique whose efficiency is limited by stability against imprecision in the measurement data. We examine how such a simulation would allow us to (i) perform a quantum simulation of the effects of complex nonperturbative and non-Markovian environments in regimes that are challenging for classical simulation; (ii) conversely, mitigate potential unwanted non-Markovian noise present in quantum devices; and (iii) restructure some of the properties of a given physical bath, such as its temperature. Published by the American Physical Society 2024

Six-minute walk test as clinical end point in cardiomyopathy clinical trials, including ATTR-CM: a systematic literature review.

Aim: The six-minute walk test (6MWT) is acommon measure of functional capacity in patients with heart failure (HF). Primary clinical study end points in cardiomyopathy (CM) trials, including transthyretin-mediated amyloidosis with CM (ATTR-CM), are often limited to hospitalization and mortality. Objective: To investigate the relationship between the 6MWT and hospitalization or mortality in CM, including ATTR-CM. Method: A PRISMA-guided systematic literature review was conducted using search terms for CM, 6MWT, hospitalization and mortality. Results: Forty-one studies were identified that reported 6MWT data and hospitalization or mortality data for patients with CM. The data suggest that a greater 6MWT distance is associated with a reduced risk of hospitalization or mortality in CM. Conclusion: The 6MWT is an accepted alternative end point in CM trials, including ATTR-CM.

Amodal Completion: Mental Imagery or 3D Modeling?

AbstractIn amodal completion the mind in some sense completes the visual perceptual representation of a scene by representing parts of the scene hidden behind other objects. Cognitive science has had a lot to say about how amodal completion occurs but has had little to say about the format of the representations involved and the way in which they represent. Some philosophers hold that amodal completions take the form of sensory imaginings of the occluded portions. This theory poses a puzzle for both philosophy and neuroscience about how the occluded parts are imagined to be located relative to the unoccluded parts. A better theory begins with the observation that for many purposes it is useful to suppose that the mind contains mental models of three-dimensional structure. Visual perceptions and mental images may be conceived as mental models that represent external scenes by virtue of homomorphism and which possess both a deep aspect, representing both visible and occluded three-dimensional structure, and a perspectival aspect, representing only an arrangement of visible surfaces. In these terms we can explain various problem-solving abilities, such as the ability to imagine what a scene will look like from another point of view. Amodal completions can be treated as deep perceptual representations of three-dimensional structure. Thus amodal completions do not consist of mental imagery, but they can be used to generate mental imagery representing how a scene would look from alternative points of view.

Pericles tirano. Aproximación a la gestión de la crisis sanitaria durante la epidemia de Atenas (430-426 a.C.)

Abstract Tyrant Pericles. Approach to the management of the health crisis during the plague of Athens (430-426 BC) The aim of this paper is to analyse the political and religious consequences of the Athenian plague of 430 BC. Regarding the political aspects, the work is focused on the popular judgement on the epidemic’s management and the consequent Pericles’ loss of political prestige. Moreover, the paper concludes that this popular response leads to the adoption of religious measures such as the introduction in Athens of Asclepius’ cult (421 BC). The facts mentioned above provide an alternative point of view of Thucydides’ epidemic main account.

Artificial Intelligence Technology for Interactive Mobile Devices and Its Application in 3D Visual Design

The use of visual rationality in planning and designing indoor 3D spaces can effectively enhance the quality of environmental art design. For the rational planning and design of 3D spaces, it is essential to assign attribute values to the rational evaluation index of 3D space planning, determine the weight vector of rational evaluation factors for indoor 3D space planning, and accomplish the visual rationality planning and design of indoor 3D spaces. 3D reconstruction is one of the primary objectives and focal points of machine vision research. The principle is to extract 3D information from the 2D image captured by the machine’s sensors in order to reconstruct a 3D scene model. The traditional method constructs the evaluation index system for indoor 3D space planning to determine the weight of the evaluation index for alternative points. However, it overlooks the weight vector of the evaluation factors, leading to low accuracy in rational planning. This paper optimizes the effect of structured light reconstruction using photometric stereo vision. Firstly, the text delves into the impact of light sources on the 3D reconstruction effect. Subsequently, a fusion algorithm combining 3D and structured light reconstruction methods is introduced, leveraging artificial intelligence (AI) technology. Experimental results show that this algorithm has a superior 3D reconstruction effect.