Applied Research Research Articles

Emergency Department Presentations of Diabetic Ketoacidosis in a Large Cohort of Children

Background. Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of childhood diabetes. However, the influence of demographic factors on presentation are not well-defined. Methods. We included children from 12 centers who were <18 years with DKA (glucose > 300 mg/dL, serum pH < 7.25, or serum bicarbonate <15 mEq/L) enrolled in the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) Trial. Data were also collected for children who presented to the centers during the enrollment period but were not enrolled due to disease or treatment-related reasons. We compared demographic, clinical, and biochemical findings among children with newly and previously diagnosed diabetes and children in different age groups. Results. Of the 1,679 DKA episodes in 1,553 children, 799 (47.5%) episodes occurred in children with newly diagnosed diabetes and 396 (23.6%) were severe (pH < 7.1). Newly diagnosed children <6 years of age were not more likely to have severe DKA in terms of pH, but had more severe hypocarbia and higher blood urea nitrogen levels, factors previously associated with the risk of cerebral injury. Lower socioeconomic status (SES) (based on family income and maternal education level) were associated with more severe DKA in new onset children, and recurrent DKA in the previously diagnosed children. Conclusions. Greater efforts are needed to identify the children with diabetes early and to prevent recurrent DKA, particularly among children in low-SES groups. Young children with DKA may need more intensive monitoring due to higher risk of cerebral injury.

On model selection criteria for climate change impact studies

Climate change impact studies inform policymakers on the estimated damages of future climate change on economic, health and other outcomes. In most studies, an annual outcome variable is observed, e.g. agricultural yield, along with a higher-frequency regressor, e.g. daily temperature. Applied researchers then face a problem of selecting a model to characterize the nonlinear relationship between the outcome and the high-frequency regressor to make a policy recommendation based on the model-implied damage function. We show that existing model selection criteria are only suitable for the policy objective if one of the models under consideration nests the true model. If all models are seen as imperfect approximations of the true nonlinear relationship, the model that performs well in the historical climate conditions is not guaranteed to perform well at the projected climate. We therefore propose a new criterion, the proximity-weighted mean squared error (PWMSE) that directly targets precision of the damage function at the projected future climate. To make this criterion feasible, we assign higher weights to historical years that can serve as “weather analogs” to the projected future climate when evaluating competing models using the PWMSE. We show that our approach selects the best approximate regression model that has the smallest weighted squared error of predicted impacts for a projected future climate. A simulation study and an application revisiting the impact of climate change on agricultural production illustrate the empirical relevance of our theoretical analysis.

Applied Research of the Possibility of Using Ion-Plasma Coatings in Order to a Achieve New Material Properties

Applied Research of the Possibility of Using Ion-Plasma Coatings in Order to a Achieve New Material Properties

Considering a Bifactor Model of Children’s Subjective Well-Being Using a Multinational Sample

In the current study, we consider the viability of a bifactor model of children’s subjective well-being (SWB) by contributing to the discussion on the dimensionality of children’s SWB. We specify a general factor of SWB and four group factors (context-free cognitive life satisfaction, domain-based cognitive life satisfaction, positive affect, and negative affect) using structural equation modelling and parceling. We used data from the Children’s Worlds International Survey of Children’s Well-Being (N = 92 782). Our analysis strategy included confirmatory factor analysis and bifactor analysis. We found a good fit for the specified bifactor model, with all items loading onto a general factor and group factors. For the bifactor analysis, after controlling for the general factor, the loadings on the group factors were substantially lower, and did not meet the criteria of acceptability for bifactor indices thresholds. The common variance of the items is largely explained by the general factor; thus, the specification of the group factors cannot be justified. Further, we found an excellent fit for a model using the parceling approach. From a measurement perspective, the construct of children’s SWB can potentially be measured as a unidimensional construct. Thus, it may be feasible to report a total score for children’s SWB, as opposed to scores on the individual subscales (group factors). Applied researchers can thus confidently use SWB as a unidimensional construct or follow the parceling approach in the structural equation model context.

The Long Scientific Journey of Sirolimus (Rapamycin): From the Soil of Easter Island (Rapa Nui) to Applied Research and Clinical Trials on β-Thalassemia and Other Hemoglobinopathies.

In this review article, we present the fascinating story of rapamycin (sirolimus), a drug able to induce γ-globin gene expression and increased production of fetal hemoglobin (HbF) in erythroid cells, including primary erythroid precursor cells (ErPCs) isolated from β-thalassemia patients. For this reason, rapamycin is considered of great interest for the treatment of β-thalassemia. In fact, high levels of HbF are known to be highly beneficial for β-thalassemia patients. The story of rapamycin discovery began in 1964, with METEI, the Medical Expedition to Easter Island (Rapa Nui). During this expedition, samples of the soil from different parts of the island were collected and, from this material, an antibiotic-producing microorganism (Streptomyces hygroscopicus) was identified. Rapamycin was extracted from the mycelium with organic solvents, isolated, and demonstrated to be very active as an anti-bacterial and anti-fungal agent. Later, rapamycin was demonstrated to inhibit the in vitro cell growth of tumor cell lines. More importantly, rapamycin was found to be an immunosuppressive agent applicable to prevent kidney rejection after transplantation. More recently, rapamycin was found to be a potent inducer of HbF both in vitro using ErPCs isolated from β-thalassemia patients, in vivo using experimental mice, and in patients treated with this compound. These studies were the basis for proposing clinical trials on β-thalassemia patients.

Interactive Marketing of Insurance Service and its Role in Customer Relationship Management: Applied Research in the Iraqi Insurance Company

Interactive Marketing of Insurance Service and its Role in Customer Relationship Management: Applied Research in the Iraqi Insurance Company

Работа Оперативно-распорядительной службы Департамента здравоохранения г.Москвы в условиях пандемии Covid-19 в 2020–2022 гг.

Summary. The aim of the study is to analyze the effectiveness of the Operations and Management Service (OMS) of Moscow Department of Health under the conditions of pandemic COVID-19 in 2020-2022. Materials and research methods. Materials of the study were statistical data on the activities of the Operations and Management Service for oral appeals of citizens and rapid response in 2020-2022: reporting forms of the Operations and Management Service (OMS) of Moscow Department of Health, containing data on the daily monitoring of the work of paramedics on the reception and transfer of calls; daily reports on the work done, as well as regulatory legal acts on the issues of medical provision for the population. Applied research methods were statistical and analytical. Results of the study and their analysis. The experience of work of the Operations and Management Service (OMS) of Moscow Department of Health during the pandemic COVID-19 in 2020-2022 is presented. By the example of the work of the Operations and Management Service (OMS) of Moscow Department of Health the importance of partnerships that ensure smooth operation of medical organizations of Moscow to provide timely medical care in an emergency epidemiological situation is revealed.

The Effect of Green Maintenance on Environmental Performance Applied Research in the General Company for Oil Products

The Effect of Green Maintenance on Environmental Performance Applied Research in the General Company for Oil Products

Potentially modifiable dementia risk factors in all Australians and within population groups: an analysis using cross-sectional survey data

Dementia is the second leading cause of disease burden in Australia. We aimed to calculate the population attributable fractions (PAFs) of dementia attributable to 11 of 12 previously identified potentially modifiable health and social risk factors (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, alcohol excess, air pollution, and traumatic brain injury), for Australians overall and three population groups (First Nations, and those of European and Asian ancestry). We calculated the prevalence of dementia risk factors (excluding traumatic brain injury) and PAFs, adjusted for communality, from the cross-sectional National Aboriginal and Torres Strait Islander Health Survey (2018-19), National Aboriginal and Torres Strait Islander Social Survey (2014-15), National Health Survey (2017-18), and General Social Survey (2014) conducted by the Australian Bureau of Statistics. We conducted sensitivity analyses using proxy estimates for traumatic brain injury (12th known risk factor) for which national data were not available. A large proportion (38·2%, 95% CI 37·2-39·2) of dementia in Australia was theoretically attributable to the 11 risk factors; 44·9% (43·1-46·7) for First Nations Australians, 36·4% (34·8-38·1) for European ancestry, and 33·6% (30·1-37·2) for Asian ancestry. Including traumatic brain injury increased the PAF to 40·6% (39·6-41·6) for all Australians. Physical inactivity (8·3%, 7·5-9·2), hearing loss (7·0%, 6·4-7·6), and obesity (6·6%, 6·0-7·3) accounted for approximately half of the total PAF estimates across Australia, and for all three population groups. Our PAF estimates indicate a substantial proportion of dementia in Australia is potentially preventable, which is broadly consistent with global trends and results from other countries. The highest potential for dementia prevention was among First Nations Australians, reflecting the enduring effect of upstream social, political, environmental, and economic disadvantage, leading to greater life-course exposure to dementia risk factors. Although there were common dementia risk factors across different population groups, prevention strategies should be informed by community consultation and be culturally and linguistically appropriate. Australian National Health and Medical Research Council and University College London Hospitals' National Institute for Health Research (NIHR) Biomedical Research Centre, and North Thames NIHR Applied Research Collaboration.

Quantitative Evaluation of Assessment Items of the Technology Audit Method for Research and Technology Organisations (RTOs)

Applied research and development (R&D) organisations strive to develop technological solutions that translate results from research and science into state-of-the-art products and services. As advanced technological capability is essential to their competitiveness, they need to be able to analyse and evaluate their technological capabilities. Hence, a tool or method is required that objectively and practically assesses the technological capability of Research and Technology Organisations (RTOs) while meeting their unique requirements. The technology audit enables the assessment of the technological capability and thus the technological maturity of an RTO. It focuses on the analysis of the research activities in the R&D service areas of the RTO. This allows for a comprehensive understanding of the technologies used, the research competencies, the technologies developed, and the established technology partnerships of the RTO. In this context of the development of a suitable technology audit methodology, this paper aims to describe the process of validation of assessment items for evaluating the technological maturity of applied R&D organisations. After a brief overview of the technology audit method and the assessment dimensions and items, the focus is placed on the process of its validation. An expert survey using a questionnaire was created and used to evaluate the relevance of the 11 assessment items for the technology audit instrument in the three dimensions of Technology Base, Products & Services and Cooperation, as well as the respective aspects within each assessment item. This evaluation is intended to validate the selection of the items and to specify their respective importance to ultimately optimise the process of auditing applied R&D organisations.

Subsidies and extra-tariff revenues in the Brazilian Public Transportation scenario and its relationship with urban mobility

Urban Passenger Transportation is an essential service of public utility and, therefore, seeks to implement the right to universal mobility for different social classes. It is evident that the model must be regulated to guarantee social equity also through sustainable mobility. The objective of this paper is to identify policies applied to Public Transportation that are directly related to the subsidy theme, to propose a method to ensure the value of the affordable fare, maintaining the economic-financial balance, without, however, conditioning it to the stipulated level of service by the public concession contract. Applied research was used with a descriptive objective, performing analysis into the Brazilian scenario. Since these are public resources intended for service providers for extra-contractual intervention, the challenges and complexity of interpreting the effectiveness of the subsidy to the detriment of the social tariff are considered. In addition to proposing the method itself, this paper shows how to use a subsidy combined with extra-tariff revenues, in order to equalize operating costs without interfering with the system's level of service.

A virtuous cycle of co-production: Reflections from a community priority-setting exercise.

Co-production is gaining increasing recognition as a good way of facilitating collaboration among different stakeholders, including members of the public. However, it remains an ambiguous concept as there is no definitive or universal model of co-production or clarity on what constitutes a good co-production approach. This paper draws on the reflections of the academic researchers, practitioners and public advisors involved in co-producing a priority-setting exercise. The exercise was conducted by the Primary and Community Health Services (PCHS) Theme of the National Institute for Health and Care Research Applied Research Collaboration for Kent, Surrey and Sussex (NIHR ARC KSS). We collected data through written and verbal reflections from seven collaborators involved in the PCHS priority-setting exercise. We used Gibbs' model of reflection to guide the data collection. We then analysed the data through an inductive, reflexive thematic analysis. A common thread through our reflections was the concept of 'sharing'. Although co-production is inherently shared, we used the virtuous cycle to illustrate a sequence of sharing concepts during the research cycle, which provides the underpinnings of positive co-production outcomes. We identified six themes to denote the iterative process of a shared approach within the virtuous cycle: shared values, shared understanding, shared power, shared responsibilities, shared ownershipand positive outcomes. Our results present a virtuous cycle of co-production, which furthers the conceptual underpinnings of co-production. Through our reflections, we propose that positive co-production outcomes require foundations of shared values and a shared understanding of co-production as a concept. These foundations facilitate a process of shared power, shared responsibilitiesand shared ownership. We argue that when these elements are present in a co-production exercise, there is a greater potential for implementable outcomes in the communities in which the research serves and the empowerment of collaborators involved in the co-production process. Three members of the public who are public advisors in the NIHR ARC KSS were involved in the priority-setting exercise that informed this paper. The public advisors were involved in the design of the priority-setting exercise and supported participants' recruitment. They also co-facilitated the focus groups during data collection and were involved in the data analysis, interpretation and preparation of the priority-setting report. For this current manuscript, two of them are co-authors. They provided reflections and contributed to the writing and reviewing of this manuscript.

Applied Research Note: Comparison of different methods for beak measurements in laying hens

Applied Research Note: Comparison of different methods for beak measurements in laying hens

Sickle Cell Disease Treatment with Arginine Therapy (STArT): study protocol for a phase 3 randomized controlled trial

BackgroundDespite substantial illness burden and healthcare utilization conferred by pain from vaso-occlusive episodes (VOE) in children with sickle cell disease (SCD), disease-modifying therapies to effectively treat SCD-VOE are lacking. The aim of the Sickle Cell Disease Treatment with Arginine Therapy (STArT) Trial is to provide definitive evidence regarding the efficacy of intravenous arginine as a treatment for acute SCD-VOE among children, adolescents, and young adults.MethodsSTArT is a double-blind, placebo-controlled, randomized, phase 3, multicenter trial of intravenous arginine therapy in 360 children, adolescents, and young adults who present with SCD-VOE. The STArT Trial is being conducted at 10 sites in the USA through the Pediatric Emergency Care Applied Research Network (PECARN). Enrollment began in 2021 and will continue for 5 years. Within 12 h of receiving their first dose of intravenous opioids, enrolled participants are randomized 1:1 to receive either (1) a one-time loading dose of L-arginine (200 mg/kg with a maximum of 20 g) administered intravenously followed by a standard dose of 100 mg/kg (maximum 10 g) three times a day or (2) a one-time placebo loading dose of normal saline followed by normal saline three times per day at equivalent volumes and duration as the study drug. Participants, research staff, and investigators are blinded to the participant’s randomization. All clinical care is provided in accordance with the institution-specific standard of care for SCD-VOE based on the 2014 National Heart, Lung, and Blood Institute guidelines. The primary outcome is time to SCD-VOE pain crisis resolution, defined as the time (in hours) from study drug delivery to the last dose of parenteral opioid delivery. Secondary outcomes include total parental opioid use and patient-reported outcomes. In addition, the trial will characterize alterations in the arginine metabolome and mitochondrial function in children with SCD-VOE.DiscussionBuilding on the foundation of established relationships between emergency medicine providers and hematologists in a multicenter research network to ensure adequate participant accrual, the STArT Trial will provide definitive information about the efficacy of intravenous arginine for the treatment of SCD-VOE for children.Trial registrationThe STArT Trial was registered in ClinicalTrials.gov on April 9, 2021, and enrollment began on June 21, 2021 (NCT04839354).

Overexpression of ASPH protein predicts poor outcomes in retroperitoneal liposarcoma patients.

Overexpression of ASPH protein predicts poor outcomes in retroperitoneal liposarcoma patients.

A methodology to determine the precision uncertainty in gas turbine engine cycle models

Abstract This paper proposes a methodology to define and quantify the precision uncertainties in aerothermodynamic cycle model comparisons. The total uncertainty depends on biases and random errors commonly found in such comparisons. These biases and random errors are classified and discussed based on observations found in the literature. The biases account for effects such as differences in model inputs, the configurations being simulated, and thermodynamic packages. Random errors consider the effects on the physics modeling and numerical methods used in cycle models. The methodology is applied to a comparison of two cycle models, designated as the model subject to comparison and reference model, respectively. The former is the so-called Aerothermodynamic Generic Cycle Model developed in-house at the Laboratory of Applied Research in Active Control, Avionics and AeroServoElasticity (LARCASE); the latter is an equivalent model programmed in the Numerical Propulsion System Simulation (NPSS). The proposed methodology is intended to quantify the bias and random errors effects on different cycle parameters of interest, such as thrust, specific fuel consumption, among others. Each bias and random errors are determined by deliberately preventing the effects from other biases and random errors. The methodology presented in this paper can be extended to other cycle model comparisons. Moreover, the uncertainty figures derived in this work are recommended to be used in other model comparisons when no better reference is available.

New Series of Zaxinone Mimics (MiZax) for Fundamental and Applied Research.

The apocarotenoid zaxinone is a recently discovered regulatory metabolite required for proper rice growth and development. In addition, zaxinone and its two mimics (MiZax3 and MiZax5) were shown to have a remarkable growth-promoting activity on crops and a capability to reduce infestation by the root parasitic plant Striga through decreasing strigolactone (SL) production, suggesting their potential for application in agriculture and horticulture. In the present study, we developed a new series of MiZax via structural modification of the two potent zaxinone mimics (MiZax3 and MiZax5) and evaluated their effect on plant growth and Striga infestation. In general, the structural modifications to MiZax3 and MiZax5 did not additionally improve their overall performance but caused an increase in certain activities. In conclusion, MiZax5 and especially MiZax3 remain the likely most efficient zaxinone mimics for controlling Striga infestation.

Evaluation and Management of Blunt Head Trauma in the Pediatric Clinic.

Head injuries, and specifically blunt head trauma, are common among pediatric patients of all ages. Patients may present to their primary care provider, to urgent care, or to the emergency department after head trauma. Such injuries may occur as a result of a variety of mechanisms, including falls, motor vehicle collisions, or sports injuries. Clinical decision rules exist to help guide the clinician in the initial evaluation of head injury and in determining when head imaging may be indicated. One such guideline that is widely used in the United States is known as the PECARN (Pediatric Emergency Care Applied Research Network) criteria. Pediatricians should also evaluate for the presence of symptoms consistent with concussion that may occur as a result of blunt head trauma and be familiar with the management and sequelae of concussion and head injuries. [Pediatr Ann. 2023;52(8):e279-e281.].

Reduction of rejects by combining data from the casting process and automatic X-ray inspection

Automatic inspection of castings with X-rays (radiographic and computed tomography) is widespread for parts that are relevant for safety or have high quality requirements. Examples in the automotive sector are aluminum wheels, chassis parts and new parts within the electric power train. Those parts are automatically inspected, which means that both the image acquisition and the evaluation of the images is done fully automatically. Today, in most industrial implementations, the generated data with a size up to several gigabytes per part is summarized to a simple good or bad decision, according to specification. All other data is dismissed, although this information can be valuable to optimize production processes and thus minimize rejects. This contribution gives an overview about the results of the project Cast Control, which is a collaboration of Fraunhofer Development Center for X-ray Technology EZRT, Fraunhofer Center for Applied Research on Supply Chain Services SCS and industry partner RONAL GROUP. RONAL GROUP is a major aluminum wheel manufacturer, mainly for the OEM market. Within the project we combined serial production data from the low pressure die casting process from a foundry of the RONAL GROUP with the data generated in the automatic X-ray inspection. After collecting a large base of sample data, we were able train a neural network for the prediction of error metrics obtained by X-ray inspection. We apply a combination of layer-wise relevance propagation and dimensionality reduction to find correlations between data of the casting machines (process and sensor) and the characteristics of anomalies detected during X-ray inspection. With this information, it is possible to adjust the casting process in an early stage – even before rejects are produced. This enables the foundry to reduce their rejects rate, which saves costs and energy and results in a better competitivenessin a better competitiveness.

NICA Beamlines and Stations for Applied Research

NICA Beamlines and Stations for Applied Research