Entire Bundle Research Articles

Direct visualization of microwires in hybrid depth electrodes using high-resolution photon-counting CT.

Hybrid depth electrodes are increasingly being used for epilepsy monitoring and human neurophysiology research. Microwires extending from the tip of the Behnke-Fried (BF) electrode into (sub)cortical areas allow to isolate single neurons and perform microstimulation. Conventional CT or MRI visualize the entire microwire bundle as an artifact extending from the BF electrode tip with low resolution, without proper identification of individual microwires. We illustrate the first direct visualization method of individual microwires using high-resolution photon-counting CT (PCCT). Coregistration of the PCCT scan with a preoperative MRI can visualize individual wires directly in cortex, which is an advantage as it provides feedback on the accuracy of the implantation method and can guide future implantations. This PCCT technique allows for accurately depicting individual microwires which could be relevant for neuroscientific research through improved visualization and implantation of specific cortical and subcortical brain areas. PLAIN LANGUAGE SUMMARY: Researchers are using hybrid depth electrodes to study epilepsy and brain activity. These electrodes, called Behnke-Fried (BF) electrodes, have microwires at the tip that can record single neurons and stimulate brain areas. Regular CT or MRI scans do not show the individual microwires clearly. The authors use a new high-resolution photon-counting CT (PCCT) technique, which can show each individual microwire in the brain. By combining PCCT with MRI, the authors can precisely see where the microwires are located. This could improve future implantation surgeries and brain research.

White matter microstructure damage measured by automated fiber quantification correlates with pain symptoms in lung cancer patients.

To investigative the white matter (WM) alterations in lung cancer patients with cancer pain (CP+), and explore the correlations between damaged WM fiber tracts and clinical indicators. Twenty-six CP+, 26 lung cancer patients without CP (CP-), and 31 healthy controls (HC) were recruited. All participants underwent diffusion tensor imaging (DTI) and clinical assessments. Automated fiber quantification (AFQ) technique was performed to identify the 20 WM fiber bundles, and the fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were extracted. Intergroup comparisons of these diffusion metrics were conducted based on the entire fiber bundle level and 100 node levels along each tract. The associations between altered diffusion metrics and the numeric rating scale (NRS) scores, as well as the pain duration, were analyzed. At the entire level, the CP + group showed impaired WM structure in the right cingulum hippocampus (CH_R). At the pointwise level, the CP + group exhibited extensive nodal FA reduction or MD, RD, and AD elevation. In addition, the AD of the posterior portion of the right inferior longitudinal fasciculus (ILF_R, nodes 71-75) in the CP + group was positively correlated with the pain duration, and the FA of CH_R (nodes 22-38) was negatively correlated with NRS score. Extensive WM microstructural damage may be a pattern of brain abnormalities in lung cancer patients with CP, and in particular, specific nodal disruption along pain-related fiber tracts may be a sensitive imaging biomarker to characterize the severity and duration of CP.

Creating an Efficient Public–Private Partnership Bundle: An Empirical Study

Public–Private Partnerships have been implemented globally as a key procurement strategy for addressing the issue of funding gaps amidst the immense pressure to deliver new major infrastructure projects. However, in current practice, procurement selection is applied to the entire bundle of project activities. This often leads to unduly large bundles of externalized project activities that create unduly large PPP contracts and attempt to transfer too much risk. To address this gap, this paper presents the development and testing of an implementable model that embodies a range of microeconomic theories—namely, transaction cost and resource-based theories—and property rights theory. This paper presents the first empirical testing of this model based on two road and two health projects, using competition as an independent measure of the validity of the recommended procurement strategy. The results provide compelling evidence that a rigorous application of the model will enable a substantial improvement of existing procurement approaches, such as identifying the most suitable bundle to be procured using a PPP approach.

Fixel-Based Analysis Reveals Tau-Related White Matter Changes in Early Stages of Alzheimer's Disease.

Several studies have shown white matter (WM) abnormalities in Alzheimer's disease (AD) using diffusion tensor imaging (DTI). Nonetheless, robust characterization of WM changes has been challenging due to the methodological limitations of DTI. We applied fixel-based analyses (FBA) to examine microscopic differences in fiber density (FD) and macroscopic changes in fiber cross-section (FC) in early stages of AD (N = 393, 212 females). FBA was also compared with DTI, free-water corrected (FW)-DTI and diffusion kurtosis imaging (DKI). We further investigated the correlation of FBA and tensor-derived metrics with AD pathology and cognition. FBA metrics were decreased in the entire cingulum bundle, uncinate fasciculus and anterior thalamic radiations in Aβ-positive patients with mild cognitive impairment compared to control groups. Metrics derived from DKI, and FW-DTI showed similar alterations whereas WM degeneration detected by DTI was more widespread. Tau-PET uptake in medial temporal regions was only correlated with reduced FC mainly in the parahippocampal cingulum in Aβ-positive individuals. This tau-related WM alteration was also associated with impaired memory. Despite the spatially extensive between-group differences in DTI-metrics, the link between WM and tau aggregation was only revealed using FBA metrics implying high sensitivity but low specificity of DTI-based measures in identifying subtle tau-related WM degeneration. No relationship was found between amyloid load and any diffusion-MRI measures. Our results indicate that early tau-related WM alterations in AD are due to macrostructural changes specifically captured by FBA metrics. Thus, future studies assessing the effects of AD pathology in WM tracts should consider using FBA metrics.

Impact of Selective Posterior Cruciate Ligament Fiber Release on Femoral Rollback in Cruciate-Retaining Total Knee Arthroplasty: A Computational Study

BackgroundPartial or total release of the posterior cruciate ligament (PCL) is often performed intraoperatively in cruciate-retaining total knee arthroplasty (CR-TKA) to alleviate excessive femoral rollback. However, the effect of the release of selected fibers of the PCL on femoral rollback in CR-TKA is not well understood. Therefore, we used a computational model to quantify the effect of selective PCL fiber releases on femoral rollback in CR-TKA. MethodsComputational models of 9 cadaveric knees (age: 63 years, range 47 to 79) were virtually implanted with a CR-TKA. Passive flexion was simulated with the PCL retained and after serially releasing each individual fiber of the PCL, starting with the one located most anteriorly and laterally on the femoral notch and finishing with the one located most posteriorly on the medial femoral condyle. The experiment was repeated after releasing only the central PCL fiber. The femoral rollback of each condyle was defined as the anterior-posterior distance between tibiofemoral contact points at 0° and 90° of flexion. ResultsRelease of the central PCL fiber in combination with the anterolateral (AL) fibers, reduced femoral rollback a median of 1.5 [0.8, 2.1] mm (P = .01) medially and by 2.0 [1.2, 2.5] mm (P = .04) laterally. Releasing the central fiber alone reduced the rollback by 0.7 [0.4, 1.1] mm (P < .01) medially and by 1.0 [0.5, 1.1] mm (P < .01) laterally, accounting for 47 and 50% of the reduction when released in combination with the AL fibers. ConclusionsReleasing the central fibers of the PCL had the largest impact on reducing femoral rollback, either alone or in combination with the release of the entire AL bundle. Thus, our findings provide clinical guidance regarding the regions of the PCL that surgeons should target to reduce femoral rollback in CR-TKA.

Posterolateral Bundle Resection for an Anterior Cruciate Ligament Ganglion Cyst

The incidence of intra-articular ganglion cysts of the anterior cruciate ligament (ACL) is low and symptomatic presentation of this pathology is even lower. Nevertheless, symptomatic cases pose a real challenge for the orthopaedic community, as no general consensus exists regarding the most appropriate treatment. The purpose of this Technical Note is to describe the surgical treatment of an ACL ganglion cyst by arthroscopic resection of the entire posterolateral bundle of the ACL in a figure-of-four position after conservative treatment has failed.

Segmental Abnormalities of White Matter Microstructure in Primary Hypothyroidism Identified by Automated Fiber Quantification

Introduction: Hypothyroidism leads to impaired white matter (WM) integrity, associated with cognitive/neuropsychiatric dysfunction. However, the specific segmental abnormalities of the fibers remain unexplored. Therefore, this study aimed to investigate whether the damage of the WM is limited to a specific segment or the entire bundle via diffusion metrics using automated fiber quantification. Methods: A cross-sectional study was conducted on 31 hypothyroid patients and 28 healthy controls. Thyroid-related hormone levels, cognitive/neuropsychiatric function, and diffusion tensor image data were collected and analyzed. Correlation and random forest analyses were also performed. Results: The mean fractional anisotropy (FA) values were reduced at the fiber tract level. The mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) values were increased in several fiber tracts, i.e., cingulum cingulate (CC), anterior forceps of corpus callosum (CCF_A). Significant correlations were found between cognitive function and diffusion indicators such as the FA value of the left corticospinal tract and arcuate fasciculus (AF), the MD value of left CC, the RD value of left AF, the AD value of left CC, and CCF_A. The widespread microstructure disruption was spread on multiple specific segments of different tracts at the point-wise level. The random forest revealed that the accuracy of recognizing hypothyroid patients was 82.5%, with the anterior component of CCF_A having the most significant contribution. Conclusion: WM microstructural integrity impairments were found in multi-segments of the multiple fiber bundles in hypothyroidism, which might be a potential mechanism of the underlying neurocognitive decline and cerebral impairment. The CCF_A might serve as a neuro biomarker for early warning of cerebral impairment in hypothyroidism.

Rebel Resource Efficiency and the Escalation of Civil Conflict

Abstract What explains the ebbs and flows of government–rebel battles during civil conflict? We posit that rebels, as actors dissatisfied with the status quo, challenge the government when they can sustain fighting and absorb losses on the battlefield. This is possible when the group's resource base is stable and unlikely to be undermined by market forces, government action, or external interveners. If, however, rebel portfolios are extraordinarily profitable, rebels will focus on profiting from their investments, making the escalation of armed conflict less likely. Using a measure that captures the efficiency of rebel resource portfolios and two illustrative cases, we find evidence for this curvilinear relationship: conflicts escalate as resource portfolio efficiency increases but de-escalate slightly when portfolios are very efficient. Thus, the decision to escalate a conflict is revealed to be a function of the entire bundle of resources controlled by rebels and the market value of those resources. By accounting for the entirety of rebel resource portfolios, this study refines the insurgent–resource nexus, leading to a better understanding of civil conflict dynamics.

Current Mode Proportional Resonant Controlled DC Micro Grid System with Enhanced Response

Closed-loop DC Micro-Grid containing sustainable power sources, stockpiling components and burdens are introduced. The regulators for helping the control of mico-grid are numerous in the power-frameworks, yet the most normally utilized one is PI regulator. Aside from PI there are, an entire bundle of independent regulators and hybrid regulators that can serve significantly better compared to PI for microgrid framework relevance’s. Closed-loop DC microgrid framework system with FOPID-FOPID (Fractional-order-Proportional-Integral Derivative controller) and PR—PR (Proportional-Resonant Controller) based DCMG structures are investigated and re-enacted utilizing Simulink in MATLAB and their outcomes are introduced. After re-enactment analyses, some preliminary eventual outcomes of FOPID-FOPID and PR-PR controlled DCMG framework are given to actually look at the sufficiency of the proposed framework.

Effect of Packing Nonuniformity at the Fiber Bundle-Case Interface on Performance of Hollow Fiber Membrane Gas Separation Modules.

High-fidelity simulations of momentum and mass transfer within a hollow fiber gas separation membrane module are here reported. The simulations capture the potential detrimental effects of poor fiber packing at the bundle-case interface on fluid distribution and performance. Results are presented for both circular and planar fiber bundles. The length over which bundle-case gaps affects flow is determined. The length increases dramatically with increasing fiber packing fraction. As the packing fraction approaches 0.6, the impact extends over the entire bundle diameter for small modules (&lt;1000 fibers). The results clearly demonstrate the detrimental effect of poor packing along the case and can be used to develop module manufacturing guidelines. To reduce computational costs, an equivalent planar bundle module approximation is developed. The approximate simulations agree well with results from full 3-D simulations and can reduce computational costs without sacrificing fidelity.

Serial Rules in a Multi-Unit Shapley-Scarf Market

We study generalized Shapley-Scarf exchange markets where each agent is endowed with multiple units of an indivisible and agent-specific good and monetary compensations are not possible. An outcome is given by a circulation which consists of a balanced exchange of goods. We focus on circulation rules that only require as input ordinal preference rankings of individual goods, and agents are assumed to have responsive preferences over bundles of goods. We study the properties of serial dictatorship rules which allow agents to choose either a single good or an entire bundle sequentially, according to a fixed ordering of the agents. We also introduce and explore extensions of these serial dictatorship rules that ensure individual rationality. The paper analyzes the normative and incentive properties of these four families of serial dictatorships and also shows that the individually rational extensions can be implemented with efficient graph algorithms.

Development of a Modular Tissue Phantom for Evaluating Vascular Access Devices.

Central vascular access (CVA) may be critical for trauma care and stabilizing the casualty. However, it requires skilled personnel, often unavailable during remote medical situations and combat casualty care scenarios. Automated CVA medical devices have the potential to make life-saving therapeutics available in these resource-limited scenarios, but they must be properly designed. Unfortunately, currently available tissue phantoms are inadequate for this use, resulting in delayed product development. Here, we present a tissue phantom that is modular in design, allowing for adjustable flow rate, circulating fluid pressure, vessel diameter, and vessel positions. The phantom consists of a gelatin cast using a 3D-printed mold with inserts representing vessels and bone locations. These removable inserts allow for tubing insertion which can mimic normal and hypovolemic flow, as well as pressure and vessel diameters. Trauma to the vessel wall is assessed using quantification of leak rates from the tubing after removal from the model. Lastly, the phantom can be adjusted to swine or human anatomy, including modeling the entire neurovascular bundle. Overall, this model can better recreate severe hypovolemic trauma cases and subject variability than commercial CVA trainers and may potentially accelerate automated CVA device development.

The relationship between headline, core, and energy inflation: A wavelet investigation

This paper investigates if core inflation, the measure of price growth obtained excluding the more volatile items such as energy and food prices, is a good approximation of headline inflation that considers the entire bundle. Starting from the mid-90s, our answer is negative. From a monetary policy perspective, this raises the issue of whether controlling core inflation is still useful to anchor medium-run inflation. Using the wavelet methodology, our analysis suggests that starting from the end of the 90s core inflation is weakly correlated with headline inflation especially at the lower frequencies. Energy inflation is strongly correlated with headline inflation at a broad range of frequencies, casting doubt on its exclusion from a trend inflation measure.

Implementation of the ABCDEF Bundle for Critically Ill ICU Patients During the COVID-19 Pandemic: A Multi-National 1-Day Point Prevalence Study.

Background: Data regarding delivery of evidence-based care to critically ill patients in Intensive Care Units (ICU) during the COVID-19 pandemic is crucial but lacking. This study aimed to evaluate the implementation rate of the ABCDEF bundle, which is a collection of six evidence-based ICU care initiatives which are strongly recommended to be incorporated into clinical practice, and ICU diaries for patients with and without COVID-19 infections in ICUs, and to analyze the impact of COVID-19 on implementation of each element of the bundle and independent associated factors.Methods: A world-wide 1-day point prevalence study investigated the delivery of the ABCDEF bundle and ICU diary to patients without or with COVID-19 infections on 27 January 2021 via an online questionnaire. Multivariable logistic regression analysis with adjustment for patient demographics evaluated the impact of COVID-19 and identified factors in ICU administrative structures and policies independently associated with delivery.Results: From 54 countries and 135 ICUs, 1,229 patients were eligible, and 607 (49%) had COVID-19 infections. Implementation rates were: entire bundle (without COVID-19: 0% and with COVID-19: 1%), Element A (regular pain assessment: 64 and 55%), Element B (both spontaneous awakening and breathing trials: 17 and 10%), Element C (regular sedation assessment: 45 and 61%), Element D (regular delirium assessment: 39 and 35%), Element E (exercise: 22 and 25%), Element F (family engagement/empowerment: 16 and 30%), and ICU diary (17 and 21%). The presence of COVID-19 was not associated with failure to implement individual elements. Independently associated factors for each element in common between the two groups included presence of a specific written protocol, application of a target/goal, and tele-ICU management. A lower income status country and a 3:1 nurse-patient ratio were significantly associated with non-implementation of elements A, C, and D, while a lower income status country was also associated with implementation of element F.Conclusions: Regardless of COVID-19 infection status, implementation rates for the ABCDEF bundle, for each element individually and an ICU diary were extremely low for patients without and with COVID-19 infections during the pandemic. Strategies to facilitate implementation of and adherence to the complete ABCDEF bundle should be optimized and addressed based on unit-specific barriers and facilitators.

Oblique circle method for measuring the curvature and twist of mitotic spindle microtubule bundles

The highly ordered spatial organization of microtubule bundles in the mitotic spindle is crucial for its proper functioning. The recent discovery of twisted shapes of microtubule bundles and spindle chirality suggests that the bundles extend along curved paths in three dimensions, rather than being confined to a plane. This, in turn, implies that rotational forces, i.e., torques, exist in the spindle in addition to the widely studied linear forces. However, studies of spindle architecture and forces are impeded by a lack of a robust method for the geometric quantification of microtubule bundles in the spindle. In this work, we describe a simple method for measuring and evaluating the shapes of microtubule bundles by characterizing them in terms of their curvature and twist. By using confocal microscopy, we obtain three-dimensional images of spindles, which allows us to trace the entire microtubule bundle. For each traced bundle, we first fit a plane and then fit a circle lying in that plane. With this robust method, we extract the curvature and twist, which represent the geometric information characteristic for each bundle. As the bundle shapes reflect the forces within them, this method is valuable for the understanding of forces that act on chromosomes during mitosis.

Impact of ABCDE Bundle Implementation in the Intensive Care Unit on Specific Patient Costs.

To measure the impact of full versus partial ABCDE bundle implementation on specific cost centers and related resource utilization. Retrospective cohort study. Two medical ICUs within Montefiore Health System (Bronx, NY). Four hundred and seventy-two mechanically ventilated patients admitted to the medical ICUs during a hospitalization which began and ended between January 1, 2013 and December 31, 2013. The full (A)wakening, (B)reathing, (C)oordination, (D)elirium Monitoring/Management and (E)arly Mobilization bundle was implemented in the intervention ICU while a portion of the bundle (A, B, and D components) was implemented in the comparison ICU. Relative to the comparison ICU, implementation of the entire bundle in the intervention ICU was associated with a 27.3% (95% CI: 9.9%, 41.3%; P = 0.004) decrease in total hospital laboratory costs and a 2,888.6% (95% CI: 77.9%, 50,113.2%; P = 0.018) increase in total hospital physical therapy costs. Cost of total hospital medications, diagnostic radiology and respiratory therapy were unchanged. Relative to the comparison ICU, total hospital resource use decreased in the intervention ICU (incidence rate ratio [95% CI], laboratory: 0.68 [0.54, 0.87], P = 0.002; diagnostic radiology: 0.75 [0.59, 0.96], P = 0.020). Full ABCDE bundle implementation resulted in a decrease in total hospital laboratory costs and total hospital laboratory and diagnostic resource utilization while leading to an increase in physical therapy costs.

Determinants of willingness to pay for traditional bundles: a study from India

PurposeThe present research aims to identify critical antecedents of willingness to pay (WTP) for traditional bundles (those comprising only goods or services) in an emerging market context. Further, it differentiates the relative importance of the determinants of customers' WTP according to the bundle type.Design/methodology/approachData were collected from Indian customers. The paper uses conjoint analysis with an orthogonal design. The experimental conditions were manipulated using vignettes.FindingsThe results indicated that purchase autonomy was considered the most important driver for customer's WTP in the case of traditional bundles. Quality variability, overall bundle quality and complementarity followed autonomy in the order of importance. Moreover, the interaction effects of autonomy and complementarity with bundle type significantly influenced the customer's WTP. Customers had a higher WTP for services bundle in high autonomy and goods bundle in high complementarity situations.Practical implicationsRetailers should allow customers to buy either the entire bundle or its components separately, irrespective of the type of traditional bundle. They should try to make bundles whose perceived quality varies significantly in the target customers. Retailers should try to keep complementary components in the goods-only bundle.Originality/valueThe present study extends the relationship of the WTP with its antecedents to traditional bundles. Earlier studies have only studied these relationships for hybrid (combination of goods and services) bundles. With the current study results, retailers can bundle traditional bundles (goods only and services only).

Reducing central catheter-associated infections in pediatric surgery clinic: Implementation of a care bundle

Purpose: Central line care bundle comprises a few evidence-based interventions for improving patients' outcomes and recovery process. This semi-experimental study aimed to determine the effect of pediatric central line care bundle implementation on central line-associated bloodstream infections (CLABSI) rates. Materials and methods: A central line care bundle was implemented for pediatric surgery patients (n=70). Baseline observations were made to determine the central line care bundle compliance of healthcare professionals for 435 catheter days. Subsequently, physicians and nurses were educated about the central line care bundle. After the implementation period, 722 catheter days were observed to determine post-implementation compliance. Baseline CLABSI rates were compared with post-implementation CLABSI rates. Results: It was found that the entire central line care bundle compliance was 32.4% pre-implementation and 86.3% post-implementation. After education, the physicians' and nurses' central line care bundle compliance showed statistically significant improvement (p= 0.0001). There were five CLABSI events in the pre-implementation period and three CLABSI events in the post-implementation period. It was determined that the number of CLABSI decreased in the post-implementation period compared to the pre-implementation period, but this difference was not statistically significant (p= 0.207). Conclusions: Central line care bundle implementation decreased the CLABSI rates. It is recommended the Implementation of a central line care bundle on the care of pediatric surgery patients with the central venous catheter.

Language Mixing as a Persuasive Strategy in Oxford, MS Bodley 649

One of the salient features of Oxford, MS Bodley 649, a fifteenth-century sermon collection, is its frequent switching from Latin to English – and back to Latin again. Building on Wenzel’s (1994) groundbreaking work on macaronic sermons, I discuss the rhetorical characteristics of English elements in MS Bodley 649, with the purpose of showing that language mixing in this collection is not random but rather one of the rhetorical devices that the author uses for persuasion. The English elements are frequently used to build grammatical cohesion through structural parallelism. Also, lexical and semantic cohesion are achieved via repetition of the same words in both languages or through English paraphrases of Latin scriptural content. Alliteration, another rhetorical device, often coincides with language switches within the sermons. I hope to show that, together with other rhetorical strategies, mixing English into Latin constitutes one means within an entire bundle of linguistic devices that all contribute to the persuasive purpose of the genre. As a preliminary finding of some work in progress, I report on the nature of the English words mixed into these highly scholastic and often allegorical sermons. The English elements within the sermons tend to provide content that is mundane, or objectionable (from the point of view of Christian conduct and goals), or even merely negative (if not repulsive). An important conclusion is that none of the rhetorical strategies that overlap with code-switching into English are used mechanically and systematically by the sermonist; the coincidence of the bundled persuasive features is never predictable. However, this does not mean that mixing English elements into Latin in MS Bodley 649 should be characterized as random. A persuasive sermon is not tamely predictable in its delivery; it must offer surprises as audience-engagement strategies. The most salient surprises in MS Bodley 649 are provided by the English elements.

Energy Method to Compute the Maximum Amplitudes of Oscillation Due to Galloping of Iced Bundled Conductors

The paper presents a modal model to describe the interaction between a 4-conductor bundle and wind. A finite-element model of the bundle is used to perform a linear analysis, to extract mode shapes and natural frequencies of the system. The motion of the expanded bundle is then described through mode coordinates representing the first horizontal, vertical and torsional modes. Wind tunnel tests were performed adding templates over the cables to mimic the presence of ice over the same conductor bundle; tests allowed to characterize the aerodynamic coefficients of the entire bundle and provided data for the model validation. The model was then applied to a case study to predict the maximum oscillations produced by iced conductor galloping. Time-domain simulations were used for the purpose, together with an alternative approach named energy method; this last directly estimates the amplitude of limit cycles avoiding the integration of the equations of motion and can be much more useful from the engineering point of view.