Global Imbalance Research Articles

Impella 5.0: An intermediate strategy for bridging a patient from infected durable LVAD to cardiac transplant

Cardiac transplant remains the gold-standard treatment for end-stage heart failure more than 50 years after the procedure was first pioneered. The number of transplant operations performed annually has been limited by the global imbalance of donor organs to recipients. This imbalance helped fuel the development of left ventricular assist devices (LVADs) first as a bridge to cardiac transplant and subsequently as destination therapy. Driveline infection is one of several problems that continue to plague LVADs through several generations of improvement. We present a patient with an infected LVAD driveline exit site that progressed to mediastinitis, pericardial and pump infection. The device was explanted, and the patient supported with an axillary Impella 5.0 as a bridge until the time of transplant. An Impella 5.0 (or 5.5) can be used as an intermediate tool to be able to explant an infected LVAD, with mediastinitis, allowing the patient to clear the infection, and prepare the patient for transplant free of infection. METHODS: The patient consented to the study and case report. The patient signed an informed consent and permission for publication.

THE USE OF NUTRITIONAL-ERGONOMIC STRATEGIES AND RECOMMENDATIONS AS FACTORS OF SUSTAINABLE NUTRITION IN THE WORKPLACE

Nutrition of the employee at work has a huge impact both on his health and labor productivity, and therefore on the financial well-being of the enterprise. But today it is wrong to limit ourselves to these factors. In today's world, it is impossible to separate human health or the well-being of an enterprise from the environmental component. Therefore the eco-consciousness and eco-choice of the worker, including in nutrition as well as carrying out the eco-policy at production is very important. The modern man spends a lot of time at work, so a healthy diet plays an important role for his health. Today healthy nutrition means ecologically conscious or in another way - sustainable. Sustainable healthy eating in the workplace should be seen as a comprehensive initiative. In today's global climate imbalance, it is nutrition awareness and sustainability that will not only improve health and business performance, but also have an impact on mitigating environmental problems. Awareness of sustainable diets and common dietary practices in the workplace are investigated. The impact of nutritional-ergonomic strategies on physical employment standards, workplace safety and productivity is analyzed. A contemporary approach to nutrition based on informed employer choices in the context of nutra-ergonomics adjusted for environmental sustainability is discussed, helping to optimize employee health and well-being. Recommendations for workplace nutrition interventions to normalize weight and improve employee health are discussed, taking into account the current requirements of the sustainability goals. Practical intra-ergonomic sustainable strategies and recommendations for employee workplace nutrition are offered. The company's eco-initiatives in sustainable nutrition for its employees help not only to show concern within the framework of production activities, but also increase the education of citizens in the issues of eco-sustainability in everyday life. This increases the eco-education of the individual, which creates conscious consumption and minimalist views in all areas of life, both for the employee and possibly for his or her environment - family and friends. Investing in nutrition in the workplace is a high return on investment for the employer, which can improve the health of workers, create comfortable working conditions, increase efficiency and productivity in the workplace. It is a direct pathway to achieving the United Nations Sustainable Development Goals (SDGs), in particular SDG 3 (good health and well-being), SDG 8 (decent work and economic growth), SDG 12 (responsible consumption and production).

Institution-wide shape analysis of 3D spinal curvature and global alignment parameters.

The spine is an articulated, 3D structure with 6 degrees of translational and rotational freedom. Clinical studies have shown spinal deformities are associated with pain and functional disability in both adult and pediatric populations. Clinical decision making relies on accurate characterization of the spinal deformity and monitoring of its progression over time. However, Cobb angle measurements are time-consuming, are limited by interobserver variability, and represent a simplified 2D view of a 3D structure. Instead, spine deformities can be described by 3D shape parameters, addressing the limitations of current measurement methods. To this end, we develop and validate a deep learning algorithm to automatically extract the vertebral midline (from the upper endplate of S1 to the lower endplate of C7) for frontal and lateral radiographs. Our results demonstrate robust performance across datasets and patient populations. Approximations of 3D spines are reconstructed from the unit normalized midline curves of 20,118 pairs of full spine radiographs belonging to 15,378 patients acquired at our institution between 2008 and 2020. The resulting 3D dataset is used to describe global imbalance parameters in the patient population and to build a statistical shape model to describe global spine shape variations in preoperative deformity patients via eight interpretable shape parameters. The developed method can identify patient subgroups with similar shape characteristics without relying on an existing shape classification system.

On the accuracy, robustness, and performance of high order interpolation schemes for the overset method on unstructured grids

AbstractA comprehensive study on interpolation schemes used in overset grid techniques is here presented. Based on a literature review, numerous schemes are implemented, and their robustness, accuracy, and performance are assessed. Two code verification exercises are performed for this purpose: a 2D analytical solution of a laminar Poiseuille steady flow; and an intricate manufactured solution of a turbulent flow case, characteristic of a boundary layer flow combined with an unsteady separation bubble. For both cases, the influence of grid layouts, grid refinement, and time‐step is investigated. Local and global errors, convergence orders, and mass imbalance are quantified. In terms of computational performance, strong scalability, cpu timings, load imbalancing, and domain connectivity information (DCI) overhead are reported. The effect of the overset‐grid interpolation schemes on the numerical performance of the solver, that is, number of nonlinear iterations, is also scrutinized. The results show that, for a second order finite volume code, once diffusion is dominant (low Reynolds number), interpolation schemes higher than second order, for example, least squares of degree 2, are needed not to increase the total discretization errors. For convection dominated flows (high Reynolds numbers), the results suggest that second order schemes, for example, nearest cell gradient, are sufficient to prevent overset grid schemes to taint the underlying discretization errors. In terms of performance, by single‐process and parallel communication optimization, the total overset‐grid overhead (with DCI done externally to the CFD code) may be less than 4% of the total run time for second‐order schemes and 8% for third‐order ones, therefore empowering higher‐order schemes and more accurate solutions.

Which Is More Predictive Value for Mechanical Complications: Fixed Thoracolumbar Alignment (T1 Pelvic Angle) Versus Dynamic Global Balance Parameter (Odontoid-Hip Axis Angle).

ObjectiveIn this study, we investigate about relationship between postoperative global sagittal imbalance and occurrence of mechanical complications after adult spinal deformity (ASD) surgery. In global sagittal balance parameters, odontoid-hip axis (OD-HA) angle and T1 pelvic angle (TPA) were analyzed. MethodsBetween January 2009 and December 2016, 199 consecutive patients (26 males and 173 females) with ASD underwent corrective fusion of more than 4 levels and were followed up for more than 2 years. Immediate postoperative and postoperative 2 years whole spine x-rays were checked for evaluating immediate postoperative OD-HA, TPA, and other parameters. In clinical outcomes, back and leg pain visual analogue scale, Scoliosis Research Society-22 spinal deformity questionnaire (SRS-22), Oswestry Disability Index (ODI), 36-item Short Form Health Survey (SF-36) were evaluated. ResultsBased on the occurrence of mechanical complications, a comparative analysis was performed for each parameter. In univariable analysis, mechanical complications were significantly much more occurred in OD-HA abnormal group (odds ratio [OR], 3.296; p<0.001; area under the curve [AUC]=0.645). In multivariable analysis, the result was much more related (OR, 2.924; p=0.001; AUC=0.727). In contrast, there was no significant difference between normal and the occurrence of mechanical complications in TPA. In clinical outcomes (normal vs. abnormal), the differences of SRS-22 (0.88±0.73 vs. 0.68±0.64, p=0.042), ODI (-24.72±20.16 vs. -19.01±19.95, p=0.046), SF-36 physical composite score (19.33±18.55 vs. 12.90±16.73, p=0.011) were significantly improved in OD-HA normal group. ConclusionThe goal of ASD surgery is to improve patient life quality through correction. In our study, TPA was associated with spinopelvic parameter and OD-HA angle was associated with health-related quality of life and complications. OD-HA angle is predictable factor for mechanical complications after ASD surgery.

Assessment of Feldstein’s ‘Global Imbalance'

This note is a systematic review of arguments provided by Feldstein (2008) on the necessity for global readjustments, both in the U.S. and in main trading partners. The purpose is to address the main arguments in the scientific and political debate on persistent To date, there has been no publication that challenged the opinions leading to totally wrong forecasts concerning the global imbalance. With a perspective of more than 10 years of post-2008-crisis developments, and together with empirical evidence one can easily see how erroneous were the arguments formulated in 2008. The tasks included a systematic review of all arguments formulated by Martin Feldstein in 2008, and casting them against empirical evidence. The U.S. current account (CA) deficit has continued for many years, since 1982, and has not changed, as foreseen by Feldstein. The primary method is a simple comparative analysis, supported by basic macroeconomic data. They allow to reveal multiple processes leading to further deterioration of the U.S. trade balance. Neither savings rate domestically nor abroad adjusted to give a basis for solving the global imbalance. In the same time, all traditional arguments presented on global imbalances seem undeniable. However, an alternative interpretation of the imbalance does not recognize the CA deficit as “a gift to the U.S. economy”. This paper sheds new light on the “global imbalance”, suggesting that increasing domestic absorption by China may be an important factor in resolving the U.S. problematic and persistent trade deficit. Disaster-scenarios may be not there in the U.S. to experience. Future developments may be far from those announced, and previously expected by Feldstein in his seminal paper. A careful reader may conclude that all coming changes and adjustments will be slow, gradual, and will not cause any major issues in the global economy. Such conclusions seem most justified by hard data and therefore encouraging. As the topic remains central to open economy empirical macroeconomics, continuation of studies on this issue seems natural. The U.S. and China will remain the biggest economies, and, as such, they are central to the global situation.

Multi-label sampling based on local label imbalance

Class imbalance is an inherent characteristic of multi-label data that hinders most multi-label learning methods. One efficient and flexible strategy to deal with this problem is to employ sampling techniques before training a multi-label learning model. Although existing multi-label sampling approaches alleviate the global imbalance of multi-label datasets, it is actually the imbalance level within the local neighbourhood of minority class examples that plays a key role in performance degradation. To address this issue, we propose a novel measure to assess the local label imbalance of multi-label datasets, as well as two multi-label sampling approaches, namely Multi-Label Synthetic Oversampling based on Local label imbalance (MLSOL) and Multi-Label Undersampling based on Local label imbalance (MLUL). By considering all informative labels, MLSOL creates more diverse and better labeled synthetic instances for difficult examples, while MLUL eliminates instances that are harmful to their local region. Experimental results on 13 multi-label datasets demonstrate the effectiveness of the proposed measure and sampling approaches for a variety of evaluation metrics, particularly in the case of an ensemble of classifiers trained on repeated samples of the original data.

Toward best practice in cancer mutation detection with whole-genome and whole-exome sequencing.

Clinical applications of precision oncology require accurate tests that can distinguish true cancer-specific mutations from errors introduced at each step of next-generation sequencing (NGS). To date, no bulk sequencing study has addressed the effects of cross-site reproducibility, nor the biological, technical and computational factors that influence variant identification. Here we report a systematic interrogation of somatic mutations in paired tumor-normal cell lines to identify factors affecting detection reproducibility and accuracy at six different centers. Using whole-genome sequencing (WGS) and whole-exome sequencing (WES), we evaluated the reproducibility of different sample types with varying input amount and tumor purity, and multiple library construction protocols, followed by processing with nine bioinformatics pipelines. We found that read coverage and callers affected both WGS and WES reproducibility, but WES performance was influenced by insert fragment size, genomic copy content and the global imbalance score (GIV; G > T/C > A). Finally, taking into account library preparation protocol, tumor content, read coverage and bioinformatics processes concomitantly, we recommend actionable practices to improve the reproducibility and accuracy of NGS experiments for cancer mutation detection.

A Review on Natural Fiber Reinforced Composites and its Applications.

Abstract: Natural fibers are gaining numerous attention due to their ecofriendly nature and sustainability. The problem of global warming and environmental imbalance is being faced throughout the world which needs to be resolved. The aim of this review paper is to give a comprehensive review about the natural fiber reinforced composites and its applications. It also explains about the various surface treatments and which are applied to the natural fibers and their effects on these fibers. The properties of natural fibers vary on various factor such as fiber type, fiber size, orientation, and its structure. Being various advantages of natural fiber reinforced composites there are some disadvantages also which are high moisture absorption, lower mechanical properties and lower fire resistance which limits the applications of natural fiber reinforced composites. Keywords: Natural fibers, composite materials, properties, applications.

Effect of swirl ratio on charge convection, temperature stratification, and combustion in gasoline compression ignition engine

Various low-temperature combustion strategies (namely, homogeneous charge compression ignition, reactivity controlled compression ignition, and partially premixed charge compression ignition) have shown the potential to comply with upcoming and prevailing stringent emissions legislations. Low octane gasoline has emerged as an ideal fuel candidate for premixed charge combustion under diesel-like conditions in gasoline compression ignition (GCI) engines. GCI is an excellent technology to rectify future global energy demand imbalance, because it aims to replace diesel (which is in short supply) with low octane fractions/naphtha (which is in surplus supply) in compression ignition engines. However, this novel combustion concept requires modifications in the conventional design of diesel engines. The combustion chamber shape and in-cylinder flows play a crucial role in charge distribution and temperature stratification. Therefore, understanding the combined effect of combustion chamber geometry and in-cylinder flows is essential for future engine designs. GCI combustion engine simulations for varying swirl ratios (SRs) were performed in CONVERGE CFD software to understand the effect of in-cylinder air motion on the mixture stratification and combustion. A 1/7th sector geometry for a conventional re-entry piston bowl was modeled and then simulated. Two different mechanisms were used for model validation. The results indicated that the large-scale flow structures govern the fuel distribution in the combustion chamber. The charge convection because of increased swirl has a substantial effect on the combustion characteristics of the engine. A distinguished ignition kernel was observed for all test cases. An interfacial region with counter-rotating vortices formed a lean mixture zone, hindering flame propagation and combustion. A lower SR, shallow depth piston, and modifications to avoid flame quenching in the squish zone need to be further investigated to optimize the engine performance.

Two Crises Separated by a Decade: Political Economy of Trade Strategy and Reserves Accumulation in East Asia

This article seeks to explore the relationship between the global financial crisis (2007–2009) and the East Asian crisis (1997–1999) via the contribution of select East Asian countries, which led to the formation of the ‘global imbalance’, that is, experience of substantial and consistent current account surplus. Taking a cue from Bernanke’s ‘savings glut’ hypothesis, which has held ‘global imbalance’ to be a factor behind the global financial crisis, specifically, the article argues that in these countries, the nature of current account balance has undergone a sea change since the end of the 1990s. They also accumulated a substantial amount of foreign exchange reserves since then along with a major shift of trade regime and consequent trade surplus in all these countries. The article conjectures that the mishandling of the rescue package by International Monetary Fund could have induced them to go aggressively for accumulation of forex reserves. Thus, the two crises separated by a decade and in different continents are, indeed, linked through providing an incentive for brewing up of global imbalance via an activist trade policy in select East Asian countries. Seen in this context and from this standpoint, the two crises, indeed, appear to be close siblings! JEL Codes: F41, F62, O53

Mitigating the impacts of COVID-19: where are the mental health trials?

Mitigating the impacts of COVID-19: where are the mental health trials?

Integrated Approach for Detecting Convection Effects in Geothermal Environments Based on TIR Camera Measurements

Thermal characterization of soils is essential for many applications, including design of geothermal systems. Traditional devices focus on the computation of thermal conductivity, omitting the analysis of the convection effect, which is important for horizontal geothermal systems. In this paper, a procedure based on the monitoring of the surface of the soil with a thermal infrared (TIR) camera is developed for the evaluation of the global thermal imbalance on the surface and in-depth. This procedure allows for the computation of thermal conductivity and global convection heat rate, consequently constituting a complete thermal characterization of the geothermal system. The validation of the results is performed through the evaluation of the radiometric calibration of the thermal infrared camera used for the monitoring and the comparison of the thermal conductivity values obtained in-depth, with traditional methods, and for the surface of the system.

The impact of data difficulty factors on classification of imbalanced and concept drifting data streams

Class imbalance introduces additional challenges when learning classifiers from concept drifting data streams. Most existing work focuses on designing new algorithms for dealing with the global imbalance ratio and does not consider other data complexities. Independent research on static imbalanced data has highlighted the influential role of local data difficulty factors such as minority class decomposition and presence of unsafe types of examples. Despite often being present in real-world data, the interactions between concept drifts and local data difficulty factors have not been investigated in concept drifting data streams yet. We thoroughly study the impact of such interactions on drifting imbalanced streams. For this purpose, we put forward a new categorization of concept drifts for class imbalanced problems. Through comprehensive experiments with synthetic and real data streams, we study the influence of concept drifts, global class imbalance, local data difficulty factors, and their combinations, on predictions of representative online classifiers. Experimental results reveal the high influence of new considered factors and their local drifts, as well as differences in existing classifiers’ reactions to such factors. Combinations of multiple factors are the most challenging for classifiers. Although existing classifiers are partially capable of coping with global class imbalance, new approaches are needed to address challenges posed by imbalanced data streams.

Health-related quality of life and sagittal balance at two to 25 years after posterior transfixation for high-grade dysplastic spondylolisthesis.

AimsHigh-grade dysplastic spondylolisthesis is a disabling disorder for which many different operative techniques have been described. The aim of this study is to evaluate Scoliosis Research Society 22-item (SRS-22r) scores, global balance, and regional spino-pelvic alignment from two to 25 years after surgery for high-grade dysplastic spondylolisthesis using an all-posterior partial reduction, transfixation technique.MethodsSRS-22r and full-spine lateral radiographs were collected for the 28 young patients (age 13.4 years (SD 2.6) who underwent surgery for high-grade dysplastic spondylolisthesis in our centre (Scottish National Spinal Deformity Service) between 1995 and 2018. The mean follow-up was nine years (2 to 25), and one patient was lost to follow-up. The standard surgical technique was an all-posterior, partial reduction, and S1 to L5 transfixation screw technique without direct decompression. Parameters for segmental (slip percentage, Dubousset’s lumbosacral angle) and regional alignment (pelvic tilt, sacral slope, L5 incidence, lumbar lordosis, and thoracic kyphosis) and global balance (T1 spino-pelvic inclination) were measured. SRS-22r scores were compared between patients with a balanced and unbalanced pelvis at final follow-up.ResultsSRS-22r domain and total scores improved significantly from preoperative to final follow-up, except for the mental health domain that remained the same. Slip percentage improved from 75% (SD 15) to 48% (SD 19) and lumbosacral angle from 70° (SD 11) to 101° (SD 11). Preoperatively, 35% had global imbalance, and at follow-up all were balanced. Preoperatively, 63% had an unbalanced pelvis, and at final follow-up this was 32%. SRS-22r scores were not different in patients with a balanced or unbalanced pelvis. However, postoperative pelvic imbalance as measured by L5 incidence was associated with lower SRS-22r self-image and total scores (p = 0.029).ConclusionIn young patients with HGDS, partial reduction and transfixation improves local lumbosacral alignment, restores pelvic, and global balance and provides satisfactory long-term clinical outcomes. Higher SRS-22r self-image and total scores were observed in the patients that had a balanced pelvis (L5I < 60°) at two to 25 years follow-up.Cite this article: Bone Jt Open 2021;2(3):163–173.

Partial Resection of Spinous Process for the Elderly Patients with Thoraco-Lumbar Kyphosis: Technical Report.

Background and objectives: Global sagittal imbalance with lumbar hypo-lordosis can cause low back pain (LBP) during standing and/or walking. This condition has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations. Decrease in disc space of anterior elements and an increase in the spinous process height of posterior elements may both contribute to the decrease in lordosis of the lumbar spine. To correct the sagittal imbalance, the mainstream option is still a highly invasive surgery, such as long-segment fusion with posterior wedge osteotomy. Therefore, we developed a treatment that is partial resection of several spinous processes of thoraco-lumbar spine (PRSP) and lumbar extension exercise to improve the flexibility of the spine as postoperative rehabilitation. Materials and Methods: Consecutively, seven patients with over 60 mm of sagittal vertical axis (SVA) underwent PRSP. The operation was performed with several small midline skin incisions under general anesthesia. After splitting the supraspinous ligaments, the cranial or caudal tip of the spinous process of several thoraco-lumbar spines was removed, and postoperative rehabilitation was followed to improve extension flexibility. Results: The average follow-up period was 13.0 months. The average blood loss and operation time were 11.4 mL and 47.4 min, respectively. The mean SVA improved from 119 to 93 mm but deteriorated in one case. The mean numerical rating scale of low back pain improved from 6.6 to 3.7 without any exacerbations. The mean Oswestry Disability Index score was improved from 32.4% to 19.1% in six cases, with one worsened case. Conclusions: We performed PRSP and lumbar extension exercise for the patients with LBP due to lumbar kyphosis. This minimally invasive treatment was considered to be effective in improving the symptoms of low back pain and HRQOL, especially of elderly patients with lumbar kyphosis.

TDP-43 aggregation induced by oxidative stress causes global mitochondrial imbalance in ALS.

Amyotrophic lateral sclerosis (ALS) was initially thought to be associated with oxidative stress when it was first linked to mutant superoxide dismutase 1 (SOD1). The subsequent discovery of ALS-linked genes functioning in RNA processing and proteostasis raised the question of how different biological pathways converge to cause the disease. Both familial and sporadic ALS are characterized by the aggregation of the essential DNA- and RNA-binding protein TDP-43, suggesting a central role in ALS etiology. Here we report that TDP-43 aggregation in neuronal cells of mouse and human origin causes sensitivity to oxidative stress. Aggregated TDP-43 sequesters specific microRNAs (miRNAs) and proteins, leading to increased levels of some proteins while functionally depleting others. Many of those functionally perturbed gene products are nuclear-genome-encoded mitochondrial proteins, and their dysregulation causes a global mitochondrial imbalance that augments oxidative stress. We propose that this stress-aggregation cycle may underlie ALS onset and progression.

РЕГУЛИРОВАНИЕ МОРСКИХ КОНТЕЙНЕРНЫХ ПЕРЕВОЗОК В ПЕРИОД ПАНДЕМИИ

This article is about the spread of the coronavirus infection COVID-19 and its consequences for intermodal transportation. As a result of the analysis, it was found that the most serious problem is the lack of empty containers and the global trade imbalance.

Barriers and drivers of the global imbalance of wind energy diffusion: A meta-analysis from a wind power Original Equipment Manufacturer perspective

Significant progress has been made globally in the transition towards a sustainable society. Since 2007, the annual investment in renewable energy exceeded the combined investment in fossil and nuclear energy. However, for many developing countries, the balance is still in favour of conventional energy. The purpose of this paper is to understand the barriers and drivers of the global imbalance in wind energy diffusion in developing countries through a systematic literature review and meta-analysis. Furthermore, it highlights the different viewpoints the literature has to offer, with the aim of understanding wind power growth from an Original Equipment Manufacturer (OEM) point of view. This is important as the sales of wind turbines are the practical building blocks of the transition towards a sustainable society. 259 factors influencing wind energy diffusion were identified and clustered into 8 categories: economic, environmental, technical potential, technological, social, regulatory, political and also an amalgam of other factors. Policymakers formed the most frequently used viewpoint, no study addressed the OEM perspective specifically. A novel closed-loop feedback system was proposed as a conceptual framework to categorize factors influencing wind energy diffusion into two types: factors related to the desire for wind energy and factors related to the mechanism for this change. This paper shows indications that economic factors are of key importance in emerging and developing countries, whereas environmental factors are not driving wind energy growth, contrary to expectations. OEM managers might consider the rebranding of wind turbine technology from “green technology” to “job-creating technology” to increase sales and stimulate a transition to a more sustainable society in many emerging and developing markets. • 259 factors influencing wind energy diffusion were found in the literature review. • Point of view of policy makers most popular, OEM perspective missing. • Novel closed-loop feedback system was developed to understand wind diffusion. • Economic drivers dominant for emerging countries, not for advanced countries. • OEM implications: economic factors drive sustainable transition emerging countries.

Prone Transpsoas Approach for Adjacent Segment Disease and Flatback Deformity: Technical Note and Case Report

The prone transpsoas approach is a relatively new technique to correct segmental kyphosis and global sagittal imbalance in a minimally invasive fashion. Here, we provide a detailed case report using the prone transpsoas approach to address adjacent segment disease and flatback deformity. This technique allows considerable restoration of segmental lordosis with lateral interbody placement and posterior decompression and fusion using a single position approach. Our experience with the surgical technique and the advantages and challenges unique to this approach are discussed.