Regular Case Research Articles

1312. Division Divided: Using Debate as an Educational Tool to Teach Evidence-Based Clinical Decision-Making

BackgroundIn medical education, there has been a push to implement innovative teaching techniques that encourage critical thinking rather than just knowledge dissemination. Debate promotes critical thinking by challenging individuals to consider alternate viewpoints, which could make it an ideal format to review the evidence relevant to common clinical dilemmas in infectious diseases (ID). We describe a pilot of one such debate format in our ID fellowship program.MethodsWe reviewed literature regarding the effectiveness of ceftriaxone for outpatient antibiotic therapy (OPAT) in methicillin-susceptible Staphylococcus aureus (MSSA) osteoarticular infections. The evidence was presented as a structured debate in place of our weekly case conference. Pre- and post-session surveys containing multiple choice questions and Likert items were administered to assess the impact of the debate on attendees’ knowledge, attitudes, and practices on this topic along with their attitudes toward the debate format. Differences between pre- and post-session surveys were analyzed using paired t-tests and McNemar’s test.ResultsAt the first debate 33 residents, fellows, and faculty members were present, and 24 (73%) completed both the pre- and post-session surveys. Attendees demonstrated significant improvement between the pre- and post-session knowledge questions, which covered the following topics: study design of articles supporting ceftriaxone use (31% vs. 62%, P = 0.008), appropriate method to assess ceftriaxone susceptibility (64% vs. 100%, P = 0.004), and whether the inoculum effect applies to ceftriaxone (35% vs. 77%, P = 0.003). After the debate, attendees were more willing to use ceftriaxone (P = 0.001) and felt more familiar with the literature (P < 0.001). The post-session survey showed that individuals both enjoyed the format and found it effective (Figure 1). Most individuals stated that they were either extremely likely (85%) or likely (8%) to attend if this format was used again. Written comments included “strongly recommend continuing this format” and “much better than regular case conference with more discussion and critical thinking.”ConclusionDebate appears to be an effective and enjoyable format to teach clinical controversies in ID.Figure 1.Disclosures All authors: No reported disclosures.

To compute or not to compute?

In a previous paper “to retrofit or not to retrofit?” (Nuti and Vanzi, 2003) a straightforward procedure able to forecast the economic return of seismic structural upgrading was presented. More recently, the authors realized that the final mathematical results can be much simplified so as to allow back-of-an-envelope computation. The title of this paper tries to highlight precisely this aspect, namely that for many a regular seismic structural upgrading cases, nearly no computation is needed (apart from one subtraction and one multiplication) to assess their economic convenience. These findings are presented and discussed in this paper, together with a state of the art on the cost-studies available in literature and technical codes. The mathematical formulation leading to the proposed approximation is suitably explained, underlining its applicability field and comparing it with the rigorous solution. Also a table and a formula are furnished that alternatively allows to calculate the maximum estimation errors, in order to obtain an upper and lower bound for the maximum amount of money which should be allocated for seismic structural upgrading. Finally an application example is described, dealing with retrofitting of reinforced concrete viaducts, a widespread bridge typology in Italy. The adopted upgrading solution consists of a concrete jacket at the base of some piers, particularly suitable in order to increase their ductility.

Cohomological tautness of singular Riemannian foliations

For a Riemannian foliation {mathcal {F}} on a compact manifold M, J. A. Álvarez López proved that the geometrical tautness of {mathcal {F}}, that is, the existence of a Riemannian metric making all the leaves minimal submanifolds of M, can be characterized by the vanishing of a basic cohomology class {varvec{kappa }}_Min H^1(M/{mathcal {F}}) (the Álvarez class). In this work we generalize this result to the case of a singular Riemannian foliation {mathcal {K}} on a compact manifold X. In the singular case, no bundle-like metric on X can make all the leaves of {mathcal {K}} minimal. In this work, we prove that the Álvarez classes of the strata can be glued in a unique global Álvarez class {varvec{kappa }}_Xin H^1(X/{mathcal {K}}). As a corollary, if X is simply connected, then the restriction of {mathcal {K}} to each stratum is geometrically taut, thus generalizing a celebrated result of E. Ghys for the regular case.

Stochastic assessment and enhancement of voltage stability in multi carrier energy systems considering wind power

Voltage instability is one of the main problems of power systems operation. Hence, voltage stability margin is kept within a sufficient range by several costly procedures such as load shedding. Coupling the electrical and natural gas systems by energy hub is a useful way to keep system voltage within a proper range following contingencies in the system. This paper proposes a new approach for assessment and enhancement of the power system voltage stability in the presence of wind power generation, as well as electrical and heat demands uncertainty. A stochastic programming method is adopted to handle the uncertainties of the wind power generation and demands. The proposed methodology shows that coupled operation of the electrical and gas systems in the presence of renewable resources can provide flexibility for the system along with a decrease in the operational cost in both regular cases and post-contingency conditions. In comparison with previous methods to enhance the power system voltage stability, in the proposed model the natural gas system could help power system to supply electrical demand without any voltage stability problem, where there is no load curtailment in some contingencies while in other cases, load curtailment is reduced dramatically which results in undeniable reduction of the total operation cost. Load margin is considered as voltage stability index, and the proposed framework is implemented on the IEEE 14-bus electrical system and 17-node natural gas system to indicate its applicability and appropriateness.

N-soliton solutions for the nonlocal two-wave interaction system via the Riemann–Hilbert method** Project supported by the National Natural Science Foundation of China (Grant Nos. 11331008 and 11522112).

In this paper, a nonlocal two-wave interaction system from the Manakov hierarchy is investigated via the Riemann–Hilbert approach. Based on the spectral analysis of the Lax pair, a Riemann–Hilbert problem for the nonlocal two-wave interaction system is constructed. By discussing the solutions of this Riemann–Hilbert problem in both the regular and non-regular cases, we explicitly present the N-soliton solution formula of the nonlocal two-wave interaction system. Moreover, the dynamical behaviour of the single-soliton solution is shown graphically.

Slopes of modular forms and the ghost conjecture, II

In a previous article we constructed an entire power series over $p$-adic weight space (the ghost series) and conjectured, in the $\Gamma _0(N)$-regular case, that this series encodes the slopes of overconvergent modular forms of any $p$-adic weight. In this paper, we construct abstract ghost series which can be associated to various natural subspaces of overconvergent modular forms. This abstraction allows us to generalize our conjecture to, for example, the case of slopes of overconvergent modular forms with a fixed residual representation that is locally reducible at $p$. Ample numerical evidence is given for this new conjecture. Further, we prove that the slopes computed by any abstract ghost series satisfy a distributional result at classical weights (consistent with conjectures of Gouvêa) while the slopes form unions of arithmetic progressions at all weights not in $\mathbf {Z}_p$.

Genetics of autosomal recessive intellectual disability.

In the last few years, next-generation sequencing has led to enormous progress in deciphering monogenic forms of intellectual disability. Autosomal dominant intellectual disability (ADID) and X chromosomal intellectual disability (XLID) have been the focus of research. Apart from metabolic disorders, autosomal recessive intellectual disability (ARID) is still behind, probably because it is more heterogeneous and less prevalent in industrial populations. The prevalence of ARID in a cohort of affected children of an outbred population is estimated to be about 10%, with an upward tendency in still unclarified cases. The risk for ARID in children of first cousins or closer is a magnitude higher than for children of unrelated parents. Taken together, it seems that children of related parents are at a 2 to 3 times higher risk for ID. There are no prevalent ARID genes, pathways, or protein complexes and the functions of the affected proteins are very diverse and limited not only to neurological aspects. Thus, in a regular case, there is no reasoning for picking a few genes for a first diagnostic step, and a genetic diagnosis of ID in general, and ARID specifically, is better made using large panels or exome sequencing. In addition, in the last few months, evidence has been growing that many ARID genes are pleiotropic and that the resulting phenotypes may have a broad spectrum. For an exhaustive deciphering of the genetics of ARID, we suggest research at the level of single genes rather than large meta-analyses.

Regular Cartan groupoids and longitudinal representations

With the intent of laying the groundwork for a program that aims at explicitly describing the space of Cartan (i.e. multiplicative) connections on a general proper Lie groupoid, we begin to investigate the space of such connections in the regular case. We point out that there is a close relationship between Cartan connections on a proper regular groupoid and representations of the groupoid on its own longitudinal bundle (i.e. on the vector distribution tangent to its orbits). This observation enables us to reduce the original problem to a simpler one. We carry out a prospective study of the latter problem, and apply the resulting analysis to produce a number of examples in rank two which serve to illustrate the diversity of the possible obstructions to the existence of multiplicative connections.

Turbulence Behind 3D Multi-Scale Sparse Grids

A fundamentally new idea in grid generated turbulence is the 3D Sparse Grid (3DS) concept [N. A. Malik. Sparse 3D Multi-Scale Grid Turbulence Generator. US Patent No. US 9,599,269 B2 (2017)] which reduces the effective blockage ratio compared to the 2D flat fractal grids, σ3DS ≪ σ2DF, and possess a much greater parameter space which could allow further optimization of the turbulence as compared to the 2D fractal (2DF) grids. Here, we report on some theoretical results regarding blockage ratio reduction in a 3-frame 3DS system, and some results from Direct Numerical Simulations comparing the turbulence characteristics generated by 3DS with Regular (RG) and 2DF grids cases.

Phase diagrams of the random nearest-neighbor mixed spin-1/2 and spin-3/2 Blume–Capel model

The mixed spin-1/2 and spin-3/2 Blume–Capel (BC) model is considered on the Bethe lattice (BL) with randomly changing coordination numbers (CN) and examined in terms of exact recursion relations. A couple of two different CNs are changed randomly on the shells of the BL in terms of a standard–random approach to obtain the phase diagrams on possible planes of the system parameters. It is found from the thermal analysis of the order-parameters that the model only gives the second-order phase transitions as in the regular mixed case. As the probability of having larger CN increases, the temperatures of the critical lines also increase as expected.

Comparative analysis of seismic behavior of RC buildings with Shape Memory Alloy rebar in regular, torsional irregularity and extreme torsional irregularity cases

SMAs (Shape Memory Alloys) have been implemented about a decade in design of the concrete buildings and improving their behavior. Among the major advantages of reinforced concrete structures with SMA one could refer to their super-elasticity property and the reversibility of inelastic displacements in the structure. In this article the seismic behavior of RC buildings with SMAs in regular, torsional irregularity and extreme torsional irregularity cases for three height types of building is investigated. For this purpose the effects of SMA as longitudinal reinforcement in structures with different number of stories (3, 6 and 9) which represented the Low, Mid and High-Rise buildings are examined. For each building, three reinforcement arrangements including the case of full Steel, the case of SMA at the plastic region of the beams and Steel reinforcement in other regions and also the case of SMA rebar over the entire length of the beams are taken into consideration. In all of the above cases, the Steel rebar is used in columns for economic purposes. In continuation, nonlinear dynamic time history analysis method was performed where the parameters of the maximum drift, residual drift, amplification factor, residual amplification factor, and base shear were investigated for each case of the mentioned buildings. The obtained results indicate that application of SMA in irregular buildings mitigates the devastative effects of irregularity, including reduction in the base shear and drift in buildings.

Global Regularity of 2D Density Patches for Viscous Inhomogeneous Incompressible Flow with General Density: Low Regularity Case

This paper presents some progress toward an open question proposed by P.‐L. Lions [26] concerning the propagation of regularities of density patches for viscous inhomogeneous incompressible flow. We first establish the global‐in‐time well‐posedness of the two‐dimensional inhomogeneous incompressible Navier‐Stokes system with initial density . Here is any pair of positive constants and Ω0 is a bounded, simply connected domain. We then prove that for any positive time t, the density , with the domain Ω(t) preserving the ‐boundary regularity. © 2018 Wiley Periodicals, Inc.

Interdisciplinary case discussions as a training modality to teach cultural formulation in child mental health.

The DSM-5 Cultural Formulation Interview (CFI) may become an important tool to help operationalize culture in the clinical realm. However, challenges exist in teaching its use to avoid the risk of stereotyping and oversimplification, which could result in misunderstanding and stigma. The aim of this article is to document whether the CFI can be taught using regular Interdisciplinary Case Discussion Seminars (ICDSs), proposed as continuing education in child mental health and as part of clinical rotations for new trainees. During a two-year evaluative research project, ICDSs were held monthly in three different primary care settings servicing recent immigrants in Montreal, Canada. ICDSs were recorded and analyzed to examine their effect on the cultural formulation process and focus groups were conducted to explore the subjective experience of the participant trainees and professionals. Results suggest that ICDSs are a helpful way to teach the use of the CFI. The group discussions helped participants to better capture the complexity of the cultural and social experience of the child and family by moving away from simple identity assignations, supporting an inquiry into structural dimensions, and considering stigma and inequality in their formulation. The multiple levels of diversity (individual, disciplinary, and interinstitutional) represented in the discussion groups helped clinicians to understand the cultural formulation as situated in a specific relational context and a particular moment and, in so doing, helped trainees to avoid cultural formulations that essentialize culture.

Good-[formula omitted] type bounds of quasilinear elliptic equations for the singular case

In this paper, we study the good-λ type bounds for renormalized solutions to nonlinear elliptic problem: −div(A(x,∇u))=μinΩ,u=0on∂Ω.where Ω⊂Rn, μ is a finite Radon measure and A is a monotone Carathédory vector valued function defined on W01,p(Ω). The operator A satisfies growth and monotonicity conditions, and the p-capacity uniform thickness condition is imposed on Rn∖Ω, for the singular case 3n−22n−1<p≤2−1n. In fact, the same good-λ type estimates were also studied by Quoc-Hung Nguyen and Nguyen Cong Phuc. For instance, in Nguyen and Phuc (0000) and Nguyen (0000) authors’ method was also confined to the case of 3n−22n−1<p≤2−1n but under the assumption of Ω is the Reifenberg flat domain and the coefficients of A have small BMO (bounded mean oscillation) semi-norms. Otherwise, the same problem was considered in Phuc (2014) in the regular case of p>2−1n. In this paper, we extend their results, taking into account the case 3n−22n−1<p≤2−1n and without the hypothesis of Reifenberg flat domain on Ω and small BMO semi-norms of A. Moreover, in rest of this paper, we also give the proof of the boundedness property of maximal function on Lorentz spaces and also the global gradient estimates of solution.

Analytic analysis of irregular discrete universes

In this work we investigate the dynamics of cosmological models with spherical topology containing up to 600 Schwarzschild black holes arranged in an irregular manner. We solve the field equations by tessellating the 3-sphere into eight identical cells, each having a single edge which is shared by all cells. The shared edge is enforced to be locally rotationally symmetric, thereby allowing for solving the dynamics to high accuracy along this edge. Each cell will then carry an identical (up to parity) configuration which can however have an arbitrarily random distribution. The dynamics of such models is compared to that of previous works on regularly distributed black holes as well as with the standard isotropic dust models of the FLRW type. The irregular models are shown to have richer dynamics than that of the regular models. The randomization of the distribution of the black holes is done both without bias and also with a certain clustering bias. The geometry of the initial configuration of our models is shown to be qualitatively different from the regular case in the way it approaches the isotropic model.

Nonlinear analysis of sloshing and floating body coupled motion in the time-domain

The aim of this paper is to develop a coupled nonlinear time-domain simulation scheme for nonlinear interactions among sloshing flows and floating body motion for both regular and irregular wave excitation. The contributions of a variety of nonlinear factors, outside waves and inside sloshing induced forces, as well as their influences on body coupled sway and roll motion were investigated. The induced forces are due to the changes in the transient wet surface of the floating body and full nonlinear sloshing. The effects of tank fill ratio and excitation wave height on the nonlinear coupled motion, as well as the relationship between sloshing and floating body nonlinear coupled motion under large wave amplitudes and severe sea conditions were also investigated and the results are presented. Finally, the numerical solutions are compared with existing experimental result. The fully nonlinear sloshing and floating body coupled motion are simulated based on the potential flow theory, with the transient position hydrodynamic assumption. The boundary value problem is solved by the B-spline higher-order panel method. The ISITIMFB (iterative semi-implicit time integration method for floating bodies) is applied to solve for the body's velocity and displacements. The sloshing energy dissipation is modeled by changing the boundary condition on the tank's solid boundaries. An extended principle to determine the energy dissipation coefficient for both regular and irregular cases is extracted. Then, the sloshing and floating body nonlinear coupled motion under large wave amplitudes and severe sea conditions are investigated, and the numerical solutions are compared with existing experimental results. The effects of tank fill ratio and excitation wave height on the nonlinear coupled motion is also investigated.

A weak minima approach to the study of the existence of saddle points of integral functionals

We study of the existence of saddle points of the functional J defined in (1.1) both in the regular case, i.e., if E belongs to (LN(Ω))N, and in the singular one, i.e., if E belongs to (L2(Ω))N.

Impact on gas-permeable contact lens parameters after storage in a non-neutralized hydrogen peroxide case during 1 to 30 days

Purpose: This study was conducted to evaluate the impact of storing large gas permeable lenses in a regular soft contact lens case, filled with non-neutralized hydrogen peroxide, during 1 to 30 days.

On the existence of topological dyons and dyonic black holes in anti-de Sitter Einstein-Yang-Mills theories with compact semisimple gauge groups

Here we study the global existence of “hairy” dyonic black hole and dyon solutions to four-dimensional, anti-de Sitter Einstein-Yang-Mills theories for a general simply connected and semisimple gauge group G, for the so-called topologically symmetric systems, concentrating here on the regular case. We generalise here cases in the literature which considered purely magnetic spherically symmetric solutions for a general gauge group and topological dyonic solutions for su(N). We are able to establish the global existence of non-trivial solutions to all such systems, both near existing embedded solutions and as |Λ| → ∞. In particular, we can identify non-trivial solutions where the gauge field functions have no zeroes, which in the su(N) case proved important to stability. We believe that these are the most general analytically proven solutions in 4D anti-de Sitter Einstein-Yang-Mills systems to date.

On Landsberg general (α,β)-metrics with a conformal 1-form

In this paper, we study almost regular Landsberg general (α,β)-metrics in Finsler geometry. The corresponding equivalent equations are given. By solving the equations, we derive the two cases of Landsberg general (α,β)-metrics under the condition that β is closed and conformal with respect to α. Under this condition, we prove that regular Landsberg general (α,β)-metrics must be Berwaldian when the dimension is greater than two. For the almost regular case, the way to construct non-Berwaldian Landsberg metrics is found and some new explicit examples are constructed.