Regular Case Research Articles

Weekly Internal Ethical Case Discussions in an ICU-Results Based on 9 Years of Experience With a Highly Structured Approach.

Various ethical challenges are prevalent in ICUs. In order to handle these problems, a highly structured internal ethical case discussion within the multiprofessional team was implemented in 2011 in a Swiss ICU and has been regularly practiced almost weekly until present. To explore the results of all ethical case discussions taking place in a general ICU and to discuss the outcomes of the patients. To identify the conditions facilitating the implementation of regular ethical case discussions. Retrospective case series analysis. Mixed academic ICU. All patients who had an ethical case discussion between January 2011 and December 2019 following the approach called Modular, Ethical, Treatment decisions, Allocation of resources at the micro-level, and Process. Weekly ethical case discussions held regularly on a fixed date were found to be practical for the observed ICU. A total of 314 ethical case discussions were realized in 281 patients. Median patient age was 70 years (interquartile range, 62-77 yr); two thirds were men. The results were categorized into the following groups: established therapy continues, complications to be treated (n = 53; 16.9%); therapy continues, patient's will to be explored further (n = 77; 24.5%); therapy continues, complications to be treated only after evaluation (n = 62; 19.7%); therapy continues with limitations (e.g., do-not-resuscitate order) (n = 98; 31.2%); and change of treatment plan to end-of-life care (n = 17; 5.4%). Of the discussed patients, 115 (40.9%) died in the ICU and 29 (10.3%) after transfer to the normal ward. Seven patients (2.5%) were transferred to a hospice and 55 (19.6%) to another hospital. Sixty-nine (24.6%) were discharged to a rehabilitative facility and six returned home. Regular ethical case discussions can be successfully implemented, enabling careful review of the patient's will and balancing it with the prognosis of the disease. This facilitates a necessary change of the therapeutic goal whenever appropriate.

Lavrentiev gap for some classes of generalized Orlicz functions

In the present paper we find optimal conditions separating the regular case from the one with Lavrentiev gap for the borderline case of double phase potential with one saddle point and related general classes of integrands.

Comparative study of base-isolated irregular RC structures subjected to pulse-like ground motions with low and high PGA/PGV ratios

Nowadays, vertically irregular reinforced concrete structures are very commonly seen in modern urban construction. These structures are of high vulnerability to lateral seismic shaking intensities as compared to regular buildings due to their inconsistent stiffness distribution along with the height. In general, the utilization of a base isolation system in a reinforced concrete building is considered an effective solution for seismic mitigation in earthquake-prone countries. The behavior of these buildings in both regular and irregular cases has been extensively studied in the literature. Moreover, the performance of the base isolated buildings under pulse-like earthquakes has attracted several researchers through the previous years due to the significant influence of such ground motions on the displacement stability of the isolation system. Currently, the literature is missing a study that evaluates and compares the full nonlinear time history behavior of different irregular reinforced concrete structures under near-fault pulse-like ground motions. Therefore, this study is intended to investigate the time history behavior of various base isolated reinforced concrete models subjected to pulse-like earthquakes with low and high PGA/PGV ratios. As a part of the study, the responses of heavy-story, soft-story, and stepped structures will be compared to the ones of a regular model. Furthermore, the effects of three different isolator’s effective damping ratios on the time history responses will be evaluated. The results of the study showed that the behavior of the isolator is influenced by the building irregularity type and the PGA/PGV ratio significantly.

Situation, Background, Assessment, and Recommendation Stepwise Education Program: A quasi-experimental study

BackgroundA nurse, as the main subject of decision-making in clinical settings, experiences various situations that require communication with a range of health care providers. The communication process is important to the process of recognizing problems and choosing one among the available alternatives after reflection, which requires communication skills based on critical thinking. Communication competence is one of the basic competencies of nurses, and it is also important for providing qualitative healthcare service. ObjectiveTo investigate how Situation, Background, Assessment, and Recommendation Stepwise Education Program (SBAR SEP) developed on the basis of the revised Bloom's Taxonomy affects nursing students on their communication competence and critical thinking. DesignNon-equivalent control group pretest–posttest design. SettingsA university in South Korea. ParticipantsA total of 96 nursing college students (48 in the experimental group and 48 in the control group). MethodThe subjects were allocated using convenience sampling to one of the two groups: SBAR SEP or control. Subjects in SBAR SEP group received a lecture-style training of SBAR a week prior to clinical practicum and performed role-play during the two-week clinical practicum. The duration of the SBAR SEP role-play intervention was 2 weeks, twice a week, for 120 min each session. A control group performed a regular case presentation in the clinical practicum. Data were collected from August to October 2019. Data were analyzed using descriptive statistics, χ2 test, independent t-test, and ANCOVA using SPSS 25.0. ResultsA significant increase was observed in the scores of communication competence (p < .001) and critical thinking (p < .001) in the experimental group compared with the control group. ConclusionsThe SBAR SEP for nursing students is an effective educational method that improves communication competence and critical thinking under similar circumstances at the clinical site.

Deep learning-augmented radiotherapy visualization with a cylindrical radioluminescence system

This study aims to demonstrate a low-cost camera-based radioluminescence imaging system (CRIS) for high-quality beam visualization that encourages accurate pre-treatment verifications on radiation delivery in external beam radiotherapy. To ameliorate the optical image that suffers from mirror glare and edge blurring caused by photon scattering, a deep learning model is proposed and trained to learn from an on-board electronic portal imaging device (EPID). Beyond the typical purposes of an on-board EPID, the developed system maintains independent measurement with co-planar detection ability by involving a cylindrical receptor. Three task-aware modules are integrated into the network design to enhance its robustness against the artifacts that exist in an EPID running at the cine mode for efficient image acquisition. The training data consists of various designed beam fields that were modulated via the multi-leaf collimator (MLC). Validation experiments are performed for five regular fields ranging from 2 × 2 cm2 to 10 × 10 cm2 and three clinical IMRT cases. The captured CRIS images are compared to the high-quality images collected from an EPID running at the integration-mode, in terms of gamma index and other typical similarity metrics. The mean 2%/2 mm gamma pass rate is 99.14% (range between 98.6% and 100%) and 97.1% (ranging between 96.3% and 97.9%), for the regular fields and IMRT cases, respectively. The CRIS is further applied as a tool for MLC leaf-end position verification. A rectangular field with introduced leaf displacement is designed, and the measurements using CRIS and EPID agree within 0.100 mm ± 0.072 mm with maximum of 0.292 mm. Coupled with its simple system design and low-cost nature, the technique promises to provide viable choice for routine quality assurance in radiation oncology practice.

Global Solution of Semi-infinite Programs with Existence Constraints

We consider what we term existence-constrained semi-infinite programs. They contain a finite number of (upper-level) variables, a regular objective, and semi-infinite existence constraints. These constraints assert that for all (medial-level) variable values from a set of infinite cardinality, there must exist (lower-level) variable values from a second set that satisfy an inequality. Existence-constrained semi-infinite programs are a generalization of regular semi-infinite programs, possess three rather than two levels, and are found in a number of applications. Building on our previous work on the global solution of semi-infinite programs (Djelassi and Mitsos in J Glob Optim 68(2):227–253, 2017), we propose (for the first time) an algorithm for the global solution of existence-constrained semi-infinite programs absent any convexity or concavity assumptions. The algorithm is guaranteed to terminate with a globally optimal solution with guaranteed feasibility under assumptions that are similar to the ones made in the regular semi-infinite case. In particular, it is assumed that host sets are compact, defining functions are continuous, an appropriate global nonlinear programming subsolver is used, and that there exists a Slater point with respect to the semi-infinite existence constraints. A proof of finite termination is provided. Numerical results are provided for the solution of an adjustable robust design problem from the chemical engineering literature.

Limit cycles in piecewise polynomial systems allowing a non-regular switching boundary

Continuing the investigation for the piecewise polynomial perturbations of the linear center ẋ=−y,ẏ=x from Buzzi et al. (2018) for the case where the switching boundary is a straight line, in this paper we allow that the switching boundary is non-regular, i.e. we consider a switching boundary which separates the plane into two angular sectors with angles α∈(0,π] and 2π−α. Moreover, unlike the aforementioned work, we allow that the polynomial differential systems in the two sectors have different degrees. Depending on α and for arbitrary given degrees we provide an upper bound for the maximum number of limit cycles that bifurcate from the periodic orbits of the linear center using the averaging method up to any order. This upper bound is reached for the first two orders. On the other hand, we pay attention to the perturbation of the linear center inside this class of piecewise polynomial Liénard systems and give some better upper bounds in comparison with the one obtained in the general piecewise polynomial perturbations. Again our results imply that the non-regular switching boundary (i.e. when α≠π) of the piecewise polynomial perturbations usually leads to more limit cycles than the regular case (i.e. when α=π) where the switching boundary is a straight line.

Highly sensitive metal-insulator-metal plasmonic refractive index sensor with a centrally coupled nanoring containing defects

A highly sensitive metal-insulator-metal plasmonic filter with a centrally coupled ring resonator containing silver nanorod defects is numerically investigated by using the finite element method and theoretically characterized by the temporal coupled-mode theory. The proposed structure can function as a plasmonic refractive index sensor compact in design with higher sensitivity and figure of merit (FOM). Simulation results reveal that the presence of silver nanorod defects in the ring resonator will significantly affect the sensor performance, which provides a tunable way to enhance the sensitivity and FOM. We found that the transmittance peak of plasmon can be controlled at constant particle size referring to its counterpart via its defect-change. The calculated refractive index sensitivity (i.e. the change in refractive index in the waveguide slot to the shift in the transmittance peak) is 3500 nm RIU−1 (RIU is refractive index unit), which remarkably enhances the sensitivity of 133.33% compared to its regular case. The central-coupling method used in this work shows the noticeably high sensitivity and FOM compared to its counterpart with the side-coupling method. For practical application, the modulation of transmittance (resonance) peaks of the proposed structure can be realized in a broad wavelength range, which may have promising applications in the on-chip plasmonic sensing and optical communication fields.

Relating second order geometry of manifolds through projections and normal sections

We use normal sections to relate the curvature locus of regular (resp. singular corank 1) 3-manifolds in R6 (resp. R5) with regular (resp. singular corank 1) surfaces in R5 (resp. R4 ). For example, we show how to generate a Roman surface by a family of ellipses different to Steiner’s way. We also study the relations between the regular and singular cases through projections. We show that there is a commutative diagram of projections and normal sections which relates the curvature loci of the different types of manifolds, and therefore, that the second order geometry of all of them is related. In particular, we define asymptotic directions for singular corank 1 3-manifolds in R5 and relate them to asymptotic directions of regular 3-manifolds in R6 and singular corank 1 surfaces in R4.

WITHDRAWN: Earth quake analysis of regular and irregular structures for all the soil types in seismic zone V

Abstract There has been a remarkable advancement in the research on design in the scope of engineering in the last couple of decades. There are many studies that contribute to better performance of buildings. Herein, to understand the seismic effects on a building when one of the design parameters is varying while others remaining constant, this study is conducted. The lateral forces at different levels of a structure in seismic zone V in all of the soil types are studied. The seismic loading with a varying soil conditions in the seismic zone is applied on all the structures. Both regularly and irregularly planned buildings are incorporated which are of varying heights (G + 3, G + 6, G + 9, and G + 12). The structure’s response in terms of lateral forces at all storey levels is analyzed varying the parameters. While the pattern observed is similar in regular and irregular cases, the soft soil type had higher storey shear when the storey levels increased.

Polysemy: Pragmatics and sense conventions

Polysemy, understood as instances of a single linguistic expression having multiple related senses, is not a homogenous phenomenon. There are regular (apparently, rule‐based) cases and irregular (resemblance‐based) cases, which have different processing profiles. Although a primary source of polysemy is pragmatic inference, at least some cases become conventionalised and linguistically encoded. Three main issues are discussed: (a) the key differences between regular and irregular cases and the role, if any, of a “core meaning”; (b) the distinction between pragmatic polysemy and semantic polysemy; and (c) the role of syntactic meaning in both generating and constraining polysemy.

The influence of regular wave and irregular wave on the mechanical characteristics of a triple-cylinder bundle structure

By using the open source DualSPHysics, the interaction between wave and a triple-cylinder bundle structure is numerically investigated. The wave is generated by applying the predefined function to the wave maker, and the free surface and the velocity of the regular wave and irregular wave are compared with the theoretical data at the measuring point. To verify the feasibility of the numerical method for simulating the fluid-structure interaction, the numerical results of smooth particle hydrodynamics (SPH) model are compared with the experimental and theoretical data, which shows a good agreement. Finally, 95 groups of cases of the interaction between wave and triple-cylinder bundles (TPB) are calculated, and the wave force acting on TPB is explored at different rotation angles. The effects of different wave parameters on the wave force characteristics are further analyzed. The results of a single vertical cylinder are introduced for making a comparison. For the regular wave case, the wave force acting on the structure is higher than that of the irregular wave case. When the rotation angle is 90°, the wave force on the TPB is the maximum; and it reaches the minimum at 180°.

Dynamics of the arab countries' involvement to the israeli-palestinian peace process (1967–2002)

The paper presents an analysis of the evolution of the Arab countries` involvement to the resolution of the Palestinian-Israeli conflict. The research was carried out through a historical analysis of the Israeli-Egyptian peace accords, the Madrid peace conference, the Oslo Process, the Israeli-Jordan peace agreements, and the Arab peace initiative. The author presents the gradual evolution of the Arab countries position to the Palestinian issue from the absolute non-recognition of Israel and open enmity to the end of the boycott and to the establishment of diplomatic relations with Israel. The author also identifies the causes and the consequences of this change in the approach of the Arab countries. Results show that the main reason was the weakening of the USSR and its collapse, which predetermined the need for Arab countries to seek a new source of support in the face of the United States. Moreover, the importance of the Palestinian problem decreases for Saudi Arabia and the United Arab Emirates, while influence of the economic factor and security issues increases. Other Arab countries such as Egypt, Lebanon, Syria and Jordan do not have sufficient resources to defend their position on Palestine. Another important factor is the destruction of the united Arab position, and the decline in the popularity of the concept of pan-Arabism. The author concludes that the Palestinian-Israeli conflict ceases to be a stumbling block for resolving the larger Arab-Israeli conflict, and becomes a bargaining chip. Thus, it can be assumed that even with the resumption of the Palestinian-Israeli peace process the participation of Arab countries in it will be comparably formal. While a gradual rapprochement of Israel with its neighbor countries, the conflict will continue to evolve spontaneously with regular cases of Palestinian resistance until the irrevocable Israeli occupation is over.

A holistic comparison between deep learning techniques to determine Covid-19 patients utilizing chest X-Ray images

Novel coronavirus likewise called COVID-19 began in Wuhan, China in December 2019 and has now outspread over the world. Around 63 millions of people currently got influenced by novel coronavirus and it causes around 1,500,000 deaths. There are just about 600,000 individuals contaminated by COVID-19 in Bangladesh too. As it is an exceptionally new pandemic infection, its diagnosis is challenging for the medical community. In regular cases, it is hard for lower incoming countries to test cases easily. RT-PCR test is the most generally utilized analysis framework for COVID-19 patient detection. However, by utilizing X-ray image based programmed recognition can diminish the expense and testing time. So according to handling this test, it is important to program and effective recognition to forestall transmission to others. In this paper, author attempts to distinguish COVID-19 patients by chest X-ray images. Author executes various pre-trained deep learning models on the dataset such as Base-CNN, ResNet-50, DenseNet-121 and EfficientNet-B4. All the outcomes are compared to determine a suitable model for COVID-19 detection using chest X-ray images. Author also evaluates the results by AUC, where EfficientNet-B4 has 0.997 AUC, ResNet-50 has 0.967 AUC, DenseNet-121 has 0.874 AUC and the Base-CNN model has 0.762 AUC individually. The EfficientNet-B4 has achieved 98.86% accuracy.

CUBATURE FORMULA FOR APPROXIMATE CALCULATION INTEGRAL OF HIGHLY OSCILLATING FUNCTION OF TREE VARIABLES (IRREGULAR CASE)

Context. The integrals of highly oscillating functions of many variables are one of the central concepts of digital signal and image processing. The object of research is a digital processing of signals and images using new information operators. Objective. The work aims to construct a cubature formula for the approximate calculation of the triple integral of a rapidly oscillating function of a general form.Method. Modern methods of digital signal processing are characterized by new approaches to obtaining, processing and analyzing information. There is a need to build mathematical models in which information can be given not only by the values of the function at points, but also as a set of traces of the function on the planes and as a set of traces of the function on the lines. There are algorithms which are optimal by accuracy for calculating the integrals of highly oscillating functions of many variables (regular case), which involve different types of information in their construction. As a solution of a broader problem for the irregular case, the work presents the cubature formula for the approximate calculation of the triple integral of the highly oscillating function in a general case. The presented algorithm for approximate calculation of the integral is based on the application of operators that restore the function of three variables using a set of traces of functions on the mutually perpendicular planes. Operators use piece-wise splines as auxiliary functions. The cubature formula correlates with a formula of the Filon type. An error estimation of the approximation of the integral from the highly oscillating function by the cubature formula on the class of differential functions is obtained.Results. The cubature formula of the approximate calculation of the triple integral from the highly oscillating function of a general form is researched.Conclusions. The experiments confirm the obtained theoretical results on the error estimation of the approximation triple integral from the highly oscillating function in a general form by the cubature formula. The prospect of further research is to obtain an estimation of the approximation error on wider classes of functions and to prove that the proposed cubature formula is optimal by the order of accuracy.

Spectral Analysis of One-Dimensional Dirac System with Summable Potential and Sturm- Liouville Operator with Distribution Coefficients

We consider one-dimensional Dirac operatorLP,U with Birkhoff regular boundary conditions and summable potential P(x) on[0, ]. We introduce strongly and weakly regular operators. In both cases, asymptotic formulas for eigenvalues are found. In these formulas, we obtain main asymptotic terms and estimates for the second term. We specify these estimates depending on the functional class of the potential: Lp[0,] with p [1,2] and the Besov space Bp,p'[0,] with p [1,2] and (0,1/p). Additionally, we prove that our estimates are uniform on balls Pp,R Then we get asymptotic formulas for normalized eigenfunctions in the strongly regular case with the same residue estimates in uniform metric on x [0,]. In the weakly regular case, the eigenvalues 2n and 2n+1 are asymptotically close and we obtain similar estimates for two-dimensional Riesz projectors. Next, we prove the Riesz basis property in the space (L2[0,])2 for a system of eigenfunctions and associated functions of an arbitrary strongly regular operatorLP,U. In case of weak regularity, the Riesz basicity of two-dimensional subspaces is proved.&#x0D; In parallel with theLP,U operator, we consider the SturmLiouville operator Lq,U generated by the differential -y'' + q(x)y expressionwith distribution potential q of first-order singularity (i.e., we assume that the primitive u = q(1) belongs to L2[0, ]) and Birkhoff-regular boundary conditions. We reduce to this case -(1y')'+i(y)'+iy'+0y, operators of more general form where '1,,0(-1)L2and 10. For operator Lq,U, we get the same results on the asymptotics of eigenvalues, eigenfunctions, and basicity as for operator LP,U .&#x0D; Then, for the Dirac operator LP,U, we prove that the Riesz basis constant is uniform over the ballsPp,R for p1 or 0. The problem of conditional basicity is naturally generalized to the problem&#x0D; of equiconvergence of spectral decompositions in various metrics. We prove the result on equiconvergence by varying three indices: fL[0,] (decomposable function), PL[0,] (potential), and Sm-Sm00,m in L[0,] (equiconvergence of spectral decompositions in the corresponding norm). In conclusion, we prove theorems on conditional and unconditional basicity of the system of eigenfunctions and associated functions of operator LP,U in the spaces L[0,],2, and in various Besov spaces Bp,q[0,].

Categories, Root Complexes and Default Stress

A new account is presented of stress assignment in deadjectival and deverbal nominalizations in Slovenian, explicitly addressing both regular cases and exceptions. The analysis is an extension of the account by Marvin (2003) and is couched in the model developed by Lowenstamm (2014), which views derivational affixes as transitive roots. The main addition to Lowenstamm’s model is the proposal that parts of the structure which only contain roots with no intermediate functional structure (the ‘radical cores’) always receive default prosody. The presented analysis dispenses with lexical stress in Slovenian affixes and derives the prosodic properties of affixed words solely from their structure.

Diminishing stepsize methods for nonconvex composite problems via ghost penalties: from the general to the convex regular constrained case

ABSTRACT In this paper, we first extend the diminishing stepsize method for nonconvex constrained problems presented in F. Facchinei, V. Kungurtsev, L. Lampariello and G. Scutari [Ghost penalties in nonconvex constrained optimization: Diminishing stepsizes and iteration complexity, To appear on Math. Oper. Res. 2020. Available at https://arxiv.org/abs/1709.03384.] to deal with equality constraints and a nonsmooth objective function of composite type. We then consider the particular case in which the constraints are convex and satisfy a standard constraint qualification and show that in this setting the algorithm can be considerably simplified, reducing the computational burden of each iteration.

Vertebral Artery Variation in Patients With Congenital Cervical Scoliosis: An Anatomical Study Based on Radiological Findings.

Observational, anatomical, radiological study. The aim of this study was to explore the incidence and type of vertebral artery (VA) variation in patients with congenital cervical scoliosis and approach their clinical importance during surgery. Congenital scoliosis of the cervical spine is usually sporadic and caused by a variety of bone structural anomalies. Most of the cases remain asymptomatic. Surgical intervention is the main management for patients with neurological compromise or with cosmetic demands. The operation involved more screw insertion and osteotomy than the regular degenerative cases. The incidence and pattern of VA variants in these patients have not been reported. Patients with congenital cervical scoliosis treated in our department were reviewed. We measured Cobb angle of cervical spine. We observed bilateral VAs and recorded variants. We measured their diameter in each segment through CT angiography. The bilateral diameter in each patient was then compared respectively. There is a total of 44 patients enrolled. The incidence of VA variation was 41% (18/44). Fifty percent (22/44) of patients had the dominant VA with no difference between concave side and convex side. Patients with a dominant VA had a larger Cobb angle than those who had not (30.25° vs. 23.24°, P < 0.05). The courses of VA were abnormal in 18 patients. Two patients had unilateral variant in V1 segment. Twelve patients had variants in V2 segment. Eight patients had variants in V3 segment. Three patients had VA variants in multiple sites. In patients with congenital cervical scoliosis, the dominance of VA is not related to the convex side or concave side, but patients with a dominance of VA have a larger Cobb angle. The incidence of variant in V2 and V3 segment is higher. A thorough evaluation of bilateral VAs is required before surgery. Extra cautions must be taken during surgery.Level of Evidence: 5.

Management of people with epilepsy during the COVID-19 pandemic: a national survey among epileptologists in China

BackgroundCompared to the healthy people, people with comorbid medical conditions are more vulnerable in the context of the coronavirus disease 2019 (COVID-19) pandemic, including the people with epilepsy. Besides a consensus recommendation by multi-national epilepsy specialists, the situation of the epilepsy management during the pandemic has seldom been reported.MethodsThe China Association Against Epilepsy carried out an online nationwide survey among its board members in April 2020. One hundred and thirty board members from 22 provinces, 5 autonomous regions, and 4 municipalities across China responded to the questionnaires. They reported the situation of clinical practice and gave opinions on the management of people with epilepsy between January 13th and March 31st, 2020, a time period concentrated with confirmed COVID-19 cases.ResultsThe proportions of patients consulting through telephone or online (88.4%) and of patients with regular case review (93.9%) were highest in the high-risk area, as reported by the responders. The patients in the high-risk area were more likely to have increased episodes of seizures (17.7%), aggravated psychological disorders (30.2%), and less accessibility to anti-seizure medications (ASMs) (77.2%). Regular ASMs supply (74.6%), medical consultation (69.2%), and psychological aids (29.2%) were urgently needed for people with epilepsy.ConclusionsThis study demonstrated the most common dilemma faced by people with epilepsy in policy circumstances during the COVID-19 epidemic in China. The opinions raised by Chinese epileptologists may provide reference for epilepsy care in other countries.