Restricted Case Research Articles

Population-based incidence and mortality of community-acquired pneumonia in Germany.

BackgroundLittle information on the current burden of community-acquired pneumonia (CAP) in adults in Germany is available.MethodsWe conducted a retrospective cohort study using a representative healthcare claims database of approx. 4 million adults to estimate the incidence rates (IR) and associated mortality of CAP in 2015. IR and mortality were stratified by treatment setting, age group, and risk group status. A pneumonia coded in the primary diagnosis position or in the second diagnosis position with another pneumonia-related condition coded in the primary position was used as the base cases definition for the study. Sensitivity analyses using broader and more restrictive case definitions were also performed.ResultsThe overall IR of CAP in adults ≥18 years was 1,054 cases per 100,000 person-years of observation. In adults aged 16 to 59 years, IR for overall CAP, hospitalized CAP and outpatient CAP was 551, 96 and 466 (with a hospitalization rate of 17%). In adults aged ≥60 years, the respective IR were 2,032, 1,061 and 1,053 (with a hospitalization rate of 52%). If any pneumonia coded in the primary or secondary diagnosis position was considered for hospitalized patients, the IR increased 1.5-fold to 1,560 in the elderly ≥60 years. The incidence of CAP hospitalizations was substantially higher in adults ≥18 years with at-risk conditions and high-risk conditions (IR of 608 and 1,552, respectively), compared to adults without underlying risk conditions (IR 108). High mortality of hospitalized CAP in adults ≥18 was observed in-hospital (18.5%), at 30 days (22.9%) and at one-year (44.5%) after CAP onset. Mortality was more than double in older adults in comparison to younger patients.ConclusionCAP burden in older adults and individuals with underlying risk conditions was high. Maximizing uptake of existing vaccines for respiratory diseases may help to mitigate the disease burden, especially in times of strained healthcare resources.

Generalized Fitch Graphs III: Symmetrized Fitch maps and Sets of Symmetric Binary Relations that are explained by Unrooted Edge-labeled Trees

Binary relations derived from labeled rooted trees play an import role in mathematical biology as formal models of evolutionary relationships. The (symmetrized) Fitch relation formalizes xenology as the pairs of genes separated by at least one horizontal transfer event. As a natural generalization, we consider symmetrized Fitch maps, that is, symmetric maps $\varepsilon$ that assign a subset of colors to each pair of vertices in $X$ and that can be explained by a tree $T$ with edges that are labeled with subsets of colors in the sense that the color $m$ appears in $\varepsilon(x,y)$ if and only if $m$ appears in a label along the unique path between $x$ and $y$ in $T$. We first give an alternative characterization of the monochromatic case and then give a characterization of symmetrized Fitch maps in terms of compatibility of a certain set of quartets. We show that recognition of symmetrized Fitch maps is NP-complete. In the restricted case where $|\varepsilon(x,y)|\leq 1$ the problem becomes polynomial, since such maps coincide with class of monochromatic Fitch maps whose graph-representations form precisely the class of complete multi-partite graphs.

【論文摘要】The Effect of Pre-transplant Pulmonary Rehabilitation on Functional Exercise Capacity in a Patient With Restrictive Lung Disease-A Case Report

【論文摘要】The Effect of Pre-transplant Pulmonary Rehabilitation on Functional Exercise Capacity in a Patient With Restrictive Lung Disease-A Case Report

Solving archaeological puzzles

This paper focuses on the re-assembly of an archaeological artifact, given images of its fragments. This problem can be considered as a special challenging case of puzzle solving. The restricted case of re-assembly of a natural image from square pieces has been investigated extensively and was shown to be a difficult problem in its own right. Likewise, the case of matching “clean” 2D polygons/splines based solely on their geometric properties has been studied. But what if these ideal conditions do not hold? This is the problem addressed in the paper. Three unique characteristics of archaeological fragments make puzzle solving extremely difficult: (1) The fragments are of general shape; (2) They are abraded, especially at the boundaries (where the strongest cues for matching should exist); and (3) The domain of valid transformations between the pieces is continuous. The key contribution of this paper is a fully-automatic and general algorithm that addresses puzzle solving in this intriguing domain. We show that our approach manages to correctly reassemble dozens of broken artifacts and frescoes.

Abstract P113: Underestimation Of Sudden Death Due To Restrictive Sudden Cardiac Death Criteria

Background: Efforts to prevent sudden death may be hampered by restrictive case definitions impairing accurate estimates of incidence and risk factors of sudden death. Sudden cardiac death (SCD) definitions include requirements for presence of comorbid coronary artery disease (CAD) and various time criteria since onset of symptoms or when victims were last seen well. We compared prevalence of three SCD definitions within a registry of all-cause natural, sudden deaths. Hypothesis: We assessed the hypothesis that the restrictive criteria of three SCD definitions underestimate sudden death and exclude populations with increased medical comorbidities. Methods: Using a registry of 399 adjudicated sudden death cases among adults aged 18-64 in Wake County, North Carolina in 2013-2015, we included 271 cases after excluding for missing values, chronic kidney disease, or heart failure. Time since last seen alive was classified as less than one hour or 24 hours from scene reports. Presence of CAD and co-morbidities were defined from clinical or autopsy records. Prevalence of SCD using criteria defined by Atherosclerosis Risk in Communities (ARIC), the World Health Organization (WHO), and the Oregon Sudden Unexpected Death (SUD) registry were calculated. Prevalence of SCD risk factors were calculated for the 3 SCD subgroups and compared to the original 271 victims using two-sample t-test and Fisher’s exact test for continuous and categorical variables. Results: Among the 271 cases, criteria were met for the three SCD definitions for n (%): ARIC 28 (10%), WHO 54 (20%), and SUD 90 (33%) (Table 1). ARIC and WHO-defined SCD cases were younger than the original 271 cases. There were no significant differences in sociodemographic and clinical factors by any SCD group compared to the original 271 cases. Conclusion: Restrictive SCD definitions that require the presence of CAD or a specific time frame of identification of death underestimate the incidence of sudden death and hinder effective prevention efforts for sudden death.

Efficient Bayesian Network Structure Learning via Parameterized Local Search on Topological Orderings

In Bayesian Network Structure Learning (BNSL), we are given a variable set and parent scores for each variable and aim to compute a DAG, called Bayesian network, that maximizes the sum of parent scores, possibly under some structural constraints. Even very restricted special cases of BNSL are computationally hard, and, thus, in practice heuristics such as local search are used. In a typical local search algorithm, we are given some BNSL solution and ask whether there is a better solution within some pre-defined neighborhood of the solution. We study ordering-based local search, where a solution is described via a topological ordering of the variables. We show that given such a topological ordering, we can compute an optimal DAG whose ordering is within inversion distance r in subexponential FPT time; the parameter r allows to balance between solution quality and running time of the local search algorithm. This running time bound can be achieved for BNSL without any structural constraints and for all structural constraints that can be expressed via a sum of weights that are associated with each parent set. We show that for other modification operations on the variable orderings, algorithms with an FPT time for r are unlikely. We also outline the limits of ordering-based local search by showing that it cannot be used for common structural constraints on the moralized graph of the network.

Labeling nonograms: Boundary labeling for curve arrangements

Slanted and curved nonograms are a new type of picture puzzles introduced by Van de Kerkhof et al. (2019). They consist of an arrangement of lines or curves within a frame B, where some of the cells need to be colored in order to obtain the solution picture. For solving the puzzle, up to two clues need to be attached as numeric labels to each line on either side of B. In this paper we study the algorithmic problem of optimizing or deciding the existence of a placement of the given clue labels to such a nonogram. We provide polynomial-time algorithms for restricted cases and prove NP-completeness in general.

The RNA landscape of the human placenta in health and disease

The placenta is the interface between mother and fetus and inadequate function contributes to short and long-term ill-health. The placenta is absent from most large-scale RNA-Seq datasets. We therefore analyze long and small RNAs (~101 and 20 million reads per sample respectively) from 302 human placentas, including 94 cases of preeclampsia (PE) and 56 cases of fetal growth restriction (FGR). The placental transcriptome has the seventh lowest complexity of 50 human tissues: 271 genes account for 50% of all reads. We identify multiple circular RNAs and validate 6 of these by Sanger sequencing across the back-splice junction. Using large-scale mass spectrometry datasets, we find strong evidence of peptides produced by translation of two circular RNAs. We also identify novel piRNAs which are clustered on Chr1 and Chr14. PE and FGR are associated with multiple and overlapping differences in mRNA, lincRNA and circRNA but fewer consistent differences in small RNAs. Of the three protein coding genes differentially expressed in both PE and FGR, one encodes a secreted protein FSTL3 (follistatin-like 3). Elevated serum levels of FSTL3 in pregnant women are predictive of subsequent PE and FGR. To aid visualization of our placenta transcriptome data, we develop a web application (https://www.obgyn.cam.ac.uk/placentome/).

Gaussian versus Non-Gaussian Filtering of Phase-Insensitive Nonclassicality.

Measures of quantum properties are essential to understanding the fundamental differences between quantum and classical systems as well as quantifying resources for quantum technologies. Here, two broad classes of bosonic phase-space functions, which are filtered versions of the Glauber-Sudarshan P function, are compared with regard to their ability to uncover nonclassical effects of light through their negativities. Gaussian filtering of the P function yields the family of s-parametrized quasiprobabilities, while more powerful regularized nonclassicality quasiprobabilities are obtained by non-Gaussian filtering. A method is proposed to directly sample such phase-space functions for the restricted case of phase-independent quantum states from balanced homodyne measurements. This overcomes difficulties of previous approaches that manually append uniformly distributed optical phases to the measured quadrature data. We experimentally demonstrate this technique for heralded single- and two-photon states using balanced homodyne detection with varying efficiency. The s-parametrized quasiprobabilities, which can be directly sampled, are non-negative for detection efficiencies below 0.5. By contrast, we show that significant negativities of non-Gaussian filtered quasiprobabilities uncover nonclassical effects for arbitrarily low efficiencies.

Prevalence of umbilical artery Doppler waveform abnormality during the early second trimester and the subsequent variation of waveforms in monochorionic diamniotic twin pregnancies: A prospective cohort study

To investigate the prevalence of qualitative abnormal umbilical artery Doppler waveforms (Abnormal UA) during the early second trimester and the subsequent variation of waveforms in monochorionic diamniotic (MCDA) twin pregnancies. This prospective cohort study included 153 MCDA twin pregnancies. Pulsed Doppler examinations for UA were performed at four points, including the free-loop (FL) and near the placental cord insertion site (CI) of each UA, between 16 and 17 weeks' gestation. Cases were classified into positive diastolic waveforms (Type I), persistent Abnormal UA (Type II), and intermittent Abnormal UA (Type III). When the diastolic velocity in UA Doppler was positive twice after different sequential recordings, the cases were determined to have achieved normalization. Follow-up Doppler examinations of the UA were performed at 24, 28, and 32 weeks' gestation. Of all 153 cases, 38 (25%; 19 Type II and 19 Type III cases) showed Abnormal UA at the first examination. Abnormal UA was detectable at FL in all selective intrauterine growth restriction (sIUGR) cases, whereas it was noted only at CI site in some non-sIUGR cases. Abnormal UA normalized in 12 (63%) Type II and 15 (79%) Type III cases. A quarter of MCDA twin pregnancies in the early second trimester demonstrated Abnormal UA. In MCDA twins with Abnormal UA between 16 and 17 weeks' gestation, it is preferable to follow them up to consider the possibility of normalization of Abnormal UA as well as features of UA waveforms specific to FL and CI.

The effect of mass legalization on US state-level institutions: Evidence from the immigration reform and control act

A new case for immigration restrictions argues that migrants may transmit low productivity to their destination countries by importing low-quality economic institutions. Using the 1986 Immigration Reform and Control Act (IRCA) as a natural experiment, we test whether the legalization of undocumented immigrants affects the quality of state-level economic institutions in the United States. Using synthetic control models, we find that, in the short run, legalization may increase the burden of government spending. However, in the long run, we find statistically insignificant effects of legalization on economic institutions.

IMPROVED PREGNANCY OUTCOME IN WOMEN WITH GESTATIONAL HYPERTENSION AS A RESULT OF OBSTETRICIAN AND CARDIOLOGIST TEAMWORK

Objective: Gestational hypertension remains the leading cause of maternal, fetal and neonatal morbidity and mortality worldwide. In spite of ESH and ESC guidelines (2011–2013) regarding the use of low-dose aspirin for preventing poor obstetric outcome due to preeclampsia and in spite of the many studies involving aspirin published by FMF our national obstetrical guidelines didn’t mentioned aspirin prophylaxis until 2018. So for many years the first to recommend aspirin to a pregnant women was the cardiologist and not the obstetrician. To asses the outcome of the second pregnancy in women of high risk for early onset/sever preeclampsia after introducing low dose aspirin in early gestation. Design and method: A case series of secundiparous women (2017–2019), with history of poor maternal and fetal outcome because of sever preeclampsia (2014–2015), was assessed after starting 150 mg of aspirin daily from the onset of the second gestation until week 36. In this retrospective study no women with diabetes, chronic hypertension, obesity, any type of autoimmune disease, kidney disease or multiple gestation were included. The followed-up of these patients was done both by the obstetrician and cardiologist. The evaluation criteria for assessing the obstetrical outcome were: gestational age at onset of hypertension, Doppler velocity indices and non-stress test results, time and mode of delivery, birth weight, Apgar score, length of hospitalization; all compared to the outcomes of the first pregnancy. Results: None of the patients developed severe preeclampsia or early onset hypertension, but all of them de late onset gestational hypertension or mild preeclampsia needing antihypertensive therapy. There were no preterm babies, all women delivered at term, week 38–39, by elective C-section or after induced labor. There were no cases of intrauterine growth restriction, no signs of fetal distress according to Doppler ultrasound examination or on CTG monitoring. The Apgar score was no lower than 8 and there was no NICU admission. Antihypertensive therapy was no longer required after birth and all mothers began brestfeeding. Conclusions: This improved obstetrical outcome was the result of team approach in the management of pregnant women with high risk of hypertensive disorders.

Constant-Delay Enumeration for Nondeterministic Document Spanners

We consider the information extraction framework known as document spanners and study the problem of efficiently computing the results of the extraction from an input document, where the extraction task is described as a sequential variable-set automaton (VA). We pose this problem in the setting of enumeration algorithms, where we can first run a preprocessing phase and must then produce the results with a small delay between any two consecutive results. Our goal is to have an algorithm that is tractable in combined complexity, i.e., in the sizes of the input document and the VA, while ensuring the best possible data complexity bounds in the input document size, i.e., constant delay in the document size. Several recent works at PODS’18 proposed such algorithms but with linear delay in the document size or with an exponential dependency in size of the (generally nondeterministic) input VA. In particular, Florenzano et al. suggest that our desired runtime guarantees cannot be met for general sequential VAs. We refute this and show that, given a nondeterministic sequential VA and an input document, we can enumerate the mappings of the VA on the document with the following bounds: the preprocessing is linear in the document size and polynomial in the size of the VA, and the delay is independent of the document and polynomial in the size of the VA. The resulting algorithm thus achieves tractability in combined complexity and the best possible data complexity bounds. Moreover, it is rather easy to describe, particularly for the restricted case of so-called extended VAs. Finally, we evaluate our algorithm empirically using a prototype implementation.

Inference for a general family of inverted exponentiated distributions with partially observed competing risks under generalized progressive hybrid censoring

In this paper, statistical inference for a competing risks model is discussed when latent failure times belong to a general family of inverted exponentiated distributions. Based on a generalized progressive hybrid censored data with partially observed failure causes, estimations for unknown parameters are presented under nonrestricted and restricted parameter cases from classic and Bayesian perspectives, respectively. The existence and uniqueness of maximum likelihood estimators of the unknown parameters are established, and the associated approximate confidence intervals are also constructed via Fisher information matrix. In sequel, the Bayes estimators and credible intervals of the parameters are also obtained as well. Finally, the performance of different estimators are evaluated using Monte Carlo simulations and a real data set is also analyzed for illustration.

VC density of definable families over valued fields

We prove a tight bound on the number of realized 0=1 patterns (or equivalently on the Vapnik–Chervonenkis codensity) of definable families in models of the theory of algebraically closed valued fields with a non-archimedean valuation. Our result improves the best known result in this direction proved by Aschenbrenner, Dolich, Haskell, Macpherson and Starchenko, who proved a weaker bound in the restricted case where the characteristics of the field K and its residue field are both assumed to be 0. The bound obtained here is optimal and without any restriction on the characteristics. We obtain the aforementioned bound as a consequence of another result on bounding the Betti numbers of semi-algebraic subsets of certain Berkovich analytic spaces, mirroring similar results known already in the case of o-minimal structure and for real closed as well as algebraically closed fields. The latter result is the first result in this direction and is possibly of independent interest. Its proof relies heavily on recent results of Hrushovski and Loeser on the topology of semi-algebraic subsets of Berkovich analytic spaces.

Behavioral Smoking Cessation Counseling During Pregnancy: A Cost-Effectiveness Analysis.

To examine the cost effectiveness of using behavioral smoking cessation counseling during pregnancy. We designed a decision-analytic model using TreeAge Pro 2020 software to compare the cost effectiveness and outcomes among women who received behavioral smoking cessation counseling compared with women who received usual care during pregnancy. We used a theoretical cohort of 285,000 women, the approximate number of pregnant women who smoke each year in the United States. Outcomes included maternal abstinence from smoking, fetal growth restriction, stillbirth, preterm delivery, neonatal death, and cerebral palsy, in addition to cost and quality-adjusted life-years (QALYs) for both the woman and the neonate. All model inputs were derived from the literature, and a willingness-to-pay threshold was set at $100,000 per QALY. Sensitivity analyses were performed to determine the robustness of baseline assumptions. In our theoretical cohort, behavioral smoking cessation counseling compared with usual care was associated with 9,019 additional women stopping smoking during pregnancy (34,604 vs 25,585). Smoking cessation counseling also resulted in 911 fewer cases of fetal growth restriction, 20 fewer stillbirths, 250 fewer preterm deliveries, 11 fewer neonatal deaths, and one less case of cerebral palsy. Using behavioral smoking cessation counseling interventions during pregnancy led to better outcomes despite higher costs, with an incremental cost-effectiveness ratio of $71,658 per QALY, which was below our willingness-to-pay threshold of $100,000 per QALY, making the intervention cost effective. Sensitivity analyses demonstrated that the counseling intervention was cost effective at probabilities of smoking cessation greater than 11.6% (baseline input: 12.1%) or the cost of the behavioral intervention was less than $475.21 (baseline input: $368.78). Behavioral smoking cessation counseling during pregnancy was associated with fewer adverse neonatal outcomes and was cost effective. Increasing utilization of such interventions and increasing insurance coverage of this care are important initiatives to improve outcomes in this at-risk population.

Irregular model sets and tame dynamics

We study the dynamical properties of irregular model sets and show that the translation action on their hull always admits an infinite independence set. The dynamics can therefore not be tame and the topological sequence entropy is strictly positive. Extending the proof to a more general setting, we further obtain that tame implies regular for almost automorphic group actions on compact spaces. In the converse direction, we show that even in the restrictive case of Euclidean cut and project schemes irregular model sets may be uniquely ergodic and have zero topological entropy. This provides negative answers to questions by Schlottmann and Moody in the Euclidean setting.

Contrarian effects and echo chamber formation in opinion dynamics

The relationship between the topology of a network and specific types of dynamics unfolding in networks constitutes a subject of substantial interest. One type of dynamics that has attracted increasing attention because of its several potential implications is opinion formation. A phenomenon of particular importance, known to take place in opinion formation, is echo chambers’ appearance. In the present work, we approach this phenomenon, while emphasizing the influence of contrarian opinions in a multi-opinion scenario. To define the contrarian opinion, we considered the underdog effect, which is the eventual tendency of people to support the less popular option. We also considered an adaptation of the Sznajd dynamics with the possibility of friendship rewiring, performed on several network models. We analyze the relationship between topology and opinion dynamics by considering two measurements: opinion diversity and network modularity. Two specific situations have been addressed: (i) the agents can reconnect only with others sharing the same opinion; and (ii) same as in the previous case, but with the agents reconnecting only within a limited neighborhood. This choice can be justified because, in general, friendship is a transitive property along with subsequent neighborhoods (e.g., two friends of a person tend to know each other). As the main results, we found that the underdog effect, if strong enough, can balance the agents’ opinions. On the other hand, this effect decreases the possibilities of echo chamber formation. We also found that the restricted reconnection case reduced the chances of echo chamber formation and led to smaller echo chambers.

Al-Mabadi’ Al-Khamsah dan Al-Kulliyah Al-Khams; Sebagai Konsep Penjamin Hak Kebebasan Beragama Berkeyakinan

The case of intolerance and restrictions on the right to religious freedom is a never-ending discourse. That is because these cases still occur in Indonesia with such high numbers. In the last five years, data shows an increase in cases of intolerance and restrictions on religious freedom. In this condition, it turns out that the right to freedom of religion and belief has not provided benefits for minority groups. This paper tries to reveal how the rights to freedom of religion and belief are upheld by the norms of Human Rights and the State as the guarantor. This article also tries to reveal that even Islam with the teachings of tolerance and the concept of Al-Mabadi 'Al-Khamsah and Al-Kulliyah Al-Khams provide support for the creation of justice, peace and harmonious relations between humans.

Proving Gödel's Completeness and Incompleteness theorems (in restricted cases) using Sd - Topology over the theory of a Model

Proving Gödel's Completeness and Incompleteness theorems (in restricted cases) using Sd - Topology over the theory of a Model