Secondary Gain Research Articles

Untangling Real Gravity

We derive a real gravity equation and gain several new insights that were hidden in the nominal specification used so far. Most importantly, the real effective exchange rate (REER) of the exporter and, via the importer's terms of trade, also the importer's REER matter, and we can identify the elasticity of substitution. We estimate real gravity for 18 OECD countries. Therefore, we extend the untangling normalization method from an “it” to an “ijt” panel data model and use it to exploit all variables proposed by theory, despite a broad set of fixed effects (FE). We find that both REERs are important and estimate an elasticity of substitution of 1.5. If we assume homogeneous parameters, as is common, the remaining unexplained exporter-time and importer-time deviations are still substantial, relaxing this assumption improves this. We now explain 64 and 70% of the exporter-time and importer-time deviations, respectively, and thus the majority of the exporter and importer multilateral resistances. Untangling normalization helps to get a better view of what is still unexplained by theory.

A STEP-NC compliant robotic machining platform for advanced manufacturing

In the era of advanced, intelligent, and flexible manufacturing, machining with industrial robots, it is expected to be set up in the next few years. This is due to the vast progress of these robots in terms of precision and stiffness. Moreover, there is a recent development of off-line programming. Consequently, industrial robots offer a real gain of modularity, flexibility, and access for machining on production lines, and are viable solutions to improve the productivity. At the same time, all the potentials of CAD/CAM solutions available for machining off-line programming are not fully exploited because of old G-code (ISO 6963, 1980) language that only enables the description of elementary actions and tools moves. In the context of Industry 4.0 and the development of smart equipments at all levels of production chain, the manufacturing digital thread has to be profoundly reconsidered in order to guarantee high-level information from the design to the manufacturing. In this paper, a solution is proposed based on the high-level programming STEP-NC standard combined with a suitable CAD/CAM solution for industrial robots machining. A complete platform has been developed to enable advanced and intelligent manufacturing with the possibility to integrate several modules of simulation, optimization, and visualization, as well as in-process fabrication adaptation, cloud manufacturing, and machine learning with database analytics.

Intentional inattention: Detecting feigned attention-deficit/hyperactivity disorder on the Personality Assessment Inventory.

Given the increasing number of college students seeking Attention-Deficit/Hyperactivity Disorder (ADHD) diagnoses as well as the potential secondary gains associated with this disorder (e.g., access to stimulant medication, academic accommodations), the detection of malingered symptom presentations in this population is a major concern. The present study examined the ability of validity indicators on the widely used Personality Assessment Inventory (PAI; Morey, 1991) to distinguish between individuals experiencing genuine ADHD symptoms and individuals instructed to present with ADHD symptomatology for secondary gain. Sixty-six participants who successfully simulated ADHD (based on elevations on the Conners' Adult ADHD Rating Scale; Conners, Erhardt, & Sparrow, 1998) were compared with a sample of undergraduate students meeting diagnostic criteria for ADHD (N = 22) and an archival sample of adults who received an ADHD diagnosis at a university psychology clinic following a comprehensive psychological evaluation (N = 41). Successful simulators obtained significantly higher scores on all relevant PAI validity indicators compared with the clinical and archival comparison samples, with the Rogers Discriminant Function demonstrating the highest predictive accuracy (AUC = .86). Traditional cut scores on the Negative Impression (NIM) validity scale used to designate probable malingering, however, were not sensitive to simulated ADHD symptoms, although they did demonstrate excellent specificity. The PAI may be informative as an indicator of potentially exaggerated or malingered symptom presentation, but alternative cut scores for symptom validity indicators may be necessary to maximize its utility in these particular types of psychological evaluations. (PsycINFO Database Record

재발성 자가유발성 이하선 기종 1예

Pneumoparotid is a rare cause of enlargement of the parotid gland. Recurrent pneumoparotid has been described in patients who generate increased intraoral pressure when playing wind instruments. Self-induced pneumoparotid has been reported to be a result of psychosomatic disorder, unintentional habit, and it is sometimes self-induced by patients to achieve secondary gain. We report a case of recurrent self-induced pneumoparotid developed by repeated behavior of insufflation. (J Clinical Otolaryngol 2017;28:307-310)

Low molecular weight heparin as an anticoagulation strategy for left-sided ablation procedures.

This quality improvement study was implemented to demonstrate consistent and reliable post procedure anticoagulation for patients undergoing left-sided ablations. We evaluated the safety and efficacy of anticoagulation practice during a transition from anticoagulation with overnight infusion of unfractionated heparin to a single subcutaneous injection of low molecular weight heparin. Outcomes for patients who received unfractionated heparin from January 2014 to October 2014, were compared with outcomes of patients who received low molecular weight heparin from October 2014 to October 2015. Complications prepractice and postpractice change were documented and compared to establish confidence in the practice change and confirm the safety of the anticoagulation therapy management. There were no differences in the type or frequency of complications/adverse events demonstrated between the patients who had received unfractionated heparin for anticoagulation prophylaxis and those who received low molecular weight heparin. No thromboembolic events were reported or documented with either anticoagulation strategy. After confidence in the safety and efficacy of the practice change was established, a decision was made to discharge patients home the same day as there procedure, effectively reducing inpatient bed days and overall costs. Administration of low molecular weight heparin provides predictable anticoagulation and equally safe as unfractionated heparin when administered to patients post left-sided ablation. A secondary gain has been reduction of procedural costs by elimination of the previously required inpatient observation stay.

Utility of the Personality Assessment Inventory in detecting feigned Attention-Deficit/Hyperactivity Disorder (ADHD): The Feigned Adult ADHD index

The high potential for secondary gain among college students presenting for Attention-Deficit/Hyperactivity Disorder (ADHD) evaluations highlights the need for psychometrically sound embedded validity indicators. The purpose of this study was to develop new validity indicators specific to feigned ADHD for the Personality Assessment Inventory (PAI) and compare them to preexisting imbedded PAI validity measures. PAI scales that were theoretically related to feigned ADHD were evaluated. A binomial (ADHD simulators, n = 138, and genuine ADHD, n = 142) logistic regression was conducted with selected PAI scales and subscales. Classification rates were compared between the new and existing validity scales. A similar approach was used for item-level data in a second study in a subgroup of the original sample. The derived PAI scale-based logistic regression had a sensitivity of 54% and specificity of 92%. This algorithm accurately identified 97% of healthy controls as not feigning ADHD and correctly identified 98% of a no diagnosis group and 75% of a mood/anxiety disorders group. Classification accuracy of the new index was superior to the majority of existing PAI validity scales across groups. An item-level PAI algorithm had a sensitivity of 85% and specificity of 97% for identifying feigned ADHD. New validity measures were compared to existing PAI validity indicators and performed better than many of them in this study. The algorithms developed in this study of ADHD simulators and genuine ADHD cases have adequate sensitivity and good specificity and appear to function differently than other PAI symptom validity scales.

Evaluation of a novel biodegradable thermosensitive keto-hydrogel for improving postoperative pain in a rat model.

This study evaluates the sustained analgesic effect of ketorolac-eluting thermosensitive biodegradable hydrogel in the plantar incisional pain model of the rat hind-paw. A ketorolac-embedded 2, 2'-Bis (2-oxazolin) (BOX) linking methoxy-poly(ethylene glycol) and poly(lactide-co-glycolide) (mPEG-PLGA) diblock copolymer (BOX copolymer) was synthesized as keto-hydrogel based on optimal sol-gel phase transition and in vitro drug release profile. The effect of keto-hydrogel on postoperative pain (POP) was assessed using the established plantar incisional pain model in hind-paw of rats and compared to that of ketorolac solution. Pain and sensory threshold, as well as pain scoring, were evaluated with behavioral tests by means of anesthesiometer and incapacitance apparatus, respectively. Pro-inflammatory cytokine levels (TNF-α, IL-6, VEGF, and IL-1β) around incisional wounds were measured by ELISA. Tissue histology was assessed using hematoxylin and eosin and Masson’s trichrome staining. Ten mg/mL (25 wt%) keto-hydrogel showed a sol-gel transition at 26.4°C with a 10-day sustained drug release profile in vitro. Compared to ketorolac solution group, the concentration of ketorolac in tissue fluid was higher in the keto-hydrogel group during the first 18 h of application. Keto-hydrogel elevated pain and sensory threshold, increased weight-bearing capacity, and significantly reduced the levels of TNF-α, IL-6, and IL-1β while enhanced VEGF in tissue fluid. Histologic analysis reveals greater epithelialization and collagen deposition around wound treated with keto-hydrogel. In conclusion, our study suggests that keto-hydrogel is an ideal compound to treat POP with a secondary gain of improved incisional wound healing.

Common pain generators after total shoulder arthroplasty and their pesky relatives

Although anatomic and reverse total shoulder arthroplasty (TSA) are generally very successful procedures with predictable pain relief, a small percentage of patients experience refractory pain postoperatively. Common etiologies of pain following such surgery are infection and joint instability in the early postoperative period, as well as implant loosening beyond 2 years postoperatively. However, once these causes of pain are ruled out, less common etiologies should be considered. These less common causes of postoperative pain include psychological factors (i.e., depression and anxiety), physiologic (i.e., narcotic dependence and neurologic), mechanical (i.e., symptomatic hardware and acromioclavicular arthritis), or secondary gain (i.e., workman’s compensation and insurance issues).

The Severe Impairment Profile: A Conceptual Shift

The current study sought to evaluate and replicate the severe impairment profile (SIP) of the Word Memory Test (WMT) in patients referred for dementia evaluations. The sample consisted of 125 patients referred for a neuropsychological evaluation at a large Veterans Affairs Medical Center. Patients were assigned a Clinical Dementia Rating (CDR) by blind raters, and were classified according to their performance on performance validity testing. Subsequent chart reviews were conducted to help in more accurately determining the presence of severe memory impairment likely due to an underlying dementing process versus poor effort/task engagement. In our sample, 51% of patients failed easy WMT subtests and 93% of these patients obtained the SIP. The rates of failure on these easy subtests generally coincided with both more severely impaired CDR ratings, as well as more impaired delayed memory composite scores. Upon chart review, it was determined that there were likely a significant portion of classification errors using the SIP, with a positive posttest probability of impairment based on having the SIP being 65% as opposed to 28% for a negative result. Our findings suggest that the SIP does not appear to function effectively in a mixed dementia sample where there is increased potential for secondary gain. Additional concern is expressed regarding the overall likelihood of obtaining the SIP and subsequent inferential decisions related to obtaining an SIP. Future research should examine more optimal cut scores or alternative methods for more accurately classifying patients in different clinical contexts and patterns of impairment.

Direct loop gain and bandwidth measurement of phase-locked loop.

A simple and robust technique for directly measuring the loop gain and bandwidth of a phase-locked loop (PLL) is proposed. This technique can be used for the real-time measurement of the real loop gain in a closed PLL without breaking its locking state. The agreement of the measured loop gain and theoretical calculations proves the validity of the proposed measurement technique. This technique with a simple configuration can be easily expanded to other phase-locking systems whose loop gain and bandwidth should be measured precisely.

Modelling and numerical assessment of a maintenance strategy with stock through piecewise deterministic Markov processes and quasi Monte Carlo methods

To ensure a power generation level, the French national electricity supply (EDF) has to manage its producing assets by putting in place adapted preventive maintenance strategies. In this article, a fleet of identical components is considered, which are spread out all around France (one per power plant site). The components are assumed to have stochastically independent lifetimes, but they are made functionally dependent through the sharing of a common stock of spare parts. When available, these spare parts are used for both corrective and preventive replacements, with priority to corrective replacements. When the stock is empty, replacements are delayed until the arrival of new spare parts. These spare parts are expensive, and their manufacturing time is long, which makes it necessary to rigorously define their ordering process. The point of the article is to provide the decision maker with the tools to take the right decision (make or not the overhaul). To do that, two indicators are proposed, which are based on an economic variable called the net present value. The net present value stands for the difference between the cumulated discounted cash-flows of the purely corrective policy and the preventive one which including the overhaul. Piecewise deterministic Markov processes are first considered for the joint modelling of the stochastic evolution of the components, stock and ordering process with and without overhaul. The indicators are next expressed with respect to these piecewise deterministic Markov processes, which have to be numerically assessed. Instead of using the most classical Monte Carlo simulations, we here suggest alternate methods based on quasi Monte Carlo simulations, which replace the random uniform numbers of the Monte Carlo method by deterministic sequences called low-discrepancy sequences. The obtained results show a real gain of the quasi Monte Carlo methods in comparison with the Monte Carlo method. The developed tools can hence help the decision maker to take the right decision.

Abstract 3141: Combined cetuximab and pemetrexed therapy enhances cytotoxicity against crizotinib-resistant non-small cell lung cancer cells by downregulating thymidylate synthase

Abstract Although non-small cell lung cancer (NSCLC) cells with anaplastic lymphoma kinase (ALK)-rearranged initially show a dramatic response to crizotinib, these cells eventually develop resistance to crizotinib. This resistance is caused by secondary mutations and copy number gain in the ALK gene. However, other resistance mechanisms through activation of the bypass tracts have yet to be clearly elucidated. To investigate the mechanisms of acquired resistance to ALK fusion-directed treatment in NSCLC, we generated crizotinib-resistant NSCLC cell lines in vitro through chronic exposure of an ALK fusion NSCLC line (SNU2292) to crizotinib. Interestingly, the resultant SNU2292-CR cells maintained activation of epidermal growth factor receptor (EGFR) and expressed increased levels of transforming growth factor alpha (TGF-α), an EGFR ligand. Additionally, we found that thymidylate synthase (TS) was overexpressed in SNU2292-CR cells compared with the parental cells. We showed reduction of TS enhanced synergistic inhibition of cell proliferation when cetuximab, an EGFR inhibitor, was combined with pemetrexed, a TS inhibitor. As a result, combined therapy was found to exhibit a synergistic growth inhibitory effect against crizotinib-resistant cells by downregulating TS expression. Taken together, these results support a potential role of activation of the bypass tracts in acquired resistance to ALK-directed treatment in ALK-rearranged NSCLC, and provide insights into strategies for preventing and/or overcoming this resistance in patients Citation Format: Hwang-Phill Kim, Sae-Won Han, Sang-Hyun Song, Tae-You Kim. Combined cetuximab and pemetrexed therapy enhances cytotoxicity against crizotinib-resistant non-small cell lung cancer cells by downregulating thymidylate synthase [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3141. doi:10.1158/1538-7445.AM2017-3141

Abstract PL04-04: Novel approaches for personalizing treatments: From nutrition to cancer

Abstract Elevated blood glucose levels are rapidly increasing in the general population, resulting in a sharp incline in the prevalence of prediabetes and impaired glucose tolerance and eventual development of type 2 diabetes mellitus. Dietary intake is considered a central determinant of glucose levels, with high postmeal glucose levels affecting weight gain, obesity, hunger, and energy dips and being associated with increased risk of cardiovascular disease, cancer, and overall mortality. However, despite their importance, existing dietary methods for controlling postmeal glucose levels have limited efficacy. By continuously monitoring week-long glucose levels in over 1,000 people, we found high variability in the response of different people to identical meals, suggesting that generic population-wide dietary recommendations have limited utility and are ineffective in achieving proper glycemic control. We devised a machine-learning algorithm that integrates blood parameters, dietary habits, anthropometrics, physical activity, and gut microbiota measured in this cohort and showed that it accurately predicts personalized postprandial glucose responses to real-life meals. Moreover, a blinded randomized controlled dietary intervention based on this algorithm resulted in significantly lower postprandial responses in a cohort of prediabetics and consistent alterations to gut microbiota configuration. These results suggest that personalized diets may successfully modify elevated postprandial blood glucose and its metabolic consequences. As another example of personalized medicine approaches that we are developing, I present our work on functional profiling of a library of over 10,000 variants that we generated for the tumor suppressor p53, the most frequently mutated gene in human cancers. Remarkably, the mutational effects observed in large-scale in-vitro assays with this library correspond to p53 mutation recurrence in patients and provide many novel insights on adverse and benign variants, protein structure, and evolutionary conservation. Apart from gaining comprehensive insights into the effects of the p53 "mutome," our results may lead to better understanding of patients' response to treatment based on their p53 sequence, potentially contributing to the development of novel patient-specific therapeutics. Finally, I also present our studies of the mechanisms driving recurrent postdieting obesity in which we identified an intestinal microbiome signature that persists after successful dieting of obese mice. This microbiome signature contributes to faster weight regain and metabolic aberrations upon re-exposure to obesity-promoting conditions and transmits the accelerated weight regain phenotype upon interanimal transfer. Notably, a microbiome-based machine-learning algorithm enabled personalized prediction of the extent of postdieting weight regain. We further find that the microbiome contributes to diminished postdieting flavonoid levels and reduced energy expenditure and demonstrate that flavonoid-based "postbiotic" intervention ameliorates excessive secondary weight gain. These results thus highlight a possible microbiome contribution to accelerated postdieting weight regain and suggest that microbiome-targeting approaches may help to diagnose and treat this common disorder. Citation Format: Eran Segal. Novel approaches for personalizing treatments: From nutrition to cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr PL04-04. doi:10.1158/1538-7445.AM2017-PL04-04

A Cautionary Note on Measuring the Duration of FDA Drug and Device Reviews

The Prescription Drug User Fee Act (PDUFA) created rewards for the Food and Drug Administration (FDA) if it can meet goals related to the duration of the 'formal review stage' of the drug development process. Later, the Medical Device User Fee and Modernization Act (MDUFMA) set up a similar scheme for medical devices. This short note assembles some evidence showing that FDA has in recent years changed its patterns of interaction with drug and device sponsors: Some interactions or steps that previously would have been carried out during the formal review stage are now very often carried out prior to that stage. In light of these changes, it could well be that the main driver causing shorter durations of the formal review stage is not an increase in review efficiency, but rather that sponsor submission of the formal application — which is the marker in time identifying the start of the formal review stage — is happening later in the new-product development process. Sponsors are likely quite willing to submit their formal applications later so long as the development process ends no later, and indeed a sponsor may be very happy to do so if it means that its product will undergo only one 'cycle' of FDA review, since a sponsor's reputation in the medical marketplace can be damaged whenever a product does not succeed on the first cycle of FDA review. The FDA's increased interaction with sponsors prior to application submission thus may have caused a real gain in reducing needless negative shocks to sponsor reputations, but it may also mean that the much-touted success of PDUFA and MDUFMA in increasing the speed with which drugs secure FDA approval has become partially illusory or false; both of these effects, however, would be difficult to verify through observation. In the limit, continued changes in the pattern of FDA-sponsor interaction could turn the formal review stage into something of a formality, with measurements of FDA's performance during the formal review stage in turn becoming mostly meaningless.

From Harmful Treatment to Secondary Gain: Adverse Event Reporting in Dyspepsia and Gastroparesis.

Medical management of gastroparesis and functional dyspepsia remains difficult with several recent trials showing limited or no benefit. If treatment comes with only marginal improvements, concerns about adverse events become more relevant. We therefore examined the type and outcomes of side effects submitted to a public repository. We searched the Federal Adverse Event Reporting System for reports associated with the treatment of dyspepsia or gastroparesis. Demographic data, medications used and implicated, side effects, and outcomes were abstracted for the years 2004-2015. Acid-suppressive agents and prokinetics were the most commonly listed medications with a stronger emphasis on prokinetics in gastroparesis. Submissions related to metoclopramide by far exceeded reports about other agents and mostly described tardive dyskinesia or other neurological concerns. They peaked around 2012, driven by submissions through legal workers. Most reports about metoclopramide described short-term use to prevent or treat nausea and vomiting. Concerns about acid-suppressive medications increased over time and spanned a wide spectrum of potential problems, including osteoporosis, worsening renal function, or cardiac events. Despite biasing factors, such as pending legal action, the voluntary repository of adverse events provides insight into current medical practice and its associated risk. Knowing about common and uncommon, but potentially serious risks may enable patients and providers to decide on effective and safe management strategies.

A New Computational Model for Real Gains in Big Data Processing Power

A New Computational Model for Real Gains in Big Data Processing Power

Design and development of VR learning environments for children with ASD

ABSTRACTBasic social interaction and executing certain tasks can be difficult for children with autism spectrum disorder (ASD). The symptoms of such behaviour include inappropriate gestures, body language and facial expressions, lack of interest in certain tasks, cognitive disability in coordination of limbs, and a difficulty in comprehending tasks’ requirements. This paper will discuss our efforts to develop virtual learning environments for children with ASD to improve their gestures and their interests in comprehending tasks’ requirements. Virtual environments are ideal for imparting skills necessary for independence before encouraging children with ASD to try these out in the real world and gain real-life experience. A high-end solution and a simplified solution will be presented together with a discussion on their comparison study.

Gaming Addiction

Gaming Addiction

Fifteen Years of Experience from a Medical School' Clinical Skills Laboratory.

Medical Education has evolved being defined as a continuum of the medical training from the pre- to the post-graduateperiod and through a lifetime of medical practice that is mirrored in the competencies framework that several international institutionshave established. This creates a challenge to educational institutions (pre- and post-graduate) that traditionally take separate pathways. The present report is a description of the efforts carried by the School of Medicine of the University of Minhoto implement a strategy of teaching/learning methods that follows modern standards towards constructive alignment of the medicalcurriculum, from the pre- to the post-graduate. The faculty members responsible for these activities make a narrative self-report of theactivities developed and where available quantitative data from participant surveys are presented. In order to achieve a constructive alignment of educational/assessment strategies several steps were taken that focused onthe revision of the learning goals, teaching methodologies and assessment strategies. This implicated the investment in the training/certification of faculty, acquisition of simulation tools and a dedicated infrastructure. Alumni were a fundamental cornerstone asvoluntary faculty contributing to pre-graduate training, but also training their own scholar skills. Overall, courses are rate with a high rateof satisfaction among course participants. Setting up the present teaching/learning environment of the School of Medicine of the University of Minho required acollective effort of the faculty, as well a progressive investment in both acquisition of equipment and training of staff. These human andmaterial efforts, however, lead to an excellent return in learning outcomes. The main conclusion is that the constructive alignment of educational and assessment strategies towards the medicaleducation continuum needs reflective thinking on the learners' needs. The secondary gain of these initiatives is to provide opportunitiesfor junior doctors to practice teaching.

Travelling‐wave modelling of the modulation dynamic performance of wavelength‐tunable laser diodes using the integrated VPI and PICS3D software

© The Institution of Engineering and Technology. The modulation dynamic performance of a three-section bulk InGaAsP/InP tunable laser diode (TLD) operating at 1550-nm under direct intensity modulation during discontinuous tuning is investigated with the travelling-wave approach, using commercial software tools VPI and PICS3D. The authors demonstrate a strong effect of the gain spectra shape on the modulation response of the TLDs. Two models have been developed for simulation of the modulation response which incorporate real gain spectra of TLDs obtained either from experiment or ab-initio calculations: (i) the VPI + PICS3D integrated model, and (ii) the fitted parabolic shape gain model. The results obtained for both models are in good agreement. A significant ~3 times increase of the relaxation oscillation frequency and the corresponding modulation bandwidth was observed under blue wavelength tuning of the TLD over a 21-nm range from the initial 1550-nm lasing wavelength. The authors show that the main physical reason for this increase is a dispersion of the differential gain which increases about 4 to 5 times when the lasing wavelength decreases over the above tuning range. The reported enhancement of the modulation response of TLDs is important for their practical applications.