Fear induced explosive transitions in the dynamics of corruption

In this article, we analyze a compartmental model aimed at mimicking the role of imitation and delation of corruption in social systems. In particular, the model relies on a compartmental dynamics in which individuals can transit between three states: honesty, corruption, and ostracism. We model the transitions from honesty to corruption and from corruption to ostracism as pairwise interactions. In particular, honest agents imitate corrupt peers while corrupt individuals pass to ostracism due to the delation of honest acquaintances. Under this framework, we explore the effects of introducing social intimidation in the delation of corrupt people. To this aim, we model the probability that an honest delates a corrupt agent as a decreasing function of the number of corrupt agents, thus mimicking the fear of honest individuals to reprisals by those corrupt ones. When this mechanism is absent or weak, the phase diagram of the model shows three equilibria [(i) full honesty, (ii) full corruption, and (iii) a mixed state] that are connected via smooth transitions. However, when social intimidation is strong, the transitions connecting these states turn explosive leading to a bistable phase in which a stable full corruption phase coexists with either mixed or full honesty stable equilibria. To shed light on the generality of these transitions, we analyze the model in different network substrates by means of Monte Carlo simulations and deterministic microscopic Markov chain equations. This latter formulation allows us to derive analytically the different bifurcation points that separate the different phases of the system

Major Adverse Cardiovascular Events in Coronary Type 2 Diabetic Patients: Identification of Associated Factors Using Electronic Health Records and Natural Language Processing

Diabetes mellitus; Natural language processing; Risk factorsDiabetis mellitus; Processament del llenguatge natural; Factors de riscDiabetes mellitus; Procesamiento del lenguaje natural; Factores de riesgoPatients with Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are at high risk of developing major adverse cardiovascular events (MACE). This is a multicenter, retrospective, and observational study performed in Spain aimed to characterize these patients in a real-world setting. Unstructured data from the Electronic Health Records were extracted by EHRead®, a technology based on Natural Language Processing and machine learning. The association between new MACE and the variables of interest were investigated by univariable and multivariable analyses. From a source population of 2,184,662 patients, we identified 4072 adults diagnosed with T2DM and CAD (62.2% male, mean age 70 ± 11). The main comorbidities observed included arterial hypertension, hyperlipidemia, and obesity, with metformin and statins being the treatments most frequently prescribed. MACE development was associated with multivessel (Hazard Ratio (HR) = 2.49) and single coronary vessel disease (HR = 1.71), transient ischemic attack (HR = 2.01), heart failure (HR = 1.32), insulin treatment (HR = 1.40), and percutaneous coronary intervention (PCI) (HR = 2.27), whilst statins (HR = 0.73) were associated with a lower risk of MACE occurrence. In conclusion, we found six risk factors associated with the development of MACE which were related with cardiovascular diseases and T2DM severity, and treatment with statins was identified as a protective factor for new MACE in this study.This study was funded by AstraZeneca Spain (Externally Sponsored Scientific Research, ESR-18-13815) and sponsored by the Spanish Society of Cardiology

Understanding the unsteady pressure field inside combustion chambers of compression-ignited engines using a computational fluid dynamics approach

[EN] In this article, a numerical methodology for assessing combustion noise in compression ignition engines is described with the specific purpose of analysing the unsteady pressure field inside the combustion chamber. The numerical results show consistent agreement with experimental measurements in both the time and frequency domains. Nonetheless, an exhaustive analysis of the calculation convergence is needed to guarantee an independent solution. These results contribute to the understanding of in-cylinder unsteady processes, especially of those related to combustion chamber resonances, and their effects on the radiated noise levels. The method was applied to different combustion system configurations by modifying the spray angle of the injector, evidencing that controlling the ignition location through this design parameter, it is possible to decrease the combustion noise by minimizing the resonance contribution. Important efficiency losses were, however, observed due to the injector/bowl matching worsening which compromises the performance and emissions levels.The authors want to express their gratitude to CONVERGENT SCIENCE Inc. and Convergent Science GmbH for their kind support for performing the CFD calculations using CONVERGE software.Torregrosa, AJ.; Broatch, A.; Margot, X.; Gómez-Soriano, J. (2018). Understanding the unsteady pressure field inside combustion chambers of compression-ignited engines using a computational fluid dynamics approach. International Journal of Engine Research. 1-13. https://doi.org/10.1177/1468087418803030S113Benajes, J., Novella, R., De Lima, D., & Tribotté, P. (2014). Analysis of combustion concepts in a newly designed two-stroke high-speed direct injection compression ignition engine. International Journal of Engine Research, 16(1), 52-67. doi:10.1177/1468087414562867Costa, M., Bianchi, G. M., Forte, C., & Cazzoli, G. (2014). 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Assessment of combustion noise in a premixed swirled combustor via Large-Eddy Simulation. Computers & Fluids, 78, 1-9. doi:10.1016/j.compfluid.2010.09.034Jamrozik, A., Tutak, W., Kociszewski, A., & Sosnowski, M. (2013). Numerical simulation of two-stage combustion in SI engine with prechamber. Applied Mathematical Modelling, 37(5), 2961-2982. doi:10.1016/j.apm.2012.07.040Qin, W., Xie, M., Jia, M., Wang, T., & Liu, D. (2014). Large eddy simulation of in-cylinder turbulent flows in a DISI gasoline engine. Applied Mathematical Modelling, 38(24), 5967-5985. doi:10.1016/j.apm.2014.05.004Broatch, A., Margot, X., Novella, R., & Gomez-Soriano, J. (2016). Combustion noise analysis of partially premixed combustion concept using gasoline fuel in a 2-stroke engine. Energy, 107, 612-624. doi:10.1016/j.energy.2016.04.045Torregrosa, A. J., Broatch, A., Martín, J., & Monelletta, L. (2007). 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Assessment of flamelet versus multi-zone combustion modeling approaches for stratified-charge compression ignition engines. International Journal of Engine Research, 17(3), 280-290. doi:10.1177/1468087415571006Torregrosa, A. J., Broatch, A., Gil, A., & Gomez-Soriano, J. (2018). Numerical approach for assessing combustion noise in compression-ignited Diesel engines. Applied Acoustics, 135, 91-100. doi:10.1016/j.apacoust.2018.02.006Torregrosa, A., Olmeda, P., Degraeuwe, B., & Reyes, M. (2006). A concise wall temperature model for DI Diesel engines. Applied Thermal Engineering, 26(11-12), 1320-1327. doi:10.1016/j.applthermaleng.2005.10.021Broatch, A., Javier Lopez, J., García-Tíscar, J., & Gomez-Soriano, J. (2018). Experimental Analysis of Cyclical Dispersion in Compression-Ignited Versus Spark-Ignited Engines and Its Significance for Combustion Noise Numerical Modeling. Journal of Engineering for Gas Turbines and Power, 140(10). doi:10.1115/1.4040287Molina, S., García, A., Pastor, J. 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Numerical approach for assessing combustion noise in compression-ignited Diesel engines

[EN] Diesel combustion noise has become a crucial aspect for the engine manufacturers due to its impact on human health and influence on the customer purchasing decision. The interaction of the pressure waves after mixture self-ignition induces cavity resonances inside the combustion chamber. This complex phenomenon produces high-frequency pressure oscillations, hence traditional in-cylinder measurements do not provide enough information to characterise the in-cylinder acoustic field. In this paper, a numerical methodology is proposed for assessing the Diesel combustion as a noise source and to overcome measurement limitations. An optimisation procedure is also presented in order to determine the numerical calculation parameters, boundary conditions definition and initialization. Results show that local flow conditions at the start of combustion have a strong influence on the acoustic response of the in-cylinder noise source. These particular conditions are only achievable by the proposed methodology which considers entire engine cycle simulations with the complete cylinder domain. Therefore, traditional Computational Fluid Dynamic (CFD) approaches, such those used for predicting combustion stability or pollutant emissions, are not suitable for reproducing the physical mechanisms of noise generation and they cannot be used for acoustic purposes. The reliability of the proposed methodology to simulate the acoustic field accurately inside the combustion chamber has been validated by comparison with experiments.The equipment used in this work has been partially supported by FEDER project funds "Dotacion de infraestructuras cientifico tecnicas para el Centro Integral de Mejora Energdtica y Medioambiental de Sistemas de Transporte (CiMeT), (FEDER-ICTS-2012-06)", framed in the operational program of unique scientific and technical infrastructure of the Spanish Ministerio de Economia y Competitividad. J. Gomez-Soriano is partially supported through the "Programa de Apoyo para la Investigacion y Desarrollo (PAID)" of Universitat Politecnica de Valencia [Grant No. FPI-S2-2016-1353].Torregrosa, AJ.; Broatch, A.; Gil, A.; Gómez-Soriano, J. (2018). Numerical approach for assessing combustion noise in compression-ignited Diesel engines. Applied Acoustics. 135:91-100. https://doi.org/10.1016/j.apacoust.2018.02.006S9110013

Development and Validation of Hepamet Fibrosis Scoring System-a Simple, Non-invasive Test to Identify Patients With Nonalcoholic Fatty liver Disease With Advanced Fibrosis

BACKGROUND & AIMS: Fibrosis affects prognoses for patients with nonalcoholic fatty liver disease (NAFLD). Several non-invasive scoring systems have aimed to identify patients at risk for advanced fibrosis, but inconclusive results and variations in features of patients (diabetes, obesity and older age) reduce their diagnostic accuracy. We sought to develop a scoring system based on serum markers to identify patients with NAFLD at risk for advanced fibrosis. METHODS: We collected data from 2452 patients with NAFLD at medical centers in Italy, France, Cuba, and China. We developed the Hepamet fibrosis scoring system using demographic, anthropometric, and laboratory test data, collected at time of liver biopsy, from a training cohort of patients from Spain (n=768) and validated the system using patients from Cuba (n=344), Italy (n=288), France (n=830), and China (n=232). Hepamet fibrosis score (HFS) were compared with those of previously developed fibrosis scoring systems (the NAFLD fibrosis score [NFS] and FIB-4). The diagnostic accuracy of the Hepamet fibrosis scoring system was assessed based on area under the receiver operating characteristic (AUROC) curve, sensitivity, specificity, diagnostic odds ratio, and positive and negative predictive values and likelihood ratios. RESULTS: Variables used to determine HFS were patient sex, age, homeostatic model assessment score, presence of diabetes, levels of aspartate aminotransferase, and albumin, and platelet counts; these were independently associated with advanced fibrosis. HFS discriminated between patients with and without advanced fibrosis with an AUROC curve value of 0.85 whereas NFS or FIB-4 did so with AUROC values of 0.80 (P=.0001). In the validation set, cut-off HFS of 0.12 and 0.47 identified patients with and without advanced fibrosis with 97.2% specificity, 74% sensitivity, a 92% negative predictive value, a 76.3% positive predictive value, a 13.22 positive likelihood ratio, and a 0.31 negative likelihood ratio. HFS were not affected by patient age, body mass index, hypertransaminasemia, or diabetes. The Hepamet fibrosis scoring system had the greatest net benefit in identifying patients who should undergo liver biopsy analysis and led to significant improvements in reclassification, reducing the number of patients with undetermined results to 20% from 30% for the FIB-4 and NFS systems (P<.05). CONCLUSIONS: Using clinical and laboratory data from patients with NAFLD, we developed and validated the Hepamet fibrosis scoring system, which identified patients with advanced fibrosis with greater accuracy than the FIB-4 and NFS systems. the Hepamet system provides a greater net benefit for the decision-making process to identify patients who should undergo liver biopsy analysis

Staphylococcus aureus bacteriuria as a prognosticator for outcome of Staphylococcus aureus bacteremia: a case-control study

<p>Abstract</p> <p>Background</p> <p>When <it>Staphylococcus aureus </it>is isolated in urine, it is thought to usually represent hematogenous spread. Because such spread might have special clinical significance, we evaluated predictors and outcomes of <it>S. aureus </it>bacteriuria among patients with <it>S. aureus </it>bacteremia.</p> <p>Methods</p> <p>A case-control study was performed at John H. Stroger Jr. Hospital of Cook County among adult inpatients during January 2002-December 2006. Cases and controls had positive and negative urine cultures, respectively, for <it>S. aureus</it>, within 72 hours of positive blood culture for <it>S. aureus</it>. Controls were sampled randomly in a 1:4 ratio. Univariate and multivariable logistic regression analyses were done.</p> <p>Results</p> <p>Overall, 59% of patients were African-American, 12% died, 56% of infections had community-onset infections, and 58% were infected with methicillin-susceptible <it>S. aureus </it>(MSSA). Among 61 cases and 247 controls, predictors of <it>S. aureus </it>bacteriuria on multivariate analysis were urological surgery (OR = 3.4, p = 0.06) and genitourinary infection (OR = 9.2, p = 0.002). Among patients who died, there were significantly more patients with bacteriuria than among patients who survived (39% vs. 17%; p = 0.002). In multiple Cox regression analysis, death risks in bacteremic patients were bacteriuria (hazard ratio 2.9, CI 1.4-5.9, p = 0.004), bladder catheter use (2.0, 1.0-4.0, p = 0.06), and Charlson score (1.1, 1.1-1.3, p = 0.02). Neither length of stay nor methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) infection was a predictor of <it>S. aureus </it>bacteriuria or death.</p> <p>Conclusions</p> <p>Among patients with <it>S. aureus </it>bacteremia, those with <it>S. aureus </it>bacteriuria had 3-fold higher mortality than those without bacteriuria, even after adjustment for comorbidities. Bacteriuria may identify patients with more severe bacteremia, who are at risk of worse outcomes.</p

HTLV-1 infection in solid organ transplant donors and recipients in Spain

Background: HTLV-1 infection is a neglected disease, despite infecting 10–15 million people worldwide and severe illnesses develop in 10% of carriers lifelong. Acknowledging a greater risk for developing HTLV-1 associated illnesses due to immunosuppression, screening is being widely considered in the transplantation setting. Herein, we report the experience with universal HTLV testing of donors and recipients of solid organ transplants in a survey conducted in Spain. Methods: All hospitals belonging to the Spanish HTLV network were invited to participate in the study. Briefly, HTLV antibody screening was performed retrospectively in all specimens collected from solid organ donors and recipients attended since the year 2008. Results: A total of 5751 individuals were tested for HTLV antibodies at 8 sites. Donors represented 2312 (42.2%), of whom 17 (0.3%) were living kidney donors. The remaining 3439 (59.8%) were recipients. Spaniards represented nearly 80%. Overall, 9 individuals (0.16%) were initially reactive for HTLV antibodies. Six were donors and 3 were recipients. Using confirmatory tests, HTLV-1 could be confirmed in only two donors, one Spaniard and another from Colombia. Both kidneys of the Spaniard were inadvertently transplanted. Subacute myelopathy developed within 1 year in one recipient. The second recipient seroconverted for HTLV-1 but the kidney had to be removed soon due to rejection. Immunosuppression was stopped and 3 years later the patient remains in dialysis but otherwise asymptomatic. Conclusion: The rate of HTLV-1 is low but not negligible in donors/recipients of solid organ transplants in Spain. Universal HTLV screening should be recommended in all donor and recipients of solid organ transplantation in Spain. Evidence is overwhelming for very high virus transmission and increased risk along with the rapid development of subacute myelopath

Infection control, genetic assessment of drug resistance and drug susceptibility testing in the current management of multidrug/extensively-resistant tuberculosis (M/XDR-TB) in Europe: A tuberculosis network European Trialsgroup (TBNET) study

Aim Europe has the highest documented caseload and greatest increase in multidrug and extensively drug-resistant tuberculosis (M/XDR-TB) of all World Health Organization (WHO) regions. This survey examines how recommendations for M/XDR-TB management are being implemented. Methods TBNET is a pan-European clinical research collaboration for tuberculosis. An email survey of TBNET members collected data in relation to infection control, access to molecular tests and basic microbiology with drug sensitivity testing. Results 68/105 responses gave valid information and were from countries within the WHO European Region. Inpatient beds matched demand, but single rooms with negative pressure were only available in low incidence countries; ultraviolet decontamination was used in 5 sites, all with &gt;10 patients with M/XDR-TB per year. Molecular tests for mutations associated with rifampicin resistance were widely available (88%), even in lower income and especially in high incidence countries. Molecular tests for other first line and second line drugs were less accessible (76 and 52% respectively). A third of physicians considered that drug susceptibility results were delayed by &gt; 2 months. Conclusion Infection control for inpatients with M/XDR-TB remains a problem in high incidence countries. Rifampicin resistance is readily detected, but tests to plan regimens tailored to the drug susceptibilities of the strain of Mycobacterium tuberculosis are significantly delayed, allowing for further drug resistance to develop