Modification and Assessment of the Bedside Pediatric Early Warning Score in the Pediatric Allogeneic Hematopoietic Cell Transplant Population

OBJECTIVES: To determine the validity of the Bedside Pediatric Early Warning Score system in the hematopoietic cell transplant population, and to determine if the addition of weight gain further strengthens the association with need for PICU admission. DESIGN: Retrospective cohort study of pediatric allogeneic hematopoietic cell transplant patients from 2009 to 2016. Daily Pediatric Early Warning Score and weights were collected during hospitalization. Logistic regression was used to identify associations between maximum Pediatric Early Warning Score or Pediatric Early Warning Score plus weight gain and the need for PICU intervention. The primary outcome was need for PICU intervention; secondary outcomes included mortality and intubation. SETTING: A large quaternary free-standing children's hospital. PATIENTS: One-hundred two pediatric allogeneic hematopoietic cell transplant recipients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 102 hematopoietic cell transplant patients included in the study, 29 were admitted to the PICU. The median peak Pediatric Early Warning Score was 11 (interquartile range, 8-13) in the PICU admission cohort, compared with 4 (interquartile range, 3-5) in the cohort without a PICU admission (p < 0.0001). Pediatric Early Warning Score greater than or equal to 8 had a sensitivity of 76% and a specificity of 90%. The area under the receiver operating characteristics curve was 0.83. There was a high negative predictive value at this Pediatric Early Warning Score of 90%. When Pediatric Early Warning Score greater than or equal to 8 and weight gain greater than or equal to 7% were compared together, the area under the receiver operating characteristic curve increased to 0.88. CONCLUSIONS: In this study, a Pediatric Early Warning Score greater than or equal to 8 was associated with PICU admission, having a moderately high sensitivity and high specificity. This study adds to literature supporting Pediatric Early Warning Score monitoring for hematopoietic cell transplant patients. Combining weight gain with Pediatric Early Warning Score improved the discriminative ability of the model to predict the need for critical care, suggesting that incorporation of weight gain into Pediatric Early Warning Score may be beneficial for monitoring of hematopoietic cell transplant patients

The Domain Interface of the Human Glutamate Transporter EAAT1 Mediates Chloride Permeation

AbstractThe concentration of glutamate within the glutamatergic synapse is tightly regulated by the excitatory amino-acid transporters (EAATs). In addition to their primary role of clearing extracellular glutamate, the EAATs also possess a thermodynamically uncoupled Cl− conductance. Several crystal structures of an archaeal EAAT homolog, GltPh, at different stages of the transport cycle have been solved. In a recent structure, an aqueous cavity located at the interface of the transport and trimerization domains has been identified. This cavity is lined by polar residues, several of which have been implicated in Cl− permeation. We hypothesize that this cavity opens during the transport cycle to form the Cl− channel. Residues lining this cavity in EAAT1, including Ser-366, Leu-369, Phe-373, Arg-388, Pro-392, and Thr-396, were mutated to small hydrophobic residues. Wild-type and mutant transporters were expressed in Xenopus laevis oocytes and two-electrode voltage-clamp electrophysiology, and radiolabeled substrate uptake was used to investigate function. Significant alterations in substrate-activated Cl− conductance were observed for several mutant transporters. These alterations support the hypothesis that this aqueous cavity at the interface of the transport and trimerization domains is a partially formed Cl− channel, which opens to form a pore through which Cl− ions pass. This study enhances our understanding as to how glutamate transporters function as both amino-acid transporters and Cl− channels

User quality of experience of mulsemedia applications

User Quality of Experience (QoE) is of fundamental importance in multimedia applications and has been extensively studied for decades. However, user QoE in the context of the emerging multiple-sensorial media (mulsemedia) services, which involve different media components than the traditional multimedia applications, have not been comprehensively studied. This article presents the results of subjective tests which have investigated user perception of mulsemedia content. In particular, the impact of intensity of certain mulsemedia components including haptic and airflow on user-perceived experience are studied. Results demonstrate that by making use of mulsemedia the overall user enjoyment levels increased by up to 77%

Interpretation and reporting of process capability results: focus on improvement

A global financial services company followed a software-mediated process assessment (SMPA) approach based on ISO/IEC 15504, ISO/IEC 20000 and the IT Infrastructure Library (ITIL®). Using an action research approach, the Incident Management, Problem Management, and Change Management processes were assessed at two points in time during an ITSM process improvement project. This paper analyzes the results of the process assessments, highlights issues with the interpretation of the results, and offers an alternative method to report process capability results to motivate process improvement. The study found that by using the proportion of SMPA recommendations as a proxy measure for process improvement, the processes did improve yielding fewer recommendations in cycle 2 when compared to cycle 1 of the action research

Mulsemedia: State of the art, perspectives, and challenges

Mulsemedia-multiple sensorial media-captures a wide variety of research efforts and applications. This article presents a historic perspective on mulsemedia work and reviews current developments in the area. These take place across the traditional multimedia spectrum-from virtual reality applications to computer games-as well as efforts in the arts, gastronomy, and therapy, to mention a few. We also describe standardization efforts, via the MPEG-V standard, and identify future developments and exciting challenges the community needs to overcome

How large are the level sets of the Takagi function?

Let T be Takagi's continuous but nowhere-differentiable function. This paper considers the size of the level sets of T both from a probabilistic point of view and from the perspective of Baire category. We first give more elementary proofs of three recently published results. The first, due to Z. Buczolich, states that almost all level sets (with respect to Lebesgue measure on the range of T) are finite. The second, due to J. Lagarias and Z. Maddock, states that the average number of points in a level set is infinite. The third result, also due to Lagarias and Maddock, states that the average number of local level sets contained in a level set is 3/2. In the second part of the paper it is shown that, in contrast to the above results, the set of ordinates y with uncountably infinite level sets is residual, and a fairly explicit description of this set is given. The paper also gives a negative answer to a question of Lagarias and Maddock by showing that most level sets (in the sense of Baire category) contain infinitely many local level sets, and that a continuum of level sets even contain uncountably many local level sets. Finally, several of the main results are extended to a version of T with arbitrary signs in the summands.Comment: Added a new Section 5 with generalization of the main results; some new and corrected proofs of the old material; 29 pages, 3 figure

A Holder Continuous Nowhere Improvable Function with Derivative Singular Distribution

We present a class of functions $\mathcal{K}$ in $C^0(\R)$ which is variant of the Knopp class of nowhere differentiable functions. We derive estimates which establish \mathcal{K} \sub C^{0,\al}(\R) for 0<\al<1 but no $K \in \mathcal{K}$ is pointwise anywhere improvable to C^{0,\be} for any \be>\al. In particular, all $K$'s are nowhere differentiable with derivatives singular distributions. $\mathcal{K}$ furnishes explicit realizations of the functional analytic result of Berezhnoi. Recently, the author and simulteously others laid the foundations of Vector-Valued Calculus of Variations in $L^\infty$ (Katzourakis), of $L^\infty$-Extremal Quasiconformal maps (Capogna and Raich, Katzourakis) and of Optimal Lipschitz Extensions of maps (Sheffield and Smart). The "Euler-Lagrange PDE" of Calculus of Variations in $L^\infty$ is the nonlinear nondivergence form Aronsson PDE with as special case the $\infty$-Laplacian. Using $\mathcal{K}$, we construct singular solutions for these PDEs. In the scalar case, we partially answered the open $C^1$ regularity problem of Viscosity Solutions to Aronsson's PDE (Katzourakis). In the vector case, the solutions can not be rigorously interpreted by existing PDE theories and justify our new theory of Contact solutions for fully nonlinear systems (Katzourakis). Validity of arguments of our new theory and failure of classical approaches both rely on the properties of $\mathcal{K}$.Comment: 5 figures, accepted to SeMA Journal (2012), to appea

Virtual Shaping on NACA 0015 by Means of a High Momentum Coefficient Synthetic Jet

Results concerning flow control on a NACA 0015 airfoil using high power synthetic jets are presented for low incidences and for Reynolds numbers ranging from 132000 to 425000. The forcing was operated through a spanwise slit positioned near the leading edge at x/c=1.25% or at x/c=10% on the upper surface. Static pressure distribution measurements around the airfoil, wake surveys and smoke flow visualizations were performed. Pressure distributions were significantly modified around the injection location, showing an area of intense suction which increased the lift and strongly affected the drag. Flow visualizations highlighted that the intense suction was due to a virtual shaping effect caused by the formation of a recirculation bubble capable of displacing the streamlines. Low momentum deficits in the wake velocity distributions and, in certain conditions, jet-like flow was observed for the forced cases. Finally, a scaling law relating the bubble size to the forcing intensity is propose

Hairs on the cosmological horizon

We investigate the possibility of having hairs on the cosmological horizon. The cosmological horizon shares similar properties of black hole horizons in the aspect of having hairs on the horizons. For those theories admitting haired black hole solutions, the nontrivial matter fields may reach and extend beyond the cosmological horizon. For Q-stars and boson stars, the matter fields cannot reach the cosmological horizon. The no short hair conjecture keeps valid, despite the asymptotic behavior (de Sitter or anti-de Sitter) of black hole solutions. We prove the no scalar hair theorem for anti-de Sitter black holes. Using the Bekenstein's identity method, we also prove the no scalar hair theorem for the de Sitter space and de Sitter black holes if the scalar potential is convex.Comment: Revtex, no figures, 16 page