From ethnographic research to big data analytics - A case of maritime energy-efficiency optimization

The shipping industry constantly strives to achieve efficient use of energy during sea voyages. Previous research that can take advantages of both ethnographic studies and big data analytics to understand factors contributing to fuel consumption and seek solutions to support decision making is rather scarce. This paper first employed ethnographic research regarding the use of a commercially available fuel-monitoring system. This was to contextualize the real challenges on ships and informed the need of taking a bigdata approach to achieve energy efficiency(EE).Then this study constructed two machine-learning models based on the recorded voyage data of five different ferries over a one-year period. The evaluation showed that the models generalize well on different training data sets and model outputs indicated a potential for better performance than the existing commercial EE system. How this predictive-analytical approach could potentially impact the design of decision support navigational systems and management practices was also discussed. It is hoped that this inter disciplinary research could provide some enlightenment for a richer methodological framework in future maritime energy research.\ua0\ua9 2020 by the authors

From ethnographic research to big data analytics - A case of maritime energy-efficiency optimization

The shipping industry constantly strives to achieve efficient use of energy during sea voyages. Previous research that can take advantages of both ethnographic studies and big data analytics to understand factors contributing to fuel consumption and seek solutions to support decision making is rather scarce. This paper first employed ethnographic research regarding the use of a commercially available fuel-monitoring system. This was to contextualize the real challenges on ships and informed the need of taking a big data approach to achieve energy efficiency (EE). Then this study constructed two machine-learning models based on the recorded voyage data of five different ferries over a one-year period. The evaluation showed that the models generalize well on different training data sets and model outputs indicated a potential for better performance than the existing commercial EE system. How this predictive-analytical approach could potentially impact the design of decision support navigational systems and management practices was also discussed. It is hoped that this interdisciplinary research could provide some enlightenment for a richer methodological framework in future maritime energy researc

Withdrawal symptoms in children after long-term administration of sedatives and/or analgesics: A literature review. "Assessment remains troublesome"

Background: Prolonged administration of benzodiazepines and/or opioids to children in a pediatric intensive care unit (PICU) may induce physiological dependence and withdrawal symptoms. Objective: We reviewed the literature for relevant contributions on the nature of these withdrawal symptoms and on availability of valid scoring systems to assess the extent of symptoms. Methods: The databases PubMed, CINAHL, and Psychinfo (1980-June 2006) were searched using relevant key terms. Results: Symptoms of benzodiazepine and opioid withdrawal can be classified in two groups: central nervous system effects and autonomic dysfunction. However, symptoms of the two types show a large overlap for benzodiazepine and opioid withdrawal. Symptoms of gastrointestinal dysfunction in the PICU population have been described for opioid withdrawal only. Six assessment tools for withdrawal symptoms are used in children. Four of these have been validated for neonates only. Two instruments are available to specifically determine withdrawal symptoms in the PICU: the Sedation Withdrawal Score (SWS) and the Opioid Benzodiazepine Withdrawal Scale (OBWS). The OBWS is the only available assessment tool with prospective validation; however, the sensitivity is low. Conclusions: Withdrawal symptoms for benzodiazepines and opioids largely overlap. A sufficiently sensitive instrument for assessing withdrawal symptoms in PICU patients needs to be developed

Evolution of P 3 morphology in Australopithecus afarensis

The Australopithecus afarensis dental sample exhibits a wide range of variation, which is most notable in the morphology of the lower third premolar (P 3 ). P 3 morphology in the A. afarensis sample ranges from the primitive sectorial extreme in AL 128-23 to the derived, bicuspid (molarized) extreme in AL 333w-1. In this paper, the degree and patterning of variation of the 20 known A. afarensis P 3 s are examined and the evolutionary implications are discussed. Initially, a series of dental and mandibular metric criteria are evaluated to determine whether this sample may be analyzed as a single species. From the metrics, it is clear that the single species hypothesis cannot be rejected. Next, a series of morphological criteria is devised to measure P 3 molarization. Taken as a whole, the A. afarensis P 3 sample displays more variation than a sample of modern hominoids ( Pan troglodytes ) and shows a slight trend toward increased molarization through time. When separated by sex, the A. afarensis sample still displays greater variation than the chimpanzee sample; however, only the male A. afarensis specimens show a trend toward increased molarization. Additionally, the male A. afarensis P 3 s are more molarized than the female, a pattern that is seen as well (though less markedly) in the chimpanzee sample. The trend toward increased molarization over time indicates selection for grinding in A. afarensis. The sexual differences parallel those seen in the postcrania (cf. Stern and Susman: Am. J. Phys. Anthropol. 60 :279–318, 1983), as the females tend to retain the primitive condition, while the males display the derived morphology. Consequently, a model of sexual differences in niche exploitation, with the females exploiting a more arboreal environment, would seem to be supported by both the dental and postcranial evidence.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37637/1/1330730105_ftp.pd

20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years

The administration of endocrine therapy for 5 years substantially reduces recurrence rates during and after treatment in women with early-stage, estrogen-receptor (ER)-positive breast cancer. Extending such therapy beyond 5 years offers further protection but has additional side effects. Obtaining data on the absolute risk of subsequent distant recurrence if therapy stops at 5 years could help determine whether to extend treatment

A family outbreak of tinea capitis due to Trichophyton violaceum in Michigan. Its control with griseofulvin

An outbreak of tinea capitis caused by Trichophyton violaceum in five siblings of a family of eight in Michigan and its control with griseofulvin are described.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43276/1/11046_2005_Article_BF02145740.pd

Guideline for Care of Patients with the Diagnoses of Craniosynostosis: Working Group on Craniosynostosis

This guideline for care of children with craniosynostosis was developed by a national working group with representatives of 11 matrix societies of specialties and the national patients' society. All medical aspects of care for nonsyndromic and syndromic craniosynostosis are included, as well as the social and psychologic impact for the patient and their parents. Managerial aspects are incorporated as well, such as organizing a timely referral to the craniofacial center, requirements for a dedicated craniofacial center, and centralization of this specialized care. The conclusions and recommendations within this document are founded on the available literature, with a grading of the level of evidence, thereby highlighting the areas of care that are in need of high-quality research. The development of this guideline was made possible by an educational grant of the Dutch Order of Medical Specialists. The development of this guideline was supported by an educational grant of the Dutch Order of Medical Specialists

Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials

Background Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. Methods We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). Findings Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5–14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21·4% for NACT versus 15·9% for adjuvant chemotherapy (5·5% increase [95% CI 2·4–8·6]; rate ratio 1·37 [95% CI 1·17–1·61]; p=0·0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38·2% for NACT vs 38·0% for adjuvant chemotherapy; rate ratio 1·02 [95% CI 0·92–1·14]; p=0·66), breast cancer mortality (34·4% vs 33·7%; 1·06 [0·95–1·18]; p=0·31), or death from any cause (40·9% vs 41·2%; 1·04 [0·94–1·15]; p=0·45). Interpretation Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered—eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Health behind bars: can exploring the history of prison health systems impact future policy?

The value of history is, indeed, not scientific but moral … it prepares us to live more humanely in the present, and to meet rather than to foretell, the future - Carl Becker. Becker\u27s quote reminds us of the importance of revealing and understanding historical practices in order to influence actions in the future. There are compelling reasons for uncovering this history, in particular to better inform government policy makers and health advocates, and to address the impacts of growing community expectations to \u27make the punishment fit the crime\u27