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Objective Heated and humidified high flow nasal cannula (HFNC) is an increasingly used form of noninvasive respiratory support with the potential to generate significant tracheal pressure. The aim of this study was to quantify the pressure generated by HFNC within the trachea in anatomically correct, pediatric airway models. Methods 3D-printed upper airway models of a preterm neonate, term neonate, toddler, and small child were connected to a spontaneous breathing computerized lung model at age-appropriate ventilation settings. Two commercially available HFNC systems were applied to each airway model at increasing flows and the positive end-expiratory pressure (PEEP) was recorded at the level of the trachea. Results Increasing HFNC flow produced a quadratically curved increase in tracheal pressure in closed-mouth models. The maximum flow tested in each model generated a tracheal pressure of 7 cm H2O in the preterm neonate, 10 cm H2O in the term neonate, 9 cm H2O in the toddler, and 24 cm H2O in the small child. Tracheal pressure decreased by at least 50% in open-mouth models. Conclusions HFNC was found to demonstrate a predictable flow-pressure relationship that achieved sufficient distending pressure to consider treatment of pediatric obstructive sleep apnea and tracheomalacia in the closed-mouth models tested.

Mobile and context-aware applications are now a reality thanks to the increased capabilities of mobile devices. In the last twenty years, researchers had proposed several software infrastructures to help the development of context-aware applications. We verified that most of them do not store contextual data history and that few of these infrastructures take into account the privacy of contextual data. This article presents a service named COP (Contextual data Offloading service with Privacy support) to mitigate these problems. Its foundations are: (i) a context model; (ii) a privacy policies; and (iii) a list of synchronization policies. The COP aims at storing and processing the contextual data generated from several mobile devices, using the computational power of the cloud. We have implemented one experiment evaluated the impact of contextual filter processing in the mobile device and the remote environment. In this experiment, we measured the processing time and the energy consumption of COP approach. The analysis detected that the migration of data from mobile device to a remote environment is advantageous.

OBJECTIVES To assess the incidence, severity, and outcomes of pediatric acute respiratory distress syndrome following trauma using Pediatric Acute Lung Injury Consensus Conference criteria. DESIGN Retrospective cohort study. SETTING Level 1 pediatric trauma center. PATIENTS Trauma patients less than or equal to 17 years admitted to the ICU from 2009 to 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We queried electronic health records to identify patients meeting pediatric acute respiratory distress syndrome oxygenation criteria for greater than or equal to 6 hours and determined whether patients met complete pediatric acute respiratory distress syndrome criteria via chart review. We estimated associations between pediatric acute respiratory distress syndrome and outcome using generalized linear Poisson regression adjusted for age, injury mechanism, Injury Severity Score, and serious brain and chest injuries. Of 2,470 critically injured children, 103 (4.2%) met pediatric acute respiratory distress syndrome criteria. Mortality was 34.0% among pediatric acute respiratory distress syndrome patients versus 1.7% among patients without pediatric acute respiratory distress syndrome (adjusted relative risk, 3.7; 95% CI, 2.0-6.9). Mortality was 50.0% for severe pediatric acute respiratory distress syndrome at onset, 33.3% for moderate, and 30.5% for mild. Cause of death was neurologic in 60.0% and multiple organ failure in 34.3% of pediatric acute respiratory distress syndrome nonsurvivors versus neurologic in 85.4% of nonsurvivors without pediatric acute respiratory distress syndrome (p = 0.001). Among survivors, 77.1% of pediatric acute respiratory distress syndrome patients had functional disability at discharge versus 30.7% of patients without pediatric acute respiratory distress syndrome patients (p < 0.001), and only 17.5% of pediatric acute respiratory distress syndrome patients discharged home without ongoing care versus 86.4% of patients without pediatric acute respiratory distress syndrome (adjusted relative risk, 1.5; 1.1-2.1). CONCLUSIONS Incidence and mortality associated with pediatric acute respiratory distress syndrome following traumatic injury are substantially higher than previously recognized, and pediatric acute respiratory distress syndrome development is associated with high risk of poor outcome even after adjustment for underlying injury type and severity.

Os dispositivos móveis estão cada vez mais presentes no dia a dia das pessoas. No entanto, apesar da evolução das novas gerações de smartphones, a quantidade de informações e a complexidade dos procedimentos delegados a esses dispositivos, ainda impõem restrições ao processamento, principalmente relacionado ao consumo de energético. Uma solução que vem sendo utilizada para esse problema é a técnica conhecida como offloading. Nos últimos anos, várias plataformas de suporte ao offloading foram propostas. Este trabalho tem foco em uma dessas plataformas, denominado CAOS. Apesar de realizar tarefas de offloading com êxito, o CAOS ainda apresenta problemas como baixa escalabilidade. Neste estudo, descrevemos o processo de migração do CAOS para uma nova arquitetura baseada em microsserviços, evidenciando as decisões e práticas que foram adotadas nessa jornada.

Android developers extensively use exception handling to improve robustness of mobile applications. The Android architecture and the object-oriented paradigm impose complexity to the way applications handle exceptions; many different components communicate among themselves and exceptions may be raised in parts that are not responsible for handling the error. A straightforward solution is to send the exception notification to its concerning handler. However, we do not know to which extent developers are sending exception notifications between Android components. Studying and analyzing the state of the practice of exception notification in Android will allow us to identify patterns and flaws in real-world applications; drawing this panorama can help developers to construct more reliable, modular and maintainable solutions. For this purpose, we conduct an empirical study that takes 66,099 Android projects and answers: (i) if the project uses exception notification; and (ii) how notification is performed (how signaling and handling code is implemented). We found that 1,327 applications use exception notification, following different practices: 2 for sending notifications and 2 for handling the exceptions. Our study paves the way for constructing better mechanisms for communicating exception notifications in Java-based Android applications.

Mobile devices are increasingly present in people's daily lives. However, despite the substantial improvement of new generations of smartphones, the amount of information and the complexity of the procedures delegated to these devices still imposes certain restrictions on processing, especially regarding energy consumption. A promise solution to this issue is the technique known as offloading. Over the last few years, several offloading support platforms have been proposed. This work has a particular interest in one of those platforms, called CAOS. Despite its success to perform offloading tasks, CAOS still has problems such as low scalability. In this paper, we report on the refactoring of CAOS into a new microservice-based architecture. Performance and scalability evaluations were performed in both monolithic and microservices versions to show the benefits achieved with the new CAOS architecture.

Bugs appear in almost any software development. Solving all or at least a large part of them requires a great deal of time, effort, and budget. Software projects typically use issue tracking systems as a way to report and monitor bug-fixing tasks. In recent years, several researchers have been conducting bug tracking analysis to better understand the problem and thus provide means to reduce costs and improve the efficiency of the bug-fixing task. In this paper, we introduce a new dataset composed of more than 70,000 bug-fix reports from 10 years of bug-fixing activity of 55 projects from the Apache Software Foundation, distributed in 9 categories. We have mined this information from Jira issue track system concerning two different perspectives of reports with closed/resolved status: static (the latest version of reports) and dynamic (the changes that have occurred in reports over time). We also extract information from the commits (if they exist) that fix such bugs from their respective version-control system (Git). We also provide a change analysis that occurs in the reports as a way of illustrating and characterizing the proposed dataset. Once the data extraction process is an error-prone nontrivial task, we believe such initiatives like this could be useful to support researchers in further more detailed investigations.

The context-aware exception handling (CAEH) is an error recovery technique employed to improve the ubiquitous software robustness. The design of CAEH is a difficult and error-prone task. The erroneous specification of such conditions represents a critical design fault that can lead the CAEH mechanism to behave erroneously or improperly at runtime. To deal with this problem, we propose a domain-specific language for modeling CAEH, called CatchML, using a high-level interface to make the design of CAEH models simpler and more intuitive. The CatchML language is integrated into a tool to allow designers to perform automatic model verifications by looking at the errors directly in the specification code. We conducted a case study on a sample system called UbiParking with nine volunteers. The results showed that the CatchML language is easy to model the context-aware exception handling and also allowed the participants to quickly locate the injected design faults.

Acute respiratory distress syndrome (ARDS) is a restrictive lung disease with severe hypoxemia and often hypercarbia. ARDS is caused by direct (alveolar epithelial) and indirect (endothelial) injuries and is conceptually divided into three phases: acute, fibroproliferative, and repair. Diffuse disruption of the alveolar epithelial-endothelial barrier (diffuse alveolar damage) resulting in noncardiogenic pulmonary edema is the main pathologic finding. The primary pathobiological mechanisms are reduction in alveolar fluid clearance, decreased production and inactivation of surfactant, inflammation, apoptosis, and coagulopathy. With multiple causes and pathobiologic mechanisms, resolving the initial injury and restoring normal lung architecture and function are complex processes that have been difficult to model experimentally. Furthermore, regulation of normal postnatal lung development overlaps with many of the pathways of the acute and repair phases of ARDS, making extrapolation of knowledge gained from adult clinical and laboratory models to children challenging.

BACKGROUND We describe organisms found in the respiratory tracts of a multicenter cohort of pediatric hematopoietic cell transplant (HCT) recipients with respiratory failure. METHODS Twelve centers contributed up to 25 pediatric allogeneic HCT recipients requiring mechanical ventilation for respiratory failure to a retrospective database. Positive respiratory pathogens and method of obtaining sample were recorded. Outcomes were assessed using Mann-Whitney U test or chi-squared analysis. RESULTS Of the 222 patients in the database, ages 1 month through 21 years, 34.6% had a positive respiratory culture. 105 pathogens were identified in 77 patients; of those, 48.6% were viral, 34.3% bacterial, 16.2% fungal, and 1% parasitic. PICU mortality with a respiratory pathogen was 68.8% compared to 54.9% for those without a respiratory pathogen (P = .045). Those with a positive respiratory pathogen had longer PICU length of stay, 20 days (IQR 14.0, 36.8) vs 15 (IQR 6.5, 32.0), P = .002, and a longer course of mechanical ventilation, 17 days (IQR 10, 29.5) vs 8 (3, 17), P

Software unbundling consists of dividing an existing software artifact into smaller ones. Unbundling can be useful for removing clutter from the original application or separating different features that may not share the same purpose, or simply for isolating an emergent functionality that merits to be an application on its own. This phenomenon is frequent with mobile apps and it is also propagating to APIs. This paper proposes a first empirical study on unbundling to understand its effects on popular APIs. We explore the possibilities of splitting libraries into 2 or more bundles based on the use that their client projects make of them. We mine over than 71,000 client projects of 10 open source APIs and automatically generate 2,090 sub-APIs to then study their properties. We find that it is possible to have sets of different ways of using a given API and to unbundle it accordingly; the bundles can vary their representativeness and uniqueness, which is analyzed thoroughly in this study.

Code Smell can be defined as any feature in the source code of a software that may indicate possible problems. In database languages, the term Bad Smell has been used as a generalization of Code Smell, once some features that are not directly related to code also can indicate problems, such as, for instance, the inappropriate type of an index structure or a SQL query written inefficiently. Bearing in mind the recurrence of different Bad Smell, they were catalogued. Along with these catalogs, tools were developed to automatically identify Bad Smell occurrences in a given code. With the help of these tools, it has become possible to perform quick and effective analysis. In this context, this paper proposes an exploratory study about Bad Smell in PL/SQL codes, from free software projects, published on GitHub. We analyzed 20 open-source PL/SQL projects and empirically study the prevalence of bad smells. Our results showed that some smells occur together. Besides, some smells are more frequent than others. Based on this principle, this paper has the potential to aid professionals from the databases area to avoid future problems during the development of a PL/SQL project.

The BRCA Challenge is a long-term data-sharing project initiated within the Global Alliance for Genomics and Health (GA4GH) to aggregate BRCA1 and BRCA2 data to support highly collaborative research activities. Its goal is to generate an informed and current understanding of the impact of genetic variation on cancer risk across the iconic cancer predisposition genes, BRCA1 and BRCA2. Initially, reported variants in BRCA1 and BRCA2 available from public databases were integrated into a single, newly created site, www.brcaexchange.org. The purpose of the BRCA Exchange is to provide the community with a reliable and easily accessible record of variants interpreted for a high-penetrance phenotype. More than 20,000 variants have been aggregated, three times the number found in the next-largest public database at the project’s outset, of which approximately 7,250 have expert classifications. The data set is based on shared information from existing clinical databases—Breast Cancer Information Core (BIC), ClinVar, and the Leiden Open Variation Database (LOVD)—as well as population databases, all linked to a single point of access. The BRCA Challenge has brought together the existing international Evidence-based Network for the Interpretation of Germline Mutant Alleles (ENIGMA) consortium expert panel, along with expert clinicians, diagnosticians, researchers, and database providers, all with a common goal of advancing our understanding of BRCA1 and BRCA2 variation. Ongoing work includes direct contact with national centers with access to BRCA1 and BRCA2 diagnostic data to encourage data sharing, development of methods suitable for extraction of genetic variation at the level of individual laboratory reports, and engagement with participant communities to enable a more comprehensive understanding of the clinical significance of genetic variation in BRCA1 and BRCA2., Author summary The goal of this study and paper has been to develop an international resource to generate an informed and current understanding of the impact of genetic variation on cancer risk across the cancer predisposition genes, BRCA1 and BRCA2. Reported variants in BRCA1 and BRCA2 available from public databases were integrated into a single, newly created site, www.brcaexchange.org, to provide a reliable and easily accessible record of variants interpreted for a high-penetrance phenotype.

Background: Noise-induced hearing loss (NIHL) is on the rise, affecting nearly 1.1 billion young people as per the World Health Organization. It is mainly due to exposure to noise in recreational settings for prolonged duration and at high intensity resulting in unsafe listening practices. Aim and Objective: This study aims to analyze the potential risk of audio device usage and hearing loss among the students. Materials and Methods: Hearing loss among students using personal music player with headphones/earphones was assessed using a self-designed audiometry mobile application and followed by a questionnaire to those found to have hearing loss asking for their preferences of personal audio devices, usage in terms of years, duration per day, volume, content, and awareness of NIHL. Results: Among the 3000 students, 3.2% (96) of students were identified with hearing loss and 72% of the total subjects were unaware of NIHL. About 81% (78) were headphones users as compared to 19% (18) earphones users. About 50% of the subjects with hearing loss had reported usage of a personal audio device for more than 6 h per day followed by 30% who used it for 4–6 h, 16% who used it for 2–4 h followed by 4% who used it for 1–2 h per day. About 90% of students used volume settings more than 60% and 10% preferred 60–40% volume settings. About 65% of the subjects were using audio devices for more than 6 years and 16% for

Marine species live out-of-sight, consequently geographic range, population size and long-term trends are extremely difficult to characterise for accurate conservation status assessments. Detection challenges have precluded listing of marine bony fishes as Extinct on the International Union for Conservation of Nature (IUCN) Red List, until now (March 2020). Our data compilation on handfishes (Family Brachionichthyidae) revealed them as the most threatened marine bony fish family, with 7 of 14 species recently listed as Critically Endangered or Endangered. The family also includes the only exclusively marine bony fish to be recognised as Extinct – the Smooth handfish (Sympterichthys unipennis). Ironically, some of the characteristics that threaten handfishes with extinction have assisted assessments. Poor dispersal capabilities leading to small, fragmented populations allow monitoring and population size estimation for some shallow water species. Evidence that the Smooth handfish is now Extinct included no sightings over 200 years in an area subject to numerous scientific surveys, inferred shallow habitat and moderate abundance at time of original collection, and major habitat transformation through fishing, aquaculture, rising sea temperature, and urban development. Contemporary threats to extant handfish species include habitat degradation, introduced species, loss of spawning substrate, climate change, and demographic risks associated with small, fragmented populations. Multifaceted conservation efforts are needed, including addressing threats to habitat quality, bolstering wild population numbers, and implementing novel techniques to find and monitor populations. Expanded monitoring, including application of eDNA methods, represent critical steps towards overcoming the challenges in studying wild populations of rare marine species. Ongoing investigation will likely reveal numerous other threatened species for which little is known.

We designed a plate impact shock recovery experiment to simulate the starting materials and shock conditions associated with the only known natural quasicrystals, in the Khatyrka meteorite. At the boundaries among CuAl_5, (Mg_(0.75)Fe^(2+)_(0.25))_2SiO_4 olivine, and the stainless steel chamber walls, the recovered specimen contains numerous micron-scale grains of a quasicrystalline phase displaying face-centered icosahedral symmetry and low phason strain. The compositional range of the icosahedral phase is Al_(68–73)Fe_(11–16)Cu_(10–12)Cr_(1–4)Ni_(1–2) and extends toward higher Al/(Cu+Fe) and Fe/Cu ratios than those reported for natural icosahedrite or for any previously known synthetic quasicrystal in the Al-Cu-Fe system. The shock-induced synthesis demonstrated in this experiment reinforces the evidence that natural quasicrystals formed during a shock event but leaves open the question of whether this synthesis pathway is attributable to the expanded thermodynamic stability range of the quasicrystalline phase at high pressure, to a favorable kinetic pathway that exists under shock conditions, or to both thermodynamic and kinetic factors.

Objective To establish the current respiratory practice patterns in pediatric hematopoietic stem cell transplant patients and investigate their associations with mortality across multiple centers. Design Retrospective cohort between 2009 and 2014. Setting Twelve children's hospitals in the United States. Patients Two hundred twenty-two pediatric allogeneic hematopoietic stem cell transplant recipients with acute respiratory failure using invasive mechanical ventilation. Interventions None. Measurements and main results PICU mortality of our cohort was 60.4%. Mortality at 180 days post PICU discharge was 74%. Length of PICU stay prior to initiation of invasive mechanical ventilation was significantly lower in survivors, and the odds of mortality increased for longer length of PICU stay prior to intubation. A total of 91 patients (41%) received noninvasive ventilation at some point during their PICU stay prior to intubation. Noninvasive ventilation use preintubation was associated with increased mortality (odds ratio, 2.1; 95% CI, 1.2-3.6; p = 0.010). Patients ventilated longer than 15 days had higher odds of death (odds ratio, 2.4; 95% CI, 1.3-4.2; p = 0.004). Almost 40% of patients (n = 85) were placed on high-frequency oscillatory ventilation with a mortality of 76.5% (odds ratio, 3.3; 95% CI, 1.7-6.5; p = 0.0004). Of the 20 patients who survived high-frequency oscillatory ventilation, 18 were placed on high-frequency oscillatory ventilation no later than the third day of invasive mechanical ventilation. In this subset of 85 patients, transition to high-frequency oscillatory ventilation within 2 days of the start of invasive mechanical ventilation resulted in a 76% decrease in the odds of death compared with those who transitioned to high-frequency oscillatory ventilation later in the invasive mechanical ventilation course. Conclusions This study suggests that perhaps earlier more aggressive critical care interventions in the pediatric hematopoietic stem cell transplant patient with respiratory failure requiring invasive mechanical ventilation may offer an opportunity to improve outcomes.

Long distance migrations by large mammals are increasingly imperiled by human development. We studied autumn migratory patterns of caribou (Rangifer tarandus) in relation to an industrial road in northwestern Alaska. We built null movement models to determine the expected time to cross the road if caribou movements were not affected by the road. We then identified individuals that took longer to cross than expected (slow crossers) and those that did not differ from that expected from the null model (normal crossers). We identified eight as slow and 20 as normal crossers. Slow crossers took an average of 33.3 ± 17.0 (± SD) days to cross the road compared to 3.1 ± 5.5 days for normal crossers. Slow crossers had an average crossing date of 8 Nov. ± 7.7 days versus 25 Oct. ± 20.6 days for normal crossers. Movement rates of the two classes did not differ before crossing the road, but slow crossers moved > 1.5 times as fast as normal crossers after crossing the road. Movement patterns were partially explained by environmental attributes, but were most strongly affected by how far a caribou was from the road and whether it was classified as slow or normal crosser. While avoidance is an important aspect of the effects of roads on populations, our results show the importance of other factors, such as how long individuals are delayed in crossing when assessing the influence of development on wildlife.

Previous studies have shown that exception handling bad practices may impact the overall software quality. We believe that quality of exception handling code is directly affected by (i) an absence, or lack of awareness, of an explicit exception handling policy; and (ii) a silent rising and spreading of exception handling anti-patterns. To investigate such phenomenon, we conducted a case study in a large-scale Java Web system, trying to better understand the relationship between (i) and (ii). The study takes into account technical and human aspects. We surveyed 21 developers regarding their perception about exception handling in the system's institution. Next, we analyse the evolution of exception handling anti-patterns across 15 releases of the target system. Finally, we conduct a semi-structured interview with three senior software architects. Our finds beneficiated the system's institution by making it aware of these problems and enabling it to take actions towards to combat them.

The burden of living with an undiagnosed condition is high and includes physical and emotional suffering, frustrations, and uncertainty. For patients and families experiencing these stressors, higher levels of empowerment may be associated with better outcomes. Thus, it is important to understand the experiences of patients with undiagnosed conditions and their families affected by undiagnosed conditions in order to identify strategies for fostering empowerment. In this study, we used the Genetic Counseling Outcome Scale (GCOS-24) to assess levels of empowerment and support group participation in 35 adult participants and 67 parents of child participants in the Undiagnosed Diseases Network (UDN) prior to their UDN in-person evaluation. Our results revealed significantly lower empowerment scores on the GCOS-24 in adult participants compared to parents of child participants [t(100) = - 3.01, p = 0.003, average difference = - 11.12, 95% CI (- 3.78, - 18.46)] and no significant association between support group participation and empowerment scores. The majority of participants (84.3%, 86/102) are not currently participating in any support groups, and participation rates were not significantly different for adult participants and parents of child participants (11.4 vs. 19.7%, respectively, FE p = 0.40). Open-ended responses provided additional insight into support group participation, the challenges of living with undiagnosed conditions, and positive coping strategies. Future research will evaluate the extent to which empowerment scores change as participation in the UDN unfolds.