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Benralizumab is an anti-eosinophilic monoclonal antibody that reduces exacerbations and improves lung function for patients with severe, uncontrolled asthma with eosinophilic inflammation. We evaluated the impact of baseline factors on benralizumab efficacy for patients with severe asthma. This analysis used pooled data from the SIROCCO (ClinicalTrials.gov identifier NCT01928771) and CALIMA (ClinicalTrials.gov identifier NCT01914757) Phase III studies. Patients aged 12–75 years with severe, uncontrolled asthma receiving high-dosage inhaled corticosteroids plus long-acting β2-agonists received benralizumab 30 mg subcutaneously every 8 weeks (Q8W, first three doses every 4 weeks (Q4W)), Q4W or placebo. Baseline factors that influenced benralizumab efficacy were evaluated, including oral corticosteroid (OCS) use, nasal polyposis, pre-bronchodilator forced vital capacity (FVC), prior year exacerbations and age at diagnosis. Efficacy outcomes included annual exacerbation rate and change in pre-bronchodilator forced expiratory volume in 1 s at treatment end relative to placebo. Benralizumab Q8W treatment effect was enhanced with each baseline factor for all patients and those with ≥300 eosinophils·μL−1 relative to the overall population. OCS use, nasal polyposis and FVC, Key baseline factors can aid in identifying patients who may respond to benralizumab http://ow.ly/uPVX30ltHTF

The presented article follows the research mainstream of econometric analyses focused on the assessment of correlations between youth unemployment rate and market and macroeconomic determinants, including economic growth and productivity of the economy, its structure in terms of NACE Rev.2 sections as well as the labor market tools. The research addresses 28 European Union (EU) countries. The analysis period covers the years 2008–2018. The econometric methods dedicated to panel data were used. The research results confirm the importance of the general economic condition as well as the development of knowledge-based economy for the improvement of the youth situation in the labor market. With regard to the economy structure, the development of manufacturing section importance turned out to be a major factor in female youth unemployment rate reduction. The growing importance of the construction sector translated into a decline in the unemployment rate among young men.

Bandung CO2 emissions continue to increase in line with its population. The emissions source comes from the industrial, transportation, Liquefied Petroleum Gas (LPG), household, and livestock sectors, whereas CO2 absorption only comes from vegetation through photosynthesis. High CO2 emissions could decrease air quality and reduce environmental health. This study aims to estimate the amount of CO2 emissions and their absorption in Bandung by implementing CO2 Emission Rate Reduction Simulation (CERRS). The simulation comprises four scenarios, namely substitution of vehicle fuel and the application of smart driving techniques, optimization of waste processing in IWPS, processing 90% of livestock waste into biogas, and green space development of 30% of Bandung City area. Estimated CO2 emission and absorption rates were calculated for the next 10 years (2021-2030) using the Stella program version 9.0.2. The results showed that without implementing the CERRS, the amount of CO2 emissions in Bandung in 2030 was estimated to reach 10,983,666.82 tons while implementing the CERRS was 2,361,721.30 tons. Without implementing the CERRS, the estimated amount of CO2 absorptions in 2030 was 214,235.11 tons, while implementing the CERRS was 2,785,703.11 tons. It is expected that the application of the CERRS could reduce the level of CO2 emissions in Bandung by 78.5% and increase CO2 absorptions by 1,200.3%.

This study aims to determine whether MSMEs in Batam have implemented PP No. 23 of 2018 according to the form of business or business profile the impact of this rate reduction of this rate reduction on tax revenue at KPP Pratama Batam Selatan. Data obtained from distributing questionnaires via Google form and interviews and direct data collection at KPP Pratama Batam Selatan. The sampling method of this research is purposive sampling technique.and uses descriptive quantitative by investigating the influence of the MSME business profile variable on State Revenue through taxpayer compliance. State revenue data comes from PPh 4 paragraph 2 specifically for MSMEs with PP. No. 46 of 2013 and PP No. 23 of 2018 over period of 4 years, namely 2016 to 2019. And using regression and path analysis. So that the results of this study indicate that the business profile is significant on taxpayer compliance, as well as the significant result between taxpayer compliance with state revenue, but business profile has no significant effect on State Revenue, the effect is direct, but the results differ if the effect of business profile on State Revenue through compliance. The result of taxpayers is significant.

Tax is the most source of financing for development in Indonesia. The tax reformation make policy and administration more comphrehensive by Directorate General of Taxes. The expectation of The tax reformation could be increase compliance of taxpayer. The rise of UMKM almost five years in District Way Kanan make Way Kanan has good potential in taxtation. In 2018 The governance has realeased regulation, it is PP No. 23 Th. 2018. The regulation about tariff reduction for UMKM, the rate reduction of 0,5%. Aim of this regulation is taxpayers get easier for do some taxation include to report tax return every year, to encourage taxpayers get into formal economics, and to give taxpayers a sense of justice. The research aim get to know how much tariff reduction influence toward to increase compliance of taxpayer about report the tax return in every year in District Way Kanan. The research applies quantitative approach and descriptive method. The research applies data collection technique by questionnaire, document, and observation. The data analysis technique by simple analysis tabulation, validy test, reliability test, normalitiy test, correlation test, determinasi coefficient test, simple linear regression test, and hypotheses test. The result of this study is that hypotheses of this study is accepted and be found how much influence tariff reduction influence toward to increase compliance of taxpayer about report the tax return in every year in District Way Kanan is 18,2%.

Analysis of declining income tax rate of economics on production sharing contract gross split and multiplier effect for the economy in upstream activity in Indonesia describes about Indonesia’s Government announces regulation of production sharing contract gross split in upstream activity for contractor to invest in oil and gas in Indonesia. Due to the pandemic of COVID-19, the Government of Indonesia announced another regulation in regard to income tax rate reduction. This has positively affected the economics on NPV and IRR of contractor and has triggered multiplier effects for the economy in general. Sensitivity analysis is used to calculate the effect of income tax rate reduction for the economics in gross split and multiplier effect. This research has shown that 1% of declining income tax rate affects US$29,333,000 of NPV, 0.3% of IRR, US$20,533,000 Gross Domestic Product and 2,933 jobs in pessimistic scenario; US$61,107,000 of NPV, 0.5% of IRR, US$42,775,000 Gross Domestic Product and 6,111 jobs in moderate scenario; and US$92,881,000 of NPV, 0.6% of IRR, US$65,016,000 Gross Domestic Product and 9,288 jobs in optimistic scenario.

El suicidio es una de las principales causas de mortalidad entre los adolescentes y jóvenes en casi todo el mundo. El objetivo de este trabajo es describir la evolución histórica en la provincia de Buenos Aires a lo largo del período 2001-2017. El diseño fue descriptivo observacional retrospectivo sobre la mortalidad por lesiones auto infligidas. Los datos de mortalidad se obtuvieron de la Dirección de Estadística e Información en Salud (DEIS) del Ministerio de Salud de la provincia de Buenos Aires. Los datos de mortalidad analizados fueron los relativos a las lesiones autoinfligidas intencionalmente. A lo largo del período estudiado se produjeron 19.287 defunciones por suicidios en la provincia de Buenos Aires, con una tasa acumulada de 7,36 por 100 mil. El tipo de modalidad más frecuentemente fue el uso de un agente externo. Al relacionar las tasas de suicidio con el tamaño poblacional de las diferentes regiones sanitarias se observa que existe una relación inversa entre el tamaño poblacional y las tasas de mortalidad. La tasa global de defunciones muestra que tuvo variaciones: disminución de la tasa desde 2001 a 2009 (con un pico en 2003); crecimiento de 2010 a 2012 y nuevamente disminución desde 2013 hasta 2017.

BackgroundThe neonatal population is at increased risk for central line-associated bloodstream infections (CLABSIs) related to prematurity, critical illness, and compromised immune function.1,4,5MethodsTo address a 30 percent CLABSI rate increase, a quality improvement (QI) project in a Level IV NICU was developed and implemented by the NICU CLABSI team in 2018. The project trialed a dedicated CLABSI prevention-registered nurse (DCP-RN) role with select responsibilities aimed at rate reduction. The DCP-RN spearheaded an RN education plan, addressed prevention bundle compliance, and aided in establishing a reliable apparent cause analysis (ACA) process.ResultsThe outcome resulted in an over 50% reduction in the CLABSI rate and permanent adoption of the DCP-RN role in the NICU.

Within the context of China’s Urban Employees’ Basic Pension Insurance (UEBPI), this paper constructs an actuarial model to analyze the financial imbalance risk of contribution rate reduction and to investigate the possibility of further reducing the contribution rate. It is found that the UEBPI fund would show financial imbalance risk in 2024 if the contribution rate is 16%, and no control strategy is introduced. In the case of single strategy (the collection system reform, delay of retirement age, or the introduction of external finance), the financial sustainability of the UEBPI fund could be improved to some extent, whereas the financial imbalance risk remains huge. In the case of a package of control strategies being implemented, the UEBPI fund could be able to continue its operation until 2060, and the contribution rate can be further reduced by 0–4 percentage. Therefore, the implementation of a package of control strategies presents a prerequisite for controlling the financial imbalance risk and further reducing the contribution rate.

The lean blowout mechanisms of premixed bluff-body flames are experimentally investigated at various turbulence intensities. Turbulence levels are varied using a novel turbulence generator, which combines static grid and fluidic jet impingement techniques. Three different turbulence levels are probed to study their effects on lean blowout. The three conditions span across the combustion regime diagram, from flamelets to broken reactions. For all three turbulence levels, the lean blowout process is induced through controlled fuel flow rate reduction. The transient blowout process is captured using three simultaneous high-speed diagnostic systems: particle image velocimetry (PIV), stereoscopic PIV (SPIV), and C2*/CH* species measurements. The two PIV systems are used to resolve the instantaneous velocity and vorticity fields, and the C2*/CH* species diagnostics allow for global equivalence ratios to be evaluated throughout the duration of blowout. The results show that the dynamics of lean blowout vary with turbulence intensity. At low turbulence levels, the flame experiences a global effect where the flame boundary interacts with the shear layer vorticity. This imparts high strain rates along the length of the flame, leading to blowout. As turbulence levels increase, the blowout mechanism becomes less dependent on flame and shear layer interactions and more driven by flame–turbulence interactions. At high turbulence conditions, flame-eddy interactions within the freestream augment flame stretching via increased flame straining and small-scale flame corrugations. Increased flame stretching disrupts the flame stabilization process, and ultimately results in blowout.

This study examines the effect of the 2010 tax credit reform, which reduced the tax credit rate, on firms' R&D in Taiwan. The empirical results suggested that the tax credit rate reduction has no overall negative effects on firms' R&D expenditure. By contrast, firms were observed to increase their expenditure on R&D. R&D tax credit recipients increased their R&D expenditure more than those who did not use the R&D tax credit. Moreover, we found a considerable difference in the treatment effects of the policy reform on R&D between R&D‐intensive and less R&D‐intensive firms. (JEL H21, H25, O31, O32, O38)

One of hip arthroplasty complications is dislocation of the endoprosthesis head. In the vast majority of cases, the cause of dislocation is multifactorial. That is why only a thorough analysis of the patient’s peculiarities, surgery and rehabilitation will help to avoid the relapse. This review analyzed the risk factors of dislocation and treatment tactics. Risk factors associated with the patient include: old age, male gender, obesity, concomitant diseases, low level of preoperative physical activity, low compliance and a some others. The problem of the biomechanical ratio in the segment “spine – pelvis – lower limb” deserves special attention. Besides, there are risk factors associated with the surgeon: access option; type, fixation and position of endoprosthesis components, experience and surgical technique of a orthopedic surgeon. The strategy of dislocations rate reduction is based on a detailed study of dislocation causes and their elimination, and adequate surgery planning. The treatment of a patient with dislocation should take into account the multifactorial etiology of the condition.

Background We compared our early experience of visual outcomes, operation time, and complications for two techniques of intrascleral intraocular lens (IOL) fixation: T-fixation and flanged IOL fixation. Methods Data from patients who underwent scleral fixation of an IOL between October 2017 and December 2018 were analyzed retrospectively. Intraoperative time for fixation steps, corneal endothelial cell density (ECD) rate reduction, and intraoperative/postoperative complications were compared between T-fixation (Group T, n = 4) and flanged IOL fixation (Group F, n = 6). Results Mean patient age was 73.7 ± 13.0 years. Intraoperative time was significantly longer for Group T (27.5 ± 9.7 min) than for Group F (13.0 ± 3.8 min; P=0.03, Mann-Whitney U-test). Intraoperative complications included iris damage from the 30-G needle in 2 eyes in Group F. Postoperative complications included iris capture by the IOL in 1 eye in Group F. No incidents of postoperative retinal detachment or IOL dislocation were identified. The ECD reduction rate did not significantly differ between groups. Conclusions Both techniques yielded favorable surgical outcomes. Flanged IOL fixation might be superior because of its shorter intraoperative time but could initially be technically difficult because of the need to perform angled sclerotomy with a 30-G needle to avoid iris injury.

BACKGROUND Patients with traumatic brain (TBI) injury often require a high dosage of propofol, which can provide an excessive caloric intake. We evaluated our strategy of using liquid protein supplement boluses concurrently with high protein-containing enteral nutrition (EN) formulas and formula rate reduction to avoid caloric overfeeding and inadequate protein intake. METHODS Adult patients (aged >17 years) with TBI admitted to the trauma intensive care unit (TICU) who received concurrent propofol and EN were retrospectively reviewed. Caloric intakes from propofol and EN were obtained. Actual protein intake was compared with projected protein intakes from high protein content and standard protein content enteral formulas when given at an isocaloric intake. RESULTS Fifty-one patients were enrolled. Average caloric intake from propofol was 356 ± 243 kcal/d or 5 ± 3 kcal/kg/d (range

Potential blood donors are blood donors who can donate their blood back after success through 2 stages of blood donation such as the physical health test (active) and the screening test (laboratory test). The purpose of this study are to obtain an application that can be used to predict potential blood donors who will donate their blood back at the PMI Palu, Sigi and Donggala Blood Transfusion Units, and to obtain their level of accuracy using the Learning Vector Quantitation algorithm. This prediction application for potential blood donors makes it easier for the public to know whether they can donate their blood or not. Classification is done using 300 data consisting of 70% training data and 30% testing data. The data used in this study are data taken in 2018. The accuracy of the best weighting in stage 1 is 95.56% obtained using the training rate (α) of 0.1≤α≤0.25 and the rate reduction training (decα) which is varied. While the best weighting results in stage 2 have an average accuracy rate of 100% obtained by using a training rate (α) of 0.000001≤α≤0.5 and a reduction in the rate of training (decα) which varies.

Objective. The investigation objective was improvement of the surgical treatment results in patients, suffering аbdominal sepsis, using individualized tactics of treatment, taking into account a possibility for the postoperative complications occurrence and the treatment results prognostication. Маterials and methods. The results of treatment of the adult patients, suffering abdominal sepsis in 2009 – 2019 yrs, excluding an acute cholecystitis cases, were analyzed. The patients were divided retrospectively and prospectively in accordance to the Sepsis–3 classification. Of them 130 have suffered peritoneal sepsis, 33 – intestinal one, and 38 – pancreatogenic abdominal. The results estimation was compared with application of modern systems: APACHE–II, Mannheim іndex of peritonitis (MPI), MODS and SOFA. The indices were estimated on the 1st, 2nd, 3rd and 4th postoperative days before subsequent outcomes of a primary operation. Results. The prognosis systems with a square under the ROC–curve (AUC) > 0.8 have included MPI only for determination of indications for reoperations: the ROC–curves value for the first subgroup (the closed treatment) have constituted 0.73, for the second subgroup (reoperations in accordance to indications) – 0.91, and for the third – 0.84 (the programmed reoperations). But in the patients of first subgroup this index have constituted 0,73, indicating its application restricting the decision making process, concerning the reoperations efficacy in patients with absence of the septic shock signs. Conclusion. Calculations of the occurrence possibility for postoperative complications and mortality in patients, depending on their preoperative state severity permits to select a most rational tactics of treatment. Most optimal approach for the rate reduction of postoperative complications occurrence and mortality in patients with abdominal sepsis and septic shock is performance of reoperations in accordance to indications to control the infection source, if it is possible.

Effective and precise neural modulation with real-time detection in the brain is of great importance and represents a significant challenge. Nanoliposome-encapsulated light-sensitive compounds have excellent characteristics such as high temporal and spatial resolution, delayed drug clearance, and restricted drug biodistribution for neural modulation. In this study, we developed a nanoliposome-based delivery system for ruthenium-based caged GABA compounds (Nanolipo-Ru) to modulate neural activity and allow for real-time monitoring using the microelectrode arrays (MEAs). The Nanolipo-Ru nanoparticles had an average size of 134.10 ± 4.30 nm and exhibited excellent stability for seven weeks. For the in vivo experiment in the rat, release of GABA by Nanolipo-Ru under blue light illumination resulted in an average firing rate reduction in interneurons and pyramidal neurons in the same brain region of 79.4% and 81.6%, respectively. Simultaneously, the average power of local field potentials in the 0–15 Hz range degraded from 4.34 to 0.85 mW. In addition, the Nanolipo-Ru nanoparticles have the potential to provide more flexible timing of modulation than unencapsulated RuBi-GABA in the experiments. These results indicated that Nanolipo-Ru could be an effective platform for regulating neuronal electrophysiology. Furthermore, nanoliposomes with appropriate modifications would render promising utilities for targeting of specific types of neurons in the future.

This study investigated effects of rate reduction and emphatic stress cues on second formant (F2) trajectories and articulatory movements during diphthong production in 11 typically developing school-aged children. F2 extent increased in slow and emphatic stress conditions, and tongue and jaw displacement increased in the emphatic stress condition compared to habitual speech. Tongue displacement significantly predicted F2 extent across speaking conditions. Results suggest that slow rate and emphatic stress cues induce articulatory and acoustic changes in children that may enhance clarity of the acoustic signal. Potential clinical implications for improving speech in children with dysarthria are discussed.

This paper focuses on the FPGA implementation of a slew-rate reduction (SR) shaping function for envelope tracking (ET) power amplifiers (PAs). The SR envelope has been proved effective to trade-off power efficiency and linearity in ET PA systems where the envelope tracking modulator (ETM) is bandwidth limited. However, the implementation issues need to be addressed when targeting high clock rates to cope with current 5G new radio wide-band signals. This paper shows the FPGA implementation of the SR envelope generation. We explore the use of high-level synthesis (HLS) for the SR envelope generation to evaluate the performance and resource usage of the hardware architecture. The HLS design is also compared with a hand-written hardware description language (HDL) version. An in-depth analysis shows strengths and limitations of the HLS design to meet the timing constraints when considering a throughput of 614.4 MSa/s. © 2022 IEEE.

Objective To evaluate the impact on cesarean section (CS) rate with of a program of multiple non-clinical interventions targeted at health-care professional within a hospital maternity ward. Materials and methods Retrospective quasi-experimental pre-post intervention study with an historical control group conducted in a second-level teaching hospital. All women who gave birth in the period 2014 to 2018 were included. A series of multiple non-clinical interventions including a dedicated team of obstetricians for delivery room and antenatal counseling, monthly internal audits and physician education by local opinion leader were prospectively introduced from September 2016. The primary outcome of the study was the CS rate. The incidences of operative vaginal delivery, 3rd−/4th-degree perineal tears and further maternal and neonatal complications were considered as secondary outcomes. Results The CS rate dropped from 33.05 to 26.06% after starting the interventions (p p p p p p = 0.010). Conclusions The introduction of multiple non-clinical interventions can significantly reduce the CS rate. However, beside an improvement in neonatal composite outcome, a potential increase in high-degree perineal tears should be taken in account.

In recent years, the involvement of synthetic strongly labeled data, weakly labeled data, and unlabeled data has drawn much research attention in semi-supervised acoustic event detection (SAED). The classic self-training method carries out predictions for unlabeled data and then selects predictions with high probabilities as pseudo-labels for retraining. Such models have shown its effectiveness in SAED. However, probabilities are poorly calibrated confidence estimates, and samples with low probabilities are ignored. Hence, we introduce a confidence-based semi-supervised Acoustic event detection (C-SAED) framework. The C-SAED method learns confidence deliberately and retrains all data distinctly by applying confidence as weights. Additionally, we apply a power pooling function whose coefficient can be trained automatically and use weakly labeled data more efficiently. The experimental results demonstrate that the generated confidence is proportional to the accuracy of the predictions. Our C-SAED framework achieves a relative error rate reduction of 34% in contrast to the baseline model.

Wheat production is dependent on costly insecticides that generate social and environmental issues. The growing demand for a rate reduction of spray applications and increased spray efficiency make essential the research for more adequate crop management. Therefore, this study aimed to evaluate technologies of imidacloprid application on wheat aphid, Schizaphis graminum and its natural enemies, Chrysoperla externa and Orius insidiosus. A set of experiments were performed to evaluate the effectiveness of S. graminum control and the toxicity to natural enemies using imidacloprid plus adjuvants sprayed with different nozzles and application rates. Improved S. graminum control was observed in the association between the adjuvant lauryl ether sodium sulfate and the hollow cone nozzle for both application rates (75 and 150 L ha-1), and the adjuvant copolymer of polyester + silicone + d-limonene with the asymmetric twin flat-fan nozzle at a low rate (75 L ha-1), since these treatments eliminate the wheat aphid after the fifth day of treatment application. The reduction of spray volume to wheat aphid control is possible with no loss of insecticide effectiveness. Imidacloprid associated with any one of the adjuvants tested is harmful to C. externa and O. insidiosus, even at the fifth day after application the insecticide continues being harmful to the natural enemies, regardless of the technology used. Key words: Triticum aestivum, Schizaphis graminum, ecological disturbance, insecticide impacts, natural control, neonicotinoid.

Objective. To study the rate of differentiated thyroid carcinomas, owing various characteristics and clinical indices of the disease course, basing on a twenty-year experience of the surgical clinic work in the Institute of Endocrinology and Metabolism named after V. P. Komisarenko NAMS of Ukraine. Materials and methods. Retrospective investigation was conducted, including data about 5526 patients, operated for differentiated thyroidal cancer in 1995 - 2014 yrs. Results. During 20 years the quantity of patients, suffering papillary carcinoma, operated in surgical clinic, have enhanced. Among them the rate of children, teenagers, men and the patients, suffering more aggressive tumors, have reduced. Clinical indices of the disease course, tactic of treatment and prognosis concerning these patients have improved essentially. The spreading, size, invasive and metastatic characteristic of follicular carcinoma through 20 years of observation did not changed essentially, but the rate of patients, suffering severe stages of the disease and those having the poorest prognosis raised. Simultaneously a mortality of patients, suffering follicular carcinomas, have lowered significantly due to the treatment optimization. Conclusion. The analysis performed have witnessed the rate reduction of potentially radio-induced papillary carcinomas, what demands a certain revision and further improvement of the patient’s treatment protocols.

We analyze a mathematical model for drug delivery monitoring subject to flow-through bioreactor. We use a convection–diffusion–reaction model combined with PID control. Enzyme-containing bioreactor converts a prodrug into an active drug. This approach connects two aspects of drug delivery, mechanical pumps and prodrugs. Drug delivery monitoring is performed by adjusting the prodrug inflow pressure. We model several dynamic treatment regimes. A combined algorithm of treatment regimes can be used for personalized treatment. A control-aided system allows us to reduce the impact of pumping fluctuations, diffusion slowdown, and drug production rate reduction.

Korea replaced its rice import quota with a tariff rate quota (TRQ) in 2015. A structural model representing the Korean rice market is developed to evaluate this new trade policy and examine the possibility of Korean rice imports under uncertainty. Results indicate that rice imports in excess of the current TRQ quantity are unlikely for a range of market conditions. Two scenarios, which are the over-quota tariff rate reduction and the TRQ quantity expansion, show how the market responds to policy changes. In addition, Korean rice imports are sensitive to consumer preferences for different rice types.

Aim: To assess Ig20Gly tolerability in pediatric patients with primary immunodeficiencies. Patients & methods: Infusion parameters and tolerability were analyzed in pediatric patients (aged 2–5 years [n = 6], 6–11 years [n = 22] and 12–17 years [n = 22]) receiving Ig20Gly in two Phase II/III trials. Results: Of 2624 Ig20Gly infusions, >99% did not require any rate reduction, interruption or discontinuation due to adverse events (AEs). Median maximum infusion rates and volumes/site were higher in patients 12–17 years of age (30 ml/h/site; 30 ml/site) versus 6–11 years (20 ml/h/site; 15 ml/site) and 2–5 years (18 ml/h/site; 14 ml/site). Rates of causally related systemic and local AEs (0.009 and 0.063 AEs/infusion) were low. Conclusion: Ig20Gly infused at relatively high rates and volumes was well tolerated in children.

Introduction Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are common laboratory assays used as markers of inflammation. ESR suffers from higher false positive and false negative rates than CRP. To that end, the American Board of Internal Medicine's (ABIM's) Choosing Wisely campaign has recommended against ESR testing for those with undiagnosed conditions in favor of CRP testing. This study describes the impact of a computerized provider order entry (CPOE) decision support rule against ESR/CRP co-ordering within a community health system that predates the ABIM's Choosing Wisely national guidance. To demonstrate the potential impact of such a CPOE rule within other healthcare settings, ESR/CRP ordering data from a multi-site tertiary care practice and from the commercially insured population in the OptumLabs® Data Warehouse (OLDW) were analyzed and the relative reduction in ESR/CRP co-ordering achieved within the community health system was projected onto these populations. Materials and methods ESR and/or CRP orders from a community health system were assessed from 2012 to 2016. Co-ordering and test concordance rates between ESR and CRP were compared before and after CPOE decision support rule launch. Similarly, ESR/CRP co-ordering across three tertiary care sites from 2015 to 2016 and the OLDW from 2009 to 2013 were assessed and the co-ordering rate reduction achieved in the community health system was mathematically projected onto these populations. Estimated payer savings from the rule's effect were calculated within each population using Medicare reimbursement rates. Results The CPOE decision support rule realized an unadjusted 42% relative rate reduction in ESR/CRP co-ordering within the community health system yielding an annual payer savings of $15,000 with a modest increase in ESR/CRP concordance rates. Projecting a 40% relative reduction in ESR/CRP co-ordering rates from a similarly effective CPOE rule, annual payer cost reductions exceeding $100,000 within a multi-site tertiary care setting and $1,000,000 within the OLDW would be expected. Conclusion ESR/CRP co-ordering represents an opportunity to eliminate testing waste and reduce payer costs. A CPOE decision support rule stably reduces ESR/CRP co-ordering rates. Similar results may occur as one component of new commercially available decision support platforms.

Background Second-grade pupils in Israel have been vaccinated against influenza since the winter of 2016–2017. This study aims to appraise the rate reduction of seasonal influenza vaccine among vaccinated children and their household members, and that of the vaccinated cohort and their household members. Methods This retrospective cohort study was performed in winter 2016–2017 in Tel-Aviv District, Israel and compared second-grade pupils who were vaccinated at school, with third-grade pupils- who were not vaccinated at school. Parents in nine schools were asked to report prior vaccination against influenza and influenza-like illness (ILI) of their children and other household members. Rate reduction was defined as [(ILI among unvaccinated) – (ILI among vaccinated)] / (ILI among vaccinated) (%). Results Of 527 participants, 359 (68.1%) were unvaccinated and 168 (31.9%) vaccinated. Unvaccinated children reported more ILI compared with vaccinated children (19.5% vs. 7.7%), yielding a rate reduction of 60.5%. Unvaccinated children also had a greater number of physicians’ visits and missed school days (35.7% vs. 14.9 and 42.9% vs. 25.6%, respectively). The rate of ILI among household members of unvaccinated children was 34.5%, compared with 25.0% among household members of vaccinated children. The vaccinated cohort (defined as all children in second grade) reported less ILI compared with the unvaccinated cohort (defined as all children in third grade), with a rate reduction of 44.6%. Pupils of the unvaccinated cohort were more likely to miss school days (42.1% vs. 32.0%, respectively), and a higher rate of ILI was reported among household members of the unvaccinated cohort (35.4% vs. 27.3%, respectively). Conclusion Influenza vaccine administered in school setting reduced ILI among the vaccinated cohort and their household members by 60.5 and 27.5%, respectively, compared with the unvaccinated cohort. Expansion of the vaccination program in a school setting increased the public health benefit of influenza vaccines among both school children and their household members.

A number of oil- and gas-producing leases have been operating in Italy in the last decades, many of which are located in the surroundings of tectonically active regions. Identifying human-induced seismicity in areas with high levels of natural seismicity is a difficult task for which virtually any result can be a source of controversy. We implemented a large-scale analysis aiming at tracking significant departures of background seismicity from a stationary behavior around active oil and gas development leases in Italy. We analyzed seismicity rates before and after hydrocarbon peak production in six oil-producing and 43 gas-producing leases, and evaluate the significance of possible seismicity rate changes. In a considerable number of cases seismicity rate results stationary. None of the observed cases of seismicity rate increase after the peak production is statistically significant (at a s.l. = 0.05). Conversely, considering cases of seismicity rate decrease after peak production, our results suggest that the seismicity rate reduction is statistically significant (s.l. = 0.05) around one oil-producing lease (Val d’Agri, Basilicata) and around a cluster of gas-producing leases in Sicily. Our results put in evidence correlated changes between the rates of shallow seismicity and hydrocarbon production in these areas, which are then identified as hotspots requiring more detailed research; assessing actual causal relationships between these processes will require further physically-based modelling. If a physical causative link between these processes exists, then the observed seismicity rate reduction could either be due to increased seismicity during the progressive increase in production before reaching its maximum, or to an actual seismicity rate reduction after that peak. Considering that there is evidence of seismicity occurring before the start of hydrocarbon production, which contrasts with the evident reduction of events observed after the peak production, we think it likely that the seismicity inhibition is a plausible hypothesis. Using a simple model we also calculate Coulomb stress changes in planes optimally oriented for failure, and we show that under some conditions the inhibition of seismicity is feasible in at least one of these cases. We conclude that more efforts to study the mechanisms and the possible consequences of anthropogenically-driven seismicity inhibition are required.

This paper presents a new approach for achieving bitrate and pixel rate reduction in the MPEG immersive video coding setting. We demonstrate that it is possible to avoid the transmission of some depth information in the Test Model for Immersive Video (TMIV) by estimating it at the receiver's side. Although the transmitted information in TMIV is considered as non-redundant, we show that it is possible to improve this algorithm. This method provides 3.4%, 9.0%, and 12.1% average BD-rate gain for natural content on high, medium, and low bitrate, respectively, with up to respectively 12.3%, 16.0%, and 18.4% peak reductions. Moreover, it preserves the perceptual quality as measured with MS-SSIM and VMAF metrics. Additionally, it decreases the pixel rate by 8.3% for each test sequence.

Background: Nuclear medicine investigations are essential diagnostic tools in paediatric urology. Child-orientated examination techniques and the avoidance of sedation or anaesthesia vary in different institutions. We aimed at evaluating child friendly measures in our department to identify the potential for improvement. Based on these data, we changed the standards regarding the sedation policy and consequently re-evaluated sedation rates. Methods: Four-hundred thirty-five consecutive investigations were evaluated regarding the need for sedation, outcome and patient satisfaction at our department. After the revision of our department standards, we re-evaluated 159 examinations. Statistical analysis was performed with JUMBO (Java-supported Münsterian biometrical platform). Results: Eighty-six percent (60/70) would agree to perform an investigation under identical conditions again. Seventy-seven percent (17/22) of eligible patients &gt, 5 years of age felt good during the investigation. By changing our sedation policy, we could reduce the sedation rate from 27.1% to 7.5% (p &lt, 0.0001, OR 0.219 95% CI 0.111–0.423). Conclusion: The evaluation of child friendly examination protocols demonstrated high reliability and patient satisfaction using situational sedation with a relatively high proportion of patients being sedated. Through protocol adaption with clear age limits, individual indication and education of staff, as well as the use of optimized sedatives, the need for sedation could be further reduced whilst maintaining a high patient satisfaction.

This paper gave an improved ensemble model for Chinese text classification based on CNN and RNN structure. We first changed the bidirectional LSTM structure in the TextRCNN model to a bidirectional GRU structure and added a learning rate reduction mechanism into it. Then TextCNN model was also added into a learning rate reduction mechanism. Finally, our ensemble model was constructed through equal weight voting between the improved TextRCNN and improved TextCNN models. Experimental results showed that compared with TextCNN [7], TextRCNN [8], LSTM+attention [15], DPCNN [5] and FastText [6], the classification error rate of our model on SINA_P News dataset dropped by 8.36%, 13.2%, 20.23%, 7.33% and 29.17% respectively; dropped by 8.28%, 3.98%, 10.68% and 5.86% and rose by 3.8% on THUC_P news dataset. Hence, our ensemble model has higher classification accuracy than most other text classification models and is a competitive method.

We consider a communication cell comprised of Internet-of-Things (IoT) nodes transmitting to a common Access Point (AP). The nodes in the cell are assumed to generate data samples periodically, which are to be transmitted to the AP. The AP hosts a machine learning model, such as a neural network, which is trained on the received data samples to make accurate inferences. We address the following tradeoff: The more often the IoT nodes transmit, the higher the accuracy of the inference made by the AP, but also the higher the energy expenditure at the IoT nodes. We propose a data filtering scheme employed by the IoT nodes, which we refer to as distributed importance filtering in order to filter out redundant data samples already at the IoT nodes. The IoT nodes do not have large on-device machine learning models and the data filtering scheme operates under periodic instructions from the model placed at the AP. The proposed scheme is evaluated using neural networks on a benchmark machine vision dataset, as well as in two practical scenarios: leakage detection in water distribution networks and air-pollution detection in urban areas. The results show that the proposed scheme offers significant benefits in terms of network longevity as it preserves the devices' resources, whilst maintaining high inference accuracy. Our approach reduces the the computational complexity for training the model and obviates the need for data pre-processing, which makes it highly applicable in practical IoT scenarios.

International audience; We present low complexity and efficient path selection algorithms for limiting the exposure to pandemic virus during and between lock-downs. The average outdoor exposure rate reduction is around 3.

Although theory predicts boards should replace underperforming CEOs, archival studies estimate that CEO underperformance has only a modest effect on turnover. Higher corporate statutory tax rates increase the sharing of corporate profits and losses with the government, partially shielding shareholders from the consequences of CEO underperformance and reducing the expected net after-tax benefits of improved performance by a replacement CEO. Thus, we predict higher corporate tax rates contribute to the modest documented effect of CEO performance on turnover. We use the corporate tax rate reduction enacted by the Tax Cuts and Jobs Act to test our prediction. Consistent with expectations, we estimate an increased sensitivity of CEO turnover to firm performance after the Tax Cuts and Job Act. Furthermore, this increased sensitivity is stronger among firms for which the expected net after-tax benefits of replacing an underperforming CEO are greatest either because the firms expect a larger gross benefit from the rate reduction or have lower estimated replacement costs. Our study extends the literature on CEO turnover and suggests statutory tax rates are an important friction in the CEO replacement decision.