bluuebunny/crossref_metadata_2025 huggingface dataset:
Descriptive Epidemiology of Sweating in a Hospice Population
Authors: Quigley Columba S. , Baines Mary
Published: April 2019

Sweating can be a distressing and difficult problem to manage in patients with advanced cancer. Despite this, few published data exist on the frequency, nature, and severity of sweating in cancer patients. This prospective survey describes the epidemiology of sweating in patients with advanced cancer on admission to a London hospice. 153 consecutive admissions were assessed. Of these, 100 were suitable for inclusion into the study. A general symptom enquiry was performed on all patients. Age, sex, primary diagnoses, extent of disease, relevant secondary diagnoses, and concurrent medication were also recorded. 16 patients volunteered sweating as a problem. For 12 of these 16 patients, sweating had been severe (drenching sweats requiring change of clothing or bedlinen or both) in nature. This survey highlights sweating as a significant problem in this group of patients.
Advance Directives Affecting Medical Treatment Choices
Authors: Waddell Charles , Clarnette Roger M. , Smith Michael , Oldham Lynn
Published: April 2019

Advance directives theoretically enhance individual autonomy and facilitate treatment decision making at the end of life. There is little empirical evidence to support this, however. Based on a national postal survey of 2172 randomly selected medical practitioners (response rate 73%), this paper examines the effect advance medical directives have on (a) treatment prescribing for terminally ill people and (b) the degree of difficulty practitioners experience in making treatment choices. A hypothetical patient with Alzheimer's disease and an acute life-threatening illness was presented with and without an advance directive. With a directive, respondents were more uniform in their choice of treatment, with 86% choosing as the patient had requested. Difficulty with decision making was also less with the directive, 31% vs 45% with no directive. The data indicate that advance directives do affect practitioners’ treatment choices in favor of patient wishes and reduce the difficulty practitioners may experience in making them.
Physician Perspectives on Unconventional Cancer Therapies
Authors: Gray Ross E. , Fitch Margaret , Greenberg Marlene , Voros Peter , Douglas Mary S. , Labrecque Manon , Chart Pamela
Published: April 2019

The popularity of unconventional therapies has grown dramatically in recent years. This paper reports on the results of a pilot study investigating the perspectives of physicians involved with cancer care regarding their reactions to this trend and their ways of trying to meet associated challenges. Nine oncologists, nine general practitioners, and one surgeon were interviewed over the telephone, employing open-ended questions. The physicians were unanimously interested in having information available about unconventional therapies. They also expressed a desire to be supportive of patient choices in this area, provided conventional therapy was not compromised. However, there was little interest in initiating communication about unconventional therapies, with most seeing such discussions as a poor use of their time. Suggestions for future research, as well as educational and policy strategies, are addressed.
A Way to Screen for Suffering in Palliative Care
Authors: Bayés Ramon , Limonero J.T. , Barreto P. , Comas M.D.
Published: April 2019

We report a new tool for screening the suffering of terminally ill patients in a palliative care service. We systematically asked 371 terminal oncological and AIDS patients on 665 different occasions, “How long did yesterday seem to you?”; we then asked them to assess their current condition. The simple answer about subjective length of time correlated well with subjective suffering in approximately half the patients. Thus it may be a good starting point for future assessment and more extensive explorations.
Family Members’ Care Expectations, Care Perceptions, and Satisfaction with Advanced Cancer Care: Results of a Multi-Site Pilot Study
Authors: Kristjanson Linda J. , Leis Anne , Koop Priscilla M. , Carrière K.C. , Mueller Bryan
Published: April 2019

Psychometric properties of assessment tools designed for use with English-speaking family members of advanced cancer patients in different care settings and different geographic locations were evaluated in this study. The robustness of the theoretical framework guiding the study and the factors identified with care satisfaction were also tested. Seventy-two family members drawn equally from medical hospital units, palliative care units, and home care programs in Alberta, Saskatchewan, and Manitoba participated. Instruments used included the F-Care Expectations Scale, F-Care Perceptions Scale, FAMCARE Scale, and the General Functioning Scale of the Family Assessment Device. All four tools yielded acceptable reliability estimates. Discrepancy theory predicted family care satisfaction in a highly significant manner (p<0.0001). Family members of patients who had been diagnosed for longer than two years had more positive perceptions of palliative care than did family members of patients diagnosed for less than two years (p=0.05). Older family members reported better family functioning than younger family members (p<0.001). Spouses reported less discrepancy between care expectations and perceptions than did other relatives (p<0.05).
The Use of Complementary Medications by Cancer Patients Attending an Outpatient Pain and Symptom Clinic
Authors: Oneschuk Doreen , Fennell Lee , Hanson John , Bruera Eduardo
Published: April 2019

Complementary medications appear to be gaining popularity among cancer patients. When we surveyed 143 advanced cancer patients attending an outpatient pain and symptom clinic at a regional cancer centre as to their use of complementary medications and nutritional supplements, we found 37% (53/143) to be making use of complementary medications. Users tended to be younger (mean age 53.3 years) and have a preference for purchase from health stores, with 61% of complementary medications being bought there. Health store staff were the primary recommenders for both men and women and especially for those over 60 years of age. Of the 197 complementary medications purchased, 78 (39.6%) were herbs, 67 (32.5%) were vitamins, 13 (6.6%) were minerals, 21 (10.7%) were other medications including shark cartilage, and 21 (10.7%) could not be identified. Both anticancer effect and the promotion of well-being were prominent among the stated reasons for using these medications.
Comparison of Palliative Care Needs of English- and Non-English-Speaking Patients
Authors: Chan Arlene , Woodruff Roger K.
Published: April 2019

This study examined whether patients who are not fluent in English receive less than optimal palliative care. The subjects were 130 consecutive patients (24 non-English speakers, NE, and 106 English speakers, E) with advanced malignant disease who were admitted to three metropolitan-area hospitals and followed for 6 months or until death. 92% of patients who were unaware of their diagnosis were NE. Control of non-pain symptoms was worse for NE patients than for E patients during their last two months. There was an increased prevalence of mood disturbance in NE patients during their first two months in the study. Of the 102 (83 E, 19 NE) patients who died during the study period, no NE patients died at home. These results suggest that patients not fluent in English received less optimal palliative care. Communication of the diagnosis and prognosis requires the cooperation of the patients’ families as well as the use of professional interpreters. Further research is necessary to identify the differences in cultural attitudes that may have contributed to these findings.
Cancer Pain Management in Home Hospice Settings: A Comparison of Primary Care and Oncologic Physicians
Authors: Nowels David , Lee Joseph T.
Published: April 2019

We compare the effectiveness of terminal cancer pain management delivered by primary care physicians with that of specialists in home-based hospice settings. Each visit record for 223 outpatients in three hospice programs was abstracted for physician type, patient age, medication usage, level of pain reported, cancer type, and metastatic status. Thirteen percent of patients reported no pain at any visit and 19% reported pain at all visits; half of the patients reported pain at two thirds of their visits. No difference was found in the presence or absence of pain between primary care and oncologic patients. When available, the level of pain reported (0–10 scale) was statistically (p<0.01) but not clinically different between physician groups; average pain rating for primary care patients was 3.7 while the mean pain rating for oncologic patients was 3.1. The reported pain level varied significantly among facilities, as did physician mix. Multivariate analysis revealed that program and an interaction term between program and physician type, but not physician type independently, explained a significant amount of variation in pain level. Overall, reported pain remained higher than optimal. Research elsewhere has shown that application of the World Health Organization (WHO) cancer pain management guidelines can control 70%–90% of cancer pain. Strategies for implementing pain guidelines that emphasize a systems approach may be effective.
Mechanical and chemical characterisation of bioresorbable polymeric stent over two-year in vitro degradation
Authors: Naseem Raasti , Zhao Liguo , Silberschmidt Vadim , Liu Yang , Scaife Ollie , Willcock Helen , Eswaran Senthil , Hossainy Syed
Published: April 2019

Polymeric stent is a temporary cardiovascular scaffold, made of biodegradable poly (l-lactic) acid, to treat coronary artery stenosis, with expected resorption by the human body over two to three years. In this paper, the mechanical properties of a polymeric stent over two-year in vitro degradation were studied and characterised using atomic force microscopy and nanoindentation techniques, complemented with analyses of weight loss, gel permeation chromatography and differential scanning calorimetry. Atomic force microscopy assessed stent degradation at the surface, whilst nanoindentation was able to investigate the property at a greater depth into the material. No significant changes to the Young’s modulus were observed with the atomic force microscopy due to bulk degradation nature of the polymer. Chemical analyses demonstrated a reduction of molecular weight and an increase of crystallinity, indicating degradation of the stents. Berkovich nanoindentation showed a trend of reduction in modulus over in vitro degradation, which was, however, not continuous due to the variations of measurements associated with the pyramidal indenter tip and the semi-crystalline structure of the polymer.
Properties of poly(lactic acid)/durian husk fiber biocomposites: Effects of fiber content and processing aid
Authors: Lee Man Chee , Koay Seong Chun , Chan Ming Yeng , Choo Hui Leng , Pang Ming Meng , Chou Pui May , Tshai Kim Yeow
Published: April 2019

Biocomposites are sustainable composite materials that, owing to their many benefits, have attracted interest of industry. In the present research, the durian husk fiber (DHF) was used as natural fiber in poly(lactic acid) (PLA) biocomposites. This study focused on the effects of fiber and processing aid content on the processing torque, tensile, thermal, and morphological properties of PLA/DHF biocomposites. The biocomposites with high fiber content have strength and modulus that are suitable for nonstructural application. The processing aid used was Ultra-Plast XP519. The addition of Ultra-Plast XP519 significantly improved the processing by lowering the torque, but it brought negative effect on mechanical properties.
Novel tooth modification methodology for multistage spur gears considering dynamic deformation of housing
Authors: Jia Hanjie , Qin Datong , Liu Changzhao
Published: April 2019

Tooth modification is critical when designing high-performance gear transmission systems. However, it is difficult to accurately calculate the system deformation and tooth modification amount using the traditional empirical formula. Although the finite element method provides accurate results, it is time consuming and its direct application to tooth modification for multistage geared systems is difficult. This study proposes a novel methodology to define tooth modification in both width and profile directions, which can be used for multistage spur gears. First, a housing-transmission coupled dynamic model is built, and the actual meshing state of each gear pair is obtained from dynamic simulation. Lead and profile modification are then conducted sequentially using the actual meshing state as an input. As the optimal tooth modification parameter is determined by the system dynamic response, and the tooth modification in turn influences the system dynamic response, the “dynamic simulation” and “tooth modification” are repeated iteratively until the modification parameter converges. Taking the drum driving system of a shearer as an example, the optimal tooth modification parameter is obtained after three iterations, and the dynamic factor and maximum tooth contact stress clearly decreased after applying the optimal tooth modification.
A model approach for considering nonmetallic inclusions in the calculation of the local tooth root load-carrying capacity of high-strength gears made of high-quality steels
Authors: Fuchs D , Schurer S , Tobie T , Stahl K
Published: April 2019

Demands for higher performance have caused a need for improved component characteristics, e.g. through surface strengthening of gears and increased cleanliness of gear steels. Unfortunately, a resultant drawback is that cracks in such high-strength gears are more often initiated in the material matrix at nonmetallic inclusions and not at the surface. In standardized calculation methods, the degree of cleanliness of steels is not yet directly correlated to the tooth root load-carrying capacity. This paper considers the effects of nonmetallic inclusions in the steel matrix on the tooth root strength based on the theoretical approach of Murakami.
Analysis of deformations of rolls in the six-high tandem mill on the basis of anti-symmetry rotation
Authors: Hongyu Wang , Dianhua Zhang , Dewen Zhao , Shijun Ji , Juncai Sun
Published: April 2019

Six-high tandem mills are widely used in the manufacturing and processing of metal materials. There are many traditional methods which can be used to calculate the deformations of rolls. Since the structures of the mills are anti-symmetry, the traditional methods are difficult to be applied. In this paper, based on the rotation of the half anti-symmetrical structures, the symmetrical structures are obtained. Through the beam theories, the deflections of the rolls are carefully analyzed. Then, the forces and moments on the rolls are also yielded and discussed in the paper. The deformations of the rolls are obtained based on a new model and they are in good agreement with the results based on finite element method. It also should be emphasized when other intermediate rolls are used, the model is also practicable with higher degree polynomials. Since the rotation method recorded in this paper is based on both geometrical and mechanical knowledge, it can be seen as a simplified way to solve the mechanical problem. From the point of model simplification, the method has a good meaning to the manufacturing.
Distributions and fitting of stress amplitude spectra for railway vehicle structures
Authors: Liu Dekun , Zhang Jun , Li Qiang , Chen Jie
Published: April 2019

Stress spectra are essential for estimating the structural fatigue and the fatigue life of railway vehicle structures. However, the data grouping and distribution fitting approaches employed by previous empirical data processing methods are excessively coarse and contain distinctive defects. To address these shortcomings, general theoretical distributions are herein corrected according to the requirements presented by lower stress amplitude data bounds, and converted into a Weibull distribution, truncated lognormal distribution, and truncated normal distribution for comparison. In addition, an innovative distribution consisting of a combined Weibull distribution and truncated lognormal distribution is proposed. The results of fitting to measured stress spectra suggest that the combined distribution has remarkable advantages. Stress spectrum extrapolation and fatigue damage calculation verify that the stress spectrum derived from the combined distribution provides the closest match of all distributions considered to that obtained from the measured spectrum, and therefore best represents the stress distribution at critical points during the practical operation of railway vehicles.
Effects of vortex structure on performance characteristics of a multiblade fan with inclined tongue
Authors: Lun Yuxin , Lin Limin , He Haijiang , Ye Xinxue , Zhu Zuchao , Wei Yikun
Published: April 2019

The effects of complex vortex structure on the internal flow and performance of a centrifugal fan with inclining symmetrical volute tongue were investigated by numerical simulations. The comparison between experimental results and numerical results on performance of a centrifugal fan is presented. To provide a quantitative analysis on the vortex structure in the internal flow of fan, Q criterion as a rule of vortex decision is implemented. Effects on vortex structure and X-velocity of the volute outlet are analyzed by modifying clearance and radius. It is analyzed to provide insight into the performance of the centrifugal fan. Special attention is devoted to the influence of the static pressure and efficiency of the fan by increasing radius of the volute tongue, changing tongue clearance and inclining volute tongue in this paper. The results also show that the static pressure of model B rises as much as 10.59 Pa and the efficiency can be improved by more than 4% compared with the original configuration due to the reduction of flow loss. It is further found that the static pressure efficiency increases with decreasing Q value distribution in the internal flow of the fan.
User recommendations for intelligent personal assistants
Authors: Lopatovska Irene , Griffin Alice London , Gallagher Kelsey , Ballingall Caitlin , Rock Clair , Velazquez Mildred
Published: April 2019

Adoption of intelligent personal assistants (IPA) is on the rise. Published studies on IPAs often focus on the analysis and critique of existing IPA features without understanding specific user needs that the technology aims to address. We present an exploratory study that gathered user recommendations for the design of their ideal IPA. The study relied on focus group and content analysis methods for data collection and analysis. Major themes in participants’ recommendations for IPA design were identified and included feature improvements (e.g. speech recognition, input/output modalities, device feedback); customizability and increased control over IPA features and functions; transparency and understanding of IPA hardware, software, and data management processes; personification; compatibility with third-party platforms; accessibility; and aesthetics. Many of these recommendations are rooted in basic user experience design principles and have been previously discussed in the context of PDAs (personal digital assistants) and other technology. Addressing these recommendations would advance IPA technology and improve user experiences with it.
Unique Calendar Effects in the Indian Stock Market: Evidence and Explanations
Authors: Harshita  , Singh Shveta , Yadav Surendra S.
Published: April 2019

Covering 20 years (1995–2015), the article ascertains the presence of the month-of-the-year effect in the Indian stock market, for the raw returns series as well as after adjusting for non-linearities of the market. Whether the effect is the same for portfolios of different sizes and values is also ascertained. The threshold generalised autoregressive conditionally heteroskedastic (TGARCH) model is employed to address non-linearity. The results suggest the presence of higher returns in November/December at the index level. Further, only firms with a size smaller than the average exhibit seasonality in the form of the April/May and November/December effect. The value-sorted portfolios exhibit weaker evidence of the December effect. Tax-loss selling, window dressing and behavioural aspects seem to provide the explanation.

JEL Classification: C58, G14
Using Technology to Increase Opportunities to Respond
Authors: Rila Ashley , Estrapala Sara , Bruhn Allison Leigh
Published: April 2019

Delivering high rates of opportunities to respond (OTR) has been shown to improve student outcomes for students with challenging behavior. High rates of OTR can maximize student engagement while providing ways for teachers to quickly assess student content mastery. Given the increasing trend of technology use in schools, teachers can leverage technology for delivering OTR. We discuss three technology-based tools teachers can use to enhance OTR delivery with examples of how to incorporate these tools into classrooms.
Neuropathological Findings in a Case of IFIH1-Related Aicardi–Goutières Syndrome
Authors: Gilani Ahmed , Adang Laura A , Vanderver Adeline , Collins Abigail , Kleinschmidt-DeMasters BK
Published: April 2019

Aicardi–Goutières syndrome (AGS) is a rare syndrome characterized by calcification, diffuse demyelination, and variable degree of brain atrophy. The syndrome is genetically heterogeneous with mutations in 7 genes, including TREX1, RNASEH2A, RNASEH2B, RNASEH2C, SAMHD1, ADAR1, and IFIH1 (interferon-induced helicase c domain-containing protein 1) associated with the syndrome, so far. These mutations lead to the overproduction of α-interferon within the central nervous system. Mutations in IFIH1 have been recently described in a subset of AGS, with only 1 previous report of neuropathological findings. We report neuropathological findings in a second case of AGS with a known mutation in IFIH1 gene. The patient is a 16-year-old adolescent boy with early-onset symptoms that progressed to profound loss of cognitive and motor functions. The patient experienced sudden cardiopulmonary arrest at the age of 16 years. At autopsy, the cause of death was determined to be pulmonary thromboembolism. Neuropathological examination revealed microcephaly (brain weight: 916 g) with relatively mild brain atrophy on gross examination. Microscopic examination revealed multifocal calcifications limited to small to medium central nervous system arteries (no evidence of calcification in other organs), involving bilateral cerebral cortex, basal ganglia, thalamus, and cerebellum. Ultrastructural examination showed Calcospherules limited to the vessel walls and the perivasulcar area without evidence of neuronal ferrugination or tubuloreticular bodies. The extent of calcifications was variable across different brain regions, resembling findings in previously reported cases and correlated with the extent of IFIH1 protein expression (data derived from Allen Brain Institute). AGS is a rare cause of brain calcifications that can closely mimic congenital and neonatal infections such as Rubella and similar infections.
Soft-core sandwich plate dynamics: Theory and blast analysis
Authors: Feldfogel Shai , Rabinovitch Oded
Published: April 2019

This work presents an analytical and computational platform that aims to face the modeling, analytical, and computational challenges associated with highly transient dynamics of soft-core sandwich plates and shed light on the dynamic behavior of this unique structural form. This platform comprises a dynamic tri-layered plate analytical model and a corresponding specially tailored triangular finite element formulation. The model is based on extended high-order kinematics for the soft core layer, and it accounts for geometrical nonlinearity, high-order inertia terms, material orthotropy in the three physical layers, the presence of interfaces linking those layers, the interfacial tractions that develop across them, and the bi-directional dynamic response of the plate structure. The governing equations of the finite element formulation are solved in the time domain using a nonlinear Newmark-type time-stepping algorithm. The methodology is validated with regard to free vibration analysis and forced motion analysis against experimental results, 2D-, and 3D-elasticity-based closed form solutions, and multilayered plate finite elements reported in the literature. Following the validation, a numerical example considers the transient response of a soft-core sandwich plate subjected to highly transient air blast loading and compares the response with experimental results taken from the literature. The study examines the ability of present formulations to capture the experimentally observed response and to shed light on some aspects of the response, including the inherently 2D nature of the response, the propagation of stress fronts through the structural medium, and the interfacial interactions.
National gambling policies and the containment of the EU’s politico-legal influence
Authors: Selin Jani
Published: April 2019

Aims:

Research has shown that the EU’s politico-legal influence over member states is contained through two political strategies: contained compliance and anticipatory obedience. Previous studies on gambling policies in the EU have quite uncritically presumed that the EU is capable of inducing changes, or even forcing changes, in national gambling policies. In this article, the objective was to investigate whether member states have adopted the two strategies allowing a containment of the EU’s influence on their national gambling policies.

Design:

The politico-legal influence of the Court of Justice of the European Union (CJEU) and the European Commission on national gambling policy is analysed in the case of Finnish monopoly-based gambling policy. The analysis is based on case law and policy documents.

Results:

The results indicate that Finland has adopted both anticipatory obedience and contained compliance when striving to safeguard its gambling monopoly system. Contained compliance was adopted during the early period of Finland’s accession (1995–2001). Anticipatory obedience was exercised between the years 2004 and 2013, a period characterised by several critical legal cases and the infringement procedure commenced by the European Commission against Finland. During the third period (2014- 2017 ), when the merger of three monopoly operators into a single state-owned company was on the agenda, neither strategy was adopted, indicating little EU influence (despite public justifications of the same).

Conclusion:

The EU’s opportunities to induce changes in the gambling policies of member states should not be overemphasised because member states are able to contain the EU’s politico-legal influence. Future analyses of national gambling policies in the EU would benefit from taking the interaction between member states and the EU into account.
Validation of the COAST score for predicting acute traumatic coagulopathy: A retrospective single-centre cohort study
Authors: Thorn Sophie , Tonglet Martin , Maegele Marc , Gruen Russell , Mitra Biswadev
Published: April 2019

Purpose

Early identification of trauma patients at risk of developing acute traumatic coagulopathy is important in initiating appropriate, coagulopathy-focused treatment. A clinical acute traumatic coagulopathy prediction tool is a quick, simple method to evaluate risk. The COAST score was developed in Australia and we hypothesised that it could predict coagulopathy and bleeding-related adverse outcomes in other advanced trauma systems. We validated COAST on a single-centre cohort of trauma patients from a trauma centre in Belgium.

Methods

The COAST score was modified to suit available data; we used entrapment, blood pressure, temperature, major chest injury and abdominal injury to calculate the score. Acute traumatic coagulopathy was defined as international normalised ratio >1.5 or activated partial thromboplastin time >60 s upon arrival of the patient to the hospital. Data were extracted from the local trauma registry on patients that presented between 1 January and 31 December 2015.

Results

In all, 133 patients met the inclusion criteria (>16 years old, available COAST and outcome data) for analysis. The COAST score had an area under the receiver operating characteristics curve of 0.941 (95% CI: 0.884–0.999) and at COAST ≥3, it had 80% sensitivity and 96% specificity. The score also identified patients with higher rates of mortality, blood transfusion and emergent surgery.

Conclusion

This retrospective cohort study demonstrated the utility of the COAST score in identifying trauma patients who are likely to have bleeding-related poor outcomes. The early identification of these patients will facilitate timely, appropriate treatment for acute traumatic coagulopathy and minimise the risk of over-treatment. It can also be used to select patients with acute traumatic coagulopathy for trials involving therapeutic agents targeted at acute traumatic coagulopathy.
Making up teachers: Pre-kindergarten policy and teachers’ lived experiences
Authors: Wilinski Bethany
Published: April 2019

Increased investment in publicly-funded pre-kindergarten (pre-K) in the USA has come with a concomitant focus on teacher professionalization. Pre-K policies and professionalization efforts often fail to acknowledge that they are layered upon a history of previous policies. New policies are inscribed onto this “discursive archive.” The intersection of a new policy and this discursive archive, viewed through the lived experiences of two pre-K teachers, is the focus of this article. Using critical policy analysis as a framework, I interrogate how a new pre-K policy in Lakeville, Wisconsin, “made up” the pre-K professional in particular ways. Lakeville’s policy came with a new conceptualization of the pre-K professional, framed in terms of particular credentials, pedagogies, and ways of being with children. I explore how this view of the pre-K professional made up two pre-K teachers by shaping their professional and material realities. The use of critical policy scholarship, which recognizes that policy is “permeated with power,” provides a way to understand Lakeville’s pre-K policy as more than an intervention into practice. Instead, it shaped teachers’ subjectivities by creating new norms and boundaries around how teachers were to be and act as pre-K professionals, which they took or resisted in particular ways.
Traditionally transnational: Cultural continuity and change in Hmong shamanism across the diaspora
Authors: Lee Sangmi
Published: April 2019

Based on ethnographic fieldwork with Hmong communities in central Laos and the United States (California), this paper examines how the power of Hmong shamans and their spiritual healing rituals remain effective across national borders and continue to be practiced transnationally among diasporic Hmong. Although shamanistic rituals can be seen as locally-embedded and territorially-bound, their power and efficacy can be transnationally projected across the Hmong diaspora because of cultural understandings about shamanistic births across borders and the mobile nature of souls, as well as extensive transnational kinship networks. Nonetheless, Hmong shamanism has also been transformed as it has travelled across national borders through the diaspora from a socially rich, localized community event to an individualized and commodified practice, while retaining its ‘traditional’ authority. In short, Hmong shamanism demonstrates how indigenous religious and healing practices are not incompatible with modernity but can remain remarkably resilient in a contemporary, globalized world.
Health-care utilization and expenditures among patients with comorbid bronchiectasis and chronic obstructive pulmonary disease in US clinical practice
Authors: Seifer Frederic Douglas , Hansen Gary , Weycker Derek
Published: April 2019

Recent research suggests that bronchiectasis (BE) may be more common than previously believed and that comorbid chronic obstructive pulmonary disease (COPD) is widespread in this patient population. Little is known about the economic burden among patients with BE, and less is known about the burden among those with comorbid BE + COPD. A retrospective matched-cohort design and data from a US health-care claims repository were employed. From the source population comprising adults who had comprehensive medical/drug benefits for ≥1 day in 2013 (i.e. the referent year) and evidence of BE and/or COPD at any time from 2009 to 2013, patients with BE + COPD were age/sex-matched (1:1:1) to patients with BE only and patients with COPD only. For each matched subgroup, annualized levels of respiratory-related and all-cause health-care utilization and expenditures in 2013 were summarized. Source population included 679,679 patients; among those with BE ( n = 31,027), 50% had comorbid COPD. Mean (95% CI) annual levels of respiratory-related utilization and expenditures among matched patients with BE + COPD ( n = 11,685) were higher by 2.4–3.5 times versus patients with BE only and 2.0–2.5 times versus patients with COPD only: hospitalizations, 0.39 (0.37–0.41) versus 0.11 (0.09–0.12) and 0.16 (0.14–0.17); ambulatory encounters, 16.5 (16.1–16.9) versus 6.8 (6.6–7.0) and 8.2 (7.9–8.4); and total expenditures, US$15,685 (14,693–16,678) versus US$5605 (5059–6150) and US$6262 (5655–6868). Respiratory-related utilization and expenditures are high among patients with BE or COPD receiving medical care in US clinical practice and are especially high among those with comorbid BE + COPD receiving medical care, emphasizing the importance of identifying and treating this unique patient population. Funding for this research was provided by RespirTech to Policy Analysis Inc. (PAI).
Genome-Wide Profiling of the Toxic Effect of Bortezomib on Human Esophageal Carcinoma Epithelial Cells
Authors: Ao Nannan , Dai Yingchu , Chen Qianping , Feng Yang , Yu Jingping , Wang Chang , Liu Fenju , Li Ming , Liu Geng
Published: April 2019

Objectives:

Bortezomib has been widely used to treat multiple myeloma and other hematological malignancies. However, not much is known about its effect on solid tumors. The aim of this study was to study the effect of Bortezomib on human esophageal cancer cell lines and investigate the potential target pathways.

Methods:

Two human esophageal cancer cell lines, TE-1 and KYSE-150, were used in this study. Cell viability, cell cycle distribution, and apoptosis after Bortezomib treatment was detected by Cell Counting Kit-8, flow cytometry, and Annexin V/propidium iodide staining, respectively. The genes targeted by Bortezomib were analyzed at the messenger RNA level by microarray chips and quantitative real-time polymerase chain reaction.

Results:

The proliferation of human esophageal cancer cell lines was inhibited by Bortezomib in a dose- and time-dependent manner. Bortezomib treatment led to G2/M arrest and apoptosis. Microarray chips revealed multiple signaling pathways targeted by Bortezomib, including proteasome, endoplasmic reticulum, Wnt-, and calcium-mediated pathway. The expression patterns of 4 representative genes UBD, CUL3, HDAC6, and GADD45A were verified by quantitative real-time polymerase chain reaction and showed consistency with the microarray assay.

Conclusion:

Bortezomib could suppress cell viability, cause G2/M arrest, and induce apoptosis in human esophageal cancer cells, with possible targets including UBD, CUL3, HDAC6, and GADD45A.
Properties of circumferential non-propagating waves in functionally graded piezoelectric cylindrical shells
Authors: Zhang Xiaoming , Li Zhi , Yu Jiangong , Zhang Bo
Published: April 2019

Each guided elastic wave mode is composed of propagating and non-propagating branches. Non-propagating branches associated with complex wavenumbers are substantially different from the propagating ones. Accurate calculation of the transcendental dispersion equation for complex wavenumbers and arbitrary ranges of frequencies is usually very difficult, especially for demanding cases such as those involving composite materials and curved structures. In this article, an extended Legendre orthogonal polynomial method is presented to determine non-propagating waves in a functionally graded piezoelectric cylindrical shell. The extended Legendre orthogonal polynomial method can obtain complete solutions without the tedious iterative search. Results are compared with those published earlier to validate the extended Legendre orthogonal polynomial method, and the convergence of this method is also discussed. Dispersion characteristics of the non-propagating waves in various graded piezoelectric cylindrical shells are studied and three-dimensional dispersion curves are plotted. The effects of piezoelectricity, graded fields, and the mechanical and electrical boundary conditions on dispersion curves are illustrated. The displacement amplitude, stress, and electric potential distributions are also analyzed in detail. Numerical results show that the extended Legendre orthogonal polynomial method is very efficient to retrieve the guided waves of any nature and the modes of all orders.
Improvement of ride quality for patient lying in ambulance with a new hydro-pneumatic suspension
Authors: Tan Bohuan , Wu Yang , Zhang Nong , Zhang Bangji , Chen Yuanchang
Published: April 2019

Instability caused by emergency braking and steering during ambulance operation would easily lead to a sharp rise of blood pressure in patient’s head, which would further cause a secondary injury to the patient. Furthermore, the vibration generated by uneven road would result in patient’s nausea and deterioration of patient’s condition. This article proposes a pitch–roll-interconnected hydro-pneumatic suspension system which can achieve the resistance control for pitch, roll, and bounce modes of ambulances to improve the stability and attenuate the vibration for the lying patients. The ambulance with pitch–roll-interconnected hydro-pneumatic suspension is characterized by 7 degrees of freedom dynamic model, in which the characteristics of pitch–roll-interconnected hydro-pneumatic suspension are explicitly formulized using hydrodynamic equation derivation. A motion-mode energy spectral density method is proposed to decouple the vibration energy for bounce, pitch, and roll modes in frequency domain. Subsequently, the parameter design approach incorporated with the suspension characteristic equations and motion-mode energy spectral density method is also presented to optimize the lying patient’s ride comfort and ambulance’s handling stability. The numerical simulation results show that the proposed pitch–roll-interconnected hydro-pneumatic suspension system can simultaneously provide pitch–roll–stiffness and damping without generating additional bounce-stiffness, resulting in superior ride comfort and handling stability compared to the conventional suspension.
Direct numerical simulation of buckling instability of thin films on a compliant substrate
Authors: Nikravesh Siavash , Ryu Donghyeon , Shen Yu-Lin
Published: April 2019

Surface buckling (wrinkling) driven by mechanical instability is commonly observed in thin-film structures with a compliant substrate. The resulting undulation, while sometimes undesirable, has been increasingly exploited to enhance mechanical and/or functional performances of many thin film devices. In this study a practical finite element modeling approach is introduced to simulate wrinkle formation in thin films atop a compliant substrate. The proposed technique is robust and easy to implement, and it overcomes typical challenges in computationally modeling the buckling instability. Using a two-dimensional geometry under the plane strain or generalized plane strain conditions, with randomly distributed imperfections bearing different material properties at the film/substrate interface, we demonstrate the model’s capability in triggering surface instability during direct compression and out-of-plane tensile loading. With sufficient mesh refinement, the predicted wrinkling wavelength, amplitude, and critical strain to activate wrinkle formation are shown to be close to analytical solutions. The effect of imperfection distribution is systematically studied, and a valid range of imperfection spacing is identified. The present numerical approach can be applied to predicting buckling instability in the design and analysis of thin film/compliant substrate systems over a wide range of material and geometric conditions. Directions for future studies are also discussed.
‘Could do better’: Report on the use of special measures in sexual offences cases
Authors: Majeed-Ariss Rabiya , Brockway Alice , Cook Kate , White Catherine
Published: April 2019

This article reports on research into the use of ‘special measures’ in sexual offence cases. It begins by outlining the background: considering the perennial problem of attrition within the criminal justice system; explaining why special measures are considered important; and outlining the rules surrounding their use. The next step is to explain the research and then the discussion turns to the results so far. This study surveyed 61 sexual offence complainants on how they had decided to give evidence in court and what influenced this decision. This is the first time a team has evaluated special measures including the remote live link, from the point of view of the complainants. The complainants’ descriptions of their choices were analysed to identify key themes, which are presented here. The results highlight that there are some problems with the practical implementation of these measures, particularly given the views of the complainants.
A commentary on land, health, and Indigenous knowledge(s)
Authors: Greenwood Margo , Lindsay Nicole Marie
Published: April 2019

This commentary explores the relationships between land, knowledge, and health for Indigenous peoples. Indigenous knowledge is fundamentally relational, linked to the land, language and the intergenerational transmission of songs, ceremonies, protocols, and ways of life. Colonialism violently disrupted relational ways, criminalizing cultural practices, restricting freedom of movement, forcing relocation, removing children from families, dismantling relational worldviews, and marginalizing Indigenous lives. However, Indigenous peoples have never been passive in the face of colonialism. Now more than ever, Indigenous knowledge in three critical areas—food and water security, climate change, and health—is needed for self-determination and collective survival in a rapidly changing world.
First Nation paths to well-being: lessons from the Poverty Action Research Project
Authors: Wien Fred , Denis Jeff , Dockstator Jennifer S. , Dockstator Mark S. , Duhaime Gérard , Loppie Charlotte , Loxley John , Moore Carla , Newhouse David , Weir Warren , Whiteduck Judy , Wuttunee Wanda
Published: April 2019

This paper describes a poverty reduction approach to addressing an important determinant of health and well-being among Canada’s First Nations. The Poverty Action Research Project (PARP) has its origins in the Make Poverty History Committee established by the Assembly of First Nations (AFN) in 2008. Academic members of the Committee in cooperation with the AFN subsequently applied for an action research grant to the Canadian Institutes of Health Research (CIHR). The project selected five volunteer First Nations from different parts of Canada, hiring a coordinator in each, undertaking background research, developing a profile and working with First Nation representatives in the development of a strategy to address upstream determinants of health and well-being. Subsequently, project team members within each region assisted where needed with plan implementation, supporting some initiatives with small grants. This paper provides insights from the project in several key areas, including First Nation rejection of the concept of poverty as usually defined, the importance of taking action to strengthen collectivities as well as individuals, the feasibility of assisting First Nations who are at different points in their development journey, the strengths of the leadership within the First Nations, and finding the appropriate balance between the elected and business leadership. These insights emerged from dialogue and reflection among project team members and community participants over the life of the project. We also describe what we have learned about how to engage effectively and with mutual respect with First Nations in this kind of project. The paper concludes with a review of our experiences with the policies and practices of the national research granting councils and the universities, which have not fully adjusted to the requirements of action research involving First Nations.
Ascitic fluid polymorphic nuclear cell count impacts on outcome of cirrhotic patients with ascites
Authors: Simbrunner Benedikt , Röthenbacher Annika , Haslacher Helmuth , Bauer David , Chromy David , Bucsics Theresa , Schwabl Philipp , Paternostro Rafael , Scheiner Bernhard , Trauner Michael , Mandorfer Mattias , Schwarzinger Ilse , Reiberger Thomas
Published: April 2019

Background

Spontaneous bacterial peritonitis (SBP) is defined as an ascitic polymorphonuclear cell count (A‐PMN) > 250 cells/µl.

Objective

We aimed to investigate the prognostic value of ascitic fluid cell counts in patients without SBP.

Patients and methods

A total of 178 patients were included and stratified by ascitic cell counts at index paracentesis: A‐LEUK‐low (<250/µl), A‐LEUK‐intermediate (250–500/µl) and A‐LEUK‐SBP (>500/µl) for leukocytes; A‐PMN‐low (<125/µl), A‐PMN‐intermediate (125–250/µl) and A‐PMN‐SBP (>250/µl) for PMN cells.

Results

One‐year mortality was comparable between group A‐LEUK‐SBP (53.9%) and patients with subclinical cell counts (34.5% for A‐LEUK‐low, 43.5% for A‐LEUK‐intermediate, log‐rank p = 0.547). However, we observed an increase in one‐year mortality already in group A‐PMN‐intermediate with 75% and A‐PMN‐SBP with 80.9% (vs 40.5% for A‐PMN‐low, log‐rank p = 0.016).

Importantly, increases of A‐PMN cell counts between two paracenteses were associated with increased mortality: per 100 cells/µl increase of absolute A‐PMN cell count: hazard ratio (HR): 1.03 (95% confidence interval (CI): 1.01–1.06), p = 0.005; per 5% increase of relative PMN cell count: HR: 1.15 (95% CI: 1.06–1.26), p = 0.001.

Conclusion

Patients with PMN cell counts of 125–250/µl are at high risk for mortality, which was very similar to SBP patients with PMN cell counts >250/µl. This highlights the need for preventive strategies. The prognostic value of changes in relative ascitic PMN cell counts should be evaluated in future studies.
Care Burden Derived from the Introduction of an Early Lung Cancer Screening Program in High-Risk HIV-Infected Patients
Authors: Cioaia Simona , Tornero Carlos , Sanchez Eugenio , Alos Mariajose
Published: April 2019

We describe the care burden derived from a lung cancer screening program in high-risk patients with HIV. In a well-selected group with the described criteria, one annual low-dose thoracic computed tomographic exploration can be applied to 7.2% of the patients attended (95% confidence interval: 4.2-9.6), with at least one follow-up exploration in another 1.3%, with the generation of at least 2 extra visits for explanation of the protocol and results. If smoking habit does not change over the next 2 years, another 4.3% of the patients will have met the inclusion criteria. Early detection of lung cancer with low-dose thoracic computed tomographic could be of interest in HIV-infected patients because of the increased of risk but would imply an increase in care burden that must be taken into account.