bluuebunny/crossref_metadata_2025 huggingface dataset:
Discovering archaeological landscapes in parks and protected areas
Authors: Bristow Robert S , Therien Anna
Published: August 2019

Monitoring cultural resources in parks and protected areas is greatly enhanced using Light Detection and Ranging (LiDAR). For this example, a pilot inventory of cultural resources is illustrated for the United States National Park Service lands that protect the Appalachian Trail in Massachusetts. In Massachusetts, the trail stretches 145.2 kilometers (90.2 miles) and is protected by nearly 2052 hectares (5070 acres) of land. To aid in the resource monitoring, these remote sensing data are corroborated with historic records to identify the historical archaeological resources in the corridor. The inventory are then added to existing management plans to help protect the national park with a more complete understanding of the historical human impacts in the backcountry of New England.
Artists Excel on Image Activation But Not Image Manipulation Tasks
Authors: Drake Jennifer E. , Simmons Seymour , Rouser Seth , Poloes Isabella , Winner Ellen
Published: August 2019

The ability to envision what is not directly seen is important in the visual arts, since artists do more than reproduce what they see. Such envisioning requires visual imagery abilities. In this study, we examined whether art students ( n = 32) have enhanced visual imagery abilities compared to nonart students ( n = 40). We administered four tasks designed to assess visual imagery. Three tasks assessed the ability to activate mental images: vividness of visual imagery, recognition of out-of-focus pictures, and abstraction; the fourth task assessed the ability to manipulate mental images: mental rotation. We also administered a verbal IQ and a creativity test to determine whether these measures should be included as covariates in our analyses. Results showed that art students excelled on two of the three image activation tasks, vividness of visual imagery and abstraction, but did not excel on the image manipulation task of mental rotation.
Cultural Barriers to Environmental Mobilization in the Republic of Turkey
Authors: Özler Ş. İlgü , Obach Brian K.
Published: August 2019

The Republic of Turkey provides an opportunity to examine how aspects of national culture can foster sentiments contrary to environmental mobilization. Two deeply rooted cultural values embedded at the founding of the Turkish Republic, a commitment to developmentalism and a strong suspicion of foreign interference, have served to undermine the Turkish environmental movement. Calls for environmental protection are perceived by many as foreign-inspired efforts to inhibit economic development and keep Turkey subservient to more developed nations. In addition, the Turkish case reveals how cultural division can divert attention from issues such as environmental protection. The country is characterized by sharp social boundaries between secularists and more conservative Islamists. This profound cultural divide taints all attempts at issue-based mobilization, including that around environmental protection. An analysis of interview data from 50 environmental movement leaders and government officials demonstrates how deeply held cultural values and social division serve to undermine environmental mobilization.
Individual Differences in Patterns of Community Violence Exposure and Internalizing and Externalizing Behaviors
Authors: Lambert Sharon F. , Tache Rachel M. , Liu Sabrina R. , Nylund-Gibson Karen , Ialongo Nicholas S.
Published: August 2019

Youth community violence has been linked with depressive and anxious symptoms, and aggressive behavior; however, little research has examined different combinations of emotional and behavioral adjustment among community-violence-exposed youth, or individual characteristics that may account for different patterns of emotional and behavioral adjustment in community-violence-exposed youth. This research used person-centered methods to examine how gender, temperament characteristics, and prior exposure to community violence were linked with classes of community violence exposure and internalizing and externalizing adjustment among a sample of urban African American youth. Participants were 464 African American adolescents (46.7% female; mean age = 14.83, SD = .43) who reported their community violence exposure in Grade 9 and for whom reports of depressive and anxious symptoms, and aggressive behavior were available. Latent class analysis identified four classes of adolescents distinguished by their exposure to community violence exposure and internalizing and externalizing behavior. The two classes with high community violence exposure were characterized by internalizing symptoms or aggressive behavior; the two classes with low community violence exposure had low internalizing symptoms with moderate aggression or had all moderate symptoms. These community violence adjustment classes were distinguished by gender, history of community violence exposure, behavioral inhibition, and fight–flight–freeze systems. Findings highlight heterogeneity in internalizing and externalizing responses of community-violence-exposed youth and suggest factors that explain community violence exposure, repeat exposure, and responses to community violence exposure.
Preparation and characterization of polyphenylene sulfide/graphene nanoplatelets composite fibers with enhanced oxidation resistance
Authors: Xing Jian , Xu Zhenzhen , Ni Qing-Qing , Ke Huizhen
Published: August 2019

Composite masterbatches of polyphenylene sulfide (PPS) with functionalized graphene nanoplatelets (GNPs) were prepared by melt blending via a twin-screw extruder. The structure and morphology of composite masterbatches were characterized by scanning electron microscopy and X-ray diffraction analysis. The PPS/functionalized GNPs composite fibers were then manufactured by a self-made spinning equipment via melt spinning. The oxidation resistance and other properties of PPS composite fibers were also examined. The results showed that the pure PPS fibers exhibited smooth surface, whereas the surface of PPS/functionalized GNPs composite fibers was rough. The addition of functionalized GNPs could be acted as heterogeneous nucleating agents to improve the crystallization and increase the degree of crystallinity. The retention rate of breaking strength of PPS/functionalized GNPs composite fibers could maintain up to 85% after the oxidation treatment. The improvement in the oxidation resistance of PPS/functionalized GNPs composite fibers is the results of comprehensive effects characterized by the X-ray photoelectron spectroscopy analyses. The addition of functionalized GNPs could limit the damage of the C–S group and retard the generation of sulfuryl groups (–SO–) during the oxidation treatment. The chemical combination of the elements sulfur (S) and oxygen (O) could also be restricted, thus weakening the oxidation activity.
Exploring High Performance Work Practices as Necessary Condition of HR Outcomes
Authors: Garg Naval , Punia B. K. , Jain Anuradha
Published: August 2019

The fundamental concept of High Performance Work Practices (HPWPs) constitutes a notion that there exists a work system of HR practices in an organization that may lead to better organizational performance. HPWPs have a positive impact on both individual level performance and organizational level performance. In this light, this paper tends to explore necessity of HPWPs for organizational level outcomes. Outcome variables are job commitment, job satisfaction and work-life balance. Data are analyzed with the help of Necessary Condition Analysis.
Rivaroxaban’s Impact on Renal Decline in Patients With Nonvalvular Atrial Fibrillation: A US MarketScan Claims Database Analysis
Authors: Coleman Craig I. , Kreutz Reinhold , Sood Nitesh , Bunz Thomas J. , Meinecke Anna-Katharina , Eriksson Daniel , Baker William L.
Published: August 2019

Warfarin has been associated with renovascular calcification and worsening renal function, whereas rivaroxaban may provide a degree of renopreservation by decreasing vascular inflammation. We sought to compare rivaroxaban and warfarin’s impact on renal decline in patients with nonvalvular atrial fibrillation (NVAF) treated in routine practice. Using US MarketScan claims data from January 2012 to December 2017, we identified patients with NVAF newly initiated on rivaroxaban or warfarin with ≥12 months of continuous insurance coverage prior to initiation. Patients with stage 5 chronic kidney disease (CKD) or receiving hemodialysis at baseline were excluded. Outcomes included rates (events/100 person-years) of hospital or emergency department admission for acute kidney injury (AKI) or progression to stage 5 CKD or need for hemodialysis. Differences in baseline covariates between cohorts were adjusted using inverse probability-of-treatment weights based on propensity scores (absolute standardized differences <0.1 achieved for all covariates after adjustment). Patients were followed until an event, anticoagulant discontinuation/switch, insurance disenrollment, or end of data availability. Hazard ratios with 95% confidence intervals (CIs) were estimated using Cox regression. We assessed 36 318 rivaroxaban (19.8% received a dose <20 mg/d) and 36 281 warfarin users. Stages 3 and 4 CKD were present in 5% and 1% of patients at baseline, and proteinuria was present in 2%. Rivaroxaban was associated with a 19% (95% CI = 13%-25%) reduction in the hazard of AKI (rates = 4.91 vs 8.45) and an 18% (95% CI = 9%-26%) reduction in progression to stage 5 CKD or hemodialysis (rates = 2.67 vs 4.12). Rivaroxaban appears associated with lower hazards of undesirable renal end points versus warfarin in patients with NVAF.
Acceleration decoupling control of 6 degrees of freedom electro-hydraulic shaking table
Authors: Guan Guang-feng , Plummer AR
Published: August 2019

Electro-hydraulic shaking tables are widely used for vibration testing where high force and displacement amplitudes are required. In particular, they are a vital tool in seismic testing, enabling the development of buildings and other structures which are earthquake resistant. Three-variable-control (TVC) is commonly used for the control of multi-degrees of freedom (DOFs) electro-hydraulic shaking tables. However, the coupling between the DOFs is often significant and is not compensated by TVC. In this paper, an acceleration decoupling control (ADC) method is presented for a 6 DOFs electro-hydraulic shaking table system to improve the acceleration tracking performance and decouple the motion in task space. The gravitational, Coriolis, and centripetal forces are compensated for in joint space based on a dynamic model of the shaking table. Modal control is used to transform the coupled dynamics into six independent systems. Inverse dynamics models are used to cancel the differences in actuator dynamics. The proportional gains in modal space are tuned heuristically to give sufficient stability margins to provide robustness in the presence of modeling errors. The input filter and feedforward controller in TVC are added to improve the acceleration tracking performance of each independent system. Experimental acceleration frequency responses are used to demonstrate the effectiveness of ADC, and in particular these show a consistent reduction in cross-axis coupling compared to TVC. Moreover, only four parameters need to be tuned, as opposed to 36 for TVC, and the method provides a viable route to improving the accuracy of seismic testing in the future.
Recommendations From the Society for the Advancement of Transplant Anesthesiology: Liver Transplant Anesthesiology Fellowship Core Competencies and Milestones
Authors: Nguyen-Buckley Christine , Wray Christopher L. , Zerillo Jeron , Gilliland Samuel , Aniskevich Stephen , Nicolau-Raducu Ramona , Planinsic Raymond , Srinivas Coimbatore , Pretto Ernesto A. , Mandell M. Susan , Chadha Ryan M.
Published: August 2019

Liver transplantation is a complex procedure performed on critically ill patients with multiple comorbidities, which requires the anesthesiologist to be facile with complex hemodynamics and physiology, vascular access procedures, and advanced monitoring. Over the past decade, there has been a continuing debate whether or not liver transplant anesthesia is a general or specialist practice. Yet, as significant data have come out in support of dedicated liver transplant anesthesia teams, there is not a guarantee of liver transplant exposure in domestic residencies. In addition, there are no standards for what competencies are required for an individual seeking fellowship training in liver transplant anesthesia. Using the Accreditation Council for Graduate Medical Education guidelines for residency training as a model, the Society for the Advancement of Transplant Anesthesia Fellowship Committee in conjunction with the Liver Transplant Anesthesia Fellowship Task Force has developed the first proposed standardized core competencies and milestones for fellowship training in liver transplant anesthesiology.
Educating Evaluators 1976–2017: An Expanded Analysis of University-Based Evaluation Education Programs
Authors: LaVelle John M.
Published: August 2019

2015 was designated the International Year of Evaluation, suggesting that evaluation has an important role to play in service of positive global ideals. It is vital to recognize the critical role that the education of evaluators plays in these efforts. The current study uses an online search and curricular analysis to provide a snapshot of evaluation education in late 2017 as well as a retrospective analysis of advanced degrees in evaluation offered at universities across time. The results indicate a period of dramatic growth in the number of certificates and master’s degrees being offered at universities across the world over the decades, with a minor decrease in doctoral programs in the past 5 years. Implications and directions for future research are discussed.
A comparison of the thermal comfort performances of a radiation floor cooling system when combined with a range of ventilation systems
Authors: Liu Jiying , Li Zhuangzhuang , Kim Moon Keun , Zhu Shengwei , Zhang Linhua , Srebric Jelena
Published: August 2019

This study conducted a series of computational fluid dynamics simulations to evaluate the thermal comfort performance of a radiant floor cooling system when combined with different ventilation systems, including mixed ventilation (MV), stratum ventilation (SV), displacement ventilation (DV) and ductless personalized ventilation (DPV). A window temperature of 32°C and three different floor temperatures including 20, 22 and 24°C were set in summer. We used the vertical air temperature differences (VATD) at ankle and head level, the percentage of dissatisfied, the draught rate at the ankle level and the equivalent temperature as our main evaluation indices. Our results show that the VATD in DV system can reach up to about 5°C, compared with about 2°C in MV and SV systems. For the DPV system, there is only a marginal drop in the VATD. For the DV and DPV cases, with a rate of air changes per hour (ACH) of 2.4−1, we recorded a higher draught rate at the ankle level, ranging from 6.55% to 9.99%. The lower equivalent temperature values for the foot and calf segments occur when the floor temperature is 20°C. In all cases, the equivalent temperature values of the whole body indicate an acceptable level of thermal discomfort.
I Coveted That Wind: Ganondorf, Buddhism, and Hyrule’s Apocalyptic Cycle
Authors: Hemmann Kathryn
Published: August 2019

This article examines the cultural background informing the overarching narrative of the Legend of Zelda series, focusing on the references to Japanese religious traditions associated with the characters Ganondorf, Demise, and Calamity Ganon. The destruction enacted by these antagonists is not entirely negative; rather, it is a part of the cycle of rebirth that is necessary for the renewal of Hyrule both within the series mythology and in the context of the player’s delight in the postapocalyptic and preindustrial green spaces that characterize the games in the Zelda franchise. A close reading of the original Japanese-language script of Breath of the Wild (2017), Skyward Sword (2011), and The Wind Waker (2002) reveals that the various permutations of Ganon add cultural depth to the games, thus endowing the conflicts underlying their stories with a greater sense of literary complexity.
Constant fear, but lingering nostalgia: British press representations of post-colonial Hong Kong 20 years on
Authors: Liu Ming , Jiang Cong
Published: August 2019

This study conducts a corpus-assisted discourse study of the representations of post-colonial Hong Kong in The Times over the past 20 years. The primary purpose is to reveal its preferential ways of representing Hong Kong and explicate the intricate relations between language use and the historical and socio-political contexts. Through an integration of the methods and theories associated with critical discourse analysis and corpus linguistics, this study conducts both synchronic and diachronic analyses of the representations of Hong Kong from 1997 to 2017. The findings suggest that The Times’ representations of Hong Kong tend to be crisis- and conflict-oriented. While evoking constant fear about the future of Hong Kong, it still suggests that it is Britain’s duty and moral obligation to protect the former British colony. The same trend can also be identified in The Times’ representations of the mass protests against the proposed extradition bill in 2019.
The place of ARBs in heart failure therapy: is aldosterone suppression the key?
Authors: Markan Uma , Pasupuleti Samhitha , Pollard Celina M. , Perez Arianna , Aukszi Beatrix , Lymperopoulos Anastasios
Published: August 2019

Since the launch of the first orally available angiotensin II (AngII) type 1 receptor (AT1R) blocker (ARB) losartan (Cozaar) in the late 1990s, the class of ARBs (or ‘sartans’, short for Angiotensin-RecepTor-ANtagonistS) quickly expanded to include candesartan, eprosartan, irbesartan, valsartan, telmisartan, and olmesartan. All ARBs have high affinity for the AT1 receptor, expressed in various tissues, including smooth muscle cells, heart, kidney, and brain. Since activation of AT1R, the target of these drugs, leads, among other effects, to vascular smooth muscle cell growth, proliferation and contraction, activation of fibroblasts, cardiac hypertrophy, aldosterone secretion from the adrenal cortex, thirst-fluid intake (hypervolemia), etc., the ARBs are nowadays one of the most useful cardiovascular drug classes used in clinical practice. However, significant differences in their pharmacological and clinical properties exist that may favor use of particular agents over others within the class, and, in fact, two of these drugs, candesartan and valsartan, continuously appear to distinguish themselves from the rest of the ‘pack’ in recent clinical trials. The reason(s) for the potential superiority of these two agents within the ARB class are currently unclear but under intense investigation. The present short review gives an overview of the clinical properties of the ARBs currently approved by the United States Food and Drug Administration, with a particular focus on candesartan and valsartan and the areas where these two drugs seem to have a therapeutic edge. In the second part of our review, we outline recent data from our laboratory (mainly) on the molecular effects of the ARB drugs on aldosterone production and on circulating aldosterone levels, which may underlie (at least in part) the apparent clinical superiority of candesartan (and valsartan) over most other ARBs currently in clinical use.
Relational activities and channel contracts: Insights from channel intermediaries in Nigeria
Authors: Uzo Uchenna , Mair Johanna , Adewusi Adedeji
Published: August 2019

This article explains how relational activities affect the design of seemingly paradoxical contractual arrangements among groups of channel intermediaries in Nigeria. The study used a grounded theory approach to investigate and analyze the contractual processes of three groups of channel intermediaries representing three diverse industries. Findings reveal that social relational activities trigger a higher prevalence of word-of-mouth agreements among channel intermediaries, whereas a blend of commercial and social relational activities trigger a higher prevalence of written agreements. Furthermore, we find that negotiation domains moderate the relationship between relational activities and the design of contractual arrangements. Insights from our work offer contributions to the literature on paradoxes, relational embeddedness, and international business.
Adaptation of the urban codes – A story of placemaking in Jerusalem
Authors: Rosner-Manor Yaara , Borghini Sayfan G , Boonstra Beitske , Silva Paulo
Published: August 2019

The tension between stability and adaptability, and the pursuit for mechanisms that allow cities to face internal and external pressures, is a fundamental question for contemporary urban planners. To understand this tension and to develop a complexity-based perspective for planning action that deals with this tension, we describe the city as a complex assemblage employing adaptive mechanisms in front of rapid change. We argue how processes of coding, decoding and recoding continuously take place in the urban setting and are part of such adaptive mechanisms, in particular where community’s informal codes diverge from formal practices. In this context, we examine ‘placemaking’ as an urban mechanism whose function is not only to allow different local voices to express themselves, but also to assist in updating and adapting the ‘urban DNA’ to the city constituents and their diversity. The placemaking project that took place in Jerusalem over the period 2016–2018 is analysed in this framework. We show how Jerusalem municipality is experimenting with new ways of working with very diverse populations via wide-scale community-led methodologies viewed as part of the city capacity to learn and adapt within a changing environment. We turn to epigenetics, a biological field researching micro- and macro-evolutionary mechanisms, to provide us with a theoretical descriptive model that can help represent the impact of such a wide project in both short-term and long-term recoding at the level of urban rules and regulations. This allows us to identify relevant operational mechanisms yielding novelty in approach to the co-existence between formal urban codes and local communities’ strong sub-codes.
Advancing Insights Into Diabetic Eye Disease: 5th Annual American Society of Retina Specialists Presidents’ Young Investigator Award Lecture
Authors: Conti Thais F. , Singh Rishi P.
Published: August 2019

Diabetes and its complications are an emerging public health crisis. Since vision changes can be irreversible in diabetic retinopathy (DR), early detection, recognition of prognostics, and treatment are important to prevent vision loss from DR. At the 2018 American Society of Retina Specialists (ASRS) Annual Meeting, Dr Rishi P. Singh was honored to receive the fifth annual ASRS Presidents’ Young Investigator Award. This article summarizes many advancements in diabetic eye disease that we have witnessed recently covering the concepts of DR, disease pathogenesis, new imaging modalities, and improving treatment outcomes.
Non-destructive three-dimensional crystallographic orientation analysis of olivine using laboratory diffraction contrast tomography
Authors: Pankhurst Matthew J , Gueninchault Nicolas , Andrew Matthew , Hill Edward
Published: August 2019

X-ray laboratory diffraction contrast tomography (LabDCT) produces three-dimensional (3D) maps of crystallographic orientation. The non-destructive nature of the technique affords the key benefit of full 3D context of these, and other, in situ measurements. This study is the first to apply the technique to any material other than a metal or silicon. We report the first 3D measurements of the crystallographic orientation of olivine, which also makes this study the first to apply LabDCT to (1) a non-metallic, non-cubic system and (2) geological material. First, we scanned fragments of olivine set in resin alongside glass microbeads using LabDCT and absorption contrast tomography (ACT). Then we reconstructed these data assuming an orthorhombic crystal system. We show that: (1) the regions within the sample that index well according to the orthorhombic system correspond to olivine fragments in the ACT image; (2) crystalline regions not corresponding to olivine are not indexed assuming the same lattice parameters; and (3) the diffraction data discriminates crystalline from non-crystalline materials as expected. Finally, we demonstrate that the method resolves sub-degree orientation differences between distinct regions within individual olivine fragments. We conclude that DCT can be applied to the study of rocks and other crystalline materials, and offers advantages over conventional techniques. We also note that LabDCT may offer a solution to the crystallographic measurement of substances that would otherwise be difficult to measure due to challenges in obtaining a perfect sample polish. Future developments to accommodate larger experimental volumes and additional crystallographic systems within a sample promises to expand the applicability and impact of DCT.
Is adjunctive CBT really effective for schizophrenia?
Authors: Reid Katherine
Published: August 2019

Although antipsychotic medication remains the mainstay of treatment for schizophrenia, medications alone are not always successful. Cognitive–behavioural therapy (CBT) is recommended as an adjunct to pharmacological treatment. The Cochrane review under consideration evaluates the effects of offering CBT as an add-on to standard care compared with standard care alone, and this commentary puts those findings into their clinical context.

DECLARATION OF INTEREST

None.
DID in resurgence, not retreat
Authors: Radcliffe Pamela , Rix Keith
Published: August 2019

Contrary to the assertion of Paris, diverse indicators suggest that the diagnosis and treatment of dissociative identity disorder (DID) are resurgent rather than retreating. This commentary reviews the evidence that justifies the description of this condition as controversial, including research into dissociative amnesia. The potential harm that can result from a diagnosis of DID and risky treatment techniques, including hypnosis and abreaction, are described. It is suggested that this scientifically unproven and potentially harmful treatment model should be confronted and quelled and its diagnosis and treatment subjected to critical clinical review, including randomised controlled trials, as a matter of urgency. A plea is made for the Royal College of Psychiatrists to update its 1997 guidance document and for professional training to incorporate updated psychological and neurobiological research on human memory.

DECLARATION OF INTEREST

None.
Characterizing the Feasibility and Performance of Real-World Tumor Progression End Points and Their Association With Overall Survival in a Large Advanced Non–Small-Cell Lung Cancer Data Set
Authors: Griffith Sandra D. , Miksad Rebecca A. , Calkins Geoff , You Paul , Lipitz Nicole G. , Bourla Ariel B. , Williams Erin , George Daniel J. , Schrag Deborah , Khozin Sean , Capra William B. , Taylor Michael D. , Abernethy Amy P.
Published: August 2019

PURPOSE

Large, generalizable real-world data can enhance traditional clinical trial results. The current study evaluates reliability, clinical relevance, and large-scale feasibility for a previously documented method with which to characterize cancer progression outcomes in advanced non–small-cell lung cancer from electronic health record (EHR) data.

METHODS

Patients who were diagnosed with advanced non–small-cell lung cancer between January 1, 2011, and February 28, 2018, with two or more EHR-documented visits and one or more systemic therapy line initiated were identified in Flatiron Health’s longitudinal EHR-derived database. After institutional review board approval, we retrospectively characterized real-world progression (rwP) dates, with a random duplicate sample to ascertain interabstractor agreement. We calculated real-world progression-free survival, real-world time to progression, real-world time to next treatment, and overall survival (OS) using the Kaplan-Meier method (index date was the date of first-line therapy initiation), and correlations between OS and other end points were assessed at the patient level (Spearman’s ρ).

RESULTS

Of 30,276 eligible patients,16,606 (55%) had one or more rwP event. Of these patients, 11,366 (68%) had subsequent death, treatment discontinuation, or new treatment initiation. Correlation of real-world progression-free survival with OS was moderate to high (Spearman’s ρ, 0.76; 95% CI, 0.75 to 0.77; evaluable patients, n = 20,020), and for real-world time to progression correlation with OS was lower (Spearman’s ρ, 0.69; 95% CI, 0.68 to 0.70; evaluable patients, n = 11,902). Interabstractor agreement on rwP occurrence was 0.94 (duplicate sample, n = 1,065) and on rwP date 0.85 (95% CI, 0.81 to 0.89; evaluable patients n = 358 [patients with two independent event captures within 30 days]). Median rwP abstraction time from individual EHRs was 18.0 minutes (interquartile range, 9.7 to 34.4 minutes).

CONCLUSION

We demonstrated that rwP-based end points correlate with OS, and that rwP curation from a large, contemporary EHR data set can be reliable, clinically relevant, and feasible on a large scale.
Chagasic Megaesophagus–Associated Carcinoma: Clinical Pattern and Outcomes
Authors: Martins Mariane C.L. , Miyazaki Daniela L. , Gabiatti Camila C.T. , Silva Leandro P. , Macedo Lígia T. , Siqueira Nádia S. , Andreollo Nelson A. , Carvalheira José B.C.
Published: August 2019

PURPOSE

Approximately 4% to 10% of patients diagnosed with Chagas-induced megaesophagus disease develop esophageal carcinoma. However, the natural history and clinical pattern of this entity are not well described.

METHODS

Herein, we retrospectively analyzed 593 patients with esophageal carcinoma treated at a single Brazilian institution. We identified 32 patients with Chagas disease, of whom 11 had megaesophagus. The epidemiologic profile and oncological treatment outcomes were evaluated.

RESULTS

Although baseline characteristics were similar among the three groups, patients with Chagas megaesophagus–associated carcinoma (CMAC) presented with a lower rate of smoking. This factor reinforced the concept that achalasia is the predominant risk factor for cancer development. The CMAC group had a higher rate of tumor in situ (two of 11 patients) compared with the other groups. These patients were treated with endoscopic resection, and no recurrence was detected. Eight of 11 patients with CMAC were diagnosed with locally advanced disease. Patients with locally advanced CMAC presented with a median progression-free survival of 7.8 months and a median overall survival of 9.1 months.

CONCLUSION

If CMAC is not promptly detected, it has a dismal prognosis, indicating that a high index of suspicion of esophageal carcinoma is required for patients with Chagasic megaesophagus. Additional studies are needed to improve the surveillance and treatment approaches for this neglected disease.
Epigenetics Mechanisms in Multiorgan Dysfunction Syndrome
Authors: Crimi Ettore , Cirri Silvia , Benincasa Giuditta , Napoli Claudio
Published: August 2019

Epigenetic mechanisms including deoxyribonucleic acid (DNA) methylation, histone modifications (eg, histone acetylation), and microribonucleic acids (miRNAs) have gained much scientific interest in the last decade as regulators of genes expression and cellular function. Epigenetic control is involved in the modulation of inflammation and immunity, and its dysregulation can contribute to cell damage and organ dysfunction. There is growing evidence that epigenetic changes can contribute to the development of multiorgan dysfunction syndrome (MODS), a leading cause of mortality in the intensive care unit (ICU). DNA hypermethylation, histone deacetylation, and miRNA dysregulation can influence cytokine and immune cell expression and promote endothelial dysfunction, apoptosis, and end-organ injury, contributing to the development of MODS after a critical injury. Epigenetics processes, particularly miRNAs, are emerging as potential biomarkers of severity of disease, organ damage, and prognostic factors in critical illness. Targeting epigenetics modifications can represent a novel therapeutic approach in critical care. Inhibitors of histone deacetylases (HDCAIs) with anti-inflammatory and antiapoptotic activities represent the first class of drugs that reverse epigenetics modifications with human application. Further studies are required to acquire a complete knowledge of epigenetics processes, full understanding of their individual variability, to expand their use as accurate and reliable biomarkers and as safe target to prevent or attenuate MODS in critical disease.
To Infinity and Beyond: The Past, Present, and Future of Tele-Anesthesia
Authors: Bridges Kathryn Harter , McSwain Julie Ryan , Wilson Phillip Ryan
Published: August 2019

Because the scope of anesthesia practice continues to expand, especially within the perioperative domain, our specialty must continually examine technological services that allow us to provide care in innovative ways. Telemedicine has facilitated the remote provision of medical services across many different specialties, but it remains somewhat unclear whether the use of telemedicine would fit within the practice of anesthesiology on a consistent basis. There have been several reports on the successful use of telemedicine within the preoperative and intraoperative realm. However, patient selection, patient and provider satisfaction, case cancellation rates, equipment reliability, and security of protected health information are just some of the issues that require further examination. This article seeks to review comprehensively the available literature related to the use of telemedicine within the preoperative, intraoperative, and postoperative phases of anesthetic care as well as analyze the major hurdles often encountered when implementing a teleconsultation service. Security of connection, data storage and encryption, federal and state medical licensure compliance, as well as overall cost/savings analysis are a few of the issues that warrant further exploration and research. As telemedicine programs develop within the perioperative arena, it is imperative for institutions to share knowledge, successes, and pitfalls to improve the delivery of care in today’s technology-driven medical landscape.
Internal Mammary Sentinel Lymph Node Biopsy in Clinically Axillary Lymph Node-Positive Breast Cancer: Diagnosis and Implications for Patient Management
Authors: Qiu Peng-Fei , Zhao Rong-Rong , Wang Wei , Sun Xiao , Chen Peng , Liu Yan-Bing , Liu Zhi-Guo , Wang Yong-Sheng
Published: August 2019

Background

Routine performance of internal mammary sentinel lymph node biopsy (IM-SLNB) remains a subject of debate due to no clinical relevance in breast cancer, because it was performed only in clinically axillary lymph node (ALN)-negative patients. In this study, IM-SLNB was performed in clinically ALN-positive patients, and its impact on nodal staging and therapeutic strategy were subsequently analyzed.

Methods

Clinically ALN-positive patients who underwent IM-SLNB were enrolled in this prospective study. Statistical analysis was performed using Chi square test, Mann–Whitney U and logistic regression models with a significance level of 0.05.

Results

Among the 352 recruited patients, the internal mammary sentinel lymph node (IMSLN) visualization rate of patients who received initial surgery and neoadjuvant systemic therapy (NST) was 71.9% (123/171) and 33.1% (60/181), respectively. The 183 patients who underwent IM-SLNB successfully had the average time duration of 7 min and the median IMSLN number of 2. There were 87 positive IMSLNs in all the 347 removed IMSLNs, which were mainly concentrated in the second (50.6%) and third (34.5%) intercostal space. The IMSLN metastasis rate was 39.8% (initial surgery) and 13.3% (NST), respectively. All of the 183 IM-SLNB patients received more accurate nodal staging, 57 of whom had stage elevated, which might have prompted modifications to the therapeutic strategy.

Conclusions

IM-SLNB should be routinely performed in clinically ALN-positive patients, and thus more accurate nodal staging and perfect pathologic complete response definition could be put forward. The identification of IMLN metastases by IM-SLNB might potentially influence therapeutic strategies.
Electrophysiological changes in the conducting properties of fast pathway following modification of the slow pathway of the atrio ventricular node for atrio ventricular nodal re-entrant tachycardia
Authors: Khan Imran , Shah Bakhtawar
Published: August 2019

Objectives: To determine the possible changes in the conducting properties of the fast pathway after modification of the atrioventricular slow pathway for AVNRT which leads to the failure of the induction of tachycardia.

Methods: This study was conducted in the Cardiac electrophysiology Laboratory of Hayatabad Medical Complex, Peshawar, Pakistan from March 2017 to March 2018. All the patients underwent radiofrequency modification of the slow pathway for AVNRT. Patients in whom typical AVNRT was inducible with demonstration of dual AV nodal physiology were included in the study.

Results: A total of 171 cases were included in the study, 42 (25%) were males, mean age recorded was 47±15 years. There were no significant changes pre and post ablation in the base line parameters like VV interval, atrioventricular nodal (AV nodal) Wenckebach cycle length, slow pathway effective refractory period (SPERP) or fast and slow pathways maximal Atrio His interval. However significant change was observed in the effective refractory period of the fast pathway 350±49 Vs 290±32 (p value 0.0001). The difference between slow and Fast pathway ERP was also decreased significantly 82±36 Vs 56±24 (p value 0.004).

Conclusion: Our study showed that ablation of AV nodal slow pathway for atrioventricular nodal reentrant tachycardia leads to changes in the effective refractory period of the fast pathway.

doi: https://doi.org/10.12669/pjms.35.5.473

How to cite this:Khan I, Shah B. Electrophysiological changes in the conducting properties of fast pathway following modification of the slow pathway of the atrio ventricular node for atrio ventricular nodal re-entrant tachycardia. Pak J Med Sci. 2019;35(5):1301-1305.  doi: https://doi.org/10.12669/pjms.35.5.473

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Case Report: Pulmonary hemorrhage as a rare cause of lung ultrasound A/B-profile
Authors: Haaksma Mark E. , Nossent Esther J. , Elbers Paul , Tuinman Pieter Roel
Published: August 2019

When using lung ultrasound to determine the cause of acute respiratory failure, the BLUE protocol is often used. In a 65-year old patient, an A/B-profile was found, suggesting pneumonia, following the flowchart of this protocol. In this case, however, pulmonary hemorrhage confirmed by bronchoscopy was the final diagnosis. This case report outlines the importance of understanding the limitations of the BLUE protocol and that lung ultrasound findings should always be used in the context of the patient’s history and physical exam. In addition, pulmonary hemorrhage should be considered in patients with no clinical signs of pneumonia and/or presence of risk factors for lung bleeding as a rare cause of lung ultrasound A/B-profile.
From systematic semiotic modelling to pseudointentional reference
Authors: Randviir Anti
Published: August 2019

Societies as open social systems work through semiotic modelling systems. We view their relevance for shaping primary and secondary needs, as well as metaneeds that are conditioned in social systems. Through conditioning in socialization, semiotic reality can be naturalized up to a level where we can start speaking about not only unconscious, but also unintentional semiosic activity. By that, the very realm of indexicality will be questioned. If indexicality is conjoined with unintended referentiality, then unintentional semiosis means the blurring and fusion of realities far beyond the so-called simulacral semiotic spaces. It is especially acute in the context of the development of technological availabilities where the physical, the semiotic, and the purely virtual reality merge. That quite novel phenomenon is exemplified by semiotic insularization. What follows is that it is hard to define the research object, for the subject is fading away, the real and the virtual are intermingling also in terms of their inhabitants (biological humans, computer users, avatars, virtual identities). Thus the pragmatic dimension of semiotics is gradually becoming lost. Also, the referential reality is moving farther from the informational space created and represented in “traditional” discursive flows, rather becoming based on pseudoreferential clues of meaning making.
Semiotics of threats: Discourse on the vulnerability of the Estonian identity card
Authors: Ventsel Andreas , Madisson Mari-Liis
Published: August 2019

This article analyses various e-threats that were expressed in media texts that focused on e-threat discourses concerning the Estonian identity card’s security risk in 2017. The discourse of cyberthreats contains strong and controversial meanings because the peculiarities of cyberspace remain intangible for average readers who do not possess expert knowledge regarding ICT. The wider aim of the paper is to suggest how the topic of e-threats could be given public coverage without fuelling irrational anxiety and unwarranted threat scenarios. Our theoretical basis combines the frameworks of the Copenhagen School of security studies and ideas of cultural semiotics. We explain the semiotic logic of phobophobia (i.e. the abstract concern with the devastating impacts of the collective feeling of fear) and the discourse of fear that is characterized by a significant reliance on analogies, drawing vague demarcation line between reference objects and the dominance of negative emotional tonality. Our study demonstrates that the main actors of threat and the consequences of the identity card’s security problems were associated with unknown hackers and the damaging of the reputation of Estonia as an e-state.
On the semiotic aspects of visual arts
Authors: Lekomtsev Yurij
Published: August 2019

Publication of a translation of an article by Yurij Lekomtsev, member of the Tartu–Moscow School with the author’s comments and a short bionote.
Practice of Moral Education in the Context of Srimad Bhagavad Gita with Reference to the Concept of Self and Pedagogy
Authors: Das Paromita
Published: August 2019

Values are ultimately personal; the implicit message is that there is no right or wrong value. Schools have a moral ethos embodied in rules, rewards and punishments, dress codes, honour codes, relationships, styles of teaching, extracurricular activities, art, and in the expression of respect. Schools convey to children what is expected of them, what is normal, what is right and wrong. It is often claimed that values are caught rather than taught; through their ethos, schools socialise children into patterns of moral behavior. The present study analyses the practice of moral education as described in the Gita with reference to concept of the Self and pedagogy and how the understanding of the Self and pedagogy can help the teachers in improving their character and pedagogical practices in imparting the real form of education to the children for both present and future.
Psycho-Historical Perceptions of Gandhi
Authors: KS Vijayalakshmi
Published: August 2019

The literature on leadership has its roots in the “Great Man” Theory of Thomas Carlyle, who declared that “The history of the world is but the biography of great men”. These works which emphasised only political, economic, and social motivations for events, gave way to Erikson‟s, “Gandhi‟s Truth: On the Origins of Militant Nonviolence”, is an attempt at understanding Gandhi through a Psycho-biographical study. Psycho-history analyses the incidents that left a deep impression on Gandhi and examines these experiences that Gandhi used on his techniques such as fasting, Ahimsa and Satyagraha later on. The present paper is a historiographical account of the psycho-historical writings on Gandhi. Erikson‟s seminal work which actually gained for Psychohistory its recognition, forms the major source of this paper and also includes some more recently published works such as Wolpert, Richards and Lelyveld. These narratives have explored the varied facets of his personality and his identity which had blurred between myth and history. Gandhi in most writings is raised to the stature of the Mahatma, but psycho-history has done justice to his character as it brings out the human side of the leader with all his frailties.
Social Impact Assessment under RFCTLARR Act 2013 and Social Costs – An Analysis
Authors: Ghosh Puranjoy , Ray Abhishek
Published: August 2019

Mass-scale development, in the backdrop of increasing population, has appreciated the market-value of "land" – the important determinant that either directly or distantly affects the objectives of sustainable development initiatives. To ensure peoples‟ participation in such governance of developmental programs and satisfy the expansion of economic aspiration, significant changes have been brought in the normative frameworks of land-acquisition, for example, streamlining of compensation policy (economic), integration of SIA and R&R scheme (physical & socio-cultural), involvement of affected persons within the fold of decision-making process (minimization of adverse effects particularly political disruptions), in the RFCTLARR, 2013. This space is used to explicate some popular economic indicators in the context of „social cost‟ in RFCTLARR, 2013.
Editorial
Authors: Varghese Bindi
Published: August 2019

Atna-Journal  of  Tourism  Studies (ATJS)  has  continued  to  make progress  in  terms  of  publishing  peer-reviewed  articles  and  has attracted an ever increasing national audience of authors, research investigators, and scholars, as indicated by the increasing number of submissions and published papers. The  scholarly  contributions  featured  in  the  current  issue  range across such areas as wine tourism, medical tourism, film induced tourism, celebrity endorsement and SWOT analysis of eco-lables. Anupama Kotur Kaddi in her article Event Motivation Study of Wine Festival Visitors in Maharashtra highlights growing interest among Indian travelers in wine tourism within the country and outside. “Medical Tourism and Inclusive Growth:
Motivation for ‘Consumer–Producer‘ Interactions in Tourism: Disintermediation and Scope for Travel Agencies
Authors: Jovial Fernandes Anthony , Emy Alex
Published: August 2019

Increase in accessibility to the internet and consumer’s faith in conducting online transactions, have paved way for a steady change in how consumers plan and buy their holidays. The role of traditional travel agents and online travel portals, as sources most knowledgeable about holiday destinations is on the wane due to the emergence of online reviewing platforms, and easily accessible and first-hand information from the service producers. Consumers today prefer to approach service producers such as resorts, restaurants, transport providers and guides to book their services. Given this scenario, this paper attempts to determine the catalyst for the changing trends in tourist buying behavior, the role of the internet and whether travel agents are aware of the said changes. The paper also looks at possible opportunities for travel agents to expand their products’ portfolio to maintain or increase their revenue in tandem with the changes in the industry. The study takes into consideration responses received from 75 tourists and structured interviews conducted with sixteen travel agents.