bluuebunny/crossref_metadata_2025 huggingface dataset:
Immigration, Cultural Distance and Natives' Attitudes Towards Immigrants: Evidence from Swiss Voting Results
Authors: Brunner Beatrice , Kuhn Andreas
Published: January 2018

We combine community‐level outcomes of 27 votes about immigration issues in Switzerland with census data to estimate the effect of immigration on natives' attitudes towards immigrants. We apply an instrumental variable approach to take potentially endogenous locational choices into account, and we categorize immigrants into two groups according to the cultural values and beliefs of their country of origin to understand how the cultural distance between natives and immigrants affects this relationship. We find that the share of culturally different immigrants is a significant and sizable determinant of anti‐immigration votes, while the presence of culturally similar immigrants does not affect natives' voting behavior at all in most specifications. We argue that the differential impact of the two groups of immigrants is, at least in part, driven by natives' concerns about compositional amenities. We finally find that the share of right‐wing votes in favor of the Swiss People's Party appears to be more elastic with respect to the share of culturally different immigrants than natives' attitudes themselves, suggesting that the party has gained a disproportionate vote share from attitudinal changes caused by immigrant inflows.
A Theory of Tasteful and Distasteful Transactions
Authors: Khalil Elias L. , Marciano Alain
Published: January 2018

This paper develops a theory of tasteful and distasteful exchanges based on rational choice. By making reference to existing literature, we first differentiate repugnant from tasteful/distasteful transactions and bring up the additional consideration of the latter. There is a key difference between the two types of proscribed exchanges: repugnancy and distastefulness. The repugnancy of a transaction is determined by a single factor: tastes (preferences). The distastefulness of a transaction is determined by two factors: the true intention of the actor and the context of the transaction. We characterize tastefulness/distastefulness as a judgment: does the context of the transaction, which expresses “declared intention,” match the “true intention” of the actor? We identify four different kinds of intentions and their matching contexts of exchange. This allows us to classify four different kinds of tasteful transactions, i.e. when true intentions correspond to declared ones—i.e., to their context. It also allows us to classify twelve different kinds of distasteful transactions.
Learnables and Teachables in Second Language Talk: Advancing a Social Reconceptualization of Central SLA Tenets. Introduction to the Special Issue
Authors: ESKILDSEN SØREN WIND , MAJLESI ALI REZA
Published: January 2018

Following Firth & Wagner's (, ) call for a social reconceptualization of central tenets of second language acquisition (SLA) research, this special issue of The Modern Language Journal focuses on practices for teaching and learning a second language (L2) with special attention to the details of socio‐interactional contexts of teaching and learning behaviors/activities. Its goal is to unveil learning processes and practices as socially observable phenomena in situ and in vivo and to discuss pedagogical implications of the findings. As such, the issue focuses on some well‐established concepts from the SLA field, including noticing, attention, and corrective feedback, but aims to explore and reconceptualize them in terms of social displays of behavior and social practices as seen through the lens of conversation analysis. This Introduction sets the stage for the articles in the special issue by tracing SLA's interest in socio‐interactional aspects of learning before moving on to a brief discussion of the epistemology of CA. We then outline the ways in which the individual articles empirically contribute to a social understanding of learning and cognition in SLA, before summarizing the main points addressed in the special issue.
Epistemological Reorientations and L2 Interactional Settings: A Postscript to the Special Issue
Authors: KASPER GABRIELE , WAGNER JOHANNES
Published: January 2018

This postscript discusses the contributions of the four articles in this issue to the field and positions them in relation to other studies in recent CA research on L2. The articles focus on the two arenas for L2 learning: the classroom and the lifeworld of learners. These arenas are widely different from each other and equally so within with respect to organization and participation frameworks and the social practices deployed; but the interactional problems that participants confront inside and outside of the classroom partially overlap. Learning and teaching objects (or ‘learnables’) are brought into being by the participants through their joint actions, at particular moments in the ongoing activity, be it in a classroom or a situation in the lifeworld. The four articles re‐specify standard SLA concepts in interactional terms: attention and noticing (Kunitz, 2018, this issue), corrective feedback (Majlesi, 2018, this issue), negotiation of/for meaning (Eskildsen, 2018, this issue), and corrections and metalinguistic explanations (Theodórsdóttir, 2018, this issue). Their re‐specification adds value to these concepts because it furnishes them with a publicly visible interactional grounding and shows in each case how linguistic items become objects for reflexive linguistic practices by the participants.
Inherited Traditions of Narrative Framing in W. G. Sebald'sDie Ausgewanderten
Authors: DeMair Jillian
Published: January 2018

InDie Ausgewanderten(1992), W. G. Sebald frames the act of storytelling in a way that draws on and reappropriates nineteenth‐century narrative traditions, in particular the frame constructions typical of the GermanNovellewith which Sebald was familiar. Sebald portrays his narrator not only as a storyteller, but also as a witness, collector of stories, and reader of documents. This is a framing technique already utilized in the nineteenth century, sometimes to assert believability and authenticity, but also to reveal ironically the ambiguity and fragility of seemingly authentic stories. By using photographs and a seemingly autobiographical style, Sebald follows in this tradition in order to represent twentieth‐century loss and tragedy, as well as to test the limits of this form of representation for life stories that revolve around death, loss, and the tension between capturing and erasing memory.
L'intermédialité comme méthode d'analyse textuelle
Authors: Lutas Liviu
Published: January 2018

Cet article a deux objectifs. Pour commencer, nous présentons la théorie intermédiale actuelle telle qu'elle s'est établie principalement dans la recherche allemande et suédoise, par exemple dans les travaux de Werner Wolf et de Lars Elleström. Ensuite, nous appliquons cette théorie sur l’œuvre de l’écrivain martiniquais contemporain Patrick Chamoiseau. Dans une première étape, nous abordons plusieurs aspects intermédiaux de cette œuvre d'une perspective générale, avant de nous lancer dans une analyse textuelle de quelques extraits de trois romans – Biblique des derniers gestes (2002), Solibo Magnifique (1988) et L'empreinte à Crusoé (2012) – où l'intermédialité est mise en œuvre de manière particulièrement intéressante. Notre parcours montre non seulement que Chamoiseau est actif dans plusieurs médias, mais que son écriture est hautement intermédiale, Il traite le médium de l’écriture de manière flexible et ouverte, non pas comme une entité essentialisé et stable. Notre conclusion est que l'originalité de l’œuvre chamoisienne peut mettre à l’épreuve la théorie de l'intermédialité de manière constructive, sans pour autant l'invalider.
Myeloperoxidase
Authors: Klebanoff Seymour J.
Published: January 2018

Phagocytes respond to stimulation with a burst of oxygen consumption, and much, if not all, of the extra oxygen consumed in the respiratory burst is converted first to the superoxide anion and then to hydrogen peroxide (H2O2). Myeloperoxidase (MPO), which is released from cytoplasmic granules of neutrophils and monocytes by a degranulation process, reacts with the H2O2 formed by the respiratory burst to form a complex that can oxidize a large variety of substances. Among the latter is chloride, which is oxidized initially to hypochlorous acid, with the subsequent formation of chlorine and chloramines. These products of the MPO‐H2O2‐chloride system are powerful oxidants that can have profound biological effects. The primary function of neutrophils is the phagocytosis and destruction of microorganisms, and the release of MPO and H2O2 into the phagosome containing the ingested microorganism generally leads to a rapid microbicidal effect. Neutrophils from patients with chronic granulomatous disease (CGD) have a microbicidal defect that is associated with the absence of a respiratory burst and, thus, H2O2 production. Neutrophils from patients with a hereditary MPO deficiency, who lack MPO, also have a microbicidal defect, although it is not as severe as that seen in CGD. MPO and H2O2 also can be released to the outside of the cell where a reaction with chloride can induce damage to adjacent tissue and, thus, contribute to the pathogenesis of disease. It has been suggested that pulmonary injury, renal glomerular damage, and the initiation of atherosclerotic lesions may be caused by the MPO system.
Myocardial G Protein‐Coupled Receptor Kinases: Implications for Heart Failure Therapy
Authors: Iaccarino Guido , Lefkowitz Robert J. , Koch Walter J.
Published: January 2018

The β‐adrenergic signaling cascade is an important regulator of myocardial function. Significant alterations of this pathway are associated with several cardiovascular diseases, including congestive heart failure (CHF). Included in these alterations is increased activity and expression of G protein‐coupled receptor kinases (GRKs), such as the β‐adrenergic receptor kinase (βARK1), which phosphorylate and desensitize β‐adrenergic receptors (βARs). A body of evidence is accumulating that suggests that GRKs, in particular βARK 1, are critical determinants of cardiac function under normal conditions and in disease states. Transgenic mice with myocardial‐targeted alterations of GRK activity have shown profound changes in the in vivo functional performance of the heart. Included in these studies is the compelling finding that inhibition of βARK1 activity or expression significantly enhances cardiac function and potentiates βAR signaling in failing cardiomyocytes. This article summarizes the advances made in the study of βARK I in the heart and addresses its potential as a novel therapeutic target for CHF.
The Natriuretic Peptides in Heart Failure: Diagnostic and Therapeutic Potentials
Authors: Chen Horng H. , Burnett John C.
Published: January 2018

The natriuretic peptides are a group of structurally similar but genetically distinct peptides that have diverse actions in cardiovascular, renal, and endocrine homeostasis. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are of myocardial cell origin and C‐type natriuretic peptide (CNP) is of endothelial origin. ANP and BNP bind to the natriuretic peptide‐A receptor (NPR‐A), which, via 3',5'‐cyclic guanosine monophosphate (cGMP), mediates natriuresis, vasodilatation, renin inhibition, antimitogenesis, and lusitropic properties. CNP lacks natriuretic actions but possesses vasodilating and growth‐inhibiting actions via the guanylyl cyclase‐linked natriuretic peptide‐B receptor (NPR‐B). All three peptides are cleared by the natriuretic peptide‐C receptor (NPR‐C) and are degraded by the ectoenzyme neutral endopeptidase 24.11 (NEP), both of which are widely expressed in the kidneys, lungs, and the vascular wall. Congestive heart failure (CHF) represents a pathological state in which the activation of the natriuretic peptides exceeds those of all other states. In this brief review, we will attempt to provide an update on important issues regarding natriuretic peptides in CHF, with a focus on their functional importance as a beneficial humoral response in asymptomatic left ventricular dysfunction (LVD), the mechanisms of natriuretic peptide hyporesponsiveness in severe heart failure, the diagnostic and prognostic significance of the natriuretic peptides in CHF, and the therapeutic potential of the natriuretic peptides in this multiorgan syndrome.
Heme Oxygenase: Recent Advances in Understanding Its Regulation and Role
Authors: Elbirt Kimberly K. , Bonkovsky Herbert L.
Published: January 2018

Heme oxygenase (HO) is responsible for the physiological breakdown of heme into equimolar amounts of biliverdin, carbon monoxide, and iron. Three isoforms (HO‐1, HO‐2, and HO‐3) have been identified. HO‐1 is ubiquitous and its mRNA and activity can be increased several‐fold by heme, other metalloporphyrins, transition metals, and stimuli that induce cellular stress. HO‐1 is recognized as a major heat shock/stress response protein. Recent work from our laboratory has demonstrated several potential consensus regulatory elements in the 5'‐untranslated region (UTR) of HO‐1, including activator protein 1 (AP‐1), metal responsive element (MRE), oncogene c‐myc/max heterodimer binding site (Myc/Max), antioxidant response element (ARE), and GC box binding (Sp 1) sites. Using deletion‐reporter gene constructs, we have mapped sites that mediate the arsenite‐dependent induction of HO‐1, and we have shown that components of the extracellular signal‐regulated kinase (ERK) and p38 (a homologue of the yeast HOG 1 kinase), but not c‐jun N‐terminal kinase (JNK), mitogen‐activated protein (MAP) kinase pathways are involved in arsenite‐dependent upregulation. In contrast, HO‐2 is present chiefly in the brain and testes and is virtually uninducible. HO‐3 has very low activity; its physiological function probably involves heme binding. Products of the HO reaction have important effects: carbon monoxide is a potent vasodilator, which is thought to play a key role in the modulation of vascular tone, especially in the liver under physiological conditions, and in many organs under “stressful” conditions associated with HO‐1 induction. Biliverdin and its product bilirubin, formed in most mammals, are potent antioxidants. In contrast, “free” iron increases oxidative stress and regulates the expression of many mRNAs (e.g., DCT‐1, ferritin, and transferrin receptor) by affecting the conformation of iron regulatory protein (IRP)‐1 and its binding to iron regulatory elements (IREs) in the 5'‐ or 3'‐UTRs of the mRNAs.
Presentation of the Kober Medal for 1999 to Jean D. Wilson Physician‐Scientist Exemplar
Authors: Goldstein Joseph L. , Brown Michael S.
Published: January 2018

This article is adapted from a lecture presented by Joseph L. Goldstein at the 1999 Joint Meeting of the American Society for Clinical Investigation and Association of American Physicians in Chicago, Illinois, USA on April 25, 1999. The George M. Kober Medal, the Association of American Physician's highest honor, has been awarded annually since 1924 to a member of the Association who has made outstanding contributions to the “progress and achievement of the medical sciences.”
Measuring progress in status of land under forest landscape restoration using abiotic and biotic indicators
Authors: Dudley Nigel , Bhagwat Shonil A. , Harris Jim , Maginnis Stewart , Moreno Jaime Garcia , Mueller Gregory M. , Oldfield Sara , Walters Gretchen
Published: January 2018

The paper suggests a minimum set of abiotic and biotic threshold indicators and progress indicators for forest landscape restoration (FLR), then also briefly discusses progress indicators of pressures and project outputs. FLR aims to restore multiple functions of forests at a landscape scale. It is predicated on the hypothesis that restoration produces enabling conditions for ecosystem services, including regulating services such as carbon sequestration and pollination, and provisioning services such as food and energy. As FLR gains greater uptake, it is increasingly important to monitor progress. The types of indicators required are influenced by the degree of forest loss and degradation. To measure the status of land under restoration, one or more abiotic and biotic threshold indicators are required, measuring the return of enabling conditions for restoration (soil quality, water, etc.), along with progress indicators measuring the reemergence of the ecosystem services. Although all elements of the proposed monitoring framework are well known, compiling them into a coherent system, suitable for application in a wide range of conditions, will take much further development.
Experimental and Numerical Study of Performance Behavior of Triangular Seal Under High Hydraulic Pressure
Authors: Mose Bruno R. , Lim Hyun-Seok , Shin Dong-Kil
Published: January 2018

In this paper, a seal with triangular cross section was proposed and its performance behavior under compression and various hydraulic pressures was analyzed through experimental and numerical methods. The seal was designed to have a 90 deg corner located near the extrusion gap while hydraulic pressure was applied at an inclination. With this design, it was found that even at hydraulic pressures of up to 18 MPa, the seal offered good fluid tight sealing capabilities without indications of extrusion failures. Such high pressure offers new possibilities for successful application of the seal in aircraft and rocket propulsion equipment. Moreover, the resistance of the seal against leakages was assured because measured contact stresses were greater than applied pressures. A numerical simulation through finite element analysis (FEA) showed that tilting of the delta ring even at angles of ±5 deg did not have any effect on the Von Mises stresses. The FEA results also demonstrated that the deformations and fringe patterns of delta ring were similar to the experimental results.
Fragility Evaluation in Building-Piping Systems: Effect of Piping Interaction With Buildings
Authors: Hee Ryu Yong , Gupta Abhinav , Seog Ju Bu
Published: January 2018

Many studies assessing the damage from 1971 San Fernando and 1994 North Ridge earthquakes reported that the failure of nonstructural components like piping systems was one of the significant reasons for shutdown of hospitals immediately after the earthquakes. This paper is focused on evaluating seismic fragility of a large-scale piping system in representative high-rise, midrise, and low-rise buildings using nonlinear time history analyses. The emphasis is on evaluating piping's interaction with building and its effect on piping fragility. The building models include the effects of nonlinearity in the performance of beams and columns. In a 20-story building that is detuned with the piping system, critical locations are on the top two floors for the linear frame building model. For the nonlinear building model, critical locations are on the bottom two floors. In an eight-story building that is nearly tuned with the piping system, the critical locations for both the linear frame and nonlinear models are the third and fourth floors. It is observed that building nonlinearity can reduce fragility due to reduction in the tuning between building and piping systems. In a two-story building, the nonlinear building frequencies are closer to the critical piping system frequencies than the linear building frequency; the nonlinear building is more fragile than the linear building for this case. However, it is observed that the linear building models give excessively conservative estimates of fragility than the nonlinear building models.
A Study of Design Fixation Related to Additive Manufacturing
Authors: Abdelall Esraa S. , Frank Matthew C. , Stone Richard T.
Published: January 2018

This study aims to understand the effect of additive manufacturing (AM) on design fixation. Whereas previous research illustrates the positive aspects of AM, the overarching hypothesis of this work is that it might also have negative effects with respect to conventional manufacturability. In this work, participants from two groups, a design for conventional manufacturing (DfCM) group, and a design for additive manufacturing (DfAM) group, were asked to design a basic product. Then, a second iteration of the design asked both groups to design for conventional processes, and to include subtractive and formative methods like machining and casting, respectively. Findings showed that the DfAM fixated on nonproducible manufacturing features and produced harder to conventionally manufacture designs, even when told specifically to DfCM. There was also evidence that the complex designs of the DfAM group limited their modeling success and seemed to encourage them to violate more design constraints. This study draws attention to the negative effect of AM knowledge on designers and provides motivation for treatment methods. This is important if AM is used in prototyping or short run production of parts that are slated for conventional manufacturing later. The issue of design fixation is not a problem if AM is the final manufacturing method—a more common practice nowadays. This work suggests that one should consider the possibility of fixation in design environments where AM precedes larger volume conventional manufacturing.
Estimation of the Two Degrees-of-Freedom Time-Varying Impedance of the Human Ankle
Authors: Ficanha Evandro , Ribeiro Guilherme , Knop Lauren , Rastgaar Mo
Published: January 2018

An understanding of the time-varying mechanical impedance of the ankle during walking is fundamental in the design of active ankle-foot prostheses and lower extremity rehabilitation devices. This paper describes the estimation of the time-varying mechanical impedance of the human ankle in both dorsiflexion–plantarflexion (DP) and inversion–eversion (IE) during walking in a straight line. The impedance was estimated using a two degrees-of-freedom (DOF) vibrating platform and instrumented walkway. The perturbations were applied at eight different axes of rotation combining different amounts of DP and IE rotations of four male subjects. The observed stiffness and damping were low at heel strike, increased during the mid-stance, and decreases at push-off. At heel strike, it was observed that both the damping and stiffness were larger in IE than in DP. The maximum average ankle stiffness was 5.43 N·m/rad/kg at 31% of the stance length (SL) when combining plantarflexion and inversion and the minimum average was 1.14 N·m/rad/kg at 7% of the SL when combining dorsiflexion and eversion. The maximum average ankle damping was 0.080 Nms/rad/kg at 38% of the SL when combining plantarflexion and inversion, and the minimum average was 0.016 Nms/rad/kg at 7% of the SL when combining plantarflexion and eversion. From 23% to 93% of the SL, the largest ankle stiffness and damping occurred during the combination of plantarflexion and inversion or dorsiflexion and eversion. These rotations are the resulting motion of the ankle's subtalar joint, suggesting that the role of this joint and the muscles involved in the ankle rotation are significant in the impedance modulation in both DP and IE during gait.
Control of Heat and Mass Transfers Due to Tearing Mode-Based Magnetic Islands During Disruption Phase in IR-T1 Tokamak
Authors: Sadeghi R. , Elahi A. Salar , Ghoranneviss M. , Salem M. K.
Published: January 2018

A structural change of perturbed magnetic configurations (such as magnetic islands) during disruption phase in IR-T1 tokamak was studied. The singular value decomposition (SVD) mode analysis and the (m,n) modes identification were presented. We also presented the SVD technique to analyze the tokamak magnetic fluctuations, time evolution of magnetohydrodynamics (MHD) modes, spatial structure of each time vector, and the energy content of each modes. We also considered different scenarios for plasma from steady-state to predisruption, complete disruption, creation of tearing modes, and finally magnetic islands.
Fast, noise-free memory for photon synchronization at room temperature
Authors: Finkelstein Ran , Poem Eilon , Michel Ohad , Lahad Ohr , Firstenberg Ofer
Published: January 2018

We implement a new, noise-free, broadband light storage scheme, opening the way to faithful multiphoton synchronization.
Increased leisure-time physical activity associated with lower onset of diabetes in 44 828 adults with impaired fasting glucose: a population-based prospective cohort study
Authors: Lao Xiang Qian , Deng Han-Bing , Liu Xudong , Chan Ta-Chien , Zhang Zilong , Chang Ly-yun , Yeoh Eng-Kiong , Tam Tony , Wong Martin Chi Sang , Thomas G Neil
Published: January 2018

Aims

To evaluate the effects of habitual leisure-time physical activity (LTPA) on incident type 2 diabetes in a prospective cohort of Chinese adults with impaired fasting glucose (IFG).

Methods

44 828 Chinese adults aged 20–80 years with newly detected IFG but free from cardiovascular and cerebrovascular disease were recruited and followed up from 1996 to 2014. Incident type 2 diabetes was identified by fasting plasma glucose ≥7 mmol/L. The participants were classified into four categories based on their self-reported weekly LTPA: inactive, low, moderate, or high. Hazard ratios (HRs) and population attributable fractions (PAFs) were estimated with adjustment for established diabetic risk factor.

Results

After 214 148 person-years of follow-up, we observed an inverse dose–response relationship between LTPA and diabetes risk. Compared with inactive participants, diabetes risk in individuals reporting low, moderate and high volume LTPA were reduced by 12% (HR 0.88, 95% CI 0.80 to 0.99; P=0.015), 20% (HR 0.80, 95% CI 0.71 to 0.90; P<0.001), and 25% (HR 0.75, 95% CI 0.67 to 0.83; P<0.001), respectively. At least 19.2% (PAF 19.2%, 95% CI 5.9% to 30.6%) of incident diabetes cases could be avoided if the inactive participants had engaged in WHO recommendation levels of LTPA. This would correspond to a potential reduction of at least 7 million diabetic patients in the Greater China area.

Conclusions

Our results show higher levels of LTPA are associated with a lower risk of diabetes in IFG subjects. These data emphasise the urgent need for promoting physical activity as a preventive strategy against diabetes to offset the impact of population ageing and the growing obesity epidemic.
Trends in type 2 diabetes detection among adults in the USA, 1999–2014
Authors: Geiss Linda S , Bullard Kai McKeever , Brinks Ralph , Hoyer Annika , Gregg Edward W
Published: January 2018

Objective

To examine recent trends in type 2 diabetes detection among adults in the USA.

Research design and methods

We used data from the 1999–2014 National Health and Nutrition Examination Surveys on non-pregnant adults (aged ≥18 years) not reporting a diagnosis of diabetes (n=16 644 participants, averaging about 2000 for each 2-year cycle). We defined undiagnosed diabetes as a fasting plasma glucose ≥126 mg/dL or a hemoglobin A1c ≥6.5% (48 mmol/mol). We measured case detection as the probability of finding undiagnosed type 2 diabetes among the population without diagnosed diabetes. Linear regression models were used to examine trends overall and by sociodemographic characteristics (ie, age, gender, race/ethnicity, education, poverty-income ratio (PIR)).

Results

Age-standardized probability of finding undiagnosed type 2 diabetes was 3.0% (95% CI 2.1% to 4.2%) during 1999–2000 and 2.8% (2.2%–3.6%) during 2013–2014 (Pfor trend=0.52). Probability increased among Mexican-Americans (Pfor trend=0.01) but decreased among adults aged 65 years or older (Pfor trend=0.04), non-Hispanic (NH) white (Pfor trend=0.02), and adults in the highest PIR tertile (Pfor trend=0.047). For all other sociodemographic groups, no significant trends were detected.

Conclusions

We found little evidence of increased detection of undiagnosed type 2 diabetes among adults in the USA during the past 15 years. Although improvements were seen among NH white, older, and wealthy adults, these improvements were not large. As the scope of primary prevention efforts increases, case detection may improve.
Protocol for a multicentred randomised controlled trial investigating the use of personalised golimumab dosing tailored to inflammatory load in ulcerative colitis: the GOAL-ARC study (GLM dose Optimisation to Adequate Levels to Achieve Response in Colitis) led by the INITIAtive group (NCT 0268772)
Authors: Sheridan Juliette , Coe Carol Ann , Doran Peter , Egan Laurence , Cullen Garret , Kevans David , Leyden Jan , Galligan Marie , O’Toole Aoibhlinn , McCarthy Jane , Doherty Glen
Published: January 2018

Introduction

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD), often leading to an impaired quality of life in affected patients. Current treatment modalities include antitumour necrosis factor (anti-TNF) monoclonal antibodies (mABs) including infliximab, adalimumab and golimumab (GLM). Several recent retrospective and prospective studies have demonstrated that fixed dosing schedules of anti-TNF agents often fails to consistently achieve adequate circulating therapeutic drug levels (DL) with consequent risk of immunogenicity treatment failure and potential risk of hospitalisation and colectomy in patients with UC.

The design of GLM dose Optimisation to Adequate Levels to Achieve Response in Colitis aims to address the impact of dose escalation of GLM immediately following induction and during the subsequent maintenance phase in response to suboptimal DL or persisting inflammatory burden as represented by raised faecal calprotectin (FCP).

Aim

The primary aim of the study is to ascertain if monitoring of FCP and DL of GLM to guide dose optimisation (during maintenance) improves rates of patient continuous clinical response and reduces disease activity in UC.

Methods and analysis

A randomised, multicentred two-arm trial studying the effect of dose optimisation of GLM based on FCP and DL versus treatment as per SMPC. Eligible patients will be randomised in a 1:1 ratio to 1 of 2 treatment groups and shall be treated over a period of 46 weeks.

Ethics and dissemination

The study protocol was approved by the Research Ethics committee of St. Vincent’s University Hospital. The results will be published in a peer-reviewed journal and shared with the worldwide medical community.

Trial registration numbers

EudraCT number: 2015-004724-62; Clinicaltrials.gov Identifier:NCT0268772;Pre-results.
Delivering comprehensive HIV services across the HIV care continuum: a comparative analysis of survival and progress towards 90-90-90 in rural Malawi
Authors: Wroe Emily B , Dunbar Elizabeth L , Kalanga Noel , Dullie Luckson , Kachimanga Chiyembekezo , Mganga Andrew , Herce Michael , Beste Jason , Rigodon Jonas , Nazimera Lawrence , McBain Ryan K
Published: January 2018

Introduction

Partners In Health and the Malawi Ministry of Health collaborate on comprehensive HIV services in Neno, Malawi, featuring community health workers, interventions addressing social determinants of health and health systems strengthening. We conducted an observational study to describe the HIV care continuum in Neno and to compare facility-level HIV outcomes against health facilities nationally.

Methods

We compared facility-level outcomes in Neno (n=13) with all other districts (n=682) from 2013 to 2015 using mixed-effects linear regression modelling. We selected four outcomes that are practically useful and roughly mapped on to the 90-90-90 targets: facility-based HIV screenings relative to population, new antiretroviral therapy (ART)enrolments relative to population, 1-year survival rates and per cent retained in care at 1 year.

Results

In 2013, the average number of HIV tests performed, as a per cent of the adult population, was 11.75%, while the average newly enrolled patients was 10.03%. Percent receiving testing increased by 4.23% over 3 years (P<0.001, 95% CI 2.98% to 5.49%), while percent enrolled did not change (P=0.28). These results did not differ between Neno and other districts (P=0.52), despite Neno having a higher proportion of expected patients enrolled. In 2013, the average ART 1-year survival was 80.41% nationally and 91.51% in Neno, which is 11.10% higher (P=0.002, 95% CI 4.13% to 18.07%). One-year survival declined by 1.75% from 2013 to 2015 (P<0.001, 95% CI −2.61% to −0.89%); this was similar in Neno (P=0.83). Facility-level 1-year retention was 85.43% nationally in 2013 (P<0.001, 95% CI 84.2% to 86.62%) and 12.07% higher at 97.50% in Neno (P=0.001, 95% CI 5.08% to19.05%). Retention declined by 2.92% (P<0.001, 95% CI −3.69% to −2.14%) between 2013 and 2015, both nationally and in Neno.

Conclusion

The Neno HIV programme demonstrated significantly higher survival and retention rates compared with all other districts in Malawi. Incorporating community health workers, strengthening health systems and addressing social determinants of health within the HIV programme may help Malawi and other countries accelerate progress towards 90-90-90.
Right Iliac Fossa Pain Treatment (RIFT) Study: protocol for an international, multicentre, prospective observational study
Authors:   RIFT Study Group On behalf of the West Midlands Research Collaborative
Published: January 2018

Introduction

Patients presenting with right iliac fossa (RIF) pain are a common challenge for acute general surgical services. Given the range of potential pathologies, RIF pain creates diagnostic uncertainty and there is subsequent variation in investigation and management. Appendicitis is a diagnosis which must be considered in all patients with RIF pain; however, over a fifth of patients undergoing appendicectomy, in the UK, have been proven to have a histologically normal appendix (negative appendicectomy). The primary aim of this study is to determine the contemporary negative appendicectomy rate. The study’s secondary aims are to determine the rate of laparoscopy for appendicitis and to validate the Appendicitis Inflammatory Response (AIR) and Alvarado prediction scores.

Methods and analysis

This multicentre, international prospective observational study will include all patients referred to surgical specialists with either RIF pain or suspected appendicitis. Consecutive patients presenting within 2-week long data collection periods will be included. Centres will be invited to participate in up to four data collection periods between February and August 2017. Data will be captured using a secure online data management system. A centre survey will profile local policy and service delivery for management of RIF pain.

Ethics and dissemination

Research ethics are not required for this study in the UK, as determined using the National Research Ethics Service decision tool. This study will be registered as a clinical audit in participating UK centres. National leads in countries outside the UK will oversee appropriate registration and study approval, which may include completing full ethical review. The study will be disseminated by trainee-led research collaboratives and through social media. Peer-reviewed publications will be published under corporate authorship including ‘RIFT Study Group’ and ‘West Midlands Research Collaborative’.
Understanding frailty: a qualitative study of European healthcare policy-makers’ approaches to frailty screening and management
Authors: Gwyther Holly , Shaw Rachel , Jaime Dauden Eva-Amparo , D’Avanzo Barbara , Kurpas Donata , Bujnowska-Fedak Maria , Kujawa Tomasz , Marcucci Maura , Cano Antonio , Holland Carol
Published: January 2018

Objective

To elicit European healthcare policy-makers’ views, understanding and attitudes about the implementation of frailty screening and management strategies and responses to stakeholders’ views.

Design

Thematic analysis of semistructured qualitative interviews.

Setting

European healthcare policy departments.

Participants

Seven European healthcare policy-makers representing the European Union (n=2), UK (n=2), Italy (n=1), Spain (n=1) and Poland (n=1). Participants were sourced through professional networks and the European Commission Authentication Service website and were required to be in an active healthcare policy or decision-making role.

Results

Seven themes were identified. Our findings reveal a ‘knowledge gap’, around frailty andawareness of the malleability of frailty,which has resulted in restrictedownership of frailtyby specialists. Policy-makers emphasised the need to recognise frailty as a clinical syndrome but stressed that it should be managed via an integrated and interdisciplinary response to chronicity and ageing. That is, through social co-production. This would require aculture shift in carewith redeployment of existing resources to deliver frailty management and intervention services. Policy-makers proposedbarriers to a culture shift,indicating a need to be innovative with solutions to empower older adults to optimise their health and well-being, while still fully engaging in the social environment. Thecultural acceptance of an integrated care systemtheme described the complexities of institutional change management, as well as cultural issues relating to working democratically, while insignposting adult care, the need for a personal navigator to help older adults to access appropriate services was proposed. Policy-makers also believed thatscreening for frailtycould be an effective tool for frailty management.

Conclusions

There is potential for frailty to be managed in a more integrated and person-centred manner, overcoming the challenges associated with niche ownership within the healthcare system. There is also a need to raise its profile and develop a common understanding of its malleability among stakeholders, as well as consistency in how and when it is measured.
A study protocol for a non-randomised comparison trial evaluating the feasibility and effectiveness of a mobile cognitive–behavioural programme with integrated coaching for anxious adults in primary care
Authors: Szigethy Eva , Solano Francis , Wallace Meredith , Perry Dina L , Morrell Lauren , Scott Kathryn , Bell Megan Jones , Oser Megan
Published: January 2018

Introduction

Generalised anxiety disorder (GAD) and subclinical GAD are highly prevalent in primary care. Unmanaged anxiety worsens quality of life in patients seen in primary care practices and leads to increased medical utilisation and costs. Programmes that teach patients cognitive–behavioural therapy (CBT) techniques have been shown to improve anxiety and to prevent the evolution of anxiety symptoms to disorders, but access and engagement have hampered integration of CBT into medical settings.

Methods and analysis

This pragmatic study takes place in University of Pittsburgh Medical Center primary care practices to evaluate a coach-supported mobile cognitive– behavioural programme (Lantern) on anxiety symptoms and quality of life. Clinics were non-randomly assigned to either enhanced treatment as usual or Lantern. All clinics provide electronic screening for anxiety and, within clinics assigned to Lantern, patients meeting a threshold level of mild anxiety (ie, >5 on Generalised Anxiety Disorder 7-Item Questionnaire (GAD-7)) are referred to Lantern. The first study phase is aimed at establishing feasibility, acceptability and effectiveness. The second phase focuses on long-term impact on psychosocial outcomes, healthcare utilisation and clinic/provider adoption/sustainable implementation using a propensity score matched parallel group study design. Primary outcomes are changes in anxiety symptoms (GAD-7) and quality of life (Short-Form Health Survey) between baseline and 6-month follow-ups, comparing control and intervention. Secondary outcomes include provider and patient satisfaction, patient engagement, durability of changes in anxiety symptoms and quality of life over 12 months and the impact of Lantern on healthcare utilisation over 12 months. Patients from control sites will be matched to the patients who use the mobile app.

Ethics and dissemination

Ethics and human subject research approval were obtained. A data safety monitoring board is overseeing trial data and ethics. Results will be communicated to participating primary care practices, published and presented at clinical and scientific conferences.

Trial registration number

NCT03035019.
Clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistulas : a prospective cohort study in two Chinese centres
Authors: Ma Yongjie , Chen Sichang , Peng Chao , Wang Chunxiu , Li Guilin , He Chuan , Ye Ming , Hong Tao , Bian Lisong , Liu Jiang , Wang Zhichao , Qureshi Adnan I , Ling Feng , Zhang Hongqi
Published: January 2018

Background

The short-term outcomes and prognostic factors of patients with spinal dural arteriovenous fistulas (SDAVFs) have not been defined in large cohorts.

Objective

To define the short-term clinical outcomes and prognostic factors in patients with SDAVFs.

Methods

A prospective cohort of 112 patients with SDAVFs were included consecutively in this study. The patients were serially evaluated with the modified Aminoff and Logue’s Scale (mALS) one day before surgery and at 3 months, 6 months and 12 months after treatment. Univariate and multivariate analyses were performed to identify demographic, clinical and procedural factors related to favourable outcome.

Results

A total of 94 patients (mean age 53.5 years, 78 were men) met the criteria and are included in the final analyses. Duration of symptom ranged from 0.5 to 66 months (average time period of 12.7 months). The location of SDAVFs was as follows: 31.6% above T7 level, 48.4% between T7 and T12 level (including T7 and T12) and 20.0% below T12 level. A total of 81 patients (86.2%) underwent neurosurgical treatment, 10 patients (10.6%) underwent endovascular treatment, and 3 patients (3.2%) underwent neurosurgical treatment after unsuccessful embolisation. A total of 78 patients demonstrated an improvement in mALS score of one point or greater at 12 months. Preoperative mALS score was associated with clinical improvement after adjusting for age, gender, duration of symptoms, location of fistula and treatment modality using unconditional logistic regression analysis (p<0.05).

Conclusion

Approximately four fifths of the patients experienced clinical improvement at 12 months and preoperative mALS was the strongest predictor of clinical improvement in the cohort.
Postdischarge service utilisation and outcomes among Chinese and South Asian psychiatric inpatients in Ontario, Canada: a population-based cohort study
Authors: Chiu Maria , Gatov Evgenia , Zaheer Juveria , Lebenbaum Michael , Fu Longdi , Newman Alice , Kurdyak Paul
Published: January 2018

Objective

We sought to examine the short-term and long-term impacts of psychiatric hospitalisations among patients of Chinese and South Asian origin.

Design

Retrospective population-based cohort study using linked health administrative data.

Setting

We examined all adult psychiatric inpatients discharged between 1 April 2006 and 31 March 2014 in Ontario, Canada, who were classified as Chinese, South Asian and all other ethnicities (ie, ‘general population’) using a validated algorithm. We identified 2552 Chinese, 2439 South Asian and 127 142 general population patients.

Primary and secondary outcome measures

We examined psychiatric severity measures at admission and discharge and performed multivariable logistic regression analyses to examine 30-day, 180-day and 365-day postdischarge service utilisation and outcomes, comparing each of the ethnic groups with the reference population, after adjustment for age, sex, income, education, marital status, immigration status, community size and discharge diagnosis.

Results

Despite presenting to hospital with greater illness severity, Asian psychiatric inpatients had shorter lengths of hospital stay and greater absolute improvements in mental health and functional status at discharge compared with other inpatients. After hospitalisation, Chinese patients were more likely to visit psychiatrists and South Asian patients were more likely to seek mental healthcare from general practitioners. They were also less likely to have a psychiatric readmission or die 1 year following hospitalisation (adjusted ORChinese=0.87; 95% CI 0.79 to 0.97; adjusted ORSouth Asian=0.82, 95% CI 0.73 to 0.91). Findings were consistent across genders, psychiatric diagnoses and immigrant groups.

Conclusion

Once hospitalised, patients of Chinese and South Asian origin fared as well as or better than general population patients at discharge and following discharge, and had a positive trajectory of psychiatric service utilisation.
Association between community socioeconomic characteristics and access to youth flag football
Authors: Kroshus Emily , Sonnen Aly J , Chrisman Sara PD , Rivara Frederick P
Published: January 2018

Background

The American Academy of Pediatrics has recommended that opportunities for non-tackling American football (e.g., flag football) be expanded, given concerns about the risks of brain trauma from tackle football. This study tested the hypothesis that flag football would be more accessible in communities characterised by higher socioeconomic status residents.

Methods

In July 2017, the locations of community-based organisations offering youth flag and tackle football for youth between the ages of 6 and 13 in two US states (Georgia and Washington) were aggregated (n=440). Organisations were coded in terms of the availability of tackle and/or flag football teams for youth at each year of age between 6 and 13. Multivariate logistic regression analyses were used to assess the odds of a community-based football organisation offering flag football, by community socioeconomic and demographic characteristics.

Results

In both states, communities with more educated residents were more likely to offer flag football for youth aged 6–12. For example, among 6 year-olds every 10% increase in the number of adult residents with a college education was associated with 1.51 times the odds of flag football availability (95% CI 1.22 to 1.86, P<0.001).

Conclusion

These results suggest that youth living in communities characterised by low educational attainment are less likely than other youth to have the option of a lower contact alternative to tackle football. Relying on voluntary community-level adoption of lower contact alternatives to tackle football may result in inequitable access to such sport options. This may contribute to an inequitable burden of brain trauma from youth sport.
Poverty, A Risk Factor Overlooked: A Cross-Sectional Cohort Study Comparing Poverty Rate and Cardiovascular Disease Outcomes in the State of Florida
Authors: Al-Turk Bashar , Harris Ciel , Nelson Grant , Smotherman Carmen , Palacio Carlos , House Jeff
Published: January 2018

The purpose of this study is to examine the relationship between poverty rate and heart disease in our state. A cross-sectional data analysis was performed using figures provided by the Center for Disease Control's Interactive Atlas of Heart Disease and Stroke Tables. Spearman's correlations and simple regressions were used to determine if there was a relationship between poverty and cardiovascular hospitalization rate and cardiovascular death rate. There was a positive monotonic correlation between poverty rate and cardiovascular hospitalization rate (Rho=0.384, P=0.001). There was a positive monotonic correlation between poverty rate and cardiovascular death rate (Rho=0.646, P<0.0001). County poverty rate had a statistically significant positive relationship with cardiovascular hospitalization and cardiovascular mortality in the state of Florida.