bluuebunny/crossref_metadata_2025 huggingface dataset:
Rajiv Gandhi’s Summit Diplomacy: A Study of the Beijing Summit, 1988
Authors: Ramanujam Velpula , Dabhade Manish S.
Published: November 2019

Summit diplomacy is the initiative to establish contact at the highest level of political leadership to transform the relationship between collectives. The heads of states are key decision makers in the nation. The objective of summit diplomacy is to establish a political dialogue at the highest level. The assumption is that once the understanding is established at the highest level, it can transform a conflicting relationship to friendly one. Rajiv Gandhi’s visit to China in 1988 ended three decades of estrangement between India and China. It is a classic example of the normalisation of relations between two countries. The proposed hypothesis is that the success of Rajiv Gandhi’s summit diplomacy depended on two factors: the leadership personality and the domestic factor. This article primarily deals with the question: How Rajiv Gandhi conducted summit diplomacy with China in 1988? The article traces the process through an analysis of archival work of private papers and diplomatic correspondence, oral history interviews, memoirs, and biographical works.
Searching for Sex Trafficking Victims: Using a Novel Link-Tracing Method Among Commercial Sex Workers in Muzaffarpur, India
Authors: Vincent Kyle , Zhang Sheldon X. , Dank Meredith
Published: November 2019

Estimating the prevalence of sex trafficking requires a practical sampling strategy to reach the hidden population. In this study, we experimented with a network sampling design to obtain a sample of sex workers from the city of Muzaffarpur, India. Backed by census data and other auxiliary information, we obtained a stratified initial sample of 111 individuals and with two waves of referrals arrived at a final sample of 317 individuals. A sophisticated network-based approach is used to estimate the population size, and a respondent-driven sampling–based strategy is used to estimate characteristics related to sex trafficking violations. We detail the sampling design and present results from the study, highlighting significant findings and lessons learned that can be used for future studies.
Critical Classrooms Matter: Baltimore Teachers’ Pedagogical Response After the Death of Freddie Gray
Authors: Flores-Koulish Stephanie A. , Shiller Jessica T.
Published: November 2019

The purpose of this article is to discuss the possibilities of public education. We argue that public schools, despite their flaws, still provide necessary spaces of civic engagement. When major social and/or political events happen, young people have few outlets to discuss, process, and understand implications. In this article, we share the experiences of Baltimore’s teachers after the death of Freddie Gray, an unarmed Black man, who lived in Baltimore and died in police custody. Following his death, the city exploded in protest, both violent and peaceful. We interviewed eight teachers and collected curriculum samples to make sense of how they used the public school classroom as a space of critical care, social justice, cultural relevance, and anti-racism to contextualize current events in their city. There are implications here for school district professional development and teacher education.
Implications of SAFTA for Indian Economy: Trade, Compatibility and Welfare Effects
Authors: Jain Hansa
Published: November 2019

Among the members of South Asian Free Trade Area (SAFTA), India dominates in terms of its geographical location, land area, population size and economic share. However, SAFTA is treated as a weak agreement as India is highly outward oriented for trade. This raises a question about India’s trade compatibility with South Asian countries. Also since SAFTA is now fully implemented, there is a need to determine its welfare effects for India as well as for the region.

The study focuses on (a) trends and patterns of India’s intra-regional trade with South Asian countries, (b) trade compatibility and (c) welfare effects of SAFTA for the Indian economy. India’s trade intensity, trade share and trade compatibility with the other regional members is calculated. GTAP simulations are used to determine welfare effects. The study is based upon the secondary data.

The study finds that with the implementation of SAFTA, India’s trade intensity and trade share with its regional members has slightly improved. Trade compatibility though low, is gradually improving. The study considers SAFTA as a positive sum game for India. India is likely to have favourable allocative efficiency effect, terms of trade effect and investment-savings effect if trade facilitation measures are adopted.

JEL Codes: F150, F10, F140, C150
India–Iran Trade Relations Under the Shadow of USA Sanctions
Authors: Hussain Wani Suadat , Mir Mohd Afzal , Ahmad Shah Imtiyaz
Published: November 2019

India and Iran have a long history of cooperation on various issues ranging from economic to strategic importance. However, the present phase of cooperation is as old as end of the cold war and reached a peak during the period 2001–2003 with the Tehran and Delhi declarations, which established a substantial set of framework for enhanced cooperation. In the present times given the changing regional and global economic and security conditions, many attempts have been made by both countries to increase their cooperation. Since Islamic revolution, Iran faces continuous confrontation and sanctions from the West and the USA. Iran has continuously tried to improve its relations with its neighbours and other friendly countries to minimize the impact of these sanctions which are badly affecting its economy. India, on the other hand, has been growing at a faster pace from last many years which has increased its energy requirements. Given Iran’s nuclear programme and its confrontation with the West and India’s energy requirements, both countries are working together to sustain their economic and energy cooperation from last many years. In 2015, both countries signed a memorandum of understanding worth USD 195 million for the development of Chabahar Port situated in south-eastern Iran and India agreed to make the investment in infrastructural development of Iran. Through this port, India will get easy access to Central Asian and Afghanistan which will increase its trade relations with these countries. The aim of this research article is to examine the impact of sanctions on Iran due to its nuclear programme on trade relations between India and Iran by using threshold autoregressive model and using trade variables including exports and imports.

JEL Codes: 00, 05, 05
An Empirical Analysis on Association Between Selected Macroeconomic Variables and Stock Market in the Context of BSE
Authors: Keswani Sarika , Wadhwa Bharti
Published: November 2019

The role of macroeconomic variables cannot be ignored because it plays a very important role in shaping the economy of any country, irrespective of whether it is developing, underdeveloped or developed. The macroeconomic variables were disposable income (DI), government policies (GP), inflation rate (INF), interest rate (IR), exchange rate (ER) and stock price. Monthly data of 10 years were used, that is, from April 2006 to March 2016. Analyses of augmented Dickey–Fuller test, preliminary tests, stability tests, cointegration, vector error correction model (VECM) variance decomposition analysis (VDA) and impulse response have been applied to examine the association between the selected macroeconomic variable and stock returns. All the variables are stationary at 1st difference. The results showed that the residues are normally distributed and that there is no problem of multicollinearity, heteroskedasticity and serial correlation. The results of the cointegration showed a strong long-term relationship among DI, GP, the inflation rate, the exchange rate and the IR on the stock price in Bombay Stock Exchange of India. Results of vector error correction model revealed that in the short run, there was a negative and significant relationship between inflation rate and stock returns; therefore, it can be implied that an increase in the inflation rate eroded the prospect of positive performance among the Sensex but was not significant.

JEL Classification: E, E01
Child Discipline in Times of Conflict
Authors: Malcolm Michael , Diwakar Vidya , Naufal George
Published: November 2019

Using a unique pairing of household survey data and geolocational conflict data, we investigate the relationship between conflict intensity and the disciplinary methods employed by Iraqi households. We find that parents in high-conflict areas are more likely to use moderate and severe corporal punishment and are less likely to use constructive parenting techniques like redirection. A corresponding difference-in-differences analysis confirms the nature of this association. While there is a general sense that war has profound long-term impacts on the psychological health of children, research on transmission mechanisms remains limited. Given the persistence of early childhood outcomes into adulthood, these results are potentially an important piece of assessing and mitigating the long-term costs of war on civilian populations.
Longer—but Harder—Lives?: The Hispanic Health Paradox and the Social Determinants of Racial, Ethnic, and Immigrant–Native Health Disparities from Midlife through Late Life
Authors: Boen Courtney E. , Hummer Robert A.
Published: November 2019

Though Hispanics live long lives, whether a “Hispanic paradox“ extends to older-age health remains unclear, as do the social processes underlying racial-ethnic and immigrant-native health disparities. Using data from the Health and Retirement Study (2004–2012; N = 6,581), we assess the health of U.S.- and foreign-born Hispanics relative to U.S.-born whites and blacks and examine the socioeconomic, stress, and behavioral pathways contributing to health disparities. Findings indicate higher disability, depressive, metabolic, and inflammatory risk for Hispanics relative to whites and similar health profiles among Hispanics and blacks. We find limited evidence of a healthy immigrant pattern among foreign-born Hispanics. While socioeconomic factors account for Hispanic-white gaps in inflammation, disparities in other outcomes persist after adjustment for socioeconomic status, due in part to group differences in stress exposure. Hispanics may live long lives, but their lives are characterized by more socioeconomic hardship, stress, and health risk than whites and similar health risks as blacks.
Voluntary Shared Leave: An Exploratory Analysis
Authors: Bradbury Mark D.
Published: November 2019

Voluntary leave sharing programs allow an employee to donate accumulated leave to a coworker who is experiencing a hardship and has exhausted their leave balance. This study examines a voluntary leave sharing program at a state agency and concludes that the program is an effective strategy for reducing the agency’s unfunded liability posed by accumulated leave balances. Such programs may also be an appealing type of family-friendly benefit as female employees are also more likely to participate in the program and receive more generous donations of leave than their male colleagues.
Lost and Found in Upstate New York: Exploring the Motivations of “Lost Boys” Refugees as Founders of International Nonprofit Organizations
Authors: Appe Susan , Oreg Ayelet
Published: November 2019

This research examines engagement in diaspora philanthropy through the lens of Lost Boys of Sudan and their founding of small international nonprofit service organizations based in the United States. We seek to understand refugees’ motivations to take upon themselves leadership roles in their local United States communities and in the provision of goods and services to their homeland, South Sudan. By becoming founders of international service nonprofits, Lost Boys make meaning of their experiences and are able to motivate local support in their United States communities to give to distant communities in South Sudan.
Experimental investigation of the effects of different types of fracturing fluids on the pore structure characteristics of Shale Reservoir Rocks
Authors: Sun Zepeng , Ni Yue , Wang Yongli , Wei Zhifu , Wu Baoxiang , Li Jing , Fan Wenhua , Wang Gailing , Li Yunxiao
Published: November 2019

The chemical and physical capabilities of shale can be altered by the interactions between fracturing fluid and shale formation, affecting the long-term reservoir productivity. To obtain information regarding how fracturing fluids with different components impact the pore structure, porosity and mineral compositions of shale reservoir rocks over time, two different types of commercial fracturing fluids (slick water and crosslinked gel) were used to react with the shales from Longmaxi Formation of Lower Silurian in the Sichuan Basin of South China. Experiments were conducted with various time intervals (1, 4 and 10 days) in a reactor at 50 MPa and 100°C, and then analytical methods including X-ray diffraction, low pressure nitrogen adsorption, field emission scanning electron microscopy and porosity measurement were used to examine the changes of mineralogical compositions, pore structure and porosity. The results demonstrated that the mineral compositions of shale samples were significantly changed after treatment with two different fracturing fluids for 4 days. The analysis of field emission scanning electron microscopy revealed that the carbonate minerals were dissolved and developed many dissolution pores after slick water treatment, while the crosslinked gel mainly caused the precipitation of carbonate minerals. After exposure to different fracturing fluids, the total pore volume and specific surface area decreased over time. Moreover, the fractal dimensions (D1 and D2) of shale showed an apparent decrease trend after treatment with two different fracturing fluids, indicating that the pore surface and structure become smooth and regular. The porosity of shale significantly decreased by 15.9% and 17.8%, respectively, after 10 days of slick water and crosslinked gel treatment. These results indicated that the injection of the two different types of fracturing fluids may negatively impact the shale gas production through reducing the nanopore structure and porosity of shale reservoir rocks.
Desire for the ‘worst’: Extending nuclear attachments in southeastern New Mexico
Authors: Saraç-Lesavre Başak
Published: November 2019

In the city of Carlsbad, New Mexico, where a deep geological repository named the Waste Isolation Pilot Plant receives regular shipments of military transuranic waste that will remain radioactive for 10,000 years, a group of local actors has been putting major efforts to extend their attachments to nuclear waste futures. In January 2012, Forbes magazine named Carlsbad ‘The Town that Wants America’s Worst Atomic Waste’. Obviously, linking the verb ‘want’ with ‘worst’ is meant to show how unexpected this desire might be. This paper offers an ethnographical account of activities undertaken by their Nuclear Task Force at a peculiar moment. Articulating the relationship between valuation and desiring, it develops the notion of proactive valuation undertakings to refer to local actors’ attempts to generate new attachments and to maintain existing ones through the succession of a series of mediated and equipped valuation undertakings. Rather than approaching desire for waste with scepticism, it follows what ‘desiring’ actors do and how they do it in ‘enterprise form’ and offers a novel, symmetrical and a more comprehensive approach to examine, not only, the co-production of places and techno political orders, but also the constitution of political and moral values at specific sites.
Converting a digital minority into a digital beneficiary: Digital skills to improve the need for cognition among Korean older adults
Authors: Oh Joohyun , Kang Jeong-han
Published: November 2019

This study explores how digital technologies can benefit older adults’ cognitive health. The need for cognition (NFC) refers to an individual’s tendency to engage in and enjoy cognitive endeavors and is an explanatory variable for behavioral outcomes. To date, little scholarly literature has examined how NFC can be affected by our behavior; therefore, this study explored whether practicing digital skills can help to improve or maintain NFC. Utilizing age as an instrumental variable, we analyzed data from 8,824 respondents (mean age = 49.43) to the 2015 Korea Media Panel survey and discovered that enhanced digital skills led to stronger NFC. This causal effect was stronger for the older cohort (baby boomers and older, who were born before 1963). These findings suggest that older adults’ NFC may not necessarily decline with age if they practice more digital skills. This study could ultimately contribute to the transformation of the older population from a digital minority to a digital beneficiary.
Allele-specific expression mediates primary resistance to poly (ADP-ribose) polymerase inhibitor therapy in a case of BRCA1/2 double-germline mutant gastric cancer
Authors: Wen Lu , Li Xiuxiu , Shi Junping , Zhang Shuo , Wang Rui , Yao Ming , Guo Jun
Published: November 2019

Breast cancer gene 1 and 2 ( BRCA1 and BRCA2) are human tumor suppressor genes. BRCA mutations increase the risk for breast, ovarian, and gastric cancer. However, double heterozygosity for BRCA1 and BRCA2 mutations in gastric cancer have not been reported and their clinical significance is unclear. In this study, a 52-year-old Chinese male patient with gastric cancer was chosen for analysis. A tumor tissue biopsy and blood sample were collected, and next-generation sequencing-based deep panel sequencing was performed on the IlluminaNextSeq-500 platform. Comprehensive genomic alterations of 450 cancer-related genes and 47 tumor susceptibility genes were analyzed. Here, we report for the first time a case of gastric cancer that carried both BRCA1 S1841Vfs*2 and BRCA2 Q1886* heterozygous mutations. Unfortunately, the patient was resistant to olaparib treatment. Further RNA analysis revealed that only the wild-type alleles of BRCA1 and BRCA2 were expressed, although genetic BRCA1 and BRCA2 mutations were present in the patient. This genetic finding may explain the mechanism for primary resistance to olaparib observed in the BRCA1/2-mutated patient.
Treatment of penetrating trauma to the buttock assisted by spinal endoscopy
Authors: Long Zhi-Sheng , Nie Xiao-Yang , Zhang Yuan-Wei
Published: November 2019

Objective

Penetrating trauma to the buttock is relatively common. Because of the location of the trauma and complicated peripheral anatomical structures, surgery to the area can be difficult. We report the cases of 2 patients who sustained penetrating trauma to the buttock and underwent operative treatment assisted by spinal endoscopy.

Methods

With the rapid development of minimally invasive spine surgery techniques in recent years, especially the wide application of endoscopy, we treated 2 cases of penetrating trauma with endoscopic probing within the wound channel, followed by hemostasis and postoperative irrigation and drainage.

Results

Drainage tubes were removed from the 2 patients within 7 days after the surgery. Their wounds were healing well and they were discharged from the hospital within 12 days.

Conclusions

If there is no injury to the large blood vessels, intestines, or urinary system, satisfactory clinical results can be obtained using spinal endoscopy to probe, irrigate, and identify foreign objects, when combined with hemostasis, postoperative short-term irrigation and debridement, and the use of antibiotics.
Physiotherapy as an Initial Treatment Option for Femoroacetabular Impingement: A Systematic Review of the Literature and Meta-analysis of 5 Randomized Controlled Trials
Authors: Hoit Graeme , Whelan Daniel B. , Dwyer Tim , Ajrawat Prabjit , Chahal Jaskarndip
Published: November 2019

Background:

Femoroacetabular impingement is a common and debilitating source of hip pain in young adults. Although physiotherapy is used as a mainstay of nonoperative care for femoroacetabular impingement, the evidence regarding different physiotherapy practices is poorly understood.

Purpose:

To collect and synthesize the best available evidence and arrive at a summary estimate of treatment effect for the utility of physiotherapy in the management of femoroacetabular impingement.

Study Design:

Meta-analysis.

Methods:

A systematic review was performed on February 2, 2019, of PubMed, EMBASE, and Cochrane Library databases using “femoroacetabular impingement OR hip pain” and “physiotherapy OR nonoperative management” and their synonyms as search terms. Central treatment themes were identified across protocols, and pooled analyses were conducted to assess for differences in patient-reported outcome measures across these themes.

Results:

A total of 5 randomized controlled trials met our inclusion criteria. The studies included 124 patients with a mean age of 35 years, of whom 24% were male. The average follow-up was 9.4 weeks (range, 6-12 weeks), and the follow-up rate across all participants was 86%. Among these 5 studies, 4 studies used a physiotherapy protocol that focused on core strengthening versus no core strengthening, 4 studies compared active strengthening versus passive modalities, and 3 studies compared supervised versus unsupervised physiotherapy. Pooled analysis across all studies demonstrated improved outcomes in the treatment groups compared with the controls (standardized mean difference [SMD], 0.76; 95% CI, 0.38-1.13; P < .0001). Core strengthening (SMD, 0.82; 95% CI, 0.39-1.26; P = .0002), active physiotherapy (SMD, 0.70; 95% CI, 0.29-1.10; P = .0008), and supervised physiotherapy (SMD, 0.58; 95% CI, 0.14-1.03; P = .01) were found to result in statistically significant improvements in functional outcomes compared with no core strengthening, passive modalities, and unsupervised care, respectively.

Conclusion:

Supervised physiotherapy programs focusing on active strengthening and core strengthening are more effective than unsupervised, passive, and non–core focused programs. Future studies with longer term follow-up and validated femoroacetabular impingement specific outcome measures are required to determine prognostic factors for success with nonoperative care as well as to determine the ideal patient profile and structured rehabilitation protocol.
Patient and Caregiver Outcomes and Experiences With Team-Based Memory Care: A Mixed Methods Study
Authors: Liu Tsai-Ling , Yates Traci D. , Taylor Yhenneko J. , Rossman Whitney , Mangieri Deanna , Black Sheila , Stephens Casey , Connor C. Danielle , Skudlarska Beata
Published: November 2019

Patients with dementia and their caregivers need ongoing educational and psychosocial support to manage their complex diagnosis. This mixed methods study evaluated the impact of a memory clinic with an embedded dementia navigator on the experiences and health outcomes of patients with dementia and their caregivers. At the 12-month follow-up, patients receiving memory clinic services ( n = 238) had higher emergency department visits than a matched cohort with dementia ( n = 938), although hospitalizations did not differ. Patient quality of life and caregiver burden scores also did not differ between baseline and 12-months. Interviews revealed that caregivers ( n = 12) valued the educational and social support components of the memory clinic and perceived that the clinic had a positive impact on their experiences. Findings suggest that this embedded navigator model is useful for addressing caregiver needs and may have potential to stem increases in caregiver burden and patient quality of life that occur with disease progression.
Use of Falls Risk Increasing Drugs in Residents at High and Low Falls Risk in Aged Care Services
Authors: Wang Kate N. , Bell J. Simon , Gilmartin-Thomas Julia F. M. , Tan Edwin C. K. , Cooper Tina , Robson Leonie , Ilomäki Jenni
Published: November 2019

Falls are associated with considerable morbidity and mortality in aged care services and falls risk increasing drugs (FRIDs) are often overlooked as a contributor to falls. This study aims to investigate the association between the risk of falling and use of FRIDs from aged care services. Inverse-probability-weighted multinomial logistic regression was used to estimate the association between falls risk and regular FRIDs in 383 residents from six Australian aged care services. Overall, residents at high and low falls risk had similar prevalence of FRIDs. Prevalence of antipsychotics and sedative-hypnotics was low. Residents at high falls risk had higher adjusted odds of using ≥2 psychotropic medications (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.17-2.61) and ≥2 medications that cause/worsen orthostatic hypotension (OR = 3.59, 95% CI = 2.27-5.69). High prevalence of FRIDs was mainly attributable to medications for which residents had clinical indications. Clinicians appeared to have largely avoided FRIDs that explicit criteria deem potentially inappropriate for high falls risk.
Sowing Across a State: Development and Delivery of a Grassroots Pediatric Palliative Care Nursing Curriculum
Authors: Weaver Meaghann S. , Jenkins Rebecca , Wichman Christopher , Robinson Jacob E. , Potthoff Meghan R , Menicucci Traci , Vail Catherine A.
Published: November 2019

Background:

Rural pediatricians and adult-trained hospice teams report feeling ill-prepared to care for children at end of life, resulting in geographies in which children are not able to access home-based services.

Objectives:

To develop a pediatric palliative care curriculum for inpatient nurses and adult-trained hospice teams caring for children in a rural region.

Methods:

Curriculum design and delivery was informed by local culture through an interdisciplinary, iterative development approach with confidence, intention, and support measured pre-, post-, and 4 months after delivery. A needs assessment was completed by pediatric nurses caring for children receiving palliative or end-of-life care to inform curricular content (phase 1). A curriculum was designed by an interdisciplinary pediatric palliative care team and piloted with nursing cohorts annually through educational conferences with monthly discussion series for 3 consecutive years (phase 2). Curricular content was then provided for 31 rural hospice team members (phase 3).

Results:

Self-reported confidence in caring for children increased by 1.1/10 points for adult-trained hospice team members. Mean score for intention to care for children increased by 5.2 points (sustained 5.1 points above baseline at 4 months). Perception of support in caring for children increased by 5 points (mean sustained 5.4 points above baseline at 4 months). Family needs, care goals, and symptom management were prioritized learning topics. Rural hospices previously unwilling to accept children enrolled pediatric patients in the 4 months following the conference.

Conclusion:

Grassroots curricular initiatives and ongoing educational mentorship can grow pediatric palliative and hospice services in rural regions.
Outcomes and Prognosis Factors in Patients With Vena Cava Filters in a Quaternary Medical Center: A 5-Year Retrospective Analysis
Authors: Elias Michael , Elias Antoine , Oropello John , Doucette John , Jebakumar Jebakaran , Kohli-Seth Roopa
Published: November 2019

Background:

Indications for inferior vena cava filter (IVCF) placement are controversial. This study assesses the proportion of different indications for IVCF placement and the associated 30-day event rates and predictors for all-cause mortality, deep vein thrombosis (DVT), pulmonary embolism, and bleeding after IVCF placement.

Method:

In this 5-year retrospective cohort observational study in a quaternary care center, consecutive patients with IVCF placement were identified through cross-matching of 3 database sets and classified into 3 indication groups defined as “standard” in patients with venous thromboembolism (VTE) and contraindication to anticoagulants, “extended” in patients with VTE but no contraindication to anticoagulants, and “prophylactic” in patients without VTE.

Results:

We identified 1248 IVCF placements, that is, 238 (19.1%) IVCF placements for standard indications, 583 (46.7%) IVCF placements for extended indications, and 427 (34.2%) IVCF placements for prophylactic indications. Deep vein thrombosis rates [95% confidence interval] were higher in the extended (8.06% [5.98-10.58]) and prophylactic (7.73% [5.38-10.68]) groups than in the standard group (3.36% [1.46-6.52]). Mortality rates were higher in the standard group (12.18% [8.31-17.03]) than in the extended group (7.55% [5.54-9.99]) and the prophylactic (5.85% [3.82-8.52]) group. Bleeding rates were higher in the standard group (4.62% [2.33-8.12]) than in the prophylactic group (2.11% [0.97-3.96]). Best predictors for VTE were acute medical conditions; best predictors for mortality were age, acute medical conditions, cancer, and Medicare health insurance.

Conclusions:

Prophylactic and extended indications account for the majority of IVCF placements. The standard indication is associated with the lowest VTE rate that may be explained by the competing risk of mortality higher in this group and related to the underlying medical conditions and bleeding risk. In the prophylactic group (no VTE at baseline), the exceedingly high DVT rate may be related to the IVCF placement.
Low Free T3 Is Associated With Worse Outcomes in Patients in the ICU Requiring Invasive Mechanical Ventilation
Authors: Rothberger Gary D. , Valestra Paul K. , Knight Khalilah , Desai Anish K. , Calixte Rose , Shapiro Lawrence E.
Published: November 2019

Objective:

Critical illness causes a decrease in serum free triiodothyronine (T3) levels. This condition, known as nonthyroidal illness syndrome (NTIS), is associated with poor outcomes. The association of NTIS and outcomes in patients in the intensive care unit (ICU) requiring mechanical ventilation has not been well studied. This study aimed to determine the impact of NTIS on the outcomes of these patients.

Methods:

This prospective study included 162 patients in the ICU who underwent mechanical ventilation. Serum free T3 levels were tested on the day of initiation of mechanical ventilation. The rates of in-hospital mortality and ventilator-free days (VFDs) at day 28 after the initiation of mechanical ventilation were compared between patients with low (<2.3 pg/mL) and normal (≥2.3 pg/mL) free T3 levels. Patients who died while on mechanical ventilation were assigned a VFD of 0.

Results:

Low T3 was present in 60% of study patients. The in-hospital mortality rate of the entire cohort was 39%, and the mean and median VFDs at day 28 were 13.5 and 21 days, respectively. Compared to patients with normal free T3, patients with low free T3 had higher in-hospital mortality (52% vs 19%, P < .001) and less mean and median VFDs at day 28 (10.7 vs 18 and 0 vs 23, respectively. P < .001 for both mean and median VFDs).

Conclusions:

The presence of low T3 due to NTIS in patients in the ICU requiring mechanical ventilation is associated with poor outcomes.
Using Social Support Matter in the Association of Post-Traumatic Cognitions and Perceived Social Support? Comparison of Female Survivors of Intimate Partner Violence With and Without a History of Child Abuse
Authors: Dodson Thomas S. , Beck J. Gayle
Published: November 2019

The association between high levels of post-traumatic stress disorder (PTSD) symptoms and low levels of perceived social support is well-documented in the trauma literature; research on processes that may underlie this association is less common. The current study examined negative attitudes about using social support as a potential link between negative post-traumatic cognitions about the world and self, one aspect of PTSD, and perceived social support in two groups of female survivors of intimate partner violence: those who had a history of child abuse ( n = 153; IPV/CA+) and those who did not ( n = 96; IPV/CA−). Negative attitudes about using social support were found to be an important link between negative post-traumatic cognitions and social support for both groups. IPV survivors with a history of child abuse had higher levels of negative post-traumatic cognitions about the world ( d = .32) and self ( d = .33), greater negative attitudes about using social support ( d = .35), and lower perceived social support from family ( d = .48), compared with IPV survivors without a history of child abuse. These results support the relevance of negative attitudes about using social support as one important factor in the relationship between PTSD symptoms and social support in interpersonal trauma survivors and highlight the impact that negative attitudes about using social support can have on the trauma survivor’s functioning.
The fatigue behavior of polymeric sulfur-modified asphalt mixtures subjected to freeze-thaw conditioning
Authors: Kavussi Amir , Azarnia Mehdi , Ayar Pooyan , Pedram Makan
Published: November 2019

Abundance, affordability, and also the usability of sulfur as a part of the binder are the main reasons for using this additive in asphalt mixtures. However, lack of proper adhesion and brittle behavior of sulfur-modified asphalt mixtures could make them susceptible to moisture damage and fatigue cracking. In this regard, anti-stripping agents and some polymers like crumb rubber may be used to overcome these types of distresses. This research aimed at investigating the effects of polymeric sulfur and crumb rubber on the moisture sensitivity and fatigue behavior of asphalt mixtures. To this end, asphalt mixtures were subjected to 1 and 3 freeze-thaw cycles. Then, an indirect tensile fatigue test was carried out. Moreover, the response surface method (RSM) was used to assess the interaction between various parameters in samples containing polymeric sulfur and crumb rubber. Results showed that with an increase in polymeric sulfur content, the fatigue life was reduced and the moisture sensitivity was increased. Additionally, the RSM was found to be effective in ranking parameters influencing the performance of asphalt mixtures. According to the experimental results, a crumb rubber-modified binder could improve the fatigue life of the polymeric sulfur-modified mixture up to 70%. Furthermore, experimental results and RSM analysis indicated that crumb rubber would be more effective in higher numbers of freeze-thaw cycles and raised temperatures, in which polymeric sulfur-modified asphalt mixtures are probably prone to moisture damages (i.e. the lack of adequate cohesion and adhesion).
Integrating health service delivery for geriatric patients after hospital admission—A register study on the outcomes and costs
Authors: Hiltunen Anna-Maria , Hörhammer Iiris , Silander Katariina , Kaikuluoma Jaakko , Linna Miika
Published: November 2019

After a care episode in a hospital, elderly patients often face delays in transitions to permanent residence. Poor care coordination burdens both the patients and the healthcare system. Whereas different models for coordinating geriatric patients’ care and discharge planning have been developed, evidence on their cost-effectiveness remains scant. In this study, we evaluated the associations of an integrated care model on health and social care costs and service utilization among geriatric patients admitted to a hospital in a Finnish city with c. 68,000 citizens. Elderly patient cohorts admitted before (N = 709) and after (N = 364) the implementation of the integrated care model were compared restrospectively. The new model consisted of changes in regional care criteria, discharge planning, coordination between inpatient facilities, and the daily work of nursing staff. Patients treated in the new model spent, on average, 7.4 days less in institutionalized care during one year, and the total annual cost of care decreased by 967€ per patient. A regionally coordinated care pathway from hospital admission to permanent residence may improve the cost-effectiveness of elderly care. Coordination and monitoring of outcomes at regional level is essential to avoid fragmentation of care and suboptimization among different care providers serving the elderly.
Constrained model predictive control of a vehicle suspension using Laguerre polynomials
Authors: Dogruer CU
Published: November 2019

In this paper, a fast constrained model predictive control algorithm was designed for the active suspension of a half-car model to increase the controller bandwidth so that high frequency displacement disturbance coming from the road can be rejected. To this end, a quasi-LTI model of a semi-active suspension model was controlled by a model predictive controller with orthogonal Laguerre polynomials. With the use of Laguerre polynomials, it has been shown that the optimization parameter set could be made minimal, and thereby it has been shown that on-line optimization takes less time. With numerical simulations, it has been shown that the time complexity of a model predictive control having Laguerre polynomials is linear in the length of prediction horizon, whereas time complexity of a regular model predictive control is quadratic in the length of prediction horizon. Since it has been shown that time complexity of the constrained model predictive controller with orthogonal Laguerre polynomial is reduced, it is possible to extend the prediction horizon to large values. Further, constraints on the input signal and the state vector were also discussed within this context.
Implementation and experimental validation of surface electromyogram and force model of Tibialis Anterior muscle for examining muscular factors
Authors: Arjunan Sridhar P , Siddiqi Ariba , Swaminathan Ramakrishnan , Kumar Dinesh K
Published: November 2019

This study reports a surface electromyogram and force of contraction model. The objective was to investigate the effect of changes in the size, type and number of motor units in the Tibialis Anterior muscle to surface electromyogram and force of dorsiflexion. A computational model to simulate surface electromyogram and associated force of contraction by the Tibialis Anterior muscle was developed. This model was simulated for isometric dorsiflexion, and comparative experiments were conducted for validation. Repeated simulations were performed to investigate the different parameters and evaluate inter-experimental variability. An equivalence statistical test and the Bland–Altman method were used to observe the significance between the simulated and experimental data. Simulated and experimentally recorded data had high similarity for the three measures: maximal power of power spectral density ( p < 0.0001), root mean square of surface electromyogram ( p < 0.0001) and force recorded at the footplate ( p < 0.03). Inter-subject variability in the experimental results was in-line with the variability in the repeated simulation results. This experimentally validated computational model for the surface electromyogram and force of the Tibialis Anterior muscle is significant as it allows the examination of three important muscular factors associated with ageing and disease: size, fibre type and number of motor units.
A comparative assessment of two designs of hip stem using rule-based simulation of combined osseointegration and remodelling
Authors: Chanda Souptick , Mukherjee Kaushik , Gupta Sanjay , Pratihar Dilip Kumar
Published: November 2019

The stem–bone interface of cementless total hip arthroplasty undergoes an adaptive process of bone ingrowth until the two parts become osseointegrated. Another important phenomenon associated with aseptic loosening of hip stem is stress-shielding induced adverse bone remodelling. The objective of this study was to preclinically assess the relative performances of two distinct designs of hip stems by addressing the combined effect of bone remodelling and osseointegration, based on certain rule-based criteria obtained from the literature. Premised upon non-linear finite element analyses of patient-specific implanted femur models, the study attempts to ascertain in silico outcome of the hip stem designs based on an evolutionary interfacial condition, and to further comment on the efficacy of the rule-based technique on the prediction of peri-prosthetic osseointegration. One of the two hip stem models was a trade-off design obtained from an earlier shape optimization study, and the other was based on TriLock stem (DePuy). Both designs predicted similar long-term osseointegration (∼89% surface), although trade-off stem predicted higher post-operative osseointegration. Proximal bone resorption was found higher for TriLock (by ∼110%) as compared to trade-off model. The rule-based technique predicted clinically coherent osseointegration around both stems and appears to be an alternative to expensive mechanobiology-based schemes.
Dexmedetomidine elevates the lethal dose threshold of bupivacaine in rats: A dosing study
Authors: Pan L , Zhang Y , He Y , Chen Z , Wang S , Xia Y , Papadimos TJ , Lin W , Xu X
Published: November 2019

Dexmedetomidine (DMED), an alpha-2 adrenoreceptor agonist, has been widely used in regional anesthesia procedures. However, the effect of DMED on local anesthetic cardiotoxicity has not been well delineated. This study consisted of two experiments. In experiment A, 42 Sprague–Dawley (SD) rats were randomly divided into 6 groups ( n = 7), each group was pretreated with DMED 0 μg kg−1 (D0 group), 1 μg kg−1 (D1 group), 3 μg kg−1 (D3 group), 6 μg kg−1 (D6 group), 12 μg kg−1 (D12 group), and 24 μg kg−1 (D24 group), administered through the right femoral vein. In experiment B, 20 SD rats were randomly divided into 4 groups ( n = 5), such as control group, DMED group, yohimbine (YOH) group, and DMED + YOH group. Each subgroup in experiment B was also pretreated similarly as in experiment A. After pretreatment of rats as described above (in experiments A and B), bupivacaine 2.5 mg kg−1 min−1 was infused to induce cardiac arrest. In experiment A, the lethal dose threshold of bupivacaine and plasma bupivacaine concentration in D3 and D6 group were higher than the other groups. In experiment B, there was no interaction between DMED and YOH in lethal dose threshold, arrhythmia time, plasma concentration of bupivacaine, and myocardial content of bupivacaine. DMED doses of 3–6 μg kg−1 elevated the lethal dose threshold of bupivacaine without involvement of the alpha-2 adrenoceptors.
Dr John Tytler (1787–1837), Superintendent of the Native Medical Institution, Calcutta
Authors: Whitfield Michael John
Published: November 2019

Dr John Tytler was a surgeon in the Indian Medical Service in Bengal who played a key role in the development of medical education in India at the beginning of the 19th century. He was a convinced orientalist, having taught himself Arabic, Sanskrit, Hindi, Persian and Bengali languages and translated many Western publications into vernacular languages. His career included work with Indian sepoy regiments, as a civilian surgeon and as superintendent of the Native Medical Institute. The end of his career in India was intensely frustrating for him as the Institute was replaced with the Calcutta Medical College where teaching was in English and he was excluded from a role in it. It is easy to ignore the important role men such as Tytler had in the development of Indian medicine.
Wise Women’s Provision of Maternal-Child Health Information and Support for Urban, African American Women
Authors: Devido Jessica , Appelt Cathleen J. , Szalla Nicole
Published: November 2019

Introduction: The United States is experiencing a maternal-child health (MCH) crisis including racial inequalities in mortality. This study explored the roles of lay experts who provide information and support to women of childbearing age (i.e., Wise Women) and cultural norms for sharing MCH information and support in an urban, predominantly African American community. Methodology: This qualitative community-engaged study ( N = 49) of social networks utilized a semistructured guide and brainstorming activities with eight focus groups (three community leader, three community women, and two Wise Women). Results: Although several sources of MCH information and support were noted, Wise Women were the most frequently reported culturally normative sources. Emergent themes included positive affirmations for informal exchange of MCH information among women and roadblocks to MCH information exchange and support. Discussion: Results suggest a need for culturally relevant interventions that would strengthen lines of communication and social connectedness among African American women.
Senales de Peligo: Guatemalan Lay Midwives’ Perceptions of Responding to Obstetrical Complications
Authors: Garcia Kimberly S. , Kilanowski Jill F.
Published: November 2019

Introduction: The Guatemalan maternal mortality rate is among the highest in Latin Americans, and lay midwives (LMs) attend home births. The study’s purpose was to explore LMs’ knowledge of, attitudes toward, and practices regarding obstetrical complications and emergencies. Method: In the remote Peten region, a descriptive ethnographic study held focus group discussions before education programs to teach/boost LMs’ awareness about obstetrical complications. The long-table approach of analyses developed a matrix of common themes. Results: Nearly 200 LMs participated in 11 groups. Six themes emerged: LMs attribute their knowledge to God, recognize signs of obstetrical danger, want more training and equipment, encounter resistance from a patriarchal culture, feel fear and despair in addressing obstetrical complications/emergencies, and experience arduous logistics in emergency hospital transfers. Discussion: Contrary to published literature, LMs were able to verbalize basic knowledge of obstetrical complications. Information learned can guide future, action-research studies to address the maternal mortality rate in resource-poor settings.
An Evaluation of Risperidone Dosing for Pediatric Delirium in Children Less Than or Equal to 2 Years of Age
Authors: Campbell Christopher T. , Grey Erin , Munoz-Pareja Jennifer , Manasco Kalen B.
Published: November 2019

Background: Risperidone dosing and safety data are limited in patients ≤2 years of age. Objective: To describe the dosing strategies, safety, and tolerability of risperidone in infants ≤2 years of age. Methods: An institutional review board–approved retrospective study was conducted in a 24-bed pediatric intensive care unit at an academic medical center in patients ≤2 years of age receiving risperidone for the management of ICU delirium. The primary outcome was mean initial daily dose of risperidone. Secondary outcomes included mean daily dose, dosing frequency, treatment duration, and adverse effects. Results: Seventeen patients who received at least 1 dose of risperidone were included in the study. The initial daily dose ranged from 0.1 to 0.25 mg (0.01-0.04 mg/kg), with a mean of 0.17 mg (0.02 mg/kg). Most patients were initiated on once-daily dosing (76.5%) versus twice-daily dosing (17.6%). More than 80% of patients required a dose increase during therapy. Median daily doses of fentanyl, morphine, ketamine, and midazolam were decreased following initiation of risperidone. No adverse events that led to discontinuation of risperidone were reported. Conclusion and Relevance: Risperidone was found to be safe and well tolerated at daily doses of risperidone of 0.1 to 0.25 mg in 1 or 2 doses per day in patients ≤2 years old for the management of ICU delirium. To our knowledge, these results provide the largest cohort describing dosing recommendations specific for risperidone in this age group. Further investigation on the effect of antipsychotic administration on other sedation and analgesic regimens is necessary.