bluuebunny/crossref_metadata_2025 huggingface dataset:
The “losers of automation”: A reservoir of votes for the radical right?
Authors: Im Zhen Jie , Mayer Nonna , Palier Bruno , Rovny Jan
Published: March 2019

This paper studies the association between the risk of automation and vote choice in 11 West European countries. We extend upon labour economics literature on the effects of automation on the labour market by focusing on the political consequences of automation. We also build on existing work relating labour market risks to support for radical right parties. We argue that automation threat is most likely to increase support for radical right parties. We demonstrate that those more inclined to vote for the radical right rather than the average voters are those who are both threatened by automation and are still “just about managing” economically. They are more receptive to the narrative of the radical right, which simultaneously highlights the risk, and proposes protection. Using cross-sectional individual level data drawn from the European Social Survey (rounds 6, 7 and 8), we find that individuals who perceive themselves as “coping on present income” are significantly more likely to vote for radical right parties as risk of automation increases. They are also less likely to vote for major right parties.
Questionnaire development and validation for designing a health telemonitoring system for frail elderly people
Authors: Shamsabadi Ahmadreza , Delbari Ahmad , Sadr Ahmad Siar , Mehraeen Esmaeil , Mohammadzadeh Niloofar , Niakan Kalhori Sharareh R.
Published: March 2019

Background

Advancements in information technology have been instrumental in successful recent developments in telemonitoring systems. In this regard, there is a lack of development of valid and reliable tools to determine the requirements and applications of telemonitoring systems used to provide health care for frail elderly people living at home, specifically in a national setting.

Method

A cross-sectional study was carried out in 2018. The statistical population was 15 geriatric and gerontology professionals and 15 health information management experts. Then, content validity ratio (CVR), Cronbach's alpha, and correlation coefficient were calculated for measuring content validity, internal consistency and external reliability (through the test–retest method) respectively. SPSS software was used to analyze the collected data.

Results

Based on the identified items, a draft questionnaire was developed. Using the validity analysis in two stages, 37 items were removed, and 60 items were approved as the essential system requirements. The final questionnaire was organized into five sections with content validity index 99% and internal reliability (Cronbach's alpha coefficient 0.9). Furthermore, the external reliability results of the questionnaire showed that this instrument has a desirable correlation coefficient ( r = 0.85, p-value<0.05).

Conclusion

Considering the desirable validity and reliability of the questionnaire developed, it is recommended to telemonitoring system designers to determine the usages and requirements of health monitoring systems for frail elderly people living at home. The verified instrument is suitable for use in countries with the same living conditions and level of development as Iran.
Mobile health interventions to promote physical activity and reduce sedentary behaviour in the workplace: A systematic review
Authors: Buckingham Sarah Ann , Williams Andrew James , Morrissey Karyn , Price Lisa , Harrison John
Published: March 2019

Objective

This systematic review aimed to assess the effectiveness, feasibility and acceptability of mobile health (mHealth) technology (including wearable activity monitors and smartphone applications) for promoting physical activity (PA) and reducing sedentary behaviour (SB) in workplace settings.

Methods

Systematic searches were conducted in seven electronic databases (MEDLINE, SPORTDiscus, Scopus, EMBASE, PsycINFO, Web of Science and the Cochrane library). Studies were included if mHealth was a major intervention component, PA/SB was a primary outcome, and participants were recruited and/or the intervention was delivered in the workplace. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Interventions were coded for behaviour change techniques (BCTs) using the Coventry, Aberdeen and London – Refined (CALO-RE) taxonomy.

Results

Twenty-five experimental and quasi-experimental studies were included. Studies were highly heterogeneous and only one was rated as ‘strong’ methodological quality. Common BCTs included self-monitoring, feedback, goal-setting and social comparison. A total of 14/25 (56%) studies reported a significant increase in PA, and 4/10 (40%) reported a significant reduction in sedentary time; 11/16 (69%) studies reported a significant impact on secondary outcomes including reductions in weight, systolic blood pressure and total cholesterol. While overall acceptability was high, a large decline in technology use and engagement was observed over time.

Conclusions

While methodological quality was generally weak, there is reasonable evidence for mHealth in a workplace context as a feasible, acceptable and effective tool to promote PA. The impact in the longer term and on SB is less clear. Higher quality, mixed methods studies are needed to explore the reasons for decline in engagement with time and the longer-term potential of mHealth in workplace interventions. Protocol registration: The review protocol was registered with PROSPERO: CRD42017058856
Intramural Aortic Course Should Always Be Considered for Anomalous Origin of the Left Coronary Artery From the Right Pulmonary Artery
Authors: Agrawal Vishal , Vaidhya Nikunj , Patel Mrinal , Mishra Amit , Patel Dinesh
Published: March 2019

Anomalous origin of the left coronary artery (LCA) from the right pulmonary artery (ALCARPA) is an extremely rare subset of an already rare entity, anomalous origin of the LCA from the pulmonary artery. Whenever it is diagnosed preoperatively, one should be extremely vigilant about the potential intramural course of the descending part of the LCA in the aorta. Preoperative imaging frequently fails to delineate this intramural course. We report our experience with one such case where we had accidentally injured the LCA during dissection from the right pulmonary artery. Although it was successfully managed, it reinforces our aforementioned point concerning the importance of vigilance in seeking to identify intramurality as a component of this anomaly of coronary artery origin.
Acute Pancreatitis Causing Descending Colonic Stricture: A Rare Sequelae
Authors: Mandal Amrendra Kumar , Kafle Paritosh , Puri Pradip , Chaulagai Baikuntha , Hassan Muhammad , Bhattarai Bikash , Kanth Rajan , Gayam Vijay
Published: March 2019

An isolated descending colonic stricture is an unlikely complication of acute pancreatitis, with the nonspecific symptoms of colonic stricture making the overall diagnosis difficult. Crohn’s disease (CD) and tuberculosis (TB) are the two common etiologies of an isolated colonic stricture and may present similarly to colonic stricture related to acute pancreatitis. Unfortunately, colonoscopy and biopsy often cannot determine the etiology, and surgical resection may be needed to provide both symptomatic relief and confirm the diagnosis. As a result, descending colonic stricture may produce a diagnostic dilemma with CD and TB as all 3 conditions may be radiologically and endoscopically indistinguishable. We describe a young male with weight loss and abdominal pain. TB testing was negative, with radiography and ELISA (enzyme-linked immunosorbent assay) testing supporting a diagnosis of the CD. The patient was initiated on sulfasalazine but worsened over the next month. Further investigations revealed that the patient had descending colonic stricture without CD. Therefore, the stricture’s etiology was most likely related to an episode of acute pancreatitis the patient had 2 months before admission and was found to have left colonic segment adherent to the pancreas eventually requiring segmentectomy. Although the pathophysiology of colonic stricture after pancreatitis is unclear, we speculate that inflammatory injury to the colon is an important component. Finally, we emphasize that colonic stricture is a rare complication of pancreatitis.
Kratom-Induced Cholestatic Liver Injury and Its Conservative Management
Authors: Fernandes Christopher T. , Iqbal Umair , Tighe Sean P. , Ahmed Aijaz
Published: March 2019

Drug-induced liver injury (DILI) is a common cause of hepatotoxicity associated with prescription-based and over-the-counter exposure to medications and herbal supplements. Use of unapproved and inadequately tested herbal supplements can cause DILI. Therefore, thorough history-taking on exposure to herbal supplements must be an integral part of clinical evaluation of DILI. Kratom is an herbal supplement or remedy that has been known for its analgesic effects and has also been used for self-treatment of opiate withdrawals. A 52-year-old man was seen for evaluation of yellow discoloration of the eyes and skin. He reported taking kratom for right shoulder strain for at least a couple of months. On workup, his total bilirubin was noted to be 23.2 mg/dL, which peaked at 28.9 mg/dL. He was noted to have mild elevation of aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase. Extensive laboratory tests were ordered and known causes of chronic liver disease ruled out. Magnetic resonance imaging of the abdomen was unremarkable without stigmata of portal hypertension or signs of chronic liver disease. He demonstrated no evidence of coagulopathy or hepatic encephalopathy during his illness. He underwent liver biopsy, which demonstrated histologic evidence of acute cholestatic hepatitis highly suspicious of DILI. He was advised to avoid kratom or other herbal supplements in future and prescribed ursodeoxycholic acid with significant improvement in his liver chemistries. Kratom is associated with significant liver enzymes derangements leading to DILI. Kratom is not approved for use in the United States and should be avoided.
The Challenges of Informed Consent in High-Stakes, Randomized Oncology Trials: A Systematic Review
Authors: Nathe Julia M. , Krakow Elizabeth F.
Published: March 2019

Importance. Oncology trials often entail high-stakes interventions where potential for morbidity and fatal side effects, and for life-prolongation or cure, intensify bioethical issues surrounding informed consent. These challenges are compounded in multistage randomized trials, which are prevalent in oncology. Objective. We sought to elucidate the major barriers to informed consent in high-stakes oncology trials in general and the best consent practices for multistage randomized trials. Evidence Review. We queried PubMed for original studies published from January 1, 1990, to April 5, 2018, that focused on readability, quality, complexity or length of consent documents, motivation and sickness level of participants, or interventions and enhancements that influence informed consent for high-stakes oncologic interventions. Exclusion criteria included articles focused on populations outside industrialized countries, minors or other vulnerable populations, physician preferences, cancer screening and prevention, or recruitment strategies. Additional articles were identified through comprehensive bibliographic review. Findings. Twenty-seven articles were retained; 19 enrolled participants and 8 examined samples of consent documents. Methodologic quality was variable. This body of literature identified certain challenges that can be readily remedied. For example, the average length of the consent forms has increased 10-fold from 1987 to 2010, and patient understanding was shown to be inversely proportional to page count; shortening forms, or providing a concise summary as mandated by the revised Common Rule, might help. However, barriers to understanding that stem from deeply ingrained and flawed sociocultural perceptions of medical research seem more difficult to surmount. Although no studies specifically addressed problems posed by multiple sequential randomizations (such as change in risk-benefit ratio due to time-varying treatment responses or organ toxicities), the findings are likely applicable and especially relevant in that context. Concrete suggestions for improvement are proposed.
How I treat chronic myeloid leukemia in children and adolescents
Authors: Hijiya Nobuko , Suttorp Meinolf
Published: March 2019

Evidence-based recommendations have been established for treatment of chronic myeloid leukemia (CML) in adults treated with tyrosine kinase inhibitors (TKIs), but the rarity of this leukemia in children and adolescents makes it challenging to develop similar recommendations in pediatrics. In addition to imatinib, which was approved for pediatric CML in 2003, the second-generation TKIs dasatinib and nilotinib were recently approved for use in children, expanding the therapeutic options and pushing allogeneic stem cell transplantation to a third-line treatment of most pediatric cases. Yet, without sufficient data on efficacy and safety specific to pediatric patients, the selection of a TKI continues to rely on clinical experience in adults. Here, we present 4 case scenarios highlighting common yet challenging issues encountered in the treatment of pediatric CML (suboptimal response, poor treatment adherence, growth retardation, and presentation in advanced phases). Limited experience with very young children, the transition of teenagers to adult medicine, and the goal of achieving treatment-free remission for this rare leukemia are additional significant obstacles that require further clinical investigation through international collaboration.
Streptococcus agalactiae maternal colonization, antibiotic resistance and serotype profiles in Africa: a meta-analysis
Authors: Gizachew Mucheye , Tiruneh Moges , Moges Feleke , Tessema Belay
Published: March 2019

Background

Maternal rectovaginal colonization with Streptococcus agalactiae (Group B Streptococcus or GBS) is the most common route for the GBS disease in the perinatal period. The knowledge of maternal colonization, antibiotic resistance and serotype profiles is substantially needed to formulate the broad vaccine. However, it has not been estimated in Africa. This meta-analysis was aimed to determine the pooled prevalence of colonization, antibiotic resistance and serotype profiles of GBS reported in Africa.

Methods

Potentially relevant studies from 1989 to 31th January, 2019 were retrieved from the Medline/PubMed, EMBASE, HINARI online databases, periodicals and by requesting authors. Unpublished studies retrieved from grey literature through Google and Google Scholar. Pooled estimates were calculated using the random effect model. Subgroup analysis was done to investigate the burden of colonization across sub-regions, sampling site and countries. Summary estimates were presented using words, Forest plots and Tables. Heterogeneity was assessed using the I2 statistic.

Results

Eighty-three articles were assessed, of which 57 studies conducted in five sub-regions with 21 countries (22,206 pregnant women) met pre-specified inclusion criteria. The overall estimate of recto-vaginal colonization was 19.3% (95% CI 16.9, 21.7). The highest estimate was observed in Southern Africa, 23.8% (95% CI 18.7, 28.9), followed by Northern Africa, 22.7% (95% CI 18.2, 27.2) while the lowest was driven from the Eastern Africa, 15.4% (95% CI 12.1, 18.7). Considerable heterogeneity across and within regions, sampling site, screening methods and countries (I2 > 75%); and the publication bias were observed (p = 0.031). GBS showed the highest resistance to tetracycline. Resistance to penicillin, amoxicillin, chloramphenicol, ampicillin, ceftriaxone, ciprofloxacin, erythromycin, vancomycin and clindamycin also observed. The V, III, Ia, Ib, and II serotypes altogether were accounted 91.8% in the African studies.

Conclusions

The pooled estimate of the maternal colonization with GBS was 19.3% which is equivalent with other many primary and review reports worldwide. The most antibiotic resistance estimate was recorded in the tetracycline followed by penicillin. Five serotypes were the most prevalent in Africa and more data on the antibiotic résistance and serotype distribution patterns are needed from developing countries to devise the effective preventive measures. In addition, the antibiotic susceptibility test methods used in the Africa shall be assessed for its quality.

Trial registration Prospero Registration Number CRD42018094525
Neurocognitive functioning in community youth with suicidal ideation: gender and pubertal effects
Authors: Barzilay Ran , Calkins Monica E. , Moore Tyler M. , Boyd Rhonda C. , Jones Jason D. , Benton Tami D. , Oquendo Maria A. , Gur Ruben C. , Gur Raquel E.
Published: March 2019

Background

Although there are extensive data on clinical psychopathology in youth with suicidal ideation, data are lacking regarding their neurocognitive function.

Aims

To characterise the cognitive profile of youth with suicidal ideation in a community sample and evaluate gender differences and pubertal status effects.

Method

Participants (N = 6151, age 11–21 years, 54.9% females) from the Philadelphia Neurodevelopmental Cohort, a non-help-seeking community sample, underwent detailed clinical evaluation. Cognitive phenotyping included executive functioning, episodic memory, complex reasoning and social cognitive functioning. We compared participants with suicidal ideation (N = 672) and without suicidal ideation (N = 5479). Regression models were employed to evaluate differences in cognitive performance and functional level, with gender and pubertal status as independent variables. Models controlled for lifetime depression or general psychopathology, and for covariates including age and socioeconomic status.

Results

Youth with suicidal ideation showed greater psychopathology, poorer level of function but better overall neurocognitive performance. Greater functional impairment was observed in females with suicidal ideation (suicidal ideation × gender interaction, t = 3.091, P = 0.002). Greater neurocognition was associated with suicidal ideation post-puberty (suicidal ideation × puberty interaction, t = 3.057, P = 0.002). Exploratory analyses of specific neurocognitive domains showed that suicidal ideation-associated cognitive superiority was more prominent in post-pubertal males compared with females (Cohen's d = 0.32 and d = 0.11, respectively) across all cognitive domains.

Conclusions

Suicidal ideation was associated with poorer functioning yet better cognitive performance, especially in post-pubertal males, as measured by a comprehensive cognitive battery. Findings point to gender and pubertal-status specificity in the relationship between suicidal ideation, cognition and function in youth.

Declaration of interest

R.B. serves on the scientific board and reports stock ownership in ‘Taliaz Health’, with no conflict of interest relevant to this work. M.A.O. receives royalties for the commercial use of the Columbia-Suicide Severity Rating Scale from the Research Foundation for Mental Hygiene. Her family owns stock in Bristol-Myers Squibb. All other authors declare no potential conflict of interest.
Multicenter Prospective Cohort Study of the Diagnostic Yield and Patient Experience of Multiplex Gene Panel Testing For Hereditary Cancer Risk
Authors: Idos Gregory E. , Kurian Allison W. , Ricker Charité , Sturgeon Duveen , Culver Julie O. , Kingham Kerry E. , Koff Rachel , Chun Nicolette M. , Rowe-Teeter Courtney , Lebensohn Alexandra P. , Levonian Peter , Lowstuter Katrina , Partynski Katlyn , Hong Christine , Mills Meredith A. , Petrovchich Iva , Ma Cindy S. , Hartman Anne-Renee , Allen Brian , Wenstrup Richard J. , Lancaster Johnathan M. , Brown Krystal , Kidd John , Evans Brent , Mukherjee Bhramar , McDonnell Kevin J. , Ladabaum Uri , Ford James M. , Gruber Stephen B.
Published: March 2019

Purpose

Multiplex gene panel testing (MGPT) allows for the simultaneous analysis of germline cancer susceptibility genes. This study describes the diagnostic yield and patient experiences of MGPT in diverse populations.

Patients and Methods

This multicenter, prospective cohort study enrolled participants from three cancer genetics clinics—University of Southern California Norris Comprehensive Cancer Center, Los Angeles County and University of Southern California Medical Center, and Stanford Cancer Institute—who met testing guidelines or had a 2.5% or greater probability of a pathogenic variant (N = 2,000). All patients underwent 25- or 28-gene MGPT and results were compared with differential genetic diagnoses generated by pretest expert clinical assessment. Post-test surveys on distress, uncertainty, and positive experiences were administered at 3 months (69% response rate) and 1 year (57% response rate).

Results

Of 2,000 participants, 81% were female, 41% were Hispanic, 26% were Spanish speaking only, and 30% completed high school or less education. A total of 242 participants (12%) carried one or more pathogenic variant (positive), 689 (34%) carried one or more variant of uncertain significance (VUS), and 1,069 (53%) carried no pathogenic variants or VUS (negative). More than one third of pathogenic variants (34%) were not included in the differential diagnosis. After testing, few patients (4%) had prophylactic surgery, most (92%) never regretted testing, and most (80%) wanted to know all results, even those of uncertain significance. Positive patients were twice as likely as negative/VUS patients (83% v 41%; P < .001) to encourage their relatives to be tested.

Conclusion

In a racially/ethnically and socioeconomically diverse cohort, MGPT increased diagnostic yield. More than one third of identified pathogenic variants were not clinically anticipated. Patient regret and prophylactic surgery use were low, and patients appropriately encouraged relatives to be tested for clinically relevant results.
Predictive Biomarkers in Metastatic Colorectal Cancer: A Systematic Review
Authors: Ruiz-Bañobre Juan , Kandimalla Raju , Goel Ajay
Published: March 2019

PURPOSE

The development and use of predictive biomarkers to guide treatment decisions are paramount not only for improving survival in patients with metastatic colorectal cancer (mCRC), but also for sparing them from unnecessary toxicity and reducing the economic burden of expensive treatments. We conducted a systematic review of published studies and evaluated the predictive biomarker landscape in the mCRC setting from a molecular and clinical viewpoint.

METHODS

Studies analyzing predictive biomarkers for approved therapies in patients with mCRC were identified systematically using electronic databases. Preclinical studies and those providing no relevant information were excluded.

RESULTS

A total of 173 studies comprising 148 biomarkers were selected for final analysis. Of all the biomarkers analyzed, 1.4% (two of 148) were explored in a prospective manner, whereas 98.6% (146 of 148) were evaluated in retrospective studies. Of the latter group, 78.8% (115 of 146) were not tested in subsequent phases, 9.6% (14 of 146) were tested in other retrospective cohorts, 8.9% (13 of 146) were retrospectively tested in at least one or more randomized cohorts, and only 2.7% (four of 146) were prospectively tested in a clinical trial. Finally, only 1.4% (two of 148) were validated sufficiently and are recognized as biomarkers for guiding treatment decision making in patients with mCRC. These markers were RAS mutational status for anti-EGFR antibodies and microsatellite instability status for anti–programmed cell death-1 drugs.

CONCLUSION

Despite notable efforts to identify predictive biomarkers for various therapies used in the mCRC setting, because of a lack of data beyond retrospective studies and successful biomarker-driven approaches, only two molecular biomarkers have thus far found their translation into the clinic, highlighting the imperative need for implementing novel strategies and additional research in this clinically important field.
Hyperglycemia and Metformin Use Are Associated With B Vitamin Deficiency and Cognitive Dysfunction in Older Adults
Authors: Porter Kirsty M , Ward Mary , Hughes Catherine F , O’Kane Maurice , Hoey Leane , McCann Adrian , Molloy Anne M , Cunningham Conal , Casey Miriam C , Tracey Fergal , Strain Sean , McCarroll Kevin , Laird Eamon , Gallagher Alison M , McNulty Helene
Published: March 2019

Context

Emerging evidence suggests that deficiencies of folate-related B vitamins can arise with metformin treatment and are independently linked with cognitive dysfunction, a comorbidity of diabetes.

Objective

To determine the impact of hyperglycemia and metformin use on relevant B vitamin biomarkers and cognitive outcomes in older adults.

Setting and Participants

Community-dwelling older adults (74.1 ± 8.3 years, n = 4160) without dementia, recruited to the Trinity, Ulster and Department of Agriculture cohort study in 2008 to 2012, were classified as normoglycemic (n = 1856) or hyperglycemic, based on HbA1c ≥5.7% (39 mmol/mol), either with (n = 318) or without (n = 1986) metformin treatment.

Main Outcome Measures

Biomarkers of folate, vitamin B12, vitamin B6, and riboflavin were measured. Cognitive assessments included the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) and the Frontal Assessment Battery (FAB).

Results

Metformin use was associated with higher risk of deficiency of vitamin B12 (combined B12 index ≤−1; OR 1.45; 95% CI, 1.03 to 2.02) and vitamin B6 (plasma pyridoxal 5-phosphate <30.0 nmol/L; OR 1.48; 95% CI, 1.02 to 2.15). Fortified foods when eaten regularly had a positive impact on all relevant B vitamin biomarkers, even with hyperglycemia. After adjustment for relevant covariates, metformin use was associated with an increased risk of cognitive dysfunction as assessed with the RBANS (OR 1.36; 95% CI, 1.03 to 1.80) and FAB (OR 1.34; 95% CI, 1.03 to 1.74).

Conclusions

Use of metformin by older adults is associated with poorer cognitive performance; B vitamin deficiency may be implicated. Fortified foods can optimize B vitamin status and may be beneficial for maintaining better cognitive health in older people with or at risk for diabetes.
Tips and Resources for Medication Reconciliation
Authors: Shenoy Anant M. , Bennett Amy , Segal Alan Z.
Published: March 2019

Medication errors occur despite best intentions and are often the result of medication discrepancies. Medication reconciliation reduces the likelihood of errors by addressing medication discrepancies that result from multiple points of care, transitions in care, or patient report. Providers and practices may feel overwhelmed by new record systems and regulatory requirements, but multiple resources are available to assist providers to perform medication reconciliation with their patients. Providers and practices should implement medication reconciliation strategies, such as adoption of a multidisciplinary approach, engagement of patients to track medications, and identification of patients who are at high risk for medication list discrepancies and errors. Medication reconciliation will ultimately improve quality of care.
Antiepileptic Drug Treatment of Epilepsy in Children
Authors: Moosa Ahsan N. V.
Published: March 2019

PURPOSE OF REVIEW

The treatment of epilepsy in children is highly individualized at each and every major step in the management. This review examines various factors that modify the treatment from the point of initiation of therapy to the decision to stop an antiepileptic drug (AED).

RECENT FINDINGS

AED therapy leads to seizure freedom in about 70% of all children with epilepsy. AED initiation could be delayed until a second seizure in most children and may be avoided altogether in many children with self-limited childhood focal epilepsies. Three key factors influence the choice of AED: seizure type(s), efficacy of the drug for the seizure type, and the side effect profile of the drug(s). For epileptic spasms, steroids and vigabatrin are the most effective treatment options. For absence seizures, ethosuximide and valproic acid are superior to lamotrigine. For focal seizures, many newer AEDs have favorable side effect profiles with efficacy comparable to older-generation drugs. For generalized epilepsies, valproic acid remains the most effective drug for a broad range of seizure types. Genetic and metabolic etiologies may guide unique treatment choices in some children. After 2 years or more of seizure freedom, if the recurrence risk after AED withdrawal is acceptable, slow weaning of AEDs should be done over the span of 6 weeks or longer. After discontinuation, about 70% of patients remain seizure free, and of those with recurrence, the majority achieve seizure control with restarting an AED. When treatment with two or more AEDs fails, other treatment opportunities for drug-resistant epilepsy, including epilepsy surgery, vagal nerve stimulation, and dietary therapies should be considered.

Carefully selected medical therapy guided by seizure type and AED characteristics is effective in more than two-thirds of children with epilepsy.
Arterial Baroreflex Resetting During Exercise in Humans: Underlying Signaling Mechanisms
Authors: Raven Peter B. , Young Benjamin E. , Fadel Paul J.
Published: March 2019

The arterial baroreflex (ABR) resets during exercise in an intensity-dependent manner to operate around a higher blood pressure with maintained sensitivity. This review provides a historical perspective of ABR resetting and the involvement of other neural reflexes in mediating exercise resetting. Furthermore, we discuss potential underlying signaling mechanisms that may contribute to exercise ABR resetting in physiological and pathophysiological conditions.
Large Firm Dynamics and the Business Cycle
Authors: Carvalho Vasco M. , Grassi Basile
Published: March 2019

Do large firm dynamics drive the business cycle? We answer this question by developing a quantitative theory of aggregate fluctuations caused by firm-level disturbances alone. We show that a standard heterogeneous firm dynamics setup already contains in it a theory of the business cycle, without appealing to aggregate shocks. We offer an analytical characterization of the law of motion of the aggregate state in this class of models, the firm size distribution, and show that aggregate output and productivity dynamics display: (i ) persistence, (ii ) volatility, and (iii ) time-varying second moments. We explore the key role of moments of the firm size distribution, and, in particular, the role of large firm dynamics, in shaping aggregate fluctuations, theoretically, quantitatively, and in the data. (JEL D21, D22, D24, E32, L11)
Vulnerable Growth
Authors: Adrian Tobias , Boyarchenko Nina , Giannone Domenico
Published: March 2019

We study the conditional distribution of GDP growth as a function of economic and financial conditions. Deteriorating financial conditions are associated with an increase in the conditional volatility and a decline in the conditional mean of GDP growth, leading the lower quantiles of GDP growth to vary with financial conditions and the upper quantiles to be stable over time. Upside risks to GDP growth are low in most periods while downside risks increase as financial conditions become tighter. We argue that amplification mechanisms in the financial sector generate the observed growth vulnerability dynamics. (JEL C53, E23, E27, E32, E44)
Alcohol and Self-Control: A Field Experiment in India
Authors: Schilbach Frank
Published: March 2019

This paper studies alcohol consumption among low-income workers in India. In a 3-week field experiment, the majority of 229 cycle-rickshaw drivers were willing to forgo substantial monetary payments in order to set incentives for themselves to remain sober, thus exhibiting demand for commitment to sobriety. Randomly receiving sobriety incentives significantly reduced daytime drinking while leaving overall drinking unchanged. I find no evidence of higher daytime sobriety significantly changing labor supply, productivity, or earnings. In contrast, increasing sobriety raised savings by 50 percent, an effect that does not appear to be solely explained by changes in income net of alcohol expenditures. (JEL C93, D14, I12, J22, J24, J31, O12)
Subsidizing Health Insurance for Low-Income Adults: Evidence from Massachusetts
Authors: Finkelstein Amy , Hendren Nathaniel , Shepard Mark
Published: March 2019

How much are low-income individuals willing to pay for health insurance, and what are the implications for insurance markets? Using administrative data from Massachusetts’ subsidized insurance exchange, we exploit discontinuities in the subsidy schedule to estimate willingness to pay and costs of insurance among low-income adults. As subsidies decline, insurance take-up falls rapidly, dropping about 25 percent for each $40 increase in monthly enrollee premiums. Marginal enrollees tend to be lower-cost, indicating adverse selection into insurance. But across the entire distribution we can observe (approximately the bottom 70 percent of the willingness to pay distribution) enrollees’ willingness to pay is always less than half of their own expected costs that they impose on the insurer. As a result, we estimate that take-up will be highly incomplete even with generous subsidies. If enrollee premiums were 25 percent of insurers’ average costs, at most half of potential enrollees would buy insurance; even premiums subsidized to 10 percent of average costs would still leave at least 20 percent uninsured. We briefly consider potential explanations for these findings and their normative implications. (JEL G22, H51, H75, I13, I18)
Blockchain and disruptive technologies in social sciences: Interdisciplinary perspectives
Authors: Koskinas Konstantinos
Published: March 2019

This special issue contains selected papers that cover a broad range of current trends and interdisciplinary approaches in the social research on Blockchain and disruptive technologies.
Digitisation and technological challenges of the banking industry
Authors: Roumeliotis Panagiotis
Published: March 2019

The strong competition and digital revolution impose to the banks their profound transformation demanding a high cost on investments. The banking system should continue, at the same time, its efforts to disengage from non-productive assets as well as to reduce the running costs. Moreover, banks should consider becoming more flexible and productive, by taking advantage of the opportunities of the new digital economy and by ameliorating accordingly the offered services. The current paper discusses and analyses the challenges for the banks, regarding the technological evolution, the digitization of banking services and the technologies of blockchain and big data.
Da Filosofia para os Estudos Organizacionais: o percurso ontológico de Schatzki na teoria da prática social
Authors: Passos Janaína Sousa Loureiro , Bulgacov Yara Lúcia Manzziotti
Published: March 2019

A multiplicidade de bases ontológicas e caminhos epistemológicos existentes no campo dos estudos organizacionais é crescente. Estudos com bases ontológicas sociais podem ser um caminho para a compreensão do que ocorre nas organizações, que são beneficiadas por perspectivas como, por exemplo, de estudos baseados em práticas. Estes têm como base teorias que buscam o acesso à realidade das organizações por meio das práticas. O presente estudo tem como objetivos explorar a construção da teoria da prática social de Schatzki e compreender sua base ontológica. O artigo se estrutura por meio de uma análise sócio histórica dos textos de Schatzki relativos à construção de sua teoria e amadurecimento de sua ontologia. Como resultado de pesquisa as principais contribuições de Schatzki para os estudos organizacionais são: 1. Rompimento com a tradição positivista; 2. Rompimento com visões reificantes /classificatórias do indivíduo na medida que toma a prática, conceito holístico, com unidade de analise; 3. Rompimento com teorias abstratas que segmentam a organização, percebendo o nexo de dizeres e fazeres nas organizações e; 4. Maior difusão de métodos de pesquisa, como autoenografia e netnografia. Foram identificadas também três fases ontológicas de Schatzki, proporcionando um entendimento global da construção de sua teoria. Consequentemente, este trabalho ajuda o pesquisador que queira utilizar a teoria da prática social de Schatzki para estudos organizacionais a se apropriar desta lente teórica.
Inovação no setor da cachaça artesanal: estudo de caso
Authors: Borges Alex Fernando , Takemoto Sane Nair Costa
Published: March 2019

O objetivo geral deste trabalho consistiu em identificar a construção de práticas de inovação em uma organização produtora de cachaça artesanal, situada na região do Alto Paranaíba, estado de Minas Gerais. Especificamente, buscou-se: caracterizar a trajetória histórica do empreendimento investigado; identificar os tipos de inovação radical desenvolvidos no âmbito da organização; e identificar os tipos de inovação incremental desenvolvidos pela empresa. A partir de um estudo de caso de natureza qualitativa, foi realizada uma entrevista, orientada por roteiro semiestruturado, junto ao diretor técnico da organização estudada. A análise dos dados permitiu identificar um conjunto de práticas de inovação radical e incremental, vinculadas ao desenvolvimento de novos produtos e melhorias de qualidade já existentes, à introdução de novos processos no sistema de produção e de melhorias nos processos já empregados, à exploração de novos mercados e ao foco em nichos de mercados já explorados. Com isso, conclui-se que inovações de natureza radical e incremental, quando colocadas em perspectiva, contribuem de forma importante para a competitividade da organização estudada, uma vez que colaboram para a renovação das estratégias de atuação da empresa no mercado e para sua sobrevivência no setor.
Risks of the organization: their accounting, analysis and control
Authors: Серебрякова Татьяна , Serebryakova Tatyana , Гордеева Ольга , Gordeeva Ol'ga
Published: March 2019

The issues of correlation of control, risks, accounting and analysis in the management of any processes are still relevant, have not found a clear solution and need to be studied and clarified.The first Chapter integrates two approaches to understanding the essence of control: as a risk-oriented activity and management process. At the same time, modern management control doctrines are considered from the point of view of their economic component. This approach made it possible to determine the ways of their use in domestic economic control.
The second Chapter is devoted to theoretical research in relation to internal economic control and its tools, during which the author formulated the categories of internal and external economic and financial control, their principles and features of methodological support.
The third Chapter contains a description of the main risk management models and a critical assessment of the ratio of control and risk, the primacy of each category in relation to each other.
The fourth Chapter discusses the institutional framework for risk management, management methods and tools, their features and interaction with internal control, accounting and analysis.
The fifth Chapter describes control as the holder of control processes, including risk management.
Final qualifying work: bachelor's degree
Authors: Лазарова Лариса , Lazarova Larisa , Каирова Фатима , Kairova Fatima
Published: March 2019

Methodical recommendations are made on the basis of federal legislation in the field of higher education, the requirements of the GEF, Provisions on final state certification of graduates of higher educational institutions of the Russian Federation dated March 25, 2003 No. 1155.
Guidelines contain recommendations and requirements for the structure and content of graduate qualification works of bachelors, the main issues of organizing their implementation.
The manual focuses on solving the settlement, analytical or research problem.
Designed to provide methodological assistance in the implementation of the calculated and analytical part of the WRC to students of all forms of education, studying in the bachelor's degree in the direction of 38.03.01 - Economics, supervisors of the WRC, reviewers, members of certification commissions.
AMBIENTE FAMILIAR E RISCO DE TRANSTORNO ALIMENTAR ENTRE UNIVERSITÁRIOS DA ÁREA DA SAÚDE
Authors: Sampaio Helena Alves de Carvalho , Silva Itamara Araújo da , Parente Nara De Andrade , Carioca Antônio Augusto Ferreira
Published: March 2019

Objetivo: Investigar, junto aos estudantes da área de saúde, a associação entre comportamentos sugestivos de risco para transtorno alimentar e ambiente familiar. Métodos: Trata-se de um estudo descritivo, transversal, com abordagem quantitativa. A coleta de dados foi realizada a partir de um instrumento dividido em três partes: dados de identificação e antropométricos; aspectos ligados ao transtorno alimentar (Teste de atitudes alimentares - Eating Attitudes Test – EAT-26); e aspectos ligados ao ambiente familiar (Escala de Ambiente Familiar). Resultados: Foi observado desejo de perda de peso por parte dos estudantes de todos os cursos, apesar de estarem saudáveis de acordo com o Índice de Massa Corporal médio (22,75kg/m²). Na distribuição do EAT-26, 16% da amostra apresentou risco positivo para TA. Maiores índices de EAT-26 positivos foram encontrados nos acadêmicos da enfermagem, com 27%, enquanto os menores percentuais foram observados nos estudantes de medicina (10%), porém, não houve diferença significativa entre os cursos (p=0,204). A análise comparativa entre EAT-26 e ambiente familiar foi pioneira neste tipo de estudo e demonstrou que apenas o domínio conflito foi significativamente associado ao EAT-26 (p=0.008), indicando que a presença transtorno alimentar está associada a famílias mais conflituosas. Conclusão: O estudo evidenciou a necessidade de se incluir avaliação de comportamentos para transtorno alimentar e escala de ambiente familiar nas ações de promoção da saúde em grupos vulneráveis ao desenvolvimento de transtornos alimentares.
NOVIDADES
Authors: Koury Josely Correa , Castro Luciana Maria Cerqueira
Published: March 2019

Chegamos a 2019 e, conforme anunciado, apresentamos DEMETRA: Alimentação, Nutrição & Saúde com algumas novidades. Contamos agora com um conselho editorial deliberativo composto por um docente de cada departamento do Instituto de Nutrição da UERJ, o qual auxiliará na condução dos rumos da revista. Na tentativa de atender aos critérios de exogenia, faz parte de nossas novidades a presença de editores associados por área de atuação, cuidadosamente escolhidos considerando a produção científica e a expertise nas diferentes áreas da Alimentação, Nutrição e Saúde, de diferentes regiões do país. Ainda estamos em processo de envio de convites para pesquisadores estrangeiros e acreditamos que, em breve, teremos um maior número deles na Revista. Os editores associados colaborarão na gestão do fluxo dos manuscritos, iniciando pela indicação de pareceristas e acompanhando todo o processo de avaliação e aprovação.Além das novidades administrativas, temos novo layout e novas regras para submissão. Incluímos uma nova categoria de artigos, denominada “Outras linguagens”, que receberá textos de reflexão sobre temas de interesse para os leitores da revista, com relação aos campos da Alimentação, Nutrição, Saúde, Comensalidade, Artes e Cultura, utilizando recursos iconográficos, poéticos, literários, musicais e audiovisuais. Gostaríamos que esta categoria de artigo estimulasse os autores a ousar, enveredando pelos caminhos da poesia, fotografia, vídeos, entre outras formas de arte, sempre contextualizando com o escopo da revista.A partir de abril 2019, DEMETRA passa a ser publicada em fluxo contínuo, ou seja, todas as edições permanecerão abertas e após a diagramação dos artigos aceitos, estes serão disponibilizados online. Com isso, o fluxo de artigos será acelerado, aumentando o tempo de exposição do material e reduzindo o tempo de espera dos autores, o que dará maior visibilidade à Revista e aos trabalhos publicados por meio de citações. Ainda como forma de aumentar a visibilidade, criamos uma página no Facebook e no Twitter.Todo o esforço para a atualização e melhora da qualidade da Revista é muito recente; desde novembro do ano passado, estamos trabalhando para que tudo funcione da melhor forma possível. Esperamos poder contar com a colaboração de todos.Aproveitamos para agradecer aos parceiros e parceiras que concordaram em participar de mais este desafio: a manutenção e o crescimento de um veículo de divulgação científica sem custo para o leitor e de qualidade acadêmica. DOI: 10.12957/demetra.2019.40758
Inferior dental blocks versus infiltration dentistry: is it time for change?
Authors: Renton Tara
Published: March 2019

Dentistry is unique in that high volume surgery is undertaken efficiently on conscious patients, an anathema to most other surgical specialties who predominantly operate on unconscious patients. Local anaesthesia provides an efficient block to nociceptive pain (the first stage of the pain pathway) but only addresses one small part of the pain experience. Currently the inferior dental block (IDB) is the ‘go to’ standard for dental LA for mandibular dentistry despite its significant shortcomings. Unfortunately, as creatures of habit clinicians continue to practise what is taught at dental school, namely IDBs, when evolving more patient-safe practice takes time to be taken up by the workforce.

Local anaesthesia blocks are inefficient in providing swift pulpal anaesthesia. Malamed stated that the rate of inadequate anaesthesia ranged from 31% to 81%. When expressed as success rates, this indicates a range of 19% to 69%. These numbers are so wide ranging as to make selection of a standard for rate of success for IDB seemingly impossible. LA blocks also increase the risk of systemic complications and they may be associated with nerve injury. Though LA-related permanent nerve injury is rare (approximately 1in 52–57K IDBs), once the injury occurs approximately 75% may resolve but the remaining 25% are untreatable. Most patients with trigeminal nerve injuries experience chronic pain in their lip, teeth and gums or tongue and gums, depending on which nerve is damaged. This is a lifelong burden that these patients find difficult to accommodate, especially when they were never warned about the possible risk.

The risk of nerve injury can be mitigated by altering the block technique or by avoiding block anaesthesia altogether. With novel development in pharmacology of LA and equipment, block anaesthesia is likely to become rarely needed in dentistry.

CPD/Clinical Relevance: Dentistry is a profession predicated upon causing and/or managing pain in patients. Providing effective pain control during surgery is essential but using techniques with the minimum risks is imperative.
In the frame
Authors: Akehurst Pennie
Published: March 2019

What is new in Ofsted's recently published Education Inspection Framework, and what are the implications for managers in the PVI sector? Former council early years leader and consultant Pennie Akehurst reports
More or less
Authors: Valle Ivana La , Lloyd Eva
Published: March 2019

The University of East London's Ivana La Valle and Eva Lloyd, who were involved in the most recent evaluation of the 30 hours entitlement, discuss the key findings of their report and how the policy may develop in the future
Initial findings
Authors: Sutton-Tsang Samantha
Published: March 2019

How useful is Early Years Teacher training and what difference does it make to leading practice? Samantha Sutton-Tsang, senior lecturer from the Department for Children and Families at the University of Worcester, did some research on the subject
Generation Z
Authors: Russell Meredith Jones
Published: March 2019

Meredith Jones Russell finds out how some early years settings are adapting to the particular needs of the youngest members of the workforce