bluuebunny/crossref_metadata_2025 huggingface dataset:
Ch’ulel Mendoza, the spa with a difference: a case study of new product development in the wellness industry
Authors: Marano Gina , Henthorne Tony , George Babu
Published: August 2017

Subject area

Hospitality and Tourism.

Study level/applicability

Senior undergraduate level and graduate level.

Case overview

This case study charts out the development of a business plan for Ch’ulel Mendoza, a hypothetical all-villa resort nestled against the Andes Mountains, where guests enjoy luxurious wine-infused spa treatments. The business plan has to be comprehensive because it should become the basis of a turnkey project for potential investors. Ch’ulel Mendoza is surrounded by the lush vineyards of some of the most famous wine estates in Argentina. The spa, facilities and services pay homage to the wine-growing heritage of the region, promoting wine to its guests as both pleasurable for consumption and conducive to healthy living. The architectural design speaks directly to the vines themselves: the earth-covered spa is where guests soak up the healing nutrients in the vinotherapy and water treatments, much like the roots are nourished by the elements and water in the soil; the resort area embraces the outdoors with decks, open patios and pools where guests can bask in the sun and enjoy other natural elements, just like the grape plants themselves. Once it becomes operational, Ch’ulel Mendoza will symbolize a blend of wellness, recreation and the charm of the Latin American culture.

Expected learning outcomes

Develop a comprehensive business plan for a new business, understand the business environment, prepare a strengths, weaknesses, opportunities and weaknesses analysis, develop functional (marketing, finance, human resources, operations, etc.) plans and understand the opportunities and challenges in the new product development process.

Subject code

CSS: 12: Tourism and Hospitality.
Role of heatlines on thermal management during Rayleigh-Bénard heating within enclosures with concave/convex horizontal walls
Authors: Biswal Pratibha , Basak Tanmay
Published: August 2017

Purpose

This study aims to carry out the analysis of Rayleigh-Bénard convection within enclosures with curved isothermal walls, with the special implication on the heat flow visualization via the heatline approach.

Design/methodology/approach

The Galerkin finite element method has been used to obtain the numerical solutions in terms of the streamlines (ψ ), heatlines (Π), isotherms (θ), local and average Nusselt number (

Nut¯) for various Rayleigh numbers (103 ≤ Ra ≥ 105), Prandtl numbers (Pr = 0.015 and 7.2) and wall curvatures (concavity/convexity).

Findings

The presence of the larger fluid velocity within the curved cavities resulted in the larger heat transfer rates and thermal mixing compared to the square cavity. Case 3 (high concavity) exhibits the largest

Nut¯ at the low Ra for all Pr. At the high Ra,

Nut¯ is the largest for Case 3 (high concavity) at Pr = 0.015, whereas at Pr = 7.2,

Nut¯ is the largest for Case 1 (high concavity and convexity).

Practical implications

The results may be useful for the material processing applications.

Originality/value

The study of Rayleigh-Bénard convection in cavities with the curved isothermal walls is not carried out till date. The heatline approach is used for the heat flow visualization during Rayleigh-Benard convection within the curved walled enclosures for the first time. Also, the existence of the enhanced fluid and heat circulation cells within the curved walled cavities during Rayleigh-Benard heating is illustrated for the first time.
Making Washington Work: Legislative Entrepreneurship and the Personal Vote from the Gilded Age to the Great Depression
Authors: Finocchiaro Charles J. , MacKenzie Scott A.
Published: August 2017

Studies of bill sponsorship in the modern Congress highlight the effects of constituency characteristics, seniority, and committee membership. These studies, however, are limited in their ability to assess the effects of institutions. We provide the first systematic study of bill sponsorship in the premodern House of Representatives. In doing so, we take advantage of this period's expansive legislative agenda and variation in electoral system rules. Using matching and event count models, we estimate the effects of institutions, electoral competition, and members’ institutional positions and political experiences on their sponsorship of different types of bills. We find that two reforms—the Australian ballot and nominating primary—increased sponsorship of bills designed to cultivate personal votes, thereby contributing to the growth in private legislation and bills aimed at local constituencies. Our results establish these reforms as a major event shaping lawmaking activity and, with it, the character of contemporary representation.
Fungal-derived cues promote ocular autoimmunity through a Dectin-2/Card9-mediated mechanism
Authors: Brown B R , Lee E J , Snow P E , Vance E E , Iwakura Y , Ohno N , Miura N , Lin X , Brown G D , Wells C A , Smith J R , Caspi R R , Rosenzweig H L
Published: August 2017

Uveitis (intraocular inflammation) is a leading cause of loss of vision. Although its aetiology is largely speculative, it is thought to arise from complex genetic–environmental interactions that break immune tolerance to generate eye-specific autoreactive T cells. Experimental autoimmune uveitis (EAU), induced by immunization with the ocular antigen, interphotoreceptor retinoid binding protein (IRBP), in combination with mycobacteria-containing complete Freund's adjuvant (CFA), has many clinical and histopathological features of human posterior uveitis. Studies in EAU have focused on defining pathogenic CD4+ T cell effector responses, such as those of T helper type 17 (Th17) cells, but the innate receptor pathways precipitating development of autoreactive, eye-specific T cells remain poorly defined. In this study, we found that fungal-derived antigens possess autoimmune uveitis-promoting function akin to CFA in conventional EAU. The capacity of commensal fungi such as Candida albicans or Saccharomyces cerevisae to promote IRBP-triggered EAU was mediated by Card9. Because Card9 is an essential signalling molecule of a subgroup of C-type lectin receptors (CLRs) important in host defence, we evaluated further the proximal Card9-activating CLRs. Using single receptor-deficient mice we identified Dectin-2, but not Mincle or Dectin-1, as a predominant mediator of fungal-promoted uveitis. Conversely, Dectin-2 activation by α-mannan reproduced the uveitic phenotype of EAU sufficiently, in a process mediated by the Card9-coupled signalling axis and interleukin (IL)-17 production. Taken together, this report relates the potential of the Dectin-2/Card9-coupled pathway in ocular autoimmunity. Not only does it contribute to understanding of how innate immune receptors orchestrate T cell-mediated autoimmunity, it also reveals a previously unappreciated ability of fungal-derived signals to promote autoimmunity.
Older People's Self–Selected Spaces of Encounter in Urban Aging Environments in the Netherlands
Authors: van Melik Rianne , Pijpers Roos
Published: August 2017

Using a narrative methodology involving 216 older people in six urban aging environments in the Netherlands, we examined how they use and experience (semi–)public spaces as spaces of encounter, and the meanings they derive from using and experiencing these spaces. The research shows that, first, older people prefer commercial spaces like shopping malls to planned and designed activity spaces in care homes or neighborhood centers. Second, older people struggle with the transformations that have taken place in urban social life since they were young adults. Third, especially frail older people derive meaning from a more passive experience of urban social life, in an observer role. The findings allow us to contribute to ongoing debates on the shifting boundaries between public and private space, and the moral implications of these shifting boundaries from the perspective of a diverse group of older users.
Left‐Corner Parsing With Distributed Associative Memory Produces Surprisal and Locality Effects
Authors: Rasmussen Nathan E. , Schuler William
Published: August 2017

This article describes a left‐corner parser implemented within a cognitively and neurologically motivated distributed model of memory. This parser's approach to syntactic ambiguity points toward a tidy account both of surprisal effects and of locality effects, such as the parsing breakdowns caused by center embedding. The model provides an algorithmic‐level (Marr, 1982) account of these breakdowns: The structure of the parser's memory and the nature of incremental parsing produce a smooth degradation of processing accuracy for longer center embeddings, and a steeper degradation when they are nested, in line with recall observations by Miller and Isard (1964) and speed‐accuracy trade‐off observations by McElree et al. (2003). Modeling results show that this effect is distinct from the effects of ambiguity and exceeds the effect of mere sentence length.
Toward personalized and adaptive QoS assessments via context awareness
Authors: Barakat Lina , Taylor Phillip , Griffiths Nathan , Taweel Adel , Luck Michael , Miles Simon
Published: August 2017

Quality of Service (QoS) properties play an important role in distinguishing between functionally equivalent services and accommodating the different expectations of users. However, the subjective nature of some properties and the dynamic and unreliable nature of service environments may result in cases where the quality values advertised by the service provider are either missing or untrustworthy. To tackle this, a number of QoS estimation approaches have been proposed, using the observation history available on a service to predict its performance. Although the context underlying such previous observations (and corresponding to both user and service related factors) could provide an important source of information for the QoS estimation process, it has only been used to a limited extent by existing approaches. In response, we propose a context‐aware quality learning model, realized via a learning‐enabled service agent, exploiting the contextual characteristics of the domain to provide more personalized, accurate, and relevant quality estimations for the situation at hand. The experiments conducted demonstrate the effectiveness of the proposed approach, showing promising results (in terms of prediction accuracy) in different types of changing service environments.
Visfatin mediates doxorubicin resistance in human non–small‐cell lung cancer via Akt‐mediated up‐regulation of ABCC1
Authors: Cao Zhili , Liang Naixin , Yang Huaxia , Li Shanqing
Published: August 2017

Objectives

Non–small‐cell lung cancer (NSCLC) is one of the leading causes of cancer deaths worldwide. Increasing levels of visfatin are correlated with worse clinical prognosis of NSCLC. However, the effects of visfatin on drug resistant are still not well illustrated.

Materials and methods

Effects of visfatin on drug resistant cells were checked by CCK‐8 kit. Gene and protein variations were measured by real‐time PCR and western blot analysis, respectively.

Results

Our present data confirmed that expression of visfatin was significantly increased in NSCLC cells and tissues. In addition, protein and mRNA expression of visfatin were significantly elevated in doxorubicin (Dox) resistance of NSCLC cells when compared with their corresponding sensitivity parental cells. Overexpression of visfatin can down‐regulate the Dox sensitivity of NSCLC cells and up‐regulate the mRNA and protein expression of ABCC1, while has no effect on ABCB1. Knockdown of visfatin can down‐regulate the expression of ABCC1 in Dox‐resistant NSCLC cells. Visfatin can increase the phosphorylation and nuclear localization of Akt in NSCLC cells. LY294002 can decrease the expression of multidrug resistance protein‐1 (MRP1) in NSCLC Dox‐resistant cells. Chromatin immunoprecipitation assays showed that overexpression of visfatin can significantly increase the binding of Akt with the promoter of ABCC1 in both A549 and H1793 cells.

Conclusions

These data showed that visfatin can decrease Dox sensitivity of NSCLC cells via activation of Akt/MRP1. It indicated that inhibition of visfatin signals might be a promising therapeutic strategy for the management of chemoresistance of NSCLC patients.
Drug‐related stigma and access to care among people who inject drugs in Vietnam
Authors: Lan Chiao‐Wen , Lin Chunqing , Thanh Duong Cong , Li Li
Published: August 2017

Introduction and Aims

There are considerable challenges faced by people with a history of injecting drug use (PWID) in Vietnam, including drug‐related stigma and lack of access to healthcare. Seeking and utilising healthcare, as well as harm reduction programs for PWID, are often hampered by drug‐related stigma. This study aimed to examine the impacts of drug‐related stigma on access to care and utilisation of harm reduction programs among PWID in Vietnam.

Design and Methods

A cross‐sectional study was conducted in two provinces in Vietnam, Phú Thọ and Vinh Phúc. The study participants completed the survey by using Audio Computer‐Assisted Self‐Interview between late 2014 and early 2015. Linear multiple regression models and logistic regression models were used to assess the relationship among drug‐related stigma, access to care and utilisation of harm reduction programs, including methadone maintenance treatment (MMT) and needle exchange programs (NEP).

Results

A total of 900 PWID participated in this study. Drug‐related stigma was significantly associated with lower level of access to care, but not with utilisation of MMT or NEP. Older age was positively associated with higher levels of access to care. Levels of education were positively correlated with access to care, as well as utilisation of MMT and NEP.

Discussion and Conclusions

This study underscores the need for future interventions to reduce drug‐related stigma in society and in health‐care settings to improve PWID's utilisation of care services. Special attention should be paid to younger PWID and those with lower levels of education.
Leprosy – an overview of clinical features, diagnosis, and treatment
Authors: Fischer Marcellus
Published: August 2017

Leprosy is a chronic infectious disease caused by Mycobacterium (M.) leprae. Worldwide, 210,758 new cases were diagnosed in 2015. The highest incidence is found in India, Brazil, and Indonesia. While the exact route of transmission remains unknown, nasal droplet infection is thought to be most likely.

The pathogen primarily affects the skin and peripheral nervous system. The disease course is determined by individual host immunity. Clinically, multibacillary lepromatous variants are distinguished from paucibacillary tuberculoid forms. Apart from the various characteristic skin lesions, the condition is marked by damage to the peripheral nervous system. Advanced disease is characterized by disfiguring mutilations. Current treatment options are based on WHO recommendations. Early treatment frequently results in complete remission without sequelae. While paucibacillary forms are treated with rifampicin and dapsone for at least six months, multibacillary leprosy is treated for at least twelve months, additionally requiring clofazimine. Leprosy reactions during therapy may considerably aggravate the disease course. Besides individual treatment, WHO‐supported preventive measures and strategies play a key role in endemic areas.
Late diagnosis and atypical brain imaging of Aicardi–Goutières syndrome: are we failing to diagnose Aicardi–Goutières syndrome‐2?
Authors: Svingen Leah , Goheen Mitchell , Godfrey Rena , Wahl Colleen , Baker Eva H , Gahl William A , Malicdan May Christine V , Toro Camilo
Published: August 2017

Aicardi–Goutières syndrome (AGS) is a rare disorder with in utero or postnatal onset of encephalopathy and progressive neurological deterioration. The seven genetic subtypes of AGS are associated with abnormal type I interferon‐mediated innate immune response. Most patients with AGS present with progressive microcephaly, spasticity, and cognitive impairment. Some, especially those with type 2 (AGS2), manifest milder phenotypes, reduced childhood mortality, and relative preservation of physical and cognitive abilities. In this report, we describe two siblings (sister and brother) diagnosed with AGS2 in their second decade, who exhibited static encephalopathy since 1 year of age with spastic quadriplegia and anarthria but preserved intellect. Both were homozygous for the common pathogenic RNASEH2B allele (c.529G>A, p.Ala177Thr). Rather than manifesting calcifications and leukoencephalopathy, both had increased iron signal in the basal ganglia. Our report broadens the clinical and imaging spectrum of AGS2 and emphasizes the importance of including AGS2 in the differential diagnosis of idiopathic spastic cerebral palsy.

What this paper adds

We identified two siblings (sister and brother) with atypical Aicardi–Goutières syndrome type 2 due to RNASEH2B mutation. Manifestations included spastic quadriplegia and anarthria but preserved intellect and increased iron signal in the basal ganglia.

RNASEH2B‐related Aicardi–Goutières syndrome type 2 can have present with a variable phenotype, including idiopathic spastic cerebral palsy.
Proportion of daily capillary blood glucose readings required in the target range for target glycaemic control: shift of focus from target range to proportion in range
Authors: Sivasubramaniyam S. , Amiel S. A. , Choudhary P.
Published: August 2017

Aim

Most guidelines provide people with Type 1 diabetes with pre‐ and post‐meal capillary blood glucose (CBG) targets to achieve optimal glycaemic control. We evaluated the proportion of daily CBG readings between 4 and 10 mmol/l in people achieving different HbA1c levels.

Method

We analysed CBG data from routine pump/meter downloads from 201 adults treated with continuous subcutaneous insulin infusion (CSII) at a single hospital clinic. Exclusion criteria were CSII < 6 months, < 3 CBG/day, pregnancy, haemoglobinopathy and continuous sensor use. People were categorized into three groups based on HbA1c: < 58 mmol/mol, < 7.5% (n = 58); 58–74 mmol/mol, 7.5–8.9% (n = 107); and ≥ 75 mmol/mol, ≥ 9.0% (n = 36).

Results

Participants had a mean age of 43 ± 13 years and mean HBA1c of 64 mmol/mol (8.0 ± 1.1%). 47% of people started CSII for raised HbA1c, 25% due to hypoglycaemia and the rest during pregnancy. Downloads contained a mean of 22 ± 6.8 days of data per participant. CBG frequency was similar between the three groups (5.6 ± 2.0, 5.6 ± 1.9 and 5.4 ± 1.2 CBG/day; P = 0.468). The proportion of CBG readings between 4 and 10 mmol/l (72–180 mg/dl) was 57.3 ± 25.4%, 50.6 ± 11.1% and 39.9 ± 16.5% (P < 0.0001); < 4 mmol was 13.8%, 8.8% and 4.4% (P < 0.0001) and > 10 mmol/l was 28.9 ± 16.5%, 40.6 ± 12.1% and 55.6 ± 17.9% (P < 0.0001) in the three groups respectively.

Conclusions

Participants achieving HBA1c < 58 mmol/mol (< 7.5%) had ~ 60% of CBG readings in range (4–10 mmol/l), with up to 30% of readings > 10 mmol/l. This target of achieving 60% or more readings within target, and being permissive with up to 30% readings > 10 mmol/l may be a novel target for people with diabetes, and may reduce anxiety associated with readings out of range.
Cross‐infectivity of oil palm by Phytophthora spp. isolated from perennial crops in Malaysia
Authors: Latifah M. , Zainal Abidin M.A. , Kamaruzaman S. , Nusaibah S. A.
Published: August 2017

Bud rot disease or “Pudricion del cogollo” (PC) of oil palm is a major constraint on production in Colombia and neighbouring countries such as Brazil, Costa Rica, Ecuador, Nicaragua, Panama, Peru and Surinam. To date, there are no documented reports of Phytophthora disease of oil palm in South‐East Asia. This research, therefore, was conducted to determine the pathogenic potential of Phytophthora palmivora and Phytophthora nicotianae on oil palm using both in vitro and nursery inoculation experiments. In vitro inoculation of both P. palmivora and P. nicotianae on immature oil palm leaflets caused discoloration within 2 days of inoculation and incubation at 25 ± 1.5°C, 100% RH. Similarly, in nursery trials, lesions formed on the buds (unopened leaflets) 3 days after inoculation with P. palmivora or P. nicotianae zoospore suspensions. No lesions developed on untreated leaflets in either in vitro or nursery inoculation experiments. Phytophthora spp. were re‐isolated from leaflet lesions and confirmed as the inoculated pathogens.
A comparative study of brachial plexus sonography and magnetic resonance imaging in chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy
Authors: Goedee H. S. , Jongbloed B. A. , van Asseldonk J.‐T. H. , Hendrikse J. , Vrancken A. F. J. E. , Franssen H. , Nikolakopoulos S. , Visser L. H. , van der Pol W. L. , van den Berg L. H.
Published: August 2017

Background and purpose

To compare the performance of neuroimaging techniques, i.e. high‐resolution ultrasound (HRUS) and magnetic resonance imaging (MRI), when applied to the brachial plexus, as part of the diagnostic work‐up of chronic inflammatory demyelinating neuropathy (CIDP) and multifocal motor neuropathy (MMN).

Methods

Fifty‐one incident, treatment‐naive patients with CIDP (n = 23) or MMN (n = 28) underwent imaging of the brachial plexus using (i) a standardized MRI protocol to assess enlargement or T2 hyperintensity and (ii) bilateral HRUS to determine the extent of nerve (root) enlargement.

Results

We found enlargement of the brachial plexus in 19/51 (37%) and T2 hyperintensity in 29/51 (57%) patients with MRI and enlargement in 37/51 (73%) patients with HRUS. Abnormal results were only found in 6/51 (12%) patients with MRI and 12/51 (24%) patients with HRUS. A combination of the two imaging techniques identified 42/51 (83%) patients. We found no association between age, disease duration or Medical Research Council sum‐score and sonographic nerve size, MRI enlargement or presence of T2 hyperintensity.

Conclusions

Brachial plexus sonography could complement MRI in the diagnostic work‐up of patients with suspected CIDP and MMN. Our results indicate that combined imaging studies may add value to the current diagnostic consensus criteria for chronic inflammatory neuropathies.
Hydrodynamics and seed dispersal in the lower Amazon
Authors: da Cunha Alan Cavalcanti , Mustin Karen , dos Santos Eldo Silva , dos Santos Éwerton Wânderson Gonçalves , Guedes Marcelino Carneiro , Cunha Helenilza Ferreira Albuquerque , Rosman Paulo Cesar Colonna , Sternberg Leonel da Silveira Lobo
Published: August 2017

The transport of seeds by water, i.e. hydrochory, is a key mechanism of long‐distance dispersal constrained by the attributes of the seed and hydrodynamics. In the freshwater Amazon estuary, river hydrodynamics are influenced by seasonal changes in precipitation and tidal cycles. It is not known to what extent a hydrodynamic model may be able to predict seed dispersal.

Here we parameterised a simulation model (SisBaHia) to estimate maximum seed dispersal distances per tidal cycle, which were then compared with data from in situ seed dispersal experiments. The study was conducted along a 27‐km stretch of a tributary of the Amazon estuary, using the seeds of a widely distributed riparian tree—Carapa guianensis (Meliaceae).

Based on the simulation model, maximum potential seed dispersal distance was higher in the rainy season (c. 8.7 km) when compared with the dry season (5.6 km), for one tidal cycle (12 hr). The seeds of C. guianensis were dispersed further during the ebb than flood tide during the rainy season, the period of seed dispersal. Average dispersal distances observed in seed dispersal experiments conducted during the rainy season, and those predicted by SisBaHia for the same period were within the same order of magnitude.

The results of this study confirm that the period of higher precipitation provides favourable hydrological conditions for hydrochory in the Amazon river‐estuary complex. The fact that the time taken for the tide to fall is longer in relation to the time taken for it to rise also favours the arrival of the seeds in the main channel of the Amazon, thereby increasing the probability of long‐distance dispersal events.
A World for Sale? An Ecofeminist Reading of Sustainable Development Discourse
Authors: Irving Simon , Helin Jenny
Published: August 2017

The aim of this study is to examine how the sustainable development discourse created by one of its most influential proponents, the World Business Council for Sustainable Development, constructs representations of gender and nature. A discourse analysis, performed from Plumwood's ecofeminist perspective, is conducted on their cornerstone text Vision 2050: The new agenda for business. We find that what might at first appear to be a roadmap out of the many crises that humanity faces today, is instead simply new twists on ‘old’ established discourses that reinforce rather than diminish forms of hierarchy and domination. Different discursive strands work together to create dualistic traits that simultaneously constructs gender, nature and some classes as a dependent ‘other’. To overcome this we elaborate on implications for teaching, research and practice.
Western medicine in Africa, part II: Ethiopia, East and Southern Africa to 1900
Authors: Roberts Jonathan
Published: August 2017

Before 1900, Western medicine struggled to attract patients in Africa. As part 2 of the history of European medical practice in Africa before 1900, this article describes how practitioners from Europe tried to win over patients in Ethiopia and East and Southern Africa, regions that already had pluralistic healing networks of herbal and spiritual therapies. Western medicine began at a disadvantage because it could offer little to combat the diseases of the tropics or fight epidemics sweeping the continent from Asia. However, over the course of several centuries, emissaries, missionaries, and explorers from Europe were able to bring a unique set of European healing ideas, practices, and medicines to the continent with them. African patients showed skepticism towards practices that they regarded as overly invasive, such as surgery at hospitals, but they were open to experimenting with pharmaceuticals as treatments for illnesses for which they had no cure. Western medicine did not “save” the people of Africa nor did it achieve hegemony, but by 1900, it was able to gain a footing on the Horn of Africa, on the coast of East Africa, and throughout Southern Africa.
Adipokines, psoriasis, systemic inflammation, and endothelial dysfunction
Authors: Lynch Maeve , Ahern Tomas , Sweeney Cheryl M. , Malara Anna , Tobin Anne‐Marie , O'Shea Donal , Kirby Brian
Published: August 2017

Adipokines are secreted by white adipose tissue, an active endocrine organ, and play a role in the regulation of metabolic functions such as lipid metabolism, inflammation, and vascular homeostasis. Adipokines are secreted in excess in obesity and contribute to the development of associated comorbidities such as metabolic syndrome and atherosclerosis. Psoriasis, a chronic immune‐mediated skin disease, is associated with obesity and increased cardiovascular risk. Understanding the role of adipokines in psoriasis may in part explain the association between psoriasis and cardiovascular disease. This review summarizes the data regarding key adipokines in patients with psoriasis and the change in adipokine profiles with psoriasis therapy. Adipokines may be mediators of cutaneous inflammation suggesting a role in the pathophysiology of psoriasis and the development of comorbidities.
Postural change in convulsive seizures: a retrospective review of video‐electroencephalographic recordings
Authors: Rigg Jane , Irwin Kimberley , Tremayne Fred , Reutens David
Published: August 2017

Background

Prone position has been identified as an important risk factor for sudden unexpected death in epilepsy raising the possibility of avoidance of this posture in sleep as a preventative measure.

Aims

To evaluate the potential utility of prone posture position, we studied patterns of postural change during generalised tonic clonic seizures.

Methods

Video‐electroencephalographic recordings of patients undergoing investigations at the Royal Brisbane and Women's Hospital between 2005 and 2013 were reviewed independently by two raters. Head and truncal positions (left and right lateral, supine, sitting, prone) at seizure onset and offset, before and after nurse interventions were recorded. Post‐ictal postural changes and evidence of stertorous respirations were also recorded.

Results

Thirty‐one seizures from 27 patients were included in the study. One seizure began with the patient asleep in the prone position. One patient became prone during a seizure, having previously been asleep in the left lateral position. Nine patients changed position during a seizure. Seven of these patients were sitting or in a lateral position at the time of seizure onset, two patients were supine at seizure onset. No patient rolled by more than 90° during a seizure. Post‐ictal stertorous respirations were observed in 14 patients, one of whom was prone.

Conclusion

The incidence of patients attaining a prone position during a seizure was low. Given that no patient rolled more than 90°, patients are least likely to attain a prone position if they are supine at the beginning of a seizure.
Associations between Maternal Behaviors at 1 Year and Child Language at 2 Years in a Cohort of Women Experiencing Adversity
Authors: Smith Jodie , Levickis Penny , Eadie Tricia , Bretherton Lesley , Conway Laura , Goldfeld Sharon
Published: August 2017

Variations in parenting have been suggested as contributing to a higher prevalence of language difficulties in children experiencing economic, environmental, and social adversity. Within these cohorts, the contribution of responsive and intrusive parenting to child language has been investigated; specific responsive and intrusive behaviors encapsulated within these parenting styles have yet to be fully examined. Additionally, the role of the mother–child dynamic in moderating mother–child associations has also not been explored. This study aimed to augment current research by identifying specific responsive and intrusive maternal behaviors associated with child language in a cohort experiencing adversity, as well as exploring the role of the fluency and connectedness of mother–child conversation in moderating associations (n = 249). Specific behaviors and the fluency and connectedness of the mother–child interaction were coded from free‐play videos at child age 12 months. Child language measures were derived from transcripts of free play at 24 months. Linear regression models were used to examine maternal–child associations. The moderating role of fluency and connectedness was then explored. Maternal imitations were positively associated with the child's total words; successful redirectives were negatively associated with the child's mean length of turn. Both associations were moderated by the fluency and connectedness of the interaction.
Policy choices in dementia care—An exploratory analysis of the Alberta continuing care system (ACCS) using system dynamics
Authors: Cepoiu‐Martin Monica , Bischak Diane P.
Published: August 2017

Background

The increase in the incidence of dementia in the aging population and the decrease in the availability of informal caregivers put pressure on continuing care systems to care for a growing number of people with disabilities. Policy changes in the continuing care system need to address this shift in the population structure. One of the most effective tools for assessing policies in complex systems is system dynamics. Nevertheless, this method is underused in continuing care capacity planning.

Methods

A system dynamics model of the Alberta Continuing Care System was developed using stylized data. Sensitivity analyses and policy evaluations were conducted to demonstrate the use of system dynamics modelling in this area of public health planning. We focused our policy exploration on introducing staff/resident benchmarks in both supportive living and long‐term care (LTC).

Results

The sensitivity analyses presented in this paper help identify leverage points in the system that need to be acknowledged when policy decisions are made. Our policy explorations showed that the deficits of staff increase dramatically when benchmarks are introduced, as expected, but at the end of the simulation period, the difference in deficits of both nurses and health care aids are similar between the 2 scenarios tested.

Modifying the benchmarks in LTC only versus in both supportive living and LTC has similar effects on staff deficits in long term, under the assumptions of this particular model.

Conclusion

The continuing care system dynamics model can be used to test various policy scenarios, allowing decision makers to visualize the effect of a certain policy choice on different system variables and to compare different policy options. Our exploration illustrates the use of system dynamics models for policy making in complex health care systems.
Clinical and economic evaluation of a Case Management Service for patients with back pain
Authors: Smith Judith , Yeowell Gillian , Fatoye Francis
Published: August 2017

Aim

To evaluate the clinical‐effectiveness and resource use associated with Case Management Services in a UK private sector

Design

An observational cohort study based on prospective data collection of patient reported outcome measures and data collection from an existing administrative health database.

Setting

A United Kingdom (UK) private healthcare provider

Participants

Consecutive referrals into the Case Management Service over a three‐month period.

Interventions

Participants were managed within the Case Management Service in accordance with usual pathways.

Main Outcome Measures

Outcome measures included EQ‐5D‐5L and PSFS. Measurements were taken at baseline, and repeated at the point at which the client's case was closed. The CARE measure examined patient reported experience.

Cost Consequence analysis was completed using existing data for the same period of time in two separate years: 2014, two years after CMS implementation, and 2011, prior Case Management Service development

Results

There was a statistically significant improvement in quality of life (EQ‐5D‐5L p < 0.0001; EQ‐VAS p < 0.001) and functional ability (p < 0.001) following the Physiotherapy Case Management. The CARE measure showed high levels of patient satisfaction with 96% of clients rating their individual case manager as good to excellent. The cost consequences analysis showed a cost reduction in therapy resource utilisation by £252 842 (from £10 772 875 to £10 520 034).

Conclusions

The Case Management Service showed the provision to be providing significant improvement in quality of life and functional outcomes within efficient use of resources, and service users are highly satisfied with their experience.
Knowledge and practice of, and attitudes toward, pulp therapy in deciduous teeth among pediatric dentists in India
Authors: Nayak Ullal A. , Wadhwa Saakshe , Kashyap Nilotpol , Prajapati Deepesh , Mahuli Amit V. , Sharma Reena
Published: August 2017

Aim

The aim of the present study was to assess the knowledge and practice of, and attitudes toward, pulp therapy in deciduous dentition among pediatric dentists.

Methods

A cross‐sectional, observational survey was conducted using a closed‐ended, multiple‐choice questionnaire evaluating the knowledge and practice of, and attitudes toward, pulp therapy in deciduous dentition, which was formulated and sent to 360 pediatric dentists across India. Descriptive statistics were done, followed by χ2‐test to test the association between years of experience and the questionnaire items.

Results

A total of 3.5% of pediatric dentists performed their treatment using a rubber dam in all cases; 30% preferred to use local anesthesia prior to indirect pulp therapy (IPT). Traditional indirect pulp capping was preferred to IPT, and only 48% of them believed in not removing it completely. Pulpotomy was preferred over IPT (70%) when there was a probability of pulp exposure following complete caries excavation. Calcium hydroxide, along with iodoform, was the material of choice for the obturation of primary teeth (73.5%). A stainless steel crown was placed after pulp therapy in the primary tooth (86.3%). Most dentists believed requested immediate and 3‐month follow up.

Conclusion

The survey helps in assessing whether our views or approaches are in line with recent trends.
White spot lesions: Does etching really matter?
Authors: Abufarwa Moufida , Voorhees Robert D. , Varanasi Venu G. , Campbell Phillip M. , Buschang Peter H.
Published: August 2017

Aim

The clinical significance of acid etching prior to orthodontic bonding is controversial. In the present study, we evaluated the effect of 15 seconds of acid etching on enamel demineralization.

Methods

Twenty‐seven human molars were sectioned and assigned to two groups. Under standardized conditions, the enamel surfaces were imaged using FluoreCam to obtain baseline data. Group 1 was etched using 37% phosphoric acid for 15 seconds, rinsed with water, and then imaged again; group 2 was only rinsed with water. Water rinse was collected for calcium chemical analysis using inductively‐coupled plasma auger electron spectrometry. Both groups were subjected to 9 days of pH cycling, after which final FluoreCam images were obtained.

Results

Group 1 showed a significant increase in lesion area (P=.012), decrease in light intensity (P=.009), and decrease in impact (P=.007) after acid etching. The amount of calcium that leached out over the 15 seconds was 14 ppm ±2.4 (0.35 mmol/L±0.06). Following pH cycling, there was no statistically‐significant between‐group difference in overall enamel demineralization.

Conclusion

Initial demineralization caused by 15 seconds of acid etching does not increase enamel susceptibility to further demineralization. This suggests that acid etching does not increase the risk of developing white spot lesions during orthodontics.
How Do Quasi‐Random Option Grants Affect CEO Risk‐Taking?
Authors: SHUE KELLY , TOWNSEND RICHARD R.
Published: August 2017

We examine how an increase in stock option grants affects CEO risk‐taking. The overall net effect of option grants is theoretically ambiguous for risk‐averse CEOs. To overcome the endogeneity of option grants, we exploit institutional features of multiyear compensation plans, which generate two distinct types of variation in the timing of when large increases in new at‐the‐money options are granted. We find that, given average grant levels during our sample period, a 10% increase in new options granted leads to a 2.8% to 4.2% increase in equity volatility. This increase in risk is driven largely by increased leverage.
Streptococcal toxic shock syndrome occurring in the third trimester of pregnancy: A case report
Authors: Irani Mohamad , McLaren Rodney , Savel Richard H. , Bogatyryova Oksana , Khoury‐Collado Fady
Published: August 2017

Group A streptococcal (GAS) toxic shock syndrome (TSS) is a rare life‐threatening illness. Most reported cases have occurred in the post‐partum period. Here, we report a rare case of a primigravid who developed GAS TSS in the third trimester. We also review the potential preventive measures and treatment modalities for this syndrome. A 29‐year‐old primigravid presented at 36 weeks' gestation with diarrhea, abdominal pain, fever, and fetal bradycardia. She underwent an emergency cesarean section and was subsequently diagnosed with GAS TSS. She had a complicated post‐partum course marked by a 3‐month hospital stay and major sequelae. Her infant died on post‐partum day 4. GAS TSS should be considered in the differential diagnosis of pregnant patients presenting with fever and rapid onset of septic shock. A consideration to treat GAS that is detected incidentally during routine screening for group B streptococcus is suggested.
The incidence of surgical site dehiscence following full‐thickness gastrointestinal biopsy in dogs and cats and associated risk factors
Authors: Swinbourne F. , Jeffery N. , Tivers M.S. , Artingstall R. , Bird F. , Charlesworth T. , Doran I. , Freeman A. , Hall J. , Hattersley R. , Henken J. , Hughes J. , de la Puerta B. , Rutherford L. , Ryan T. , Williams H. , Woods S. , Nicholson I.
Published: August 2017

Objectives

The objectives of this study were to: (1) document the incidence of surgical site dehiscence after full‐thickness gastrointestinal biopsy in dogs and cats and (2) identify potential risk factors.

Methods

Data relating to dogs and cats undergoing full‐thickness gastrointestinal biopsy were reviewed retrospectively following submission of a completed questionnaire by 12 referral institutions. Outcome measures were definite dehiscence, possible dehiscence (clinical records suggestive of dehiscence but not confirmed), suspected dehiscence (definite and possible combined) and death within 14 days. Logistic regression was planned for analysis of association of dehiscence with low preoperative serum albumin, biopsy through neoplastic tissue, biopsy alongside another major abdominal surgical procedure and biopsy of the colon.

Results

Of 172 cats, two (1·2%) had definite dehiscence, and four (2·3%) had possible dehiscence. Low preoperative serum albumin was significantly associated with definite dehiscence in univariable analysis and with suspected dehiscence and death within 14 days in univariable analysis, but all odds ratios had wide 95% confidence intervals. A histopathological diagnosis of neoplasia was significantly associated with death within 14 days in univariable analysis. Of 195 dogs, two (1·0%) had definite dehiscence, and three (1·5%) had possible dehiscence. In dogs, there was no association between any outcome measure and the putative risk factors.

Clinical Significance

Incidence of dehiscence following full‐thickness gastrointestinal biopsy was low in this study. When determining the appropriateness of biopsy in individual cases, this information should be balanced against the potentially life‐threatening consequences of dehiscence.
The lack of analgesic use (oligoanalgesia) in small animal practice
Authors: Simon B. T. , Scallan E. M. , Carroll G. , Steagall P. V.
Published: August 2017

Oligoanalgesia is defined as failure to provide analgesia in patients with acute pain. Treatment of pain in emergencies, critical care and perioperatively may influence patient outcomes: the harmful practice of withholding analgesics occurs in teaching hospitals and private practices and results in severe physiological consequences. This article discusses the prevalence, primary causes, species and regional differences and ways to avoid oligoanalgesia in small animal practice. Oligoanalgesia may be addressed by improving education on pain management in the veterinary curriculum, providing continuing education to veterinarians and implementing pain scales.
Prevalence and Risk Factors of Urinary Incontinence and Overactive Bladder in Japanese Women
Authors: NINOMIYA Sanae , NAITO Kiyoko , NAKANISHI Kyoko , OKAYAMA Hisayo
Published: August 2017

Objectives

The prevalence of storage symptoms, including stress urinary incontinence (SUI) and overactive bladder (OAB), is high in women worldwide. In Japan, there have been few large‐scale epidemiological surveys of lower urinary tract symptoms (LUTS), and the risk factors for these symptoms are unclear. The aim of this study was to explore the prevalence and risk factors of storage symptoms in Japanese women.

Methods

A cross‐sectional Internet survey was conducted in Japan. Five thousand women aged 20–79 years were selected to answer demographic questionnaires, Japanese version of International Consultation on Incontinence Questionnaire–Short Form, and the Overactive Bladder Symptom Score (OABSS) pertaining to their symptoms in the previous month. Descriptive statistics were used to evaluate the prevalence of storage symptoms. Logistic regression analysis was performed to determine risk factors for SUI and OAB.

Results

The answers from 4804 women (average age, 40.4 years) were analyzed. The prevalence of SUI was 16.7% (SUI, 13.0%; mixed urinary incontinence, 3.7%). The prevalence of OAB diagnosed on OABSS was 8.1%. The prevalence of SUI and OAB symptoms increased with age, and 68.0% of women had one or more storage symptoms. Age ≥40 years, body mass index ≥25 kg/m2, and constipation were common risk factors for SUI and OAB. Childbirth was an additional risk factor for SUI.

Conclusions

The prevalence of storage symptoms in Japanese women was high, and risk factors associated with these symptoms were similar to those reported in studies in other countries.
Factors influencing parenting efficacy of Asian immigrant, first‐time mothers: A cross‐sectional, correlational survey
Authors: Roh Eun Ha , Ahn Jeong‐Ah , Park Somi , Song Ju‐Eun
Published: August 2017

In this study, we determined the factors influencing parenting efficacy of Asian immigrant, first‐time mothers. The research design was a cross‐sectional, correlational study. The study included 125 first‐time mothers who immigrated and married Korean men, and were living in Korea. Data were collected using translated questionnaires, and analyzed for descriptive statistics, Pearson correlation, and multiple regression analysis. The major finding was that the parenting efficacy of immigrant women was influenced by childcare support from their husbands, maternal identity, and original nationality. The findings suggest that customized programs be developed and used to enhance parenting efficacy for Asian immigrant, first‐time mothers. In developing such programs, the advantages of maternal identity, social support from the husband, and women's cultural context should be considered.
Lingual leiomyomatous hamartoma with bifid tip of tongue and ankyloglossia in an infant
Authors: Dhua A.K. , Kumar K. , Nagendla M.K. , Bhatnagar V. , Mridha A.R.
Published: August 2017

Lingual leiomyomatous hamartoma (LLH) is a rare cause of midline tongue swelling. LLH with bifid tongue and ankyloglossia is still rarer, and so far only one case report in an adult exists in the literature. Here, we report a 5 months old male infant with a 1.5 cm × 0.5 cm LLH with bifid tongue and ankyloglossia.
Editors’ Introduction
Authors: Isett Kimberley R. , Head Brian W. , VanLandingham Gary
Published: August 2017

Related Content: Barbero et al. (PAR September/October 2017)

Related Content: Crowley and Scott (PAR September/October 2017)
Tunnel Vision: Part One – Resisting post‐colonialism in Australian anthropology
Authors: Cowlishaw Gillian
Published: August 2017

This essay is based on my conviction that Australian ethnography's narrow purview and anthropology's theoretical limitations need exploring and explaining. While internationally the discipline developed new sites, new theoretical fields and new political ideas in the post‐colonial era from around 1970, classicism continued to dominate research in Australia. New forms of Aboriginal social life and politics created by changing ‘post‐colonial’ conditions largely escaped ethnographic attention, but anthropology was rescued from irrelevance with the emergence of opportunities to assist the courts and Aborigines with land retrievals. By examining selected ethnographies and exceptions to the discipline's main trajectory, I hope to encourage reflection and expansion so that the discipline might realise its potential as the most radical and critical of the social sciences.