bluuebunny/crossref_metadata_2025 huggingface dataset:
The Gamification of Meditation: A Randomized-Controlled Study of a Prescribed Mobile Mindfulness Meditation Application in Reducing College Students’ Depression
Authors: Fish Matthew T. , Saul Amelia D.
Published: June 2019

Objective. Roughly 35% of college students report depression as a significant concern, which unaddressed, can lead to an increased likelihood to quit school and develop comorbid conditions. Traditional depression interventions are useful; however, they are often expensive, stigmatizing, tedious, and time-intensive. We examined a prescribed mindfulness meditation regimen, which incorporates gamification principles, in reducing symptoms of depression compared to a control group.

Materials and methods. We recruited and randomly assigned 72 college students to an experimental group (n = 33) or a control group (n = 39). The prescription for experimfiental group participants was ten 10-minute mobile mindfulness meditation sessions over a 14-day period; control group participants continued with business as usual. The Patient Health Questionnaire (PHQ-9) was used to test our hypothesis.

Results. Repeated-measures ANOVA demonstrated a significant interaction of group by time for depression scores, supporting the hypothesis that experimental group participants would significantly decrease their depression symptom severity compared to control group participants post-intervention. Within-subjects contrasts and between-group analyses showed a significant decrease in depression symptom severity scores.

Conclusion. Prescribed use of a gamified mindfulness meditation application significantly decreased depression symptom severity as measured by the PHQ-9. College students and mental health providers should consider these fun, inexpensive, and non-stigmatizing applications as a feasible intervention for college students to improve symptoms associated with depression.
Service Leadership, Work Engagement, and Service Performance: The Moderating Role of Leader Skills
Authors: Zheng Yuyan , Graham Les , Epitropaki Olga , Snape Ed
Published: June 2019

Using social learning theory, the job demands-resources model and idiosyncrasy credit theory, the present study casts additional light on the explanatory mechanisms underlying the effects of service leadership on service performance. We examine employee work engagement as an important mediator of this relationship and explore the moderating role of leader task-based professional and managerial skills on the indirect relationship between service leadership and service performance via work engagement. Drawing upon 903 leader–follower dyads nested in 187 teams, with data collected from two sources, we find that after controlling for transformational leadership, follower work engagement mediates the relationship between service leadership and follower service performance. Furthermore, the results support the moderating role of leader task-based professional skills, but not of managerial skills. Specifically, the indirect effect of service leadership on service performance via work engagement is stronger when leaders display high levels of task-based professional skills. Theoretical and practical implications of these findings are discussed.
Chatter stability of the constrained layer damping composite boring bar in cutting process
Authors: Yuhuan Zhang , Yongsheng Ren , jishuang Tian , jingmin Ma
Published: June 2019

Traditional boring bars are generally made up of isotropic metallic materials and exhibit extremely poor chatter suppression ability. For enhancing the chatter stability, using anisotropic composite materials in the preparation of boring bars proves to be an effective method so as to enhance the boring bar’s natural frequency and damping. Additionally, the addition of constrained layer damping (CLD) technology on the composite boring bar can further improve the damping performance. This study aims to develop a theoretical analysis model for the prediction of the chatter stability of the CLD composite boring bar and explore the effectiveness and practicability of the CLD technology in suppressing the chatter of composite boring bar. Based on Euler–Bernoulli beam theory and the complex stiffness method of CLD, the structural dynamic model of the CLD composite boring bar was derived, and some structural parameters of the bar mainly including the ply angle of the composite material, the thicknesses of both damping layer, and constrained layer were also optimized. By combining the linear model of cutting force with a regenerative delay effect and the established dynamic model, the chatter analysis model of the CLD composite boring bar was constructed and the lobe diagram of the chatter stability of the cutting system was plotted by means of frequency domain method. The effects of the ply angle of the composite boring bar, the thicknesses of damping layer, and constrained layer on the chatter stability were examined. By performing time integral of the delay equation of motion, the time-domain response curves of the cutting system are obtained. The chatter stability prediction results based on the lobe diagram fit well with the prediction results on the basis of dynamic stiffness calculation and time-domain numerical integral results.
News You Can’t Use: Jon Stewart’s Daily Show Media Critiques
Authors: Fox Julia R. , Steinberg Edo
Published: June 2019

Against the backdrop of continued declining public trust in media, particularly network television news, along with rising ratings and recognition for The Daily Show with Jon Stewart, this research examined Stewart’s network television news critiques during presidential election campaigns in 2000, 2004, 2008, and 2012. The study found an increase in frequency and prominence of critiques over the years and a shift in focus to more undermining criticism of professional practices, raising the question of whether Stewart’s stepped-up criticism may have been at least partly responsible for growing distrust during those years among younger adults, his primary viewing audience.
Investiture rules and formation of minority governments in European parliamentary democracies
Authors: Cheibub José Antonio , Martin Shane , Rasch Bjørn Erik
Published: June 2019

In parliamentary systems, political parties must often bargain with each other in order to form a government. Do parliamentary rules regulating government formation impact the type of government that is formed? Existing scholarship suggests that the need for an investiture vote—a requirement that a new government must face a parliamentary vote at some point during its formation—reduces the likelihood of a minority government. This article suggests that while real-world investiture rules can vary across several dimensions, only the investiture decision rule—which specifies the size of the majority required for a decision to be made—impacts the propensity for parties to form minority governments. Using new data on investiture rules for 26 European countries since 1946 or the first year of democracy, we find that parliamentary democracies that have an investiture requirement are not less likely to experience minority governments than those where governments come to power without an investiture vote. However, when an absolute majority is required for a government to succeed at the investiture stage, minority governments are considerably less likely to form; absolute majority investiture rules reduce the frequency of minority governments.
Communication and cross-examination in court for children and adults with intellectual disabilities: A systematic review
Authors: Morrison Joanne , Forrester-Jones Rachel , Bradshaw Jill , Murphy Glynis
Published: June 2019

Courts in England, Wales and Northern Ireland have identified children and adults with intellectual disabilities (ID) as vulnerable witnesses. The call from the English Court of Appeal is for advocates to adjust questioning during cross-examination according to individual needs. This review systematically examined previous empirical studies with the aim of delineating the particular communication needs of children and adults with ID during cross-examination. Studies utilising experimental methodology similar to examination/cross-examination processes, or which assessed the communication of actual cross-examinations in court were included. A range of communication challenges were highlighted, including: suggestibility to leading questions and negative feedback; acquiescence; accuracy; memory and understanding of court language. In addition, a number of influencing factors were identified, including: age; IQ level; question styles used. This review highlights the need for further research using cross-examination methodology and live practice, that take into consideration the impact on communication of the unique environment and situation of the cross-examination process.
Optimization of fly ash content in cement and assessment of radiological risk
Authors: Mehra Rohit , Kaur Sarabjot , Prakash Rajat
Published: June 2019

As for all materials of mineral origin, fly ash contains natural radionuclides such as 226Ra, 232Th and 40K which contribute to radiation exposure. The present study is aimed to investigate variation of natural radionuclides (226Ra, 232Th and 40K) in Ordinary Portland Cement due to variation in the concentration of fly ash. For this purpose, seven cement–fly ash mixtures were experimentally tested for radiological content with NaI(Tl) gamma spectrometer. From the measured gamma-ray spectra, radium equivalent, hazard indices, gamma index, annual effective and gonadal dose were determined. Radium equivalent for samples ranged from 209.53 Bq kg−1 to 336.06 Bq kg−1 with a mean of 265.41 Bq kg−1. The external and internal hazard indices varied from 0.57 to 0.91 Bq kg−1 and 0.64 to 1.13 Bq kg−1, respectively. The gamma index exceeded unity for samples with fly ash concentration greater than or equal to 20% by mass. The average annual effective and gonadal dose from different cement–fly ash mixtures was 0.92 mSv y−1 and 0.95 mSv y−1, respectively. The study demonstrated that as concentration of fly ash increased in the cement, the concentration of 226Ra and 232Th also increased, whereas 40K content remained the same for all practical purposes.
The use of methoxyflurane (Penthrox®) for procedural analgesia in the emergency department and pre-hospital environment
Authors: Williams Owen D , Pluck Graham
Published: June 2019

Background

Methoxyflurane is an inhaled analgesic agent licensed in the United Kingdom for the relief of moderate to severe pain in conscious patients with trauma. Methoxyflurane has been widely used by Australian ambulance services since the 1970s.

Aims

Primary aim: To assess the efficacy of methoxyflurane for procedural analgesia in the emergency department and pre-hospital environment. Secondary aims: to assess the efficacy of methoxyflurane for analgesia in the emergency department and pre-hospital environment; to assess the safety of methoxyflurane as an analgesic.

Method

A literature search of Medline, EMBASE, CINAHL and Cochrane databases was performed. A total of 59 articles were reviewed.

Results

One study using methoxyflurane for procedural analgesia in the emergency department was found. Multiple studies demonstrate the use of methoxyflurane for procedural analgesia for painful procedures outside the emergency department. Compared to other analgesics, methoxyflurane provides adequate analgesia. Overall, methoxyflurane is inferior to fentanyl or morphine, but it provides quicker onset analgesia compared to fentanyl and tramadol. It provides similar analgesia to nitrous oxide. Nephrotoxicity is dose dependent. Used in the analgesic doses, the risk of clinically significant kidney injury is negligible. Rare cases of unpredictable, severe hepatitis are reported.

Discussion

The efficacy of methoxyflurane and its acceptability to patients and clinicians has been shown in a number of studies. As would be expected in any procedural analgesic choice, patient and clinician factors and the procedure planned are all important considerations. Compared to other analgesic agents, methoxyflurane performs favourably with a low chance of adverse events.

Conclusion

Methoxyflurane is an efficacious analgesic agent in the emergency department and pre-hospital environment. It is easily portable and has a rapid onset. Methoxyflurane is suitable for use in procedural analgesia and as a bridging analgesic agent. Risks to the patient from renal or hepatic injury, cardiorespiratory depression or malignant hyperthermia are low.
EU environmental compliance assurance
Authors: Čavoški Aleksandra
Published: June 2019

As part of his overall strategy to create a closer dialogue with citizens, Commission President Juncker pledged to regain the credibility of citizens by focusing on matters of importance to them. In order to fulfil the environmental objectives which are addressed in the context of creating new jobs and boosting growth and investment, the European Commission had to address the issues of poor compliance in the environmental policy area. To that end, the Commission published the 2018 Environmental Compliance Assurance Action Plan containing a set of nine measures specific to environmental policy with the aim of improving compliance with EU environmental law and strengthening environmental governance in both Member States and the EU. This article analyses the approach to compliance in the new Environmental Compliance Assurance Action Plan by exploring the measures set out within it and their alignment with previous initiatives of the Commission to address poor compliance. The Commission’s choice of measures to address sources of non-compliance is assessed using the management theory of compliance. The article concludes that pursuit of the management approach to compliance under the Environmental Compliance Assurance Action Plan should allow for a more coherent and strategic approach to compliance aimed at preventing non-compliance at an earlier stage and addressing the most common reasons of non-compliance in Member States.
Out of the frying pan, into the fire? Environmental governance vulnerabilities in post-Brexit Northern Ireland
Authors: Brennan Ciara , Dobbs Mary , Gravey Viviane
Published: June 2019

Environmental governance in Northern Ireland has been highly problematic and the subject of intense criticism. Since the collapse of the devolved government in January 2017, environmental policy development and urgently needed processes of environmental governance reform have stagnated. Combined with the continuing uncertainty surrounding Brexit, this situation has the potential to exacerbate an already challenging governance context and the severe environmental consequences of political inaction are already becoming clear. This article will reflect on how future environmental governance arrangements in Northern Ireland might develop in light of both distinctive local challenges and reforms that have been proposed for other parts of the UK post-Brexit. Its central theme is the potential for the distinctive environmental governance vulnerabilities present in Northern Ireland to be compounded by Brexit. It concludes that a process of reform centred on the development of common frameworks, underpinned by environmental objectives, principles, rights and duties and enforced via meaningful accountability mechanisms would help strengthen environmental protection even where the political will or power is lacking. Such a process of reform could help address both existing environmental problems and potential environmental governance gaps posed by Brexit, as well as providing valuable lessons for other jurisdictions facing major environmental governance reform or contending with the practical implications of governance without a functioning government.
Super-knock suppression for highly turbocharged gasoline engines using lean mixture control strategy with the same energy density
Authors: Liu Hui , Wang Zhi , He Xin , Qi Yunliang , Wang Yingdi , Wang Jianxin
Published: June 2019

Super-knock has been the main obstacle to improve power density and engine efficiency of modern gasoline engines. Previous researches show that the key points of super-knock are composed of pre-ignition and detonation. The former is the inducement and the latter is the root reason why super-knock could damage engines dramatically. Lots of studies have been conducted to suppress super-knock by eliminating pre-ignition. Using a rapid compression machine, this work explores the lean mixture control strategy to eliminate detonation and thus suppressing super-knock. Furthermore, a one-dimensional simulation model was set up to investigate the mechanism of how lean mixture could suppress detonation and super-knock. The experimental and simulation results show that based on detonation and super-knock operating condition, adding 80% additional air while keeping the same fuel energy density could transfer combustion from detonation mode to super-sonic auto-ignitive deflagration mode. The peak pressure and pressure oscillation could be reduced significantly. This indicates that boosted lean burn could suppress detonation and thus suppress super-knock effectively, even if pre-ignition occurs. It could be an effective and practical control strategy to protect modern highly turbocharged gasoline engines.
Crime scripting: A systematic review
Authors: Dehghanniri Hashem , Borrion Hervé
Published: June 2019

More than two decades after the publication of Cornish’s seminal work about the script-theoretic approach to crime analysis, this article examines how the concept has been applied in our community. The study provides evidence confirming that the approach is increasingly popular; and takes stock of crime scripting practices through a systematic review of over 100 scripts published between 1994 and 2018. The results offer the first comprehensive picture of this approach and highlight new directions for those interested in using data from cyber-systems and the Internet of Things to develop effective situational crime prevention measures.
Outcomes of Lung Transplantation for Cystic Fibrosis in the Setting of Extensively Drug-Resistant Organisms
Authors: Winstead Ryan J. , Waldman Georgina , Autry Elizabeth B. , Evans Rickey A. , Schadler Aric , Kays Lindsey , Baz Maher , Anstead Michael I. , Shafii Alexis , Goetz Megan E.
Published: June 2019

Introduction:

Since the largest study on extensively drug-resistant organisms and lung transplantation in patients with cystic fibrosis, there have been innovations and advancements in the treatment of Pseudomonas aeruginosa.

Research Question:

What differences exist for patients with cystic fibrosis with a history of extensively drug-resistant infections who undergo lung transplantation despite treatment advances with antimicrobial therapy?

Study Design:

Two-center, retrospective, cohort study conducted in 44 patients with cystic fibrosis chronically infected with extensively drug-resistant organisms who received a lung transplant from January 2008 through August 2016. Patients in the resistant cohort were chronically infected with pan-resistant P aeruginosa, polymyxin-sensitive only, or sensitive to 2 antibiotic classes (polymyxin plus one other); remaining patients with more susceptible P aeruginosa or no P aeruginosa remained in the control cohort. The primary outcome is a composite of patient survival, retransplantation, chronic lung allograft dysfunction, and acute rejection 12 months posttransplant. Categorical variables were analyzed using χ2 testing. The independent samples t test was utilized for continuous variables.

Results:

There was no difference in the primary outcome (40% vs 37%, P = .831). Differences between patient survival (84% vs 95%, P = .487), the incidence of acute rejection (20% vs 33%, P = .323), and the incidence of chronic lung allograft rejection (12% vs 5%, P = .441) were not different between groups.

Discussion:

Recipients chronically infected with an extensively resistant P aeruginosa had similar outcomes compared to those infected with more sensitive organisms.
Viscoelastic behavior of aloevera/hemp/flax sandwich laminate composite reinforced with BaSO4: Dynamic mechanical analysis
Authors: Arulmurugan M , Prabu K , Rajamurugan G , Selvakumar AS
Published: June 2019

In the structural applications, the composite material employs a significant contribution in various industrial applications. In this paper, the experimental nonlinear viscoelastic behavior, tensile and flexural strength properties are analyzed in aloevera /hemp/flax natural fiber sandwich laminate composites (NSLC) with the addition of barium sulfate filler. The dynamic mechanical properties such as storage modulus (E′), loss modulus (E″) and damping factor (Tan δ) are analyzed using dynamic mechanical analyzer as a function of temperature and frequency. The homogeneity, crosslink between the fiber and the matrix of the natural fiber sandwich laminate composite samples are analyzed by a cole-cole plot and complex modulus models. The improvement in flexural strength is observed in the NSLC4 sample (138.34 N/mm2), but the addition of barium sulfate affects the tensile strength (28.8 N/mm2). From the dynamic mechanical analyzer, it is observed that the storage modulus (E′) at the glassy region in the NSLC2 sample is 19.9% whereas in the NSLC4 sample it is 15.57%. Further, the addition of barium sulfate filler enhances the loss modulus (E″) by 28% in NSLC4 sample. The NSLC4 sample shows the better homogeneity in the cole-cole plot and high crosslink between the fiber and the matrix is observed from the complex modulus.
When a Good Cop Turns Bad: The Pro-Ictal Action of Parvalbumin Expressing Interneurons During Seizures
Authors: Raimondo Joseph V. , Dulla Chris
Published: June 2019

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Effectiveness of a Functional Literacy Program for Sheltered Homeless Adults
Authors: Grajo Lenin C. , Gutman Sharon A. , Gelb Hannah , Langan Katie , Marx Karen , Paciello Devon , Santana Christie , Sgandurra Ashley , Teng Krysti
Published: June 2019

This study aims to determine whether a functional literacy program using principles from the Cognitive Orientation to daily Occupational Performance approach and Occupational Adaptation theory, and embedded in community-based daily activities, could enhance occupational participation in a sample of sheltered homeless adults. This study used a two-group, controlled design with pre- and post-intervention measures. Intervention was carried out in a group setting in 1.5 hr, twice-weekly sessions over 8 weeks. Intervention addressed literacy skills needed to complete participant identified, desired daily activities. Statistically significant differences were found between intervention and control groups’ perceived functional literacy skills with regard to occupational performance ( Z = −4.075, p < .0001, d = 1.02) and satisfaction ( Z = −4.113, p < .0001, d = 1.40); reading frequency ( Z = −3.594, p < .0001, d = 0.48), reading effectiveness ( Z = −10.673, p < .0001, d = 0.68), level of support ( Z = −10.410, p < .0001, d = 1.81), and reading efficiency ( Z = −10.297, p < .0001, d = 1.83). The intervention enhanced perceived reading and occupational participation in the study’s sample. Further research is needed to replicate and translate results in daily practice.
Intraoperative Lipid-Rich Nutrition in the Detection of Chylothorax in Minimally Invasive Ivor Lewis Esophagectomy
Authors: Lubbers Merel , van Det Marc J. , Kouwenhoven Ewout A.
Published: June 2019

Background. Chylothorax is a rare but severe complication after esophagectomy with an incidence of 1.9% to 8.9%. The aim of this study was to evaluate the efficacy of intraoperative lipid-rich feeding in reducing the incidence of post-esophagectomy chylothorax. Methods. A retrospective cohort study was performed among patients who underwent totally minimally invasive esophagectomy with intrathoracic anastomosis (tMIE Ivor Lewis) from February 2015 until December 2016. In this group, a lipid-rich solution was administered intraoperatively via a feeding jejunostomy. A historical cohort of identical patients operated in the period December 2012 to February 2015 did not receive intraoperative feeding and was used as a control. Results. In total, 133 patients underwent tMIE Ivor Lewis, of whom 59 patients (44%) received lipid-rich solution intraoperatively. The administered median total volume was 800 mL. During thoracic dissection, the thoracic duct was clearly visible in 37 patients (63%). With the help of lipid-rich feeding, intraoperative unintended duct damage was detected in 3 patients and treated. Postoperatively, 1 out of 59 patients (1.7%) developed chylothorax that was managed nonoperatively. In the control group, chylothorax was seen in 3 out of 74 patients (4.1%), P = .629. Conclusions. Intraoperative lipid-rich solution through a feeding jejunostomy helps identify thoracic duct damage during tMIE and may reduce postoperative chylothorax.
The Principle of Division in Roger Caillois’s Man, Play and Games
Authors: McDonald Peter D.
Published: June 2019

Caillois’s classic text Man, Play and Games leaves open a basic question: Why focus on four specific kinds of play? Subsequent authors have offered their own rationalizations and expanded upon his game categories but have not explained Caillois’s approach. This essay performs a close reading of Man, Play and Games in order to evince his methodology. I argue that Caillois holds to the idea that play reproduces uncertainty in a safe and confined way but that a paradox troubles this vision and pushes him into a baroque formalism. Instead of a simple relation between model and copy, Caillois develops another, stranger concept of mimesis that continues and extends his Surrealist writing about insects and the unconscious. My reading builds on previous analyses of Caillois within game studies, sociology, and media theory to revise the methodological presuppositions built into the categorization of games.
Distal Digital Nerve Repair Using Nerve Allograft With a Dermal Substitute: A Case Report
Authors: McKee Desirae , Osemwengie Bradley , Cox Cameron
Published: June 2019

Background: Distal digital nerve repairs can present unique challenges for hand surgeons due to their sensitive location and ongoing difficulty obtaining soft tissue coverage in this region. Although autografts and nerve conduits have been shown to be of benefit with nerve gaps, they can have morbidities associated with their use. Nerve allografts have become a viable option over the past decade as their use has increased and data are now showing similar outcomes, particularly in short gap segments. Flaps and skin grafts are traditional coverage options for full thickness wounds but can pose challenges with multiple digit involvement, depth of wound, and critical structures exposed. Methods: We present a case where nerve allograft was used for distal digital nerve repair. Due to the distal nature of the nerve repair in the index digit distal to the trifurcation, the distal end of the nerve graft was connected to multiple small nerve ends. Dermal substitute was placed to achieve distal coverage of the affected digits. Results: At 6-month follow-up, the patient demonstrated improved strength, normal sensation, and full return of digital function. Conclusion: Nerve allograft can be used in combination with dermal skin substitute to achieve normal sensation and return of digital function following distal digital nerve injuries.
Mid-term follow-up of staged bilateral internal carotid artery aneurysm treatment with Pipeline embolization
Authors: Tejada Juan G , Lopez Gloria VV , Koovor Jerry ME , Riley Kalen , Martinez Mesha
Published: June 2019

Background

Endovascular treatment of large complex morphology aneurysms is challenging. High recanalization rates have been reported with techniques such as stent-assisted coiling and balloon-assisted coiling. Flow diverter devices have been introduced to improve efficacy outcomes and recanalization rates. Thromboembolic complications and in-device stenosis are certainly more worrisome when treatment of bilateral internal carotid arteries has been performed. This study aimed to report our experience with mid-term imaging follow-up of staged bilateral Pipeline embolization device placement for the treatment of bilateral internal carotid artery aneurysms.

Methods

We reviewed the clinical, angiographic, and follow-up imaging data in all consecutive patients treated with bilateral internal carotid artery aneurysms who underwent elective Pipeline embolization.

Results

Six female patients were treated, harboring a total of 13 aneurysms. Of these, 60% were asymptomatic. Diplopia and headache were the most common symptoms. The most common location was the paraclinoid segment (6/13), including by cavernous segment (4/13) and ophthalmic segment (2/13). Successful delivery of the device was achieved in 12 cases. Difficult distal access precluded the deployment of the device in one case. The treatment was always staged with at least eight weeks' difference between the two procedures. All aneurysm necks were covered completely. There were no periprocedural complications. Angiographic follow-up ranged between 3 and 12 months, and computed tomography angiogram follow-up ranged between 2 and 24 months. Complete aneurysm occlusion was achieved in all cases.

Conclusion

In our series, Pipeline deployment for the treatment of bilateral internal carotid artery aneurysms in a staged fashion is safe and feasible. Mid-term imaging follow-up showed permanent occlusion of all the treated aneurysms.
Evaluating safety performance of highway alignment utilizing fault tree analysis and energy method
Authors: Chen Zhijian , Ge Yinen , Wang Kai , Song Jiahua
Published: June 2019

To improve the accuracy of road safety evaluation, this article presents a method to calculate the average crash probability for highway sections based on fault tree and energy method. First, the average crash probability of sections was formulated based on fault tree theory, taking lateral instability, rollover, and rear-end crash into account. Second, an instability factor, which described the extent of steering instability and tire sideslip, was proposed based on energy method. Thereafter, the relationships between the instability factor and probability of lateral instability crash, the load transfer ratio and probability of rollover crash, the available sight distance and probability of rear-end crash were investigated. Then, the driver–vehicle–road multi-body dynamics model was developed based on the three-dimensional alignments of Ning-Luo Expressway using CarSim, the dynamics indexes such as lateral velocity, wheel vertical load were obtained, and the average crash probability of each section was calculated. Finally, the correlation between average crash probability and the average number of accidents was analyzed to validate the accuracy of the proposed method. Results reveal that the proposed method can improve the accuracy of evaluation results, compared with existing methods, thus providing theoretical basis for black spot identification of both design phase and in-service highways.
Celebratory consumerism on China’s Singles’ Day: From grass-roots holiday to commercial festival
Authors: Sun Weimei , Creech Brian
Published: June 2019

Singles’ Day, or 11 November, was initially conceived as a way to celebrate singlehood among Chinese youth. Since 2009, the e-commerce giant Alibaba has transformed Singles’ Day into the world’s largest online shopping day, using its discursive power to define the day as overtly commercial. To analyse emerging consumerist discourses around Singles’ Day, we considered news coverage alongside posts on Sina Weibo. Although the Singles’ Day bent towards consumerism occurred over time, in concert with demographic and political changes within China, our research shows that consumerist understandings of Singles’ Day emerged from a nascent cultural logic that celebrated togetherness through consumption.
Rib soft fixation produces better analgesic effects and is associated with cytokine changes within the spinal cord in a rat rib fracture model
Authors: Liu Yuan-Yuarn , Wang Jeffrey Chi-Fei , Lin Ya-Chi , Hsiao Hung-Tsung , Liu Yen-Chin
Published: June 2019

Traumatic rib fracture can cause severe pain and is usually associated with the depression of respiratory drive followed by severe respiratory complications. It is critical for patients with rib fracture to receive adequate analgesia. However, strong opioids and other analgesics often produces side effects and may even cause respiratory suppression. Meanwhile, rib fixation now has become a popular method for treating rib fracture patients. However, the actual molecular mechanism leading to its effectiveness as an analgesia has not been fully investigated, and the best analgesic method for its use in rib fracture patients has not yet been determined. We developed a new animal model for rib fracture and evaluated changes in pain severity after rib fixation. Our data indicated significantly better analgesic behavior if a soft string rib fixation is performed, which is associated with cytokine (interleukine-6 and interleukine-10) decreases in the spinal cord and co-localization with glia cells. Our results provided a treatment suggestion for rib fracture patients and the possible molecular mechanism for the analgesic effects. Further molecular mechanisms and the best therapeutic methods are still needed for this severe painful condition.
Computer-assisted clinical coding: A narrative review of the literature on its benefits, limitations, implementation and impact on clinical coding professionals
Authors: Campbell Sharon , Giadresco Katrina
Published: June 2019

Background:

Information technology has the potential to streamline processes in healthcare for improved efficiency, quality and safety, while reducing costs. Computer-assisted clinical coding (CAC) has made it possible to automate the clinical coding process by assigning diagnoses and procedures from electronic sources of clinical documentation. Implementation of CAC requires both investigation of the clinical coding workflow and exploration of how the clinical coding professional’s role might change and evolve as a result of this technology.

Objective:

To examine the benefits and limitations of CAC technology; best practices for CAC adoption; the impact of CAC on traditional coding practices and roles in the inpatient setting.

Method:

This narrative review explores the current literature available on CAC. Literature indexed in ProQuest, Medline and other relevant sources between January 2006 and June 2017 was considered.

Results:

A total of 38 journal articles, published dissertations and case studies revealed that CAC has demonstrated value in improving clinical coding accuracy and quality, which can be missed during the manual clinical coding process.

Conclusion:

Clinical coding professionals should view CAC as an opportunity not a threat. CAC will allow clinical coding professionals to further develop their clinical coding skills and knowledge for future career progression into new roles such as clinical coding editors and clinical coding analysts. Sound change management strategies are essential for successful restructuring of the clinical coding workflows during the implementation of CAC.
Between three chairs: Experiences of being a patient with chronic widespread pain in an intersectoral setting in Denmark
Authors: Schultz Rikke , Kousgaard Marius Brostrøm , la Cour Peter , Davidsen Annette Sofie
Published: June 2019

This study explores how patients with chronic widespread pain experience their contacts with health and social services in Denmark, including general practice, hospitals, and municipality job centers. We analyzed interviews with 10 patients using interpretative phenomenological analysis and found the following four superordinate themes: meeting different attitudes, fragmentation of treatment, the importance of time, and feeling trapped. Findings show that when patients do not feel understood by professionals, they can resort to withdrawal strategies. On an organizational level, patients said that they needed sufficient time in meetings and better coordination of interventions in and between the health and social care sectors.
Children of Tribal Unwed Mothers and Their Non-Legitimate Origin: A Social Exclusion Perspective
Authors: Cherayi Shanuga , Jose Justin P. , Sudhakar Sreejith
Published: June 2019

Using phenomenological design, we purposively selected 10 children of tribal unwed mothers for in-depth interview to explore children’s social identity in the context of non-legitimate origin, aspects of psychosocial disability, and exclusion. We analyzed data through open coding, progressive focusing, coding frame, summarizing, and interpreting the findings. The results reveal that tribal communities actively, though indirectly, engage in social system maintenance. The children of unwed mothers explicitly deviate and breach traditional tribal boundaries, thus victimized by socially ascribing disabling social identity of non-legitimate origin, in addition to their poorly valued social identity as tribals. As a result, non-legitimate children experience conflicts in social relationships, poor social integration, reduced support, poor peer acceptance, and exclusion that characterized everyday communal and school life. To conclude, these children internalized negative social (also non-legitimate) identities, psychosocial disabilities, and exclusion at neighborhood and schools.
Visualizing Individual Outcomes of Social Mobility Using Heatmaps
Authors: Präg Patrick
Published: June 2019

Research on the consequences of social mobility usually draws on information about categorical origin and destination variables as well as an outcome variable. The author shows an example of a heatmap created in Stata to visualize the relationship between social mobility and poor self-rated health in Germany and discusses the advantages of this heatmap approach to other visualization approaches.
Pulmonary type-2 innate lymphoid cells in paediatric severe asthma: phenotype and response to steroids
Authors: Nagakumar Prasad , Puttur Franz , Gregory Lisa G. , Denney Laura , Fleming Louise , Bush Andrew , Lloyd Clare M. , Saglani Sejal
Published: June 2019

Children with severe therapy-resistant asthma (STRA) have poor control despite maximal treatment, while those with difficult asthma (DA) have poor control from failure to implement basic management, including adherence to therapy. Although recognised as clinically distinct, the airway molecular phenotype, including the role of innate lymphoid cells (ILCs) and their response to steroids in DA and STRA is unknown.

Immunophenotyping of sputum and blood ILCs and T-cells from STRA, DA and non-asthmatic controls was undertaken. Leukocytes were analysed longitudinally pre- and post-intramuscular triamcinolone in children with STRA. Cultured ILCs were evaluated to assess steroid responsivenessin vitro.

Airway eosinophils, type 2 T-helper (Th2) cells and ILC2s were significantly higher in STRA patients compared to DA and disease controls, while IL-17+lymphoid cells were similar. ILC2s and Th2 cells were significantly reducedin vivofollowing intramuscular triamcinolone andin vitrowith steroids. Furthermore, asthma attacks and symptoms reduced after systemic steroids despite persistence of steroid-resistant IL-17+cells and eosinophils.

Paediatric STRA and DA have distinct airway molecular phenotypes with STRA characterised by elevated type-2 cells. Systemic corticosteroids, but not maintenance inhaled steroids resulted in improved symptom control and exacerbations concomitant with a reduction in functional ILC2s despite persistently elevated IL-17+lymphoid cells.
Enabling multi-hop remote method invocation in device-to-device networks
Authors: Le Minh , Clyde Stephen , Kwon Young-Woo
Published: June 2019

To avoid shrinking down the performance and preserve energy, low-end mobile devices can collaborate with the nearby ones by offloading computation intensive code. However, despite the long research history, code offloading is dilatory and unfit for applications that require rapidly consecutive requests per short period. Even though Remote Procedure Call (RPC) is apparently one possible approach that can address this problem, the RPC-based or message queue-based techniques are obsolete or unwieldy for mobile platforms. Moreover, the need of accessibility beyond the limit reach of the device-to-device (D2D) networks originates another problem. This article introduces a new software framework to overcome these shortcomings by enabling routing RPC architecture on multiple group device-to-device networks. Our framework provides annotations for declaring distribution decision and out-of-box components that enable peer-to-peer offloading, even when a client app and the service provider do not have a direct network link or Internet connectivity. This article also discusses the two typical mobile applications that built on top of the framework for chatting and remote browsing services, as well as the empirical experiments with actual test-bed devices to unveil the low overhead conduct and similar performance as RPC in reality.
The use of leukocytes’ secretome to individually target biological therapy in autoimmune arthritis: a case report
Authors: Poubelle Patrice E. , Pagé Nathalie , Longchamps Marie‐Pier , Sampaio Moura Natalia , Beck David B. , Aksentijevich Ivona , Tessier Philippe A. , Pelletier Martin
Published: June 2019

Background

Biological agents have allowed remarkable improvement in controlling autoimmune arthropathies, although none of the numerous biologics readily available represent a universal treatment standard. Moreover, classical and genetic predictors are currently unsatisfactory to predict individual response to a biologic, and the best treatment selection is still based on a trial‐and‐error approach. Here, we report a clinical case demonstrating the usefulness of examining the leukocytes’ secretome of patients. We set up and standardized a protocol that examines a patient's immune responses to establish the secretome of the blood mononuclear leukocytes and personalize the biotherapy.

Case presentation

A 24‐year‐old woman was diagnosed with active early rheumatoid arthritis. The initial treatment regimen (prednisone, methotrexate, hydroxychloroquine, naproxen) was inefficient, as well as the anti‐TNF adalimumab. The diagnosis was revised as possible rheumatoid arthritis‐like psoriatic arthritis and adalimumab was replaced by abatacept (IgG1 Fc‐CTLA‐4) to no avail. Five years later, abatacept was replaced by the anti‐IL‐12/IL‐23 ustekinumab with no objective control over the symptoms. The patient was thus enrolled in a prospective study based on the quantification of cytokines secreted by peripheral blood leukocytes stimulated with well‐known immune activators of pattern recognition receptors and cytokine signalling. The results of this study revealed that plasma concentrations of cytokines were similar between the patient and healthy donors. In comparison to leukocytes from healthy donors, the patient's secretome showed a unique overproduction of IL‐6. The anti‐IL‐6 receptor tocilizumab was, therefore, administered with a rapid improvement of her active psoriatic arthritis that remained dependent on low prednisone dosage. Clinical parameters progressively returned to normal levels and her quality of life was greatly improved, despite the major delay to begin the present personalized treatment.

Conclusions

An efficient way to effectively treat patients with complex autoimmune arthropathies, and avoid irreversible disability, is to know their leukocytes’ secretome to identify abnormally secreted cytokines and personalize their biotherapy, as exemplified by this case report.
Tobacco smoking and schizophrenia: re-examining the evidence
Authors: Isuru Amila , Rajasuriya Mahesh
Published: June 2019

Tobacco smoking among people with mental illnesses can be explained by biological, psychological and social factors. The prevalence of smoking in people diagnosed with schizophrenia is higher than in people with other mental disorders and in the general population. This article explores three current hypotheses that explain this higher prevalence of smoking in schizophrenia. The first, the self-medication hypothesis, is increasingly countered by a growing body of evidence indicating that smokers experience more severe symptoms of schizophrenia. Numerous researchers have already identified smoking as a possible risk factor for the development of schizophrenia, which is the second hypothesis. The third hypothesis (shared genetic vulnerability) identifies certain genes that confer vulnerability for both schizophrenia and nicotine dependence. Understanding the reasons behind the higher prevalence of smoking among people with schizophrenia is vital in planning effective primary, secondary and tertiary smoking prevention for these individuals.

LEARNING OBJECTIVES

At the end of this article, readers will be able to:

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understand the self-medication hypothesis in relation to tobacco smoking by people with schizophrenia

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understand the role of tobacco smoking as a possible risk factor for causation of schizophrenia

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understand the role of shared genetic vulnerability in the causation of both schizophrenia and nicotine dependence.
Resumption of Immune Checkpoint Inhibitor Therapy After Immune-Mediated Colitis
Authors: Abu-Sbeih Hamzah , Ali Faisal S. , Naqash Abdul Rafeh , Owen Dwight H. , Patel Sandipkumar , Otterson Gregory A. , Kendra Kari , Ricciuti Biagio , Chiari Rita , De Giglio Andrea , Sleiman Joseph , Funchain Pauline , Wills Beatriz , Zhang Jiajia , Naidoo Jarushka , Philpott Jessica , Gao Jianjun , Subudhi Sumit K. , Wang Yinghong
Published: June 2019

PURPOSE

Immune checkpoint inhibitor (ICI) therapy often is suspended because of immune-mediated diarrhea and colitis (IMDC). We examined the rate of and risk factors for IMDC recurrence after ICI resumption.

METHODS

This retrospective multicenter study examined patients who resumed ICI therapy after improvement of IMDC between January 2010 and November 2018. Univariable and multivariable logistic regression analyses assessed the association of clinical covariates and IMDC recurrence.

RESULTS

Of the 167 patients in our analysis, 32 resumed an anti–cytotoxic T-cell lymphocyte-4 (CTLA-4) agent, and 135 an anti–programmed cell death 1 or ligand 1 (PD-1/L1) agent. The median age was 60 years (interquartile range [IQR], 50-69 years). The median duration from IMDC to restart of ICI treatment was 49 days (IQR, 23-136 days). IMDC recurred in 57 patients (34%) overall (44% of those receiving an anti–CTLA-4 and 32% of those receiving an anti–PD-1/L1); 47 of these patients (82%) required immunosuppressive therapy for recurrent IMDC, and all required permanent discontinuation of ICI therapy. The median duration from ICI resumption to IMDC recurrence was 53 days (IQR, 22-138 days). On multivariable logistic regression, patients who received anti–PD-1/L1 therapy at initial IMDC had a higher risk of IMDC recurrence (odds ratio [OR], 3.45; 95% CI, 1.59 to 7.69; P = .002). Risk of IMDC recurrence was higher for patients who required immunosuppression for initial IMDC (OR, 3.22; 95% CI, 1.08 to 9.62; P = .019) or had a longer duration of IMDC symptoms in the initial episode (OR, 1.01; 95% CI, 1.00 to 1.03; P = .031). Risk of IMDC recurrence was lower after resumption of anti–PD-1/L1 therapy than after resumption of anti–CTLA-4 therapy (OR, 0.30; 95% CI, 0.11 to 0.81; P = .019).

CONCLUSION

One third of patients who resumed ICI treatment after IMDC experienced recurrent IMDC. Recurrence of IMDC was less frequent after resumption of anti–PD-1/L1 than after resumption of anti–CTLA-4.