bluuebunny/crossref_metadata_2025 huggingface dataset:
Child trafficking victims and legal guardians: Exploring the fulfilment of the EU trafficking directive in the context of the UK modern Slavery Act 2015 – Best practice or not fit for purpose?
Authors: Weatherburn Amy , Mellon Yvonne Eloise
Published: March 2019

Child victims of trafficking are recognized as particularly vulnerable victims, who require additional protection and support and a more rigorous legal framework. The regional anti-trafficking instruments 1 explicitly enforce the importance of protecting child trafficking victims, requiring Member States to ‘appoint a guardian or a representative for a child victim of trafficking in human beings from the moment the child is identified by the authorities’. 2 The problem of child trafficking and exploitation has received increased attention in England and Wales in recent years, with record number of minors referred to the National Referral Mechanism in 2016. Running parallel to this are the apparent failings of the domestic social care system to safeguard not only trafficked children but also those who are seeking asylum or unaccompanied. Over a quarter of officially identified trafficked children were found to have gone missing between 2014 and 2015. 3 Across the United Kingdom when transposing the European Union (EU) legal framework, the Government maintained that existing provisions by local authorities under their statutory child protection obligations, including social workers and independent reviewing officers, fulfilled the guardian requirements in the Directive. The Modern Slavery Act 2015 has placed significant emphasis on reforming the approach to the protection for child trafficking victims, culminating in the introduction a specific statutory provision establishing Independent Child Trafficking Advocates (ICTAs). 4 Such a scheme is the first guardian of its kind, designed specifically for child trafficking victims in Europe. Taking into account the recent evaluation of pilot schemes, 5 and the slight variation in approach taken in the devolved jurisdictions of the United Kingdom, 6 this article will consider the extent to which the protection of child trafficking victims under the jurisdiction of the Modern Slavery Act 2015 is sufficient to fulfil the legal positive obligations imposed by EU Law. This article will demonstrate that as it stands the Modern Slavery Act 2015 fulfils the obligations of the EU Trafficking Directive in relation to the protection of child trafficking victims. However, its fully effective enforcement requires further efforts in policy to ensure that these legal obligations are implemented in practice.
Improving the resistance of concrete panels to hard projectile impact
Authors: Abdel-Kader Mohamed , Fouda Ahmed
Published: March 2019

In this article, the response of nine plain concrete panels to an impact of hard projectiles was examined in an experimental study. The tests were planned with an aim to observe the influence of compressive strength on the performance of concrete under impact loading. Concrete panels with compressive strengths within the range of 26 to 92 MPa subjected to impact by 23 mm hard projectile at velocities within the range of 270 to 348 m/s were studied. Also, using a glass fiber reinforced polymer sheet, as a liner on the rear face of the plain concrete panel, to strengthen the panel was examined. The experimental results indicate that strengthening concrete panel with a rear glass fiber reinforced polymer sheet showed more satisfactory performance under the impact load than increasing compressive strength of concrete. Also, the use of glass fiber reinforced polymer sheets as rear liners in addition to increasing the concrete strength showed superior performance of concrete panels against impact; it is recommended to be used in protective structures.
Amazon Go: Disrupting retail?
Authors: Ives Blake , Cossick Kathy , Adams Dennis
Published: March 2019

In January of 2018, AMAZON.COM Inc. (Amazon) opened its first self-service Amazon Go convenience store in Seattle, Washington. Armed only with a smartphone app tied to a credit card, a customer could enter the store, select merchandise from the aisles and refrigeration cases, and just walk out—no lines, no waiting, no cashier. A can of coke, chocolate bar, or chicken sandwich placed in a shopper’s bag, is identified, accounted for, and charged to a payment card, all facilitated by computer vision, deep learning, and sensor-based information technologies (IT). Based on extensive public sources, the Amazon Go case provides a rich opportunity to explore an IT-enabled startup that potentially threatens three industries: convenience stores, grocery stores, and fast food outlets. In the future, the technology, either by licensing or expansion by Amazon, arguably could disrupt the broader retail industry and its millions of employees. Students have an opportunity to explore the boundary between IT and business strategy, while seeing the potential economic implications of fixed cost investments in IT. They will see how one company, Amazon, strategically develops, deploys, and extends its growing arsenal of IT weapons. The case also catalyzes discussions of social issues, including the impact of technology on employment and the tradeoffs between personal privacy and customer service.
The Potential Role of Learning Capacity in Cognitive Behavior Therapy for Depression: A Systematic Review of the Evidence and Future Directions for Improving Therapeutic Learning
Authors: Bruijniks Sanne J. E. , DeRubeis Robert J. , Hollon Steven D. , Huibers Marcus J. H.
Published: March 2019

Insight into how cognitive behavioral therapy (CBT) works is urgently needed to improve depressive outcome. First, we discuss the role of learning in CBT for depression by reviewing evidence for learning processes involved in the development and maintenance of depression. Second, we investigate the role of learning capacity as a moderator by reviewing empirical evidence for the relation between (a) CBT procedures and learning processes, (b) learning processes and CBT treatment processes, and (c) learning processes and CBT outcome. We propose that learning capacity moderates the relation between CBT procedures and change in CBT treatment processes and explains why therapeutic procedures lead to process change and long-term success in some but not all patients. Third, we identify procedures that lead to successful therapeutic learning and describe how experimental studies help to better explain causal mechanisms of change and the role of learning capacity in CBT for depression.
Surgical Treatment of Degenerative Disk Disease in Three Scandinavian Countries: An International Register Study Based on Three Merged National Spine Registers
Authors: Andersen Mikkel Østerheden , Fritzell Peter , Eiskjaer Søren Peter , Lagerbäck Tobias , Hägg Olle , Nordvall Dennis , Lönne Greger , Solberg Tore , Jacobs Wilco , van Hooff Miranda , Gerdhem Paul , Gehrchen Martin
Published: March 2019

Study Design:

Observational study of prospectively collected data.

Objectives:

Patients with chronic low back pain resistant to nonoperative treatment often face a poor prognosis for recovery. The aim of the current study was to compare the variation and outcome of surgical treatment of degenerative disc disease in the Scandinavian countries based on The International Consortium for Health Outcomes Measurement core spine data sets.

Methods:

Anonymized individual level data from 3 national registers were pooled into 1 database. At the time of surgery, the patient reports data on demographics, lifestyle topics, comorbidity, and data on health-related quality of life such as Oswestry Disability Index, Euro-Qol-5D, and back and leg pain scores. The surgeon records diagnosis, type of surgery performed, and complications. One-year follow-ups are obtained with questionnaires. Baseline and 1-year follow-up data were analyzed to expose any differences between the countries.

Results:

A total of 1893 patients were included. At 1-year follow-up, 1315 (72%) patients responded. There were statistically significant baseline differences in age, smoking, comorbidity, frequency of previous surgery and intensity of back and leg pain. Isolated fusion was the primary procedure in all the countries ranging from 84% in Denmark to 76% in Sweden. There was clinically relevant improvement in all outcome measures except leg pain.

Conclusions:

In homogenous populations with similar health care systems the treatment traditions can vary considerably. Despite variations in preoperative variables, patient reported outcomes improve significantly and clinically relevant with surgical treatment.
Return to sports after chronic anterior exertional compartment syndrome of the leg: Conservative treatment versus surgery
Authors: Thein Ran , Tilbor Ido , Rom Eyal , Herman Amir , Haviv Barak , Burstein Gideon , Tenenbaum Shay
Published: March 2019

Aim:

To evaluate whether surgical treatment for anterior chronic exertional compartment syndrome (CECS) of the lower leg will lead to full athletic activity recovery compared to conservative treatment.

Methods:

Patients diagnosed with anterior CECS of the leg were offered surgical treatment, as surgery considered today to be the mainstay of treatment. Patients unwilling to be treated surgically were treated conservatively. They were followed up, assessing both groups for pain, functional status, and the Tegner sports activity score with comparisons at diagnosis and following treatment.

Results:

Forty-three patients were treated for CECS (31; 72.1% with surgery and 12; 27.9% conservatively) with a mean follow-up of 28.15 (4.16–54.09) months. Reported pain improved at follow-up by 1.59 (0–6) points and by 4.27 ± (0–10) points in the conservatively and the surgically treated patient groups, respectively ( p = 0.014) with a mean change in the Tegner score of 0.09 (−5 to 5) and 3.22 (−4 to 7), respectively ( p = 0.009). Three patients in the conservatively treated group (25% of 12) and 24 patients in the operated group (77.4% of 31) reported full resumption of their pre-diagnosis activity level ( p = 0.001).

Conclusion:

This study supports surgery as the treatment of choice for anterior CECS of the leg with differential benefit for fasciotomy in terms of pain and return to pre-diagnosis athletic activity.
Role of routine blood tests for predicting clinical outcomes in osteosarcoma patients
Authors: Jettoo P , Tan GJS , Gerrand CH , Rankin KS
Published: March 2019

Background:

This retrospective cohort study aimed to investigate whether simple routine blood tests at presentation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alkaline phosphatase and albumin) predict survival in patients with osteosarcoma.

Methods:

Between January 1998 and February 2015, 134 patients with a histological diagnosis of osteosarcoma were treated in our unit. Of these, 79 patients with high-grade osteosarcomas were included in the study. Demographic and clinical data, and laboratory parameters obtained prior to biopsy (CRP, ESR, alkaline phosphatase and albumin levels), were obtained from patients’ records.

Results:

There were 44 males and 35 females. Univariate analysis showed that high pre-biopsy CRP ( p = 0.004), raised pre-biopsy ESR ( p = 0.010), older age ( p < 0.001), poor tumour necrosis rates (≤90%, p = 0.023) and metastasis at presentation ( p < 0.001) were poor prognostic factors. Multivariate analysis showed pre-biopsy CRP and ESR levels to be independent predictors of overall survival ( p = 0.020 and p = 0.025, respectively). Kaplan–Meier survival was significantly lower in patients with elevated CRP ( p = 0.002) and ESR ( p = 0.003). Hypoalbuminaemia and elevated alkaline phosphatase levels did not correlate with overall survival.

Conclusion:

Preoperative CRP and ESR levels may have value in building a prognostic model for patients presenting with osteosarcoma.
Can We Accurately Predict the Quadruple Hamstring Graft Diameter From Preoperative Magnetic Resonance Imaging?
Authors: Vardiabasis Nicolas , Mosier Brian , Walters Jason , Burgess Aaron , Altman Greg , Akhavan Sam
Published: March 2019

Background:

Anterior cruciate ligament (ACL) reconstruction with a quadruple hamstring (QH) autograft is a widely utilized procedure with good outcomes. A graft diameter less than 8 mm, however, has been associated with higher revision rates. Accurately determining the diameter of the hamstring tendon preoperatively can help surgeons plan accordingly.

Purpose/Hypothesis:

The purpose of our study was to determine whether QH graft size can be reliably predicted from preoperative magnetic resonance imaging (MRI) measurements. We hypothesized that we can achieve a high predicted QH graft size correlation with regard to preoperative and intraoperative measurements.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

We evaluated patients undergoing ACL reconstruction using QH autografts. At the time of surgery, the semitendinosus tendon (ST) and gracilis tendon (GT) were harvested and sized and then sized as a QH graft. Preoperative individual ST and GT sizes were determined from T2-weighted fat-saturated MRI at 3 cm above the joint line using correlating axial and coronal images. We then used a predictive chart to predict what the size of the QH graft would be and compared this with the actual measurements. Pearson correlation coefficients between predicted and actual graft sizes were calculated.

Results:

The predicted GT graft size was within 0.5 mm of the actual size in 45 of 60 (75%) patients and within 1 mm of the actual graft size in 59 of 60 (98%) patients. The predicted GT graft size from MRI measurements correlated with the actual GT graft size ( r = 0.62, P < .00001). The predicted ST graft size was within 0.5 mm of the actual size in 45 of 60 (75%) patients and within 1 mm of the actual graft size in 56 of 60 (93%) patients. The predicted ST graft size from MRI measurements correlated with the actual ST graft size ( r = 0.71, P < .00001). The predicted QH graft size was within 0.5 mm of the actual size in 52 of 60 (87%) patients and within 1 mm of the actual graft size in 60 of 60 (100%) patients. The predicted QH graft size from MRI measurements correlated with the actual QH graft size ( r = 0.81, P < .00001).

Conclusion:

The current technique can reliably predict the size of a QH graft within 1 mm of the final graft size.
Comparison of Graft Length Changes During Knee Motion Among 5 Different Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Approaches: A Biomechanical Study
Authors: Tanabe Yoshie , Yasuda Kazunori , Kondo Eiji , Kawaguchi Yasuyuki , Akita Keiichi , Yagi Tomonori
Published: March 2019

Background:

In several anatomic single-bundle anterior cruciate ligament (ACL) reconstruction (ASB-ACLR) procedures, the femoral and tibial tunnel apertures are created at different locations within the native ACL attachment area.

Hypothesis:

Graft length changes during knee motion will be different among ASB-ACLR procedures with different femoral and tibial tunnel aperture locations.

Study Design:

Controlled laboratory study.

Methods:

A total of 12 cadaveric knees were used in this study. In each knee, 4 and 3 thin tunnels were created within the ACL attachment area on the femur and the tibia, respectively. Using 1 of 5 different combinations of femoral and tibial tunnel aperture location, 5 ASB-ACLRs were performed on each knee. In each reconstruction approach, a strong thread was used in place of the tendon graft, and the tibial graft end was tethered to a custom-made isometric positioner at 0° of knee flexion, with an approximately 12-N load applied to the thread. Then, each specimen underwent 5 cycles of knee flexion-extension motion in a range between 0° and 120°, and graft length changes were determined for each SB-ACLR approach.

Results:

The length changes of the graft were significantly different among the 5 ASB-ACLRs. The maximum length change values of the 3 grafts that were implanted between the femoral and tibial centers of the posterolateral bundle attachments or implanted into the femoral tunnel created at the center of the fanlike extension fiber attachment were significantly greater than those of the graft implanted between the centers of the anteromedial bundle attachments ( P < .0001) and of the graft implanted between the centers of the whole ACL attachments ( P < .0001).

Conclusion:

The length changes of the graft during knee motion were significantly different among the 5 ASB-ACLR approaches, even though all of the tunnel apertures were created within the femoral and tibial attachments of the native ACL.

Clinical Relevance:

The grafts in the first 3 graft locations may be so relaxed during knee flexion that they cannot resist anterior drawer loads exerted on the tibia.
Monitoring of the Inner Ear Function During and After Cochlear Implant Insertion Using Electrocochleography
Authors: Haumann Sabine , Imsiecke Marina , Bauernfeind Günther , Büchner Andreas , Helmstaedter Victor , Lenarz Thomas , Salcher Rolf B.
Published: March 2019

To preserve residual hearing during cochlear implant (CI) surgery, it is desirable to use intraoperative monitoring of inner ear function (cochlear monitoring), especially during electrode insertion. A promising method is electrocochleography (ECochG). Within this project, the relations between ongoing responses (ORs), recorded extra- and intracochlearly (EC and IC), and preservation of residual hearing were investigated. Before, during, and after insertion of hearing preservation electrodes, intraoperative ECochG recordings were performed EC using a cotton wick electrode and after insertion also IC using the CI electrode (MED-EL) and a research software tool. The stimulation was delivered acoustically using low frequency tone bursts. The recordings were conducted in 10 adult CI recipients. The amplitudes of IC ORs were detected to be larger than EC ORs. Intraoperative EC thresholds correlated highly to preoperative audiometric thresholds at 1000 Hz, IC thresholds highly at 250 Hz and 500 Hz. The correlations of both intraoperative ECochG recordings to postoperative pure tone thresholds were low. When measured postoperatively at the same appointments, IC OR thresholds correlated highly to audiometric pure tone thresholds. For all patients, it was possible to record ORs during or directly after electrode insertion. Consequently, we conclude that we did not observe any cases with severe IC trauma. Delayed hearing loss could not be predicted with our method. Nevertheless, intraoperative ECochG recordings are a promising tool to gain further insight into mechanisms impacting residual hearing. Postoperatively recorded IC OR thresholds seem to be a reliable tool for frequency specific hearing threshold estimation.
Is Assertiveness Paying the Bill? China’s Domestic Audience Costs in the South China Sea Disputes
Authors: Ramadhani Eryan
Published: March 2019

China’s assertiveness in the South China Sea has drawn international attention, especially in the past decade. Yet China has not always resorted to assertive foreign policy. Efforts to de-escalate tension are evident despite the domestic preference for tougher action. This study centres on a question: what makes for China’s assertiveness. I argue that China’s assertive foreign policy originates in leaders’ domestic consideration. Utilizing audience costs theory I focus on two assumptions that need to be relaxed: unitary domestic audiences and consistency in leaders’ crisis behaviour. China’s non-unitary domestic audiences, namely the elites and public, have different interests, although they share support for assertiveness in the South China Sea. Domestic audiences can tolerate inconsistency insofar as leaders are able to justify their decision, that is, to de-escalate the South China Sea disputes without dropping assertiveness. Foreign policy decision-making in China remains somewhat opaque, but domestic audiences can influence the process albeit not directly. In this regard, China’s assertiveness serves to generate audience costs so as to underpin regime legitimacy.
India–Pakistan Relations: Challenges and Opportunities
Authors: Hussain Ejaz
Published: March 2019

Mario E. Carranza. 2016. India-Pakistan Nuclear Diplomacy: Constructivism and the Prospects for Nuclear Arms Control and Disarmament in South Asia. New York, NY: Rowman & Littlefield. 267 pp. ISBN: 978-1-4422-4561-7.

Daniel Haines. 2016. Rivers Divided: Indus Basin Waters in the Making of India and Pakistan. New York, NY: Oxford University Press. 264 pp. ISBN: 978-0-19064866-4.

Hein G. Kiessling. 2016. Faith, Unity, Discipline: The ISI of Pakistan. London: Hurst & Co. 307 pp. ISBN: 978-1-84904-517-9.

A. S. Dulat, Asad Durrani and Aditya Sinha. 2018. The Spy Chronicles: RAW, ISI and the Illusion of Peace. New Delhi: HarperCollins Publishers. 344 pp. ISBN: 978-9352779253.
What’s War Got to Do with It? Post-conflict Effects on Gender Equality in South and Southeast Asia, 1975–2006
Authors: Bhattacharya Srobana , Burns Courtney
Published: March 2019

Does gender equality get better or worse following civil conflict? Given the plethora of research linking gender equality to less bellicosity, we aim to look at the relationship between post-conflict situations and gender equality. Specifically, we argue that circumstances surrounding how a conflict ends can better explain gender equality levels in a country in the post-conflict set up. We discuss whether outright victory for rebel groups will have the best impact for women due to the regime change and democratic process that typically follows. We conduct a Qualitative Comparative Analysis of 13 cases of intrastate conflicts in South and Southeast Asia for the years 1975–2006 along with an in-depth case study of Nepal. We find that rebel victory does have a positive impact on women in post-conflict situations when religious freedom was high, the conflict was centre seeking and wanted to establish a democratic regime.
Domestic Protests and Foreign Policy: An Examination of Anti-China Protests in Vietnam and Vietnamese Policy Towards China Regarding the South China Sea
Authors: Hoang Phuong
Published: March 2019

The Sino-Vietnamese relationship is characterized by asymmetry, yet Vietnam’s post-Cold War foreign policy towards China encompasses three paradigms: (a) internal and external balancing against China, (b) greater international integration to prevent political and economic dependence on China and (c) ‘cooperation’ with China on mutual interests while ‘struggling’ against China’s encroachment on Vietnam’s sovereignty. The ongoing dispute in the South China Sea presents a primary security concern for Vietnam as well as a challenge to its bilateral relations with China, particularly as maritime tensions provoke nationalist and anti-China protests among the Vietnamese public. This article presents an analysis of anti-China protests in Vietnam that resulted from South China Sea tensions between 2007 and 2017 in order to examine whether the protests—which are rare in Vietnam—had any effect on Vietnam’s foreign policy towards China. The findings reveal that the protests did not result in a change in Vietnam’s foreign policy towards China both during the maritime crises or in the long term.
A Pilot Study of Simulation Training in Difficult Bag Mask Ventilation Using a Computerized Patient Simulator
Authors: Pastis Nicholas J , Tobin Catherine D , Wolf Bethany J , Reves Jerry G , Schaefer John J
Published: March 2019

Objective:

Bag mask ventilation (BMV) is fundamental to airway management. Simulation is effective in airway management training, but its effectiveness for difficult BMV training is less clear. We evaluated the difference between type of training (simulation vs on patients) and the pass rate on a post-test on patients.

Design:

A single center pilot study was performed with 32 medical students randomized to participate in difficult BMV training on simulators or patients. Pre- and post-training tests on the simulator and on patients were recorded. Surveys of trainee confidence level were collected. The primary goal was to estimate the difference between type of training (simulation vs on patients) and the pass rate on the post-test on patients with an improvement of 10% or more in passing rate considered as a meaningful improvement. Secondary outcomes included whether or not participants passed the simulator post-test, post-test on patient confidence, and pre- and post-test confidence.

Measurements and main results:

Participants trained on the simulator had 13% higher passing rate on the post-test on patients compared to participants trained on patients (88% vs 75%). In addition, subjects that passed the simulator post-test had 11 times the odds of passing a post-test on patients relative to subjects that did not pass the simulator post-test ( P = 0.023, odds ratio = 11.0, 95% confidence interval [CI] = 1.48-81.6). Post-training confidence levels were higher among those who passed the simulator pre-test and post-test and received simulator training.

Conclusions:

Simulation training for difficult BMV led to a higher passing rate on a post-test on patients compared to those trained on patients. This finding will need to be confirmed in larger randomized controlled trials. Successfully completing difficult BMV training on a simulator with a passing grade correlated with passing a test on difficult BMV on patients.
Treat stroke to target trial design: First trial comparing two LDL targets in patients with atherothrombotic strokes
Authors: Amarenco Pierre , Kim Jong S , Labreuche Julien , Giroud Maurice , Lee Byung-Chul , Mahagne Marie-Hélène , Nighoghossian Norbert , Simon Tabassome , Steg Philippe Gabriel , Touboul Pierre-Jean , Vicaut Eric , Yelles Nessima , Bruckert Eric
Published: March 2019

Background

In patients with non-cardio-embolic stroke, atorvastatin 80 mg/day reduced the relative risk of recurrent stroke by 16%, and a post hoc analysis showed that achieving an LDL-c of less than 70 mg/dL reduced the relative risk by 28% as compared to an on-treatment LDL of 100 mg/dL or more. Current guidelines from the French drug agency recommend treating with a statin after an ischaemic stroke to a target of less than 100 mg/dL, but no study directly tested LDL-c targets. The Treat Stroke to Target (TST) trial will compare the efficacy of achieving an LDL-c of less than 70 mg/dL versus an achieved LDL-c of 100 ± 10 mg/dL for secondary prevention in patients with recent ischaemic stroke of atherosclerotic origin. Main hypothesis: An achieved on-treatment LDL-c of less than 70 mg/dL will reduce by 25% the risk of recurrent ischaemic stroke, myocardial infarction, urgent coronary or carotid revascularisation following new symptoms requiring hospitalisation, and vascular death compared with on-treatment LDL-c of 100 ± 10 mg/dL.

Design

Patients are randomised to either LDL-c levels, and the investigator who is not blinded can use the lipid-lowering agent of his/her choice available on the market (including statins and ezetimibe), in order to achieve the assigned LDL-c level. To be eligible for enrolment, patients have a recent ischaemic stroke or TIA of atherosclerotic origin with at least one arterial stenosis of a cerebral artery, enrolled between acute phase of the qualifying stroke (once the neurological deficit is stabilised) and three months. The initial planned sample size of 3760 participants followed three years was amended to allow follow-up of all enrolled patients until 385 primary efficacy outcome events have occurred, and no later than 31 December 2019. Patients will be recruited in 76 sites in two countries (France and South Korea) between March 2010 and December 2018 (last included patient followed up to one year). Safety outcomes will include haemorrhagic strokes and new onset diabetes. All primary endpoints will be adjudicated by an endpoint committee, blinded to the assigned LDL-c level. Two sub-studies assess (1) the relative effect of assigned LDL-c levels on occurrence of new atherosclerotic plaque as detected by carotid ultrasound during follow-up, using M’ATH software for repositioning and (2) the genetic and biomarker drivers of recurrent primary endpoints according to assigned LDL-c lowering arm, in atherosclerotic strokes.

The TST trial is evaluating the benefits of achieving an LDL-c less than 70 mg/dL for secondary stroke prevention in ischaemic stroke patients of atherosclerotic origin. Main results are anticipated in 2020 or earlier (ClinicalTrials.gov NCT01252875).
Perceived impact of contextual determinants on depression, anxiety and stress: a survey with university students
Authors: Othman Nasih , Ahmad Farah , El Morr Christo , Ritvo Paul
Published: March 2019

Background

Young adults starting college or university education encounter multiple stressors related to transitional life-stage and novel environments. Current studies reveal high rates of symptoms related to common mental health problems like depression, anxiety and stress. However, limited knowledge exists on the determinants on these problems among Canadian students. The primary aim of the study was to investigate the impact of contextual determinants, as perceived by students, on self-reported mental health, and how these impacts varied by depression, anxiety and stress.

Methods

A cross-sectional survey was conducted with students attending a large university in Toronto, Canada. Participants completed a self-administered online questionnaire as part of a larger project. The questions asked about contextual determinants related to personal, interpersonal, family, social, socio-economic and political factors along with levels of depression, anxiety and stress as measured by Patient Health Questionnaire-9, Beck Anxiety Inventory and Perceived Stress Scale.

Results

A total of 148 students completed the questionnaire (37 males and 111 females) with an age range of 19–54 years (median 22, IQR 21–24.8). English was reported as first language by 62.8% while 34.5% self-identified as white and 58.1% reported being born in Canada. Overall, 39.5% reported symptoms of moderate to severe depression, 23.8% reported moderate–severe anxiety and 80.3% reported moderate–severe levels of perceived stress, with no significant differences between males and females. In the final multivariate analysis, variables significantly associated with depression were grade-point-average (aOR 2.46, 95% CI 1.017–5.97), family factors (aOR 3.46, 95% CI 1.50–7.94), social factors (aOR 3.24, 1.30–8.1), self-rated health (aOR 0.34, 95% CI 0.14–0.82) and political factors (aOR 0.40, 95% CI 0.16–0.97). Anxiety was significantly associated with family factors (aOR 2.79, 1.09–7.18), socioeconomic factors (aOR 2.59, 95% CI 1.05–6.42) and age (aOR 0.33, 95% CI 0.11–0.98). The significant factors for stress were grade-point-average (aOR 2.41, 1.01–5.75) and social factors (aOR 3.87, 95% CI 1.59–9.43).

Conclusion

The study found strong to moderate impact of several determinants on depression, anxiety and stress. The results suggest a need to address a variety of factors affecting students’ mental health.

Trial registration Parent trial: http://www.isrctn.com/ISRCTN92827275
Externalities and Taxation of Supplemental Insurance: A Study of Medicare and Medigap
Authors: Cabral Marika , Mahoney Neale
Published: March 2019

Most health insurance uses cost-sharing to reduce excess utilization. Supplemental insurance can blunt the impact of this cost-sharing, increasing utilization and exerting a negative externality on the primary insurer. This paper estimates the effect of private Medigap supplemental insurance on public Medicare spending using Medigap premium discontinuities in local medical markets that span state boundaries. Using administrative data on the universe of Medicare beneficiaries, we estimate that Medigap increases an individual’s Medicare spending by 22.2 percent. We calculate that a 15 percent tax on Medigap premiums generates savings of $12.9 billion annually with a standard error of $4.9 billion. (JEL G22, H24, H51, I13, J14)
Was the First Public Health Campaign Successful?
Authors: Anderson D. Mark , Charles Kerwin Kofi , Olivares Claudio Las Heras , Rees Daniel I.
Published: March 2019

The US tuberculosis (TB) movement pioneered many of the strategies of modern public health campaigns. Using newly transcribed mortality data at the municipal level for the period 1900–1917, we explore the effectiveness of public health measures championed by the TB movement, including the establishment of sanatoriums and open-air camps, prohibitions on public spitting and common cups, and requirements that local health officials be notified about TB cases. Our results suggest that these and other anti-TB measures can explain, at most, only a small portion of the overall decline in pulmonary TB mortality observed during the period under study. (JEL H51, I12, I18, N31, N32)
Cooperation in Polygynous Households
Authors: Barr Abigail , Dekker Marleen , Janssens Wendy , Kebede Bereket , Kramer Berber
Published: March 2019

Using a carefully designed series of public goods games, we compare, across monogamous and polygynous households, the willingness of husbands and wives to cooperate to maximize household gains. Compared to monogamous husbands and wives, polygynous husbands and wives are less cooperative, one with another, and co-wives are least cooperative, one with another. The husbands’ and wives’ behavior in a corresponding series of inter-household games indicates that these differences cannot be attributed to selection of less cooperative people into polygyny. Finally, behavior in polygynous households is more reciprocal and less apparently altruistic. (JEL C93, D13, J12, O12)
Bridging the Intention-Behavior Gap? The Effect of Plan-Making Prompts on Job Search and Employment
Authors: Abel Martin , Burger Rulof , Carranza Eliana , Piraino Patrizio
Published: March 2019

The paper tests the effects of plan making on job search and employment. In a field experiment with unemployed youths, participants who complete a detailed job search plan increase the number of job applications submitted (by 15 percent) but not the time spent searching, consistent with intention-behavior gaps observed at baseline. Job seekers in the plan-making group diversify their search strategy and use more formal search channels. This greater search efficiency and effectiveness translate into more job offers (30 per cent) and employment (26 percent). Weekly reminders and peer support sub-treatments do not improve the impacts of plan making. (JEL C93, D91, J64, J68)
Stereotactic body radiotherapy to the prostate and pelvic lymph nodes: A detailed dosimetric analysis of a phase II prospective trial
Authors: Kishan Amar U , Tyran Marguerite , Weng Julius , Upadhyaya Shrinivasa , Lamb James , Steinberg Michael , King Christopher , Cao Minsong
Published: March 2019

Objective:

To evaluate the dosimetric ramifications of simultaneously irradiating the prostate and pelvic lymph nodes (PLNs) with a stereotactic body radiotherapy approach based on rigid registration to intraprostatic markers (IPMs).

Methods and materials:

Nineteen patients received concurrent SBRT to the prostate and PLNs on a phase II clinical trial. The translational and rotation shifts required for rigid registration to bony anatomy and changes in bladder and rectal anatomy were compared between patients with > 90% and < 90% coverage of the nodal clinical target volume (CTVN ) as drawn on fractional kilovoltage cone-beam CTs. Stepwise multivariable regression models evaluated relationships between these anatomical parameters and the change in V100%CTVN.

Results:

The average V100%CTVN per patient was 92.4 % (IQR, 90.2 – 96.4 %). For five patients (26.3%), the average was 85.0 % (IQR, 82.4–88.3 %). The left-right and superior-inferior translational shifts, sagittal rotational shift, and change in bladder volume were significantly different ( p < 0.05 for all via Student’s t-test). Changes in bladder height, left/right shift, superior/inferior shift, 3-D shift, and axial rotation as significant predictors of change in dosing of V100%CTVN.

Conclusion:

While simultaneous SBRT to the prostate and PLNs based on rigid registration to IPMs provides adequate PLN coverage in most instances, overall coverage may be lower than anticipated if anatomy is unstable. Careful evaluation of bladder filling on kV-CBCT before treatment may be the most practical method for estimating accuracy prior to treatment.

Advances in knowledge:

Simultaneous SBRT to the prostate and PLNs based on rigid registration to IPMs provides adequate PLN coverage in most instances.
CONTRIBUTION TO THE ARTIFICIAL MILK FEEDING OF LAMBS 3. Influence of the artificial milk composition on the production of heavy milkfed lambs
Authors: ΚΑΛΑΪΣΑΚΗΣ Π. , ΠΑΠΑΔΟΠΟΥΛΟΣ Γ.
Published: March 2019

Three kinds of artificial milk have been tried for the fattening of lambs Friesland X Chios and Friesland X Local breed of Attica for the production of heavy weight milk - lamb carcass (60 days old). They were the following: 1) Artificial milk made by the Agricultural college of Athens (total protein 37,5"/0 DM. fat 30'/n DM). 2) Ewelac (total protein 25,5% DM, fat 31%, DM) and 3) Ewelac enriched with hydrolyzed casein (total protein 37°/0 DM, fat 26°/0 DM), The milk substitutes were reconstituted to contain 20°/QDM. The liquid diets were offered individually two times per day (each time 600 g) at body temperature. Dry pelleted feed (630 S.U , 180 g D.P. per kg DM) and water were available after the 15th day. The quantities fed was adjusted to a total consumption of 7-8 kg DM per lamb. Results have shown that the artificial milk of commerce iEwelacj. supplied as above, produces in the case of Friesland X Local breed lambs satisfactory yields with final weight 18- 19 kg. Jn the case of lambs Friesland X Chios heavier weights are obtained (21 -22 kg) but the fattening conditions of the carcass is not satistactory. Enrichment of the artificial milk of commerce with hydrolysed casein does not prove to be worth while.
COMPARATIVE EVALUATION OF SIX SELECTIVE MEDIA FOR THE DETECTION AND ENUMERATION OF STAPHYLOCOCCUS AUREUS IN FOODS
Authors: ΑΛΜΠΑΛΑΣ Β.
Published: March 2019

Six selective media for the detection and enumeration of coagulase-positive staphylococci werl ctudied evaluated for their efficiency in the recovery and easy recognition of five strains of Staphylococcus aureus. They were Mannitol Salt agar (MS', Tellurite Polymyxine Egg Yolk agar (TPEY),Egg Yolk Azide Agar (EYAA), Egg yolk Tellurite Glycine Pyruvate Agar (ETGPA). Milk Salt Agar (MSA), in combination with Salt Egg Yolk Agar (SEYA), and Vogel-Johnson agar (VJ), after enrichement in Trypticase Soy Broth 10V» NaCl.The recovery of the used strains was evaluated in pure cultures and after inoculation in various foods. None of the tested media was proved to be the ideal one. The media TPEY, ETGRA. and EYAA were considered as the nost appropriate for the detection of S. aureus in foods. The selective ability of eash medium is greatly depended on the strain and the food involved The simultaneoue use of two selective media is suggested if that is possible.
SOME OBSERVATIONS ON THE PRODUCTION CAPACITY OF NATIVE MOUNTAIN SHEEP
Authors: ΚΑΤΣΑΟΥΝΗΣ Ν. , ΖΥΓΟΓΙΑΝΝΗΣ Δ.
Published: March 2019

The authors studied the meat performance of lambs produced in Greece from the mountain type native sheep as well as the ability of ewes to suckle two lambs together. It was observed that the milk yield was low, and the ewes could not suckle satisfactory twin lambs. On the other hand the meat yield of the lambs could not be increased on the basis of the nutrition improvement only, but an improvement of the genetic material by hybridization was necessary.
Genomic architecture differences at the HTT locus underlie symptomatic and pre-symptomatic cases of Huntington’s disease.
Authors: Salter Matthew , Powell Ryan , Back Jennifer , Grand Francis , Koutsothanasi Christina , Green Jayne , Hunter Ewan , Ramadass Aroul , Westra Jurjen , Akoulitchev Alexandre
Published: March 2019

Background:Huntington’s disease (HD) is a progressive neurodegenerative condition that causes degeneration of neurons in the brain, ultimately leading to death. The root cause of HD is an expanded trinucleotide cytosine-adenine-guanine (CAG) repeat in the “huntingtin gene” (HTT). While there is a rough correlation between the number of CAG repeats and disease onset, the development of clinical symptoms can vary by decades within individuals and little is known about this pre-symptomatic phase.

Methods:Using peripheral blood samples from HD patients and healthy controls we usedEpiSwitch™, a validated high-resolution industrial platform for the detection of chromosome conformations, to assess chromatin architecture in the immediate vicinity of theHTTgene. We evaluated chromatin conformations at 20 sites across 225 kb of theHTTlocus in healthy controls, verified symptomatic HD patients (CAG, n>39) and patients with CAG expansions who had not yet manifested clinical symptoms of HD.

Results:Discrete chromosome conformations were observed across the patient groups. We found two constitutive interactions (occurring in all patient groups) and seven conditional interactions which were present in HD, but not in healthy controls. Most important, we observed three conditional interactions that were present only in HD patients manifesting clinical symptoms (symptomatic cases), but not in presymptomatic cases. Of the patients in the symptomatic HD cohort, 86% (6 out of 7) demonstrated at least one of the specific chromosome conformations associated with symptomatic HD.

Conclusion:Our results provide the first evidence that chromatin architecture at theHTTlocus is systemically altered in patients with HD, with conditional differences between clinical stages. Given the high clinical need in having a molecular tool to assess disease progression in HD, these results strongly suggest that the non-invasive assessment of chromosome conformation signatures can be a valuable addition to prognostic assessment of HD patients.
Impact of Pharmacist‐led Discharge Counseling on Hospital Readmission and Emergency Department Visits: A Systematic Review and Meta‐analysis
Authors: Bonetti Aline F , Reis Walleri C , Mendes Antonio M , Rotta Inajara , Tonin Fernanda S , Fernandez‐Llimos Fernando , Pontarolo Roberto
Published: March 2019

BACKGROUND

Transitions of care can contribute to medication errors and other adverse drug events.

PURPOSE

The aim of this study was to evaluate the impact of pharmacist‐led discharge counseling on hospital readmission and emergency department visits through a systematic review and meta‐analysis.

DATA SOURCES

Electronic searches were performed in PubMed, Scopus, and DOAJ (Directory of Open Access Journals), along with a manual search (July 2017). PROSPERO registration no. CRD42017068444.

STUDY SELECTION

Two independent reviewers performed all the steps of the systematic review process (screening of titles and abstracts, full‐text appraisal, data extraction, and quality assessment), with contributions from a third researcher. We included randomized controlled trials (RCTs) reporting data on pharmacist‐led discharge counseling.

DATA EXTRACTION

Primary extracted outcomes were emergency department visits and hospital readmission rates.

DATA SYNTHESIS

Meta‐analyses of intervention versus usual care for hospital readmission and emergency department visit rates were performed using the inverse variance method. Results are reported as risk ratios (RRs) with 95% confidence intervals (CIs). Prediction intervals (PIs) were also calculated. Sensitivity and subgroup analyses were performed. A total of 21 RCTs were included in the qualitative synthesis and 18 in the meta‐analyses (n = 7,244 patients). The original meta‐analysis revealed a significant difference in the impact between pharmacist‐led discharge counseling and usual care on overall hospital readmission (RR = 0.864 [95% CI 0.763‐0.997], P = .020) and emergency department (RR = 0.697 [95% CI 0.535‐0.907], P = .007) visits. However, the small number of included studies, the high heterogeneity among trials (I2 between 40% and 60%), and the wide PIs (hospital readmission: PI 0.542‐1.186; emergency department visits: PI 0.027‐1.367) prevented drawing further conclusions.

CONCLUSIONS

Insufficient evidence exists regarding the effect of pharmacist‐led discharge counseling on hospital readmission and emergency department visits. Further well‐designed clinical trials with defined core outcome sets are needed.
Propriedades psicométricas de questionários de atividade física na adolescência: revisão sistemática
Authors: Campos Maria Cristine , Felicidade Cristiele de Aguiar , Aguiar Susana da Costa , Vieira Danielle Soares Rocha
Published: March 2019

O objetivo desta revisão foi recuperar e sumarizar os estudos que avaliaram as propriedades psicométricas (validade, confiabilidade e responsividade) de questionários utilizados para mensurar a atividade física (AF) em adolescentes. Trata-se de uma revisão sistemática realizada de acordo com o protocolo PRISMA. A busca foi realizada nas bases de dados: MEDLINE (via Ovid), CINAHL, LILACS, Cochrane, SciELO, PsycINFO, Web of Science e SPORTDiscus, utilizando descritores específicos. O risco de viés foi avaliado por meio do Checklist COSMIN. Foram incluídos 26 estudos na revisão e, destes, apenas cinco foram realizados no Brasil. A qualidade dos estudos variou de fraca a boa. Dos 25 questionários que foram avaliados quanto à confiabilidade teste-reteste, 11 apresentaram coeficientes de correlação intraclasse ≥ 0,70, incluindo o Questionário de Atividade Física para Adolescentes (QAFA). No que se refere à validade, apenas um dos 32 questionários avaliados quanto a esta propriedade apresentou coe ciente de correlação ≥ 0,70 e cinco apresentaram coe - cientes de magnitude moderada (0,56 a 0,69), sendo dois de nacionalidade brasileira. Porém, ambos foram comparados a medidas subjetivas de AF. A responsividade dos questionários não foi avaliada em nenhum dos estudos. Os questionários de AF incluídos nesta revisão apresentaram melhores índices de confiabilidade do que validade e não foram investigados quanto à sua responsividade. Esses resultados reforçam a necessidade de realização de novos estudos com qualidade metodológica mais adequada, que investiguem principalmente a validade e a responsividade desses instrumentos.
INTERCULTURALIDADE NA FORMAÇÃO DE PROFESSORES/AS INDÍGENAS: REFLEXÕES A PARTIR DE UM OLHAR SOBRE O PENSAMENTO AMERÍNDIO
Authors: Stumpf Beatriz Osorio
Published: March 2019

Este trabalho desenvolve reflexões sobre interculturalidade na formação continuada de professores indígenas, partindo de uma experiência desenvolvida na Amazônia brasileira, em diálogo com autores que contribuem para uma maior compreensão do pensamento ameríndio. O acompanhamento participativo e investigativo desse processo de formação revelou a riqueza e a profundidade do conhecimento indígena, com seus grandes potenciais de contribuição para a educação em geral e para a sociedade como um todo, ressaltando a importância do apoio ao registro desses saberes, em diferentes formas e linguagens, tendo a arte uma função essencial.