bluuebunny/crossref_metadata_2025 huggingface dataset:
Validity of QuickDASH at day of surgery versus day of initial consultation: Does informed consent make a difference?
Authors: Ikpeze Tochukwu C , Childs Sean , Buckley Taylor , Elfar John C
Published: May 2018

Introduction:

The trend toward requiring explicit consent from patients participating in observational research increases time and resources required to perform such research. Informed consent introduces the potential for “consent bias”—either through selection bias or through the “Hawthorne effect,” where patients may alter responses based upon the awareness of participation in a study, thus potentially limiting its applicability to a generalized orthopedic practice. We hypothesized that administering Quick Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) to patients on the day of surgery with informed consent would alter responses in a statistically and clinically meaningful way compared to patients who complete QuickDASH as a quality control measure.

Methods:

We previously instituted the QuickDASH questionnaire as the standard new patient intake and postoperative questionnaire for quality assurance purposes. We retrospectively reviewed data on a cohort of patients who underwent isolated carpal tunnel release (CTR) who had completed preoperative and postoperative QuickDASH forms without providing consent for study participation. Next, a cohort of patients scheduled to undergo isolated CTR who completed the intake questionnaire was approached on the day of surgery for consent to participate in the study. After obtaining consent but prior to surgery, these patients completed a second questionnaire and then completed a postoperative questionnaire on follow-up at a mean of 8 weeks postoperatively.

Results:

Thirty-nine patients and 35 patients were included in the retrospective and prospective cohorts, respectively. No significant differences were observed in age, gender, symptom duration, nerve conduction study/electromyography results, or disease severity between the two groups. We identified no statistically significant difference in preoperative or postoperative QuickDASH score between the retrospective and prospective cohorts (39.8 ± 22.7 vs. 39.7 ± 19.1 preoperatively; 27.3 ± 24.7 vs. 18.7 ± 13.3 postoperatively) or within the prospective cohort before and after obtaining informed consent.

Conclusion:

Informed consent did not significantly alter patient responses to the QuickDASH questionnaire. These results suggest that both “opt-in” and “opt-out” approaches to observational research in hand surgery provide results that may be applicable to a generalized orthopedic practice.

Clinical Relevance:

This study provides evidence that will inform the interpretation of observational research findings in hand surgery.
Application of Data Mining to “Big Data” Acquired in Audiology: Principles and Potential
Authors: Mellor Joseph C. , Stone Michael A. , Keane John
Published: May 2018

The ubiquity and cheapness of miniature low-power sensors, digital processing, and large amounts of storage contained in small packages has heralded the ability to acquire large amounts of data about systems during their course of operation. The size and complexity of the data sets so generated have colloquially been labeled “big data.” The computer science field of “data mining” has arisen with the purpose of extracting meaning from such data, expressly looking for patterns that not only link historic observations but also predict future behavior. This overview article considers the process, techniques, and interpretation of data mining, with specific focus on its application in audiology. Modern hearing instruments contain data-logging technology to record data separate from the audio stream, such as the acoustic environments in which the device was being used and how the signal processing was consequently operating. Combined with details about the patient, such as the audiogram, the variety of data generated lends itself to a data mining approach. To date, reports of the use and interpretation of these data have been mostly constrained to questions such as looking for changes in patterns of daily use, or the degree and direction of volume control manipulation as the patient’s experience with a hearing aid changes. In this, and an accompanying results paper, the practical applications of some data mining techniques are described as applied to a large data set of examples of real-world device usage, as supplied by a hearing aid manufacturer.
Feedback Quality Using an Observation Form
Authors: Beck Dallaghan Gary L , Higgins Joy , Reinhardt Adam
Published: May 2018

Background:

Direct observations with focused feedback are critical components for medical student education. Numerous challenges exist in providing useful comments to students during their clerkships. Students’ evaluations of the clerkship indicated they were not receiving feedback from preceptors or house officers.

Objective:

To encourage direct observation with feedback, Structured Patient Care Observation (SPCO) forms were used to evaluate third-year medical students during patient encounters.

Design:

In 2014-2015, third-year medical students at a Midwestern medical school completing an 8-week pediatrics clerkship provided experiences on inpatient wards and in ambulatory clinics. Students were expected to solicit feedback using the SPCO form.

Results/Findings:

A total of 121 third-year medical students completed the pediatrics clerkship. All of the students completed at least one SPCO form. Several students had more than one observation documented, resulting in 161 SPCOs submitted. Eight were excluded for missing data, leaving 153 observations for analysis. Encounter settings included hospital (70), well-child visits (34), sick visits (41), not identified (8). Observers included attending physicians (88) and residents (65). The SPCOs generated 769 points of feedback, comments coalesced into themes of patient interviews, physical examination, or communication with patients and family. Once themes were identified, comments within each theme were further categorized as either actionable or reinforcing feedback.

Discussion:

SPCOs provided a structure to receive formative feedback from clinical supervisors. Within each theme, reinforcing feedback and actionable comments specific enough to be useful in shaping future encounters were identified.
Energy Balance of Indian Villages: A Case Study of Seven Villages
Authors: Garg Amit , Chauhan Jaypalsinh , Chhabra Abha , Nag Tirthankar
Published: May 2018

This paper estimates the rural energy balance of 7 Indian villages of different agro-climate zones. This was done through primary survey of households in each village covering energy consumption, production, export, import and stock change across Crop, Livestock, Industry/Trade, Tree outside forest/plantations and Residential Sector. An energy flow model was created to capture all the various energy flows at household levels. Two villages are showing Negative annual energy balance—one is the desert village of Gujarat state and another is a tribal village of Mizoram state. All other villages were found to be energy positive mainly due to high forest density and high crop yields.
Research-to-Resource: Initial Steps in Vocal Technique for Boys Experiencing Difficulty With Phonation During the Adolescent Voice Change
Authors: Freer Patrick K.
Published: May 2018

This research-to-resource article reports pedagogical implications of several types of research literature. This literature collectively focuses on boys’ adolescent development, with specific attention to psychological and sociological implications on the teaching of vocal technique during the period of voice change. From this foundation, the concept of breath control is identified as a relatively stable process during adolescence, providing teachers and their students a beginning point for conversations about the developing voice and explorations of rudimentary vocal technique. This article describes a step-by-step process for approaching these pedagogical conversations and singing explorations.
Trends of testing for and diagnosis of α1-antitrypsin deficiency in the UK: more testing is needed
Authors: Soriano Joan B. , Lucas Sarah J. , Jones Rupert , Miravitlles Marc , Carter Victoria , Small Iain , Price David , Mahadeva Ravi
Published: May 2018

α1-antitrypsin deficiency (AATD) significantly increases the risk of developing chronic obstructive pulmonary disease (COPD), and testing of all COPD patients for AATD is recommended by the World Health Organization, European Respiratory Society and Global Initiative for Chronic Obstructive Lung Disease (GOLD). We aimed to determine trends for testing and diagnosing AATD from 1990 to 2014.

This study analysed all patients diagnosed with COPD from about 550 UK Optimum Patient Care Research Database general practices, including a subgroup of those diagnosed before the age of 60 years.

We identified 107 024 COPD individuals, of whom 29 596 (27.6%) were diagnosed before 60 years of age. Of them, only 2.2% (95% CI 2.09–2.43%) had any record of being tested for AATD. Of those tested, 23.7% (95% CI 20.5–27.1%) were diagnosed with AATD. Between 1994 and 2013 the incidence of AATD diagnosis generally increased. A diagnosis of AATD was associated with being male, being an ex-smoker, more severe COPD with a lower forced expiratory volume in 1 s % pred and higher GOLD 2017 stages (all p<0.05).

Despite an increase in the frequency of AATD testing since 1990, only 2.2% of patients diagnosed with COPD before the age of 60 years were tested. AATD prevalence was 23.7% in those tested. Thus, it appears that AATD remains markedly underdiagnosed in COPD patients.
The mucus bundles responsible for airway cleaning are retained in cystic fibrosis and by cholinergic stimulation
Authors: Ermund Anna , Meiss Lauren N. , Dolan Brendan , Bähr Andrea , Klymiuk Nikolai , Hansson Gunnar C.
Published: May 2018

The beneficial effect of anticholinergic therapy for chronic lung diseases such as chronic obstructive pulmonary disease (COPD) is well documented, although cholinergic stimulation paradoxically inhibits liquid absorption, increases ciliary beat frequency and increases airway surface liquid transport.

Using pig tracheobronchial explants, we quantified basal mucus transport before as well as after incubation with the clinically used antimuscarinic compound ipratropium bromide (Atrovent) and stimulation with acetylcholine.

As expected, surface liquid transport was increased by acetylcholine and carbachol. In contrast, the mucus bundles secreted from the submucosal glands normally transported on the cilia were stopped from moving by acetylcholine, an effect inhibited by ipratropium bromide. Interestingly, in pigs lacking a functional cystic fibrosis (CF) transmembrane conductance regulator (CFTR) channel, the mucus bundles were almost immobile. As in wild-type pigs, CF surface liquid transport increased after carbachol stimulation. The stagnant CF mucus bundles were trapped on the tracheal surface attached to the surface goblet cells.Pseudomonas aeruginosabacteria were moved by the mucus bundles in wild-type but not CF pigs.

Acetylcholine thus uncouples airway surface liquid transport from transport of the surface mucus bundles as the bundles are dynamically inhibited by acetylcholine and the CFTR channel, explaining initiation of CF and COPD, and opening novel therapeutic windows.
Reptin drives tumour progression and resistance to chemotherapy in nonsmall cell lung cancer
Authors: Mikesch Jan-Henrik , Schwammbach Daniela , Hartmann Wolfgang , Schmidt Lars H. , Schliemann Christoph , Angenendt Linus , Wiewrodt Rainer , Marra Alessandro , Thoennissen Nils H. , Wardelmann Eva , Köhler Gabriele , Lenz Georg , Müller-Tidow Carsten , Berdel Wolfgang E. , Arteaga Maria-Francisca
Published: May 2018

While targeted nonsmall cell lung cancer (NSCLC) therapies have improved the outcome of defined disease subtypes, prognosis for most patients remains poor. We found the AAA+ ATPase Reptin to be highly expressed in the vast majority of 278 NSCLC tumour samples. Thus, the objective of the study was to assess the role of Reptin in NSCLC.

Survival analyses of 1145 NSCLC patients revealed that high RNA expression levels of Reptin are associated with adverse outcome. Knockdown of Reptin in human NSCLC cells impaired growthex vivoand eliminated engraftment in a xenograft model. Reptin directly interacted with histone deacetylase 1 (HDAC1) as the critical mechanism driving NSCLC tumour progression. Pharmacological disruption of the Reptin/HDAC1 complex resulted in a substantial decrease in NSCLC cell proliferation and induced significant sensitisation to cisplatin.

Our results identify Reptin as a novel independent prognostic factor and as a key regulator mediating proliferation and clonal growth of human NSCLC cellsex vivoandin vivo. We unveil a Reptin/HDAC1 protein complex whose pharmacological disruption sensitises NSCLC cells to cisplatin, suggesting this approach for application in clinical trials.
Challenges and perspectives in obstructive sleep apnoea
Authors: Randerath Winfried , Bassetti Claudio L. , Bonsignore Maria R. , Farre Ramon , Ferini-Strambi Luigi , Grote Ludger , Hedner Jan , Kohler Malcolm , Martinez-Garcia Miguel-Angel , Mihaicuta Stefan , Montserrat Josep , Pepin Jean-Louis , Pevernagie Dirk , Pizza Fabio , Polo Olli , Riha Renata , Ryan Silke , Verbraecken Johan , McNicholas Walter T.
Published: May 2018

Obstructive sleep apnoea (OSA) is a major challenge for physicians and healthcare systems throughout the world. The high prevalence and the impact on daily life of OSA oblige clinicians to offer effective and acceptable treatment options. However, recent evidence has raised questions about the benefits of positive airway pressure therapy in ameliorating comorbidities.

An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field, and proposed topics for future research on epidemiology, phenotyping, underlying mechanisms, prognostic implications and optimal treatment of patients with OSA.

The group concluded that a revision to the diagnostic criteria for OSA is required to include factors that reflect different clinical and pathophysiological phenotypes and relevant comorbidities (e.g.nondipping nocturnal blood pressure). Furthermore, current severity thresholds require revision to reflect factors such as the disparity in the apnoea–hypopnoea index (AHI) between polysomnography and sleep studies that do not include sleep stage measurements, in addition to the poor correlation between AHI and daytime symptoms such as sleepiness. Management decisions should be linked to the underlying phenotype and consider outcomes beyond AHI.
The identification and appraisal of assessment tools used to evaluate metatarsus adductus: a systematic review of their measurement properties
Authors: Marshall Nicole , Ward Emily , Williams Cylie M.
Published: June 2018

Background

Metatarsus adductus is the most common congenital foot deformity in newborns. It involves adduction of the metatarsals at the Lisfranc joint. A systematic literature review was conducted to investigate the following question: What tools are used to identify and quantify metatarsus adductus and how reliable, valid and responsive are they?

Methods

The following electronic databases were searched for studies describing tools for the identification and quantification of metatarsus adductus in adults and children published from inception to June 2016: Ovid MEDLINE, Embase, CINAHL, Scopus, Web of Science and AMED. Two researchers initially searched all articles by screening titles and abstracts. If there was any doubt as to an article's eligibility, the full text paper was retrieved. Reference lists and citations of all retained studies were examined in an attempt to locate further studies. Articles were excluded if they were not in English or described other congenital foot conditions that did not include metatarsus adductus. Studies included in the review reporting measurement properties of measurement tools were critically appraised using the Consensus‐based Standards for the selection of health Measurement Instruments (COSMIN) critical appraisal tool.

Results

There were 282 articles screened by title and abstract and 28 articles screened from full text. Fifteen articles were included and nine had data that were extractable for appraisal using the COSMIN critical appraisal tool. Techniques to measure metatarsus adductus included the heel bisector method, photocopies, ultrasound, footprints, dynamic foot pressure and radiographs. There was a paucity of quality data reporting the reliability, validity or responsiveness for measuring metatarsus adductus. Several radiographic angles showed good reliability (intraclass correlation (ICC) – 0.84, 0.97) in adults during pre‐operative planning.

Conclusion

There have been multiple assessment techniques proposed for quantification of metatarsus adductus, but there is paucity of reliability, validity or responsiveness to measurement data about these techniques, especially in relation to the paediatric population. Further consideration of measurement testing is required to determine if the most common non‐radiographic measures of metatarsus adductus are acceptable for clinical use.
Time reversal for wave refocusing and scatterer detection using machine learning
Authors: Shustak Matan , Landa Evgeny
Published: May 2018

Conventional seismic migration and inversion are inherently limited in their ability to detect and characterize subsurface elements smaller than the seismic wavelength, such as faults, pinchouts, karsts, fractures, fluid contact, etc. However, those elements, playing an important role in seismic exploration and production, act as scattering objects, which can be effectively detected and positioned using the time reversal (TR) principle. We use TR to spatially localize subsurface sources in passive seismic scenarios and scatterers in active seismic surveys, both having the physical properties of a point diffractor. The method uses numerical back propagation of the time-reversed registered wavefield followed by an analysis of its obtained focusing, based on a supervised learning approach. In this novel approach, no imaging condition is applied. In addition, it does not require knowledge of the source wavelet and it accounts for multiple scattering. The usefulness of the method is demonstrated using synthetic and field examples.
Phased Reconnaissance Approach to Documenting Landslides following the 2016 Central Italy Earthquakes
Authors: Franke Kevin W. , Lingwall Bret N. , Zimmaro Paolo , Kayen Robert E. , Tommasi Paolo , Chiabrando Filiberto , Santo Antonio
Published: May 2018

The 2016 Central Italy earthquake sequence caused numerous landslides over a large area in the Central Apennines. As a result, the Geotechnical Extreme Events Reconnaissance Association (GEER) organized post-earthquake reconnaissance missions to collect perishable data. Given the challenging conditions following the earthquakes, the GEER team implemented a phased reconnaissance approach. This paper illustrates this approach and how it was used to document the largest and most impactful seismically induced landslides. This phased approach relied upon satellite-based interferometric damage proxy maps, preliminary published reports of observed landslides, digital imaging from small unmanned aerial vehicles (UAVs), traditional manual observations, and terrestrial laser scanning. Data collected from the reconnoitered sites were used to develop orthophotos and meshed three-dimensional digital surface models. These products can provide valuable information such as accurate measurements of landslide ground movements in complex topographic geometries or boulder runout distances from rock falls. The paper describes three significant landslide case histories developed and documented with the phased approach: Nera Valley, Village of Pescara del Tronto, and near the villages of Crognaleto and Cervaro.
Multidisciplinary Tool for Evaluating Strengthening Designs for Earthquake-Prone Buildings
Authors: Giaretton Marta , Egbelakin Temitope K. , Ingham Jason M. , Dizhur Dmytro
Published: May 2018

In many seismically active countries, there is a high level of earthquake risk because of the presence of large stocks of earthquake-prone buildings. The typically high cost of earthquake retrofit and the difficulties associated with satisfying the interests of multiple stakeholders within a meaningful time frame potentially result in building demolition as the default seismic risk reduction solution. The Heritage Evaluation Framework (HEF) is a multidisciplinary decision-making tool to guide proposed seismic retrofit design by gathering inputs from all project stakeholders and to evaluate a particular seismic retrofit design against client expectations. The performance of the HEF is demonstrated for two retrofit projects using input data acquired via interviews, site walkthroughs, and regular meetings with project teams and clients. Results show that the HEF accommodates conceptual designs and provides useful feedback while encouraging early multidisciplinary collaboration.
Generalized Response Spectrum Analysis for Structures with Dampers
Authors: Terazawa Yuki , Takeuchi Toru
Published: May 2018

In this study, a computational seismic design routine is proposed based on a generalized response spectrum analysis for highly indeterminate structures with energy-dissipation members, such as viscous or elasto-plastic dampers. Complex stiffness terms are introduced to account for displacement-dependent damping, and a three-dimensional (3-D) element stiffness matrix with complex axial stiffness is proposed for elasto-plastic dampers. A modified complete quadratic combination method previously developed for real symmetric damped systems is extended to complex asymmetric damped systems, based on a theoretical analysis of eigenvalue equations. The response is evaluated by iteratively conducting complex eigenvalue analysis and modal combination. The accuracy is confirmed through comparison to nonlinear response history analysis of 2-D frame models. Finally, an example application is presented of a 3-D truss tower seismically retrofitted by replacing the braces with viscoelastic and then elasto-plastic dampers. The proposed design routine is used to rapidly identify novel and efficient damper arrangements and sizing distributions, avoiding computationally intensive nonlinear response history analysis.
Treatment of Relapsed Myeloma in a Patient With Renal Insufficiency
Authors: Bladé Joan , Rosiñol Laura , Cibeira María Teresa , Fernández de Larrea Carlos
Published: May 2018

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice.

A 45-year-old man was diagnosed in March 2010 with stage III immunoglobulin G kappa multiple myeloma (MM) after presenting with bone pain as a result of multiple lytic bone lesions and T12 vertebral collapse. Laboratory work-up showed a serum M protein of 72 g/L and a 24-hour kappa light-chain urine protein excretion of 730 mg, hemoglobin of 10.2 g/dL, serum albumin of 49 g/L, serum β2-microglobulin of 6.4 mg/L, serum creatinine level of 1.6 mg/dL with an estimated glomerular filtration rate (eGFR) of 47 mL/min/1.73 m2, and normal serum calcium and lactate dehydrogenase (LDH) levels. His bone marrow contained 58% plasma cells, which showed the 17p deletion abnormality (Fig 1). He was treated with vertebroplasty and alternating chemotherapy with carmustine, vincristine, cyclophosphamide, melphalan, and prednisone and vincristine, carmustine, doxorubicin and dexamethasone. Because of progressive disease, salvage therapy with bortezomib and dexamethasone was administered with no response. The patient was then switched to lenalidomide and dexamethasone, which yielded minimal response. He underwent autologous stem-cell transplantation (ASCT) with melphalan 200 mg/m2 as high-dose therapy in February 2011, which led to a partial response, but in December 2011, progressive disease was documented, and the patient was enrolled in a clinical trial of carfilzomib monotherapy, with stable disease for 33 cycles. In October 2014 serum M protein rose to 38.6 g/L, with 24-hour kappa light-chain urine protein excretion of 840 mg, serum creatinine of 2.1 mg/dL, and an eGFR of 41 mL/min/1.73 m2. He presented to discuss ongoing treatment options.
The LDIFLARE and CCM Methods Demonstrate Early Nerve Fiber Abnormalities in Untreated Hypothyroidism: A Prospective Study
Authors: Sharma Sanjeev , Tobin Victoria , Vas Prashant R J , Rayman Gerry
Published: May 2018

Context

Recent studies using skin biopsy suggest presence of small-fiber neuropathy in subclinical hypothyroidism. This study uses two noninvasive methods—the laser Doppler imager flare technique (LDIFLARE) and corneal confocal microscopy (CCM)—to assess small-fiber function (SFF) and small-fiber structure (SFS), respectively, in newly diagnosed hypothyroidism (HT) before and after adequate treatment.

Design and Setting

Single-center, prospective, intervention-based cohort study.

Patients and Participants

Twenty patients with newly diagnosed HT (15 with primary HT and 5 with post-radioiodine HT) along with 20 age-matched healthy controls (HCs).

Interventions

Patients with HT and HCs were assessed neurologically at diagnosis and baseline, respectively. The HT group was reassessed after optimal replacement (defined as TSH level of 0.27 to 4.20 mIU/L) with levothyroxine (LT4) and HCs were reviewed after 1 year.

Main Outcome Measures

Neurologic assessment for small fibers was performed by using LDIFLARE for SFF and CCM for SFS; large fibers were studied by sural nerve conduction velocity (SNCV) and sural nerve amplitude (SNAP).

Results

At baseline, both LDIFLARE (mean ± SD) (6.74 ± 1.20 vs 8.90 ± 1.75 cm2; P = 0.0002) and CCM nerve fiber density (CNFD) (expressed as number of fibers per mm2: 50.77 ± 6.54 vs 58.32 ± 6.54; P = 0.002) were significantly reduced in the HT group compared with HCs whereas neither SNCV nor SNAP was different (P ≥ 0.05). After optimal LT4 treatment, both LDIFLARE (7.72 ± 1.12 vs 6.74 ± 1.20 cm2; P ≤ 0.0001) and CNFD (54.43 ± 5.70 vs 50.77 ± 6.54 no./mm2; P = 0.02) improved significantly but remained significantly reduced compared to HCs (P = 0.008 and P = 0.01, respectively) despite normalization of TSH.

Conclusions

This study demonstrates that dysfunction of small fibers precedes large neural fiber abnormalities in early HT. This can be reversed by replacement therapy to achieve a biochemically euthyroid state, but small-fiber neural outcomes continued to remain low compared with values in HCs.
Memory Dysfunction
Authors: Gliebus G. Peter
Published: June 2018

PURPOSE OF REVIEW

This article reviews the current understanding of memory system anatomy and physiology, as well as relevant evaluation methods and pathologic processes.

RECENT FINDINGS

Our understanding of memory formation advances each year. Successful episodic memory formation depends not only on intact medial temporal lobe structures but also on well-orchestrated interactions with other large-scale brain networks that support executive and semantic processing functions. Recent discoveries of cognitive control networks have helped in understanding the interaction between memory systems and executive systems. These interactions allow access to past experiences and enable comparisons between past experiences and external and internal information. The semantic memory system is less clearly defined anatomically. Anterior, lateral, and inferior temporal lobe regions appear to play a crucial role in the function of the semantic processing system. Different but tightly interconnected cortical regions, such as the prefrontal region, may play a controlling role in this system. The presentation of clinical disease affecting memory is the result of the selective vulnerability of the memory system. An understanding of current concepts of memory anatomy, physiology, and evaluation plays a central role in establishing an accurate diagnosis.

Different memory systems rely on separate but overlapping distributed brain networks. Certain pathologic processes preferentially affect memory systems. An understanding of memory formation stages will enable more accurate diagnosis.
Economic Liberalization in India: Economic Contributes and Social Consequences
Authors: R Mohanraj
Published: June 2018

The experience of economic liberalisation began to be felt by every co­mmon person in India during the mid 90s.The effects, however, were not uniform. It had a number of resultant outcomes depending upon the variables in the respective situations. The effects, for example, on rural and urban lives, were different. The receiver-benefits by the 'haves' and 'have-nots' were not the same. The economic liberalisation had two broad economic contributes to the people in India: emergence of monetary economy over and above other forms of economies, and increase in the options and opportunities for livelihood. The social con­sequences of economic liberalisation could be seen in the three main constituents of the social system: the individual, the family and the community. And the consequences are not all very encouraging.The paper argues that identifying change is the first step towards managing change and acknowledging change is a precondition for effective change management. Identifying and acknowledging the social consequences of economic liberalisation is most likely to help in the continuation of interventions that are needed for the constructive strengthening of the social order of society
Editorial
Authors: Team Editorial
Published: June 2018

Editorial
The Impact of Attachment Styles on Social Competence of Adolescent Students
Authors: Sujan Kumar D M , Raj S John Michael
Published: June 2018

Attachment styles are indispensable elements in evoking human behavior. Precious and priceless social relations or social behavior of every individual is ever more determined by these styles only. Adapting to positive well-being at home, school and peer adjustments are the essential social capabilities expected from the adolescents in order to have effective behavior potentials. Mostly, accomplishments and achievements of academic pursuits of adolescents seem to get initiated by the affectionate bond they receive either from their parents or from their caretakers. Hence, the current study seeks to sketch the probable link between attachment styles on the social competence of the adolescent students. Here, sample consists of 1152 male and 1188 female adolescent students. The Attachment Styles Questionnaire and The Adolescent Social Competence Scale were used to collect relevant data. Suitable statistical analyses were adopted for analyzing the data. The findings showed that the attachment styles seem to persuade the social competence of the adolescent students.
Identity and the Ethics of Tolerance
Authors: Geels Antoon
Published: June 2018

Our self-image is constructed in the interplay between man and culture. Religious traditions play a key role in this interplay; myths create meaning to the individual and to society at large. Sacred narratives provide man with patterns of behavior, how life should be lived. The other side of the picture is that identity and integrity may lead to intolerance, a dividing line between them and us: the most serious obstacle to peace and intercultural understanding. Religions can reinforce strong feelings of humiliation, of being a victim. This, in turn, may lead to the splitting of humanity into good and evil; one group demonizes the other. This coupled with an idealized, wrathful and punitive deity or leader may lead to violence, and violence is sanctified. Religion may encourage feelings of humiliation, but it can also deliver an antidote. There are theological resources that can counter terror and violence. A merciful and compassionate God can replace a wrathful and punitive deity. A stage of faith known as gerotranscendence is characterised by “an increasing feeling of belonging to the universe”. Representatives of ‘glocal’ spirituality reject claims of exclusivity. A glocal perspective is crucial. What we need today is that a greater number of spiritual leaders stand up and insist on values that touch upon the sanctity of life.
Grotesque Realism in O.V Vijayan’s The Saga of Dharmapuri
Authors: Thaliath Maria Rajan
Published: June 2018

The Saga of Dharmapuri by O.V. Vijayan is a dystopian fantasy set in the imaginary country of Dharmapuri, which could be a depiction of India or any other newly independent country in the post-colonial era. Mikhail Bakhtin in his treatise Rabelais and his World (1965) justifies the use of Grotesque Realism, a literary trope that allows the author to move away from the conventions of propriety and decency to convey messages that are real and powerful nevertheless. Usually exaggeration and hyperbole are key elements of this style. Through the centuries, literature has often been a medium through which contemporary concerns have been transmitted. This paper argues that O.V. Vijayan uses Grotesque Realism in his novel to depict the political, social and economic condition of India of the 1970s- specifically a country that was under emergency. Like all dystopian fables, The Saga of Dharmapuri has been prophetic in anticipating some of the social issues that we face even today. The paper aims at examining how Vijayan uses explicit language and scatological and sexual imagery so as to achieve this sense of realism within his novel.
The Analysis of the International Climate Change on Environmental Justice
Authors: Xueqin Wu , . Chengping
Published: June 2018

Since the Club of Rome published "Limits to Growth" in 1972, the environmental problems have caused the attention of people around the world and become a global issue. The international community has also organized special meetings to promote the study of environmental issues. One of the most important meetings is the United Nations Conference on Environment and Development, held every year since 1972. The most important issue is on how to deal with climate change, which has become an international mainstream issue. From the perspective of the environmental justice, the following is a brief analysis of the negotiations on international climate changes, based on the opportunities of the 2009 Copenhagen Summit, the 2010 Cancun Summit and the 2011 South Africa Bender Climate Summit.
Infrastructural Determinants of Tourism in India
Authors: Ayyappan Suraj V , Kumar  P Santhosh
Published: June 2018

This paper investigates the significance of infrastructure as a factor in destination development. The classical demand for international tourism function is extended to include a proxy for infrastructure. An application involving India is presented whereby total tourist arrivals as well as arrivals from Europe/America, Asia and Africa are modeled. The findings show that tourists are sensitive to the infrastructure of India, particularly those from Europe/America and Asia. Tourism infrastructure, income of tourists, distance, and relative prices are important ingredients in their own respect in the tourism demand equation
Editorial
Authors: Thomas Joby
Published: June 2018

Atna, Journal of Tourism Studies (AJTS) has offered a platform for the publication of quality articles on research and learning in tourism over the years, thus reading out to researchers and professionals in the field. The Journal has continued to make serious inroads to understand the varied aspects and issues related to the study of tourism. Scholars, with the submission of excellent articles and reviewers through their critical feedback have helped to enhance the quality of the articles published. We are grateful to all authors and reviewers for helping AJTS to build a quality journal among the travel and tourism community in our country. The scholarly contributions featured in the current issue range across such wide areas, as Tourism Development, Local Community and Tourism, Coastal Tourism, Human Resource Management in Tourism, Tourism Management and Heritage Tourism. “A Study on Creation and Development of Wine Tourism Circuits in Maharashtra, by Anupama Kotur Kaddi examines the most important considerations for the creation of wine tourism circuits and analyses the opinions of wine tourism service providers on the creation and development of wine tourism circuits in the wine regions of Maharashtra. Local Community Involvement in Tourism: A Content Analysis of Websites of Wildlife Resorts, by Nagarjuna G reports on the various activities and practices adopted by wildlife resorts for the development of the local community. “Sustainable Coastal Tourism: A Community Perspective,” by Joseph P D and Pakkeerappa P examines the indicators of coastal sustainability from the perspective of the local community along the selected beaches of Dakshina Kannada.  Cheryl Venan Dias and Venan Bonaventure Dias try to identify the human resource issues which are prevalent in the micro, small and medium travel, tourism and hospitality enterprises in their article “A Shift from Work-Life Balance to Work-Life Choices: A Study on Tourism Professionals in Goa”.
A Shift from Work-Life Balance to Work-Life Choices: A Study on Tourism Professionals in Goa
Authors: Dias Cheryl Venan , Dias Venan Bonaventure
Published: June 2018

Work-life balance is passé, enter work-life choices. But the next question arises, is this concept applicable to every working individual? Goa is predominantly a tourist destination, which thrives on inbound tourism through its extensive dependency on chartered flights, EDM festivals and as a wedding destination. However this study focuses on career oriented men and women, as well as entrepreneurs who work for the tourism industry in Goa. Their focus is on providing travel solutions in terms of visa assistance, booking air travel, planning itineraries. In a nutshell their orientation is towards outbound travel. These individuals have also made some serious choices in life to achieve what they wanted in their professional front. The study tries to identify the human resource issues that are prevalent in the micro, small and medium enterprises that they work with. This also calls for defining the term small and medium tourism enterprises (SMTE). Issues may be translated into remuneration, ethical aspects, relocation, and working hours. The survey responses will reveal the work-life choices made in their business or career.
Hotel Industry Strategies for Entrepreneurship
Authors: Ghosh Jyotirmoy , Anjaneyaswamy G
Published: June 2018

Few industries have such an attraction for those who want to own their own business as hotel keeping and catering. It has about it glamour and holds out the promise of considerable personal and financial satisfaction. The glamour certainly exists. There is something intensely theatrical in running a hotel or restaurant, where new and often surprising events occur every day, bringing the owner into contact with people from many different walks of life, some of them famous. And there are numerous examples of inexperienced businessmen who have come into the industry, ventured in their own hotel and gained for themselves a happy and secure future.
Ecotourism and Community Involvement: Challenges and Strategies
Authors: P D Joseph , Pakkeerappa P
Published: June 2018

Tourism has emerged as the global industry and has been playing a leading role in the all-round development of any country. A planned and sustained development of tourism industry in the form of 'Ecotourism' or 'Responsible Tourism' would lead the country to everlasting prosperity in all aspects. Intensive care should be given in developing tourism in the respective areas to maximize output and minimize the bad impacts.The co-operation and participation of local community is of great significance to all industries especially tourism industry since it deals with the people of different regions, languages, cultures etc. But it is equally difficult to elicit the encouragement, co-operation and support from the local community in developing ecotourism effectively.The major objective of this article presents the role of local communities in promoting ecotourism in any region. The authors have portrayed the emerging challenges to be faced in developing ecotourism and suitable strategies have been suggested to overcome the challenges.
Heritage Walks as a Tool for Promoting Sustainable Historical Tourism
Authors: Thomas Joby
Published: June 2018

Historical sites have always been popular attractions for both domestic and international tourists. Most of the tourists who visit the countries other than their own are often interested in the historical importance of the place. The cultural heritage of an area is expressed in its historical resources. Many tourist destinations are devoted to history. The preservation of history, the quality and management of museums are of most importance for successful tourism. Heritage monuments are important tourist attraction in cultural tourism. Heritage sites are products or, perhaps, constructions of history; they owe distinctiveness to the past. That distinctiveness remains recognizable but is often presented in new ways. The Cultural expressions of these monuments constitute potential learning and recreation resources. These resources, coupled with heritage, contribute to the richness of any landscape, which can attract innumerable tourists looking for the "cultural experience Cultural tourism is perhaps the fastest growing sector of the industry today and thus its potential is yet to be fully tapped. This article looks at the new and upcoming area of heritage walks as a component of sustainable urban cultural tourism. It highlights the growing area of heritage tourism and its relevance in context of India. It also explains the concept of heritage walks and its various versions in different cities of the world. Historical resources when presented properly will not only educate tourists but also the local community and helps in conserving it for future generations. They will help the younger generations to appreciate the past and also encourage the study of history. It also shows how walks could be used as field trips to educate students about the subject. The study included opinions from students of different disciplines, history teachers and corporate in order to gauge their potential interest in heritage walks. The findings suggest that heritage walks can be harnessed to give a different perspective of history to the discerning traveler and the local community while giving a boost to sustainable tourism practices in the area.
A Study on the Gap Areas in Ecotourism Planning, Policy Implications and Initiatives in Kerala
Authors: Mathew Ravish , Chandran Anu
Published: June 2018

It is an unvarnished fact that Ecotourism is a niche segment in God's own Country, which is ardently subscribed by tourists from across the globe. Kerala boasts of rich, diverse and potent natural resources ideally suited for ecotourism promotion. The positive attributes of ecotourism was realized by destination planners and designers of the state, especially its remarkable potential to foster sensitivity towards the environment. The accentuation of eco tourism in Kerala is credited with numerous beneficial impacts for tourists, host communities and environments including conservation, promotion of positive environmental ethics, sustainable development opportunities, environmental education(which is the central characteristic of eco tourism,) and revenue to the government that helps to implementmanagement protection systems. Kerala has pioneered novel concepts and practices in the realm of tourism and in the process, this renowned tourist destination was showered with accreditations from numerous global institutions and agencies. It obviously mattered a lot when the state drafted an ecotourism policy, clearly stream lining the action plan. Then mala an idyllic tourist spot situated in southern Kerala is recognized as the first planned ecotourism destination in India. It also bagged several international awards including the coveted PATA award for the best eco tourism project. Similar projects were incepted and EIA's were conducted across the eco tourism spots as an off shoot of the Policy decisions. Yet, the eco tourist destinations in the state experience certain travails that pose constraints in the smooth operation of eco tourism. This paper elucidates on those factors both tangible and intangible that create hurdles in the path of sustainable eco tourism promotion in Kerala. The effort is directed to bring to light the grey areas that fail the eco tourism goals. The nuances of eco tourism planning are studied in this work with reference to the major recognized eco tourism destinations of Kerala and the efficiency of ecotourism projects. A model is also proposed in the study on pragmatic ecotourism management in the Kerala context.
Public committees and corporatism: How does Iceland compare to Scandinavia?
Authors: Óskarsdóttir Stefanía
Published: May 2018

This paper compares the number of corporatist public committees, appointed by central government, in Iceland and Scandinavia (Denmark, Norway, Sweden). Its main aim is to shed light on where Iceland stands compared to these countries in term of corporatist practices. Scholars view corporatist public committees as the core expression of Scandinavian corporatism and thus well suited for the measurement of corporatism. This study shows that the functional representational channel is an important feature of Icelandic democracy. In Iceland various interest groups are integrated into the democratic process of decision-making and implementation in an institutionalized and privileged manner. This is the essence of corporatism, defined as the institutionalized and privileged integration of organized interests in the preparation and/or implementation of public policies. Moreover, the results show that Iceland is today much more corporatist than the Scandinavian countries; especially, in terms of preparatory corporatism. Already in 1970, it appears that Iceland was more corporatist than Sweden in terms of the number of corporatist committees. The paper also sheds light on sectoral corporatism in Iceland.
The Icelandic news media in times of crisis and change
Authors: Jóhannsdóttir Valgerður , Ólafsson Jón Gunnar
Published: May 2018

The news media around the world has experienced drastic changes in recent decades, and the Icelandic media is no exception. These changes originate in political, economic and not least technological developments. In this article we map key developments in the Icelandic media system and illustrate the changes it has undergone in the first decades of the 21st century. Journalism and media studies are under-researched fields of study in Iceland, and the country is usually absent from comparative work in these fields. Often it is simply grouped together with the other four Nordic countries. We argue that the Icelandic media system differs from those countries in several ways. Whilst it has moved towards the liberal model there are also indications of increased partisanship in the media in the last decade. The smallness of the media system has made it more vulnerable to the increasing competition and commercialisation in the digital era, and Iceland was particularly badly hit by the financial crisis in 2008. News media companies in Iceland are struggling financially, several media outlets have come and gone, mergers have been frequent and trust in the media is low. The view that some sort of public support is required to secure an independent media and high-quality journalism is gaining ground in Iceland. This could lead to its media system becoming more similar to the democratic corporatist Nordic countries than is the case now.