bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Financial Development Promote Industrial Production in Pakistan? Evidence from Combined Cointegration and Causality Approach
Authors: Ahad Muhammad , Dar Adeel Ahmad , Imran Muhammad
Published: April 2019

This study investigates the impact of financial development on industrial production from 1972 to 2014 in Pakistan. We use the Bayer and Hanck (2013, Journal of Time Series Analysis 34(1), 83–95,) combined cointegration technique to predict the long-run relationship between financial development, saving and industrial production. The results predict three cointegration vectors which confirm the existence of a long-run relationship between underlying variables. The empirical evidence shows a positive impact of financial development and savings on industrial growth in the long run as well as in the short run. The result of the VECM (Vector Error Correction Model) Granger causality confirms the bidirectional causality between financial development and industrial production in the long run. The variance decomposition approach shows that financial development has major contributions in explaining industrial production. The impulse response function also confirms the results of variance decomposition. This research opens new insights for policymaking.
Beyond psychiatry: motivations for considering an Australian wellbeing program within Malaysian health services
Authors: Silim Umi Adzlin , Suhaimi Aida Farhana , Moore Gaye , Ryan Brigid , Castle David J
Published: April 2019

Objectives:

To explore the relevance and adaptability of the Optimal Health Program for mental and primary healthcare providers in Malaysia.

Methods:

Evaluate stakeholder engagement and training programme for psychiatrists, family medicine specialists, public health specialists, physicians, clinical psychologists, counsellors, and representatives from a patient support group. Evaluate the programme for applicability, as well as participant’s knowledge and confidence in using key components.

Results:

The training was very well received in terms of content, training materials and facilitation style. Development of culturally specific materials will be needed. Improvement in the self-rating measurement for knowledge and confidence in using key Optimal Health Program components was reported at the completion of the 2-day training.

Conclusions:

The Optimal Health Program has potential as a comprehensive socio-culturally responsive self-management programme that is relevant within mental health services and adaptable for task-sharing of mental health care in Malaysia.
Organizational Aspirations and External Venturing: The Contingency of Entrepreneurial Orientation
Authors: Titus Varkey , Parker Owen , Covin Jeffrey
Published: April 2019

We contribute to the organizational aspirations and corporate venturing literature by theorizing and testing (a) the influence of a firm’s idiosyncratic strategic posture on behavioral responses to performance attainment discrepancies, and (b) that performance feedback may influence multifaceted yet thematically related forms of search. Specifically, we examine the influence of performance feedback on equity-based external corporate venturing. We then propose that a firm’s entrepreneurial orientation (EO) is a critical contingency when theorizing about how firms respond to attainment discrepancies. Our findings indicate that a firm’s EO is an important contingency when considering behavioral responses to attainment discrepancies.
A Practical Guide to Queering the Adult English Language Classroom
Authors: Rhodes Christy M.
Published: April 2019

There are few places more open and inclusive than an adult English language class. Or, are there? Although adult educators teaching in these multi-cultural and linguistically heterogeneous environments use practices designed to embrace their students’ diverse ethnic and linguistic identities, they less frequently incorporate practices to be inclusive of another important element students bring into the classroom, their sexual identity. Evidence suggests that while educators want to be inclusive, they are reluctant or unsure of how to do so. The purpose of this article is to supply English language teachers of adults with strategies to positively address sexual identity in ways that establish an inclusive environment for all learners.
Maintenance of Professional Boundaries and Family Involvement in Residential Aged Care
Authors: Omori Maho , Baker Courtney , Jayasuriya Jude , Savvas Steven , Gardner Anastasia , Dow Briony , Scherer Sam
Published: April 2019

The importance of family’s involvement in care planning has been stressed to cater individualized, person-centered care in residential aged care. However, in reality, there are numerous structural obstacles and barriers that limit opportunities for their involvement. The aim of this article is to explore what they are. The findings based on the 12 focus groups, six groups of care professionals and six groups of family/relatives, reveal that the narrow pathway of communication between staff and families, which is hierarchically structured, one-directional, and clinically driven, enables the former to maintain and control professional boundaries between formal and informal care-giving. Such communication style delimits an opportunity for families to engage in quality discussion about care planning for their loved ones with care staff. Communication within residential aged care facilities embodies complex dynamics of care expectations and responsibilities held by care staff and families.
Mobile Health Apps: Improving Usability for Older Adult Users
Authors: Morey Stephanie A. , Stuck Rachel E. , Chong Amy W. , Barg-Walkow Laura H. , Mitzner Tracy L. , Rogers Wendy A.
Published: April 2019

With smartphone use among older populations on the rise, older adults have increased access to health-focused mobile apps. Despite their potential benefits for managing health, currently no guidelines exist for designing these apps specifically for older adult users. We evaluated the usability of one medication management app and two congestive heart failure management apps using cognitive walkthroughs, heuristic analysis, and user testing. We identified design issues that may affect usability for older users, including poor navigation, small button sizes, and inadequate data visualizations. We provide guidelines for developers of health apps to facilitate use by older adults.
Democracy and Compulsory Voting
Authors: Volacu Alexandru
Published: April 2019

In this article I aim to show that compulsory voting cannot be defended on democratic grounds. In pursuing this task, I first offer a generic account of the democratic argument in favor of compulsory voting, drawing on some of the most salient recent defenses of a moral duty to vote. I then offer an overarching objection that defeats both the generic form of the democratic argument for compulsory voting and its various operationalizations. The crux of the objection is that the democratic justification of a moral duty to vote is parasitical upon the existence of a moral duty to vote well. This decisively undermines the democratic argument for compulsory voting, since the latter can only be deployed as an enforcement mechanism for a duty to vote, regardless of the substantive content of that vote.
Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot
Authors: Lufrano Reuben , Nies Matt , Ebben Beau , Hetzel Scott , O’Toole Robert V. , Doro Christopher J.
Published: April 2019

Background:

Treatment of compartment syndrome of the foot with fasciotomy remains controversial because of the theoretical risk of infection and soft tissue coverage issues. The purpose of this study was to evaluate the efficacy of compartment decompression with dorsal dermal fascial fenestration compared with fasciotomy in a cadaveric foot compartment syndrome model. We hypothesized that fasciotomies and dorsal dermal fenestrations would provide equivalent compartment decompression.

Methods:

Intracompartmental pressure was monitored in the first dorsal interosseous (FDIO), abductor (ABD), and superficial plantar (SP) compartments of 10 fresh frozen cadaveric limbs. A compartment syndrome model was created. Pressure measurements were obtained after dorsal dermal fascial fenestrations and after formal fasciotomies. Primary outcome variables were intracompartmental pressure in the FDIO, ABD, and SP compartments for 4 specific conditions: (1) baseline pressure, (2) pressure after compartment syndrome, (3) pressure after dermal fascial fenestrations, and (4) pressure after fasciotomies.

Results:

Fasciotomies decreased compartment pressures to within 10 mm Hg of baseline in all compartments ( P < .001). Compared with fasciotomies, dorsal dermal fascial fenestrations decreased the average pressure only in the FDIO compartment. Pressure decreases after fasciotomies compared with dorsal dermal fascial fenestrations were significantly greater ( P < .005).

Conclusion:

Fasciotomies were more effective than dorsal dermal fascial fenestrations at decreasing intracompartmental pressure. It seems that dermal fascial fenestrations were unable to provide effective decompression of the ABD and SP compartments of the foot and could provide only partial decompression of the dorsal compartments.

Clinical Relevance:

The findings of this study indicate the need for caution in using fenestrations alone to treat acute compartment syndrome of the foot.
Impact of Cine Frame Selection on Quantitative Coronary Angiography Results
Authors: Ito Shigenori , Kinoshita Kanako , Endo Akiko , Nakamura Masato
Published: April 2019

We evaluated intra- and interobserver variability of quantitative coronary angiography (QCA) due to cine frame selection for 9 coronary stenoses. The projection was selected in advance. Cine frames were selected by 2 blinded experts (blind frame QCA) followed by assignment by supervisor (pre-selected frame QCA). Each expert analyzed 18 frames twice with a 3-month interval. A total of 72 measurements by 2 experts were used for intra- and interobserver variability analysis in calibration factor (CF), minimal lumen diameter (MLD), percent diameter stenosis (%DS), interpolated reference diameter (Int R), and lesion length (LL). Accuracy, precision, and coefficient of variation (CV) were calculated based on 2 measurements. For interobserver variability, intraclass correlation coefficient (ICC) was evaluated. Regarding intraobserver variability, precision (CV) was 0.0026 (1.45), 0.220 (25.1), 0.282 (11.0), 7.626 (11.8), and 4.042 (28.7) for blind frame QCA and 0.0044 (2.46), 0.094 (11.2), 0.225 (8.6), 3.924 (5.9), and 1.941 (12.1) for pre-selected frame QCA and regarding interobserver variability, precision (CV) was 0.0037 (2.09), 0.271 (31.8), 0.307 (11.9), 10.10 (15.4), and 5.121 (39.5) for blind frame QCA and 0.0050 (2.82), 0.098 (11.4), 0.246 (9.5), 5.253 (8.0), and 2.857 (19.0) for pre-selected frame QCA in CF, MLD, Int R, %DS, and LL, respectively. Intraclass correlation coefficient of Int R was almost perfect in blind and pre-selected frame QCA. Intraclass correlation coefficient of MLD, %DS, and LL were substantial/lower by blind frame QCA and improved to almost perfect by pre-selected frame QCA. Blind cine film selection might affect intra- and interobserver variability, especially in MLD and LL. In the multiple linear regression analysis, blind frame QCA was selected as an explanatory factor of QCA variability in MLD, %DS, and LL. The error range due to frame selection must be taken into consideration in clinical use.
Physical Exercise for Individuals with Hypertension: It Is Time to Emphasize its Benefits on the Brain and Cognition
Authors: Rêgo Maria LM , Cabral Daniel AR , Costa Eduardo C , Fontes Eduardo B
Published: April 2019

Hypertension affects more than 40% of adults worldwide and is associated with stroke, myocardial infarction, heart failure, and other cardiovascular diseases. It has also been shown to cause severe functional and structural damage to the brain, leading to cognitive impairment and dementia. Furthermore, it is believed that these cognitive impairments affect the mental ability to maintain productivity at work, ultimately causing social and economic problems. Because hypertension is a chronic condition that requires clinical treatment, strategies with fewer side effects and less-invasive procedures are needed. Physical exercise (PE) has proven to be an efficient and complementary tool for hypertension management, and its peripheral benefits have been widely supported by related studies. However, few studies have specifically examined the potential positive effects of PE on the brain in hypertensive individuals. This narrative review discusses the pathophysiological mechanisms that hypertension promotes in the brain, and suggests PE as an important tool to prevent and reduce cognitive damage caused by hypertension. We also provide PE recommendations for hypertensive individuals, as well as suggestions for promoting PE as a method for increasing cognitive abilities in the brain, particularly for hypertensive individuals.
A wear model for subrough surface contacts of martensitic steels
Authors: Suslov Anatoliy G , Shalygin Mikhail G
Published: April 2019

This article includes an analysis of techniques for determining wear of contact areas to show two lines of wear research – due to deformations and adhesion forces. It has been established that surface subroughness is not presently taken into account in calculations of wear despite the fact that this surface property is of increasing research interest. The paper aims to develop a mathematical model of wear for subrough surface contacts in the context of deformation and theories of adhesion. Mathematical wear modelling for subrough surfaces is based on studies on causes of their formation due to phase and structural heterogeneity of the material. The article considers contact interaction at the level of surface subroughness; physics of interaction of contact areas at the level of surface subroughness; a mathematical model of deformation and adhesive wear for subrough surface contacts of martensitic steels; some analytical dependences of the theoretical model for a body-centred tetragonal lattice. Analysis of the theoretical concepts shows that wear of subrough surface contacts depends largely on the deformation component, while the adhesive component is significant only during the ‘bedding-in’ period for a friction couple. The materials of the article can be used to calculate the wear for contact areas at the level of surface subroughness.
The Political Is Personal: The Importance of Affective Narratives in the Rise of Poly-activism
Authors: Cardoso Daniel
Published: April 2019

There is a considerable gap on how social movements that center around non/monogamies decide to organize and articulate their strategies, as well as how they manage their tensions with other activist groups and ideologies or even the State. In addition to this, the fact that much of the literature that circulates is written in English and in an Anglophone context, hampers the ability of researchers to come into contact with other experiences of non/monogamies. This article gives a situated account of the rise of the Portuguese polyamorous social movement and shows how interpersonal relationships fundamentally shape the way activism is performed, and how archives are also important in establishing the identity of activists and activist groups. Using data from the Portuguese polyamorous group PolyPortugal, and interviews with high-profile activists, I argue that the idea of a politics of relating (the politicized analysis of how we connect and perform a given ethics of connection) is a conceptually useful tool to think about the transformations of contemporary intimacies, but it is also fundamental to think about how activism is done by people and for people – people who relate to one another, who exist in tension.
“Becoming an expert in driving for Uber”: Uber driver/bloggers’ performance of expertise and self-presentation on YouTube
Authors: Chan Ngai Keung
Published: April 2019

There is a new cast of self-proclaimed experts offering “how-to-succeed” resources aimed at coaching and inspiring gig workers. The emergence of such resources raises questions about the performance of expertise regarding the workings of algorithmic labor platforms. This article examines how Uber driver/bloggers—workers who are driving for Uber, while also creating Uber-related video content—perform expertise in driving for Uber on YouTube. I conducted in-depth interviews with 11 driver/bloggers and a qualitative analysis of the textual and video content published by driver/bloggers. Through the data, I show how driver/bloggers’ empowerment narratives became intertwined with their individualistic aspirations to develop dual careers as Uber drivers and YouTubers. Driver/bloggers employed three self-presentation strategies to perform expertise, including the construction of uniqueness and “know-how,” realness, and relatability with audiences. The study concludes with implications for our collective understandings of gig workers, expertise, and online curation across a wider platform ecology.
Rights, regulation and redistribution: The global politics of investment protection
Authors: Koivusalo Meri
Published: April 2019

The analysis of the implications of trade and investment agreements usually follows either economic policy modelling or the analysis of specific arbitration cases. These two approaches are often less helpful from the perspective of more systemic impacts or other policy aims as the potential concerns tend to be accounted for on the basis of a single issue (e.g. tobacco) or case or are carved out from particular agreements. The 3R framework on rights, regulation and redistribution provides a broader framework to analyse trade and investment agreements in relation to other policy aims, such as health or social policies and protection. I apply here the 3R framework to examine how and on what basis investment liberalisation and protection, as negotiated by the European Union, could affect both global and national policy space for health and social policies.
Using a Mindset Intervention to Reduce Anxiety in the Statistics Classroom
Authors: Smith Tamarah F. , Capuzzi Grace
Published: April 2019

The primary goal of this article is to provide detailed instructions as to how to run a mindset intervention in a psychology statistics course. A secondary goal is to provide preliminary data on such an intervention’s relationship to students’ statistics anxiety and course grades. Large randomized studies have demonstrated that using a one-time mindset intervention can have positive benefits for students’ course outcomes. We adapted this approach to design an intervention that includes a 75-minute presentation on what mindsets are, how are they are related to learning, and strategies for students to learn statistics with a growth mindset and, thereby, reduce their anxiety. Data from N = 75 students split into an experimental and comparison group suggested that receiving the intervention resulted in students’ mindsets becoming more growth oriented and that this was related to a decrease in anxiety and an increase in course grade.
The daylight climate of Athens: Variations and tendencies in the period 1992–2017, the brightening era
Authors: Kambezidis HD
Published: April 2019

Though numerous daylight studies have been conducted worldwide, works for the daylight climate and/or the daylight variations/trends are rare. This gap is treated here. Therefore, the innovative trend analysis and the month–hour diagrams are applied to the illuminance time series at Athens over the period of 1992–2017 under all-/clear-sky conditions. For all skies, the global illuminance shows a broad maximum at summer noon, while the diffuse counterpart is in spring. Under clear skies, the global illuminance maximum becomes broader, covering spring/summer. However, the diffuse illuminance maximum splits into minor ones in April and June. The innovative trend analysis method finds that the identified trends are + 2.83%/decade (−1.89%/decade) for the global (diffuse) illuminance, under all skies. In clear skies, the above values are modified to +2.66%/decade (−2.00%/decade). These results confirm a recovery in the Athens daylight levels as in the solar radiation ones found by many researchers. Another outcome of the study concerns the observed decline in diffuse illuminance levels in the examined period, which may be attributed to a decline in cloudiness and an increase of sunshine over the area. Also, the variation of the global and diffuse illuminance efficacies on a month–hour basis is examined using the month–hour diagram method.
Preoperative Measurements and Planning Sheet for an Endograft With 3 Inner Branches to Repair Aortic Arch Pathologies
Authors: Spanos Konstantinos , Haulon Stephan , Tsilimparis Nikolaos , Rohlffs Fiona , Panuccio Giuseppe , Kölbel Tilo
Published: April 2019

Purpose: To present a methodology for aortic arch anatomy measurement to plan and size an arch endograft with 3 inner branches. Technique: The arch endograft is custom manufactured with 3 inner side branches. Computed tomography angiography should be used to measure the clock position, the distances between the supra-aortic vessels, and the length and diameter of the proximal and distal landing zones. On the planning sheet, the vertical axis on the grid represents the spiral stabilizing wire at the 12 o’clock position; the horizontal baseline at 0 mm represents the idealized proximal margin of the innominate artery (IA). The first inner branch for the IA would be at 12:30 clock position and −20 mm from the horizontal baseline, while the second inner branch would be at the 11:30 clock position and at 0 mm. The third inner branch would vary among the different potential positions. Conclusion: Preoperative measurements of aortic arch anatomy can be made using a standard methodology to plan the size and position of inner branches. Future studies will show the potential applicability of a standard 3-inner-branch arch endograft using the planning sheet.
Effectiveness of alternative routes of intra-arterial chemotherapy administration for retinoblastoma: Potential for response and complications
Authors: Quinn Coridon , Tummala Ramachandra , Anderson Jill , Dahlheimer Tambra , Nascene David , Jagadeesan Bharathi
Published: April 2019

Objective

Intra-arterial chemotherapy (IAC) is now the first line treatment for selected patients with retinoblastoma (Rb). Typically, IAC is infused following the selective catheterization of the ophthalmic artery (OA) on the affected side. However, in some patients, the OA alone may not provide vascular supply to the tumor, whereas in other instances the efficacy of IAC could be compromised due to the presence of prominent collateral vessels from the external carotid artery (ECA). We report our experience with catheterizing vessels other than the OA for IAC treatment for Rb.

Methods

After institutional review board approval, a retrospective analysis was conducted of electronic medical records and imaging of our Rb population.

Results

We identified 13 patients who received IAC for Rb treatment. Of these, five patients required alternative methods of chemotherapy delivery other than through the OA, totaling 17 treatments. Two patients needed balloon-assisted occlusion of the ECA, two patients required selective catheterization of the middle meningeal artery, and one patient had no internal carotid artery supply to the choroidal blush, thus the superficial temporal artery provided access for IAC. Total globe salvage rate was 76% and 80% with the alternative route subset.

Conclusions

Alternatives to the OA may be necessary to deliver IAC for selected cases of Rb. These routes can be safe and effective. However, thorough understanding of the orbital blood supply is essential. Whether these alternative IAC methods result in similar outcomes to OA infusions has not been established.
Multiple democracies in one country: Belgian narratives of democracy, 1830–1950
Authors: Beyen Marnix
Published: April 2019

Narratives of democracy have played an important part in Belgium’s self-understanding ever since the country gained its independence in the 1830–1831 revolution. In the more or less official historiography created by the Belgian political and intellectual élites, collective actors of lower and middle strata much rather than monarchs and aristocrats were presented as the forerunners of the Belgian nation. This situation stimulated a proliferation of alternative, and often dissident, democratic narratives among those who saw themselves as the true heirs of these collective actors. Left-wing Republicans and at a later stage Socialists used their narratives to criticize the oligarchic character of the existing political structures, but remained firmly within the Belgian framework. The democratic narratives fostered among Catholics in Flanders, on the contrary, were based on a more fundamental tension with the mainly Francophone and secular Belgian State. Since the First World War, this tension developed into a consistently anti-Belgian and anti-parliamentary narrative of democracy within the emerging Flemish Nationalist subculture and party. By analysing these divergent narratives, this essay thus shows how the initially democratic self-understanding of the Belgian state substantially mortgaged the creation in the long run of stable and unifying national discourses.
Predictably confirmatory: The influence of stereotypes during decisional processing
Authors: Falbén Johanna K , Tsamadi Dimitra , Golubickis Marius , Olivier Juliana L , Persson Linn M , Cunningham William A , Macrae C Neil
Published: April 2019

Stereotypes facilitate the processing of expectancy-consistent (vs expectancy-inconsistent) information, yet the underlying origin of this congruency effect remains unknown. As such, here we sought to identify the cognitive operations through which stereotypes influence decisional processing. In six experiments, participants responded to stimuli that were consistent or inconsistent with respect to prevailing gender stereotypes. To identify the processes underpinning task performance, responses were submitted to a hierarchical drift diffusion model (HDDM) analysis. A consistent pattern of results emerged. Whether manipulated at the level of occupational (Expts. 1, 3, and 5) or trait-based (Expts. 2, 4, and 6) expectancies, stereotypes facilitated task performance and influenced decisional processing via a combination of response and stimulus biases. Specifically, (1) stereotype-consistent stimuli were classified more rapidly than stereotype-inconsistent stimuli; (2) stereotypic responses were favoured over counter-stereotypic responses (i.e., starting-point shift towards stereotypic responses); (3) less evidence was required when responding to stereotypic than counter-stereotypic stimuli (i.e., narrower threshold separation for stereotypic stimuli); and (4) decisional evidence was accumulated more efficiently for stereotype-inconsistent than stereotype-consistent stimuli and when targets had a typical than atypical facial appearance. Collectively, these findings elucidate how stereotypes influence person construal.
Tactile memory Ranschburg effects under conditions of concurrent articulation
Authors: Johnson Andrew J , Skinner Rachel , Takwoingi Pwamoti , Miles Christopher
Published: April 2019

In a single experiment, we investigate the Ranschburg effect for tactile stimuli. Employing an immediate serial recall (ISR) procedure, participants recalled sequences of six rapidly presented finger stimulations by lifting their fingers in the order of original stimulation. Within-sequence repetition of an item separated by two intervening items resulted in impaired recall for the repeated item (the Ranschburg effect), thus replicating the findings of Roe et al. Importantly, this impairment persisted with concurrent articulation, suggesting that the Ranschburg effect is not reliant upon verbal recoding. These data illustrate that the Ranschburg effect is evident beyond verbal memory and further suggest commonality in process for both tactile and verbal order memory.
Early Sports Specialization in Elite Wrestlers
Authors: McDonald Colin , Deitch John , Bush Chelsea
Published: April 2019

Background:

Sports specialization is becoming an increasingly common training strategy in young athletes. Very little research currently exists examining the occurrence of serious injury (>3 months off sport or loss of season) in elite-level wrestlers who specialize early (before age 12 years).

Hypothesis:

Wrestlers who specialize early will sustain more serious injuries than wrestlers who specialize at age 12 years or older.

Study Design:

Descriptive epidemiological study.

Methods:

We sent an anonymous online survey to a total of 312 elite-level wrestlers (National Collegiate Athletic Association Division I athletes and World/Olympic team members) containing questions documenting age of specialization and number of serious injuries sustained. The number of serious injuries both before and after starting college were compared between wrestlers specializing at <12 years old and ≥12 years old using an independent-samples t test. Respondents’ opinions on the necessity of early specialization and their primary source of encouragement to specialize were also reported.

Results:

A total of 143 wrestlers completed the survey, for a total response rate of 46%. Thirty-six (25%) wrestlers specialized at <12 years old. The early specialization group sustained significantly more serious injuries than the late specialization group (1.14 vs 0.60; P = 0.035). Sixty-two (43%) believed early specialization was necessary to achieve elite-level status. The decision to specialize was encouraged primarily by the athlete (78/143; 55%), parents (37/143; 26%), and coaches (22/143; 15%).

Conclusion:

Elite wrestlers who specialize prior to age 12 years sustain a greater number of serious injuries before starting college than those who specialize at or after the age of 12 years.

Clinical Relevance:

Athletes, coaches, and parents should consider the risk of injury before adopting a wrestling-specialized training strategy at a young age.
Cost of peripheral neuropathy in patients receiving treatment for multiple myeloma: a US administrative claims analysis
Authors: Song Xue , Wilson Kathleen L. , Kagan Jerry , Panjabi Sumeet
Published: April 2019

Background:

Peripheral neuropathy (PN) is a common consequence of multiple myeloma (MM) among those commonly treated with older-generation proteasome inhibitors (PIs). In this study, we evaluated the economic burden attributable to PN among MM patients in real-world practice settings in the US.

Methods:

Adults diagnosed with MM and first treated (index event) between 1 July 2006 and 28 February 2017 were identified from MarketScan® Commercial and Medicare claim databases. Continuous enrollment for at least 12 months without treatment and PN diagnoses were required pre-index. Patients were followed for at least 3 months until inpatient death or end of data. The International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes were used to identify PN. Propensity-score matching was applied to match every patient with PN to two MM patients without a PN diagnosis (controls). Healthcare utilization and expenditures per patient per month (PPPM) in the postindex period were estimated.

Results:

Of 11,851 patients meeting the study criteria, 15.5% had PN. After matching 1387 patients with PN and 2594 controls were identified. Baseline characteristics were well balanced between cohorts; mean follow up was 23–26 months. PPPM total costs were significantly higher by $1509 for patients with PN than controls, driven by higher hospitalization (PN 77.4%, controls 67.2%; p < 0.001) and emergency department rates (PN 67.8%, controls 58.4%; p < 0.001) and more outpatient hospital-based visits PPPM (PN 13.5 ± 14.7, controls 11.5 ± 18.0; p < 0.001).

Conclusions:

PN is a prevalent MM treatment complication associated with a significant economic burden adding to the complexity and cost of MM treatment. Highly effective novel treatments such as carfilzomib may reduce the overall disease burden.
Early intervention: should we conduct therapeutic trials for mild pulmonary hypertension before onset of symptoms?
Authors: Huston Jessica H. , Frantz Robert P. , Brittain Evan L.
Published: April 2019

Pulmonary arterial hypertension (PAH) is a rare disease that carries a poor prognosis. For 45 years, the definition of pulmonary hypertension (PH) has been a mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg, based on expert opinion. Recent data indicate that the mortality risk starts in the mPAP range of 21–24 mmHg, which has recently been reflected in the World Symposium on PH consensus document defining PH as a mPAP > 20 mmHg. The mortality associated with these lower levels of pulmonary pressures suggests that these values reflect a more advanced disease stage than previously recognized. It is unknown whether interventions targeting patients with mPAP values in the range of 21–24 mmHg in the absence of left ventricular or hypoxic lung disease are of clinical benefit. Here we present historical perspective on the hemodynamic definition of PH, discuss recent epidemiologic data, and outline obstacles to enrolling and evaluating response to therapy in mild PAH patients, as well as potentially useful study designs.
Gender variation in symptomatic peripheral arterial occlusive disease among type-2 diabetic patients
Authors: Al-Zoubi Nabil A , Shatnawi Nawaf J
Published: April 2019

Purpose:

Little is known about the existence of potential gender disparities in peripheral arterial occlusive disease. To our knowledge, this is the first study to analyze differences attributed to gender in type-2 diabetic patients with symptomatic peripheral arterial occlusive disease, with regard to clinical presentations, risk factors and anatomical distributions of atherosclerosis.

Patients and methods:

This study was conducted at King Abdullah University Hospital, Jordan. Medical records of all diabetic (type-2) patients who presented with symptomatic peripheral arterial occlusive disease in the period from January 2012 and November 2017 were reviewed, data were collected retrospectively. In all, 364 patients (282 males and 82 females) were involved. Criteria for diagnosis include the following Ankle-Brachial Index ⩽ 0.9 and intermittent claudication or critical limb ischemia. Risk factors for atherosclerosis (age, smoking and hypertension) and computed tomography-angiogram findings were analyzed using Statistical Package for the Social Sciences. p < 0.05 was considered statistically significant.

Results:

The mean age was higher in females than males (67.61 vs 62.61 years; p = 0.001). Females had greater prevalence of uncontrolled diabetes compared to males (HbA1c 9.07 in females vs 8.51 in males; p = 0.03). High density lipoprotein was higher in females than males (1.02 vs 0.935; p = 0.009). Females presented more with critical limb ischemia than intermittent claudication in comparison with males (p = 0.017). Involvement of superficial femoral artery, deep femoral artery and peroneal artery in hemodynamic relevant atherosclerotic lesion was significantly higher in females than males (p < 0.05). However, involvement of common iliac artery with hemodynamic relevant atherosclerotic lesion was significantly higher in males than females (p = 0.003).

Conclusions:

Clinical presentation, risk factors and anatomical distributions of atherosclerosis among type-2 diabetic patients with symptomatic peripheral arterial occlusive disease are different between males and females. When compared to males, female patients presented more with critical limb ischemia than intermittent claudication. Females showed higher age at presentation, poor control of diabetes mellitus and higher level of high density lipoprotein. Involvement of superficial femoral artery, deep femoral artery and peroneal artery in hemodynamic relevant atherosclerotic lesion were significantly higher in females than males. In contrast, common iliac artery involvement with hemodynamic relevant atherosclerotic lesion was significantly higher in males than females.
Resection of a functioning intrapericardial paraganglioma associated with succinate dehydrogenase B mutation
Authors: Siejka Dylan A , Vittorio Alexander F , Thakur Sameer , Burgess John R , Hardikar Ashutosh
Published: April 2019

Functional paragangliomas are rare neuroendocrine tumours that secrete catecholamines and are infrequently found in the mediastinum. We report a case of a young male with symptoms of catecholamine excess and a personal and family history of the paraganglioma predisposing succinate dehydrogenase subunit B mutation. The lesion had anatomical intrapericardial juxtaposition to important cardiac anatomy and posed the significant challenge of dissection at surgery. The lesion was successfully resected via sternotomy on cardiopulmonary bypass and confirmed histopathologically as paraganglioma. Intrapericardial paraganglioma is rare and treatment is difficult and time critical considering the proximity of cardiac anatomy as well as malignant potential.
Curricular Development and Implementation of a Longitudinal Integrative Medicine Education Experience for Trainees and Health-Care Professionals at an Academic Medical Center
Authors: Cutshall Susanne M , Khalsa Tejinder K , Chon Tony Y , Vitek Sairey M , Clark Stephanie D , Blomberg Debra L , Mustafa Rafid , Bhagra Anjali
Published: April 2019

A growing number of patients and consumers are seeking integrative medicine (IM) approaches as a result of increasing complex medical needs and a greater emphasis on prevention and health promotion. Health-care professionals need to have knowledge of the evidence-based IM resources that are safe and available to patients. Medical institutions have acknowledged the need for education and training in various IM modalities and whole-health approaches in medical curricula. There is a strong need to develop and incorporate well-structured IM curricula across all levels of learning and practice within medicine. This article provides an example of the development, implementation, impact, and assessment of IM education curricula across all learner levels at a large academic medical center.
Surgical or Radiation Therapy for the Treatment of Cervical Spine Metastases: Results From the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) Cohort
Authors: Bond Michael R. , Versteeg Anne L. , Sahgal Arjun , Rhines Laurence D. , Sciubba Daniel M. , Schuster James M. , Weber Michael H. , Fehlings Michael G. , Lazary Aron , Clarke Michelle J. , Boriani Stefano , Bettegowda Chetan , Arnold Paul M. , Gokaslan Ziya L. , Fisher Charles G.
Published: April 2019

Study Design:

Ambispective cohort study design.

Objectives:

Cervical spine metastases have distinct clinical considerations. The aim of this study was to determine the impact of surgical intervention (± radiotherapy) or radiotherapy alone on health-related quality of life (HRQOL) outcomes in patients treated for cervical metastatic spine tumours.

Methods:

Patients treated with surgery and/or radiotherapy for cervical spine metastases were identified from the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) international multicentre prospective observational study. Demographic, diagnostic, treatment, and HRQOL (numerical rating scale [NRS] pain, EQ-5D (3L), SF-36v2, and SOSGOQ) measures were prospectively collected at baseline, 6 weeks, 3 months, and 6 months postintervention.

Results:

Fifty-five patients treated for cervical metastases were identified: 38 underwent surgery ± radiation and 17 received radiation alone. Surgically treated patients had higher mean spinal instability neoplastic scores compared with the radiation-alone group (13.0 vs 8.0, P < .001) and higher NRS pain scores and lower HRQOL scores compared to the radiation alone group ( P < .05). From baseline to 6 months posttreatment, surgically treated patients demonstrated statistically significant improvements in NRS pain, EQ-5D (5L), and SOSGOQ2.0 scores compared with nonsignificant improvements in the radiotherapy alone group.

Conclusions:

Surgically treated cervical metastases patients presented with higher levels of instability, worse baseline pain and HRQOL scores compared with patients who underwent radiotherapy alone. Significant improvements in pain and HRQOL were noted for those patients who received surgical intervention. Limited or no improvements were found in those treated with radiotherapy alone.
Book review: Sharankuma Limbale and Jaydeep Sarangi (Eds.), Dalit Voice: Literature and Revolt
Authors: Dissanayake Daya
Published: April 2019

Sharankuma Limbale and Jaydeep Sarangi (Eds.), Dalit Voice: Literature and Revolt. New Delhi: Authorspress, 2018, ₹1,200, 282 pp., ISBN: 978-9387281783.
Implementing robotic assisted myomectomy in surgical practice – a retrospective cohort study
Authors: Aendekerk Silvie , Verguts Jasper , Housmans Susanne , Timmerman Dirk
Published: April 2019

Background

To compare surgical outcomes of patients with leiomyomas after robotic-assisted laparoscopic myomectomy (RALM), laparoscopic myomectomy (LsM), or laparotomic myomectomy (LtM) and to construct a useful algorithm for the best modus operandi for uterine leiomyomas.

Methods

Design: A retrospective chart review. Data included patient (age and BMI) and fibroid characteristics (number, measurements of the primary fibroid, type, and location), operating time, blood loss, hospitalization length, complications during and after surgery, and complications during posttreatment pregnancies. Comparisons were based on chi-square and two-sample t tests. Setting: University teaching hospital. Patients: Between 1 January 2009 and 31 December 2016, 51 RALMs, 84 LsMs, and 52 LtMs were performed at our institution. Interventions: Three different approaches of myomectomy were performed: robotic-assisted laparoscopy (RALM), laparoscopy (LsM), and laparotomy (LtM).

Results

There was no significant difference in the distribution of the location and the type of myoma between the three groups. The mean size of the largest myoma removed by LsM, RALM, and LtM was 60.9, 70.8, and 92.6 mm (p < 0.05), respectively. Surgical outcomes between the three modalities were comparable except for increased mean blood loss and postoperative bleeding and longer hospital stay for patients with LtM and for longer operation time when performing RALM.

Conclusion

RALM should replace open surgery if feasible and should not replace traditional laparoscopy unless other benefits are proven.
On construction of a cloud storage system with heterogeneous software-defined storage technologies
Authors: Yang Chao-Tung , Chen Shuo-Tsung , Chan Yu-Wei , Shen Yu-Chuan
Published: April 2019

With the rapid development of networks and Information technologies, cloud computing is not only becoming popular, the types of cloud services available are also increasing. Through cloud services, users can upload their requirements via the Internet to the cloud environment and receive responses following post-processing, for example, with cloud storage services. Software-Defined Storage (SDS) is a virtualization technology for cloud storage services. SDS uses software to integrate storage resources and to improve the accessibility and usability of storage services. Currently, there are many different open source projects available for SDS development. This work aims to utilize these open source projects to improve the efficiency of integration for hardware and software resources. In other words, in this work, we propose a cloud storage system that integrates various open source SDS software to make cloud storage services more compatible and user friendly. The cloud service systems can also be managed in a more convenient and flexible manner. The experimental results demonstrate the benefits of the proposed system.
Occupation-specific suicide risk in England: 2011–2015
Authors: Windsor-Shellard Ben , Gunnell David
Published: April 2019

Background

Previous research has documented marked occupational differences in suicide risk, but these estimates are 10 years old and based on potentially biased risk assessments.

Aims

To investigate occupation-specific suicide mortality in England, 2011–2015.

Method

Estimation of indirectly standardised mortality rates for occupations/occupational groups based on national data.

Results

Among males the highest risks were seen in low-skilled occupations, particularly construction workers (standardised mortality ratio [SMR] 369, 95% CI 333–409); low-skilled workers comprised 17% (1784/10 688) of all male suicides (SMR 144, 95% CI 137–151). High risks were also seen among skilled trade occupations (SMR 135 95% CI 130–139; 29% of male suicides). There was no evidence of increased risk among some occupations previously causing concern: male healthcare professionals and farmers. Among females the highest risks were seen in artists (SMR 399, 95% CI 244–616) and bar staff (SMR 182, 95% CI 123–260); nurses also had an increased risk (SMR 123, 95% CI 104–145). People in creative occupations and the entertainment industry – artists (both genders), musicians (males) and actors (males) – were at increased risk, although the absolute numbers of deaths in these occupations were low. In males (SMR 192, 95% CI 165–221) and females (SMR 170, 95% CI 149–194), care workers were at increased risk and had a considerable number of suicide deaths.

Conclusions

Specific contributors to suicide in high-risk occupations should be identified and measures – such as workplace-based interventions – put in place to mitigate this risk. The construction industry seems to be an important target for preventive interventions.

Declaration of interest

None.
Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline
Authors: Mikhael Joseph , Ismaila Nofisat , Cheung Matthew C. , Costello Caitlin , Dhodapkar Madhav V. , Kumar Shaji , Lacy Martha , Lipe Brea , Little Richard F. , Nikonova Anna , Omel James , Peswani Namrata , Prica Anca , Raje Noopur , Seth Rahul , Vesole David H. , Walker Irwin , Whitley Alexander , Wildes Tanya M. , Wong Sandy W. , Martin Tom
Published: April 2019

PURPOSE

To provide evidence-based recommendations on the treatment of multiple myeloma to practicing physicians and others.

METHODS

ASCO and Cancer Care Ontario convened an Expert Panel of medical oncology, surgery, radiation oncology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and some phase II studies published from 2005 through 2018. Outcomes of interest included survival, progression-free survival, response rate, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 124 relevant studies to inform the evidence base for this guideline.

RECOMMENDATIONS

Evidence-based recommendations were developed for patients with multiple myeloma who are transplantation eligible and those who are ineligible and for patients with relapsed or refractory disease.
Hydro-eroticism
Authors: Chow Jeremy , Bushman Brandi
Published: April 2019

In tracing the ways that eroticism and violence are mapped onto bodies of and relationships with water, this essay offers “hydro-eroticism” to consider an ecofeminist and queer ecological reading of water. Hydro-eroticism signifies two interventions: first, how aqueous locations become sites of queer community and punishment while registering associations with the fluid female body, and second, how human and nonhuman intimacy is enabled by aqueous proximity. The essay focuses on Hulu’s The Handmaid’s Tale, based loosely on Margaret Atwood’s novel, and The Shape of Water. Whereas in The Handmaid’s Tale the river is configured doubly as a site of bodily violation wherein violence against queer characters is palpable but also as a space that informs nostalgic reunion for queer female community, in The Shape of Water hydro-eroticism speaks to the fraught and layered entanglements of human female and nonhuman male creature in concert with queer kinship.