bluuebunny/crossref_metadata_2025 huggingface dataset:
Large observer variation of clinical assessment of dyspnoeic wheezing children
Authors: Bekhof Jolita , Reimink Roelien , Bartels Ine-Marije , Eggink Hendriekje , Brand Paul L P
Published: February 2015

Background

In children with acute dyspnoea, the assessment of severity of dyspnoea and response to treatment is often performed by different professionals, implying that knowledge of the interobserver variation of this clinical assessment is important.

Objective

To determine intraobserver and interobserver variation in clinical assessment of children with dyspnoea.

Methods

From September 2009 to September 2010, we recorded a convenience sample of 27 acutely wheezing children (aged 3 months–7 years) in the emergency department of a general teaching hospital in the Netherlands, on video before and after treatment with inhaled bronchodilators. These video recordings were independently assessed by nine observers scoring wheeze, prolonged expiratory phase, retractions, nasal flaring and a general assessment of dyspnoea on a Likert scale (0–10). Assessment was repeated after 2 weeks to evaluate intraobserver variation.

Results

We analysed 972 observations. Intraobserver reliability was the highest for supraclavicular retractions (κ 0.84) and moderate-to-substantial for other items (κ 0.49–0.65). Interobserver reliability was considerably worse, with κ<0.46 for all items. The smallest detectable change of the dyspnoea score (>3 points) was larger than the minimal important change (<1 point), meaning that in 69% of observations a clinically important change after treatment cannot be distinguished from measurement error.

Conclusions

Intraobserver variation is modest, and interobserver variation is large for most clinical findings in children with dyspnoea. The measurement error induced by this variation is too large to distinguish potentially clinically relevant changes in dyspnoea after treatment in two-thirds of observations. The poor interobserver reliability of clinical dyspnoea assessment in children limits its usefulness in clinical practice and research, and highlights the need to use more objective measurements in these patients.
Nicorandil-induced colonic ulceration
Authors: Jacob Jason Vazhayil
Published: February 2015

A 76-year-old woman with significant cardiovascular comorbidities was investigated under general surgery for weight loss and change in bowel habit. Endoscopic investigations revealed a large ulcer extending from the ileocaecal valve to the ascending colon. Histology of the biopsies from this site revealed chronic inflammation and reactive changes. However, considering the history and suspicious radiological and endoscopic findings, decision was made at a multidisciplinary meeting to offer laparoscopic right hemicolectomy. Owing to complications, the procedure was converted to an open surgery. Postoperatively, histology of resected bowel revealed chronic inflammation and no evidence of malignancy. In light of an 8-year history of nicorandil therapy, the histological changes were thought to represent nicorandil-induced colonic ulceration.
Type 2 diabetes presenting with hyperglycaemic hyperosmolar state in an adolescent renal transplant patient
Authors: Harrington Francesca Ruth , Wolfenden Helen , Makaya Tafadzwa
Published: February 2015

Hyperglycaemic hyperosmolar state (HHS) is a life-threatening condition rarely seen in paediatrics. It is becoming increasingly recognised with the growing incidence of childhood type 2 diabetes mellitus (T2DM). We present a 16-year-old boy with Bardet-Biedl syndrome, with comorbidities including chronic renal impairment requiring renal transplant, isolated growth hormone (GH) deficiency and obesity, who presented on routine follow-up with new onset T2DM and in HHS. Investigations revealed hyperglycaemia (45.7 mmol/L), ketones of 0.1 mmol/L, pH 7.38 and osmolarity 311 mOsmol/kg. After acute management with fluid resuscitation and intravenous insulin, he is now stable on metformin. He has lost weight, renal function is stable and he has stopped GH therapy. We discuss the dilemmas encountered in his long-term management due to his renal transplant and comorbidities, and whether or not, given his significant T2DM risk, this case was preventable or predictable.
An unusual relapse in acute myeloid leukaemia
Authors: Abu Saadeh Feras , Collins Vicki , Al-Saadi Maimuna , Gleeson Noreen
Published: February 2015

A 40-year-old nulliparous woman, with a history of acute myeloid leukaemia (AML), presented at a gynaecological clinic with an incidental finding of a 5 cm pelvic mass on ultrasound during workup for subfertility. Biopsies confirmed a myeloid sarcoma. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by chemotherapy and radiotherapy. She recovered well from her surgery, 21 months postsurgery with no evidence of recurrence.
Breastfeeding duration and non-verbal IQ in children
Authors: Sajjad Ayesha , Tharner Anne , Kiefte-de Jong Jessica C , Jaddoe Vincent VW , Hofman Albert , Verhulst Frank C , Franco Oscar H , Tiemeier Henning , Roza Sabine J
Published: February 2015

Background

Breastfeeding has been related to better cognitive development in children. However, due to methodological challenges, such as confounding, recall bias or insufficient power, the mechanism and nature of the relation remains subject to debate.

Methods

We included 3761 participants of a population-based cohort study from fetal life onwards and examined the association of breastfeeding duration with non-verbal intelligence in children of age 6 years. Maternal and paternal lifestyle, sociodemographic factors, child factors and maternal IQ were tested for their confounding effects on the association.

Results

We observed an initial association between breastfeeding duration and child IQ conferring an advantage of 0.32 (0.20 to 0.44) points for each additional month of breastfeeding. This association strongly attenuated to 0.09 (−0.03 to 0.21) points after adjustment for child factors, sociodemographic factors, parental lifestyle factors and maternal IQ. Similarly, the associations with breastfeeding duration as a categorical variable largely disappeared after confounding factors were added to the models.

Conclusions

The association between breastfeeding and child IQ can be largely explained by sociodemographic factors, parental lifestyle and maternal IQ. Our results cannot confirm beneficial effects of breastfeeding on child intelligence.
Excessive crying at 3 months of age and behavioural problems at 4 years age: a prospective cohort study
Authors: Santos Iná S , Matijasevich Alicia , Capilheira Marcelo F , Anselmi Luciana , Barros Fernando C
Published: February 2015

Background

Excessive crying in early infancy has been associated with behavioural problems among preschool children from high income countries but studies in low income and middle income countries are scarce.

Methods

The 2004 Pelotas Birth Cohort is a population-based study planned to enrol all live births occurring in Pelotas that year and comprises 4231 children who so far have been followed up at 3, 12, 24, 48 and 72 months of age. Several familial, maternal and child characteristics were gathered in every follow-up. At the 3-month follow-up, infants whose mothers perceived them as crying more than others of the same age were classified as ‘crying babies’. Child behavioural problems were assessed through the Child Behavior Checklist (CBCL) applied to the mother at the 48-month follow-up. Crude and adjusted ORs with 95% CIs were calculated by logistic regression.

Results

Prevalence of excessive crying at 3 months was 11.9% (10.9% to 13.0%). Among children with excessive crying at 3 months the proportion in the clinical range for CBCL total, internalising and externalising problems at 4 years of age was 31.2%, 12.9% and 37.5%, respectively, against 20.6%, 6.8% and 29.6%, respectively, among non-crying babies. After controlling for confounders crying babies presented increased risk of being in clinical range of CBCL total (OR=1.34; 1.03 to 1.74), internalising (OR=1.55; 1.09 to 2.21) and externalising problems (OR=1.29; 1.01 to 1.64) than infants without excessive crying.

Conclusions

Excessive crying in early infancy may represent one important risk factor for developing behavioural problems in later phases of early childhood.
Nodopathies of the peripheral nerve: an emerging concept
Authors: Uncini Antonino , Kuwabara Satoshi
Published: February 2015

Peripheral nerve diseases are traditionally classified as demyelinating or axonal. It has been recently proposed that microstructural changes restricted to the nodal/paranodal region may be the key to understanding the pathophysiology of antiganglioside antibody mediated neuropathies. We reviewed neuropathies with different aetiologies (dysimmune, inflammatory, ischaemic, nutritional, toxic) in which evidence from nerve conductions, excitability studies, pathology and animal models, indicate the involvement of the nodal region in the pathogenesis. For these neuropathies, the classification in demyelinating and axonal is inadequate or even misleading, we therefore propose a new category of nodopathy that has the following features: (1) it is characterised by a pathophysiological continuum from transitory nerve conduction block to axonal degeneration; (2) the conduction block may be due to paranodal myelin detachment, node lengthening, dysfunction or disruption of Na+channels, altered homeostasis of water and ions, or abnormal polarisation of the axolemma; (3) the conduction block may be promptly reversible without development of excessive temporal dispersion; (4) axonal degeneration, depending on the specific disorder and its severity, eventually follows the conduction block. The term nodopathy focuses to the site of primary nerve injury, avoids confusion with segmental demyelinating neuropathies and circumvents the apparent paradox that something axonal may be reversible and have a good prognosis.
Standard medical care of patients with systemic lupus erythematosus (SLE) in large specialised centres: data from the Russian Federation, Ukraine and Republic of Kazakhstan (ESSENCE)
Authors: Nasonov E , Soloviev S , Davidson J E , Lila A , Togizbayev G , Ivanova R , Baimukhamedov Ch , Omarbekova Zh , Iaremenko O , Gnylorybov A , Shevchuk S , Vasylyev A , Pereira M H S
Published: February 2015

Objectives

To describe disease characteristics and treatment regimens for adult patients with systemic lupus erythematosus (SLE) with autoantibody positive disease in three countries (the Russian Federation, Ukraine and Republic of Kazakhstan).

Methods

The ESSENCE study was a 1-year, retrospective, multicentre, observational study. Data included patients’ characteristics, disease activity and severity, and healthcare resource use in 2010.

Results

Twelve centres enrolled 436 eligible patients: 232 in Russia, 110 in Kazakhstan and 94 in Ukraine. Mean age ranged from 36 to 42 years and median SLE duration from 3 to 6.8 years. According to study definitions, 69.2% of patients in Russia, 72.7% in Kazakhstan and 55.4% in Ukraine had severe disease at diagnosis. SLE activity (Nasonova classification, 1972) decreased from diagnosis to the last visit in 2010 in all countries. At the last visit, mean (SD) Safety of Estrogens in Lupus Erythematosus National Assessment–Systemic Lupus Erythematosus Disease Activity Index score was 13.8 (10.5) in Russia, 19.4 (16.9) in Kazakhstan and 7.2 (6.8) in Ukraine, and Systemic Lupus International Collaborative Clinics/American College of Rheumatology damage index was 2.0 (2.2), 3.3 (3.2) and 2.2 (2.0), respectively. Treatment regimens included predominantly glucocorticoids (96.7–99.1%), immunosuppressants or cytotoxic drugs, for example, azathioprine and cyclophosphamide (20.7–53.2%), and antimalarial drugs (18.3–40.8%).

Conclusions

The study provides reliable insight into the SLE clinical profiles in the referenced countries. Patients were 4–10 years younger in the study and had 3–7 years shorter SLE duration than in Western European countries and both SLE activity and severity were higher with higher rate of hospitalisations, but decreased during treatment. Local and international scales demonstrated correlation in SLE activity and organ damage evaluation. There were differences in clinical characteristics and healthcare features across the countries.
Differential effects of age and type 2 diabetes on dynamic vs. peak response of pulmonary oxygen uptake during exercise
Authors: O'Connor Eamonn , Green Simon , Kiely Catherine , O'Shea Donal , Egaña Mikel
Published: February 2015

We investigated if the magnitude of the type 2 diabetes (T2D)-induced impairments in peak oxygen uptake (V̇o2) and V̇o2 kinetics was affected by age. Thirty-three men with T2D (15 middle-aged, 18 older), and 21 nondiabetic (ND) men (11 middle-aged, 10 older) matched by age were recruited. Participants completed four 6-min bouts of constant-load cycling at 80% ventilatory threshold for the determination of V̇o2 kinetics. Cardiac output (inert-gas rebreathing) was recorded at rest and 30 and 240 s during two additional bouts. Peak V̇o2 (determined from a separate graded test) was significantly ( P < 0.05) reduced in middle-aged and older men with T2D compared with their respective ND counterparts (middle-aged, 3.2 ± 0.5 vs. 2.5 ± 0.5 l/min; older, 2.7 ± 0.4 vs. 2.4 ± 0.4 l/min), and the magnitude of these impairments was not affected by age. However, the time constant of phase II of the V̇o2 response was only slowed ( P < 0.05) in middle-aged men with T2D compared with healthy counterparts, whereas it was similar among older men with and without T2D (middle-aged, 26.8 ± 9.3 vs. 41.6 ± 12.1 s; older, 40.5 ± 7.8 vs. 41.1 ± 8.5 s). Similarly, the “gains” in systemic vascular conductance (estimated from the slope between cardiac output and mean arterial pressure responses) were lower ( P < 0.05) in middle-aged men with T2D than ND controls, but similar between the older groups. The results suggest that the mechanisms by which T2D induces significant reductions in peak exercise performance are linked to a slower dynamic response of V̇o2 and reduced systemic vascular conductance responses in middle-aged men, whereas this is not the case in older men.
Evaluation of a Patient CAM-with-Chemotherapy Educational Brochure
Authors: Smith Peter J. , Clavarino Alexandra M. , Long Jeremy E. , Steadman Kathryn J.
Published: February 2015

Biologically active CAM may detrimentally interfere with chemotherapy treatment, so cancer patients require targeted, evidence-based information on chemotherapy-CAM integration consequences. The object of this study was to investigate the potential for medical doctor recommendation and patient acceptance of a purpose-designed patient educational brochure on the safe use of CAM with chemotherapy. Cancer care doctors (n=17) were provided a draft version of a patient educational brochure developed by the authors and completed a structured feedback form. Cancer patients receiving treatment (n=12) were provided with the brochure and completed the local health service consumer testing feedback form. All 17 doctors perceived a need for the brochure and all would recommend the brochure to their patients. Approximately 59% of the doctors indicated they would recommend the brochure to all patients receiving chemotherapy and 41% preferred that only patients using CAM or who enquired about CAM be given the brochure. Cancer patients receiving chemotherapy reported that the brochure information answered their questions and was easy to understand. This evidence-based CAM-chemotherapy patient brochure may be a useful adjunct for use by cancer care health professionals to educate patients on the potential dangers of biologically active CAM use with chemotherapy and to provide patients with safe CAM alternatives.
Analyzing the Influence of Mobile Phone Use of Drivers on Traffic Flow Based on an Improved Cellular Automaton Model
Authors: Xiao Yao , Shi Jing
Published: February 2015

This paper aimed to analyze the influence of drivers’ behavior of phone use while driving on traffic flow, including both traffic efficiency and traffic safety. An improved cellular automaton model was proposed to simulate traffic flow with distracted drivers based on the Nagel-Schreckenberg model. The driving characters of drivers using a phone were first discussed and a value representing the probability to use a phone while driving was put into the CA model. Simulation results showed that traffic flow rate was significantly reduced if some drivers used a phone compared to no phone use. The flow rate and velocity decreased as the proportion of drivers using a phone increased. While, under low density, the risk of traffic decreased first and then increased as the distracted drivers increased, the distracted behavior of drivers, like using a phone, could reduce the flow rate by 5 percent according to the simulation.
Hysteresis in Two-Dimensional Liquid Crystal Models
Authors: Buček Slavko , Kralj Samo , Sluckin T. J.
Published: February 2015

We make a numerical study of hysteresis loop shapes within a generalized two-dimensional Random Anisotropy Nematic (RAN) model at zero temperature. The hysteresis loops appear on cycling a static external ordering field. Ordering in these systems is history dependent and involves interplay between the internal coupling constantJ, the anisotropy random fieldD, and the ordering external fieldH. Here the external field is represented by a traceless tensor, analogous to extension-type fields in continuum mechanics. The calculations use both a mean field approach and full lattice simulations. Our analysis suggests the existence of two qualitatively different solutions, which we denote assymmetricandsymmetry breaking. For the set of parameters explored, only the symmetric solutions are stable. Both approaches yield qualitatively similar hysteresis curves, which are manifested either by single or double loops. But the quantitative differences indicate that mean field estimates are only of limited predictive value.
PolySia-Specific Retargeting of Oncolytic Viruses Triggers Tumor-Specific Immune Responses and Facilitates Therapy of Disseminated Lung Cancer
Authors: Kloos Arnold , Woller Norman , Gürlevik Engin , Ureche Cristina-Ileana , Niemann Julia , Armbrecht Nina , Martin Nikolas T. , Geffers Robert , Manns Michael P. , Gerardy-Schahn Rita , Kühnel Florian
Published: February 2015

Polysialic acid (polySia) is expressed on several malignant tumors of neuroendocrine origin, including small cell lung cancer. In this study, we investigated the therapeutic efficacy of tumor-directed T-cell responses, elicited by polySia-retargeted oncolytic adenovirus infection, in an orthotopic murine model of disseminated polySia-positive lung cancer. In several cell lines, we demonstrated highly polySia-selective retargeting of adenoviral infection using a bispecific adapter comprising the ectodomain of the coxsackievirus/adenovirus receptor and a polySia-recognizing single-chain antibody domain. PolySia-dependent systemic infection in vivo facilitated effective uptake of viruses in subcutaneous polySia-expressing human tumors, whereas hepatic viral load and hepatotoxicity were significantly reduced. The impact and nature of antitumoral immune responses triggered by systemic delivery of polySia-retargeted oncolytic adenoviruses were investigated in an orthotopic model of disseminated lung cancer. Interestingly, improved transduction by polySia-retargeted oncolytic adenoviruses led to CD45-positive cell infiltrates in close association with large lytic areas. Consistently, enhanced tumor regression and prolonged survival was only observed in immunocompetent mice, but not in T-cell–deficient mice. To investigate whether improved systemic infection by polySia retargeting would elicit a tumor-specific T-cell response, we screened the used lung cancer cells for mutated oncogenes by complete exon sequencing. In agreement with our other results, only retargeted oncolysis was able to induce a significant response specific for the tumor-associated neoepitope Gsta2-Y9H. In conclusion, we demonstrated that effective retargeting of oncolytic adenovirus against polySia-expressing tumors elicits an effective tumor-directed T-cell response after systemic virus delivery and facilitates therapy of disseminated lung cancer. Cancer Immunol Res; 3(7); 751–63. ©2015 AACR.
Randomized Pilot Trial of Gene Expression Profiling Versus Heart Biopsy in the First Year After Heart Transplant
Authors: Kobashigawa Jon , Patel Jignesh , Azarbal Babak , Kittleson Michelle , Chang David , Czer Lawrence , Daun Tiffany , Luu Minh , Trento Alfredo , Cheng Richard , Esmailian Fardad
Published: February 2015

Background—

The endomyocardial biopsy (EMB) is considered the gold standard in rejection surveillance post cardiac transplant, but is invasive, with risk of complications. A previous trial suggested that the gene expression profiling (GEP) blood test was noninferior to EMB between 6 and 60 months post transplant. As most rejections occur in the first 6 months, we conducted a single-center randomized trial of GEP versus EMB starting at 55 days post transplant (when GEP is valid).

Methods and Results—

Sixty heart transplant patients meeting inclusion criteria were randomized beginning at 55 days post transplant to either GEP or EMB arms. A positive GEP ≥30 between 2 and 6 months, or ≥34 after 6 months, prompted a follow-up biopsy. The primary end point included a composite of death/retransplant, rejection with hemodynamic compromise or graft dysfunction at 18 months post transplant. A coprimary end point included change in first-year maximal intimal thickness by intravascular ultrasound, a recognized surrogate for long-term outcome. Corticosteroid weaning was assessed in both the groups. The composite end point was similar between the GEP and EMB groups (10% versus 17%; log-rank
P
=0.44). The coprimary end point of first-year intravascular ultrasound change demonstrated no difference in mean maximal intimal thickness (0.35±0.36 versus 0.36±0.26 mm;
P
=0.944). Steroid weaning was successful in both the groups (91% versus 95%).

Conclusions—

In this pilot study, GEP starting at 55 days post transplant seems comparable with EMB for rejection surveillance in selected heart transplant patients and does not result in increased adverse outcomes. GEP also seems useful to guide corticosteroid weaning. Larger randomized trials are required to confirm these findings.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00962377.
Noninvasive Imaging of Early Venous Thrombosis by
19
F Magnetic Resonance Imaging With Targeted Perfluorocarbon Nanoemulsions
Authors: Temme Sebastian , Grapentin Christoph , Quast Christine , Jacoby Christoph , Grandoch Maria , Ding Zhaoping , Owenier Christoph , Mayenfels Friederike , Fischer Jens W. , Schubert Rolf , Schrader Jürgen , Flögel Ulrich
Published: February 2015

Background—

Noninvasive detection of deep venous thrombi and subsequent pulmonary thromboembolism is a serious medical challenge, since both incidences are difficult to identify by conventional ultrasound techniques.

Methods and Results—

Here, we report a novel technique for the sensitive and specific identification of developing thrombi using background-free
19
F magnetic resonance imaging, together with α2-antiplasmin peptide (α2
AP
)–targeted perfluorocarbon nanoemulsions (PFCs) as contrast agent, which is cross-linked to fibrin by active factor XIII. Ligand functionality was ensured by mild coupling conditions using the sterol-based postinsertion technique. Developing thrombi with a diameter <0.8 mm could be visualized unequivocally in the murine inferior vena cava as hot spots in vivo by simultaneous acquisition of anatomic matching
1
H and
19
F magnetic resonance images at 9.4 T with both excellent signal-to-noise and contrast-to-noise ratios (71±22 and 17±5, respectively). Furthermore, α2
AP
-PFCs could be successfully applied for the diagnosis of experimentally induced pulmonary thromboembolism. In line with the reported half-life of factor XIIIa, application of α2
AP
-PFCs >60 minutes after thrombus induction no longer resulted in detectable
19
F magnetic resonance imaging signals. Corresponding results were obtained in ex vivo generated human clots. Thus, α2
AP
-PFCs can visualize freshly developed thrombi that might still be susceptible to pharmacological intervention.

Conclusions—

Our results demonstrate that
1
H/
19
F magnetic resonance imaging, together with α2
AP
-PFCs, is a sensitive, noninvasive technique for the diagnosis of acute deep venous thrombi and pulmonary thromboemboli. Furthermore, ligand coupling by the sterol-based postinsertion technique represents a unique platform for the specific targeting of PFCs for in vivo
19
F magnetic resonance imaging.
Echolucency of the Carotid Artery Intima‐Media Complex and Intima‐Media Thickness Have Different Cardiovascular Risk Factor Relationships: The Women's Interagency HIV Study
Authors: Jung Molly , Parrinello Christina M. , Xue Xiaonan , Mack Wendy J. , Anastos Kathryn , Lazar Jason M. , Selzer Robert H. , Shircore Anne M. , Plankey Michael , Tien Phyllis , Cohen Mardge , Gange Stephen J. , Hodis Howard N. , Kaplan Robert C.
Published: February 2015

Background

Adults infected with
HIV
have increased atherosclerosis potentially associated with both
HIV
and non‐
HIV
associated factors. We characterized risk factors for atherosclerosis as measured by noninvasive vascular imaging.

Methods and Results

We used B‐mode ultrasound to examine levels and correlates of echogenicity and vessel wall thickness of the carotid artery intima‐media complex in 1282
HIV
‐infected and 510
HIV
‐uninfected women of the Women's Interagency
HIV
Study. Levels of gray scale median (
GSM
, a measure of echogenicity) did not vary between
HIV
infection groups. In both groups, smokers had increased
GSM
, whereas age, diabetes, elevated blood pressure, and high
BMI
were associated with lower (rather than higher)
GSM
. Each of these non‐lipid
CVD
risk factors, especially age and blood pressure, was also associated with higher levels of carotid artery intima‐media thickness (
cIMT
). Higher serum triglyceride levels were associated with lower
GSM
in both
HIV
‐infected and
HIV
‐uninfected groups. Additional lipid risk factors for low
GSM
including high LDL cholesterol and low HDL cholesterol levels were identified in
HIV
uninfected but not in
HIV
infected women. In contrast to findings for
GSM
, among the lipid parameters only LDL cholesterol level had an association with
cIMT
, which was observed only in the
HIV
uninfected group.

Conclusions

Lipid and non‐lipid risk factor associations with echolucency of the carotid artery and the thickness of the common carotid artery intima‐media layer suggest that these measures capture different aspects of atherosclerosis.
Reggie Wilson and the Traditions of American Dance
Authors: Manning Susan
Published: February 2015

The significance of Reggie Wilson’s research-to-performance method within the canons of American dance arises from the way his distinctive approach confounds critical categories, blurring the divide between Black Dance and black postmodernism. Is his work too postmodernist for advocates of Black Dance and too Black for advocates of postmodernism?
Military Targeting in the Context of Self-Defence Actions
Authors: Green James A. , Waters Christopher P.M.
Published: February 2015

For self-defence actions to be lawful, they must be directed at military targets. The absolute prohibition on non-military targeting under the jus in bello is well known, but the jus ad bellum also limits the target selection of states conducting defensive operations. Restrictions on targeting form a key aspect of the customary international law criteria of necessity and proportionality. In most situations, the jus in bello will be the starting point for the definition of a military targeting rule. Yet it has been argued that there may be circumstances when the jus ad bellum and the jus in bello do not temporally or substantively overlap in situations of self-defence. In order to address any possible gaps in civilian protection, and to bring conceptual clarity to one particular dimension of the relationship between the two regimes, this article explores the independent sources of a military targeting rule. The aim is not to displace the jus in bello as the ‘lead’ regime on how targeting decisions must be made, or to undermine the traditional separation between the two ‘war law’ regimes. Rather, conceptual light is shed on a sometimes assumed but generally neglected dimension of the jus ad bellum’s necessity and proportionality criteria that may, in limited circumstances, have significance for our understanding of human protection during war.
Striving against the ‘Nafs’
Authors: Al-Sharmani Mulki Mohamed
Published: February 2015

I analyze how Somalis in Helsinki re-interpret religious norms on marriage in light of: 1) the challenges of socioeconomic hardships and marginalization in Finland; and 2) ethical principles in Islamic tradition that underlie religious rulings such as striving against the selfishness of the ‘nafs’ (self) and seeking spiritual advancement. I examine how norms on spousal roles and rights are contested and reinterpreted. I highlight how young women, in particular, foreground the ‘ethical' in their religious understandings of marriage norms. I explore if Veit Bader’s1 concept of ‘internal religious governance’ can analytically explain these processes. I draw on data from individual interviews and focus group discussions with women and men; and interviews with mosque imams and a clan elder.
Civil capacities for peace support operations: The case of Bosnia and Herzegovina
Authors: Dizdarević Emsad
Published: February 2015

Bosnia and Herzegovina (BiH) has gone from being a receiver to providing assistance to post-conflict countries. Through its experience with rebuilding the country after conflict, BiH can make relevant and useful contributions to further peacebuilding and sustainable development in other countries. This article details current contributions BiH is making to international peace operations, maps the civilian capacities BiH could contribute in the future, and provides recommendations on how this could be implemented with regards to training, rostering and deployment of civilian capacities. Successful training, rostering and deployment of civilian capacities from BiH could be replicated at the Western Balkans level and bear witness to the development of security communities in BiH and the region.
Mapping western Balkans civilian capacities for peace operations
Authors: Karlsrud John , Milošević Marko
Published: February 2015

Over the past several years the United Nations has increasingly emphasized the role that civilian capacities can play in post-conflict peacebuilding and called for member states to provide expertise. This special issue of the Journal of Regional Security will explore the civilian capacities of the Western Balkans countries and whether there is political will to respond to the call to deploy civilian capacities to UN peace operations and other international organizations. Looking at how Western Balkan countries train, roster and deploy civilian capacities, it will also explore whether increased cooperation in this area could be considered as a security community practice, nurturing bilateral relations and building cooperation in the Western Balkan region. The article finds that there is still a great gap between the expressed policy intent of providing civilian capacities to peace support operations, and putting it into practice. There is also lack of a strategic consideration of how the training and deployment of civilian capacities to peace operations could build legitimacy in international organizations and enhance regional cooperation among the states in the Western Balkans. The article recommends the initiation of a regional dialogue on training and rostering of civilian capacities, realizing synergies and furthering regional cooperation.
Serbian civilian capacities for peace operations: Untapped potential
Authors: Milošević Marko
Published: February 2015

This article examines Serbia's capacities to participate in civilian peace operations, including the analysis of legislation regulating international cooperation and contribution to peace operations. Furthermore, based on interviews with representatives of various institutions, it also addresses the key practical challenges that these institutions are currently facing in civilian contribution. It examines the roles of relevant stakeholders, the Ministry of Foreign Affairs, the military and the police, with potential participants from other branches of government also included in this analysis. The research sample also included local persons working by contract for international organizations in Serbia, in order to examine the capacities they possess. Several challenges and opportunities for further development of existing frameworks were detected therein. Initial interest expressed by various 'civil' ministries to contribute to peace operations (Ministry of Foreign Trade, Ministry of Justice) could contribute to building of CIVCAP. Also, existing institutions, such as Office for cooperation with CSOs and Governmental Department of Human Resources Management could be easily turned into rosters of potential candidates for peace operations. The article argues that a huge potential exists in Serbia, however, its adequate use is prevented by the lack of clear foreign policy goals and coherent government policy. In this regard, the article recommends the government to increase the existing training capacities, coordinate the efforts of various stakeholders and establish two potential rosters of experts.
Child developmental outcomes in preschool children following antidepressant exposure in pregnancy
Authors: Galbally Megan , Lewis Andrew J , Buist Anne
Published: February 2015

Objective:

To examine child developmental outcomes in preschool-aged children exposed to antidepressant medication in pregnancy and compare their outcomes to children not exposed.

Method:

A prospective case-controlled study of 20 children exposed to antidepressants in pregnancy and 21 unexposed controls was available from the Victorian Psychotropic Registry. Child development outcomes at 4 years of age were assessed using the Wechsler Preschool and Primary Scale of Intelligence, third edition; the Movement Assessment Battery for Children; Behaviour Rating Inventory of Executive Functioning–Preschool; and the Child Behavior Checklist (1.5–5 years). Maternal depression was assessed using the Beck Depression Inventory-II in pregnancy and at four time points across infancy and early childhood.

Results:

Children exposed to antidepressants in pregnancy had no statistically significant differences compared to unexposed children on any of the measures of child development undertaken. There was a trend to slightly lower scores in motor development with a small effect size for two scales of the Movement Assessment Battery for Children: balance – Cohen’s d=0.36; aiming and catching – Cohen’s d=0.34.

Conclusions:

The finding of no effect on cognition and behaviour are consistent with other previous studies conducted with younger children. Likewise, the trend towards lower motor development is similar to earlier findings from this study and a number of other similar studies. Given this trend there is a need for future research that focuses on this area of development in older children using robust measures of motor development.
Oral health promotion and homelessness: A theory-based approach to understanding processes of implementation and adoption
Authors: Beaton Laura , Freeman Ruth
Published: February 2015

Objective:

To use the Theory of Diffusion of Innovations as a framework to explore the qualitative data gleaned from a process evaluation of the Smile4life intervention across Scottish National Health Service (NHS) Boards and to inform future oral health promotion and homelessness.

Design:

A qualitative exploration.

Setting:

In 2012, the Smile4life programme to promote the oral health of homeless people was launched in Scotland. Practitioners received training to ensure its successful implementation and adoption. A process evaluation began in February 2013.

Method:

A total of 20 oral health officers from the 11 participating NHS Boards took part in the process evaluation. They were interviewed each month for a 17-month period. Boards were placed into adoption categories based on the time taken to adoption. The data were analysed using a framework approach.

Results:

The Theory of Diffusion of Innovations was used to define ‘time to adoption’ and to classify participating NHS Boards’ adoption categories. It was also used to identify diffusion variables that underpinned Smile4life adoption. For Boards that more readily adopted Smile4life, the diffusion variables of familiarity and good social exchanges appeared to promote implementation. Numerous conflicts emerged, however, in late adoption Boards. These included a lack of resources and practitioner ambivalence, which slowed up implementation.

Conclusion:

The Theory of Diffusion of Innovations provided a useful theoretical framework for understanding the processes in the implementation and adoption of the Smile4life programme. It allowed specific training requirements for the practitioners to emerge to facilitate diffusion of the programme in their Boards.
Trial, error and economic development in colonial Punjab: The Agri-Horticultural Society, the state and sericulture experiments, c. 1840–70
Authors: Lally Jagjeet
Published: February 2015

The history of economic change in colonial and post-colonial Punjab is well-studied, at least for the period from c. 1880, when Punjab became a major producer of relatively low-value-added crops, such as cereals, raw cotton and sugar. This article argues that the colonial state’s intervention in the economy in the 1840s to 1870s—the decades of the British colonial conquest of Punjab and the early administration in the province—should not be seen as a prelude to later developments. Specifically, this article argues that state policy proceeded by trial and error, that the state worked through a seemingly private organisation—the Agri-Horticultural Society—to trial a scheme that sought to re-model Punjab as a producer of higher-value-added commodities for the global market such as silk following the precedent of colonial Bengal, and that the resultant failure of these experiments contributed to the changes in policy and the pattern of development from the final-quarter of the century. In studying the Agri-Horticultural Society’s silk experiments, furthermore, this article also sheds light on the history of the early colonial state and the history of sericulture in Punjab.
Ambedkar’s paradox of differentiation: Language, nation and recognition of states in post-colonial India
Authors: Bharadwaj Vasudha
Published: February 2015

Set against the backdrop of the linguistic states movement in the Telugu-speaking regions that would eventually come to form the state of Andhra Pradesh in 1956, this article explores Ambedkar’s views on state formation as articulated during the worst periods of unrest. Apparently driven by language, the Andhra movement of the first half of the twentieth century was an exercise in the self-definition and empowerment of an increasingly self-conscious political community. Ambedkar viewed the demand for linguistically defined states as comparable to the Muslim League’s demand for a separate Pakistan in the manifest desire for cultural recognition and self-determination. His proposed resolution against the potential threat to national unity posed by recognising language as a factor in state formation was twofold. One, he emphasised the idea of ‘one state, one language’ originally proposed by the States Reorganisation Commission, arguing that multiple states sharing a common language would be less likely to see themselves as a ‘nation’, with the added advantage that the majority-to-minority ratio would remain reasonable. Two, the language of administration should be common irrespective of the linguistic identity of the state, and that this should be English until Hindi became universally acceptable. As he saw it, the thoughtful implementation of such a solution that compromised on certain notions of the ideal could paradoxically facilitate the unity of the post-colonial republic, by recognising anxieties of minority groups, whether religious, linguistic or of another kind, and protecting them.
Young Girls’ Embodied Experiences of Femininity and Social Class
Authors: Francombe-Webb Jessica , Silk Michael
Published: February 2015

Based on research with middle-upper class 12–13-year-old school girls, we discuss how femininities were embodied and discursively reconstructed in class-based ways. The data suggests the girls understood class antagonisms within the boundaries of neoliberal discourses of responsibilization, self-discipline, self-worth, and ‘proper’ conduct and choices. With social class stripped of any structural or structuring properties, instead imparted to the fleshy sinews of the (excessive) body, the data reveals how social class was made visible and manifest in various mechanisms of, and meanings about, inclusion, exclusion, pathology and normalization. Thus, in explicating the ways in which the school girls embodied middle-upper class femininity (as the epitome of localized and everyday neoliberalism) we highlight how, in turn, ‘others’ (‘chavs’) were pathologized and deemed in need of regulation, management and governance.
Efficacy Beliefs in Third-Person Effects
Authors: Rosenthal Sonny , Detenber Benjamin Hill , Rojas Hernando
Published: February 2015

People generally believe they are less susceptible than others to influences of media, and a growing body of research implicates such biased processing, or third-person perception, in public support for censorship, a type of third-person effect. The current study extends research of the third-person effect by studying two efficacy-related concepts in the context of sexual content in films. Analysis of cross-sectional data from 1,012 Singaporeans suggests that people exhibit self-other asymmetries of efficacy beliefs: They believe others are less capable than they are of self-regulation and that censorship is more effective at restricting others’ access to sexual content in films. Furthermore, the former belief was directly related to the belief that others are more susceptible to negative influence, and thus was indirectly related to support for censorship; whereas the latter belief was directly related to support for censorship. Results may help distinguish the roles of self-regulation and government censorship as bases of local media standards.
Building a Moral Metropolis: Philanthropy and City Building in Houston, Texas
Authors: Henthorn Thomas C.
Published: February 2015

When Houston Texas grew from a sleepy, southern entrepot to sunbelt metropolis, the city’s commercial civic elite adopted a systematic approach of organized philanthropy as a way to rationalize giving and bring it in line with modern urban services. As a select set of city builders transformed local giving from random charitable impulses to increasingly complex philanthropic undertakings, their benevolent behavior took many forms, from scientific charity to regulatory action and, finally, to detached foundations. Over time, more rational giving also became more professional and wealthy donors sought a new status—that of philanthropist—and with it, the great cultural authority to address the city’s social problems. Philanthropists in Houston fashioned a number of mechanisms to realize their vision of what the modern metropolis should be. Understanding this vision adds to our knowledge of the multiple voices that derived power and status from their efforts to guide the construction of growing cities.
ISPS-modular command-filtered adaptive back-stepping control of non-linearly parameterized pure-feedback systems
Authors: Ji Yuehui , Zhou Hailiang , Zong Qun
Published: February 2015

An input-to-state practically stable (ISPS)-modular command-filtered adaptive back-stepping control (CFABC) is investigated for non-linearly parameterized pure-feedback systems, which can obviate the complicate analytic derivatives in traditional back-stepping design. In the proposed CFABC scheme, sliding-mode-based integral filters are introduced to approximate the virtual control derivatives, to solve the ‘circular construction problem’ and the problem of an ‘explosion of complexity’ in a pure-feedback system. The resulting closed-loop system consists of a controller-filter pair, which satisfies the ISPS property, providing the celebrated small-gain theorem can be exploited to guarantee the stability of the closed-loop system. Referring to the issue of non-linearly parameterized uncertainty, adaptive laws are derived via the parameter separation technique. Numerical simulations are included to illustrate the effectiveness of the proposed control scheme.
Assessment of Cardiovascular Risk in Adults With Type 2 Diabetes and Metabolic Syndrome
Authors: Kim Chun-Ja , Kang Hee Sun , Schlenk Elizabeth A. , Chae Sun-Mi
Published: February 2015

Purpose

The purpose of this study was to assess risk of cardiovascular disease (CVD) by comparing the Framingham and United Kingdom Prospective Diabetes Study (UKPDS) risk equations in Korean adults with type 2 diabetes (T2DM) and metabolic syndrome.

Methods

The study was a cross-sectional survey enrolling a convenience sample of 110 Korean adults with T2DM and metabolic syndrome. The 10-year CVD risk scores were calculated using the Framingham risk equation and UKPDS risk engines.

Results

Overall participants had a moderate prevalence (average, 64.3%) of metabolic syndrome factors, with the most prevalent being abdominal obesity (86.4%) and elevated blood pressure (78.2%). A lower percentage of women were current smokers and consumed alcohol than men, whereas a higher percentage of men had their weight and stress controlled than women. The mean scores of 10-year CVD risk using the Framingham and UKPDS equations were 14.55% and 15.99%, respectively. However, there were no significant differences between results of the 2 equations. Regarding level of CVD risk, the percentage of high risk (>20%) was about 24% using both equations. Also, the area under the receiver operating characteristic curves using Framingham and UKPDS equations was similar: 0.707 and 0.696, respectively, which indicated moderate accuracy.

Conclusions

About one-fourth of adults with T2DM and metabolic syndrome had high level of CVD risk (>20%). In practice, people with diabetes and metabolic syndrome could be managed earlier and more intensively based on their risk estimated by the Framingham or UKPDS equations.