bluuebunny/crossref_metadata_2025 huggingface dataset:
Formal rules, informal norms and the everyday practice of coalition governance
Authors: Matthews Felicity
Published: October 2018

Despite the significant attention devoted to their birth and death, the day-to-day operation of coalition government remains understudied. This article addresses this lacuna and sheds light on the dynamics of coalition governance by examining the interplay between macro-level institutions, meso-level values and micro-level practices. Focusing on the Conservative – Liberal Democrat Coalition that governed the United Kingdom between 2010 and 2015, this analysis reveals the extent to which the everyday practice of coalition governance is flexible, contingent, and proceeds through informal negotiation and accommodation. It also draws attention to the dilemmas faced by coalition actors in terms of reconciling competing loyalties and appeasing a wide range of audiences. Through this analysis, the article makes an important distinction between the ‘rules-in-form’ and ‘rules-in-use’ of coalition governance and between the different ways that coalition governance is enacted on the ‘frontstage’ and ‘backstage’. Together, these findings point to an important new avenue of research for coalition scholars.
A typology of job search sources: Exploring the changing nature of job search networks
Authors: Piercy Cameron W , Lee Sun Kyong
Published: October 2018

This study explored American job seekers’ network of information sources using a random sample. Results revealed a pattern that job seekers segmented information sources by social (i.e. personal and professional acquaintances, family, and friends), formal (i.e. employment agencies, printed advertisements, and career events), and online (i.e. online pages and social network sites) types. Although online sources were particularly central in the network, job seekers who used one source type did so at the expense of other types of sources. Older and poorer job seekers were more likely to use formal sources, while online sources were used more by job seekers with higher education and Internet efficacy. The discussion offers advice for job seekers and those who coach job search. This study extends strength of weak ties theory by demonstrating the importance of online sources in job search.
Representations – A critical look at media’s role in cleanliness conventions and inconspicuous consumption
Authors: Jack Tullia
Published: October 2018

In post-industrialist societies, similar high standards of living are becoming not only desired but also expected the world over. Globalising processes ensure that every material desire is within the reach of ordinary citizens, and then flame these desires in order to sustain continuous growth narratives. But are increasingly resource-intensive lifestyles sustainable, or even desirable? This article investigates cleanliness using representations in media to understand how practices – including washing, disinfecting and sanitising – have become increasingly normal. Five popular Swedish magazines from 1985 to 2015 are used to track the representations of cleanliness. Idealisation, shame and medicalisation are the main themes arising from this data set. These themes aim to perpetuate higher cleanliness conventions and translate them into consumer goods. The article is inspired by a critical theoretical perspective which helps to reveal inequalities perpetuated by the way media represents cleanliness and suggests that the imperative to clean falls most heavily on those who lack the resources to resist. Processes of inclusion and exclusion are inherent in consumer culture and this attempt at using critical theory to understand consumption practices illuminates consumption’s role in not only increasing pressure on the natural environment but also amplifying social stratification.
Supporting First-Generation Students’ Adjustment to College With High-Impact Practices
Authors: Conefrey Theresa
Published: October 2018

This qualitative case study describes some of the issues faced by incoming first-generation college students at a private, 4-year institution in the northwest. Using constructs drawn from social cognitive theory and social cognitive career theory, it explores how high-impact practices such as learning communities, writing-intensive courses, and ePortfolios might impact first-generation students’ adjustment during their first year of college. The findings of the research on students’ writing in their first-year composition course suggest that the cumulative impact of engaging in multiple high-impact practices improves students’ literacy and study skills. In addition, these educational practices appear to increase students’ self-appraisal of their academic abilities in general and their institutional commitment. As a consequence of their increased self-efficacy and engagement, this study suggests that students are more likely to experience better academic outcomes, leading them to persist in their studies and be retained after their first year at college.
Rhazyaminine from Rhazya stricta Inhibits Metastasis and Induces Apoptosis by Downregulating Bcl-2 Gene in MCF7 Cell Line
Authors: Iqbal Waqas , Alkarim Saleh , Kamal Tahseen , Choudhry Hani , Sabir Jamal , Bora Roop S. , Saini Kulvinder S.
Published: October 2018

Background: The role of alkaloids isolated from Rhazya stricta Decne (Apocynaceae family) (RS) in targeting genes involved in cancer and metastasis remains to be elucidated. Objective: Identify and characterize new compounds from RS, which inhibit gene(s) involved in the survival, invasion, self-renewal, and metastatic processes of cancer cells. Methods: Bioinformatics study was performed using HISAT2, stringtie, and ballgown pipeline to understand expressional differences between a normal epithelial cell line-MCF10A and MCF7. NMR and ATR-FTIR were performed to elucidate the structure of rhazyaminine (R.A), isolated from R stricta. Cell viability assay was performed using 0, 25, and 50 μg/mL of total extract of R stricta (TERS) and R.A, respectively, for 0, 24, and 48 hours, followed by scratch assay. In addition, total RNA was isolated for RNA- seq analysis of MCF7 cell line treated with R.A followed by qRT-PCR analysis of Bcl-2 gene. Results: Deptor, which is upregulated in MCF7 compared with MCF10A as found in our bioinformatics study was downregulated by R.A. Furthermore, R.A effectively reduced cell viability to around 50% ( P < .05) and restricted cell migration in scratch assay. Thirteen genes, related to metastasis and cancer stem cells, were downregulated by R.A according to RNA- seq analysis. Additionally, qRT-PCR validated the downregulation of Bcl-2 gene in R.A-treated cells by less than 0.5 folds ( P < .05). Conclusion: R.A successfully downregulated key genes involved in apoptosis, cell survival, epithelial-mesenchymal transition, cancer stem cell proliferation, and Wnt signal transduction pathway making it an excellent “lead candidate” molecule for in vivo proof-of-concept studies.
Long-Term Effects of the Abdominal Aortic Aneurysm Model in Rabbits Prepared by Pancreatic Elastase Combined With Angiotensin II
Authors: Chen Qing , Nie Mao-xiao , Zhao Quan-ming
Published: October 2018

Objective:

This study aimed to observe the effect of pancreatic elastase combined with angiotensin II on a stable rabbit abdominal aortic aneurysm model.

Methods:

A total of 20 male New Zealand rabbits were randomly divided into groups A and B, with 10 rabbits per group. The rabbits in group A were given an intraperitoneal perfusion of pancreatic elastase, and the rabbits in group B were given continuous pumping of angiotensin II in addition to the operation of group A. Before the operation and at 2, 4, and 16 weeks postoperation, vascular color Doppler ultrasonography was performed, and blood samples were collected to measure the serum matrix metalloproteinase 9 (MMP9) and MMP2 levels. At 16 weeks postoperation, all rabbits in both groups were killed, and hematoxylin and eosin, Elastic-van-Gieson, Masson’s, and immunohistochemical staining were performed for the vessel specimens.

Results:

At 2 weeks postoperation, the aneurysm formation rates of the 2 groups were both 100%, and the average expansion rates of the aneurysm diameters were 85% and 93%, respectively; these differences were not significant ( P = .150 and P = .280, respectively). At 4 weeks postoperation, the aneurysm formation rates of the 2 groups were 71.4% and 100%, and the average expansion rates of the aneurysm diameter were 68% and 99%, respectively; the differences between the groups were significant ( P = .031 and P = .022, respectively). At 16 weeks postoperation, the aneurysm formation rates of the 2 groups were 14.3% and 100%, and the average expansion rates of the aneurysm diameter were 12% and 108%, respectively; the differences between the groups were significant ( P = .026 and P = .014, respectively).

Conclusion:

Compared to the abdominal aortic aneurysm modeling method in rabbits based on pancreatic elastase alone, the abdominal aortic aneurysm modeling method in rabbits using pancreatic elastase combined with angiotensin II maintained the morphology of the abdominal aortic aneurysm for a longer time, showing an important application value for the long-term observation of changes in abdominal aortic aneurysms.
Threatcasting: a framework and process to model future operating environments
Authors: Vanatta Natalie , Johnson Brian David
Published: October 2018

Threatcasting, a new foresight methodology, draws from futures studies and military strategic thinking to provide a novel method to model the future. The methodology fills gaps in existing military futures thinking and provides a process to specify actionable steps as well as progress indicators. Threatcasting also provides an ability to anticipate future threats and develop strategies to reduce the impact of any event. This technical note provides a detailed explanation of the Threatcasting methodology. It provides the reader with its connections to the current body of work within the foresight community and then explains the four phase methodology through the use of a real-life example.
Modeling of situation assessment in regional air defense combat
Authors: Yang Hai-yan , Zhang Shuai-wen , Li Xu-yu
Published: October 2018

The purpose of situation assessment in regional air defense combat is to quickly fuse data as well as to provide commanders with timely support for decision making. We propose a new framework for situation assessment in regional air defense combat, which plays a very concrete role in real combat and follows the combat process. The proposed framework involves three aspects: assessment of the air defense capability of a region; the prediction of an enemy’s invasion route; and the generation of an interception plan. A Bayesian network is used to evaluate and infer the air defense capability of a region. In the network, the calculation of input evidence is based on threat models from radar, the terrain, and anti-aircraft firepower. The weak areas for air defense can be observed when the evaluation is completed. Accordingly, the possible flight path of an enemy invader can be predicted via particle swarm optimization. We build an interception model based on existing attack modes for intercepting enemy aircraft to provide pre-planning for interception. The experimental results prove the feasibility and effectiveness of the proposed method. In particular, the proposed method can contribute to quick decision making in regional air defense combat.
Prediction of changes in functional ability of inpatients with schizophrenia using logarithmic and linear regression modelling
Authors: Kawaguchi Takayuki , Matsunaga Atsuhiko , Watanabe Aki , Suzuki Makoto , Asano Etsuko , Shirakihara Yoko , Shimizu Shinobu , Sawayama Toru , Fukuda Michinari , Miyaoka Hitoshi
Published: October 2018

Background/Objective

Few studies have addressed the type of time course regression that can predict changes in functional ability in inpatients with schizophrenia. This study investigated the possibility of predicting changes in functional ability by logarithmic and linear regression modelling when treating schizophrenia.

Methods

This longitudinal study included two analysis rounds. Analysis 1 comprised 40 inpatients (male/female: 16/24, mean age: 39.7 ± 13.5 years) for the identification of the time course of changes in functional ability based on the Activity Profile Scale for Patients with Psychiatric Disorders score from the group data. Analysis 2 comprised 17 inpatients (male/female: 9/8, mean age: 38.5 ± 9.4 years) to ensure correlation of the group data with the prediction of each individual’s degree of functional ability.

Results

In Analysis 1, Activity Profile Scale for Patients with Psychiatric Disorders score was assessed at the initial occupational therapy visit, one week and one month thereafter, and at discharge; logarithmic modelling using the scores at the initial visit, one month later and at discharge was more suitable (R2 = .506, p < .001) than the logarithmic and linear regression models using other score combinations. In Analysis 2, the individual’s predicted Activity Profile Scale for Patients with Psychiatric Disorders scores at discharge, as calculated by logarithmic modelling using scores from the initial visit and one month later, correlated moderately with actual Activity Profile Scale for Patients with Psychiatric Disorders scores (R2 = .574, p < .001; ICC = .747, p < .001).

Conclusion

Logarithmic modelling based on Activity Profile Scale for Patients with Psychiatric Disorders score accurately predicted changes in the functional ability of inpatients with schizophrenia and is sufficiently uncomplicated to be adopted in daily clinical practice.
Design and simulation for driving system and steering system of hydraulic chassis of rice transplanter
Authors: Hu Kai , Zhang Wenyi
Published: October 2018

A new hydraulic chassis of rice transplanter is designed based on the paddy machinery operation requirements. Driving system adopts single pump four-motor scheme, and the anti-slide valve group is used to prevent the slippage of the shunt-wound hydraulic motors. Hydraulic steering system adopts single-way stable diverter valve for ensuring its response in time. Then, hydraulic system and components parameters are designed and calculated. The driving resistance and average slip rate are measured in paddy field. The experimental data verifies the correctness of theoretical calculation. The designed hydraulic driving system and steering system are simulated in AMESim. The simulated data, including pressure, flow, and torque, basically conform to the design requirement. The results verify the feasibility and reliability of chassis hydraulic scheme. The proposed design scheme may be extended to other vehicles for improving chassis performance.
“Together we rise”: Collaboration and contestation as narrative drivers of the Women’s March
Authors: Just Sine Nørholm , Louise Muhr Sara
Published: October 2018

The Women’s March is arguably the most important counter-narrative to Trump’s post-truth regime, but does it also present a leadership alternative to his populist and authoritarian style? And is this alternative necessarily better than currently dominant social formations? In this paper, we argue that the Women’s March is partially configured by similar forces of affective circulation as those governing pro-Trump narratives, but that it is different and better in one important respect. The narratives of the Women's March are driven by both collaboration and contestation, meaning its circulation is both centripetal and centrifugal. We substantiate this claim through a close reading of the narration of the Women’s March – from its inception until its first anniversary. Here, we focus particularly on the development from a moment of resistance to a political movement, arguing that this process offers a prototype for conceptualizing a new form of “rebel” or social movement leadership. Hence, the Women’s March not only offers a different and better alternative to the leadership of Trump but also an opportunity for promoting and refining leadership theory in the post-heroic vein.
I recognise your name but I can’t remember your face: An advantage for names in recognition memory
Authors: Burton A Mike , Jenkins Rob , Robertson David J
Published: October 2018

Forgetting someone’s name is a common failure of memory, and often occurs despite being able to recognise that person’s face. This gives rise to the widespread view that memory for names is generally worse than memory for faces. However, this everyday error confounds stimulus class (faces vs. names) with memory task: recognition versus recall. Here we compare memory for faces and names when both are tested in the same recognition memory framework. Contrary to the common view, we find a clear advantage for names over faces. Across three experiments, we show that recognition of previously unfamiliar names exceeds recognition of previously unfamiliar faces. This advantage persists, even when the same face pictures are repeated at learning and test—a picture-memory task known to produce high levels of performance. Differential performance between names and faces disappears in recognition memory for familiar people. The results are discussed with reference to representational complexity and everyday memory errors.
The consultation beyond the Clinical Skills Assessment
Authors: Newbegin Claudia
Published: October 2018

Working for the Clinical Skills Assessment (CSA) can feel like trying to jump through the proverbial ‘hoop’; like being a circus dog training to jump higher and higher. I prepared for my CSA with two friends on a similar schedule. For months, my consulting style was scrutinised. They commented on my facial expressions, my body position and my tone of voice. I learned that graphs do not help patients understand preventative medicine, and that I sound patronising when trying to empathise. I learned how to break bad news, explain contraception, work with interpreters, and assess a young person’s Gillick competence. We progressed through cards, books and online resources. My acting skills became prodigious. I became more confident in conducting a certain kind of consultation. Eventually, we all jumped through the hoop. However, what of the consultation once you land on the other side? Do you forget how to read emotional temperature and to involve patients in decision making? Do you revert to a paternalistic approach in bashing through the volume of patients and paperwork? Do you accept everything patients say, and give them exactly what they want in order to get them out of the room? Hopefully, this is far from the case.
Performance analysis of vertically offset overlapped propulsion system based quadrotor in an aerial mapping mission
Authors: Nandakumar Ganeshram , Saphal Rohan , Joishy Ashish , Thondiyath Asokan
Published: October 2018

In this paper, the authors present the performance analysis of a Vertically Offset Overlapped Propulsion System (VOOPS)-based quadrotor in an aerial mapping mission. The dynamic model of the VOOPS quadrotor with the effect of overlapping propellers and the profile drag has been derived and simulated. A path-tracking mission is taken as an example for aerial survey. The controller used for this task is presented, followed by the response study of the attitude and the position controller with standard test inputs. A graphical interface has been built to select the area to be mapped by defining a polygon around it, and waypoints for lawn-mower type survey grid were generated based on the direction of wind. The path-tracking algorithm is presented along with course correction and simulations were performed with both conventional and VOOPS quadrotor. An experimental vehicle based on the proposed VOOPS concept has been built, tested on the same path, and the results are discussed. The results show that the VOOPS quadrotor is capable of performing the aerial mapping mission with quick response and good accuracy.
Resilience-building in Georgia, Moldova and Ukraine: Towards a tailored regional approach from the EU
Authors: Lavrelashvili Teona
Published: October 2018

The article considers the dimensions and specificity of the concept of ‘resilience’ as applied to the concrete cases of three Eastern neighbourhood states: Georgia, Moldova and Ukraine. It argues that EU policymakers should acknowledge the similarities and differences between the three when considering policies to strengthen these countries’ resilience. At the same time, however, they need to recognise that the biggest common threat to their security emanates from neighbouring Russia. The article further suggests that fostering regional cooperation between Georgia, Ukraine and Moldova, as well as working with political institutions such as the political parties in these countries, will contribute to strengthening their resilience.
Decision making in crisis
Authors: Dionne Shelley D. , Gooty Janaki , Yammarino Francis J. , Sayama Hiroki
Published: October 2018

Despite recognition that emotions are present and salient during a crisis, traditional views of crisis decision making, such as crisis decision theory and naturalistic decision making, emphasize mainly the role of cognitive processes. Several recent crises illustrate individuals face complex, dynamic, and significant situations requiring decisions with which they are unfamiliar and/or lack experience. Moreover, dangerous and life-threatening situations activate negative emotions such as anger, regret, guilt, fear, disappointment, and shame, which may uniquely affect recursive associations with the immediate cognitive schema elicited after a crisis. Also consider individuals do not experience crises in a vacuum. Rather, they perceive, interpret, and assess information via interactions with others, thus creating collective crisis decision making as a substantive level of analysis. As such, we present a multilevel theoretical model examining the interactive role cognitions and emotions play in crisis decision making, and offer implications regarding individual and collective decisions during crises.
Psychiatric outcomes observed in patients living with HIV using six common core antiretrovirals in the Observational Pharmaco-Epidemiology Research and Analysis database
Authors: Hsu Ricky , Fusco Jennifer , Henegar Cassidy , Mounzer Karam , Wohlfeiler Michael , Vannappagari Vani , Aboud Michael , Curtis Lloyd , Fusco Gregory
Published: October 2018

Background:

Psychiatric outcomes are common among people living with HIV and may be associated with specific antiretroviral use. We evaluated the occurrence of psychiatric outcomes in patients taking dolutegravir (DTG)-containing regimens compared with five other core agents.

Methods:

Patients in the OPERA database prescribed regimens based on DTG, efavirenz (EFV), raltegravir (RAL), darunavir (DRV), rilpivirine (RPV), or elvitegravir (EVG) for the first time between 1 January 2013 and 31 December 2015 were analyzed. Psychiatric outcomes included diagnoses of anxiety, depression, insomnia, or suicidality during core agent exposure. Multivariable Cox analysis models were used to assess time to psychiatric outcomes between core agents stratified by psychiatric history, with DTG as the referent.

Results:

A total of 13,261 patients initiated a regimen of interest (DTG: 2783; RAL: 979; EVG: 3895, EFV: 1746, RPV: 1921, DRV: 1937). Psychiatric history was common, with varied prevalence across groups (DTG 38%, EFV 24%, RAL 40%, DRV 34%, RPV 29%, EVG 31%). Among patients without a psychiatric history, the likelihood of a psychiatric outcome during follow up did not differ between DTG and the other core agents. Among patients with a psychiatric history, risk during follow up for patients taking DTG was equivalent ( versus RPV), marginally reduced ( versus RAL and EFV), or reduced ( versus EVG and DRV).

Conclusions:

In a large cohort of HIV+ patients in care, patients with a psychiatric history appeared channeled towards drugs with known favorable psychiatric safety profiles, including DTG. Despite this, DTG exposure was not associated with an increased risk of psychiatric outcomes during follow up in patients with or without a psychiatric history.
The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities
Authors: Reardon David C
Published: October 2018

The abortion and mental health controversy is driven by two different perspectives regarding how best to interpret accepted facts. When interpreting the data, abortion and mental health proponents are inclined to emphasize risks associated with abortion, whereas abortion and mental health minimalists emphasize pre-existing risk factors as the primary explanation for the correlations with more negative outcomes. Still, both sides agree that (a) abortion is consistently associated with elevated rates of mental illness compared to women without a history of abortion; (b) the abortion experience directly contributes to mental health problems for at least some women; (c) there are risk factors, such as pre-existing mental illness, that identify women at greatest risk of mental health problems after an abortion; and (d) it is impossible to conduct research in this field in a manner that can definitively identify the extent to which any mental illnesses following abortion can be reliably attributed to abortion in and of itself. The areas of disagreement, which are more nuanced, are addressed at length. Obstacles in the way of research and further consensus include (a) multiple pathways for abortion and mental health risks, (b) concurrent positive and negative reactions, (c) indeterminate time frames and degrees of reactions, (d) poorly defined terms, (e) multiple factors of causation, and (f) inherent preconceptions based on ideology and disproportionate exposure to different types of women. Recommendations for collaboration include (a) mixed research teams, (b) co-design of national longitudinal prospective studies accessible to any researcher, (c) better adherence to data sharing and re-analysis standards, and (d) attention to a broader list of research questions.
Angiosarcoma complicating lower leg elephantiasis in a male patient: An unusual clinical complication, case report and literature review
Authors: Shavit Eran , Alavi Afsaneh , Limacher James J , Sibbald R Gary
Published: October 2018

Chronic lymphedema is rarely complicated by an angiosarcoma. Angiosarcoma superimposed on chronic lymphedema (Stewart–Treves syndrome) is usually seen post breast cancer surgery accompanied by lymph node resection of the axilla. This is a case report of a 59-year-old male patient with elephantiasis that developed an angiosarcoma of the lower leg. He died a month after the diagnostic biopsy was obtained. This is a rare multifocal tumor in a male with an unusual lower leg location. We reviewed the literature and the need to differentiate this often deadly lesion from a Kaposi’s sarcoma.
Gemcitabine-induced skin necrosis
Authors: Haydock Maria Monica , Sigdel Saroj , Pacioles Toni
Published: October 2018

Since its emergence as a chemotherapy agent, gemcitabine has been associated with cutaneous adverse reactions. Rash is reported to be the most common cutaneous adverse effect. Other reported cutaneous reactions in the literature include bullous dermatosis, pseudocellulitis, subacute cutaneous lupus alopecia, and palmar–plantar erythrodysesthesia. Skin necrosis is a very rare adverse effect of this otherwise well-tolerated chemotherapeutic agent. In searching the literature, only one other case has been reported. In our report, we present a 74-year-old male with adenocarcinoma of the pancreas, status-post pancreaticoduodenectomy (Whipple procedure), who developed a rare case of skin necrosis of the lower leg 2 weeks after completing six cycles of monotherapy gemcitabine treatment.
Law Enforcement and the Depiction of Minorities and Women on Social Media: A Review of Municipal Police Department Facebook Pictures
Authors: Sever Brion , Elg Eric , Ellis Sydney
Published: October 2018

There is a growing area of research today focusing on how the demographics of law enforcement officers and criminals are depicted. This research has concentrated on portrayals by the media, popular culture, criminal justice textbooks, training manuals, and other literature surrounding criminal justice. There is little known, however, about the way the race and gender of police and criminals are represented on social media. This study attempts to fill this void by examining police Facebook pages in the 171 largest cities in the United States. Specifically, 20,152 images of police and criminals on these police Facebook pages are examined to determine whether there are disparities in representation based on race, gender, and other variables. We found that female and minority officers are appropriately represented in the images of police on Facebook pages in relation to their actual representation in the field. In contrast, images of criminals tend to be disproportionately composed of Black males. Implications for the recruitment of minority officers and other relevant issues are discussed.
Rethinking the Business Strategy in the Gaming Industry in India: The Case of Virtual Infocom
Authors: Chattopadhyay Subrata , Bhattacharya Subhajit , Bhattacharya Arijit
Published: October 2018

The case is about rethinking the business strategy in the gaming industry in India vis-à-vis the world. It discusses the start-up Virtual Infocom (Virtual Information & Communications) and how over the years it has grown into a formidable local and global player. The case is about revamping market strategy and the attributes therein, the prospects and the potential, and envisages to explore as to how the company should, if so, alter their business strategy to be a top brand reckoning in the industry. Virtual Infocom, primarily a training institute, is considering whether to develop games for the market instead of being a secondary player. It unravels the dilemma as to whether it should continue with training or diversify to earn revenues globally to ensure a sustainable competitive advantage in the gaming industry.
Aśokan edicts: The genesis of the imperial idea and culture in early India and the debt to Iran
Authors: Sahu Bhairabi Prasad
Published: October 2018

The Mauryan Empire was preceded by the Achaemenian Empire, which in extent, and centralisation appears to have set a model for it. There is much on the surface to justify this thesis. Most remarkably there is the use of stone inscriptions for which the Achaemenid emperors, especially Darius and Xerxes, set a precedent. Stone and stone-cut art and architecture, not traceable in post-Indus India begin with Aśoka, and this too had Achaemenid precedents on a grand scale. This essay concedes the connection but argues that the contexts and contents of Aśokan inscriptions were essentially different from their Achaemenid precedents, and Mauryan art too, in both its forms and message, owed much to indigenous tastes and genius.
Prescription Drug Monitoring Program Use: National Dental PBRN Results
Authors: McCauley J.L. , Gilbert G.H. , Cochran D.L. , Gordan V.V. , Leite R.S. , Fillingim R.B. , Brady K.T. ,   the National Dental PBRN Collaborative Group
Published: October 2018

Introduction:

The American Dental Association recommends that dentists use a prescription drug monitoring program (PDMP) prior to prescribing an opioid for acute pain management.

Objective:

The objective of this study was to examine dentists’ experiences using their state PDMP, as well as the impact that state-mandated registration policies, mandated use policies, and practice characteristics had on the frequency with which dentists used their PDMP.

Methods:

We conducted a web-based cross-sectional survey among practicing dentist members of the National Dental Practice-Based Research Network ( n = 805). The survey assessed prescribing practices for pain management and implementation of risk mitigation strategies, including PDMP use. Survey data were linked with network Enrollment Questionnaire data to include practitioner demographics and practice characteristics.

Results:

Nearly half of respondents ( n = 375, 46.6%) reported having never accessed a PDMP, with the most common reasons for nonaccess being lack of awareness ( n = 214, 57.1%) and lack of knowledge regarding registration and use ( n = 94, 25.1%). The majority of PDMP users reported the program to be very helpful (58.1%) or somewhat helpful (31.6%). Dentists reported that PDMP use most often did not change their intended prescribing behavior (40.2%), led them not to prescribe an opioid (33.5%), or led them to prescribe fewer opioid doses (25.5%). Presence of a mandated use policy was significantly associated with increased frequency of PDMP use across a variety of situations, including prior to 1) prescribing any opioid for pain management, 2) issuing refills, 3) prescribing to new patients, and 4) prescribing to patients deemed high risk.

Conclusion:

Findings suggest that the majority of dentists find PDMPs helpful in informing their opioid-prescribing practices. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists’ PDMP use, outreach and education efforts may overcome key barriers to use identified in this study.

Knowledge Transfer Statement:

Findings from this national survey suggest that the majority of practicing dentists find PDMPs helpful in informing their opioid-prescribing practices; however, consistent PDMP use was not common. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists’ PDMP use, outreach and education efforts may overcome key barriers to use identified in this study.
Sexual Slavery: A Case Study of Joginis in South India
Authors: Tejpal Mansi
Published: October 2018

In the religious land of India, in the hearts of the bifurcated southern states of Telangana and Andhra Pradesh, there exists the exploitative custom of ritual sexual slavery—the Jogini system (a local variation of the Devadasi system) of marrying young girls to a deity. This social evil has resisted the legal measures aimed at curbing it until date, despite having been prohibited as per the Devadasi (Prohibition of Dedication) Act (the Jogini Act) which became a law in Andhra Pradesh in March 1988. Although education and increasing awareness of human rights have yielded great positive results in terms of the decline in initiations, yet cases indicating the existence of the system still exist. This article, based on a qualitative study of three Joginis (also addressed as Jogins) in the Mahbubnagar district of Telangana, is an attempt to understand the reasons behind the persistent decline, yet existence, of this practice through the eyes of those directly affected by it—the Jogins, their families and the community.
Body integrity identity disorder: clinical features and ethical dimensions
Authors: Barrow Emma , Oyebode Femi
Published: October 2018

Body integrity identity disorder (BIID) is a rare and complex identity disorder described by the desire to acquire a physical disability and an associated sense of incompleteness at being able-bodied. Individuals with the disorder often delay presentation until later in life because of perceived stigma about wishing to acquire a physical disability, and may have sought amputation already through ‘underground’ means or self-harm (attempts at self-amputation). In this article we present an account of the recent history and origins of the disorder, from its early descriptions and case reports through to the current neuropsychiatric theory of right superior parietal lobe dysfunction as basis for the disorder. We consider the epidemiology, pathogenesis and clinical features of this identity disorder of bodily integrity, highlighting the associations with conditions such as gender identity disorder. With this we then discuss the ethical considerations for available treatment options, mainly elective surgical amputation.

LEARNING OBJECTIVES

•

Understand the current definition and clinical features of body integrity identity disorder

•

Be familiar with the conceptual history of the disorder, epidemiology and current neuropsychiatric perspective

•

Be aware of the ethical aspects of elective surgical amputation as a treatment for the disorder

DECLARATION OF INTEREST

None.
Addressing Burnout in Oncology: Why Cancer Care Clinicians Are At Risk, What Individuals Can Do, and How Organizations Can Respond
Authors: Hlubocky Fay J. , Back Anthony L. , Shanafelt Tait D.
Published: October 2018

Despite their benevolent care of others, today, more than ever, the cancer care professional who experiences overwhelming feelings of exhaustion, cynicism, and inefficacy is in grave jeopardy of developing burnout. Clinicians are repeatedly physically and emotionally exposed to exceedingly long hours in direct care with seriously ill patients/families, limited autonomy over daily responsibilities, endless electronic documentation, and a shifting medical landscape. The physical and emotional well-being of the cancer care clinician is critical to the impact on quality care, patient satisfaction, and overall success of their organizations. The prevention of burnout as well as targeting established burnout need to be proactively addressed at the individual level and organizational level. In fact, confronting burnout and promoting wellness are the shared responsibility of both oncology clinicians and their organizations. From an individual perspective, oncology clinicians must be empowered to play a crucial role in enhancing their own wellness by identification of burnout symptoms in both themselves and their colleagues, learning resilience strategies (e.g., mindful self-compassion), and cultivating positive relationships with fellow clinician colleagues. At the organizational level, leadership must recognize the importance of oncology clinician well-being; engage leaders and physicians in collaborative action planning, improve overall practice environment, and provide institutional wellness resources to physicians. These effective individual and organizational interventions are crucial for the prevention and improvement of overall clinician wellness and must be widely and systematically integrated into oncology care.
Immunotherapy for Soft Tissue Sarcoma: Tomorrow Is Only a Day Away
Authors: Lee Alex , Huang Paul , DeMatteo Ronald P. , Pollack Seth M.
Published: October 2018

Despite the advances taking place for patients with many types of cancer, to date there has been little success in meeting the great need for novel treatments of advanced soft tissue sarcoma with effective immunologic therapies. Here, we review recent clinical and preclinical data that indicate immune responses against sarcomas occur spontaneously and can also be successfully provoked. Efforts to manipulate the sarcoma immune microenvironment have the potential to eradicate disease and may also sensitize tumors to other tumor-targeted immunotherapeutic approaches. Other approaches, including vaccines and genetic engineering of T cells, offer a promising opportunity to actively direct cytotoxic lymphocytes toward antigen-bearing sarcomas. Drawing parallels with recent advances made in other cancer types, we identify ways in which sarcomas can be included in the ongoing immunotherapy revolution.
Treatment of Older Women With Endometrial Cancer: Improving Outcomes With Personalized Care
Authors: Duska Linda , Shahrokni Armin , Powell Melanie
Published: October 2018

Endometrial cancer is the most common gynecologic cancer, and with a median age of 62 at diagnosis, it affects a significant number of older women. With increasing age and obesity rates in the world’s population, there is an anticipated concomitant increase in older women with endometrial cancer. Older women are more likely to die of endometrial cancer compared with younger patients. Reasons for this include more aggressive tumor biology, less favorable clinicopathologic features, and more advanced disease. Other factors, however, such as reluctance to offer surgical treatment to the older patient and increased complications of treatment are likely to be important. Management of endometrial cancer requires multidisciplinary care (surgery, radiation therapy, and systemic therapy). For each treatment, the feasibility (related to technical aspect of the procedure/treatment), side effects and safety (related to older-patient factors), and the overall benefit as it pertains to older women with endometrial cancer should be assessed carefully with a multidisciplinary approach. Despite the importance of these issues, the data are limited to answer these issues with clarity. In this article, we will review each treatment modality for older women with endometrial cancer. We will introduce the components of comprehensive geriatric assessment and their practical implication for older women with cancer in general and older women with endometrial cancer specifically.
Enhancing Care of the Survivor of Gynecologic Cancer: Managing the Menopause and Radiation Toxicity
Authors: Van Le Linda , McCormack Mary
Published: October 2018

It is expected that there will be 290,000 cases of gynecologic cancers in 2016. Of these cancers, 60,000 will be endometrial and 22,000 will be ovarian—the two most common gynecologic cancers. Endometrial and ovarian cancers occur in menopausal women with mean ages of 60 and 63, respectively. The majority of endometrial cancers are early stage, and 5-year survival is considered good at upwards of 75%. For ovarian cancer, while survival rates have improved, the 5-year survival rate for the most common stage (stage III) is 40%. Thus, a substantial number of patients with gynecologic cancer are menopausal, and a significant number of patients are survivors, particularly of endometrial cancers. It will be important for survivors of gynecologic cancers to receive care tailored to their needs as women and to mitigate gender-specific side effects of their cancer treatment.
Updated Diagnostic Criteria and Staging System for Multiple Myeloma
Authors: Rajkumar S. Vincent
Published: October 2018

There has been remarkable progress made in the diagnosis and treatment of multiple myeloma (MM). The median survival of the disease has doubled as a result of several new active drugs. These advances have necessitated a revision of the disease definition and staging of MM. Until recently, MM was defined by the presence of end-organ damage, specifically hypercalcemia, renal failure, anemia, and bone lesions (CRAB features) that can be attributed to the clonal process. In 2014, the International Myeloma Working Group (IMWG) updated the diagnostic criteria for MM to add three specific biomarkers that can be used to diagnose the disease in patients who did not have CRAB features: clonal bone marrow plasma cells greater than or equal to 60%, serum free light chain (FLC) ratio greater than or equal to 100 provided involved FLC level is 100 mg/L or higher, or more than one focal lesion on MRI. In addition, the definition was revised to allow CT and PET-CT to diagnose MM bone disease. These changes enable early diagnosis and allow the initiation of effective therapy to prevent the development of end-organ damage for patients who are at the highest risk. A new staging system has been developed that incorporates high-risk cytogenetic abnormalities in addition to standard laboratory markers of prognosis.
Moving Beyond Autologous Transplantation in Multiple Myeloma: Consolidation, Maintenance, Allogeneic Transplant, and Immune Therapy
Authors: Krishnan Amrita , Vij Ravi , Keller Jesse , Dhakal Binod , Hari Parameswaran
Published: October 2018

For multiple myeloma, introduction of novel agents as part of the front-line treatment followed by high-dose chemotherapy and autologous hematopoietic stem cell transplantation (ASCT) induces deep responses in a majority of patients with this disease. However, disease relapse is inevitable, and, with each relapse, the remission duration becomes shorter, ultimately leading to a refractory disease. Consolidation and maintenance strategy after ASCT is one route to provide sustained disease control and prevent repeated relapses. Though the consolidation strategy remains largely confined to clinical trials, significant data support the efficacy of consolidation in improving the depth of response and outcomes. There are also increasing rates of minimal residual disease–negativity with additional consolidation therapy. On the other hand, maintenance with novel agents post-transplant is well established and has been shown to improve both progression-free and overall survival. Evolving paradigms in maintenance include the use of newer proteasome inhibitors, immunotherapy maintenance, and patient-specific maintenance—a concept that utilizes minimal residual disease as the primary driver of decisions regarding starting or continuing maintenance therapy. The other approach to overcome residual disease is immune therapeutic strategies. The demonstration of myeloma-specific alloimmunity from allogeneic transplantation is well established. More sophisticated and promising immune approaches include adoptive cellular therapies, tumor vaccines, and immune checkpoint manipulations. In the future, personalized minimal residual disease–driven treatment strategies following ASCT will help overcome the residual disease, restore multiple myeloma–specific immunity, and achieve sustained disease control while minimizing the risk of overtreatment.
Challenges in Treating Premenopausal Women with Endocrine-Sensitive Breast Cancer
Authors: Azim Hatem A. , Davidson Nancy E. , Ruddy Kathryn J.
Published: October 2018

For the hundreds of thousands of premenopausal women who are diagnosed annually with endocrine-sensitive breast cancer, treatment strategies are complex. For many, chemotherapy may not be necessary, and endocrine therapy decision making is paramount. Options for adjuvant endocrine regimens include tamoxifen for 5 years, tamoxifen for 10 years, ovarian function suppression (OFS) plus tamoxifen for 5 years, and OFS plus an aromatase inhibitor for 5 years. There are modest differences in efficacy between these regimens, with a benefit from OFS most obvious among patients with higher-risk disease; therefore, choosing which should be used for a given patient requires consideration of expected toxicities and patient preferences. An aromatase inhibitor cannot be safely prescribed without OFS in this setting. Additional research is needed to determine whether genomic tests such as Prosigna and Endopredict can help with decision making about optimal duration of endocrine therapy for premenopausal patients. Endocrine therapy side effects can include hot flashes, sexual dysfunction, osteoporosis, and infertility, all of which may impair quality of life and can encourage nonadherence with treatment. Ovarian function suppression worsens menopausal side effects. Hot flashes tend to be worse with tamoxifen/OFS, whereas sexual dysfunction and osteoporosis tend to be worse with aromatase inhibitors/OFS. Pregnancy is safe after endocrine therapy, and some survivors can conceive naturally. Still, embryo or oocyte cryopreservation should be considered at the time of diagnosis for patients with endocrine-sensitive disease who desire future childbearing, particularly if they will undergo chemotherapy.