bluuebunny/crossref_metadata_2025 huggingface dataset:
Seismic response of short restrainers used to protect cladding panels in RC precast buildings
Authors: Zoubek Blaz , Fischinger Matej , Isakovic Tatjana
Published: July 2016

In the presented study, a second-line back-up system for the seismic protection of cladding panels in RC precast buildings is first presented. The system consists of special anchoring elements and a rope restrainer. The latter is activated only in the case when the existing connections between the primary structure and the panel fail, resulting in the occurrence of relatively large impact forces in the restrainer and in the anchoring elements. In order to adequately design the constitutive parts of the system, a simple yet sufficiently accurate procedure for the estimation of the impact forces is needed. A relatively easy-to-use formula was therefore proposed for this purpose. Next, an extensive parametric study, using response history analysis (RHA), was performed and the influence of several parameters affecting the impact forces in the restrainers was studied. The results obtained in the study were used to evaluate the proposed analytical formula. Considering the simplicity of the proposed formula, its accuracy was good. It can therefore be applied to the design of short restrainers which could be used in reinforced concrete (RC) precast buildings for the protection of cladding panels against the effects of earthquakes.
Analytical study of the coupled motions of decks in skew bridges with the deck–abutment collision
Authors: Amjadian Mohsen , Kalantari Afshin , Agrawal Anil K
Published: July 2016

It has been observed from failures of highway bridges during major earthquakes that skew bridges are among the most vulnerable to seismic loading. It has been shown that the coupling between the translational motions of the deck and the collision of the deck with the abutments are two major factors influencing the vulnerability of skew bridges. This paper studies the influence of deck–abutment collision (seismic pounding) on the coupled motions of decks of skew bridges during strong earthquakes using an analytical approach. A three-degree-of-freedom model is presented to study key dynamic features of skew bridges. It is assumed that the deck of the model is rigid and the columns remain elastic during the ground motion. Contact planes between the deck and the abutments are idealized by several contact points pairwise arrayed at the end-span expansion joints. The mechanism of energy absorption and dissipation during the contact duration is simulated through the implementation of a nonlinear contact element between the contact points. A parametric study has been carried out by varying different parameters, including the skew angle (β), the size of the gap between the deck and the abutments at the end-span expansion joints (gap), and the normalized stiffness eccentricity along the x-axis ( ex/ r). The results of this study show that the transverse displacements of acute corners of the deck and the rotation of the deck about the mass center noticeably increase with the increases of β and ex/ r, and with the decrease of the gap.
Effect of ethylene and 1-methylcyclopropene on the postharvest behavior of cape gooseberry fruits (Physalis peruviana L.)
Authors: Balaguera-López Helber E , Espinal-Ruiz Mauricio , Zacarías Lorenzo , Herrera Aníbal O
Published: July 2016

Cape gooseberry ( Physalis peruviana L.) fruits are highly perishable berries that exhibit a climacteric respiratory behavior. The objective of this study was to evaluate the effect of ethylene and the ethylene action inhibitor 1-methylcyclopropene on the postharvest behavior of cape gooseberry fruits (ecotype Colombia). Fruits were treated with ethylene, in an ethephon application (1000 µL L−1), and pretreated with 1-methylcyclopropene (1 µL L−1), 1-methylcyclopropene+ethylene, and results compared with a control without application. Subsequently, the fruits were maintained at room temperature (20 ℃, 75% RH) for up to 11 days. The pretreatment of the cape gooseberry fruits with 1-methylcyclopropene delayed most of the ripening-associated parameters, with a reduction in the respiration rate and ethylene production, skin color development, total soluble solids, total carotenoid content, loss of firmness, loss of total titratable acidity and emission of volatile compounds such as ethyl octanoate, ethyl butanoate, ethyl decanoate, and hexyl decanoate. Conversely, application of ethephon accelerated most of these physiological changes and also overcame most of the effects prevented by the ethylene action inhibitor. Altogether, the results supported the idea of a climacteric-like behavior for cape gooseberry fruits and pointing out that the pretreatment with 1-methylcyclopropene may be a promising and efficient postharvest treatment to delay maturity and extend the postharvest period.
Purchase of local products within the rural tourist experience context
Authors: Kastenholz Elisabeth , Eusébio Celeste , Carneiro Maria João
Published: July 2016

Rural tourism is frequently considered a development tool for rural areas. In particular, demand for local products may stimulate local economy and is simultaneously an important part of the tourist experience. Little is known, however, of the role of local product purchase within and as a result of the rural tourist experience. The present article addresses this gap by analysing the impact of the tourist experience on (a) the decision to purchase local products and (b) the amount of respective expenditures made, based on survey data on rural tourists in Portugal. Results reveal a positive impact of the knowledge, sensorial and interaction dimensions of the tourist experience in both models, and length of stay, age, place attachment and nationality also play a role.
A short-run model of a two-sector economy with tourism and unemployment
Authors: Schubert Stefan F.
Published: July 2016

The article develops a Keynesian style short-run model of a two-sector economy, comprising an industrial sector and a tourism sector. Industrial goods can be consumed, invested, exported, and imported. Tourism services produced in the tourism sector are consumed by foreigners and domestic residents. The two sectors are linked via consumption of domestic residents, which, in the Keynesian tradition, depends positively on disposable income, and via investment. An increase in sectoral production (industrial and tourism sector) stimulates consumption and investment expenditures. Output is completely demand determined, and resulting in unemployment in case of a lack of demand is Keynesian. Via the production function, changes in sectoral outputs translate into changes in unemployment. Focusing on the short run, prices are held constant. The article provides a graphical apparatus to analyze different types of sectoral demand shocks. We investigate an increase in foreigners’ demand for domestically produced tourism services (inbound tourism). Depending on the exchange rate regime or monetary policy, sectoral outputs and unemployment rates may move in tandem or in opposite directions. Our results support the popular view that tourism can reduce unemployment.
An integrated fuzzy-stochastic model for revenue management
Authors: Lacagnina Valerio , Provenzano Davide
Published: July 2016

Revenue management aims at improving the performance of an organization by selling the right product/service to the right customer at the right time. This task is very dependent on uncontrollable external factors. In the hospitality industry, rooms of the hotel represent perishable assets and fixed capacities at the same time. Therefore, in the case of a stochastic process for customers calling in reservations prior to a particular booking date, a common problem for hotels is to devise a policy for maximizing the total expected profit conditional on the set of bookings. We propose a fuzzy model for the hotel revenue management under an uncertain and vague environment. Fuzziness of objective and constraint functions have been incorporated into a stochastic booking model considering multiple-day stays to show the effect of uncertainty on the optimal demand. By changing the relaxation parameters of the objective function, we have found a set of optimal solutions with, in most of the cases, a value of the objective function equal to the optimal solution of the stochastic model, providing several alternative optimal room allocations.
Market segmentation and their potential economic impacts in an ecotourism destination
Authors: Neuts Bart , Romão João , Nijkamp Peter , Shikida Asami
Published: July 2016

In a heterogeneous tourist market, segmentation is a valuable marketing tool to focus attention on the most advantageous clusters of visitors. In an ecotourism destination, the attractiveness of tourists may be defined by their ecological awareness, but also their (potential) economic impact, since there is a need to balance ecological sustainability and economic viability. This article proposes a model-based latent class analysis of visitors’ preferences and choices in order to identify different demand clusters in the Shiretoko Peninsula, Japan. The method yields four distinct clusters, each differing in motivations, information search and activities undertaken. We also describe how our approach can be used to make informed decisions about management strategies on tourist heterogeneity in order to maximize benefits for the local economy.
A regional analysis of willingness-to-pay in Asian cruise markets
Authors: Chen Jamie M. , Zhang Junzhou , Nijkamp Peter
Published: July 2016

This article tests whether the willingness-to-pay (WTP) of cruise tourists is affected by multivariables, namely regional level variables, socio-demographic variables, cruise perception variables, cruise motivations and cruise preferences. Our research aims to measure the influence of the multivariables on the WTP of cruise tourists, in order to trace the determinants of WTP. Using a censored regression model, the following variables are found to be highly associated with the WTP of cruise tourists: income, education, family structure, occupation, cruise experience, cruise duration and cruise preferences. The results of the modelling not only fill in existing research gaps in the theory of WTP but also shed new light on the comparison of multiple regions in terms of the difference of WTP of cruise tourists. A latent cluster analysis is further conducted to identify market segments with different cruise WTPs, and this knowledge can be used to improve the marketing performance of cruise companies in the growing Asian markets.
Customer satisfaction and expenditure behaviour in musical festivals
Authors: Borges Ana Pinto , Rodrigues Paula , Matias Álvaro
Published: July 2016

We evaluate the determinants of the two different types of tourists’ expenditure behaviour at a musical festival: the expenditure per day in the city of the event and expenses in the enclosure during the event. We prove that the domestic tourists who live out of the town of the event and foreigners who came purposely for the event spend more in the enclosure. Comparing the expenditures in the city, foreigners spend more in town than the nationals who came from out of the city. Four distinct factors of satisfaction emerged in the application of the factorial analysis: organization of the festival, kind of music, conditions of the enclosure and accessibility to the venue. It was also found that the most satisfied with the event also have a higher propensity to spend more on the enclosure and in the city. This research reveals an important framework for event managers and for politicians. The results of this study will be important for the promotion and dissemination by the event organization to the extent that marketing campaigns should be directed to the identification of socio-demographic characteristics of the tourists, the factors of satisfaction and the lovers of the event that positively contribute to the expenditure in the city and in the enclosure. The results may be of interest to politicians, as the event, if properly assessed and planned, can be used as important marketing strategy in cities where it occurs. Moreover, this kind of event is already part of an itinerary tourism tour and for this reason, its social, cultural and economic importance will have to be properly assessed.
Travel motivations of seniors
Authors: Patuelli Roberto , Nijkamp Peter
Published: July 2016

Over the past decades, leisure travel has become increasingly popular in older segments of the world population, as a consequence of global factors such as a rise in life expectancy, improved health conditions, a higher disposable income and increased availability of discretionary time in retirement age. Consequently, researchers have become more interested in studying the motivations for travel of seniors. A number of questions may be raised or have been addressed in the recent past: What are the main factors explaining the travelling choices of seniors? Are their travel motivations different from the ones of the general population, which have been widely studied in the past? Are geographical differences in terms of motivations comparable between different age groups? Why is senior tourism a topic of particular interest with regard to Asia? In order to answer such questions, in this article, we provide a review of the literature on the travel motivations of seniors. On the basis of 29 articles published between 1988 and 2015 on the topic, we present a qualitative and meta-analytic assessment of past findings, by investigating the dimensions of travel motivations most frequently identified in past seniors surveys. Finally, we discuss a research agenda for further analysis of senior travel motivations and for the integration of this branch of travel research within the wider framework of senior tourism analysis and management.
Numerical study of different ceiling-mounted air distribution systems for a virtual classroom environment
Authors: Conceição Eusébio Z. E. , Santiago Cristina I. M. , Awbi Hazim B.
Published: July 2016

This paper presents a comparative numerical study of different ceiling-mounted-localized air distribution systems placed above students in a virtual classroom in summer conditions. The influence of four different ceiling-mounted-localized air distribution systems, using vertical descendent jets, on the thermal comfort, local thermal discomfort, and air quality levels was numerically evaluated. The air distribution index, developed previously, was used for non-uniform environment. This index considers the thermal comfort level, air quality level, effectiveness for heat removal, and effectiveness for contaminant removal. Numerical simulations were conducted for a virtual classroom equipped with one of four different ceiling-mounted-localized air distribution systems and with 6 desks, 6 or 12 students, and 2 upper airflow outlets. Inlet air supply temperature of 20 and 24℃ and an outdoor air temperature of 28℃ were used. The simulation results show that the air supply system having a vertical air jet placed at 1.8 m above the floor level (Case III), and with an inlet area of 0.01 m2 and a supply air velocity of 3 m/s would represent the best option in comparison with other air supply methods. In general, the air distribution index value decreases with an increase in inlet air temperature and the number of occupants. The air distribution index values are highest for Case III representing a classroom with 6 or 12 occupants with an inlet air temperature of 20 or 24℃.
Renewable energy sources-integrated refurbishment approach for low-rise residential prefabricated building in Belgrade, Serbia
Authors: Matic Dubravka , Roset Calzada Jaume , Todorovic Marija S.
Published: July 2016

The refurbishment of the existing housing stock has a twofold aim: to decrease consumption of fossil fuels and to reduce the CO2 emissions. The main focus of the presented paper is the evaluation of the integrated design approach applied in scenarios for refurbishment of the prefabricated residential multi-apartment building. The criteria used in searching for the best approach to the renewable energy sources-integrated refurbishment were minimized energy loads, minimized CO2 emissions and improved indoor environment quality, health and comfort. After in-depth environmental analysis, a series of energy efficiency improvement measures were implemented, as a comprehensive optimization of the building’s envelope structure, natural and mixed ventilation and source energy delivery. The building’s dynamic behaviour and energy efficiency have been analysed and optimized by the building performance simulation and PV panels’ integration for the typical meteorological year of Belgrade, Serbia. Energy refurbishment should be approached in an organized, pragmatic and interdisciplinary way. Hence, the focus should be not only on the latest leading-edge technology, but on the synergy of different practices and principles in order to ensure the path to sustainable development and achieving desired objectives.
A study of diurnal and short-term variations of indoor radon concentrations at the University of Michigan, USA and their correlations with environmental factors
Authors: Xie Dong , Liao Maili , Wang Hanqing , Kearfott Kimberlee J.
Published: July 2016

Measurements of indoor radon concentrations and environmental parameters were collected continuously on an hourly basis over a three-month period (April 2012 to June 2012). These were performed both in a well-ventilated ground floor laboratory and in the unventilated basement directly below it in a two-storey building at the University of Michigan, USA. The diurnal variations of indoor radon concentration were investigated along with their correlations to the environmental parameters. The results showed that in the laboratory with typical air exchange, the highest radon values appeared in the early morning while lower values emerged in the afternoon. A similar time-course was followed by radon concentrations in the basement with stagnant air. The day-average radon concentrations in the laboratory ranged from 27 ± 2 Bq m−3 to 54 ± 5 Bq m−3, with the overall mean of 37 ± 6 Bq m−3 over the three-month data collection period. The overall basement average, 900 ± 92 Bq m−3 is significantly higher than the population-weighted world average value of 39 Bq m−3. For the ground-level laboratory, the indoor humidity, outdoor temperature and indoor–outdoor temperature difference were positively correlated with indoor radon. The indoor radon negatively correlated with outdoor barometric pressure, wind speed and indoor–outdoor barometric pressure differences. However, for the unventilated basement, the only statistically significant correlation of indoor radon concentration was a positive one with hourly rainfall.
Conceptualising and researching the body in digital contexts: towards new methodological conversations across the arts and social sciences
Authors: Jewitt Carey , Price Sara , Xambo Sedo Anna
Published: July 2016

The turn to the body in social sciences has intensified the gaze of qualitative research on bodily matters and embodied relations and made the body a significant object of reflection, bringing new focus on and debates around the direction of methodological advances. This article contributes to these debates in three ways: 1) we explore the potential synergies across the social sciences and arts to inform the conceptualization of the body in digital contexts; 2) we point to ways qualitative research can engage with ideas from the arts towards more inclusive methods; and 3) we offer three themes with which to interrogate and re-imagine the body: its fragmenting and zoning, its sensory and material qualities, and its boundaries. We draw on the findings of an ethnographic study of the research ecologies of six research groups in the arts and social sciences concerned with the body in digital contexts to discuss the synergetic potential of these themes and how they could be mobilized for qualitative research on the body in digital contexts. We conclude that engaging with the arts brings potential to reinvigorate and extend the methodological repertoire of qualitative social science in ways that are pertinent to the current re-thinking of the body, its materiality and boundaries.
Structures and programme supports for Creativity, Action, Service in the International Baccalaureate Diploma Programme: An implementation study in Turkey
Authors: Martin Robin Ann , Tanyu Manolya , Perry Stirling
Published: July 2016

This qualitative multiple-case study examined the implementation of an experiential learning component of an academic curriculum in six high schools in Turkey. Structures and supports that influenced programme implementation were examined using an implementation framework adapted from Durlak and Dupre. The study describes how the experiential learning programme is implemented. Findings indicate four areas that need ongoing attention: (1) supports for programme coordinators, (2) teacher training, (3) integration with academics and (4) school cultures that better support experiential learning.
The UK Independence Party and the Politics of Englishness
Authors: Hayton Richard
Published: July 2016

The rise of the UK Independence Party (UKIP) has been one of the most dramatic and widely discussed features of British politics in recent years. This article argues that one vital but largely overlooked facet of this phenomenon has been the politics of national identity. It argues that despite UKIP’s ostensibly unionist stance, Englishness is an important pivot around which key elements of the party’s appeal revolve, notably in terms of its Euroscepticism, its opposition to immigration and its anti-establishment narrative. It argues that the Anglo-Britishness promulgated by UKIP allows space for the celebration of English identity rather more easily than of other sub-state national identities, as it does not challenge the legitimacy of the UK state, which is itself seen as the expression of Anglo-British identity and sovereignty. Scottish nationalism, on the other hand, is seen as a threat to the Union and therefore anti-English.
The ‘Politicisation’ of Englishness: Towards a Framework for Political Analysis
Authors: Kenny Michael
Published: July 2016

The constitutional position of England has become the subject of intense focus following the decision by the Conservative Party to table the question of English devolution in the immediate aftermath of the Scottish Referendum. Various pundits have argued that English nationalism has become a major factor in British politics and a source of deepening territorial tension. Academic commentators have been slower to interrogate the nature and implications of these assertions and, despite the ubiquity of references to English interests and anxieties in political discourse, there is a much less extensive analytical literature on the make-up and political dimensions of the national identity of the largest people of the United Kingdom. How, then, should the political status and character of the English identity be understood and studied? Notions of a politicised Englishness reflect various, often contentious, judgements of both interpretive and empirical kinds. This article highlights the different ways in which ‘politicisation’ in this context has been characterised, and shows that each of these established perspectives yields a different sort of political response and policy approach. I finish with some observations about how politicisation might be conceptualised, and identify the elements of a more comprehensive and fluid understanding of this phenomenon.
Clinical Efficacy Test of Polyester Containing Herbal Extract Dressings in Burn Wound Healing
Authors: Muangman Pornprom , Praditsuktavorn Banjerd , Chinaroonchai Kusuma , Chuntrasakul Chomchark
Published: July 2016

Technological advancement has assisted in developing various availabilities of wound products that help in not only in healing and preventing infection but also in providing patients’ comfort and pain reduction during application. However, most of advanced wound healing products in Thailand were imported at high costs to patients. Nowadays, there are increased numbers of local researches of herbs that could provide healing environment for successful wound care. Herbal wound products are currently being introduced as alternatives to those imported dressings. The aim of this study was to report the clinical efficacy of using polyester containing herbal extract dressings in healing of second-degree burns. The volunteers were divided by simply randomized method into the study group of patient using polyester containing herbal extract dressing and the control group of patients treating with dressings that are commercially available and common use. The standard treatment protocols were performed at every 3 days of dressing change. Comparative evaluation consisted of time of healing, length of hospital stays, pain analog score assessment, percentage of infection, and descriptive notification of unfavorable clinical symptoms or signs or side effects.
Effect of fermented porcine placenta on physical fatigue in mice
Authors: Kim Hee-Yun , Han Na-Ra , Kim Na-Rae , Lee Mikyung , Kim Jongbae , Kim Chang-Ju , Jeong Hyun-Ja , Kim Hyung-Min
Published: July 2016

The fatigue spreads among the people who live under stressful life and brings about a negative impact on physical function. Here we evaluated the anti-fatigue effects of fermented porcine placenta (FPP) and main constituents, lysine (Lys) and leucine (Leu) with treadmill stress test and forced swimming test (FST) in animal models. The mice were administrated with FPP, Lys, and Leu for 21 days. After treadmill exercise, FPP, Lys, and Leu significantly reduced fatigue-related biochemical parameters, including lactate, lactate dehydrogenase, glucose, creatine kinase, urea nitrogen, cortisol, and pro-inflammatory cytokines, whereas superoxide dismutase activity and glycogen levels were significantly increased by FPP, Lys, and Leu. In the FST, FPP, Lys, and Leu significantly decreased immobility times and up-regulated brain-derived neurotrophic factor expression in brain. Furthermore, FPP, Lys, and Leu significantly decreased production of tumor necrosis factor-α, interleukin (IL)-6, IL-1β, and IL-4 through blockade of caspase-1/nuclear factor-κB pathway in stimulated splenocytes. In addition, FPP, Lys, and Leu significantly promoted proliferation of splenocytes. In conclusion, these findings suggest the potential of FPP as a novel functional food for the regulation of fatigue.
The efficacy of novel anatomical sites for the assessment of muscle oxygenation during central hypovolemia
Authors: Sprick Justin D , Soller Babs R , Rickards Caroline A
Published: July 2016

Muscle tissue oxygenation (SmO2) can track central blood volume loss associated with hemorrhage. Traditional peripheral measurement sites (e.g., forearm) may not be practical due to excessive movement or injury (e.g., amputation). The aim of this study was to evaluate the efficacy of three novel anatomical sites for the assessment of SmO2 under progressive central hypovolemia. 10 male volunteers were exposed to stepwise prone lower body negative pressure to decrease central blood volume, while SmO2 was assessed at four sites—the traditional site of the flexor carpi ulnaris (ARM), and three novel sites not previously investigated during lower body negative pressure, the deltoid, latissimus dorsi, and trapezius. SmO2 at the novel sites was compared to the ARM sensor and to stroke volume responses. A reduction in SmO2 was detected by the ARM sensor at the first level of lower body negative pressure (−15 mmHg; P = 0.007), and at −30 (the deltoid), −45 (latissimus dorsi), and −60 mmHg lower body negative pressure (trapezius) at the novel sites ( P ≤ 0.04). SmO2 responses at all novel sites were correlated with responses at the ARM (R ≥ 0.89), and tracked the reduction in stroke volume (R ≥ 0.87); the latissimus dorsi site exhibited the strongest linear correlations (R ≥ 0.96). Of the novel sensor sites, the latissimus dorsi exhibited the strongest linear associations with SmO2 at the ARM, and with reductions in central blood volume. These findings have important implications for detection of hemorrhage in austere environments (e.g., combat) when use of a peripheral sensor may not be ideal, and may facilitate incorporation of these sensors into uniforms.
Biochemical and biological characterization of Bothriechis schlegelii snake venoms from Colombia and Costa Rica
Authors: Prezotto-Neto José P , Kimura Louise F , Alves André F , Gutiérrez José María , Otero Rafael , Suárez Ana M , Santoro Marcelo L , Barbaro Katia C
Published: July 2016

Snakebites inflicted by the arboreal viperid snake Bothriechis schlegelii in humans are characterized by pain, edema, and ecchymosis at the site of the bite, rarely with blisters, local necrosis, or defibrination. Herein, a comparative study of Bothriechis schlegelii snake venoms from Colombia (BsCo) and Costa Rica (BsCR) was carried out in order to compare their main activities and to verify the efficacy of Bothrops antivenom produced in Brazil to neutralize them. Biochemical (SDS-PAGE and zymography) and biological parameters (edematogenic, lethal, hemorrhagic, nociceptive, and phospholipase A2 activities) induced by BsCo and BsCR snake venoms were evaluated. The presence of antibodies in Bothrops antivenom that recognize BsCo and BsCR snake venoms by enzyme-linked immunosorbent assay and Western blotting, as well as the ability of this antivenom to neutralize the toxic activities were also verified. SDS-PAGE showed differences between venoms. Distinctive caseinolytic and hyaluronidase patterns were detected by zymography. BsCo and BsCR showed similar phospholipase A2 activity. Strong cross-reactivity between BsCo and BsCR was detected using Bothrops antivenom with many components located between 150 and 35 kDa. BsCR was more edematogenic and almost fourfold more hemorrhagic than BsCo, and both venoms induced nociception. BsCR (LD50 5.60 mg/kg) was more lethal to mice than BsCo (LD50 9.24 mg/kg). Bothrops antivenom was effective in the neutralization of lethal and hemorrhagic activities of BsCo and BsCR and was partially effective in the neutralization of edematogenic and nociceptive activities. In conclusion, geographic distribution influences the composition and activities of Bothriechis schlegelii venoms. Bothrops antivenom cross-reacted with these venoms and was partially effective in neutralizing some toxic activities of BsCo and BsCR.
The importance of early detection of endotoxemia
Authors: Adamik Barbara , Smiechowicz Jakub , Kübler Andrzej
Published: July 2016

Endotoxin is considered a key signaling molecule in the pathogenesis of sepsis and septic shock. Anti-endotoxin therapies may result in the improvement of a patient’s clinical condition and lower mortality. The pressing clinical challenge is to identify patients for whom endotoxin elimination would be the most beneficial. An endotoxin activity assay (EAA) has been available for detection of endotoxins, allowing selection of patients at high risk of endotoxemia in intensive care units (ICUs). We studied a cohort of 172 consecutive patients who had septic shock on admission to the ICU. Endotoxin activity (EA) was measured with a rapid chemiluminescent EAA, regarded as point-of-care testing. Endotoxemia with a mean EA of 0.59 ± 0.14 EAU was present in 104 patients (60%) and absent in 68 patients (EA = 0.25 ± 0.11 EAU). The risk of endotoxemia increased with the presence of a Gram-negative infection [odds ratio (OR) 3.1, 95% confidence interval (CI) 1.6–5.9; P = 0.001] and bacteremia (OR 3.8, 95% CI 1.6–8.9; P = 0.02) but did not change with a diagnosis of peritonitis (OR 1.03, 95% CI 0.54–1.97; P = 0.90). These findings indicate that anti-endotoxin interventions should be tailored to individual patients based on both clinical conditions and measured endotoxin levels.
Independent validation of the Pain Management Plan in a multi-disciplinary pain team setting
Authors: Quinlan Joanna , Hughes Richard , Laird David
Published: July 2016

Context/background:

The Pain Management Plan (PP) is a brief cognitive behavioural therapy (CBT) self-management programme for people living with persistent pain that can be individually facilitated or provided in a group setting. Evidence of PP efficacy has been reported previously by the pain centres involved in its development.

Objectives:

To provide a fully independent evaluation of the PP and compare these with the findings reported by Cole et al.

Methods:

The PP programme was delivered by the County Durham Pain Team (Co. Durham PT) as outlined in training sessions led by Cole et al. Pre- and post-quantitative/patient experience measures were repeated with reliable and clinical significant change determined and compared to the original evaluation.

Results:

Of the 69 participants who completed the programme, 33% achieved reliable change and 20% clinical significant change using the Pain Self-Efficacy Questionnaire (PSEQ). Across the Brief Pain Inventory (BPI) interference domains between 11% and 22% of participants achieved clinical significant change. There were high levels of positive patient feedback with 25% of participants scoring 100% satisfaction. The mean participant satisfaction across the population was 88%.

Conclusion:

The results from this evaluation validate those reported by Cole et al. It demonstrates clinically significant improvement in pain and health functioning and high patient appreciation results. Both evaluations emphasise the potential of this programme as an early intervention delivered within a stratified care pain pathway. This approach could optimise the use of finite resources and improve wider access to pain management.
Respiratory Protection Toolkit
Authors: Bien Elizabeth Ann , Gillespie Gordon Lee , Betcher Cynthia Ann , Thrasher Terri L. , Mingerink Donna R.
Published: July 2016

International travel and infectious respiratory illnesses worldwide place health care workers (HCWs) at increasing risk of respiratory exposures. To ensure the highest quality safety initiatives, one health care system used a quality improvement model of Plan-Do-Study-Act and guidance from Occupational Safety and Health Administration’s (OSHA) May 2015 Hospital Respiratory Protection Program (RPP) Toolkit to assess a current program. The toolkit aided in identification of opportunities for improvement within their well-designed RPP. One opportunity was requiring respirator use during aerosol-generating procedures for specific infectious illnesses. Observation data demonstrated opportunities to mitigate controllable risks including strap placement, user seal check, and reuse of disposable N95 filtering facepiece respirators. Subsequent interdisciplinary collaboration resulted in other ideas to decrease risks and increase protection from potentially infectious respiratory illnesses. The toolkit’s comprehensive document to evaluate the program showed that while the OSHA standards have not changed, the addition of the toolkit can better protect HCWs.
Chronic Myeloid Leukemia in India
Authors: Ganesan Prasanth , Kumar Lalit
Published: July 2016

Background

In the last decade, the use of imatinib has brought a paradigm shift in the management of chronic myeloid leukemia (CML). In India, imatinib has been available for more than a decade and has been made accessible to all segments of the population because of patient assistance programs and cheaper generic versions. Despite improvements in survival, there are unique challenges in the Indian context.

Methods

We reviewed published data pertaining to CML in India for the period of 1990 to 2016, using PubMed advanced search with the terms chronic myeloid leukemia and India, and included studies that reported on epidemiology, monitoring for therapy, treatment outcomes, and resistance. Additionally, the references in retrieved articles were also reviewed.

Results

Thirty-seven studies were identified. The incidence of CML may be slightly lower in India than in the West, but there was only a single article reporting population-based data. Indian patients presented with more advanced disease. Most centers have access to imatinib as first-line therapy, but there is limited availability of molecular monitoring and second-line therapy. Most of the outcome data were retrospective but seemed comparable with that reported in Western centers. Drug adherence was impaired in at least one third of patients and contributed to poor survival.

Conclusion

Focused prospective studies and cooperative studies might improve the quality of data available. Future studies should focus on adherence, its effects on outcomes, and methods to address this problem.
Documentation of HIV Testing and Treatment Status Among Patients Presenting for Cancer Care in Uganda
Authors: Ghadrshenas Matine J. , Bender Ignacio Rachel A. , Low Daniel H. , Phipps Warren , Orem Jackson , Duerr Ann , Casper Corey
Published: July 2016

Abstract 23

HIV increases the incidence and mortality of cancer; knowledge of HIV status and treatment is essential for management of patients with HIV-associated malignancies (HIVAM). In Uganda, where the prevalence of HIV infection is 7.4%, the incidence of AIDS-defining cancers (ADCs) is high, and non-AIDS defining cancers (NADCs) are increasingly common. We investigated how often cancer providers documented HIV status and clinical parameters of HIV infection among patients at the Uganda Cancer Institute (UCI).

Medical records of patients aged ≥18 who registered at the UCI June - September 2015 were abstracted for demographics and cancer and HIV parameters. We calculated binomial proportions and used χ2 tests to evaluate factors associated with HIV.

Among 1,130 patients in this analysis, 71% of charts documented HIV status. Of those documenting HIV status, 32% were HIV+, and 58% of HIV+ individuals had an ADC. The documented HIV prevalence in NADCs was 21%. Women were more likely to lack HIV results (RR 1.32, p=0.009); 36% of women lacked results, including 40% with cervical cancer. HIV+ patients were younger than HIV-negative patients (median age 41 vs. 49, p<0.001). 62% of HIV-infected patients had a CD4 count recorded; CD4 counts were lower among persons with ADC (median 270 cells/ml, IQR 80-460) compared with NADC (median 370, IQR 215-564), p=0.006. There was no difference in the proportion of HIV patients with ADCs and NADCs receiving ART (both 86%, p=0.45).

HIV prevalence was 4.5 times higher in Ugandan cancer patients with documented status than in the general population. Though the majority of cancer patients had HIV testing performed, gaps remained in documenting HIV status, even among cancers considered AIDS-defining in HIV. This study highlights opportunities to educate cancer clinicians in Africa on the burden of HIV in cancer patients and opportunities to coordinate management of both cancer and HIV.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST:

Matine J. Ghadrshenas No relationship to disclose Rachel A. Bender Ignacio No relationship to disclose Daniel H. Low No relationship to disclose Warren Phipps No relationship to disclose Jackson Orem No relationship to disclose Ann Duerr No relationship to disclose Corey Casper Leadership: Temptime Consulting or Advisory Role: Janssen Pharmaceuticals Research Funding: Janssen Pharmaceuticals Travel, Accommodations, Expenses: Temptime Corporation, GlaxoSmithKline
Molecular Detection of Oncogenic Human Papillomavirus (HPV) Genotypes in Vulva Cancers, Penile Cancers and Anal Cancers in Myanmar
Authors: Shwe Mu Mu , Thu Hlaing Myat , Mar Khin Shwe
Published: July 2016

Abstract 12

A causal role for human papillomavirus (HPV) associated cancers of vulva, penile, and anus is supported by evidence from molecular and epidemiologic investigations. This study detected the oncogenic HPV genotypes in vulva cancers, penile cancers and anal cancers by a cross-sectional descriptive study in 2013. A total of 100 paraffin embedded biopsy tissues of histologically confirmed vulva cancers, penile cancers and anal cancers within past five years during 2008 and 2012 were studied. Those cases were 61 vulva cancers from Central Women Hospital, Yangon and 30 penile cancers and 9 anal cancers from Yangon General Hospital. HPV-DNA testing and genotyping were performed by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). Consensus sequence primer pairs within the E6 andE7 open reading were used to amplify oncogenic HPV genotypes (HPV-16,-18,-31,-33,-35,-52b,-58). Restriction enzymes were used for determination of specific HPV genotypes. HPV was identified in 36.1% of vulva cancers (22/61), 26.7% of penile cancers (8/30) and 44.4% of anal cancers (4/9). In vulva cancers, HPV-33 was the most common genotype (40.9%) followed by HPV-16 (31.8%), HPV-31 (22.7%), and HPV-18 (4.6%). In penile cancers, HPV-16 (62.5%) was the most common genotype followed by HPV-33 (25%) and HPV-18 (12.5%). Among anal cancers, the most frequent genotypes were HPV-16 (75%) and HPV-18 (25%). This study is the first report of evidence based oncogenic HPV genotypes in vulva cancers, penile cancers and anal cancers in Myanmar. This research provides the valuable information in understanding the burden of HPV associated cancers of the vulva, penile, and anus in Myanmar and the consideration of the effectiveness of prophylactic HPV vaccination in not only cervical cancer but also non-cervical cancers.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST:

No COIs from the authors.
Risk, Persistence and Multiplicity of HPV Infections among HIV Negative and HIV Positive Nigerian Women
Authors: Adebamowo Sally N. , Olawande Toyosi , Famooto Ayotunde , Dareng Eileen O. , Olaniyan Olayinka , Offiong Richard , Adebamowo Clement A.
Published: July 2016

Abstract 64

Background:

The incidence, prevalence, persistence, and multiplicity of high-risk HPV infection is different between HIV positive and HIV negative women. We examined the association between HIV, prevalent HPV, and persistent HPV infections among women in a prospective cohort in Nigeria.

Methods:

We enrolled women presenting at cervical cancer screening programs in Abuja, Nigeria, between 2012 and 2014 and collected information on their demographic characteristics, risk factors of HPV infection, and cervical exfoliated cells samples at baseline, 6 month and 12 month follow-up visits. DNA enzyme immunoassay (DEIA) and Roche Linear Array HPV Genotyping Test were used to characterize HPV. Persistent HPV infection was defined as a positive result on 2 consecutive DEIA tests. We used logistic regression models to estimate the association between HIV and risk of HPV infection.

Results:

Among the 1,020 women enrolled, the mean age (±SD) was 37(8), and 44% and 56% were HIV+ and HIV-, respectively. HPV52 and 35 were the most common HPV types in the study population. The prevalence was 34% for any HPV, 24% for persistent HPV and 9% for multiple HPV infections; these were higher among HIV+ women (p-value <0.001). The multivariate odds ratio (OR) and 95 % CI comparing HIV+ to HIV- women was 6.29 (95% CI 3.64 – 10.87, p-value <0.001) for any high-risk HPV; 6.22 (95% CI 3.02 – 12.83, p-value <0.001) for persistent high-risk HPV; and 6.46 (95% CI 2.69 – 15.52, p-value <0.001) for multiple high-risk HPV infections,

Conclusions:

HIV infection is associated with increased risk of persistence and multiplicity of low-risk and high-risk HPV infections. These findings may explain, in part, the increased risk of cervical cancer among women with HIV infections.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST:

Sally N. Adebamowo No relationship to disclose Toyosi Olawande No relationship to disclose Ayotunde Famooto No relationship to disclose Eileen O. Dareng No relationship to disclose Olayinka Olaniyan No relationship to disclose Richard Offiong No relationship to disclose Clement A. Adebamowo Speakers' Bureau: Merck [Table: see text]
Application of Flexible Display Technology to Low Cost Multiplexed Point-of-Care Medical Diagnostic Testing
Authors: Katchman Benjamin A. , Smith Joseph T. , Christen Jennifer Blain , Anderson Karen S.
Published: July 2016

Abstract 62

One of the key roadblocks limiting the transition of high-sensitivity and high-specificity point-of-care technologies from the research laboratory to wide spread use is the availability of a low-cost-high-volume manufacturing technology.

This work presents a new interdisciplinary approach combining low cost commercial display manufacturing technology with programmable high density protein microarray printing technology to fabricate disposable point-of-care immunosensors with clinical level sensitivity.

Our approach is designed to leverage advances in commercial display technology to reduce pre-functionalized biosensor substrate costs to pennies per cm2, as well as to leverage the display industry’s ability to manufacture an immense number of low cost consumer electronic products annually. For this work, we demonstrate that our new approach can offer diagnostic sensitivity at or below 10 pg/mL, which approaches the lower limit of detection of typical clinical laboratory instrumentation.

Our new approach is also designed to overcome the limited analytical sensitivity of existing POC devices (>100x improved sensitivity). It also contains new capability for multiplexed biomarker detection (>10 antigens) in a single low cost POC device through an innovative disposable and scalable architecture, based on flat panel display technology.

Here, we demonstrate multiplexed detection of antibodies to the HPV16 proteins E2, E6, and E7, which are circulating biomarkers for cervical as well as head and neck cancers. This detection technology has 100 percent correlation to our current laboratory-based measurement instrumentation.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST:

Benjamin A. Katchman Patents, Royalties, Other Intellectual Property: Arizona State University Joseph T. Smith Patents, Royalties, Other Intellectual Property: Arizona State University Jennifer Blain Christen Patents, Royalties, Other Intellectual Property: Arizona State University Karen S. Anderson Stock or Other Ownership: Provista Diagnostics Consulting or Advisory Role: Provista Diagnostics Patents, Royalties, Other Intellectual Property: Arizona State University