bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of curve severity on obstetric complications and regional anesthesia utilization in pregnant patients with adolescent idiopathic scoliosis: a preliminary analysis
Authors: Chan Emily W. , Gannon Stephen R. , Shannon Chevis N. , Martus Jeffrey E. , Mencio Gregory A. , Bonfield Christopher M.
Published: October 2017

OBJECTIVE

Adolescent idiopathic scoliosis (AIS), the most common type of scoliosis, often presents immediately prior to a woman’s childbearing years; however, research investigating the impact of AIS on women’s health, particularly pregnancy delivery outcomes, is sparse, with existing literature reporting mixed findings. Similarly limited are studies examining the change in scoliotic curve during or after pregnancy. Therefore, this study aims to determine 1) the impact of scoliotic curvature on obstetric complications (preterm births, induction of labor, and urgent/emergency caesarean section delivery), 2) regional anesthetic decision making and success during delivery for these patients, and 3) the effect of pregnancy on curve progression.

METHODS

Records of all pregnant patients diagnosed with AIS at the authors’ institution who delivered between January 2002 and September 2016 were retrospectively reviewed. Demographic information, pre- and postpartum radiographic Cobb angles, and clinical data for each pregnancy and delivery were recorded and analyzed. The Wilcoxon rank-sum test and the Wilcoxon signed-rank test were used for statistical analyses.

RESULTS

Fifty-nine patients (84 deliveries) were included; 14 patients had undergone prior posterior spinal fusion. The median age at AIS diagnosis was 15.2 years, and the median age at delivery was 21.8 years. Overall, the median major Cobb angle prior to the first pregnancy was 25° (IQR 15°–40°). Most births were by spontaneous vaginal delivery (n = 45; 54%); elective caesarean section was performed in 17 deliveries (20%). Obstetric complications included preterm birth (n = 18; 21.4%), induction of labor (n = 20; 23.8%), and urgent/emergency caesarean section (n = 12; 14.0%); none were associated with severity of scoliosis curve or prior spinal fusion. Attempts at spinal anesthesia were successful 99% of the time (70/71 deliveries), even among the patients who had undergone prior spinal fusion (n = 13). There were only 3 instances of provider refusal to administer spinal anesthesia. In the subset of 11 patients who underwent postpartum scoliosis radiography, there was no statistically significant change in curve magnitude either during or immediately after pregnancy.

CONCLUSIONS

The results of this study suggest that there was no effect of the severity of scoliosis on delivery complications or regional anesthetic decision making in pregnant patients with AIS. Moreover, scoliosis was not observed to progress significantly during or immediately after pregnancy. Larger prospective studies are needed to further investigate these outcomes, the findings of which can guide the prenatal education and counseling of pregnant patients with AIS.
Single-stage deformity correction in children with neurogenic kyphoscoliosis: nuances and a proposal for risk stratification
Authors: Udayakumaran Suhas , Menon Sajesh K. , Onyia Chiazor U. , Tahasildar Naveen
Published: October 2017

OBJECTIVE

Neurogenic kyphoscoliosis in pediatric patients has varied causes and diverse management options. The most common management strategy is to stage the orthopedic and neurosurgical aspects of the correction at an interval of 3–6 months from each other. The aim of this study was to report the authors’ experience with correction of deformity in children with associated neurological abnormalities requiring intervention as a single-stage surgical treatment.

METHODS

Of 591 pediatric patients with scoliosis treated at the Amrita Institute of Medical Sciences and Research Centre between January 2001 and January 2011, the authors identified all patients with neurogenic kyphoscoliosis who underwent deformity correction and a neurosurgical procedure in the same surgical session when they were younger than 15 years. Data regarding the demographic details, preoperative Cobb angle/kyphotic angle, surgical details, postoperative complications, cost of the procedure, and long-term neurological outcome were collected for each case and analyzed. Based on the results of this analysis, the authors propose a 2-category risk stratification system for the timing of deformity correction depending on the primary neurogenic etiology.

RESULTS

Ten cases involving patients with neurogenic kyphoscoliosis requiring both deformity correction and neurosurgical procedure met the criteria and were included in the analysis. All 10 patients were younger than 15 years; their mean age was 10.8 years. The average Cobb angle was 59.5°. Five patients underwent foramen magnum decompression, 5 patients underwent spinal cord detethering, and 1 patient had intraspinal intradural tumor excision. The mean estimated blood loss was 1177 ml (range 700–1550 ml), and the mean operative time was 4.4 hours (range 3–5.5 hours). There were no intraoperative complications. None of the patients had any new postoperative neurological deficits. The mean postoperative Cobb angle of the main thoracic curve was 12.6°.

CONCLUSIONS

Simultaneous deformity correction along with a definitive neurosurgical procedure in patients with neurogenic kyphoscoliosis can be performed without added morbidity and avoids both the added costs and the risk of complications associated with a second surgery. The risk stratification system proposed in this paper may serve as a guideline for case selection and help to optimize outcome.
Intraoperative neuromonitoring alerts in a pediatric deformity center
Authors: Zuccaro Maria , Zuccaro James , Samdani Amer F. , Pahys Joshua M. , Hwang Steven W.
Published: October 2017

OBJECTIVE

Intraoperative neuromonitoring (IONM) involves the use of somatosensory evoked potentials (SSEPs) and transcranial electric motor evoked potentials (TceMEPs). In this retrospective study the authors examined the sensitivity and specificity of both SSEPs and TceMEPs during pediatric spinal deformity surgeries.

METHODS

The authors performed a retrospective quantitative analysis of data obtained in 806 patients (197 males and 609 females) treated from December 2011 until October 2015. All patients were diagnosed with scoliosis that was classified as one of the following: adolescent idiopathic scoliosis (AIS) (38%), congenital scoliosis (22%), or syndromic scoliosis (40%). Also, 53 patients underwent vertebral column resection (VCR). All surgeries were monitored by high-level neuromonitoring specialists and were performed with total intravenous anesthesia. Alerts were described as a decrease in amplitude by 50% or greater (bilateral or unilateral) in SSEPs, TceMEPs, or both.

RESULTS

True-positive alerts for TceMEPs were observed in 60 of the 806 patients (7.4%). True-positive alerts for SSEPs were observed in 7 of the 806 patients (0.9%). In contrast, there were no false-positive or false-negative outcomes. Only 1 case (0.1%) was reported with a permanent postoperative deficit. No reported false negatives or false positives were observed, and thus sensitivity was 100% and specificity was 93%–100% for TceMEPs. The rate of sensitivity was 13.2% and the rate of specificity was 100% for SSEPs. The breakdown of total alert was as follows: 6.6% in AIS cases, 24.5% in congenital scoliosis cases, and 10.2% in syndromic scoliosis cases. Neurological injury rates were significantly lower than in previous studies, as there were 0% for AIS cases (p = 0.12), 0.6% for congenital scoliosis cases (p = 0.17), and 0% for syndromic scoliosis cases (p = 0.07). One injury in a patient with congenital scoliosis occurred during a VCR procedure, which brought the injury rate to 1.9% (p < 0.005). IONM alerts occurred during 34% of rod/correction cases, 25% of thoracic screw placements, 20% of the osteotomies, 17% of the resections, 3% of the cage insertions, and 2% of the sublaminar wiring procedures.

CONCLUSIONS

The authors hypothesize that the results of this study will support the necessity, as a standard of care, of multimodality neuromonitoring during high-risk pediatric spinal deformity surgery because of the decrease in postoperative deficits. Their data suggest that the TceMEPs are more sensitive than SSEPs, but when used in combination, they offer the patient a level of safety that would otherwise not exist. Last, these findings support the notion that better outcomes are achieved with high-level IONM professionals.
Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the Scoliosis Research Society Morbidity and Mortality database
Authors: Cognetti Daniel , Keeny Heather M. , Samdani Amer F. , Pahys Joshua M. , Hanson Darrell S. , Blanke Kathy , Hwang Steven W.
Published: October 2017

OBJECTIVE

Postoperative complications are one of the most significant concerns in surgeries of the spine, especially in higher-risk cases such as neuromuscular scoliosis. Neuromuscular scoliosis is a classification of multiple diseases affecting the neuromotor system or musculature of patients leading to severe degrees of spinal deformation, disability, and comorbidity, all likely contributing to higher rates of postoperative complications. The objective of this study was to evaluate deformity correction of patients with neuromuscular scoliosis over a 12-year period (2004–2015) by looking at changes in postsurgical complications and management.

METHODS

The authors queried the Scoliosis Research Society (SRS) Morbidity and Mortality (M&M) database for neuromuscular scoliosis cases from 2004 to 2015. The SRS M&M database is an international database with thousands of self-reported cases by fellowship-trained surgeons. The database has previously been validated, but reorganization in 2008 created less-robust data sets from 2008 to 2011. Consequently, the majority of analysis in this report was performed using cohorts that bookend the 12-year period (2004–2007 and 2012–2015). Of the 312 individual fields recorded per patient, demographic analysis was completed for age, sex, diagnosis, and preoperative curvature. Analysis of complications included infection, bleeding, mortality, respiratory, neurological deficit, and management practices.

RESULTS

From 2004 to 2015, a total of 29,019 cases of neuromuscular scoliosis were reported with 1385 complications, equating to a 6.3% complication rate when excluding the less-robust data from 2008 to 2011. This study shows a 3.5-fold decrease in overall complication rates from 2004 to 2015. A closer look at complications shows a significant decrease in wound infections (superficial and deep), respiratory complications, and implant-associated complications. The overall complication rate decreased by approximately 10% from 2004–2007 to 2012–2015.

CONCLUSIONS

This study demonstrates a substantial decrease in complication rates from 2004 to 2015 for patients with neuromuscular scoliosis undergoing spine surgery. Decreases in specific complications, such as surgical site infection, allow us to gauge our progress while observing how trends in management affect outcomes. Further study is needed to validate this report, but these results are encouraging, helping to reinforce efforts toward continual improvement in patient care.
Anziani e gioco d'azzardo: una ricerca su consapevolezza, abitudini e rischi tra gli over 65 anni con il Senior Problem Gambling Questionnaire (SPGQ)
Authors: Pistuddi Annalisa , Broggi Paola , Cavicchioli Marco , Lucchini Alfio
Published: October 2017

Lo studio del gioco d'azzardo all'interno degli anziani ha mostrato un fenomeno estremamente complesso  associato a determinanti bio-psico-sociali. Ad oggi, non esistono studi che hanno esplorato le abitudini del gioco d'azzardo all'interno di una popolazione italiana over 65. Con tale obiettivo, un autore del presente lavoro ha costruito uno strumento auto-somministrato di 9 item denominato "Senior Problem Gambling Questionnaire" (SPGQ). SPGQ indaga due aspetti del gioco d'azzardo: a) il livello di consapevolezza dei rischi associati alla condotta; b) la severità dei comportamenti associati al gioco d'azzardo. SPGQ è stato somministrato a un campione di 387 soggetti (353 hanno completato la valutazione). Il genere sessuale era equamente distribuito. L'85.6% del campione ha mostrato dei buoni livelli consapevolezza dei rischi associati al gioco d'azzardo. Il 22.2% dei soggetti ha dichiarato di intraprendere dei comportamenti legati al gioco d'azzardo almeno 1 volta alla settimana. Il 4.4% del campione ha risposto affermativamente ad entrambi gli item legati agli aspetti patologici della condotta. Seppur gli uomini intraprendono con una maggiore frequenza comportamenti legati al gioco d'azzardo, il genere è risultato equamente distribuito tra i soggetti che dichiarano di giocare almeno 2 volte alla settimana. Infine, è stata mostrata una modesta, seppur epidemiologicamente rilevante, porzione di Italiani over 65 che potrebbe manifestare un quadro di gioco d'azzardo patologico.
Evidenze preliminari dalla piattaforma terapeutica online Giocaresponsabile. Condizioni socio-economiche e comportamenti di gioco
Authors: Lucchini Fabio , Fea Maurizio , Nava Felice
Published: October 2017

I giocatori problematici non sempre riconoscono la situazione critica in cui versano. Inoltre, vergogna e timore dello stigma si rivelano spesso ostacoli insormontabili che impediscono di intraprendere un trattamento formale. Ciò spiega la nascita di nuove tipologie di aiuto professionale attraverso l'utilizzo del telefono e delle tecnologie informatiche (es. helpline professionali, counselling online, siti web dedicati). Nel presente lavoro sono stati analizzati i record relativi ai soggetti che hanno iniziato un trattamento mediante la piattaforma online Giocaresponsabile.it, che offre una terapia online basata sul modello cognitivo-comportamentale (Internet-delivered cognitive behavior therapy, ICBT). Dall'esame dei profili socio-economici e dei comportamenti di gioco sia di chi ha concluso la terapia sia di coloro i quali la hanno interrotta prematuramente, emerge che determinate caratteristiche dei pazienti possono avere un peso significativo sugli esiti trattamentali. Ciò suggerisce di raffinare l'analisi sull'impatto di tali fattori in modo da ‘cucire' con maggior precisione la terapia sulle specifiche esigenze dei pazienti. 
Collaborative Research on the Ecology and Management of the ‘Wulo’ Monsoon Rainforest in Wunambal Gaambera Country, North Kimberley, Australia
Authors: Vigilante Tom , Ondei Stefania , Goonack Catherine , Williams Desmond , Young Paul , Bowman David
Published: October 2017

Indigenous groups are increasingly combining traditional ecological knowledge and Western scientific approaches to inform the management of their lands. We report the outcomes of a collaborative research project focused on key ecological questions associated with monsoon vine thickets in Wunambal Gaambera country (Kimberley region, Western Australia). The study mapped monsoon rainforests and analysed the environmental correlates of their current distribution, as well as the historical drivers of patch dynamics since 1949. Remote sensing was used to chart the effectiveness of an intervention designed to re-instate Aboriginal fire regimes according to customary principles. We identified the most vulnerable patches based on size, distance from neighbouring patches, and fire frequency. More than 6000 rainforest patches were mapped. Most were small (<1 ha), occurring predominantly on nutrient-rich substrates (e.g., basalt) and fire-sheltered topographic settings (e.g., slopes and valleys). Rainforests with low fire frequency and no cattle were more likely to expand into surrounding long-unburnt savannas. Frequent fires and cattle did not cause substantial contraction, although the latter affected rainforest understories through trampling. Fire management performed by Aboriginal rangers effectively shifted fire regimes from high-intensity late dry season fires to early dry season fires, particularly in areas with clusters of vulnerable rainforests. The remote sensing methods developed in this project are applicable to the long-term monitoring of rainforest patches on Aboriginal-managed land in North Kimberley, providing tools to evaluate the impacts of fire management, feral animal control, and climate change. The study confirmed the importance of the cattle-free and rarely burnt Bougainville Peninsula as one of the most important rainforest areas in Western Australia.
Livelihood Implications and Perceptions of Large Scale Investment in Natural Resources for Conservation and Carbon Sequestration: Empirical Evidence from REDD+ in Vietnam
Authors: Bayrak Mucahid , Marafa Lawal
Published: October 2017

The complex relationship between local development and current large scale investments in natural resources in the Global South for the purpose of conservation and carbon sequestration is not fully understood yet. The Reducing Emissions from Deforestation and Forest Degradation programme (REDD+) is an example of such investment. This study examines the livelihood implications and perceptions of REDD+ among indigenous and forest-dependent communities in the Central Highlands of Vietnam. A systems-based livelihood survey has been conducted with two communities affected by REDD+ (n = 102)—Kala Tonggu village (participating in UN-REDD, a multilateral programme) and Hieu commune (participating in a REDD+ project of Fauna and Flora International). The positive effects of REDD+ included: introduction of community-based forest management; shifting power relations in favour of local communities; communities receiving financial benefits for forest monitoring; and positive community perceptions on REDD+. The negative impacts concerned: more restricted access to the natural forest; raising false expectations on the financial benefits of REDD+; increasing risks of food insecurity; exclusion of customary institutions and forest classifications; and lack of livelihood alternatives in dealing with changing socio-ecological conditions. Based on the findings of this study, we argue that REDD+ implementation needs to incorporate the temporality and dynamics of community livelihoods, power relations, and customary and formal socio-ecological systems more comprehensively. This to ultimately achieve inclusive local development and effective conservation of global forest commons.
Telomere Dynamics in Immune Senescence and Exhaustion Triggered by Chronic Viral Infection
Authors: Bellon Marcia , Nicot Christophe
Published: October 2017

The progressive loss of immunological memory during aging correlates with a reduced proliferative capacity and shortened telomeres of T cells. Growing evidence suggests that this phenotype is recapitulated during chronic viral infection. The antigenic volume imposed by persistent and latent viruses exposes the immune system to unique challenges that lead to host T-cell exhaustion, characterized by impaired T-cell functions. These dysfunctional memory T cells lack telomerase, the protein capable of extending and stabilizing chromosome ends, imposing constraints on telomere dynamics. A deleterious consequence of this excessive telomere shortening is the premature induction of replicative senescence of viral-specific CD8+ memory T cells. While senescent cells are unable to expand, they can survive for extended periods of time and are more resistant to apoptotic signals. This review takes a closer look at T-cell exhaustion in chronic viruses known to cause human disease: Epstein–Barr virus (EBV), Hepatitis B/C/D virus (HBV/HCV/HDV), human herpesvirus 8 (HHV-8), human immunodeficiency virus (HIV), human T-cell leukemia virus type I (HTLV-I), human papillomavirus (HPV), herpes simplex virus-1/2(HSV-1/2), and Varicella–Zoster virus (VZV). Current literature linking T-cell exhaustion with critical telomere lengths and immune senescence are discussed. The concept that enduring antigen stimulation leads to T-cell exhaustion that favors telomere attrition and a cell fate marked by enhanced T-cell senescence appears to be a common endpoint to chronic viral infections.
Novel primary care treatment package for patients with medically unexplained symptoms: a cohort intervention study
Authors: Röhricht Frank , Zammit Ivan , Papadopoulos Nina
Published: October 2017

Background

Existing care models for patients with persistent medically unexplained symptoms (MUS) do not adequately address the needs of these patients. New and innovative intervention strategies are necessary to achieve better health and corresponding economic outcomes.

Aim

To explore the feasibility of implementing a pragmatic care package that provides primary care treatment for patients with persistent MUS and to evaluate recruitment, retention, and acceptability as well as the potential impact on clinical outcomes and service utilisation.

Design & setting

Prospective cohort intervention study involving a cluster of seven GP surgeries in Newham, East London, providing a 'One-Stop-Shop' primary care treatment service.

Method

The care package included: identification, assessment, engagement, psychoeducation, and a choice of group interventions (mindfulness-based stress reduction [MBSR] and body-oriented psychological therapy [BOPT]). Baseline and follow-up data on somatic symptom levels (PHQ-15), health-related quality of life (SF-36, EQ-5D) and service utilisation was analysed.

Results

In total, 145 patients were referred and assessed for eligibility, and 93 were included in the study. Participants engaged well with different components of the care package and gained significant improvements in somatic symptom levels with corresponding increases of quality-of-life ratings and a reduction in healthcare utilisation (GP contacts and referrals to specialist services) as well as associated healthcare costs.

Conclusion

The primary care treatment package can be successfully implemented in primary care at a relatively low cost and easily adopted into routine care. The body-oriented approach is well accepted by clinicians and patients. Controlled trials should be conducted to test the efficacy of the treatment package.
Managing Social Media During a Crisis: A Conundrum for Event Managers
Authors: Devine Adrian , Boluk Karla , Devine Frances
Published: October 2017

In August 2013, Northern Ireland hosted the World Police and Fire Games. The official event evaluation found that the games projected Northern Ireland in a positive light; however, this survey does not tell the full story. Leading up to this event Northern Ireland experienced 4 months
of civil unrest. Many consumers turned to social media to seek reassurance and guidance. However, the event organizers did not provide such support during this crisis. In fact, by mismanaging concerns regarding political stability and visitor safety, this event in effect reinforced the negative
stereotypical images of Northern Ireland and because it happened online, it was ignored in the official event evaluation. The two key lessons event organizers can learn from this case study are do not underestimate the power of social media, especially in a time of crisis, and in this digital
age an event must have a social media strategy that has the flexibility to deal with a crisis.
Viability of Nonresident Open Water Swimming Event Competitors as a Target Market: A Case Study
Authors: Spencer Daniel M. , Adams Allison P.
Published: October 2017

No research has been published on the characteristics and behavior patterns of athletes traveling to compete in open water swimming events, despite the growing popularity of such events. This article fills this gap by profiling nonresident competitors in the Waikiki Roughwater Swim,
an iconic community-based event held annually on the Hawaiian island of Oahu. Data were collected in an intercept survey of swimmers shortly after they finished the race. Nonresident competitors in the event were found to be a viable market segment according to established criteria for such
viability. Their significant numbers and high incomes evidenced their potential profitability and their high levels of affiliation with swimming organizations suggested that personal selling to the organizations' leaders and advertising via the organizations' newsletters and websites might
be effective channels through which to reach them. In addition, their high levels of education, athletic identity, experienced "flow," involvement with open water swimming, and importance ascribed to swimming "the famous Waikiki coastline" suggested that advertisements directed at them should
be designed to resonate with well-educated, accomplished, and committed athletes, include reminders of the psychological and social benefits of race participation, and explicitly mention the event's unique and attractive geographic and historical setting.
How Event Managers Lead: Applying Competency School Theory to Event Management
Authors: Abson Emma
Published: October 2017

A lack of research into human resource development, managerial skillsets, and leadership practices of event managers has resulted in widespread assumptions about the nature of leadership within events, which is unsupported by primary research. This qualitative research based on semistructured
interviews focused on event managers working within the business events industry. Data analysis using thematic analysis and a ranking list establishes six key leadership practices—engaging communication, strategic perspectives, critical analysis and judgement, resource management, emotional
resilience, and interpersonal sensitivity. This research argues that these leadership practices are essential for the development of successful event managers. Additionally, this study shows there is tension at the heart of leadership within events—event projects are intangible and temporary
in nature, providing only one opportunity to get it right and this results in event managers attempting to control all aspects of the event delivery. However, in order to be successful leaders, they also need to work in teams, motivate and empower others, and develop team members. This then
is the challenge for human resource development in event management: How do event managers resolve this tension in order to become successful leaders?
Knowledge Transfer and Organizational Memory: An Events Perspective
Authors: Muskat Birgit , Deery Marg
Published: October 2017

Although there is substantial research on various elements of knowledge management in organizations, there is a gap in our understanding of how event organizations transfer knowledge. We address this gap using qualitative interview data and show in our results that knowledge transfer processes can be categorized into three distinct phases: 1)preevent, 2)event operations, and 3)postevent. Event managers and staff mostly transfer explicit knowledgepreevent; yet, tacit knowledge is transferred during theevent operations. However, tacit knowledge is rarely converted into explicit knowledge in theposteventphase, and organizational memory is largely underutilized. Practical implications are deduced, suggesting for event organizations to adopt a more strategic approach to knowledge transfer. We suggest that event management then operates more effectively in this fast-paced and knowledge-intensive business environment, and better integrates heterogeneous event staff, including both paid employees and event volunteers.
Event Experiences Through the Lens of Attendees
Authors: Liu Wei , Sparks Beverley , Coghlan Alexandra
Published: October 2017

This study takes a holistic approach to investigating customer experience at a food and wine event. Drawing on an ecosystem concept from service design and the concept of cocreation of value, the authors develop a conceptual framework to capture the complexity of customer experience.
Using photo elicitation methodology to combine customers' in situ experience as reflected in photos, narratives, and attribute ratings, the authors identify five main themes, of which sensory experience, discovery, and entertainment/fun demonstrate a high level of impact on customer experience.
The photo elicitation method provides insight into fluctuations in customers' emotions over a 1-day period and captures various customer experiences, from ordinary to extraordinary, which created the overall customer experience at the event. Results show that both positive and negative customer
experiences are affected by the ecosystem, especially with respect to whether components of the system are functioning in a harmonious manner. The study's findings demonstrate that when designing event programs, event management should be aware of the importance of balance within the ecosystem.
A Model of Expectancy Motivation for Business Event Tourism: Evidence From China
Authors: Lu Ying (Tracy)
Published: October 2017

This research refined the construct of attendee motivation for business event tourism by integrating perspectives from different disciplines, by examining the behavioral consequence of the refined motivation construct, and by investigating the motivation of event travelers solely. An
empirical test of the motivation construct was conducted with 395 travelers attending exhibitions in China. Results showed that motivation consists of three levels: cognitive benefits sought, psychological fulfillment, and touristic desire. Cognitive and touristic motives had an effect on
attendees' satisfaction and future intentions toward events. This research also provided a better understanding of the motivation of Chinese business event travelers and market segmentations. Results showed that Chinese attendees can be classified into two clusters (i.e., passionate vs. rational)
based on their attendance motivations. Theoretical and practical implications are discussed regarding the refined motivation model, its influences on subsequent behavior of attendees, and characteristics of Chinese attendees for business event tourism.
Investigating the Size and Economic Value of the Business Tourist Market in Malaysia
Authors: Hussain Kashif , Kumar Jeetesh , Kannan Suresh , Nor Manisa Mohamed
Published: October 2017

The business tourism sector is recognized as a high-yield component of the tourism industry with hedonic economic impact on businesses, destinations, local economies, and the development of human capital. It is considered as one of the fastest developing and most profitable sectors.
Therefore, the current research was set out to investigate the size and economic value of the business tourist market in Malaysia by highlighting the microareas of business tourists' expenditure and their experience, and presenting a model defining the total economic impact (direct, indirect,
and induced), contribution to employment, and contribution to tax revenue generated for Malaysia. A quantitative research approach was applied with two self-administered survey questionnaires used to collect the data (n=5,555) in order to observe the travel information, spending patterns,
and experiences of international travelers attending business events in Malaysia, which are mainly conferences and exhibitions. The economic impact assessment in the study was made using a money generation model (MGM). The current study provides its novel findings at a national level and defines
business tourists (international travelers) as conference delegates and exhibition buyers attending/joining business events in Malaysia. Along with presenting the demographics, spending patterns, and behavioral patterns of the business tourists, the results also show that in 2014 the business
tourism sector contributed significantly to the Malaysian economy at MYR4.7 billion (US$1.44 billion) of direct economic value, MYR9.7 billion (US$2.96 billion) of total economic impact (direct, indirect, and induced), along with 325,437 job opportunities in the local economy
and MYR416 million (US$127.2 million) in tax revenue (direct, indirect, and induced).
Welcome to Hell: Rio 2016 Olympics Failing to Secure Sustainable Transport Legacy
Authors: Malhado Acácia C. M. , Araujo Lindemberg M.
Published: October 2017

The aim of this research note is to report on the preparation and implementation of the urban transport projects for the Rio 2016 Olympics. A range of studies shows that infrastructure development and/or improvement is the main reason for hosting a mega-event; however, initial analyses
indicate the opposite. The main conclusion is that, in terms of transport, Rio de Janeiro is very unlikely to cope with its longed-for sustainable transport legacy.
Uncovering the Genetic Architecture of Seed Weight and Size in Intermediate Wheatgrass through Linkage and Association Mapping
Authors: Zhang Xiaofei , Larson Steven R. , Gao Liangliang , Teh Soon Li , DeHaan Lee R. , Fraser Max , Sallam Ahmad , Kantarski Traci , Frels Katherine , Poland Jesse , Wyse Donald , Anderson James A.
Published: October 2017

Intermediate wheatgrass [IWG; Thinopyrum intermedium (Host) Barkworth & D.R. Dewey subsp. intermedium] is being developed as a new perennial grain crop that has a large allohexaploid genome similar to that of wheat (Triticum aestivum L.). Breeding for increased seed weight is one of the primary goals for improving grain yield of IWG. As a new crop, however, the genetic architecture of seed weight and size has not been characterized, and selective breeding of IWG may be more intricate than wheat because of its self‐incompatible mating system and perennial growth habit. Here, seed weight, seed area size, seed width, and seed length were evaluated across multiple years, in a heterogeneous breeding population comprised of 1126 genets and two clonally replicated biparental populations comprised of 172 and 265 genets. Among 10,171 DNA markers discovered using genotyping‐by‐sequencing (GBS) in the breeding population, 4731 markers were present in a consensus genetic map previously constructed using seven full‐sib populations. Thirty‐three quantitative trait loci (QTL) associated with seed weight and size were identified using association mapping (AM), of which 23 were verified using linkage mapping in the biparental populations. About 37.6% of seed weight variation in the breeding population was explained by 15 QTL, 12 of which also contributed to either seed length or seed width. When performing either phenotypic selection or genomic selection for seed weight, we observed the frequency of favorable QTL alleles were increased to >46%. Thus, by combining AM and genomic selection, we can effectively select the favorable QTL alleles for seed weight and size in IWG breeding populations.
Regions Underlying Population Structure and the Genomics of Organ Size Determination in Capsicum annuum
Authors: Hill Theresa A. , Chunthawodtiporn Jareerat , Ashrafi Hamid , Stoffel Kevin , Weir Allyson , Van Deynze Allen
Published: October 2017

Fruits, as an important part of the human diet, have been under strong selection during domestication. In general, continued directed selection has led to varieties having larger fruit with greater shape variation and tremendous increases in fruit mass. Common cultivated peppers (Capsicum annuum L.) are found in a wide range of sizes and shapes. Analysis of genetic relatedness and population structure has shown that the large‐fruited, nonpungent types have reduced diversity and comprise a highly structured group. To explore this population structure, a statistical method for detecting fixation within subpopulations was applied to a set of 21 pungent and 19 nonpungent lines that represent the pepper breeding germplasm. We have identified 17 blocks within the pepper genome that are conserved among nonpungent large‐fruited varieties. To determine if these regions were fixed by selection on fruit size or pungency, quantitative trait loci (QTLs) from seven studies along with capsaicin biosynthesis genes and homologs of organ size regulatory genes were mapped onto the current pepper genome assembly. Of the 17 fixed regions, 14 overlapped with fruit size or shape QTLs. There were seven putative organ size regulators and seven capsaicin biosynthetic genes within these regions. This work defines genomic regions that underly structure within the nonpungent pepper germplasm and QTLs or genes that may have been selected for during the development of large‐fruited nonpungent pepper varieties.
An algebraic model of high-altitude aircraft decompression and emergency descent
Authors: DAIDZIC Nihad E.
Published: October 2017

An emergency descent maneuver initiated by pilots shortly after the onset of the decompression recognition was developed for subsonic, supersonic and hypersonic cruisers. Among other findings, the times when a passenger cabin is exposed to altitudes above 25,000 and 40,000 ft and the maximum cabin altitude reached are estimated. An airplane descent aerodynamic model was incorporated for high-speed and low-speed high-drag emergency descents. Airplane cabin atmosphere is assumed to be isothermal. The environmental atmosphere is simulated using the NLPAM nonlinear atmospheric model valid up to 47 geopotential kilometers. Rapid and slow decompressions at several discrete cruising altitudes ranging from 12 to 40 km and varying pilot reaction times in initiating the emergency descent were simulated. The main motivation for this work was to estimate times and altitudes a cabin reaches during depressurization for various flight conditions. This model can be utilized in optimizing the emergency-descent piloting techniques, calculating oxygen supplies, evaluating aeromedical factors, estimating harmful exposures to low pressures, and for other important high-altitude aircraft operations.
Molecular-cloud-scale Chemical Composition. II. Mapping Spectral Line Survey toward W3(OH) in the 3 mm Band
Authors: Nishimura Yuri , Watanabe Yoshimasa , Harada Nanase , Shimonishi Takashi , Sakai Nami , Aikawa Yuri , Kawamura Akiko , Yamamoto Satoshi
Published: October 2017

To study a molecular-cloud-scale chemical composition, we conducted a mapping spectral line survey toward the Galactic molecular cloud W3(OH), which is one of the most active star-forming regions in the Perseus arm. We conducted our survey through the use of the Nobeyama Radio Observatory 45 m telescope, and observed the area of 16′ × 16′, which corresponds to 9.0 pc × 9.0 pc. The observed frequency ranges are 87–91, 96–103, and 108–112 GHz. We prepared the spectrum averaged over the observed area, in which eight molecular species (CCH, HCN, HCO+, HNC, CS, SO, C18O, and 13CO) are identified. On the other hand, the spectrum of the W3(OH) hot core observed at a 0.17 pc resolution shows the lines of various molecules such as OCS, H2CS CH3CCH, and CH3CN in addition to the above species. In the spatially averaged spectrum, emission of the species concentrated just around the star-forming core, such as CH3OH and HC3N, is fainter than in the hot core spectrum, whereas emission of the species widely extended over the cloud such as CCH is relatively brighter. We classified the observed area into five subregions according to the integrated intensity of 13CO, and evaluated the contribution to the averaged spectrum from each subregion. The CCH, HCN, HCO+, and CS lines can be seen even in the spectrum of the subregion with the lowest 13CO integrated intensity range (<10 K km s−1). Thus, the contributions of the spatially extended emission is confirmed to be dominant in the spatially averaged spectrum.
KASCADE-Grande Limits on the Isotropic Diffuse Gamma-Ray Flux between 100 TeV and 1 EeV
Authors: Apel W. D. , Arteaga-Velázquez J. C. , Bekk K. , Bertaina M. , Blümer J. , Bozdog H. , Brancus I. M. , Cantoni E. , Chiavassa A. , Cossavella F. , Daumiller K. , Souza V. de , Pierro F. Di , Doll P. , Engel R. , Feng Z. , Fuhrmann D. , Gherghel-Lascu A. , Gils H. J. , Glasstetter R. , Grupen C. , Haungs A. , Heck D. , Hörandel J. R. , Huege T. , Kampert K.-H. , Kang D. , Klages H. O. , Link K. , Łuczak P. , Mathes H. J. , Mayer H. J. , Milke J. , Mitrica B. , Morello C. , Oehlschläger J. , Ostapchenko S. , Pierog T. , Rebel H. , Roth M. , Schieler H. , Schoo S. , Schröder F. G. , Sima O. , Toma G. , Trinchero G. C. , Ulrich H. , Weindl A. , Wochele J. , Zabierowski J. ,   KASCADE-Grande Collaboration
Published: October 2017

KASCADE and KASCADE-Grande were multi-detector installations to measure individual air showers of cosmic rays at ultra-high energy. Based on data sets measured by KASCADE and KASCADE-Grande, 90% C.L. upper limits to the flux of gamma-rays in the primary cosmic ray flux are determined in an energy range of

eV. The analysis is performed by selecting air showers with a low muon content as expected for gamma-ray-induced showers compared to air showers induced by energetic nuclei. The best upper limit of the fraction of gamma-rays to the total cosmic ray flux is obtained at

eV with

. Translated to an absolute gamma-ray flux this sets constraints on some fundamental astrophysical models, such as the distance of sources for at least one of the IceCube neutrino excess models.
Multiple Primary Acral Lentiginous Melanomas (MPALM)
Authors: González Miriam , Tchernev Georgi , Atanasova–Chokoeva Anastasiya , França Katlein , Lotti Torello
Published: October 2017

We present a rare case of a patient with multiple primary acral lentiginous melanomas of the foot. We would like to highlight the importance of whole-skin examination in all patients, even by the general practitioners, aiming the maximal early detection of acral lentiginous melanomas, considering their rapid progression, early metastatic spread and extremely poor prognosis. It can be extrapolated from current literature; however, that appropriate management of these patients, including staging work and surgical intervention, is to be determined by the individual characteristics of the melanoma and the patient's concomitant risk factors, if any.
One Step Surgery for Cutaneous Melanoma: “We Cannot Solve Our Problems with the Same Thinking We Used When We Created Them?”
Authors: Tchernev Georgi
Published: October 2017

One step melanoma surgery is, in fact, an innovative combined method for diagnosis and treatment of cutaneous melanoma (at the same time). The methodology allows an accurate assessment of the actual status of the affected patients by 1) clinical status, dermatoscopy, high-frequent ultrasonography (HFUS) of the pigmented lesion (eventually in combination with normal lymph nodes ultrasonography), followed by a single surgical intervention. Within this intervention, the primary tumour is removed with the appropriate surgical field, with or without parallel detection and draining lymph node biopsy (depending on the established tumour thickness). Removal of the lymph node may, in turn, be associated with or without locoregional lymphadenectomy, which is determined by its macroscopic appearance, established intraoperatively or after the histopathological evaluation. The methodology is sparing, innovative, easy to apply, tested in its functionality and logically justified. For an unknown reason, this methodology is not applicable in melanoma treatment’s guidelines in Europe and America. In Bulgaria and France, however, there are centres and hospitals that apply the technique mentioned above with enormous results, in particular in Bulgaria, the methodology is getting more and more improved to the current moment. Based on the above, as well as on the scant experience, we may share the opinion that the current melanoma treatment’s guidelines need major corrections in their recommendations, which are not optimal for patients due to the following facts: (1) the adverse effects on patients as a result of the necessity of at least 2 surgical interventions; (2) the frequent occurrence of changes in the lymph flow after the primary excision; (3) the frequent non-obtaining of the suggested in the guidelines terms for re-excisions with or without sentinel lymph node removal; and (4) the creation of additional financial difficulties for the patients in the framework of two unneeded hospitalizations.
Rebound in Measures of Disease Activity and Symptoms in Corrona Registry Patients with Psoriatic Arthritis Who Discontinue Tumor Necrosis Factor Inhibitor Therapy after Achieving Low Disease Activity
Authors: Harrold Leslie R. , Stolshek Bradley S. , Rebello Sabrina , Collier David H. , Mutebi Alex , Wade Sally W. , Malley Wendi , Greenberg Jeffrey D. , Etzel Carol J.
Published: October 2017

Objective.

Rebound may occur in patients with psoriatic arthritis (PsA) who discontinue TNF inhibitor (TNFi) therapy in low disease activity (LDA).

Methods.

Using physician and patient reports, we quantified rebound following TNFi discontinuation [defined as Clinical Disease Activity Index (CDAI) score > 10 or TNFi restart] and time to rebound in adults with PsA in LDA (CDAI score ≤ 10) at TNFi discontinuation.

Results.

Rebound occurred in 73% (69/94) of patients soon after discontinuation (median time to rebound 8.0 mos, 95% CI 6.0–12.0).

Conclusion.

Rebound occurred frequently in patients with PsA after TNFi discontinuation. TNFi discontinuation after achieving LDA should be carefully considered.
The Fascinating Paradox of Osteoporosis in Axial Spondyloarthropathy
Authors: Fitzgerald Gillian E. , O’Shea Finbar D.
Published: October 2017

Low bone mineral density (BMD) is a recognized feature of axial spondyloarthropathy (axSpA). However, the osteoproliferation inherent in axSpA can make traditional dual-energy x-ray absorptiometry assessment inaccurate, particularly in structurally advanced disease. As a result, much about osteoporosis in axSpA is unknown. There is a wide variation in prevalence figures for low BMD in the literature. There is also no consensus regarding risk factors for developing low BMD in axSpA. It is accepted that there is an excess of vertebral fractures in patients with axSpA, but the role of low BMD in contributing to this risk is virtually unknown. This article provides a comprehensive review of the current knowledge regarding low BMD in axSpA. It highlights our current BMD measurement techniques along with their potential pitfalls, and discusses the significance of BMD in vertebral fractures. It also identifies gaps in our knowledge and makes recommendations for future research.
Transmission et identité
Authors: Picard Jean
Published: October 2017

L’auteur présente les activités du Collège Aquitain de Psychopathologie de l’Adolescent, puis questionne l’actuel mal-être des adolescents, entre impasses identificatoires et défaut de perspectives historiques. S’ensuivent des réflexions sur les prises en charge cliniques.
Crise de la transmission ?
Authors: Braconnier Alain
Published: October 2017

L’auteur interroge les liens entre crise de la transmission, crise des identifications transgénérationnelles et crise d’identité, et leurs effets sur la construction identitaire des adolescents. Dans notre pratique, ne serions-nous pas confrontés à la conflictualité de ces trois domaines et nous-mêmes les supports transférentiels (et contre-transférentiels) potentiels de trois modes de relation d’objets avec les adolescents et les familles que nous rencontrons.
Filiation et transhumanisme
Authors: Arènes Jacques
Published: October 2017

Ce travail expose une théorie de la filiation pensée comme forme dynamique, et fait le diagnostic d’une souffrance contemporaine à habiter la temporalité. Le rapport actuel au temps est saisi à travers le prisme des théories transhumanistes, afin d’illustrer l’idée d’un présent qui ne se déploie pas, et d’un futur peu investi par l’élan vital, quand bien même la mémoire serait « parfaite ». Une vignette clinique donne à comprendre l’impasse subjective d’une mémoire « totale ».
Classes préparatoires
Authors: Dejours Roxane
Published: October 2017

À partir d’une recherche menée auprès de cinquante et un étudiants de classes préparatoires, cet article cherche à montrer comment les contraintes encadrant la transmission des savoirs en classe préparatoire conduisent ces élèves à recourir à des stratégies défensives qui, bien que leur permettant de lutter efficacement contre la souffrance, tendent à se constituer comme un obstacle à la résolution des conflits de la fin de l’adolescence et à générer des bouleversement profonds dans leur identité.