bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifiability Analysis of Three Control-Oriented Models for Use in Artificial Pancreas Systems
Authors: Garcia-Tirado Jose , Zuluaga-Bedoya Christian , Breton Marc D.
Published: August 2018

Objective:

Our aim is to analyze the identifiability of three commonly used control-oriented models for glucose control in patients with type 1 diabetes (T1D).

Methods:

Structural and practical identifiability analysis were performed on three published control-oriented models for glucose control in patients with type 1 diabetes (T1D): the subcutaneous oral glucose minimal model (SOGMM), the intensive control insulin-nutrition-glucose (ICING) model, and the minimal model control-oriented (MMC). Structural identifiability was addressed with a combination of the generating series (GS) approach and identifiability tableaus whereas practical identifiability was studied by means of (1) global ranking of parameters via sensitivity analysis together with the Latin hypercube sampling method (LHS) and (2) collinearity analysis among parameters. For practical identifiability and model identification, continuous glucose monitor (CGM), insulin pump, and meal records were selected from a set of patients (n = 5) on continuous subcutaneous insulin infusion (CSII) that underwent a clinical trial in an outpatient setting. The performance of the identified models was analyzed by means of the root mean square (RMS) criterion.

Results:

A reliable set of identifiable parameters was found for every studied model after analyzing the possible identifiability issues of the original parameter sets. According to an importance factor ([Formula: see text]), it was shown that insulin sensitivity is not the most influential parameter from the dynamical point of view, that is, is not the parameter impacting the outputs the most of the three models, contrary to what is assumed in the literature. For the test data, the models demonstrated similar performance with most RMS values around 20 mg/dl (min: 15.64 mg/dl, max: 51.32 mg/dl). However, MMC failed to identify the model for patient 4. Also, considering the three models, the MMC model showed the higher parameter variability when reidentified every 6 hours.

Conclusion:

This study shows that both structural and practical identifiability analysis need to be considered prior to the model identification/individualization in patients with T1D. It was shown that all the studied models are able to represent the CGM data, yet their usefulness in a hypothetical artificial pancreas could be a matter of debate. In spite that the three models do not capture all the dynamics and metabolic effects as a maximal model (ie, our FDA-accepted UVa/Padova simulator), SOGMM and ICING appear to be more appealing than MMC regarding both the performance and parameter variability after reidentification. Although the model predictions of ICING are comparable to the ones of the SOGMM model, the large parameter set makes the model prone to overfitting if all parameters are identified. Moreover, the existence of a high nonlinear function like [Formula: see text] prevents the use of tools from the linear systems theory.
Analysis of “Use of Blood Glucose Meters Featuring Color Range Indicators Improves Glycemic Control and Patients With Diabetes in Comparison to Blood Glucose Meters Without Color (ACCENTS Study)”
Authors: Drincic Andjela T.
Published: August 2018

Self-monitoring of blood glucose is a part of integral care of patients with diabetes mellitus. Understanding and appropriately responding to glucose levels is a fundamental part of self-management. Grady et al’s work, published in the current issue of Journal of Diabetes Science and Technology, investigated whether switching people with diabetes from their usual meter to a meter featuring color range indicator (CRI) could improve glycemic control, by facilitating improved understanding of blood glucose targets. In this small but well-designed study, the authors have shown that meters with CRI features offer a potential advantage and may improve glucose control in patients with diabetes, both with T1D and T2D, across the therapy spectrum from oral agents to insulin therapy.
Reflective Thoughts on Teaching the Future of Tourism
Authors: Yeoman Ian , McMahon-Beattie Una
Published: August 2018

This reflective paper considers how Dr. Ian Yeoman teaches futures studies and scenario planning to tourism students across several undergraduate and postgraduate degree programs at Victoria University of Wellington, New Zealand. It is based on his teaching philosophy of visualization, authenticity, problem-based learning, scaffolding, and his understanding of how students negotiate their own learning. The paper examines the approach taken in three papers, where Yeoman is the primary lecturer. As part of the bachelor of tourism management degree, two papers are taught. TOUR104 is a first-year introductory paper addressing how the drivers and trends in the macro-environment influence tourism from a political, economic, social, technology, and environmental perspective. TOUR301 is a third-year paper that aims to help students develop the skills and knowledge necessary to understand and critically analyze tourism public policy, planning, and processes primarily within New Zealand. TOUR413 is a scenario planning paper, applied in a tourism context and taught to students in postgraduate programs. The contribution this paper makes is in its demonstration of the link between teaching philosophy and student learning, the challenges students encounter with futures thinking in a problem-based learning environment and the evolution of the papers.
Revisiting classic MRI findings of venous malformations: Changes in protocols may lead to potential misdiagnosis
Authors: Alexander MD , Hughes N , Cooke DL , Hess CP , Frieden IJ , Phelps AS , Dowd CF
Published: August 2018

Introduction

Magnetic resonance imaging (MRI) is most sensitive and specific for characterizing venous malformations (VMs). VMs typically demonstrate central enhancement on delayed-contrast imaging. Fluid-fluid levels (FFLs) are uncommon in VMs and common in lymphatic malformations (LMs). Technology has advanced since the initial description of these findings. Rates of detection of these MRI findings in VMs may have changed as MRI technology and techniques have evolved.

Methods and methods

A prospectively maintained database from a multidisciplinary vascular anomalies clinic was reviewed to identify patients with final diagnosis of VM or LM. Patients with reviewable contrast-enhanced MRIs were selected, reviewing the oldest MRI studies in the database against the newest MRI studies to identify equal numbers of patients from the temporal extremes. Imaging was reviewed to assess for presence of FFLs. Enhancement was quantified by measuring signal in the same location of the lesion both on pre- and postcontrast sequences

Results

Forty patients were identified for analysis. Twenty studies with sufficient archived imaging for review were performed between 1995 and 2006; 20 such studies were performed between 2011 and 2012. The new imaging cohort had higher rates of FFL visualization ( p = 0.001). Correlation was found between time to imaging following contrast and degree of enhancement ( p < 0.001). Inverse correlation was found between scan date and time to contrast ( p = 0.001) and scan date and enhancement ( p = 0.021).

Conclusion

FFLs should no longer be considered exclusionary for the diagnosis of VMs. Timing following contrast administration should be maximized to increase degree of enhancement to confirm the diagnosis of VMs.
Improvements in long standing cardiac pathologies by individualized homeopathic remedies: A case series
Authors: Tenzera Lenka , Djindjic Boris , Mihajlovic-Elez Olivera , Pulparampil Bindu John , Mahesh Seema , Vithoulkas George
Published: August 2018

We present three cases of cardiac arrest at different stages of pathology. Acute myocardial infarction and resulting heart failure is emerging as the leading cause of mortality. In the long run, acute episodes and cardiac remodelling can cause considerable damage and result in heart failure. In these cases, individualized homeopathic therapy was instituted along with the conventional medicines and the results were encouraging. The changes in the laboratory diagnostic parameters (single-photon emission computed tomography, electrocardiograph, echocardiography and ejection fraction as the case may be) are demonstrated over time. The key result seen in all three cases was the preservation of general well-being while the haemodynamic states also improved. While the three cases provide evidence of positive outcomes for homeopathic therapy, more extensive studies are required in a hospital setting to establish the real extent to which this therapy may be employed.
Chlorhexidine-related anaphylaxis in urological practice
Authors: Dyer James E , Taktak Samih Y , Parkes Andrew W , Garcez Tomaz , Gall Zara
Published: August 2018

Introduction:

There have been numerous case reports highlighting the risk of anaphylactic reactions when using chlorhexidine-containing urethral gels. However, there is no evidence that the inclusion of chlorhexidine in urethral gels reduces the risk of catheter associated urinary tract infection.

Methods:

Pubmed and Medline were searched for the keywords anaphylaxis (and) chlorhexidine. Case reports were reviewed and information regarding year, patient demographics, country, chlorhexidine administration route, signs, symptoms encountered and the presence of subsequent allergy testing were analysed.

Results:

In terms of clinical features, 89% (32/36) of patients were noted to have skin changes recorded as either urticaria, flushing, rash, erythema or wheals. Respiratory changes were recorded in 67% (24/36), which included those described as bronchospasm, chest tightness, wheeze or cough. Hypotension was documented in 92% of reports (33/36) while hypoxia was recorded in half of the reports (18/36) and a quarter (8/36) had periorbital angioedema or documented oral or tongue swelling. Only four out of 36 patients required formal cardiopulmonary resuscitation and no patients died.

Conclusion:

Chlorhexidine-related anaphylaxis is a relatively frequently reported entity. Despite this, there appears to be no compelling evidence that chlorhexidine mitigates the risk of catheter-associated urinary tract infection.

Level of evidence:

Level 4 evidence.
Antibiotic Dosing in Sustained Low-Efficiency Dialysis in Critically Ill Patients
Authors: Sethi Sidharth Kumar , Krishnappa Vinod , Nangethu Nisha , Nemer Paul , Frazee Lawrence A. , Raina Rupesh
Published: August 2018

Purpose of review:

Sustained low-efficiency dialysis (SLED) is increasingly used as a renal replacement modality in critically ill patients with acute kidney injury (AKI) and hemodynamic instability. There is, therefore, a greater need for the understanding of the antibiotic dosage and pharmacokinetics in these patients, to provide them with optimal therapy.

Sources of information:

PubMed/Medline, Embase, and Google Scholar.

Methods:

PubMed/Medline, Embase, and Google Scholar databases were searched using a combination of key words: dialysis, end stage renal disease, renal failure, sustained low efficiency dialysis, extended daily dialysis, prolonged intermittent renal replacement therapy (PIRRT), and antibiotic dosing. Studies that investigated antibiotic dosing and pharmacokinetics during SLED/extended daily dialysis/PIRRT were selected for this review.

Key findings:

Eleven studies met inclusion criteria and selected for data extraction. The data with regard to dialysis specifications, type of antibiotic including dosages, drug clearances, and dosage recommendations are summarized in Table 1. It is a challenge to find therapeutic doses for antibiotics during SLED therapy because, in general, only aminoglycosides and vancomycin can be assayed in clinical laboratories.

Limitations:

Although current studies on antibiotic dosing in SLED are limited due to diverse and undersized patient populations, antibiotic dosage adjustments for patients receiving SLED discussed here will serve as a valuable guide. Future large-scale research should focus on establishing guidelines for antibiotic dosage in SLED.

Implications:

Pharmacokinetic principles should be taken into consideration for the appropriate dosing of drugs during SLED, yet it is vital to monitor response to drug to make sure therapeutic goals are achieved. Antibiotic dosing and timing relative to the initiation of SLED may be important to maximize either the time above the minimum inhibitory concentration (MIC) (time-dependent) or the peak to MIC ratio (concentration-dependent), balancing efficacy and toxicity concerns. Critical care physicians should liaise with nephrologists to make decisions regarding appropriate antibiotic dosing in patients undergoing SLED.
The Mediating Effect of Emotion Inhibition and Emotion Regulation Between Adolescents’ Perceived Parental Psychological Control and Depression
Authors: Ha Jung Hee , Jue Juliet
Published: August 2018

The purpose of this study is to investigate the relationship between parental psychological control (PPC) as perceived by adolescents, emotion inhibition, emotion regulation, and depression in adolescents using a structural equation model. The participants were 316 middle school students in metropolitan areas of South Korea who completed the Domain-Specific Assessment of Psychological Control (DAPC), Children’s Sadness Management Scale (CSMS) and Children’s Anger Management Scale (CAMS), and the Center for Epidemiological Studies–Depression Scale (CES-D) survey. Data were analyzed using descriptive statistics, correlation analysis, structural model verification, and bootstrap analysis. The results of this study indicated that PPC had a direct effect on depression. In addition, PPC had a significant effect on the emotion inhibition of dysfunctional emotion regulation, and emotion inhibition significantly affected depression. Therefore, emotion inhibition had a mediating effect between PPC and depression. Finally, this study’s implications and limitations are presented.
Using Stress Ultrasonography to Understand the Risk of UCL Injury Among Professional Baseball Pitchers Based on Ligament Morphology and Dynamic Abnormalities
Authors: Shanley Ellen , Smith Matthew , Mayer Braden K. , Bailey Lane Brooks , Thigpen Charles A. , Tokish John M. , Kissenberth Michael J. , Noonan Thomas J.
Published: August 2018

Background:

Ulnar collateral ligament (UCL) injury of the elbow is a common and debilitating problem seen frequently among elite baseball pitchers. Ultrasound is a useful diagnostic tool in evaluating UCL injuries.

Hypothesis:

Evaluation with stress ultrasound of the elbow to measure the morphology of the UCL and the ulnohumeral joint space gapping is indicative of higher risk of UCL injury among professional baseball pitchers.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

Ultrasound imaging was used to assess the medial joint laxity of the elbow of 70 asymptomatic professional baseball pitchers during spring training. Medial joint laxity and UCL morphology were assessed with OsiriX imaging software under 2 conditions—gravity valgus load and 5.5 lb of valgus load per a handheld dynamometer—with the shoulder in the maximal cocking position and the elbow in 90° of flexion. Two trials of resting position, elbow gapping, and UCL thickness were collected, measured, and averaged for data analysis. Intra- and interrater reliabilities were established and maintained, with intraclass correlation coefficients in the acceptable range for all measures (0.84-0.99). One-way analysis of variance was used to compare dominant variables between those pitchers who sustained a subsequent UCL injury and those who did not. A receiver operating curve was used to identify pitchers who, based on elbow gapping measures (by cut score), were at high risk versus low risk for UCL injury.

Results:

Players who went on to injure the UCL (n = 7) displayed a significantly wider opening under 5.5 lb of applied stress (6.5 ± 1.2 vs 5.3 ± 1.2 mm, P = .01) when compared with pitchers without UCL injury history (n = 63); they also presented a trend toward wider dominant arm resting joint opening (4.9 ± 1.2 vs 4.0 ± 1.1 mm, P = .07). Professional pitchers with valgus stress ulnohumeral joint gapping ≥5.6 mm (area underneath the curve, 0.77; P = .02) of the dominant arm were at a 6-times greater risk of sustaining a UCL tear requiring reconstruction within a season.

Conclusion:

Our data suggest that ultrasound evaluation of UCL morphology may be indicative of pitchers who are at risk of sustaining UCL injury and that it may improve player assessment.
Auditory and Cognitive Training for Cognition in Adults With Hearing Loss: A Systematic Review and Meta-Analysis
Authors: Lawrence Blake J. , Jayakody Dona M. P. , Henshaw Helen , Ferguson Melanie A. , Eikelboom Robert H. , Loftus Andrea M. , Friedland Peter L.
Published: August 2018

This systematic review and meta-analysis examined the efficacy of auditory training and cognitive training to improve cognitive function in adults with hearing loss. A literature search of academic databases (e.g., MEDLINE, Scopus) and gray literature (e.g., OpenGrey) identified relevant articles published up to January 25, 2018. Randomized controlled trials (RCTs) or repeated measures designs were included. Outcome effects were computed as Hedge’s g and pooled using random-effects meta-analysis (PROSPERO: CRD42017076680). Nine studies, five auditory training, and four cognitive training met the inclusion criteria. Following auditory training, the pooled effect was small and statistically significant for both working memory ( g = 0.21; 95% CI [0.05, 0.36]) and overall cognition ( g = 0.19; 95% CI [0.07, 0.31]). Following cognitive training, the pooled effect for working memory was small and statistically significant ( g = 0.34; 95% CI [0.16, 0.53]), and the pooled effect for overall cognition was large and significant ( g = 1.03; 95% CI [0.41, 1.66]). However, this was dependent on the classification of training approach. Sensitivity analyses revealed no statistical difference between the effectiveness of auditory and cognitive training for improving cognition upon removal of a study that used a combined auditory–cognitive approach, which showed a very large effect. Overall certainty in the estimation of effect was “low” for auditory training and “very low” for cognitive training. High-quality RCTs are needed to determine which training stimuli will provide optimal conditions to improve cognition in adults with hearing loss.
How Robust Refugee Protection Policies Can Strengthen Human and National Security
Authors: Kerwin Donald
Published: August 2018

This paper makes the case that refugee protection and national security should be viewed as complementary, not conflicting state goals. It argues that refugee protection can further the security of refugees, affected states, and the international community. Refugees and international migrants can also advance national security by contributing to a state's economic vitality, military strength, diplomatic standing, and civic values. The paper identifies several strategies that would, if implemented, promote both security and refugee protection. It also outlines additional steps that the US Congress should take to enhance US refugee protection policies and security. Finally, it argues for the efficacy of political engagement in support of pro-protection, pro-security policies, and against the assumption that political populism will invariably impede support for refugee protection.
Making America 1920 Again? Nativism and US Immigration, past and Present
Authors: Young Julia G.
Published: August 2018

This paper surveys the history of nativism in the United States from the late nineteenth century to the present. It compares a recent surge in nativism with earlier periods, particularly the decades leading up to the 1920s, when nativism directed against southern and eastern European, Asian, and Mexican migrants led to comprehensive legislative restrictions on immigration. It is based primarily on a review of historical literature, as well as contemporary immigration scholarship. Major findings include the following:

• There are many similarities between the nativism of the 1870–1930 period and today, particularly the focus on the purported inability of specific immigrant groups to assimilate, the misconception that they may therefore be dangerous to the native-born population, and fear that immigration threatens American workers.

• Mexican migrants in particular have been consistent targets of nativism, immigration restrictions, and deportations.

• There are also key differences between these two eras, most apparently in the targets of nativism, which today are undocumented and Muslim immigrants, and in President Trump's consistent, highly public, and widely disseminated appeals to nativist sentiment.

• Historical studies of nativism suggest that nativism does not disappear completely, but rather subsides. Furthermore, immigrants themselves can and do adopt nativist attitudes, as well as their descendants.

• Politicians, government officials, civic leaders, scholars and journalists must do more to reach sectors of society that feel most threatened by immigration.

• While eradicating nativism may be impossible, a focus on avoiding or overturning nativist immigration legislation may prove more successful.
Redefining American Families: The Disparate Effects of IIRIRA's Automatic Bars to Reentry and Sponsorship Requirements on Mixed-Citizenship Couples
Authors: López Jane Lilly
Published: August 2018

With passage of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), the goal of discouraging illegal immigration and the legal immigration of the poor triumphed over the longstanding goal of family unity in US immigration policy. This shift resulted in policy changes that prevent some mixed-citizenship families from accessing family reunification benefits for the immigrant relatives of US citizens. Two specific elements of IIRIRA — (1) the three- and 10-year bars to reentry, and (2) the minimum income thresholds for citizen sponsors of immigrants — have created a hierarchy of mixed-citizenship families, enabling some to access all the citizenship benefits of family preservation and reunification, while excluding other, similar families from those same benefits. This article details these two key policy changes imposed by IIRIRA and describes their impact on mixed-citizenship couples seeking family reunification benefits in the United States. Mixed-citizenship couples seeking family reunification benefits do not bear the negative impacts of these two policies evenly. Rather, these policies disproportionately limit specific subgroups of immigrants and citizens from accessing family reunification. Low-income, non-White (particularly Latino), and less-educated American families bear the overwhelming brunt of IIRIRA's narrowing of family reunification benefits. As a result, these policy changes have altered the composition of American society and modified broader notions of American national identity and who truly “belongs.” Most of the disparate impact between mixed-citizenship couples created by the IIRIRA would be corrected by enacting minor policy changes to (1) allow the undocumented spouses of US citizens to adjust their legal status from within the United States, and (2) include the noncitizen spouse's income earning potential toward satisfying minimum income requirements.
The Promise of a Subject-Centered Approach to Understanding Immigration Noncompliance
Authors: Ryo Emily
Published: August 2018

Unauthorized immigrants and immigration enforcement are once again at the center of heated public debates and reform agendas. This paper examines the importance of applying a subject-centered approach to understanding immigration noncompliance and to developing effective, ethical, and equitable immigration policies. In general, a subject-centered approach focuses on the beliefs, values, and perceptions of individuals whose behavior the law seeks to regulate. This approach has been widely used in non-immigration law contexts to produce a richer and more nuanced understanding of legal noncompliance. By contrast, the subject-centered approach has been an overlooked and underappreciated tool in the study of immigration noncompliance. This paper argues that a subject-centered understanding of why people obey or disobey the law has the potential to generate new insights that can advance public knowledge and inform public policy on immigration in a number of important ways. Specifically, the paper considers how the use of this approach might help us: (1) recognize the basic humanity and moral agency of unauthorized immigrants, (2) appreciate not only direct and immediate costs of immigration enforcement policies, but also their indirect and long-term costs, and (3) develop new and innovative strategies to achieving desired policy goals.
Weeping in the Playtime of Others: The Obama Administration's Failed Reform of ICE Family Detention Practices
Authors: Schriro Dora
Published: August 2018

The United States has long struggled with the practice of detaining immigrant families and over time, most reform efforts have flagged, if not failed. This paper examines the impact of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA) through an exploration of the evolution of the family residential center (FRC) for families in immigration custody, established prior to the 9/11 terrorist attack by the Immigration and Naturalization Service (INS), and expanded by Immigration and Customs Enforcement (ICE) in its aftermath. The paper provides an inside look at how policymakers, at various points in the Obama administration, sought to roll back its most infirm practices and the fate of those efforts. It begins with a brief history of family detention in the United States, continues with a summary of the reforms undertaken both early and late in the Obama administration, and examines the significant challenges it faced and the less progressive positions it adopted during its first and second terms in office.

The paper concludes with a discussion of reasons for the rapid reversal of its previous reforms and provides recommendations to achieve a civil, civil system of immigration enforcement for families and all others, which means nothing less than the transformation of the immigrant detention system from a criminal to a civil paradigm, consistent with the population and legal authorities.2 The need for such an effort is all the more urgent in light of executive actions taken in the early days of the Trump administration and their initial outcomes. Among those thwarting admissions are orders to Customs and Border Protection (CBP) and US Citizenship and Immigration Services (USCIS) to seal the US borders, shun refugees fleeing from war-torn regions until “extreme vetting” measures are put into place, and reassess others who have already been issued visas. Additional orders issued to ICE expanded and expedited the removal of persons whose conduct could result in charges or convictions as well as those with criminal charges or convictions, resulting in a 38 percent increase in arrests by ICE agents within the first 100 days of the Trump administration (Dickerson 2017b; Duara 2017).
Thrive or Survive? Explaining Variation in Economic Outcomes for Refugees
Authors: Betts Alexander , Omata Naohiko , Bloom Louise
Published: August 2018

In the context of protracted refugee situations, there has been a revival in concern among policymakers to transcend the so-called humanitarian-development divide and create greater opportunities for self-reliance. Yet, these discussions too often neglect an analytical focus on refugees' own economic lives, and their own interactions with markets. Despite a growing literature on the economic lives of refugees, much of that work has lacked theory or data. The work that has been quantitative has generally focused on the economic impact of refugees on host countries rather than explaining variation in economic outcomes for refugees.

In order to explain variation in economic outcomes for refugees, this paper asks three questions about the economic lives of refugees: 1) what makes the economic lives of refugees distinctive from other populations; 2) what explains variation in refugees' income levels; and 3) what role does entrepreneurship play in shaping refugees' economic outcomes? In order to answer these questions, the paper draws upon extensive qualitative and quantitative research conducted in Uganda by the Humanitarian Innovation Project at Oxford University. The quantitative data set is based on a survey of 2,213 refugees in three types of contexts: urban (Kampala), protracted camps (Nakivale and Kyangwali settlements), and emergency camps (Rwamwanja). It supplements this with qualitative research from other parts of Africa and the Middle East.

The economic lives of refugees are argued to be distinctive not because refugees are any different qua human beings but because they often occupy a distinctive institutional space. Following new institutional economics, the paper argues that “refugee economies” represent a distinctive analytical space insofar as refugees face different formal and informal institutional barriers and distortions in their economic lives compared to nationals or other migrants.

Even within the same country, refugees exhibit significant variation in their economic outcomes, most notably in their income levels. A number of variables are significant in explaining this variation. These include: regulatory context, education, occupation, social networks, gender, and the number of years spent in exile.

Entrepreneurship is an important explanation for “outliers” within the refugee community, explaining why some refugees have significantly higher incomes. However, refugees also often play a wider role within the community, creating opportunities for others. Furthermore, a significant part of refugee entrepreneurship is social rather than simply for-profit.

In order to enhance opportunities for greater refugee self-reliance, policymakers need to develop a better understanding of the transnational, national, and local markets within which refugees participate. Instead of engaging in top-down interventions, enabling environments should be created that enable autonomous, community-led initiatives to flourish.
Strengthening the Global Refugee Protection System: Recommendations for the Global Compact on Refugees
Authors: Appleby Kevin
Published: August 2018

On September 19, 2016, the United Nations (UN) General Assembly adopted the New York Declaration for Refugees and Migrants. This document launched a two-year process to develop a Global Compact on Responsibility Sharing on Refugees (“Global Compact on Refugees”) and a Global Compact for Safe, Orderly, and Regular Migration. With a record 65 million displaced persons in the world, the global community must come together to fashion a stronger protection regime for persons on the move. This paper outlines broad themes and specific recommendations that the Global Compact on Refugees should adopt on how to strengthen the global refugee protection system. The recommendations fall into several categories: (1) responsibility sharing for the protection of refugees; (2) filling in protection gaps; (3) balancing and replacing deterrence strategies with protection solutions; (4) refugee resettlement; and (5) building refugee self-sufficiency. Some of the key recommendations include:

• the development of a responsibility-sharing formula to respond to large movements of refugees;

• the development of an early warning system to identify and respond to nations in crisis;

• the adoption of principles included in the Nansen and Migrants in Countries of Crisis initiatives;

• the use of temporary protection measures to protect populations that flee natural disaster;

• the adoption of model processes that ensure safe and voluntary return;

• cooperation between destination and transit countries to expand refugee protections;

• the provision of asylum and due process protections at borders;

• the use of development assistance to ensure the self-sufficiency of refugees;

• the adoption of a goal to resettle 10 percent of the global refugee population each year;

• the establishment of a refugee matching system between refugees and resettlement countries; and

• the adoption of coherent strategies, involving all sectors, to address large movements of refugees.

This paper draws heavily, albeit not exclusively, from a series of papers published as a special collection in the Journal on Migration and Human Security1 on strengthening the global system of refugee protection.
My Body of Work: Promotional Labor and the Bundling of Complementary Work
Authors: Schieber David
Published: August 2018

What if certain types of work allow workers to earn higher incomes when bundled together? Using qualitative interview data on the careers of sex workers in California, the author argues that workers can attempt to increase overall earnings by taking part in promotional labor: a specific type of labor in which workers strategically bundle complementary forms of work with differing status and income levels to increase overall income. Because of a sharp decline in adult film production beginning in 2007, adult film performers relied on escorting to make up for lower wages and fewer filming opportunities. However, these sex workers still performed in adult films, despite filming being more time intensive and less financially lucrative, to promote themselves as high-end escorts. The author concludes that promotional labor is a mechanism by which workers and firms in general mitigate labor uncertainty by using the cross-promotional benefits of different types of complementary work.
Implications of Network Relations for the Governance of Complex Projects
Authors: Adami Vivian Sebben , Verschoore Jorge Renato
Published: August 2018

Our article aims to answer the call for studies on new perspectives of complex projects and their governance. We adopt the social network approach to investigate the implications of network relations for the governance of project networks. We analyze quantitative and qualitative data following two theoretical models: flow and coordination. Our results show how the supply, contractual, and information networks influence the governance of project networks. We contribute to the literature explaining the dependence of the project network governance to network relations. It is necessary to use different theoretical models to analyze the coordination and control of complex project networks.
Managing Healthcare Integration
Authors: Gordon Aaron , Pollack Julien
Published: August 2018

Healthcare integration projects typically involve significant organizational change, with the intention of providing improved patient services and outcomes through the integration of healthcare services. Some of the management needs of healthcare integration arguably go past the traditional domain of project management, leading practitioners in these projects to use change management in combination with project management. The focus of this article is on the ways that project managers, responsible for merging and integrating healthcare services, have used project management and change management approaches in combination when delivering these projects. The article involves an inductive analysis of data from the integration of 10 healthcare networks. The aim of this article is to contribute to the growing stream of project management literature that explores the blending of both project management and change management. Analysis of these healthcare integration projects led to five key themes, which can be summarized as: (1) traditional project management only partly aligns to the needs of healthcare integration projects; (2) benefits were found in combining project management with change management; (3) change management was particularly beneficial if used early in the project life cycle; (4) the life cycles of these two disciplines did not align, causing complications in practice, and (5) practitioners used an intuitive and improvisational approach to combining the disciplines.
Maternal dietary antioxidant intake in pregnancy and childhood respiratory and atopic outcomes: birth cohort study
Authors: Bédard Annabelle , Northstone Kate , Holloway John W. , Henderson A. John , Shaheen Seif O.
Published: August 2018

Evidence for a possible protective effect of maternal dietary antioxidant intake during pregnancy on childhood asthma and other atopic outcomes is conflicting, and associations with childhood lung function have been little studied.

In the Avon Longitudinal Study of Parents and Children, we analysed associations between maternal intake of fruits, vegetables, vitamins C and E, carotene, zinc, and selenium in pregnancy and current doctor-diagnosed asthma, atopy and lung function in 8915 children at age 7–9 years. Potential modification of associations by maternal smoking and common maternal antioxidant gene polymorphisms was explored to strengthen causal inference.

After controlling for confounders, positive associations were observed between maternal intake of zinc and childhood forced expiratory volume in 1 s and forced vital capacity (difference in age-, height- and sex-adjustedsdunits per quartile increase in maternal dietary zinc intake β 0.05 (95% CI 0.01–0.08); ptrend=0.01 and 0.05 (95% CI 0.02–0.09); ptrend=0.005, respectively). Weak evidence was found for an interaction between maternal zinc intake and maternal glutathioneS-transferaseGSTM1genotype on childhood forced vital capacity (pinteraction=0.05); association among theGSTM1null group β 0.11 (95% CI 0.05–0.17); ptrend=0.001.

Our results suggest that a higher maternal intake of zinc during pregnancy may be associated with better lung function in the offspring.
The vitamin D binding protein axis modifies disease severity in lymphangioleiomyomatosis
Authors: Miller Suzanne , Coveney Clare , Johnson Janice , Farmaki Aliki-Eleni , Gupta Nishant , Tobin Martin D. , Wain Louise V. , McCormack Francis X. , Boocock David J. , Johnson Simon R.
Published: August 2018

Lymphangioleiomyomatosis (LAM) is a rare disease of women. Decline in lung function is variable, making appropriate targeting of therapy difficult. We used unbiased serum proteomics to identify markers associated with outcome in LAM.

101 women with LAM and 22 healthy controls were recruited from the National Centre for LAM in the UK. 152 DNA and serum samples with linked lung function and outcome data were obtained from patients in the National Heart, Lung and Blood Institute LAM Registry in the USA. Proteomic analysis was performed on a discovery cohort of 50 LAM and 20 control serum samples using a SCIEX SWATH mass spectrometric workflow. Protein levels were quantitated by ELISA and single nucleotide polymorphisms inGC(group-specific component) encoding vitamin D binding protein (VTDB) were genotyped.

Proteomic analysis showed VTDB was 2.6-fold lower in LAM than controls. Serum VTDB was lower in progressive compared with stable LAM (p=0.001) and correlated with diffusing capacity of the lung for carbon monoxide (p=0.01). Median time to death or lung transplant was reduced by 46 months in those withCCgenotypes at rs4588 and 38 months in those with non-A-containing haplotypes at rs7041/4588 (p=0.014 and 0.008, respectively).

The VTDB axis is associated with disease severity and outcome, andGCgenotype could help predict transplant-free survival in LAM.
Enumerating the economic cost of antimicrobial resistance per antibiotic consumed to inform the evaluation of interventions affecting their use
Authors: Shrestha Poojan , Cooper Ben S. , Coast Joanna , Oppong Raymond , Do Thi Thuy Nga , Phodha Tuangrat , Celhay Olivier , Guerin Philippe J. , Wertheim Heiman , Lubell Yoel
Published: August 2018

Background

Antimicrobial resistance (AMR) poses a colossal threat to global health and incurs high economic costs to society. Economic evaluations of antimicrobials and interventions such as diagnostics and vaccines that affect their consumption rarely include the costs of AMR, resulting in sub-optimal policy recommendations. We estimate the economic cost of AMR per antibiotic consumed, stratified by drug class and national income level.

Methods

The model is comprised of three components: correlation coefficients between human antibiotic consumption and subsequent resistance; the economic costs of AMR for five key pathogens; and consumption data for antibiotic classes driving resistance in these organisms. These were used to calculate the economic cost of AMR per antibiotic consumed for different drug classes, using data from Thailand and the United States (US) to represent low/middle and high-income countries.

Results

The correlation coefficients between consumption of antibiotics that drive resistance in S. aureus, E. coli, K. pneumoniae, A. baumanii, and P. aeruginosa and resistance rates were 0.37, 0.27, 0.35, 0.45, and 0.52, respectively. The total economic cost of AMR due to resistance in these five pathogens was $0.5 billion and $2.9 billion in Thailand and the US, respectively. The cost of AMR associated with the consumption of one standard unit (SU) of antibiotics ranged from $0.1 for macrolides to $0.7 for quinolones, cephalosporins and broad-spectrum penicillins in the Thai context. In the US context, the cost of AMR per SU of antibiotic consumed ranged from $0.1 for carbapenems to $0.6 for quinolones, cephalosporins and broad spectrum penicillins.

Conclusion

The economic costs of AMR per antibiotic consumed were considerable, often exceeding their purchase cost. Differences between Thailand and the US were apparent, corresponding with variation in the overall burden of AMR and relative prevalence of different pathogens. Notwithstanding their limitations, use of these estimates in economic evaluations can make better-informed policy recommendations regarding interventions that affect antimicrobial consumption and those aimed specifically at reducing the burden of AMR.
Funding approaches for mental health services: is there still a role for clustering?
Authors: Jacobs Rowena , Chalkley Martin , Aragón María José , Böhnke Jan R. , Clark Michael , Moran Valerie
Published: August 2018

Funding for mental health services in England faces many challenges, including operating under financial constraints where it is not easy to demonstrate the link between activity and funding. Mental health services need to operate alongside and collaborate with acute physical hospital services, where there is a well-established system for paying for activity. The funding landscape is shifting at a rapid pace and we outline the distinctions between the three main options – block contracts, episodic payment and capitation. Classification of treatment episodes via clustering presents an opportunity to demonstrate activity and reward it within these payment approaches. We discuss the results of our research into how well the clustering system is performing against a number of fundamental criteria. We find that, according to these criteria, clusters are falling short of providing a sound basis for measuring and financing services. Nevertheless, we argue that clustering is the best available option and is essential for a more transparent funding approach for mental healthcare to demonstrate its claim on resources, and that clusters should therefore be a starting point for evolving a better funding system.

LEARNING OBJECTIVES

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Understand the different payment models currently being used and proposed in mental health services in England

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Understand the role of clustering in measuring mental health activity and providing a basis for funding

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Understand how a robust model of clustering can benefit the provision of mental health services

DECLARATION OF INTEREST

None.
Narrative Review of Decision-Making Processes in Critical Care
Authors: Alexis Ruiz Adrian , Wyszyńska Patrycja K. , Laudanski Krzysztof
Published: August 2018

Several theories describing the decision-making process in the intensive care unit (ICU) have been formulated. However, none of them appreciate the complexities of the process in an eclectic way by unifying several miscellaneous variables in 1 comprehensive theory. The purpose of this review is to highlight the key intricacies associated with the decision-making process in the ICU, to describe the theoretical frameworks with a special emphasis on gaps of knowledge, and to offer some avenues for improvement. The application of theoretical framework helps us to understand and to modify the structure of the process. Expected utility theory, regret theory, prospect theory, fuzzy-trace theory, construal level theory, and quantum probability theory were formulated over the years to appreciate an increased complexity of the decision-making process in the ICU. However the decision makers engage, these models may affect patient care because each of these frameworks has several benefits and downsides. There are gaps of knowledge in understanding how physicians match the different theoretical frameworks of the decision-making process with the potentially high ICU variability and load, especially when the “best outcome” is often nondiscrete and multidimensional. Furthermore, it is unclear when the preferential application of reflexive, habitual, variable, and biased-prone processes results in patient and staff detriment. We suggest better matching of theoretical frameworks with strengths of the human decision-making process and balanced application computer aids, artificial intelligence, and organizational modifications. The key component of this integration is work to increase the self-awareness of decision-making processes among residents, fellows, and attending physicians.