bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of cycle ergometer use in early mobilization following cardiac surgery: a randomized controlled trial
Authors: Gama Lordello Gleide Glícia , Gonçalves Gama Glicia Gleide , Lago Rosier Gabriela , Viana Patrícia Alcântara Doval de Carvalh , Correia Luís Cláudio , Fonteles Ritt Luiz Eduardo
Published: January 2020

Objective:

To evaluate the effect of early use of a cycle ergometer, compared to a standard care protocol, in postoperatory in-hospital mobility following cardiac surgery.

Design:

A randomized controlled trial.

Setting:

Tertiary hospital in Salvador, Bahia, Brazil.

Subjects:

Patients submitted to elective cardiac surgery (valvular or coronary bypass surgery by sternotomy).

Intervention:

Patients were randomly allocated in two groups: (1) cycle ergometer training group (10-minute session) and (2) control group submitted standard physiotherapy protocol (10-minute session). Training was provided twice a day, immediately following extubation and until patient was discharged from the intensive care.

Main measures:

The primary outcome was the difference in the total number of steps recorded on the pedometer over three days. Secondary outcomes were mobility in different subgroups and the reasons that prevented individuals from walking during early cardiac rehabilitation.

Results:

A total of 228 participants completed the study. No significant difference was found in the total number of steps between the groups after intervention: 2183 (range: 1729–2772) in the intervention group versus 2006 (1517–2657) in the control group ( P = 0.167). However, self-reports indicated better motivation in the intervention group ( P = 0.044). No adverse events occurred during the study.

Conclusion:

As a strategy for early mobilization following cardiac surgery, the use of a cycle ergometer failed to increase independent physical activity compared to a standard care protocol. Nevertheless, it was safe and could be an alternative to make rehabilitation more attractive and motivational for this patient population.
Early-Age Performance of 3D Printed Carbon Nanofiber and Carbon Microfiber Cement Composites
Authors: Kosson M. , Brown L. , Sanchez F.
Published: January 2020

3D printed cement composites with and without carbon nanofiber (CNF) and microfiber (CF) reinforcement within the cement ink were evaluated at seven days and compared with their traditionally cast counterparts. A liquid lubrication layer at the extrusion nozzle was noted. The reinforcement type influenced the formation of the extruded filament, with underextrusion seen during 3D printing with the CNF cement ink while sudden discontinuation of extrusion was experienced during 3D printing with the CF cement ink. No noticeable interfacial region between printed filaments was observed in the 3D printed cement composites, with the exception of air cavities between printed filaments of the composite fabricated with the CNF cement ink. Lower compressive strengths were seen in the direction orthogonal to the print path for the 3D printed composites compared with the cast composites. The addition of CFs within the cement ink reduced this strength difference and led to strain softening in the post peak behavior.
Association Between Overt and Subtle Experiences of Discrimination and Violence and Mental Health in Homosexual and Bisexual Men in Mexico
Authors: Mendoza-Perez Juan C. , Ortiz-Hernandez Luis
Published: January 2020

The aim of this study was to determine whether the experiences of direct or subtle forms of discrimination and violence are associated with mental health in Mexican gay, homosexual, and bisexual (GHB) men. A cross-sectional survey was conducted online; the sample consisted of 4,827 GHB men. Ten forms of overt and subtle sexual orientation–based discrimination and violence (SO-DV) were assessed. Linear and logistic regression models were used to evaluate the association between SO-DV experiences and mental health outcomes. Physical violence was reported less frequently than the other forms of SO-DV. As the number of settings in which SO-DV were experienced increased, a stronger association with negative mental health outcomes was observed. Experiences of subtle SO-DV were associated with increased distress, lower vitality, and increased risk of suicidal ideation. Disapproval of gender nonconformity was associated with negative mental health outcomes independently of violence based on sexual orientation. Subtle forms of SO-DV are more common than direct and overt forms. Both types of SO-DV could negatively affect mental health. Studies investigating these negative experiences are required to gain an understanding of the health inequalities faced by non-heterosexual populations.
Old Problem, New Perspectives: Applying Anzaldúan Concepts to Underrepresentation in STEM
Authors: McWhirter Ellen Hawley , Cinamon Rachel Gali
Published: January 2020

Women and members of many ethnic minority groups continue to be significantly underrepresented in science, technology, engineering, and mathematics (STEM) education and work settings. In this article, we propose that Gloria Anzaldúa’s concepts of nepantla and nepantleras/os can be used to enrich perspectives on underrepresentation among those studying, working, and persisting in STEM fields. We describe how diversity practices may fail to address and foster inclusion in STEM education and workplaces and link inclusion and belonging to engagement and retention in STEM. Recommendations are offered for combining top-down and bottom-up strategies providing information, awareness, and skills training in STEM environments, including recognizing and engaging the insights and experiences of nepantleras/os.
Vertical vibration modelling and vibration response analysis of Chinese high-speed train passengers at different locations of a high-speed train
Authors: Chen Chun-jun , Fang Chao , Qu Guo-qing , He Zhi-ying
Published: January 2020

To study the vibration of a passenger's head and internal organs at different locations of a high-speed train, a 9-degrees-of-freedom (DOF) model of seated passengers is proposed in this paper, and its parameters of the damping coefficients and stiffnesses are identified. Next, the response of the head and internal organs is simulated by applying the vibrational stimulation generated by a 27-DOF vehicle model under track irregularity. Moreover, by applying the measured vibration signal, the following conclusions can be drawn: (1) the weakest response is detected at the centre of the compartment of the wagon, and a stronger response is detected at the centre of the bogie, with the rolling motion having a greater effect 1 m away from the centre of the bogie; (2) the response of the human internal organs is stronger than that of the head under stimulation with a lower frequency of less than 3 Hz, and a similar conclusion can be drawn in the range of 5 to 8 Hz. However, if the frequency is in the range between 8 and 15 Hz, the situation is entirely different. The responses of both the head and internal organs are reduced at frequencies over 20 Hz; (3) from the real application, it can be inferred that the greatest response can be detected at approximately 3 Hz for internal organs and at 8 Hz or higher for the head.
Syphilis testing among spouses of patients with syphilis in Japan: an epidemiological study using an administrative claims database
Authors: Matsubayashi Keisuke , Kawakami Koji
Published: January 2020

The number of syphilis cases reported in Japan, transmitted mainly by heterosexual contact, has been increasing since 2014. However, Japan has not introduced partner services programmes, and it remains unclear whether contacts of patients with syphilis undergo testing. This study aimed to estimate the proportion of spouses of patients with syphilis who underwent syphilis testing. We retrospectively identified patients who had recently started syphilis treatment as well as their spouses from a Japanese claims database for employee health insurance plans, collected between 2010 and 2017. Spousal syphilis testing was defined as either a nontreponemal or treponemal test within three months after the index patient started treatment. We determined the proportion of spousal syphilis testing and analysed its associations with patient and spouse characteristics, and year of syphilis treatment. Of the 217 patients who were identified to have started syphilis treatment, 29 (13.3%) spouses underwent syphilis testing: 23/182 (12.6%) among wives, and 6/35 (17.1%) among husbands, of male and female index patients, respectively. Among wives aged <45 years, the proportion tested declined over time. Despite the rise in syphilis incidence, the proportion of spouses tested, including women of reproductive age, declined. In Japan, partner services programmes need to be implemented to control sexually transmitted infections.
Institutional Quality and Financial Development: Evidence from Developing and Emerging Economies
Authors: Khan Hayat , Khan Sher , Zuojun Fan
Published: January 2020

Using a panel data set of 189 countries by employing dynamic models OLS, fixed effect, random effect and generalized method of moments (GMM) estimators. The study revisits the relationship between institutional quality and financial development in developing and emerging countries. This study is ever the first comprehensive and wide-ranging that categorizes the countries into developing and emerging countries using multiple dynamic approaches. Experimental findings of the study are based on GMM, which indicates that better institutions are important for financial development, specifically political stability, control of corruption and regulatory quality positively affect financial development in the global panel of the study. Rule of law negatively affects financial development, which reveals that in most of the global countries, the rule of law is very feeble. Control of corruption index is positively effecting financial development in emerging and global panel which indicates that most of the countries have reduced corruption to low level. The current study also found that emerging countries have reduced corruption, but other institutional indicators are found to be insignificant. The overall result concludes that good quality institutions are the main drivers of financial development and it stimulates financial development. The present study suggests that developing and emerging countries should focus to improve the institutional quality by re-examining the rules of law, government effectiveness and voice accountability institutional factors to make it better.
A guest-worker state? The declining power and agency of migrant labour in Australia
Authors: Wright Chris F , Clibborn Stephen
Published: January 2020

This article presents an historical and comparative analysis of the bargaining power and agency conferred upon migrant workers in Australia under distinct policy regimes. Through an assessment of four criteria – residency status, mobility, skill thresholds and institutional protections – we find that migrant workers arriving in Australia in the period from 1973 to 1996 had high levels of bargaining power and agency. Since 1996, migrant workers’ power and agency has been incrementally curtailed, to the extent that Australia’s labour immigration policy resembles a guest-worker regime where migrants’ rights are restricted, their capacity to bargain for decent working conditions with their employers is truncated and their agency to pursue opportunities available to citizens and permanent residents is diminished. In contrast to recent assessments that Australia’s temporary visa system is working effectively, our analysis indicates that it is failing to protect temporary migrants at work.

JEL Codes: J24, J61, J83
Nausea in Numbers: Electronic Medical Record Nausea and Vomiting Assessment for Children With Cancer
Authors: Evans Anna , Vingelen Mary Beth , Yu Candy , Baird Jennifer , Murray Paula , Bryant Pamela
Published: January 2020

Purpose: Chemotherapy-induced nausea and vomiting (CINV) is a distressing, underrecognized effect of treatment that can occur in up to 80% of patients. The purpose of this quality improvement project was to evaluate the impact of implementation of a standardized nausea assessment tool, the Baxter Animated Retching Faces (BARF) scale, on nursing compliance with nausea assessment and the frequency and severity of patient-reported CINV for children with cancer. Method: The Plan-Do-Study-Act cycle was used to implement this practice change. With stakeholder support and hospital governance council approval, the BARF scale was introduced into the electronic medical record. Nurses were provided education about the assessment tool and were given badge buddy cards to prompt use of the tool, and workstation reminders were created. A root cause analysis was conducted to provide feedback for continuous quality improvement. Results: Retrospective, aggregate electronic medical record data from May 2018 to April 2019 were analyzed for assessment compliance, total number of admissions with vomiting episodes, and average BARF score. Over the 12-month implementation period, run charts demonstrated a shift in nursing practice with increased compliance in documented nausea assessments during the second 6-month period. There was not a significant decrease in patient-reported CINV. Conclusion: The use of standardized nausea assessments based on patient self-reporting can provide useful and consistent feedback for nurses and health care providers. This quality improvement project demonstrated increased compliance with nausea assessment documentation. Further studies are needed to demonstrate that improvements in nausea assessment may reduce the frequency and severity of CINV.
“Thrown Into the Deep End”: Mapping the Experiences of Young People Living in a Family Affected by a Neurological Condition
Authors: Masterson-Algar Patricia , Williams Sion
Published: January 2020

In this case study research, we investigated the impact that having a parent with a neurological condition can have on young adults’ experiences of growing up and the nature of their support networks. The work was informed by models of interface of chronic conditions and the family. Stroke ( n = 6), multiple sclerosis ( n = 14), and dementia ( n = 11) were selected as discrete cases. Within each case, the researcher (a) carried out semi-structured interviews with young adults (16–25 years) living in families affected by this condition and (b) organized a workshop in which all participants reviewed preliminary themes and reflected on their support networks. A thematic analysis identified four themes: the condition has shaped me, thrown into the deep end, I need to talk about this, and they don’t understand. A model of networks and support for these young adults was generated reflecting the need to increase their visibility and their access to support.
Characteristics, Mortality Rates, and Treatments Received in Last Few Days of Life for Patients Dying in Intensive Care Units: A Multicenter Study
Authors: Almansour Issa Mohammad , Ahmad Muayyad Mustafa , Alnaeem Mohammad Minwer
Published: January 2020

Background:

Information is presently lacking about the end-of-life care in intensive care unit (ICU). We explored the characteristics, mortality rates, and treatments received in the last few days of life for patients who died in ICU.

Methods:

This was a retrospective multicenter cohort study. We included patients who died from different medical illnesses between January 2014 and January 2017 in 8 medical ICUs across 3 major health-care systems in Jordan. Of 11 029 patients who were admitted for the study in ICUs, data from 3885 health records were retrieved and analyzed. Pediatric patients aged younger than 18 years and patients admitted to an ICU for less than 4 hours were excluded.

Results:

The mean ICU mortality rate was 34.6% (29%-38%), with a slight decline from 2014 through 2016. Most of the patients who died were male (56.6%), transferred from the emergency department (46.8%), and had multiple comorbidities (74%). Cardiopulmonary resuscitation, invasive mechanical ventilation, pharmacological hemodynamic support, and artificial hydration were pursued until death for most patients (91.5%, 80.1%, 78.8%, and 94.1%, respectively).

Conclusions:

Aggressive treatment modalities were usually pursued for critically ill patients at the end of their lives. There is a need to explore further the current end-of-life care needs and practices in ICUs in Jordan and to tailor end-of-life care and management suitably to meet the needs of Islamic and Arabic cultures.
Explaining Supervised Learning Models: A Preliminary Study on Binary Classifiers
Authors: Wang Xiaomei , Bisantz Ann M. , Bolton Matthew L. , Cavuoto Lora , Chandola Varun
Published: January 2020

The reach of artificial intelligence continues to grow, particularly with the expansion of machine learning techniques that capitalize on increased computing power. Such systems could have tremendous benefits by providing predictions and suggestions. However, they are limited by the fact that they offer incomplete explanations of their predictions to human decision makers. The objective of this work was to summarize general information that could help users make judgments about whether a system is trustworthy and whether the system’s training “makes sense.” A preliminary study was summarized to show the importance of iterative design and testing for visualizing explanations.
Mammary Extranodal Rosai-Dorfman Disease With and Without Associated Axillary Lymphadenopathy: Insights for Practitioners of Breast Pathology
Authors: Shetty Sindhu , Sharma Nidhi , Booth Christine N. , Oshilaja Olaronke , Downs-Kelly Erinn P. , McKenney Jesse K. , Sturgis Charles D.
Published: January 2020

Rosai-Dorfman disease is a rare proliferative histiocytic disorder of lymph nodes that is descriptively known as sinus histiocytosis with massive lymphadenopathy. Extranodal involvement of the parenchyma of the breast is uncommonly reported, with fewer than 50 cases of mammary extranodal disease detailed in the English-language literature. We characterize a retrospective series of adult female patients from a single institution with Rosai-Dorfman disease of the breast and axillary lymph nodes. Because Rosai-Dorfman disease of the breast and axillary lymph nodes may clinically, radiographically, and histologically mimic breast carcinoma and other conditions, we present an illustrated review of the disease and its relevant differential diagnoses in hopes of raising awareness and allowing for accurate management of affected patients.
Identification of the Intron 22 and Intron 1 Inversions of the Factor VIII Gene in Iraqi Kurdish Patients With Hemophilia A
Authors: Abdulqader Aveen M. Raouf , Mohammed Ali Ibrahim , Rachid Shwan , Ghoraishizadeh Peyman , Mahmood Sarwar Noori
Published: January 2020

Hemophilia A (HA) is a severe coagulation disorder affecting 1 in 5000 to 10 000 male births. In severe cases, the most deleterious large DNA rearrangements are inversions of intron 22 (Inv22) and intron 1 (Inv1) of the factor VIII (FVIII) gene. These account for 40% to 50% and 1% to 5% of all causative mutations, respectively. Nevertheless, no genetic analysis to identify the actual causative mutation of FVIII, particularly Inv22 and Inv1, among Iraqi Kurdish hemophiliacs has been performed. In this study, we aimed to genotype Inv22 and Inv1 of the FVIII gene in our patients with HA and reveal the genotype/phenotype correlation with the inversion mutations and their role as a risk factor for the development of inhibitors. Analyses of the Inv22 and Inv1 mutations in 80 Iraqi Kurdish patients with HA (60 severe, 18 moderate, and 2 mild) were performed using the inverse shifting–polymerase chain reaction (IS-PCR) method. In severe cases, 46.7% (28/60) had Inv22 and 3.3% (2/60) had Inv1. The genotype/phenotype relation of Inv22 and Inv1 illustrated a statistically significant association ( P = .012) between disease severity and inversion mutations. Slightly more patients with Inv22 (39%) developed inhibitors than those without Inv22 (28%; odds ratio = 1.65, 95% confidence interval = 0.56-4.87, P = .361). Inv22 is a major cause of severe HA in Iraqi Kurdish patients, and IS-PCR is a rapid, robust, and effective method that can be applied for carrier detection and prenatal diagnosis of HA in developing countries.
Intimate Partner Relationships and Gender Norms in Mali: The Scope of Cash Transfers Targeted to Men to Reduce Intimate Partner Violence
Authors: Lees Shelley , Kyegombe Nambusi , Diatta Ampa , Zogrone Amanda , Roy Shalini , Hidrobo Melissa
Published: January 2020

Mali has implemented the Filets Sociaux (Jigisémèjiri) program that aims to reduce poverty through cash transfers (CTs) to predominantly male heads of household with accompanying measures. This paper reports on a qualitative study of the effects of the program on intimate partner relationships. In-depth interviews were conducted with men and women in monogamous and polygamous households. Findings revealed that the positive aspects of intimate partner relationships were communication and shared values. However, discussions around decision-making revealed male authority with limited influence by women. Physical violence was reported to be caused by tensions and disputes. Whereas sexual violence was contested, some women described sexual force as violence but men and women asserted that compliance in sexual matters by women was expected. Men also asserted control through preventing women from working outside the home. The CTs were managed by the husband, with some involvement of wives in decision-making about the use of CTs. CTs were reported to reduce household poverty and improve wellbeing, especially for men. There were reports of the effects of the program on IPV, especially in the reduction of physical violence, its effects on sexual violence and controlling behaviour were reported to be limited. Since women are not the primary recipients of the CT, there is limited effect on women’s agency to challenge male authority and control around sexual and financial matters. CTs may be more effective if targeted to women, alongside skill and knowledge strengthening to utilize cash transfers to assert their rights to equality and prevent violence
Feeling Manipulated: How Tip Request Sequence Impacts Customers and Service Providers?
Authors: Warren Nathan , Hanson Sara , Yuan Hong
Published: January 2020

Technology is changing frontline service scripts. Businesses are now using mobile point-of-sale applications (e.g., Square) and mobile technology (e.g., iPad) to prompt customers for tips. Tip requests are occurring more frequently at the start of service transactions, before any service has been provided. This research examines how requesting a tip either before or after service completion affects customers and service providers. We test the effects of preservice versus postservice tip sequence in four studies (a natural experiment in the field and three controlled experiments) across food and beauty service contexts. Findings reveal that requesting a tip before (vs. after) completing a service leads to smaller tips, reduced return intentions, diminished word-of-mouth intentions, and lower online ratings. Inferred manipulative intent is revealed as the psychological mechanism underlying the harmful effects of requesting a tip before service. Findings suggest that emphasizing the benefits of automated point-of-sale systems can reduce, but not eliminate, the negative effects of preservice tip requests. Contrary to norms within the service industry, we find that service providers should avoid requesting tips before serving customers.
The effect of angioplasty of single arteriovenous fistula–associated stenosis on arteriovenous fistula blood flow rate
Authors: Nassar George M , Beathard Gerald , Nguyen Duc T , Graviss Edward A
Published: January 2020

Introduction:

Percutaneous balloon angioplasty of arteriovenous fistula–associated stenosis is performed for a variety of indications. Successful percutaneous transluminal angioplasty (PTA) is expected to increase in arteriovenous fistula blood flow rate (Qa). A validated approach to predicting changes in Qa based upon stenosis characteristics is not available.

Methods:

Three baseline parameters were determined in a group of patients with a single arteriovenous fistula–associated stenosis undergoing PTA. These were percent estimated stenosis, stenosis minimum luminal diameter, and baseline Qa. The relationship between these parameters and changes in Qa following PTA was analyzed using Spearman’s rank correlation and linear regression.

Results:

113 patients (total group) were studied. Of these,106 had peripheral stenosis (total peripheral subgroup) and 7 had central stenosis. For the total group and total peripheral subgroup, a highly significant inverse correlation was seen between changes in Qa and baseline Qa. A weaker correlation was seen between changes in Qa and minimum luminal diameter, but no correlation was seen with percent estimated stenosis. A minimum luminal diameter ⩽2.0 mm was predictive of ⩾300-mL/min increases in Qa, whereas a minimum luminal diameter >4.5 mm was associated with <300-mL/min increases in Qa. PTA of Central vein stenosis was not associated with significant changes in Qa.

Conclusion:

Baseline Qa is the best predictor for change in Qa following PTA. Stenosis minimum luminal diameter cutoffs of ⩽2.0 and >4.5 mm are useful in predicting the magnitude of changes in Qa. Percent estimated stenosis is not predictive of change in Qa. PTA of central veins does not seem to change Qa.
Technical note: An alternative method for AV access superficialization
Authors: Fontenot Danielle , Illig Karl A
Published: January 2020

Introduction:

An arteriovenous fistulae for dialysis access is only functional if superficial enough for reliable cannulation. We describe a previously unreported technique to superficialize arteriovenous fistulae too deep for reliable cannulation.

Method:

The path of the fistula is marked using ultrasound, and three to four transverse incisions are made along this path. The subcutaneous tissue is separated from the dermis over this entire area. The fistula is then accessed through transverse incisions and by dividing the overlying adipose tissue. The mobilized vein is then “trapped” directly under the dermis by closing the superficial fascia and adipose tissue beneath it and using this tissue to elevate the fistula. No anastomotic revisions are necessary, and moderate straightening can be performed.

Results:

We have performed this procedure on 20 patients with 100% technical success. One fistula had thrombosis within 8–10 weeks of the superficialization procedure and one patient refused access due to pain, but all other fistulas were successfully cannulated. Two patients were lost to follow-up, and one patient developed skin breakdown in the area of the flap which delayed cannulation. Our 3-month patency was 94.4% with a functional patency, defined as a clinically patent fistula successfully being used for hemodialysis, of 87.5%.

Conclusion:

The technique described allows elevation of the vein to the level of the dermis without division and re-anastomosis or re-tunneling, through several small incisions maintaining virgin skin and normal contour for easier cannulation.
Canadian Burden of Skin Disease From 1990 to 2017: Results From the Global Burden of Disease 2017 Study
Authors: Bridgman Alanna C. , Fitzmaurice Christina , Dellavalle Robert P. , Karimkhani Aksut Chante , Grada Ayman , Naghavi Mohsen , Manafi Navid , Olagunju Andrew T. , Olagunju Tinuke O. , Somayaji Ranjani , Drucker Aaron M.
Published: January 2020

Background

Skin diseases can have high morbidity that can be costly to society and individuals. To date, there has been no comprehensive assessment of the burden of skin disease in Canada.

Objectives

To evaluate the burden of 18 skin and subcutaneous diseases from 1990 to 2017 in Canada using the Global Burden of Disease (GBD) data.

Methods

The 2017 GBD study measures health loss from 359 diseases and injuries in 195 countries; we evaluated trends in population health in Canada from 1990 to 2017 using incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Data are presented as rates (per 100 000), counts, or percent change with the uncertainty interval in brackets.

Results

From 1990 to 2017 for all skin diseases, DALY rates increased by 8% to 971 per 100 000 (674-1319), YLD rates increased by 8% to 897 per 100 000 (616-1235), YLL rates increased by 4% to 74 per 100 000 (53-89), and death rates increased by 18% to 5 per 100 000 (3-6). DALY rates for melanoma increased by 2% to 54 per 100 000 (39-68), for keratinocyte carcinoma by 14% to 17 per 100 000 (16-19), and for skin and subcutaneous disease by 8% to 900 per 100 000 (619-1233). The observed over expected ratios were higher for skin and subcutaneous disease (1.37) and keratinocyte carcinoma (1.17) and were lower for melanoma (0.73).

Conclusions

The burden of skin disease has increased in Canada since 1990. These results can be used to guide health policy regarding skin disease in Canada.
Dynamics of tourism demand in Turkey: Panel data analysis using gravity model
Authors: Ulucak Recep , Yücel Ali Gökhan , İlkay Salih Çağrı
Published: January 2020

Turkey, an emerging economy, ranked 8th among the most visited countries in the world in 2017. Given the importance of the tourism sector in Turkey, it is of utmost importance to identify the dynamics of tourism demand to achieve sustainable tourism. The aim of this article is, therefore, to explore the demand-side factors that affect the number of international tourist arrivals to Turkey. To this end, an augmented gravity model has been employed to analyze the factors affecting the number of international tourists visiting Turkey from the top 25 originating countries from 1998 to 2017. The results show that the gravity model is very effective in explaining the tourist arrivals to Turkey. Empirical findings suggest that per capita income of both origin country and Turkey, relative exchange rate, and globalization positively affect the demand for tourism, while it is negatively affected by consumer price index, violence/terrorism, household debt level, and bilateral distance between Turkey and the origin country.
Is the rise of crowdfunding for medical expenses in the United Kingdom symptomatic of systemic gaps in health and social care?
Authors: Coutrot Isabel Pifarré , Smith Richard , Cornelsen Laura
Published: January 2020

Crowdfunding for medical care is a new phenomenon but increasingly used by individuals to seek financial help to cover the costs of health care. Ethical concerns have been raised about medical crowdfunding, including implications for equity, resource allocation, medical decision-making, the promotion of non-evidence based therapies, platforms’ lack of transparency and corporate interests. Medical crowdfunding efforts may point to shortcomings in health service provision, but they tend to have wider motivations and implications. However, there is no firm evidence base for establishing answers to even the most basic questions, such as who is seeking funds, for what, where and why. In this Essay, we provide an introduction to medical crowdfunding in the United Kingdom (UK). We synthesize what is currently known and the insights that might be gained from an exploratory review of 400 medical crowdfunding campaigns on the GoFundMe UK website: for instance, whether medical crowdfunding occurs in response to gaps in service provision, supports ‘queue jumping’ and how it relates to ‘medical tourism’. We conclude with a call for research on medical crowdfunding in the UK (and elsewhere) as a means to better understand patients’ perceived or actual unmet need for health and social care and inform policy development.
Book review: Enghel, F. and Noske-Turner, J., editors. 2018: Communication in international development: Doing good or looking good?
Authors: Srinidhi Arjuna
Published: January 2020

Enghel, F. and Noske-Turner, J., editors. 2018: Communication in international development: Doing good or looking good? London, UK: Routledge. 198 pp. £31.99 (paperback), £110.00 (hardback). ISBN: 9781138569928 (paperback), ISBN: 9781138569911 (hardback).
Trajectory of self-care behaviour in patients with heart failure: the impact on clinical outcomes and influencing factors
Authors: Liljeroos Maria , Kato Naoko P , van der Wal Martje HL , Brons Maaike , Luttik Marie Louise , van Veldhuisen Dirk J , Strömberg Anna , Jaarsma Tiny
Published: January 2020

Background:

Patients’ self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied.

Aims:

(1) To describe the trajectory of patients’ self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour.

Methods:

In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of ⩾70 was used to define good self-care behaviour.

Results:

Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p < 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p < 0.05).

Conclusion:

Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.
Legitimate concerns: On complications of identity in school punishment
Authors: Thompson Winston C. , Beneke Abigail J. , Mitchell Garry S.
Published: January 2020

In the present unjust context of US schools, many educators face uncertainty about the legitimacy of their issuing punishments, especially when their identity meaningfully differs from that of their students. In this article, we address these doubts by acknowledging distinctive elements of schools to provide helpful distinctions and analyses of the legitimacy of punishments within them. Specifically, we interrogate the role that identity categories such as race and gender play in establishing legitimate punishment within schools, with a particular focus on the case of Black girls attending US schools. We offer a taxonomy of legitimate responses to undesired student behavior, arguing that a particular person in their role within a school might lack legitimacy to punish based upon their identity even while other, related yet more nuanced, behavioral responses remain. In this work, we aim to equip educators with tools to better navigate the options available to them and better understand the significance of their actions in response to student behavior.
A Comparison of Common Health Indicators From Two Surveys of Latinos in the Bronx, New York
Authors: Crossa Aldo , Jessup Jillian , Liu Sze Yan , Isasi Carmen R. , Hanna David B. , Hua Simin , He Fangtao , Seligson Amber Levanon , Lim Sungwoo
Published: January 2020

Introduction:

Population health surveys inform and demonstrate the impact of public health policies. However, the performance of such surveys in specific groups of interest (e.g., Hispanics/Latinos in a neighborhood of New York City) is rarely studied.

Method:

We compared measures for obesity, hypertension, diabetes, and current smoking based on the New York City Community Health Survey (CHS, a telephone survey of New York City adults) with the Hispanic Community Health Survey/Study of Latinos (HCHS/SOL), an in-person survey of Hispanic/Latino adults in four communities in the United States (2008-2011), including the Bronx. CHS data were limited to Hispanic/Latinos living in the HCHS/SOL Bronx catchment area.

Results:

Compared with CHS, HCHS/SOL estimated higher prevalence of obesity (in HCHS/SOL, PHCHS/SOL = 45.0% vs. in CHS, PCHS = 30.6%, p < .01) and current smoking (PHCHS/SOL = 21.2% vs. PCHS = 16.2%, p < .01) but similar for hypertension (PHCHS/SOL = 33.1% vs. PCHS = 33.8%, p > .05) and diabetes (PHCHS/SOL = 15.2% vs. PCHS = 15.7%, p > .05). Stratified estimates (by age, sex, education, and Hispanic/Latino heritage) followed similar trends.

Conclusion:

Our study emphasizes the importance of assessing potential bias in population-based surveys of Hispanics/Latinos and other populations of interest and highlights the complex nature of measuring health outcomes via population-based surveys.
Tension-Free Mesh Repair for Incarcerated Groin Hernia: A Comparative Study
Authors: Chen Fuqiang , Liu Min , Jin Cuihong , Wang Fan , Shen Yingmo , Zhao Fenglin , Chen Jie
Published: January 2020

Background. Management of emergent groin hernias remains challenging, due to limited consensus in surgical approach and repair options (eg, mesh vs nonmesh, biological mesh, and polypropylene [PP] mesh). Methods. A 5-year retrospective study was conducted on 118 patients who received emergency incarcerated groin hernia repair in Beijing Chaoyang Hospital. The incidence of surgical site infection (SSI), preoperative mortality, sepsis, and ileus was noted. In the follow-up, postoperative foreign body sensation, chronic pain, seroma/hematoma, and recurrence were recorded. The outcomes of different surgical procedures (with mesh/without mesh, biological mesh/PP mesh, transabdominal preperitoneal (TAPP)/Lichtenstein repair) were compared and analyzed. Results. Out of the 118 patients, 14 cases received suture repair (as group A); 104 cases had TAPP repair (n = 44) or Lichtenstein repair (n = 60) with meshes, including 23 cases of biological mesh (as group B); and 81 cases had repair with PP mesh (group C). There were no significant differences between the 3 groups regarding SSI, mortality, sepsis, and ileus. After 20.5 months of follow-up (range from 6 to 65 months), 21.4% of group A developed recurrence, a rate significantly higher than that of group B (4.3%) and group C (0). The incidence of seroma/hematoma in group B was higher than that in group A (7.1%) and group C (7.4%). The results between TAPP group and Lichtenstein group were comparable. Conclusion. Tension-free mesh repair in the treatment of emergency incarcerated groin hernia is safe and effective, which can reduce hernia recurrence without increasing infection risk. The results of biological mesh and PP mesh were comparable.
Ceftolozane/Tazobactam Dosing Requirements Against Pseudomonas aeruginosa Bacteremia
Authors: Ruiz Jesus , Ferrada Alejandra , Salavert Miguel , Gordon Mónica , Villarreal Esther , Castellanos-Ortega Álvaro , Ramirez Paula
Published: January 2020

Objectives:

To assess the probability of reaching adequate pharmacokinetic/pharmacodynamics values for ceftolozane/tazobactam at different doses and degrees of renal functions in patients with Pseudomonas aeruginosa bacteremia.

Methods:

Six dosing regimens were evaluated: 0.5/0.25 g, 1/0.5 g, and 2/1 g every 8 hours given as 1 hour or 3 hours infusions. Pharmacokinetic data were obtained from the literature. Susceptibility data to ceftolozane were collected from patients with P aeruginosa infection treated with ceftolozane-tazobactam. Probability of reaching a fraction of time (fT) >40% minimum inhibitory concentration (MIC) and fT >100%MIC value for ceftolozane at 3 different renal clearance values was evaluated. For tazobactam, the probability of reaching an fT >40% and >70% for 3 limit values was calculated.

Results:

Thirty-seven strains were included. For ceftolozane, the probability of reaching a fT >40%MIC was greater than 90% for any degree of renal function. The probability of reaching a fT >100%MIC for 1 g dose infused over 1 hour and 3 hours was 82.2% and 86.4% for a creatinine clearance (ClCr) >90 mL/min. Using a 2 g dose, the probability was greater than 90% for both infusions rates. For tazobactam, the probability of reaching a value of fT >50% of the limit concentrations was greater than 90% for a ClCr of 70 mL/min. In the case of a ClCr >90 mL/min and limit concentration values ≥ 0.25 mg/mL, only extended infusions showed a probability >90%.

Conclusions and Relevance:

The standard doses of ceftolozane/tazobactam achieve an adequate fT >40%MIC value. However, doses of 2 g in extended infusion is necessary to reach a value of fT >100%MIC, especially in patients with an increased renal clearance and high levels of beta-lactamases expression.
HNF-1 binding point mutation of the AFP gene promotes cirrhosis in post-menopausal women
Authors: Wang Jing-wen , Chen Yong , Liu Qi-cai , Liu Guo-zhong , Zhang Shu-yu , Guo Yu-jia , Li Dong-hong , Chen Xing-ting , Lin Chen , Gao Feng
Published: January 2020

Objective:

α-fetoprotein (AFP) expression is activated during the embryonic stage or hepatocellular carcinogenesis, so it is presumed that AFP is a key endogenous molecule to promote cell proliferation or differentiation. We carried out gene screening in an unknown family with hyper-alpha-fetoproteinemia and some sporadic menopausal women, and discussed the relationship between AFP expression and liver cirrhosis.

Methods:

Peripheral blood samples from family members, patients with malignant liver tumors, and normal controls were collected. Full-length sequence of AFP was amplified and directly sequenced, and compared with normal controls. HNF-1α and HNF-1β in plasma levels of family members, patients with liver cancer, newborns, pregnant women, and normal subjects were detected by ELISA, and the relationship between HNF-1 and AFP mutation or high expression was evaluated.

Results:

There was a mutation in AFP promoter region at c.-200 C>T, which was located at the binding site of AFP hepatocyte nuclear factor 1 (HNF-1). AFP was higher than 4000 ng/L in all members carrying the mutation, but liver cancer was excluded in the family with hyper-alpha-fetoprotein. However, cirrhosis occurred in post-menopausal women. The cases reviewed showed that unknown hyper-alpha-fetoprotein was closely related to HNF-1 binding point of AFP in post-menopausal women with cirrhosis (7/11), while the plasma levels of HNF-1α and HNF-1β were not significantly different.

Conclusion:

The mutation of the HNF-1 binding point of AFP may lead to an abnormal high expression of AFP by altering the binding of HNF transcription factors, which is closely related to cirrhosis in menopausal women.
Neonatal brain ultrasound training for beginners: Could a head phantom be useful?
Authors: La Torre Antonio , Visioli Carmen Beatriz
Published: January 2020

Background

The traditional method of teaching the technique of neonatal brain ultrasonography is based upon the interaction between the practitioner and the neonate under the supervision of a tutor. This approach has disadvantages in that it may result in a longer imaging examination and the patient may become agitated. As demand for ultrasound services escalates and departments get busier, this often means that the trainee and supervisor are under pressure to work rapidly. Such environments are common but not conducive to the development of adequate skills and competencies. A neonatal head phantom used as part of a dedicated study day could help the beginner to learn basic elements of the ultrasound examination within a safe stress-free environment. It offers the opportunity to repeat the examination as often as the trainee wishes without time pressures and the distraction of a moving and potentially very sick baby.

Aim

The aim of this study is to evaluate the efficacy of a commercial phantom as a means for the practitioner to acquire the fundamental principles of neonatal brain ultrasound.

Method

A total of 17 participants attending a one day neonatal ultrasound course aimed at beginners were invited to complete a short two-part questionnaire that assessed their perceived improvement in scanning ability before and after using a commercially available head phantom.

Results

Of the 14 returned questionnaires, the overall perceived understanding, ability and confidence improved and anxiety levels about the procedure fell. The median pre-training score was 9.0 compared with the median post-training score of 12.0 (P = 0.005, Wilcoxon signed-rank test). At least 79% (up to 86%) of participants valued their experience with the phantom and would recommend the course to colleagues. Furthermore, about two-thirds reported that they would like to have additional practise with the phantom. Preliminary data from this study suggest that beginners found the head phantom useful for mastering some of the early skills required for neonatal brain ultrasound examinations, which in turn improved their confidence and reduced anxiety.
A new 3-hydroxyphthalimide-based turn-on fluorescent probe for Hg2+ detection in aqueous solution
Authors: Pan Xue-Tao , Li Qiao , Xu Yuan-Yuan , Hu Sheng-Li
Published: January 2020

A new 3-hydroxyphthalimide-based turn-on fluorescent probe is designed and synthesized. This probe can be used to determine the presence of Hg2+ ions by fluorescence spectroscope with high selectivity over other metal ions in aqueous solution. The analytical detection limit for Hg2+ is as low as 6.5 × 10−7 M. The recognition mechanism is attributed to Hg2+-promoted carbonothioate group cleavage and a subsequent excited-state intramolecular proton transfer mechanisms.
LIZZIE LEIGH! Or, the Murder Near the Old Mill: A Story of Three Christmas Nights – A Domestic Drama, in Three Acts by W. R. Waldron
Authors: Recchio Thomas , Cline Lauren Eriks , Christman-Lavin Sophie
Published: January 2020

Richard Waldon’s play Lizzie Leigh can be interpreted as a domestic drama, a temperance play, or a sensational melodrama. In editing the script we asked ourselves which generic frame – the domestic or temperance – enables the sensation narrative to speak to an audience more powerfully today. Since the discourse of temperance is effectively culturally dead, our first editing decision was to delete the opening temperance dialogue and all subsequent references to temperance as such. We open our version of the play in the midst of an action, and all subsequent deletions to the script were made in the service of keeping the core action of the play in the foreground. We strived to capture how the action might speak to our audience within the contexts that we carry with us from our own cultural moment, our heightened awareness of forms of violence against women, and uncertainties about truth claims being the most prominent. Thus, we shortened the long paeans to lost domestic security and happiness, keeping domesticity as a thread but not a preoccupation. In other words, we kept enough of the domestic context to highlight the action with the intention to make the action as legible and as credible as we could.