bluuebunny/crossref_metadata_2025 huggingface dataset:
New Products, Upgrades, and New Releases: A Rationale for Sequential Product Introduction
Authors: Padmanabhan V. , Rajiv Surendra , Srinivasan Kannan
Published: December 2018

Network externality is an important consideration in many high-technology product markets. In these markets, consumers’ expectations about the future installed base and the resultant externality benefits play a critical role in their product adoption decisions. The authors investigate the strategic implications of consumer uncertainty regarding network externality and show that a firm can credibly convey private information about future installed base through its new product introduction strategy. The authors initially consider a market in which consumers are homogeneous in their valuation of quality. They show that under complete information the optimal strategy entails provision of full (efficient) quality in the first period itself, providing any upgrade in the second period is suboptimal. However, under asymmetric information about externality, a high-externality firm provides less than full quality initially and then makes up for the quality differential through provision of an upgrade in the second period. Thus, underprovision of introductory quality (i.e., withholding quality) serves as a signal of high externality, and upgrades serve as the mechanism for implementation of the signaling strategy. The authors demonstrate the robustness of this result by extending the model to incorporate consumer heterogeneity in quality valuation. The additional insight here is that signaling entails sequential targeting of segments in addition to sequential provision of quality.
An Anchoring and Adjustment Model of Purchase Quantity Decisions
Authors: Wansink Brian , Kent Robert J. , Hoch Stephen J.
Published: December 2018

How do consumers decide how many units to buy? Whereas prior research on individual consumers’ purchases has focused primarily on purchase incidence and brand choice, the authors focus on the psychological process behind the purchase quantity decision. The authors propose that a simple anchoring and adjustment model describes how consumers make purchase quantity decisions and suggests how point-of-purchase promotions can increase sales. Two field experiments and two lab studies show that anchor-based promotions—presented as multiple-unit prices, purchase quantity limits, and suggestive selling—can increase purchase quantities. The final study shows that consumers who retrieve internal anchors can counter these anchor-based promotions effectively. Firms might receive net benefits from anchor-based promotions depending on whether increases in unit sales reflect increased category consumption, brand switching, variety switching, store switching, or stockpiling.
Distance Representations of Consumer Perceptions: Evaluating Appropriateness by Using Diagnostics
Authors: Ghose Sanjoy
Published: December 2018

To understand consumer perceptions of product/market structures, marketers must choose from a wide variety of spatial and tree models. Because spatial and tree representations in general possess different distance patterns, diagnostic measures calculated from the input data of dissimilarities or similarities should be able to indicate how appropriate a certain type of representation might be for a given set of input data. In this article, the author draws from previous literature on the characteristics of diagnostic measures and representation models to develop some partial hypotheses about how well the measures might indicate the appropriateness (in terms of fit) of different models. Empirical analysis indicates that the skewness diagnostic is clearly the best predictor of the appropriateness of representation models; this finding is consistent across a variety of comparable spatial and tree models. Centrality and the reciprocity-related measure, in conjunction with skewness, are useful for specific types of space–tree pairs. The author uses the U-Method (closely related to jackknifing) of prediction, in conjunction with discriminant analysis models, to show that the diagnostics can predict the relative appropriateness of spaces versus trees with accuracy levels substantially greater than what would be expected by chance.
Perceptions of Price Unfairness: Antecedents and Consequences
Authors: Campbell Margaret C.
Published: December 2018

Using two studies, the author examines the influence of the inferred motive for a firm's price increase on perceptions of price unfairness. Prior to the research presented here, the only established causal antecedent of perceived price unfairness was increased relative profit. In Study 1, the author extends the existing research by demonstrating that the inferred motive, as well as inferred relative profit, provides causal explanation of perceived price unfairness. When participants inferred that the firm had a negative motive for a price increase, the increase was perceived as significantly less fair than the same increase when participants inferred that the firm had a positive motive. In addition, the author shows in Study 2 that the firm's reputation can influence the inferred motive, thereby altering perceptions of price unfairness. Specifically, participants sometimes gave a firm with a good reputation the benefit of the doubt when inferring motive. If the “good” firm did not profit from the price increase, participants inferred significantly more positive motives than if it did profit. The firm with a poor reputation did not receive this benefit; inferred motive was equally negative regardless of whether the firm profited from the price increase. Together, these studies provide evidence that consumer inferences of the motive for a price increase influence the perceived fairness of the increase. Furthermore, reputation is shown to moderate the effect of inferred relative profit on inferred motive. Finally, analyses show that perceived unfairness leads to lower shopping intentions and demonstrate that perceived unfairness mediates the effects of inferred motive and relative price on consumers’ shopping intentions.
A Meta-Analysis of Satisfaction in Marketing Channel Relationships
Authors: Geyskens Inge , Steenkamp Jan-Benedict E.M. , Kumar Nirmalya
Published: December 2018

The authors advance a conceptual model of channel member satisfaction that distinguishes between economic and noneconomic satisfaction. The resulting model then is tested using meta-analysis. Meta-analysis enables the empirical investigation of a model involving several constructs that never have been examined simultaneously within an individual study. More specifically, the authors unify the stream of research on power use—the focus of many satisfaction studies in the 1970s and 1980s—with more recent work on trust and commitment, which usually explores antecedents other than power use. The results indicate that economic satisfaction and noneconomic satisfaction are distinct constructs with differential relationships to various antecedents and consequences. Furthermore, this study demonstrates that satisfaction is both conceptually and empirically separable from the related constructs of trust and commitment.
New Product Introduction and Incumbent Response Strategies: Their Interrelationship and the Role of Multimarket Contact
Authors: Shankar Venkatesh
Published: December 2018

In this article, the author studies the determinants of both new product introduction and incumbent response strategies in a single integrated framework. Building on previous research in strategic management, industrial organization, and marketing, the author conceptually identifies the factors that potentially influence these strategies, develops hypotheses about the impact of the key factors on these strategies, and focuses on the interrelationship between new product introduction and incumbent response strategies and on the role of multimarket contact in these strategies. To test these hypotheses, the author formulates models of introduction and response strategies, including an anticipated incumbent reaction formation model. The results of the empirical analysis show that new product introduction strategy is influenced significantly by incumbent reaction strategy, and vice versa. The relationship of a new product's marketing spending to the anticipated incumbent reaction is different for incumbents of different sizes. The analysis shows that higher spending by a new brand results in incumbent response that is significantly lower in magnitude. The results also show that multimarket contact leads to both lower introduction spending and milder incumbent response. The author discusses the managerial implications of these results.
A Model of Customer Satisfaction with Service Encounters Involving Failure and Recovery
Authors: Smith Amy K. , Bolton Ruth N. , Wagner Janet
Published: December 2018

Customers often react strongly to service failures, so it is critical that an organization's recovery efforts be equally strong and effective. In this article, the authors develop a model of customer satisfaction with service failure/recovery encounters based on an exchange framework that integrates concepts from both the consumer satisfaction and social justice literature, using principles of resource exchange, mental accounting, and prospect theory. The research employs a mixed-design experiment, conducted using a survey method, in which customers evaluate various failure/recovery scenarios and complete a questionnaire with respect to an organization they recently had patronized. The authors execute the research in the context of two different service settings, restaurants and hotels. The results show that customers prefer to receive recovery resources that “match” the type of failure they experience in “amounts” that are commensurate with the magnitude of the failure that occurs. The findings contribute to the understanding of theoretical principles that explain customer evaluations of service failure/recovery encounters and provide managers with useful guidelines for establishing the proper “fit” between a service failure and the recovery effort.
Welcome to My Home! An Empirical Analysis of Airbnb Supply in US Cities
Authors: Yang Yang , Mao Zhenxing (Eddie)
Published: December 2018

We propose a conceptual framework to investigate factors influencing the supply of Airbnb units in US urban communities. Based on a sample of Airbnb supply data from 1068 zip codes in 28 major US cities, we apply a mixed-effects negative binomial model to uncover supply determinants. The results confirm the significance of five supply determinant categories, namely, hotel market demand and supply, housing market demand and supply, and short-term rental regulation. We also highlight the respective impacts of supply determinants on three different Airbnb units: entire houses, private rooms, and shared rooms. Moreover, we examine the unique effects of different types of regulation policies. In general, regulations related to tailored legal framework and hostile enforcement significantly decrease Airbnb unit supply.
Cross-Cultural Adaptation and Psychometric Evaluation of the Herth Hope Index Within a Sample of Iranian Older Peoples
Authors: Yaghoobzadeh Ameneh , Pahlevan Sharif Saeed , Ong Fon Sim , Soundy Andrew , Sharif Nia Hamid , Moradi Bagloee Mohammad , Sarabi Mahnaz , Goudarzian Amir Hossein , Morshedi Hadi
Published: December 2018

There is a need to better understand the measurement of hope within a variety of cross-cultural contexts and older population. The objective of this study was to examine the psychometric characteristics of the Persian translation of the Herth Hope Index (HHI-Persian). This study used a sample of 500 Iranian older people in Iran. Psychometric properties of the HHI-Persian were evaluated using face, content, and construct validity. The construct validity of the instrument was tested using exploratory and confirmatory factor analysis. Reliability assessed is within the acceptable range. Construct validity of the scale showed two factors explaining 49.22% of the variance. Internal consistency of 12 items was greater than .70. The HHI-Persian is a short, reliable, and valid assessment scale of hope in older people. The article ends with suggestions for further research.
Validity of the International Physical Activity Questionnaire–Short Form for Application in Asian Countries: A Study in Vietnam
Authors: Tran Van Dinh , Do Van Vuong , Pham Ngoc Minh , Nguyen Chung Thanh , Xuong Nguyen Tuyet , Jancey Jonine , Lee Andy H.
Published: December 2018

This is the first study in the Asia-Pacific region to examine the criterion validity of the self-reported International Physical Activity Questionnaire–Short form (IPAQ-SF) using accelerometers, in terms of achieving the World Health Organization’s (WHO) recommended physical activity guidelines for health benefits. Vietnamese adults aged 40–65 years ( n = 240) wore an ActiGraph GT3X+ accelerometer for at least 5 days and completed the Vietnamese version of the IPAQ-SF. Correlations between IPAQ-SF and accelerometer-measured physical activity intensities varied from .087 to .232. Mean difference in moderate–vigorous physical activity was 0.699 min/day (95% limits: [−107, 109]). Agreement on the classification of achieving the WHO’s physical activity guidelines was 69.16%. The IPAQ-SF identified 71.86% of adults who met the guidelines, whereas 56.09% of those not meeting the guidelines were classified correctly. The IPAQ-SF was found to have acceptable criterion validity and is a useful instrument to classify Vietnamese adults as achieving or not achieving the WHO’s physical activity guidelines for health benefits.
Bugging out: darknets as parasites of large-scale media objects
Authors: Gehl Robert , McKelvey Fenwick
Published: December 2018

Platforms and infrastructures have quickly become seminal concepts to understand large-scale computational systems. The difference between a platform and an infrastructure is subject to debate. In this article, we use the concept of the darknet to describe how infrastructure tends toward being public with other things where platforms tend to private relations. The darknet reveals these relations negatively, as we discuss, by turning these media objects into that which they desire not to be. We analyze these negative relations through the concept of the parasite developed by Michel Serres. By following how darknets parasite both platforms and infrastructure, we suggest a need to develop new concepts to understand the diversity of relations now possible in a network society.
The Return of Citizenship? An Empirical Assessment of Legal Integration in Times of Radical Sociolegal Transformation
Authors: Moreh Chris , McGhee Derek , Vlachantoni Athina
Published: December 2018

Intra-EU migrants have traditionally faced few pressures or incentives to formalize their “permanent” residence or to naturalize in their EU host countries. Focusing on the United Kingdom and combining an analysis of secondary administrative data and primary online survey data ( N = 1,413), this article examines practices and attitudes toward such legal integration in the context of the 2016 EU Referendum among five major EU nationality groups. The analysis reveals that British citizenship is the main legal mechanism of integration among intra-EU migrants in the United Kingdom and that while there is continuity in this respect with pre-Brexit processes, Brexit also has a strong but differential effect as a driver of legal integration. The article identifies some of the main decision-influencing factors shaping legal integration, making a significant contribution to understanding the complexities of integrative processes in times of radical structural change.
Early prediction of falls after stroke: a 12-month follow-up of 490 patients in The Fall Study of Gothenburg (FallsGOT)
Authors: Samuelsson Carina M , Hansson Per-Olof , Persson Carina U
Published: December 2018

Objective:

To identify the incidence of falls and factors present shortly after stroke, which are associated with the occurrence of falls over the first 12 months after stroke onset, following discharge from inpatient rehabilitation.

Design:

Prospective follow-up study.

Setting:

Stroke unit and outpatient department.

Subjects:

A total of 490 individuals with acute stroke.

Methods:

Postural control was assessed using the Swedish modified version of the Postural Assessment Scale for Stroke Patients. Data on self-reported falls were collected using a standardized questionnaire at three months after discharge and six and 12 months after stroke onset. Associations between characteristics during the acute phase after a stroke and falls after six and 12 months were investigated using univariable and multivariable regression analyses.

Main measures:

The endpoint was a self-reported fall.

Results:

Within three months after discharge, 38 of 165 respondents (23%) had experienced at least one fall. Within six and 12 months after stroke onset, respectively, 108 of 376 (29%) and 140 of 348 (40%) of the respondents had experienced at least one fall. Poor postural control (odds ratio 3.92, 95% confidence interval 2.07–7.45, P < 0.0001) and using a walking aid (odds ratio 2.84, 95% confidence interval 1.71–4.72, P < 0.0001) were predictors of falls after discharge within 12 months after stroke onset. The same variables were independent predictors of falls within six months.

Conclusion:

Poor postural control and using a walking aid in the acute phase after a stroke are associated with falls after discharge from a stroke unit within 12 months after stroke onset.
“She Was What They Call a ‘Pepe’”: Kinship Practice and Incest Codes in Late Colonial Guatemala
Authors: Saffa Sarah N.
Published: December 2018

Incest taboos have long been intriguing to anthropologists because they are apparently common to all human societies. The definition of incest in the Spanish American colonies was codified in law, but not all residents abided by such regulations. This article focuses on incestuous crime in late colonial Guatemala, a region that is underrepresented in incest literature. It shows how preoccupations with incest problematized aspects of kinship practice and discusses the ways colonial actors took advantage of kinship and incest during various crises in their lives. Overall, it demonstrates the power of incest codes to shape human interactions in colonial Guatemala.
Ugandan Health Care Professionals’ Response to Sexual Violence Survivors: Exploring Local Strategy and International Guidelines
Authors: Fay Kathryn E. , Beyeza-Kashesya Jolly , Gossett Dana R.
Published: December 2018

This survey-based study gathered information on health professionals’ attitudes and behaviors regarding victims of sexual assault, focusing on the applicability and utility of best practices put forth by the World Health Organization and the United Nations. This cross-sectional study involved a self-administered, 84-question survey to health care professionals affiliated with Mulago National Referral and Kayunga Hospitals in Uganda. The survey included demographic questions as well as questions about participants’ attitudes toward sexual violence and the role of HPs in addressing sexual violence. The remainder of the survey transformed two sets of international guidelines into a series of statements with which participants could agree or disagree using a Likert-type scale. In total, 75 partially or fully completed surveys were collected, 45 from Mulago, and 30 from Kayunga. A minority of participants indicated that the guidelines were unrealistic (4.1%) or culturally inappropriate (14.1%). Most HPs agreed (91.8%) with the key components of recommended care. However, many respondents highlighted the need for additional training (68%). Nearly half of participants were uncertain or disagreed that there was a clear protocol for care of survivors of sexual violence (48%). Targets for improvement identified by participants included enhanced support of staff, access to resources, and relationships with community partners. Ugandan HPs have been receptive to the World Health Organization and United Nations guidelines. The majority of participants felt that the guidelines were realistic and culturally appropriate. Furthermore, many of these guidelines have been implemented. However, additional steps identified by Ugandan health workers could be undertaken to further improve the care received by survivors of sexual violence.
Southern Hemispheric Westerlies control sedimentary processes of Laguna Azul (south-eastern Patagonia, Argentina)
Authors: Zolitschka Bernd , Fey Michael , Janssen Stephanie , Maidana Nora I , Mayr Christoph , Wulf Sabine , Haberzettl Torsten , Corbella Hugo , Lücke Andreas , Ohlendorf Christian , Schäbitz Frank
Published: December 2018

Multiproxy investigations of lacustrine sediments from Laguna Azul (52 °S) document multi-millennial Holocene influences of Southern Hemispheric Westerlies (SHW) on the hydroclimatic variability of south-eastern Patagonia. During the last 4000 years, this hydroclimatic variability is overprinted by centennial warm/dry periods. A cool/wet period from 11,600 to 10,100 cal. BP is succeeded by an early Holocene dry period (10,100–8300 cal. BP) with a shallow lake, strong anoxia, methanogenesis and high salinity. Between 8300 and 4000 cal. BP the influence of SHW weakened, resulting in a freshwater lake considered to be related to less arid conditions. Since 4000 cal. BP, regional temperature decreased accompanied by re-intensification of SHW reaching full strength since 3000 cal. BP. Centred around 2200, 1000 cal. BP and in the 20th century, Laguna Azul experienced century-long warm/dry spells. Between these dry periods, two pronounced moist periods are suggested to be contemporaneous to the ‘Dark Age Cold Period’ and the ‘Little Ice Age’. Different from millennial SHW variations, centennial fluctuations appear to be synchronous for South America and the Northern Hemisphere. Changes in solar activity, large volcanic eruptions and/or modulations of ocean circulation are potential triggers for this synchronicity.
Volatility Behaviour of the Foreign Exchange Rate and Transmission Among Central and Eastern European Countries: Evidence from the EGARCH Model
Authors: Hung Ngo Thai
Published: December 2018

This article attempts to examine the changing nature of volatility spillovers among foreign exchange markets of select Central and Eastern European countries (CEEs-5), namely, Hungary, the Czech Republic, Croatia, Romania and Poland in the pre- and post-2007 financial crisis period. Daily data ranging from April 2000 to September 2017 are used for the purpose of analysis. In order to capture volatility transmission and its asymmetry, the multivariate Exponential Generalized Autoregressive Conditional Heteroskedasticity (EGARCH) model is utilized to catch the effect of good and bad news. The key findings of the study provide useful insights into how information is transmitted and disseminated across CEEs-5 foreign exchange markets. In particular, the estimation presents the precise measures of return spillovers and volatility spillovers. The analysis highlights that the foreign exchange markets become more independent after crises. Similarly, in such time, the volatility spillover among the foreign exchange markets decreases dramatically and financial markets have not been transmitted during the crisis period. Also, we find that positive shocks generate more volatility spillovers than negative shocks of the same magnitude. The asymmetric spillover effect is evident for price shocks originating from CEEs-5 foreign exchange markets. Further, our findings have essential portfolio management implications for international investors and policymakers.
Integrating model-based system engineering with set-based concurrent engineering principles for reliability and manufacturability analysis of mechatronic products
Authors: Borchani Mohamed Firas , Hammadi Moncef , Ben Yahia Noureddine , Choley Jean-Yves
Published: December 2018

The point-based approach consists of committing a set of requirements and a single design solution from the design space. This approach is time-consuming and often leads to deadline excess when developing a new complex system such as mechatronic systems. In fact, this approach could generate iterative loops between engineers in the downstream design stage to evaluate the manufacturability and the quality of the developed system. To overcome this issue, introducing a model-based system engineering (MBSE) approach in the upstream design stage hinged on set-based concurrent engineering (SBCE) principles is a good solution to diminish the exchange loops between engineers and to enhance efficiency in the design process. This approach consists in evaluating a large set of system solutions, then gradually narrowing these solutions until converging to a limited set of optimized solutions. In this article, a novel approach entitled “Model based for reliability and manufacturability analysis (MBRMA)” and based on model-based system engineering and set-based concurrent engineering in the preliminary design phases is used to filter out weak or costly solutions over time and to assess system engineer when adopting trade-off analysis. First, customer requirements, functional and structural aspect of the system are defined using SysML diagrams. Next, the application of the algorithm allows narrowing the design space, and finally, a trade-off analysis is carried out to select the best system architecture. The first contribution of this article is the creation of novel stereotypes of composition and allocation flows in a profile diagram between functions and alternative solutions. The second contribution is the implementation of an algorithm to analyze system robustness and to converge on the final set of optimized solutions. To test this newly developed model “model based for reliability and manufacturability analysis (MBRMA),” a case study of an air conditioning electrical compressor is considered to illustrate the various stages of this concurrent engineering approach.
Psychoeducational Strategies During Outpatient Transition to Extended-Release Naltrexone for Patients With Opioid Use Disorder
Authors: Zavod Abigail , Akerman Sarah C. , Snow Martha M. , Tierney Matt , Sullivan Maria A.
Published: December 2018

BACKGROUND: The United States is experiencing an opioid epidemic. Better approaches to encourage outpatient utilization of Food and Drug Administration–approved medications for the treatment of opioid use disorder, including extended-release naltrexone (XR-NTX), are needed. Withdrawal management before initiation of XR-NTX is challenging for clinicians and patients and represents a major barrier to treatment. AIMS: To review psychoeducational strategies that support patients during outpatient withdrawal management and transition to XR-NTX. METHOD: We reviewed the literature on psychoeducational strategies used during opioid withdrawal management and described the role that nurses can play in facilitating transition to XR-NTX in a Phase 3, placebo-controlled, outpatient trial comparing induction regimens. RESULTS: Supportive interventions include general psychoeducation on addiction, overcoming ambivalence, treatment adherence, anticipating XR-NTX induction, managing psychological and physiological aspects of opioid withdrawal, risks of opioid use, and sources of support during recovery. CONCLUSIONS: Psychoeducational strategies led by nurses can promote treatment adherence during withdrawal management and induction onto XR-NTX.
Short stems in total hip replacement: evidence on primary stability according to the stem type
Authors: Drosos Georgios I , Touzopoulos Panagiotis
Published: December 2018

Background:

As the prevalence of total hip replacement is increasing in younger patients, less invasive implants (short stems) are becoming more favourable. However, despite the advantages of these stems, clinical results with a follow-up of more than 10 years are limited to a very few stem designs. There has been an increase in publications recently – mechanical and clinical studies – concerning the primary stability of short stems. Primary stem stability is an important factor as it reflects final stem stabilisation and is related to the clinical results of the prosthesis.

Method:

We conducted a systematic review of the literature to retrieve evidence concerning primary implant stability in short stems – as expressed by implant micromotion and stem subsidence – according to our previously proposed short-stem classification.

Results:

Mechanical in vitro studies on stem micromotion are very few and limited to type 2 “partial collum” short stems. The results are comparable to those of stems with a known long-term excellent clinical course. Clinical results concerning stem migration patterns are also limited to some of the commercially available short stems. Although comparative studies are very few, the results for most of the short stems are similar to those of standard stems.

Conclusion:

There are promising results concerning biomechanical studies of the initial micromotion of short stems, as well as clinical results of stem migration patterns. Long-term clinical studies are needed in order to confirm these findings. The existing literature concerns very few of the many commercially available implants.
Replicating agent-based models: Revisiting March’s exploration–exploitation study
Authors: Chanda Sasanka Sekhar , Miller Kent D
Published: December 2018

To validate prior agent-based models, public disclosure of model code is necessary, but not sufficient. Conceptual model replication, involving independent reproduction of a model without referring to the originator’s code, is crucial for detecting nonconformity between the publication text and the model implemented. We frame and evaluate four scenarios to expose the shortfalls of replication efforts that use the original study’s program code and neglect the published model description. We identify, evaluate, and offer recommendations regarding disparities between the text and the program code that generated the results reported in March’s classic study of exploration and exploitation in organizational learning. Based on our experience replicating his model, we suggest a two-step method of model verification—beginning with replicating the model from the published description, then turning to the program code of the original implemented model to account for divergent results. Exclusive reliance on either the published model description or the original program code does disservice to theory advancement, because disparities between the original conceptual and implemented models go unaddressed.
Does Latinx Representation Matter for Latinx Student Retention in STEM?
Authors: Rincón Blanca E.
Published: December 2018

Using student-level data, this study explores the relationship between Latinx student representation in science, technology, engineering and mathematics (STEM) and student retention. Results revealed that a 1% increase in cohort-level Latinx student representation in STEM subfields is associated with a decrease in student departures from the university, but not STEM. Furthermore, Latinx STEM students may be more responsive to changes in the representation of their cohorts compared with increases in diversity for upper-division undergraduate or graduate students.
Thermal Coagulation Device for Treating Cervical Dysplasia
Authors: Langell Ashley , Pickett Timothy , Mangum Catherine , Chen Jennwood , Langell John
Published: December 2018

Background. Cervical cancer remains a leading cause of cancer-related deaths worldwide despite being a highly preventable disease. Nine out of every 10 deaths due to cervical cancer occur in developing regions with limited access to medical care and unique resource constraints. To address cervical cancer prevention within the confines of these unique limitations, our team of students and faculty advisors at the University of Utah’s Center for Medical Innovation developed a low-cost, portable technology that utilizes thermal coagulation, a form of heat ablation, to treat cervical intraepithelial neoplasia. Methods. A multidisciplinary team of students worked with clinical and industry advisors to develop a globally applicable treatment for cervical intraepithelial neoplasia through a systematic process of problem validation, stakeholder analysis, user-centered design, business plan development, and regulatory clearance. Results. Our efforts resulted in the development of a functional, self-contained, battery-operated prototype within 72 days, followed by Food and Drug Administration clearance of a finalized device within 18 months. Conclusion. Interdisciplinary university programs that leverage the capabilities of academic-industry partnerships can accelerate the development and commercialization of affordable medical technologies to solve critical global health issues.
“The Only Thing You’ve Managed to Break So Far Is My Heart”: An Analysis of Portal’s Monstrous Mother GLaDOS
Authors: Harkin Stephanie
Published: December 2018

This article interrogates Portal’s monstrous antagonist GLaDOS through a psychoanalytical lens, granting specific attention to her maternal coding. The process of presenting maternal authority as monstrous and in need of containment is a patriarchal practice that reinforces the mother gamer’s unwelcome presence within video game culture, outlined through a brief examination of various representational trends regarding the maternal figure in games. These patriarchal signifying practices also operate to preserve broader domestic and societal gendered ideologies. Portal’s projections of maternal monstrousness are located within its villain’s taunting dialogue and her all-pervasive presence within the unsettling game space, representative of the reabsorbing maternal body. The application of Julia Kristeva’s abjection theory and Barbara Creed’s faces of the “monstrous-feminine” inform these observations and the construction of GLaDOS as an abject, abusive, and archaic mother.
Making the case for completion bonuses in clinical trials
Authors: Largent Emily A , Fernandez Lynch Holly
Published: December 2018

Attrition is a serious problem in many clinical trials. The practice of offering completion bonuses—financial incentives offered to participants on the condition that they remain in a trial until they reach a prespecified study endpoint—is one means of addressing attrition. Despite their practical appeal, however, completion bonuses remain ethically controversial due to concern that they will coerce or unduly influence participants to not exercise their right to withdraw from a trial. Although this interaction with the right to withdraw does render completion bonuses conceptually distinct from other incentive payments offered to research participants, we argue here that completion bonuses are never coercive and, in the context of effective institutional review board oversight, are unlikely to be unduly influential. Nonetheless, because completion bonuses may in some cases still encourage unreasonable continued participation in a study, additional safeguards are appropriate. Rejecting completion bonuses entirely is, however, unnecessary and would problematically fail to address the significant ethical problems associated with participant attrition.
Are Psychotherapies for Young People Growing Stronger? Tracking Trends Over Time for Youth Anxiety, Depression, Attention-Deficit/Hyperactivity Disorder, and Conduct Problems
Authors: Weisz John R. , Kuppens Sofie , Ng Mei Yi , Vaughn-Coaxum Rachel A. , Ugueto Ana M. , Eckshtain Dikla , Corteselli Katherine A.
Published: December 2018

With the development of empirically supported treatments over the decades, have youth psychotherapies grown stronger? To investigate, we examined changes over time in treatment effects for four frequently treated youth mental-health problems: anxiety, depression, attention-deficit hyperactivity disorder (ADHD), and conduct disorders. We used PubMed and PsycINFO to search for randomized controlled trials (RCTs) that were published between January 1960 and May 2017 involving youths between the ages of 4 and 18 years. We also searched reviews and meta-analyses of youth psychotherapy research, followed reference trails in the reports we identified, and obtained additional studies identified by therapy researchers whom we contacted. We identified 453 RCTs (31,933 participants) spanning 53 years (1963–2016). Effect sizes for the problem-relevant outcome measures were synthesized via multilevel meta-analysis. We tracked temporal trends for each problem domain and then examined multiple study characteristics that might moderate those trends. Mean effect size increased nonsignificantly for anxiety, decreased nonsignificantly for ADHD, and decreased significantly for depression and conduct problems. Moderator analyses involving multiple study subgroups showed only a few exceptions to these surprising patterns. The findings suggest that new approaches to treatment design and intervention science may be needed, especially for depression and conduct problems. We suggest intensifying the search for mechanisms of change, making treatments more transdiagnostic and personalizable, embedding treatments within youth ecosystems, adapting treatments to the social and technological changes that alter youth dysfunction and treatment needs, and resisting old habits that can make treatments unduly skeuomorphic.
Remarkable response of recurrent endometrial adenocarcinoma to daily oral administration of half-dose etoposide
Authors: Nakamura Yasuhiko , Sanai Hiromi , Miwa Ichiro
Published: December 2018

A 71-year-old woman with right chest and left lumbar pain was referred to our hospital. Computed tomography showed multiple recurrent tumors in the abdominal cavity and bilateral lungs. She had already received several chemotherapies for the recurrent tumor, and palliative care would be appropriate. However, she was seeking another anti-cancer therapy. Therefore, she was told about low-dose etoposide therapy and consented to its administration. Treatment was very effective; serum tumor marker levels decreased dramatically, the pain was controlled, and the recurrent masses were shrinking. However, her recurrent tumor had become refractory again in the 22nd month of treatment.
Misinterpretation of online surgical outcomes: The British Association of Urological Surgeons Surgical Outcomes Audit
Authors: Sathianathen Niranjan J , Albersheim-Carter Jacob , Labine Lucas , Watson Brett , Konety Badrinath R , Weight Christopher J
Published: December 2018

Objective:

The purpose of this study was to evaluate whether the information presented in the British Association of Urological Surgeons Surgical Outcomes Audit is comprehended by the general population.

Methods:

An in-person electronic survey was administered at the local state fair in 2016. Participants were presented with an representative output from the British Association of Urological Surgeons Surgical Outcomes Audit and were asked to estimate the complication rate and make a hypothetical healthcare decision. The primary output depicted a complication rate of 6.7% which was above the 99th percentile. The degree of misinterpretation and the risk of making an inappropriate healthcare decision was evaluated.

Results:

Of the 350 completed responses, only 142 (40.6%) correctly estimated the surgeons’ complication rate. Individuals who were not college educated (odds ratio 3.02, 95% confidence interval 1.88–4.95) were more likely to misinterpret the information. Only 7.6% recognized that the surgeon’s complication rate was above the 99th percentile. Despite the high complication rate, 16.6% decided to continue with the surgery as planned and not ask the surgeon about their rates, seek a second opinion or change surgeons. Misinterpreters had a higher risk of making an inappropriate hypothetical decision (odds ratio 2.75, 95% confidence interval 1.42–5.62).

Conclusion:

The general population have difficulty in interpreting the data presented by The British Association of Urological Surgeons Surgical Outcomes Audit and are thus vulnerable to making poor healthcare decisions or decisions which are inconsistent with their goals of care.

Level of evidence:

IIb
Prone versus modified supine percutaneous nephrolithotomy: which is more cost effective in an Australian tertiary teaching hospital?
Authors: Chu Isabel E-Hui , Ranasinghe Weranja , Jones Madeleine Nina , McCahy Philip
Published: December 2018

Introduction:

Percutaneous nephrolithotomy is currently one of the main treatment options for large renal stones, but the effect of positioning on comparative costing has been scarcely documented. We aimed to compare the cost effectiveness of modified supine with traditional prone percutaneous nephrolithotomy procedures in the context of Victoria, Australia.

Materials and methods:

A prospective group of 236 renal units (224 patients) was included in the two-site study, with 76 performed in the prone position and 160 performed in the modified supine position. Costing was calculated using a ‘bottom-up’, all-inclusive framework that generates per-hour costs for theatre, recovery unit and ward costs from base costs and maintenance costs. Percutaneous nephrolithotomy-specific equipment was added to calculate comparative costs of modified supine versus prone procedures. Chi squared and T tests were used for statistical analysis.

Results:

There was a significant difference in the overall costing between the modified supine and prone groups. The modified supine group had a lower total cost (AUD$6424.29) compared to the prone group (AUD$7494.79) ( P=0.007), lower operative costs (AUD$4250.93 vs. AUD$5084.29, P=0.002) and lower ward costs (AUD$533.55 vs. AUD$1130.20, P<0.001). There was no significant difference in recovery times in the modified supine and prone groups, although the modified supine group appeared to have shorter recovery times (AUD$690.69 vs. AUD$586.05, P=0.209).

Conclusions:

Modified supine percutaneous nephrolithotomy has significantly lower total costs, operative costs and ward costs compared to prone percutaneous nephrolithotomy. Larger randomised trials are needed to assess these findings further. Level of evidence: Not applicable for this multicentre audit.
Youth Transitioning Out of Residential Care in South Africa: Toward Ubuntu and Interdependent Living
Authors: Moodley Rajeshree , Raniga Tanusha , Sewpaul Vishanthie
Published: December 2018

Informed by the qualitative method and the descriptive-interpretive design, this study, which was underscored by radical humanist goals of structural social work, reflects the voices of 16 youth who had transitioned out of care. The results show that emerging adults, transitioning out of care, are vulnerable and in need of support. This article discusses three main themes derived via an inductive approach: the influence of sociocultural networks, connecting with family, and the multiple risk factors associated with getting into and out of care that compromise youth’s quest for security. The neoliberal discourse on independent living needs to shift to interdependence and Ubuntu. It is interdependence, not independence, that gives a human face to care leavers as service providers respond to their past trauma, present vulnerability, and future risks, while promoting family preservation and resourceful, caring communities.
Resident Involvement in Shoulder Arthroscopy Is Not Associated With Short-term Risk to Patients
Authors: Basques Bryce A. , Saltzman Bryan M. , Mayer Erik N. , Bach Bernard R. , Romeo Anthony A. , Verma Nikhil N. , Cole Brian J. , Weber Alexander E.
Published: December 2018

Background:

Shoulder arthroscopy is a commonly performed, critical component of orthopaedic residency training. However, it is unclear whether there are additional risks to patients in cases associated with resident involvement.

Purpose:

To compare shoulder arthroscopy cases with and without resident involvement via a large, prospectively maintained national surgical registry to characterize perioperative risks.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The prospectively maintained American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent 1 of 12 shoulder arthroscopy procedures from 2005 through 2012. Multivariate Poisson regression with robust error variance was used to compare the rates of postoperative adverse events and readmission within 30 days between cases with and without resident involvement. Multivariate linear regression was used to compare operative time between cohorts.

Results:

A total of 15,774 patients with shoulder arthroscopy were included in the study, and 12.3% of these had a resident involved with the case. The overall rate of adverse events was 1.09%. On multivariate analysis, resident involvement was not associated with increased rates of any aggregate or individual adverse event. There was also no association between resident involvement and risk of readmission within 30 days. Resident involvement was not associated with any difference in operative time ( P = .219).

Conclusion:

Resident involvement in shoulder arthroscopy was not associated with increased risk of adverse events, increased operative time, or readmission within 30 days. The results of this study suggest that resident involvement in shoulder arthroscopy cases is a safe method for trainees to learn these procedures.
Against the stream: drugs policy needs to be turned on its head
Authors: Meacher Baroness Molly
Published: December 2018

Humans have always used mind-altering drugs. However, in 1961 the United Nations approved the Single Convention, under which the production, sale or possession of a number of drugs, including heroin, cocaine, ecstasy and cannabis, became illegal. The prohibitionist regime was then introduced by most countries around the world and has substantially remained in place ever since. Some countries, particularly those in Latin America, have never criminalised the use of cannabis. A small number of countries have introduced more liberal policies. This article examines the evidence of the consequences of policy liberalisation and argues that there is now a clear case for every country to examine its drug policies and to introduce evidence-based policies with a public health focus.

Declaration of interest

None.