bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Unbound Aggregate Base Layers using Moisture Monitoring Data
Authors: Zegeye Teshale Eyoab , Shongtao Dai , Walubita Lubinda F.
Published: March 2019

The behaviors of unbound aggregate base (UAB) and subgrade layers are considerably affected by seasonal moisture fluctuations which ultimately affect both their load-bearing capacity and the overall performance of the pavement structure. As part of an effort towards designing optimal performing pavements, this study was undertaken to evaluate, characterize, and quantify the effects of moisture and temperature variations on UAB and subgrade materials commonly used in Minnesota. The scope included analyses of subsurface moisture and temperature measurements and characterization of moisture variation in multiple instrumented pavement sections. Key findings indicated that dense-graded aggregate base materials with high quality crushed aggregates and lower fine particles were more resistant to seasonal moisture variations. By contrast, the subbase and subgrade materials exhibited considerable sensitivity to seasonal moisture variations. The subgrade layers, in particular, were found to operate in fully saturated conditions for more than half of their service life. Overall, the study results are a valuable contribution to establishing guidelines for laboratory testing and designing optimal performing pavement structures.
Who Are High Users of Hospitals in Canada? Findings From a Population-Based Study
Authors: Wilson Donna M. , Shen Ye , Birch Stephen
Published: March 2019

Background

Dying people and older people have often been thought of as high users of hospitals, but current population-based evidence is needed to confirm or refute this claim.

Purpose

Quantitative population-based study designed to identify and describe hospital patients who are high users.

Methods

Data for all 2014–2015 Canadian hospital patients (excluding Quebec) were analyzed to identify and describe high users through descriptive-comparative and regression analysis tests.

Results

Only a small proportion of patients are high users in relation to multiple admissions or 30+ inpatient days of care, and with considerable diversity among them and relatively few of these advanced in age or dying in hospital.

Conclusions

Relatively few patients are high users of hospitals. These people are most often under age 65, so they have the potential to be ill and high users for many years. Flagging would enable individualized care planning to reduce illness exacerbations or slow disease progression and address other risk factors for long or repeat hospitalizations.
The pathologisation of trans* persons in the ECtHR’s case law on legal gender recognition
Authors: Cannoot Pieter
Published: March 2019

The European Court of Human Rights is the human rights monitoring body that has dealt with the largest number of cases related to gender identity and trans* persons. In this regard, it has recognised under Article 8 ECHR both a right to gender self-determination and a positive obligation for the State to adopt a procedure for legal gender recognition. However, Contracting States were given a wide margin of appreciation to set conditions for the legal recognition of a person’s actual gender identity, leading to the acceptance by the Strasbourg Court of pathologising requirements such as a diagnosis of gender dysphoria and compulsory sex reassignment surgery. This contribution analyses and conceptually explains this message of trans* pathologisation in the ECtHR’s case law. Subsequently, on a normative level, it argues that this case law cannot be upheld taking into account the international trend towards full trans* depathologisation, and the scope of the margin of appreciation that States (ought to) have in cases concerning gender identity.
Modelling the Effects of Materialism, Ethics and Variety-Seeking Behaviour on Counterfeit Consumption of Young Consumers
Authors: Nagar Komal , Singh Vishab Pratap
Published: March 2019

Research investigating consumer’s willingness to purchase counterfeit brands is scarce, particularly in emerging Asian markets. The present research explores the relationship between materialism, variety seeking and counterfeit consumption among Indian consumers. Consumers of counterfeit brands were surveyed to collect data for the study. Structural equation modelling results suggest that there exists a positive relationship between materialism, variety seeking and counterfeit consumption. Also as predicted, findings reflect a negative relation between materialism and ethics. However, contrary to previous findings, it was found that ethics and willingness to purchase counterfeit fashion apparels were positive. The present study contributes to the growing research on non-deceptive counterfeits by empirically confirming the effect of materialism, ethics and variety seeking on consumers’ purchase behaviour in the context of ever-growing counterfeit fashion apparels.
Assessing Psychopathic Traits Among Children: The First Validation Study of the Child Problematic Traits Inventory in a Clinical Sample
Authors: Colins Olivier F. , Roetman Peter J. , Lopez-Romero Laura , Andershed Henrik
Published: March 2019

This is the first study that tested the psychometric properties of the Child Problematic Traits Inventory (CPTI) in clinic-referred children (ages 6-13 years). Teachers ( N = 159) and parents ( N = 173) completed the CPTI and various other measures. Confirmatory factor analyses supported the CPTI’s three-factor structure when teachers and parents rated the 28 CPTI items. Teacher- and parent-reported CPTI scores showed the expected relations with external correlates (e.g., conduct problems and proactive aggression). Crucially, the validity of the CPTI scores was also supported across informants (i.e., when linking teacher-reported CPTI scores to parent-reported external correlates, and vice versa) and across methods (i.e., regardless if a questionnaire or a diagnostic interview was used to measure external correlates). We conclude that the CPTI holds promise as a research tool for assessing psychopathic traits in clinic-referred children. Until our findings have been replicated and extended, the CPTI should not be used for clinical decision making.
The Wedding as a Reproductive Ritual
Authors: Burch Rebecca L.
Published: March 2019

Research on patterns of marriage has determined that marriages serve as a reproductive contract between men and women. Marriage usually lasts for periods of time sufficient to raise a child until he or she can care for himself or herself. Patterns of marriage and divorce also embody features showing that the sexes act in their own reproductive best interests, for example, men initiating divorce later in life to find younger, more fertile partners. With this in mind, this article investigates the rituals, symbols, and ceremonies associated with marriages across several cultures to compile evolutionarily salient events and symbolism. In many cultures, the wedding ceremony contains not only rituals of reproduction and fertility important to both sexes but also displays of wealth and resources on the part of the groom, which is of particular evolutionary interest to females, and symbols of chastity on the part of the bride, which is of particular evolutionary interest to males. Essentially, the wedding is not only a pair-bonding codification but also a display of male and female reproductive goals and strategies.
Integral patient scheduling in outpatient clinics under demand uncertainty to minimize patient waiting times
Authors: Munavalli Jyoti R , Rao Shyam Vasudeva , Srinivasan Aravind , van Merode GG
Published: March 2019

This study addressed the problem of scheduling walk-in patients in real time. Outpatient clinics encounter uncertainty in patient demand. In addition, the disparate departments are locally (department-centric) organized, leading to prolonged waiting times for patients. The proposed integral patient scheduling model incorporates the status and information of all departments in the outpatient clinic along with all possible pathways to direct patients, on their arrival, to the optimal path. The developed hybrid ant agent algorithm identifies the optimal path to reduce the patient waiting time and cycle time (time from registration to exit). An outpatient clinic in Aravind Eye Hospital, Madurai, has a huge volume of walk-in patients and was selected for this study. The simulation study was performed for diverse scenarios followed by implementation study. The results indicate that integral patient scheduling reduced waiting time significantly. The path optimization in real time makes scheduling effective and efficient as it captures the changes in the outpatient clinic instantly.
Beyond self-tracking: Exploring and unpacking four emerging labels of patient data work
Authors: Piras Enrico Maria
Published: March 2019

Despite the growing attention of researchers, healthcare managers and policy makers, data gathering and information management practices are largely untheorized areas. In this work are presented and discussed some early-stage conceptualizations: patient-generated health data, observations of daily living, quantified self and personal health information management. As I shall try to demonstrate, these labels are not neutral; rather, they underpin quite different perspectives with respect to health, patient–doctor relationship and the status of data.
The Ecuadorian indigenist school of good living (sumak kawsay)
Authors: Hidalgo-Capitán Antonio Luis , Cubillo-Guevara Ana Patricia , Masabalín-Caisaguano Francisco
Published: March 2019

Taking an analytical-descriptive and synthetical approach, this article presents a retrospective construction of the Ecuadorian indigenist school of good living from the current conception of good living as the sumak kawsay currently held by Ecuadorian indigenist intellectuals, assuming that thought on good living evolves within competitive epistemic communities. To that end, the thought on good living of this school has been characterized by nine criteria used in studies of schools of development, the various intellectuals that comprise this school have been identified and grouped into four categories, the institutional and intellectual factors that have contributed to the emergence of this school have been determined, and the main criticisms received and their countercriticism have been summarized.
Western hysteria over killing of Cecil the lion! Othering from the Zimbabwean gaze
Authors: Chimuka Garikai
Published: March 2019

The Western media exploded in August 2015 because of a lion killed in Africa. Politicians, conservationists, civil society, musicians, sports stars, talk show hosts and ordinary people were outraged by the killing of a lion called Cecil in Zimbabwe. Interestingly there was not much focus on the reaction of Zimbabweans who were most injured by Cecil’s death. If anything, Zimbabweans were surprised by the blanket coverage of Cecil. In this essay, Zimbabweans’ reaction to the Western media coverage was analysed within the broader context of Edward Said’s concept of ‘Othering’. Viewing the concept of Othering through the Zimbabwean lenses deepened and widened the traditional definition of Othering to include self-Othering and what I termed reverse-Othering. The Zimbabwean gaze must be understood and contextualised. Without this understanding, the ultimate outrage over Cecil, which is about sustainable wildlife management, might not be won for local people must be partners in the sustainability endeavour.
Dementia: When music is the only way in – An emergency intervention: Innovative Practice
Authors: Garabedian Claire E
Published: March 2019

Music cannot only provide comfort and reduce agitation associated with dementia, but can also generate connections between all who are present. This article describes an ‘emergency’ music intervention conducted by the author during doctoral fieldwork, which illustrates how music was used as a medium for connection and comfort with a highly agitated person with advanced dementia. This experience provides strong support for increasing the training of musicians towards providing music for people living with dementia – particularly when other nonpharmaceutical methods are not proving effective.
Thermal-aware resource allocation in earliest deadline first using fluid scheduling
Authors: Shehzad Muhammad Naeem , Bashir Qaisar , Ahmad Ghufran , Anjum Adeel , Awais Muhammad Naeem , Manzoor Umar , Shaikh Zeeshan Azmat , Balubaid Muhammad A , Saba Tanzila
Published: March 2019

Thermal issues in microprocessors have become a major design constraint because of their adverse effects on the reliability, performance and cost of the system. This article proposes an improvement in earliest deadline first, a uni-processor scheduling algorithm, without compromising its optimality in order to reduce the thermal peaks and variations. This is done by introducing a factor of fairness to earliest deadline first algorithm, which introduces idle intervals during execution and allows uniform distribution of workload over the time. The technique notably lowers the number of context switches when compare with the previous thermal-aware scheduling algorithm based on the same amount of fairness. Although, the algorithm is proposed for uni-processor environment, it is also applicable to partitioned scheduling in multi-processor environment, which primarily converts the multi-processor scheduling problem to a set of uni-processor scheduling problem and thereafter uses a uni-processor scheduling technique for scheduling. The simulation results show that the proposed approach reduces up to 5% of the temperature peaks and variations in a uni-processor environment while reduces up to 7% and 6% of the temperature spatial gradient and the average temperature in multi-processor environment, respectively.
Robotic Totally Endoscopic Coronary Artery Bypass Grafting: Systematic Review of Clinical Outcomes from the Past two Decades
Authors: Göbölös Laszlo , Ramahi Jehad , Obeso Andres , Bartel Thomas , Hogan Maurice , Traina Mahmoud , Edris Ahmad , Hasan Faisal , Banna Mosaad El , Tuzcu Emin Murat , Bonatti Johannes
Published: March 2019

Robotic totally endoscopic coronary artery bypass grafting (TECAB) was introduced in 1998 and has over a period of two decades gradually emerged from single-vessel revascularization to multivessel bypass grafting. Dedicated centers have continuously evolved and further developed this minimally invasive method of coronary bypass surgery. A literature review was conducted to assess intra- and postoperative outcomes of TECAB. PubMed returned 19 comprehensive articles on TECAB. Investigation was focused on perioperative outcome parameters, i.e.: operative time, conversion to larger incision, revision for bleeding, atrial fibrillation, stroke, acute renal failure, and mortality. Outcome from the analysis of 2,397 reported cases showed an average operative time of 291 ± 57 minutes (range 112 to 1,050), conversion rate to larger incisions at 11.5%, and perioperative mortality at 0.8%. Pooled data demonstrated 4.2% operative revision rate due to postoperative hemorrhage, 1.0% stroke incidence, 1.6% acute renal failure, and 13.3% de novo atrial fibrillation. The mean length of hospital stay measured 5.8 ± 1.7 days. Conversion rates and operative times decreased over time. According to data in the literature, coronary bypass surgery carried out in completely endoscopic fashion utilizing robotic assistance can require relatively extensive operative times and conversion rates are somewhat higher than in other robotic cardiac surgery. However, major postoperative events lie in an acceptable range. TECAB remains the surgical revascularization method with the least tissue trauma and represents an opportunity for coronary artery bypass grafting via port access. Rates of major complications are at least similar to conventional surgical access procedures.
Postoperative Euglycemic Diabetic Ketoacidosis and Encephalopathy Related to SGLT-2 Inhibitors: A Case Report and Discussion of Diabetes Treatment and “Sweet Pee Encephalopathy” in Perioperative Hospital Management
Authors: Mackintosh Christopher , Tewari Arti , Siegel Jason , Wang R. Doris , Freeman William
Published: March 2019

During preanesthesia evaluation, patient medications are reviewed and many are not administered on the day of surgery. Additionally, neurosurgical patients can develop postoperative encephalopathy from a variety of etiologies, including metabolic derangements. We report a case of postoperative neurosurgical euglycemic ketoacidosis which presented as unexplained encephalopathy and was the result of continued action of the patient’s serum glucose cotransporter-2 (SGLT-2) inhibitor combined with perioperative fasting. A 68-year-old woman with a history of type 2 diabetes mellitus was admitted to the neurocritical care service after resection of a left temporal meningioma. On postop day 1, she became lethargic and with worsening aphasia. Laboratory studies revealed blood glucose 140 to 160 mmol/L, bicarbonate 9 mmol/L, anion gap of 21, and pH of 7.2. Urine was positive for ketones and glucose, and serum was positive for β-hydroxybutyrate. Endocrinology was consulted and the patient was diagnosed with euglycemic diabetic ketoacidosis and treated with insulin until her anion gap closed. Over the next 2 days, her neurological examination improved to baseline. Although the patient did not take empagliflozin the day of surgery, the drug has a half-life of >12 hours, and other reports have described continued glycosuria for up to 10 days after drug discontinuation. This case illustrates the need for increased awareness of SGLT-2 inhibitors and “sweet pee encephalopathy” among neurosurgical and neurointensivist teams as well as potential modification of perioperative management of patients using newly emerging SGLT-2 inhibiting pharmaceuticals.
A case of tracheobronchomalacia due to relapsing polychondritis treated with Montgomery T-tube
Authors: Jeong Nari , Jang Hang Jea , Lee Jae Ha , Kim Hyeon-Kuk , Park Jin Han , Lee Yoo Jin , Park Bong Soo
Published: March 2019

Relapsing polychondritis is a rare and multi-system autoimmune disease of unknown etiology characterized by inflammation and destruction of cartilaginous structures. Its clinical manifestations include recurrent chondritis of the ears, nose, pinna, peripheral joints, and laryngotracheobronchial tree and can be life-threatening in advanced cases of laryngotracheal stenosis. Because of the rarity of relapsing polychondritis and lack of understanding of its pathogenesis, there is no standard medical therapy, and treatment is tailored according to disease activity and site of organ involvement. In respiratory failure due to laryngotracheal involvement, which has been reported in up to 50% of relapsing polychondritis patients and is a major cause of death, immediate procedures such as stenting and tracheostomy are very important. This report describes a 70-year-old male patient suffering from tracheobronchomalacia due to relapsing polychondritis who was treated with Montgomery T-tube insertion.
An analytical review of Ahmadinejad’s foreign policy frameworks in terms of constructivism theory
Authors: Aghdaci Ali AbolAli
Published: March 2019

The foreign policy of the Islamic Republic of Iran in the administration of Mahmoud Ahmadinejad, due to its importance and its not so in significant achievements, from the structuralist point of view, created a different identity and role in international relations and a special approach in relation to foreign and international systems. The author’s main question is that what impact has the foreign policy of Mahmoud Ahmadinejad had in the international community? It seems that the role of domestic norms that came from the international community was damaged by internal policies due to Mahmoud Ahmadinejad’s policies, which, from the structuralist point of view, had a profound effect on the declining of Iranian foreign policy during the Ahmadinejad era in the international system. Direct conflict with the global system, presenting incorrect policies of foreign policy of the Islamic Republic, the lack accepting common understanding minds of the international community, non-convergence in foreign policy, the adoption of irrational foreign policy, are all important factors that could undermine the foreign policy of the Islamic Republic of Iran in the public opinion of the international community.
The association between white blood cell subtypes and prevalence and incidence of nonalcoholic fatty liver disease
Authors: Zhang Hongmei , Niu Yixin , Gu Hongxia , Lu Shuai , Su Weikang , Lin Ning , Li Xiaoyong , Yang Zhen , Qin Li , Su Qing
Published: March 2019

The association between white blood cell (WBC) and nonalcoholic fatty liver disease (NAFLD) has been studied before, but whether different WBC subtypes were related to NAFLD was not detailed. The aim of our study was to investigate the relationship between WBC subtypes and NAFLD cross-sectionally and prospectively. The detailed research design has been described previously. At baseline, there were 9930 participants who had complete information, in the end a total of 8079 participants (2588 men and 5491 women) were eventually included in this study. Hepatic ultrasound examination was performed on each participant at baseline and at the end of follow-up. Alcohol abuse and hepatitis were excluded. WBC subtypes and other serum indices were measured at baseline. We found that the total WBC, neutrophil, and lymphocyte counts were independently associated with the prevalence and incidence of NAFLD. After multiple adjustments for age, gender, body mass index (BMI), insulin, HOMA-IR, TG, TC, LDL, and HDL, increased odds ratios (ORs) for new onset NAFLD were observed from the 1st to the 4th quartiles of WBC, neutrophil, and lymphocyte (all P < 0.001 for trend). In conclusion, total WBC counts, neutrophils, and lymphocytes were all independent risk factors for NAFLD in the rural Chinese population. The association was independent of insulin resistance.
The English Communication and Learning Needs of Master of Business Administration Students and Curriculum Development at a Chinese University
Authors: Xie Qing , Chen Jie
Published: March 2019

This study investigates the communication and learning needs of Master of Business Administration (MBA) business English students and their perceptions of effective curriculum design. The research instruments are two-stage surveys of 99 MBA students from a public university in China. The results of the study show that English is not extensively used in the workplaces of MBA business English students, and that the majority of them use Chinese. Most English usage occurs in foreign businesses. The most difficult skills for MBA business English learners are found to be oral communication and listening comprehension. However, there are still very strong needs for further improvement in English communication. For the MBA business English courses, oral communication activities, especially with expatriate teachers, are particularly needed. The MBA business English courses should connect with real-world practice and be relevant to job and business needs. This study has significant implications for MBA business English curriculum reform in both Chinese and international contexts.
Mediating Effects of Upward Communications on the Relationship Between Team Autonomy and Burnout: A Study of Employees at Care Facilities in Japan
Authors: Yamaguchi Ikushi
Published: March 2019

The objective of the present study is to elucidate whether upward communication has mediating effects on the relationship between team autonomy and burnout at Japanese care facilities. Data collected from 21 care facilities for the elderly in Tokyo from February to March 2015 were analyzed. The questionnaires were distributed to 719 workers, and 386 completed questionnaires were returned directly to the researcher (response rate was 53.69%). As a result of structural equation modeling, Sobel test, and bootstrap test, upward communication to immediate leaders and superiors did not mediate the relationships between team autonomy and three dimensions of burnout, while upward communication to senior leaders/superiors fully and partially mediated the relationships between team autonomy and emotional exhaustion and between team autonomy and depersonalization, respectively. Based on those findings, some academic implications are discussed, and some practical implications for management to mitigate burnout are presented.
Helping People Know Whether Measurements Have Good or Bad Implications: Increasing the Evaluability of Health and Science Data Communications
Authors: Zikmund-Fisher Brian J.
Published: March 2019

Patients, policy makers, and the public have access to many types of health and scientific data relevant to various individual and societal decisions. Yet, these audiences often struggle with the meaning and the potential usefulness of those data, so they may choose not to engage with the data at all. Scientific and health data are generally difficult to interpret, yet presentations often implicitly assume that the recipient has the necessary contextual knowledge to identify the data’s meaning. To address this problem, designers of data communications should go beyond considering audience characteristics (e.g., numeracy) and focus more on increasing information evaluability (a concept from the judgment and decision-making literatures). The challenge is understanding which data characteristics guide people’s ability to extract meaning from data in a given situation. Prioritizing use-relevant contextual information (e.g., by defining action thresholds, comparison standards, meaningful categories, and/or significant differences) is the single best thing experts can do to improve data communication effectiveness. Doing so increases the chances that the patient, public, or policy maker audience does not just know what their numbers are but also what they mean.
Vitamin K for reversal of excessive vitamin K antagonist anticoagulation: a systematic review and meta-analysis
Authors: Khatib Rasha , Ludwikowska Maja , Witt Daniel M. , Ansell Jack , Clark Nathan P. , Holbrook Anne , Wiercioch Wojtek , Schünemann Holger , Nieuwlaat Robby
Published: March 2019

Patients receiving vitamin K antagonists (VKAs) with an international normalized ratio (INR) between 4.5 and 10 are at increased risk of bleeding. We systematically reviewed the literature to evaluate the effectiveness and safety of administering vitamin K in patients receiving VKA therapy with INR between 4.5 and 10 and without bleeding. Medline, Embase, and Cochrane databases were searched for relevant randomized controlled trials in April 2018. Search strategy included terms vitamin K administration and VKA-related terms. Reference lists of relevant studies were reviewed, and experts in the field were contacted for relevant papers. Two investigators independently screened and collected data. Risk ratios (RRs) were calculated, and certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. Six studies (1074 participants) were included in the review and meta-analyses. Pooled estimates indicate a nonsignificant increased risk of mortality (RR = 1.42; 95% confidence interval [CI], 0.62-2.47), bleeding (RR = 2.24; 95% CI, 0.81-7.27), and thromboembolism (RR = 1.29; 95% CI, 0.35-4.78) for vitamin K administration, with moderate certainty of the evidence resulting from serious imprecision as CIs included potential for benefit and harm. Patients receiving vitamin K had a nonsignificant increase in the likelihood of reaching goal INR (1.95; 95% CI, 0.88-4.33), with very low certainty of the evidence resulting from serious risk of bias, inconsistency, and imprecision. Our findings indicate that patients on VKA therapy who have an INR between 4.5 and 10.0 without bleeding are not likely to benefit from vitamin K administration in addition to temporary VKA cessation.
On closed-form expressions for the approximate electromagnetic response of a sphere interacting with a thin sheet — Part 1: Theory in the frequency and time domain
Authors: Desmarais Jacques K.
Published: March 2019

In mineral exploration and geologic mapping of igneous and metamorphic terranes, the background is often dominantly resistive. The most important electromagnetic interaction is between a discrete conductor and an overlying sheet of conductive overburden (e.g., glacial clays or weathering products of the basement rocks). To enable the electromagnetic modeling of these common situations, here I provide closed-form expressions for the approximate electromagnetic response of a sphere embedded in highly resistive rocks and interacting with an overlying thin sheet. The sphere is assumed to be dipolar and excited by a locally uniform field. The expressions in the time and frequency domains are represented as sums of complete and incomplete cylindrical functions. New asymptotic approximations are provided for the efficient evaluation of the required incomplete cylindrical functions. The frequency-domain formulas are validated by numerical transformation to the time domain and comparison to the time-domain solution.
Common and distinct patterns of grey matter alterations in borderline personality disorder and bipolar disorder: voxel-based meta-analysis
Authors: Yu Hua , Meng Ya-jing , Li Xiao-jing , Zhang Chengcheng , Liang Sugai , Li Ming-li , Li Zhe , Guo Wanjun , Wang Qiang , Deng Wei , Ma Xiaohong , Coid Jeremy , Li Tao
Published: March 2019

Background

Whether borderline personality disorder (BPD) and bipolar disorder are the same or different disorders lacks consistency.

Aims

To detect whether grey matter volume (GMV) and grey matter density (GMD) alterations show any similarities or differences between BPD and bipolar disorder.

Method

Web-based publication databases were searched to conduct a meta-analysis of all voxel-based studies that compared BPD or bipolar disorder with healthy controls. We included 13 BPD studies (395 patients with BPD and 415 healthy controls) and 47 bipolar disorder studies (2111 patients with bipolar disorder and 3261 healthy controls). Peak coordinates from clusters with significant group differences were extracted. Effect-size signed differential mapping meta-analysis was performed to analyse peak coordinates of clusters and thresholds (P< 0.005, uncorrected). Conjunction analyses identified regions in which disorders showed common patterns of volumetric alteration. Correlation analyses were also performed.

Results

Patients with BPD showed decreased GMV and GMD in the bilateral medial prefrontal cortex network (mPFC), bilateral amygdala and right parahippocampal gyrus; patients with bipolar disorder showed decreased GMV and GMD in the bilateral medial orbital frontal cortex (mOFC), right insula and right thalamus, and increased GMV and GMD in the right putamen. Multi-modal analysis indicated smaller volumes in both disorders in clusters in the right medial orbital frontal cortex. Decreased bilateral mPFC in BPD was partly mediated by patient age. Increased GMV and GMD of the right putamen was positively correlated with Young Mania Rating Scale scores in bipolar disorder.

Conclusions

Our results show different patterns of GMV and GMD alteration and do not support the hypothesis that bipolar disorder and BPD are on the same affective spectrum.

Declaration of interest

None.
The clinical impact of bone scan (BS) flare with enzalutamide (ENZA) in men with metastatic castration-resistant prostate cancer (mCRPC).
Authors: Armstrong Andrew J. , Al-Adhami Mohammed , Lin Ping , Parli Teresa , Sugg Jennifer , Steinberg Joyce Leta , TOMBAL Bertrand F. , Sternberg Cora N. , De Bono Johann S. , Scher Howard I. , Beer Tomasz M.
Published: March 2019

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Background: Current PCWG3 guidelines for men with mCRPC define BS progression during therapy as requiring confirmation of new bone lesions that develop over time with additional new lesions. New unconfirmed BS lesions may reflect slow progression or a favorable osteoblastic reaction called a “BS flare” that can be misinterpreted as radiographic progression and lead to premature therapy discontinuation. The prevalence and clinical impact of BS flare is unknown for ENZA. Methods: We analyzed the association of BS flare with clinical outcomes and quality of life (QoL) in a retrospective analysis of two phase 3 trials of men with mCRPC treated with ENZA after (AFFIRM n = 1199) and before (PREVAIL n = 1717) docetaxel. Early and late BS flare was defined as new lesions on the first posttreatment BS (weeks 9-13) or subsequent BS, respectively, that were not confirmed to meet progression criteria on the next BS, while also requiring responding/stable PSA and soft-tissue disease. Results: Unconfirmed BS lesions were observed in 22% and 25% of stable/responding men receiving ENZA in AFFIRM and PREVAIL, respectively. Most BS flares were early, but late flares (week 17 or later) were seen in 2% and 13% of men, respectively. Unconfirmed BS lesions (early or late) had no impact on OS (HR 0.87; 95% CI 0.62-1.21) or rPFS (HR 0.91; 95% CI 0.58-1.44) in PREVAIL, but were associated with worse OS (HR 2.26; 95% CI 1.55-3.30) and rPFS (HR 1.73; 95% CI 1.33-2.26) in AFFIRM. Soft-tissue responses and PSA declines were more prominent in chemo-naïve men with unconfirmed BS lesions, which also had no impact on QoL or pain deterioration in either setting. Conclusions: BS flare occurred in ≈25% of responding men with mCRPC receiving ENZA and was not associated with adverse outcomes in chemo-naïve men. Our findings support the importance of avoiding premature treatment discontinuation in the presence of unconfirmed new BS lesions in the first 4 months of therapy. Worse outcomes associated with unconfirmed lesions in men post docetaxel illustrate the need for improved functional bone imaging in mCRPC and broader patient assessment to decide on treatment continuation. Clinical trial information: NCT00974311; NCT01212991.
A phase III, randomized, double-blind, placebo-controlled study of enzalutamide in men with nonmetastatic castration-resistant prostate cancer: Post-hoc analysis of PROSPER by prior therapy.
Authors: De Giorgi Ugo , Efstathiou Eleni , Berry William R. , Payne Heather Ann , Madziarska Katarzyna , Modelska Katharina , Guan Xiaowei , Sugg Jennifer , Steinberg Joyce Leta , Sternberg Cora N.
Published: March 2019

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Background: Men with nonmetastatic castration-resistant prostate cancer (nmCRPC) are at high risk of developing metastatic CRPC. In the primary analysis of PROSPER, enzalutamide (ENZA) provided a statistically significant and clinically meaningful improvement in metastasis-free survival (MFS) in men with nmCRPC. Here we report the impact of prior therapy on MFS. Methods: Eligible men with nmCRPC, prostate-specific antigen (PSA) doubling time ≤ 10 months, and PSA ≥ 2 ng/mL at screening continued androgen deprivation therapy and were randomized 2:1 to ENZA 160 mg or placebo (PBO). The primary endpoint was MFS. Results: 1401 men were enrolled, with a median age of 74 y (range, 50-95 y). In all men, ENZA reduced the risk of metastasis or death by 71% (hazard ratio [HR], 0.29; 95% confidence interval [CI], 0.24-0.35; P < .0001). The treatment effect consistently favored ENZA regardless of whether men had prior bilateral orchiectomy, prior radiation, ≤1 or > 1 prior hormonal therapy, or prior bone-targeting therapy (Table). Men who received > 1 prior hormonal therapy had a shorter median MFS than those who received ≤1 line of hormonal therapy (5 months and 3 months in the ENZA and PBO groups, respectively). Conclusions: In men with nmCRPC and rapidly rising PSA, ENZA treatment resulted in a clinically meaningful reduction in the risk of developing metastases or death irrespective of prior surgery, radiation, or bone-targeting therapy. MFS was longer in men who had received ≤1 prior hormonal therapy. Clinical trial information: NCT02003924. [Table: see text]
Defining Essential Elements of Caregiver Support in Gynecologic Cancers Using the Modified Delphi Method
Authors: Hand Lauren C. , Thomas Teresa H. , Belcher Sarah , Campbell Grace , Lee Young Ji , Roberge Mary , Donovan Heidi S.
Published: March 2019

PURPOSE:

Family caregivers are instrumental to patients with gynecologic cancer and can be deeply affected by the demands of caregiving. Our aims were as follows: (1) increase awareness of unmet needs of caregivers and (2) identify and prioritize the unmet needs of caregivers and essential support services to be provided in gynecologic cancer centers.

METHODS:

From July 2017 to June 2018, a 16-person steering committee and 40 stakeholders, including caregivers, patients, and clinicians, participated in a modified Delphi approach to generate, review, and prioritize a set of essential elements for caregiver support. Stakeholders prioritized caregiver needs and brainstormed, discussed, and prioritized essential support services to meet those needs, using three rounds of a consensus-building protocol. Basic descriptive statistics were performed to feed means and rankings back to stakeholders before each round.

RESULTS:

The top three caregiver needs were as follows: (1) to obtain information about their loved one’s cancer, (2) how to provide support and comfort to their loved one, and (3) how to maintain their own emotional health and well-being. Fifteen essential elements of support for caregivers of patients with gynecologic cancer were identified and ranged from elements currently attainable (eg, information on managing symptoms, skilled-care training, a point person to help navigate the system) to more aspirational elements (eg, integrative services to promote caregiver well-being).

CONCLUSION:

To ensure comprehensive quality care, clinicians and health care providers should strive to provide caregivers with the identified essential elements of support. Health care settings should work to incorporate caregiver needs into cancer care delivery.
Percutaneous MR-guided whole-gland prostate cancer cryoablation: safety considerations and oncologic results in 30 consecutive patients
Authors: De Marini Pierre , Cazzato Roberto Luigi , Garnon Julien , Tricard Thibault , Koch Guillaume , Tsoumakidou Georgia , Ramamurthy Nitin , Lang Hervé , Gangi Afshin
Published: March 2019

Objective:

To assess the safety and oncological efficacy of percutaneous MR-guided whole-gland prostate cancer (PCa) cryoablation (CA).

Methods and materials:

Between July 2009 and January 2018, 30 patients (mean age 72.9 ± 5.13 years) with histologically proven, organ-confined (≤ T2cN0M0), predominantly low/intermediate-risk PCa (median Gleason score 7; mean prostate specific antigen 6.05 ± 3.74 ng ml−1 ) underwent MR-guided whole-gland CA. Patients were selected on the basis of prior pelvic radiotherapy (n = 16; 12 for previous PCa), or contra indication/refusal of surgery or radiotherapy. Complications, local progression-free survival (LPFS) and overall survival (OS) were retrospectively investigated.

Results:

Eighteen [60%] patients reported procedure-related complications: 5/18 [28%] needed surgical/interventional treatments and 13 [72%] conservative or pharmacological treatment. Eleven [73%] complications were noted in the first 15 patients and 7 [47%] in the last 15 patients (p = 0.26). Mean nadir prostate specific antigen was 0.24 ± 1.5 ng ml−1 (mean follow-up 3.8 years; range: 2 – 2915 days). Seven [23%] patients developed histologically proven local progression (mean time to recurrence 775 days, range: 172 – 2014). Mean clinical follow-up was 3.8 years (range 1–2915 days). LPFS was 92.0, 75.7 and 69.4 % at 1-, 3- and 5 year follow-up, respectively. For patients in salvage treatment, LPFS was 100%, 75%, and 75% at 1-, 3- and 5 year follow-up. OS was 100%, 94.4 and 88.5 % at 1-, 3- and 5 year follow-up respectively, with no patients dying from PCa.

Conclusion:

Whole-gland PCa CA offers good oncological efficacy, particularly in post-radiotherapy cases. Although the complication rate is significant, the majority is minor and is managed with conservative or pharmacologic management.

Advances in knowledge:

MRI-guided whole-gland prostate cancer cryoablation offers good oncological efficacy, particularly in post-radiotherapy cases with a contained complication rate.
Fibroblast growth factor-6 enhances CDK2 and MAKT expression in microvesicles derived from human stem cells extracted from exfoliated deciduous teeth
Authors: Othman Ahmed , Mubarak Rabab , Sabry Dina
Published: March 2019

Background: Stem cells from human exfoliated deciduous teeth (SHEDs) are considered one of the most convenient sources of adult stem cells. This study aimed to examine the effect of fibroblast growth factor 6 (FGF-6) on SHEDs and evaluate CDK2 and MATK gene expression in SHED-derived microvesicles (MVs). SHEDs were cultured from deciduous teeth pulp.

Methods: SHEDs were divided into two groups: the control group and test groups, with and without FGF-6 supplementation, respectively. After the third passage, SHED proliferation was assessed by MTT assay. MVs were purified and CDK2 and MATK gene expression was assessed by real time polymerase chain reaction. SHEDs were identified by their positivity for CD90 and CD73, and negativity for CD45 and CD34.

Results: SHEDs proliferation in the test group was significantly higher than in the control group (P<0.001). mRNA from SHED-derived MVs from the test group exhibited a markedly elevated expression of CDK2 and MAKT, (P<0.002 and P<0.005, respectively) in comparison with those of the control group. FGF-6 enhanced the proliferation of SHEDs. Proliferation enhancement is favorable for the production of a large number of stem cells, which will then be beneficial for cell-based therapies.

Conclusions: CDK2 and MAKT genes in SHED-derived MVs can be used as molecular biomarkers for SHED proliferation.
Automated Pathologist Scheduling at The Ottawa Hospital
Authors: Patrick Jonathan , Montazeri Amine , Michalowski Wojtek , Banerjee Diponkar
Published: March 2019

The authors describe the development of a decision support tool to simplify the task of scheduling pathologists to subspecialties in the Department of Pathology and Laboratory Medicine at the Ottawa Hospital.
A Recommendation Engine to Aid in Identifying Crime Patterns
Authors: Chohlas-Wood Alex , Levine E. S.
Published: March 2019

The authors describe the development of a set of three supervised machine-learning models, which the New York City Police Department uses to help identify related crimes, including burglaries, robberies, and grand larcenies.
Time to have your say
Authors: Silverton Louise
Published: March 2019

The Nursing and Midwifery Council has opened its consultation into the future of midwifery standards. Louise Silverton CBE explains why now is the time to make sure your voice is heard
Evaluating the contribution of interdisciplinary obstetrics skills and drills emergency training
Authors: Hayes Catherine , Hinshaw Kim , Hogg Robert , Graham yitka
Published: March 2019

Background

High-fidelity simulation is integral to health professional training. The effect of interdisciplinary training on levels of confidence in obstetric emergencies is less well explored.

Aim

To evaluate the impact of a multidisciplinary training project in obstetric emergency skills and drills on the confidence of staff.

Methods

A mixed-methods approach was used to evaluate the self-reported confidence levels of obstetrics staff. A total of 69 staff voluntarily attended emergency skills and drills training with a birthing simulator manikin. The programme used four emergency scenarios that had potential for poor maternal outcomes. A debrief followed each scenario and confidence levels were self-reported before and after each training session.

Findings

There were significant (P<0.05) effects on teams' self-perceived confidence levels. Staff reported that training improved their knowledge and understanding of interdisciplinary roles, and improved capacity within and between professional disciplines.

Conclusion

This model is of significant use in interdisciplinary obstetric emergency care training. Training had a direct effect on the staff's perceived confidence and encouraged critical reflection on professional practice in emergency obstetrics.
The Messy Little Thing Called Peace: Postwar Memories and Durable Disorder in El Salvador
Authors: Ross Norbert , Sanchez Antonia Ross
Published: March 2019

We argue that present-day El Salvador is still enmeshed in a memory struggle over the meanings of the civil war (1980–92). With the United Nations (UN) Truth Commission having failed to address the roots of the civil war and initial postwar amnesty avoiding prosecution and investigation of war crimes, a consensus about the past is yet to be created. Instead, maintaining prewar power constellations and the increased importance of the military make us think of El Salvador as a durable disorder and a low-intensity democracy at best.
Doujinshi and Comiket: A day of ‘hare’
Authors: McInerney Tara
Published: March 2019

Since 1975, the increasing success of Comiket (Comic Market) stands testament to the popularity of doujinshi in Japan. At first attracting only 700 visitors, Comiket now attracts roughly one million visitors yearly, with nine million doujinshi sold per market. Meiji University’s Yoshihiro Yonezawa Memorial Library is entirely dedicated to the collection and preservation of hundreds of thousands of fancomics – their status elevated to that of high cultural and historical worth, worthy of their own archive. Whilst doujinshi are now a valued commodity, seen as inextricable from the manga industry, they are still categorically illegal. Doujinshi (fan-comics) are hailed as the foundation of the Manga industry, supporting creative talent, craft tradition and financial revenue. There are many practical legal defenses for doujinshi that are widely agreed upon, a symbiosis that has been acknowledged by lawyers and academics, creators and fans alike. Even Japanese Prime Minister Shinzo Abe commented that doujinshi ‘operate in a different market’ to original manga, and therefore do not warrant litigation. These arguments sit well with Japanese lawyers, but if doujinshi have proven so beneficial to the Japanese comic industry, why are fan-comics shrouded in taboo in the West? Even before one attempts to sell a fan-comic, the sheer creation of them is culturally shameful – not a parody, but a soulless copy. In Japan there is a learning model of creating utsushi (replicas) that functions through applied copying, used in traditional crafts such as basket-weaving, lacquering and now, even manga (in the West we may liken it to rotelearning or embodied learning). In light of utsushi, I aim to examine the boundary between copying craft and copying ideas. I hope to explain the inextricability of learning Manga as a visual language with learning storytelling through reappropriation of archetypes and the folkloric tradition of the East. I aim to depict this cultural and cognitive dissonance between Japan and the West, this disagreement of exactly what constitutes a copy.
Goffman’s Frame Analysis, modality and comics
Authors: Davies Paul Fisher
Published: March 2019

This article explores how comics can ‘frame’ experience by instantiating borders in various ways, temporally, spatially and socially. It approaches ‘frame analysis’ in two senses: first, the ‘framing’ of comics in the sense of their nesting in bookended narrative structures, drawing attention to the hypotaxis inherent to graphic narrative, and highlighting parallels to the framing of experience in Goffman’s sense. Second, with a focus on the frame itself, the panel border: attending to how this can be used to signal the status of the material enclosed, that is, to modalize the narrative in ways parallel to those suggested by Goffman. The article will bring together Goffman’s social pragmatics and M. A. K. Halliday’s functional approach to multimodal texts, offering not only an approach to the reading of comics texts but also a method for comics creators to present imaginary, fictional, remembered and otherwise ‘framed’ experience. During the course of discussion, the article will also consider disruptions of framing, and transitions from frame to frame, both in the sense of panel-to-panel and from modality to modality.