bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Decisions of Pediatric Residents Turn Riskier after a 24-Hour Call with No Sleep
Authors: Aran Adi , Wasserteil Netanel , Gross Itai , Mendlovic Joseph , Pollak Yehuda
Published: January 2016

Background. Despite a gradual reduction in the workload during residency, 24-hour calls are still an integral part of most training programs. While sleep deprivation increases the risk propensity, the impact on medical risk taking has not been studied. Objective. This study aimed to assess the clinical decision making and psychomotor performance of pediatric residents following a limited nap time during a 24-hour call. Methods. A neurocognitive battery (IntegNeuro) and a medical decision questionnaire were completed by 44 pediatric residents at 2 time points: after a 24-hour call and following 3 nights with no calls (sleep ≥5 hours). To monitor sleep, residents wore actigraphs and completed sleep logs. Results. Nap time during the shift was <1 hour in 14 cases (32%), 1 to 2 hours in 16 cases (35%), and 2 to 3 hours in 14 cases (32%). Residents who napped less than 1 hour chose the riskier medical option in 50% of cases compared with 36% when answering the same questionnaire after 3 nights with no calls ( P = 0.002). This effect was not found in residents who napped 1 to 2 hours (no change in risk taking) or 2 to 3 hours (4% decreased risk taking) (difference between groups, P = 0.001). Risk-taking tendency inversely correlated with sustained attention scores (Pearson = −0.433, P = 0.003). Sustained attention was the neurocognitive domain most affected by sleep deprivation (effect size = 0.29, P = 0.025). Conclusions. This study suggests that residents napping less than an hour during a night shift are prone to riskier clinical decisions. Hence, enabling residents to nap at least 1 hour during shifts is recommended.
Children’s Approximate Number System in Haptic Modality
Authors: Gimbert Fanny , Gentaz Edouard , Camos Valérie , Mazens Karine
Published: January 2016

The approximate number system (ANS) is a primitive system used to estimate quantities. It can process quantities in visual and auditory modalities. The aim of the present study was to examine whether ANS can process quantities presented haptically. Moreover, to assess age-related changes, two groups of children (5- and 7-year-olds) were compared. In a newly designed haptic task, children compared two arrays of dots by touching them simultaneously using both hands, without seeing them, and for limited duration to prevent counting. Using Panamath, a frequently used visual ANS task, we verified that our population exhibited the typical pattern of approximation with visual arrays: Older children outperformed younger children, and an increased ratio between the two quantities to be compared led to more accurate responses. Performance in the haptic task revealed that children, in both age-groups, were able to haptically compare two quantities above chance level, with improved performance in older compared with younger children. Moreover, our results revealed a ratio effect, a well-known signature of the ANS. These findings suggest that haptic numerical discrimination in children is dictated by the ANS, and that ANS acuity measured with a haptic task improves with age, as commonly observed with the visual task.
Effects of Numerosity Range on Tactile and Visual Enumeration
Authors: Cohen Zahira Z. , Henik Avishai
Published: January 2016

Our study explores tactile enumeration using both hands and investigates the effects of numerosity range’s (NR) on general enumeration. In Experiment 1, using custom-made vibro-tactile apparatus, we replicated results of Cohen, Naparstek, and Henik (2014, Acta Psychologica, 150C, 26–34) and again found a moderate increase in RT up to four stimuli and then a decrease for five stimuli. In Experiment 2, we used a within participants design and compared NR 1 to 5 and 1 to 10 in tactile and visual enumeration. The results showed that enumeration for NR 5 to 1 was faster than for NR 1 to 10, especially for numerosities four and five. Within NR 1 to 10, in the visual modality the subitizing range was 4, the counting range was from 5 to 9, and there was an end effect of 10 dots. In the tactile modality, when excluding one-hand arrangements, the subitizing range was 2, the counting range was from 3 to 5, there was an acceleration of counting from 5 and on, and there was an end effect for 10 stimuli that was stronger than for 10 visual stimuli. We suggest that NR influences enumeration and that number-hand association (i.e. resulting from finger counting) influences enumeration, resulting in faster counting.
Anarchism as emancipatory theory and praxis: Implications for critical Marxist research
Authors: Wigger Angela
Published: January 2016

Whereas Marxist literatures are almost automatically considered ‘critical’ in canonical overviews on critical approaches, anarchism is often sidelined. Scholarly engagements between Marxists and anarchists, moreover, can be overshadowed by orthodox platitudes. This article explores ‘the critical’ in anarchism and identifies the anarchist transformative praxis of prefiguration, propaganda by the deed and direct action as the crux of what it means to be critical. Rather than seeking to reconcile what may or may not be reconciled, the article suggests that a joint commitment to being critical allows for the exploitation of productive tensions, and hence possibilities for a future left-wing convergence.
Prospective Use of a Standardized Nonoperative Early Weightbearing Protocol for Achilles Tendon Rupture
Authors: Ecker Timo M. , Bremer Anne K. , Krause Fabian G. , Müller Thorsten , Weber Martin
Published: January 2016

Background:

Acute traumatic rupture of the Achilles tendon can be treated operatively or nonoperatively. Throughout the literature, there is no consensus regarding the optimal treatment protocol.

Purpose:

To report on 17 years of experience with treating this injury with a standardized nonoperative treatment protocol.

Study Design:

Case Series; Level of evidence, 4.

Methods:

The treatment protocol was based on a combination of an equinus cast and rehabilitation boot, which promoted immediate full weightbearing and early functional rehabilitation. A total of 171 patients were consecutively treated and prospectively followed from 1996 to 2013. Assessed were subjective parameters such as pain, loss of strength, return to previous activity level, meteosensitivity, and general satisfaction with the treatment outcome. Clinical assessment included testing of plantar flexion strength and endurance, calf circumference, and tendon length. Subjective and clinical parameters were then used to calculate a modified Thermann score. The correlation between tendon lengthening and function was calculated using the Pearson correlation coefficient.

Results:

A total of 114 patients were followed for a minimum of 12 months (mean, 27 ± 20 months; range, 12-88 months). The mean Thermann score was 82 ± 13 (range, 41-100), and subjective satisfaction was rated “very good” and “good” in 90%. An inverse correlation was found between tendon length and muscle strength ( R = −0.3). There were 11 reruptures (8 with and 3 without an adequate trauma). General complications were 5 deep venous thromboses, 1 complex regional pain syndrome, and minor problems such as transient heel pain (n = 3), heel numbness (n = 1), and cast-associated skin abrasions (n = 4).

Conclusion:

Seventeen years of experience with a nonoperative treatment protocol for acute rupture of the Achilles tendon confirmed good functional outcome and patient satisfaction. Reruptures mostly occurred with new traumatic events in the vulnerable phase from 6 to 12 weeks after the initial injury. Muscle strength correlated to tendon length, making its assessment a crucial follow-up parameter. The protective equinus cast and boot can protect against excessive tendon lengthening during the healing process.
Revision Meniscal Surgery in Children and Adolescents
Authors: Shieh Alvin K. , Edmonds Eric W. , Pennock Andrew T.
Published: January 2016

Background:

The mechanisms of failure and risk factors for failed meniscal surgery in children and adolescents have not been well described.

Purpose:

To investigate the risk factors, mechanisms of failure, and subsequent operative management for revision meniscal surgery in a pediatric population, as well as to identify the local incidence of failed meniscal surgery.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

All patients younger than 20 years who had arthroscopic management for meniscal injuries at a single institution between 2008 and 2012 underwent retrospective review. Demographic data and intraoperative findings at the time of the initial surgery were documented. All patients undergoing a second procedure on the same meniscus were further analyzed. Multivariate logistic regression with purposeful selection was performed to identify independent risk factors for revision meniscal surgery.

Results:

Arthroscopic knee surgery was performed on 293 patients and 324 menisci, including 129 primary repairs, 149 primary partial meniscectomies, and 46 discoid saucerizations ± stabilization. At a mean of 40 months (range, 19-62 months) after surgery, 13% of all menisci required a revision procedure. The primary repair cohort had the highest failure rate (18%), followed by the primary discoid saucerization cohort (15%) and the partial meniscectomy cohort (7%). Multivariate analysis indicated that meniscal repair was predictive of retear (odds ratio, 2.04 [95% CI, 1.01-4.1]; P = .046), and children with an open physis and a bucket-handle tear had the highest retear rate of 46% ( P = .039). Independent variables shown to have no significant relationship to revision meniscal surgery included age, sex, body mass index, extremity side, laterality (medial-lateral), time to repair, tear location, and associated ligament reconstruction. The most common indication for revision surgery was an acute reinjury during intense physical activity. Revision procedures were performed at a mean of 14 months after the index procedure, and the majority of failures (83%) were identified within 1 year. Of patients undergoing a revision surgery, 44% underwent a further debridement, whereas 56% underwent a repair.

Conclusion:

The success rate of meniscal surgery is 87% in children and adolescents. The revision rate was higher when repair was attempted in the index procedure, particularly in those children with open physes and bucket-handle tears. Most failures are the result of an acute reinjury within 1 year, and nearly half will require debridement of the retorn meniscus.
Cost of Dementia and Its Correlation With Dependence
Authors: Åkerborg Örjan , Lang Andrea , Wimo Anders , Sköldunger Anders , Fratiglioni Laura , Gaudig Maren , Rosenlund Mats
Published: January 2016

Objective: To estimate the cost of dementia care and its relation to dependence. Method: Disease severity and health care resource utilization was retrieved from the Swedish National Study on Aging and Care. Informal care was assessed with the Resource Utilization in Dementia instrument. A path model investigates the relationship between annual cost of care and dependence, cognitive ability, functioning, neuropsychiatric symptoms, and comorbidities. Results: Average annual cost among patients diagnosed with dementia was €43,259, primarily incurred by accommodation. Resource use, that is, institutional care, community care, and accommodation, and corresponding costs increased significantly by increasing dependency. Path analysis showed that cognitive ability, functioning, and neuropsychiatric symptoms were significantly correlated with dependence, which in turn had a strong impact on annual cost. Discussion: This study confirms that cost of dementia care increases with dependence and that the impact of other disease indicators is mainly mediated by dependence.
A new resin with improved processability and thermal stability
Authors: Sheng Liping , Zeng Jingcheng , Xing Suli , Yin Changping , Yang Jinshui , Yang Yudong , Xiao Jiayu
Published: January 2016

To maintain outstanding thermal stability, amino- and hydroxyl-containing phthalonitrile monomers, 4-(4-aminophenoxy)-phthalonitrile (APN) and 4-(4-hydroxyphenoxy)-phthalonitrile (HPN) were selected and synthesized. Their structures were confirmed by proton nuclear magnetic resonance spectroscopy. Their curing polymers were characterized by Fourier transform infrared spectroscopy. The self-catalytic curing behaviors of the monomers were investigated by differential scanning calorimetry (DSC) at different heating rates. From the results, APN exhibits a higher curing temperature, while HPN exhibits a longer curing time. Then, mixtures of these monomers were investigated by DSC. The result shows that the 50/50 mixture exhibits different autocatalytic behaviors: the curing temperature is lower than that of APN and the curing time of the mixture is shorter than that of HPN. Furthermore, thermogravimetric analysis shows that the polymer from the mixture exhibits higher temperature of 5% weight loss ( T5%) and char yield value at 800°C than those of the polymers from each monomer. All these results indicate that the new mixture resin exhibits improved processability with excellent thermal stability, attributed to the synergistic effect between similar monomers; the synergistic effect optimizes the cure reaction kinetics and promotes cross-linking reactions, thereby producing an excellent resin; this approach is a new method for improving the processability without sacrificing thermal stability.
Synthesis and properties of highly soluble branched polyimide based on 2,4,6-triaminopyrimidine
Authors: Chen Ying , Huang Rumin , Zhang Qiuyu , Sun Wanlu , Liu Xiaobo
Published: January 2016

A series of novel soluble polyimides was synthesized from commercially available 2,4,6-triaminopyrimidine (TAP), 2,2-bis(3,4-dicarboxylphenyl) hexafluoropropane dianhydride (6FDA), α,ω-aminopropylpoly(dimethylsiloxane) and 1,3-bis(3-aminophenoxy)benzene. TAP is the branched monomer, and polymerization process had been improved in three ways by using TAP to prepare soluble polyimides. The polyimides were characterized by Fourier transform infrared spectra, proton nuclear magnetic resonance, ultraviolet–visible spectrometer analysis, wide-angle X-ray diffraction, and size-exclusion chromatography with multiangle laser light-scattering detection. The branched polyimides showed excellent solubility both in strong polar solvents and in common low-boiling point solvents. Differential scanning calorimetric and thermogravimetric analyses showed high glass transition temperatures and excellent thermal stability for branched polyimides with moderate content of TAP. Polyimide membranes were formed at relatively low temperature, and the mechanical properties were tested. These results ensure that soluble polyimides with moderate content of TAP showed outstanding combined features and are desirable candidate materials for advanced applications.
Effect of crystallographic orientation and employment of different cutting tools on micro-end-milling of monocrystalline silicon
Authors: Choong Zi Jie , Huo Dehong , Degenaar Patrick , O’Neill Anthony
Published: January 2016

This article presents the research on the effect of crystallographic orientation and different cutting tool effect during micro-milling of (001) silicon wafer. Excessive generation of undesirable surface and subsurface damages often occurs when machined at thick depth of cut of several hundreds of microns. Up-milling operations along <100> and <110> directions were performed on a (001) wafer, and the results show that machining surfaces along <100> were of better quality than those of <110> and are in agreement with previous studies. In addition, comparative studies of diamond-coated, chemical vapour–deposited and single crystal diamond end-mills were performed along [Formula: see text] at 150 µm deep. Results have shown that diamond-coated tool generates the least edge chipping. This might be due to the large negative rake angle creating highly compressive hydrostatic pressure in the cutting zone and therefore suppressing the crack propagation. Furthermore, no visible defects were detected on the bottom-machined surface when machined by chemical vapour–deposited and single crystal diamond end-mills. Surface edge chipping however remains a challenge, even though micro-milling were performed along <100> with single crystal diamond end-mill. Apart from milling along <100>, protection to the top silicon surface is required to achieve fracture-free quality micro-milled silicon.
Characterization of wear and prediction of wear zone locations on the rake face using Mamdani fuzzy inference system
Authors: Pavani PNL , Prasad CLVRSV , Ramji K , Ramana SV
Published: January 2016

In order to improve the performance of the cutting tool, third-generation tools with multi-layered nanocoatings on the rake face are used. During machining, the chip–tool interactions depict that although the tool wear on the rake face is located in the close proximity of the cutting edge, that is, within 800 µm, all the commercially available cutting tools have the coatings on the entire rake face. Taking into account the tribological properties required by the rake face close to the cutting edge, that is, high wear resistance and low friction, this study makes an attempt to identify, characterize and locate the actual wear zones/regions in terms of hard and soft zones in the chip contact area of tungsten carbide (WC) inserts close to the cutting edge in turning. Mamdani fuzzy inference system model was developed, trained with the sample experimental data and tested with the test data. The simulated results showed that the average error values of edge chipping (in X- and Y-directions), nose damage and crater wear (in X- and Y-directions) are about 2.37%, 3.01%, 2.86%, 2.66% and 1.89%, respectively. The fuzzy model developed in this study showed remarkable prediction of the wear zone locations and is also helpful for the researchers to decide the type of coating (hard and soft) along the specified zones for reducing the cost of production.
Investigation of waviness error in surface grinding of large axisymmetric aspheric lenses
Authors: Lin Xiaohui , Liu Jianchun , Ke Xiaolong , Guo Yinbiao
Published: January 2016

Waviness error is one of the most critical errors in the large aspheric lenses grinding and one that has a strong impact on the performance of the optical system. In this article, the waviness error of large axisymmetric aspheric lenses for X-axis direction as well as Z-axis direction is analyzed by employing grate parallel grinding method. The grinding wheel vibration and Z-axis interpolation pace are regarded as the main causes of the surface waviness error. Furthermore, to reduce the waviness error, the influence of grinding parameters on waviness error is investigated. The waviness errors measured during grinding experiments are in good agreement with the theoretical results and the appropriate grinding parameters are recommended.
Effect of metformin and sitagliptin on doxorubicin-induced cardiotoxicity in adult male albino rats
Authors: Sheta A , Elsakkar M , Hamza M , Solaiman A
Published: January 2016

The use of doxorubicin (DOX) as an antitumor therapeutic agent is limited due to its cardiotoxic effects. Metformin (Met) and sitagliptin (Sitg) are suggested to improve cardiac function. The present study aimed to determine the potential protective effects of Met and Sitg on DOX-induced cardiotoxicity. Rats were divided into six groups: groups I, II, and III received normal saline, Met, and Sitg, respectively. Groups IV, V, and VI received DOX only, Met + DOX, and Sitg + DOX, respectively. Heart tissue was used for biochemical assays which measured cardiac reduced glutathione (GSH), thiobarbituric acid reactive substances (TBARS), and tumor necrosis factor α (TNF-α). Serum creatinine kinase (CK) and lactate dehydrogenase (LDH) were also measured. The heart apex was prepared for histological (hematoxylin and eosin) and immunohistochemical examination. Intoxication of DOX was associated with a significant elevation in serum CK-MB and LDH, reduction in cardiac GSH, and increased TBARS and TNF-α compared to the controls. Administration of Met or Sitg to DOX-intoxicated rats suppressed serum CK-MB and LDH. Moreover, cardiac GSH was elevated with decreased TBARS and TNF-α. These results were confirmed by histological study. Met and Sitg caused inhibition of caspase 3 and upregulation of B-cell lymphoma 2 (Bcl-2) expression in DOX-intoxicated animals. Sitg was found to exert a significantly better protective effect compared to that of Met. It was concluded that Sitg might be more effective than Met in reducing myocardial injury in DOX-induced cardiotoxicity in rats.
Decline in ethical concerns about reproductive technologies among a representative sample of US women
Authors: Greil Arthur L. , Slauson-Blevins Kathleen S. , Shreffler Karina M. , Johnson Katherine M. , Lowry Michelle H. , Burch Andrea R. , McQuillan Julia
Published: January 2016

Public awareness and utilization of assisted reproductive technology has been increasing, but little is known about changes in ethical concerns over time. The National Survey of Fertility Barriers, a national, probability-based sample of US women, asked 2031 women the same set of questions about ethical concerns regarding six reproductive technologies on two separate occasions approximately 3 years apart. At Wave 1 (2004–2007), women had more concerns about treatments entailing the involvement of a third party than about treatments that did not. Ethical concerns declined between Wave 1 and Wave 2, but they declined faster for treatments entailing the involvement of a third party. Ethical concerns declined faster for women with greater levels of concern at Wave 1. Initial ethical concerns were higher, and there was less of a decline in ethical concerns for women with higher initial levels of religiosity.
Corporate Social Responsibility and the Law
Authors: Karhu Juha
Published: January 2016

Corporate social responsibility (CSR) started as a philanthropic activity. The recent changes in Indian Companies Act represent the latest development making financing CSR activities mandatory for certain big companies. From a comparative law perspective, the Indian CSR seems to be a Western legal transplant in a legal system of a developing country. This first impression is problematised by showing the dynamic capacity of the Indian CSR rules also for already established CSR standards. The Indian model contains several elements responding more accurately to the needs of development than the Western models concentrating more on individual rights and environmental protection.
Factors Explaining Corporate Social Responsibility Expenditure in India
Authors: Rai Shachi , Bansal Sangeeta
Published: January 2016

The passage of the CSR clause in the Companies Act, 2013 has been a landmark decision. This article tries to understand the reasons that determine the CSR expenditure by firms before the implementation of the law through a cross section study. The study finds that industry types and environmental factors determine the CSR expenditure by firms and also explains the endogenous relationship between CSR expenditure and profitability which had remained unexplored for Indian firms.
Antipsychotic prescribing and its correlates in New Zealand
Authors: Dey Sangeeta , Menkes David B , Obertova Zuzana , Chaudhuri Sreemanti , Mellsop Graham
Published: January 2016

Objectives:

Antipsychotics are the cornerstone of schizophrenia management. There is substantial literature on their efficacy and optimal use. Doubts remain, however, regarding the translation of this knowledge into day-to-day practice. This study aimed to investigate antipsychotic prescribing in three New Zealand regions and its relationship to clinical guidelines and patient characteristics.

Methods:

We studied 451 patients discharged from inpatient units with a diagnosis of schizophrenia or a related disorder (International Classification of Disease, version 10) between July 2009 and December 2011. Available information included patient demography, legal status, prescribed medications, duration of index admission and prescriber’s country of postgraduate training and years of postgraduate experience.

Results:

There was a high rate (33.7%) of multiple antipsychotic prescription, and lower than expected clozapine use (20%); Maori were prescribed clozapine more frequently than non-Maori (24% vs. 13%, respectively). Compulsory treatment was associated with more use of injectable medication and increased length of stay in hospital. Clinician characteristics did not significantly influence prescribing.

Conclusions:

Observed prescribing practice aligned with existing guidelines except for antipsychotic polypharmacy and clozapine under-utilisation.
A critical interpretive synthesis of the most commonly used self-report measures in Australian mental health research
Authors: Bibb Jennifer , Baker Felicity A , Skewes McFerran Katrina
Published: January 2016

Objective:

To critically examine the self-report measures most commonly used in Australian mental health research in the last 10 years.

Method:

A critical interpretive synthesis was conducted using seven outcome measures that were identified as most popular in 43 studies from three mental health journals.

Results:

Results suggest that the amount and type of language used in outcome measures is important in both increasing the accuracy of the data collected and fostering positive experiences of data collection for participants.

Conclusions:

Results indicate that many of the measures most often used in Australian mental health research may not align with the current contemporary philosophy of mental health clinical practice in Australia.
Agenda Setting in the Partisan TV News Context
Authors: Hyun Ki Deuk , Moon Soo Jung
Published: January 2016

This study examines the agenda setting of candidates’ attributes and its relationship with polarized candidate evaluation among TV news viewers. Content analyses of candidates’ affective attributes during the 2012 presidential election indicate partisan imbalance from CNN’s Anderson Cooper and Fox’s Special Report. NBC Nightly News was relatively balanced. Watching a particular program was positively associated with attribute agenda setting by each program. Also, agenda setting by the Fox program was positively related to viewers’ polarized candidate evaluations, whereas agenda setting by the NBC program was negatively associated. Implications of the partisan TV news context for agenda-setting theory are discussed.
Elastic field due to dislocation loops in isotropic bimaterial with dislocation-like and force-like interface models
Authors: Wu Wenwang , Lv Cunjing , Xu Shucai , Zhang Jinhuan
Published: January 2016

Based on the two-dimensional discrete Fast Fourier Transformation (FFT) method, a semi-analytical solution is developed for calculating the elastic fields of dislocation loops within isotropic bimaterials, where the imperfect interface can be described as two types of models: (a) dislocation-like and (b) force-like. Calculation examples of dislocation loops within Al–Cu bimaterials are performed to verify the reliability of the semi-analytical approach. Effects of constant matrix for the dislocation-like and force-like models on the interface elastic fields are studied, and it is shown that the interface elastic field is remarkably influenced by the interface conditions. Comparisons between perfect-bonding, dislocation-like and force-like imperfect interface models are performed to study the effects of interface conditions on the in-plane and out-of-plane elastic fields across the bimaterial interface plane.
Netrin-1 promotes mesenchymal stem cell revascularization of limb ischaemia
Authors: Ke Xianjin , Liu Chenxiao , Wang Ying , Ma Jianhua , Mao Xiaoming , Li Qian
Published: January 2016

This study examines the effect and mechanism of action of Netrin-1 on bone marrow mesenchymal stem cells in angiogenesis. Tube formation and migration of bone marrow mesenchymal stem cells were observed in cell culture. Bone marrow mesenchymal stem cells or Netrin-1–bone marrow mesenchymal stem cells were injected into the ischaemic area of the rat hind limb on the first day after surgery. Laser Doppler perfusion imaging was performed to analyse the levels of vascular endothelial growth factor in plasma and muscles, and immunohistochemistry and immunofluorescence were used to analyse angiogenesis. Bone marrow mesenchymal stem cells in medium containing Netrin-1 markedly increased the number of tubes formed and the migration of bone marrow mesenchymal stem cells compared with the untreated control group. The function of Netrin-1 in tube formation and migration is similar to vascular endothelial growth factor, and combined with vascular endothelial growth factor, Netrin-1 has more enhanced effect than in the other three groups. The Netrin-1–bone marrow mesenchymal stem cell group had better augmented blood-perfusion scores and vessel densities, as well as improved function of the ischaemic limb than that of the group injected with bone marrow mesenchymal stem cells (treated with bone marrow mesenchymal stem cells individually) or the control group (treated with medium). These results suggest that Netrin-1 has the ability to augment the angiogenesis of bone marrow mesenchymal stem cells and improve the function of the ischaemic hind limb by increasing the level of vascular endothelial growth factor.
A randomised controlled trial evaluating the impact of targeted vitamin D supplementation on endothelial function in type 2 diabetes mellitus: The DIMENSION trial
Authors: Dalan Rinkoo , Liew Huiling , Assam Pryseley Nkouibert , Chan Edwin SY , Siddiqui Fahad Javaid , Tan Alvin WK , Chew Daniel EK , Boehm Bernhard O , Leow Melvin KS
Published: January 2016

We sought to determine if vitamin D supplementation, to target 25(OH)D concentrations of 30–40 ng/mL, improves endothelial function in Singapore’s multi-ethnic type 2 diabetes mellitus population. We randomised 64 type 2 diabetes mellitus patients with hypovitaminosis D to cholecalciferol 4000 International Unit/matching placebo [baseline 25(OH)D < 20 ng/mL] or cholecalciferol 2000 International Unit/matching placebo [baseline 25(OH)D: 20–30 ng/mL] daily for 16 weeks with a down titration at 8 weeks if 25(OH)D > 30 ng/mL. Endothelial function was assessed by peripheral tonometry (reactive hyperaemia index–endothelial peripheral arterial tonometry) and vascular biomarkers: E-selectin, von-Willebrand factor and high-sensitivity C-reactive protein. We compared the change from baseline parameters in the two groups using Student’s t-test or Kruskal–Wallis test. A log-normal multivariate regression analysis was used to adjust for relevant baseline variables. The median reactive hyperaemia index in the vitamin D group increased from 0.65 (interquartile range: 0.42) to 0.73 (interquartile range: 0.36), whereas it decreased from 0.73 (interquartile range: 0.65) to 0.65 (interquartile range: 0.38) ( p = 0.02) in the placebo group. After adjustment for baseline variables, the change was not statistically significant for reactive hyperaemia index ( p = 0.07) and for other vascular biomarkers ( p > 0.05). Targeted vitamin D supplementation for 16 weeks resulted in a small but non-significant improvement in endothelial function in a type 2 diabetes mellitus cohort.
Customized Tool for the Validation of Optical Coherence Tomography in Differentiation of Prostate Cancer
Authors: Muller B. G. , Swaan A. , de Bruin D. M. , van den Bos W. , Schreurs A. W. , Faber D. J. , Zwartkruis E. C. H. , Rozendaal L. , Vis A. N. , Nieuwenhuijzen J. A. , van Moorselaar R. J. A. , van Leeuwen T. G. , de la Rosette J. J. M. C. H.
Published: January 2016

Objective:

To design and demonstrate a customized tool to generate histologic sections of the prostate that directly correlate with needle-based optical coherence tomography pullback measurements.

Materials and Methods:

A customized tool was created to hold the prostatectomy specimens during optical coherence tomography measurements and formalin fixation. Using the tool, the prostate could be sliced into slices of 4 mm thickness through the optical coherence tomography measurement trajectory. In this way, whole-mount pathology slides were produced in exactly the same location as the optical coherence tomography measurements were performed. Full 3-dimensional optical coherence tomography pullbacks were fused with the histopathology slides using the 3-dimensional imaging software AMIRA, and images were compared.

Results:

A radical prostatectomy was performed in a patient (age: 68 years, prostate-specific antigen: 6.0 ng/mL) with Gleason score 3 + 4 = 7 in 2/5 biopsy cores on the left side (15%) and Gleason score 3 + 4 = 7 in 1/5 biopsy cores on the right side (5%). Histopathology after radical prostatectomy showed an anterior located pT2cNx adenocarcinoma (Gleason score 3 + 4 = 7). Histopathological prostate slides were produced using the customized tool for optical coherence tomography measurements, fixation, and slicing of the prostate specimens. These slides correlated exactly with the optical coherence tomography images. Various structures, for example, Gleason 3 + 4 prostate cancer, stroma, healthy glands, and cystic atrophy with septae, could be identified both on optical coherence tomography and on the histopathological prostate slides.

Conclusion:

We successfully designed and applied a customized tool to process radical prostatectomy specimens to improve the coregistration of whole mount histology sections to fresh tissue optical coherence tomography pullback measurements. This technique will be crucial in validating the results of optical coherence tomography imaging studies with histology and can easily be applied in other solid tissues as well, for example, lung, kidney, breast, and liver. This will help improve the efficacy of optical coherence tomography in cancer detection and staging in solid organs.
In the Biosimilar Marketplace Will There Be 50 Ways to Leave Your Insulin?
Authors: Carter Alan W.
Published: January 2016

The future biosimilar insulin marketplace could be a bane, benefit, or something in between, to patients under our care in the United States. Formulary preferred product status, with or without FDA interchangeability designation, coupled with current and proposed state pharmacy substitution laws may lead to an environment with as many as 50 different substitution guidelines depending on in which state a patient presents his or her prescription to be filled. If online global prescription supply options, often referred to as “Canada Drug,” are utilized, other country substitution guidelines come into play, which may yield a recipe for confusion, if not disaster.
Distressed Elephants: Policy Initiatives for Sustainable Groundwater Management in India
Authors: Kumar M. Dinesh
Published: January 2016

This article reviews the dominant arguments which shaped public policies in the agricultural groundwater sector in India. It also examines the initiatives to arrest groundwater depletion. It is a synthesis of the research carried out by the author over the last two decades and review of the work by others. Following were the arguments that shaped public policies in the agricultural groundwater sector in India, as per the review: high density of farm wells in remote areas increases the transaction cost of metering and charging for electricity on a pro-rata basis, as a tool to control groundwater draft; groundwater economy is controlled by small and marginal farmers, and attempts to regulate it are politically sensitive; and raising power tariff would adversely affect farmers who buy water. Furthermore, the regions with high density of wells do not experience intensive groundwater use; groundwater economy is mainly controlled by large farmers. In water-abundant regions, subsidized power does not reduce the monopoly of water sellers; in water-scarce regions, an increase in power tariff would have only marginal effect on it; and, in semi-arid regions, raising farm power tariff would result in improved efficiency, equity and sustainability in groundwater use and would be socio-economically viable. In water-scarce regions, the large public funds spent for watershed management, dug well recharging and community-based water harvesting produce no positive outcomes. Attempts to introduce electricity pricing or groundwater taxes or water rights are absent. Schemes promoting the use of micro irrigation do raise farm productivity, but leave no incentive among farmers to reduce water use.
More Crop and Profit per Drop of Water: Drip Irrigation for Empowering Distressed Small Farmers
Authors: Narayanamoorthy A. , Devika N. , Bhattarai M.
Published: January 2016

In the light of the rapid decline in the irrigation water potential and increasing demand for water from different sectors in India, there is a need of the emergence of small-scale irrigation technology to conserve scarce water resources. Drip irrigation is one such technology that has been introduced to reduce water consumption in the agriculture sector, leading to sustainability of this sector. It allows farmers to cultivate crops without moisture stress even under water-scarce conditions, thereby increasing farm productivity. Earlier studies have analyzed the economics of drip irrigation in the case of high-value crops, which are mostly cultivated by rich farmers. Drip irrigation is also suitable for cultivating vegetable crops that are mostly cultivated by small farmers. However, in the Indian context, research on the effectiveness of drip irrigation is rare for these crops. We show that farmers cultivating green chilli could reduce the use of water by about two-thirds and increase productivity by more than half by adopting the drip irrigation method, compared to the same crop cultivated under conventional flood irrigation. The farm profitability too is impressive. The discounted cash flow analysis shows that the investment in drip irrigation for green chilli cultivation is economically viable even without the state subsidy. Despite such favourable outcomes, poor awareness prevailing among small farmers prevents adoption of drip irrigation. We suggest that there is a need to spread the benefits of cultivating vegetable crops under drip irrigation through a quality extension network on a continuous basis through various means. It would curtail the distress of the small farmers as well.
Rainwater Harvesting In Chennai: What Made It Work?
Authors: Vivek Vivek
Published: January 2016

Sustainable water management is vital for sustainable development, especially in light of threats such as climate change, growing population, rising prosperity and industrialization. India is facing increasing freshwater scarcity, particularly in urban centres such as Chennai, and is struggling to manage water resources. It is widely believed that Chennai has had a very successful experience with rainwater harvesting since its 2002 law mandating it for every building. This article tries to find out what has made RWH work in Chennai, at least to the extent it has worked, as many such policies in our country either tend to fail or at least run a very high risk of failure. The article argues that Chennai has been a case of non-government agents from the public leading the charge to start with and later working with government agents. It is this broad alignment of government and non-government agents that helped make the policy fairly successful. The policy directives essentially reinforced the general practice that was already being followed by local practitioners and experts of RWH. The government aggressively pursued a tight implementation timeline in 2003 to push for rainwater harvesting implementation before north-eastern monsoon. The article examines and provides evidence for the key assumption that RWH is a partial success in Chennai. It also provides evidence for the strong role of non-government agents in making it a successful venture. The article provides valuable insights into achieving sustainable water management in cities in India and elsewhere.
Participatory Groundwater Management: Lessons from Programmes Across India
Authors: Rangan Amrtha Kasturi
Published: January 2016

With an annual extraction of 230 cubic kilometres, India is the largest user of groundwater in the world. The value derived from the use of groundwater for irrigation is estimated to be four times the annual investments in irrigation projects. However, unregulated abstraction of groundwater has led to more than 60 percent of districts being affected by scarcity or quality issues. To tackle this, an alternate paradigm that espouses resource understanding and community participation has been tested under the Participatory Groundwater Management (PGWM) programme. In practice areas, the PGWM programme has led to increase in groundwater levels and, in some cases, improved crop productivity through the evolution of protocols for better water use. Several principles enshrined in the PGWM approach are now finding place in governance frameworks for groundwater management.
Reforming Watershed Management Institutions for Inclusive and Sustainable Growth: Role of Institutional Interaction and Participative Decision Making
Authors: Jain Dinesh , Gandhi Vasant P.
Published: January 2016

The rainfed areas of rural India often lack the services of able water management institutions. Thus, management of water in such areas is not a stand-alone activity but is significant for the overall development of the area, which also takes into account natural resource management, productivity enhancement and livelihood supporting activities. This is commonly referred to as watershed development (WSD). These WSD programmes are run on a massive scale and have been dovetailed with the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA). But, even after massive investment, these programmes or the institutions did not generate effective performance. There is an urgent need of good institutional arrangement that reduces transaction costs and favours co-operative solutions. In this context, the literature on new institutional economics identifies good interaction as one of the most important features of effective institutions. This article uses new institutional economics, theories of governance, management and organizational design to develop a conceptual framework for understanding the role of institutional interaction and participative decision-making in generating enhanced performance and sustainable outcome. Conceptually, the demand for interaction depends upon generic and specific drivers, and the supply of good interaction would come through structures, processes and governance features of institutions and also through consideration of different rationalities (e.g., technical and social). This article involved an exploratory research followed by an in-depth survey of 30 local watershed institutions in three districts of Andhra Pradesh. The findings indicate that the quantity of interaction alone is not sufficient in generating effective institutional performance. Quality of institutional interaction based on various rationalities is equally important. The study may help in designing the institutions involved in WSD in a better way for inclusive and sustainable outcomes.
An Enquiry into Equity Impact of Groundwater Markets in the Context of Subsidised Energy Pricing: A Case Study
Authors: Mukherjee Sarbani , Biswas Durba
Published: January 2016

In India, groundwater over-extraction is often linked with subsidized electricity in the agricultural sector. Proponents of electricity subsidy argue that such a subsidy helped even the resource-poor farmers to have had access to groundwater irrigation. This article explores inter- and intra-generational equity implications of groundwater markets in the context of subsidized electricity where the market enables even non-well owners to access groundwater for irrigation. The study is based on survey data collected from two districts in the state of Madhya Pradesh, India. The sample includes farmers who use electricity- and diesel-powered pumps to lift groundwater. The structure of the existing water market is examined through the determination of the water price–cost ratio. The article finds that, in the short run, water markets improve accessibility to groundwater irrigation, particularly for marginal and small farmers. With the help of this, farmers are able to mitigate water-scarcity-related vulnerabilities. However, in the long run, electricity subsidy may have negative dynamic implications by causing over-exploitation of groundwater that reduces the volume of groundwater available for future agricultural use. In other words, this article finds that, in the initial phases of the development of the water markets, there are intra-generational equity implications. However, in the advanced phases, the unsustainable extraction of groundwater could lead to inter-generational inequities.
Why Sustainable Water Management Is Not About Efficiency
Authors: Narayan P.S.
Published: January 2016

Water stress and scarcity is one of the biggest environmental, geopolitical and resource risks facing businesses today in many parts of the world. But the ‘wicked’, complex nature of the water challenge demands adaptive responses that are collaborative, multi-stakeholder and inclusive. In this article, we examine the critical nature of this challenge, set in the urban context of Bangalore city in India. Through the illustrative case of Wipro’s multi-year engagement in participatory groundwater management in Sarjapur, Bangalore, we examine the nature of the problem in some detail. Wipro’s programme can be characterized as a social experiment in progress that is centred around the ideas of decentralized, citizen-led governance of groundwater. This requires an artful blending of a rigorous, data-driven approach based on hydrogeological science and a decision-making template that is citizen-driven and participatory. Emerging from this is a key axiomatic principle that businesses must learn to look beyond the notion of efficiency. Water is a boundaryless issue and efficiency-based approaches result in limited outcomes that prevent the ability to look at the larger picture. It is increasingly imperative, therefore, that businesses recognize the changing nature of the water problem and embed such an inclusive approach in their risk management strategies.
Managing Water for Sustainable Development: An Economist’s Perspective
Authors: Singh Katar
Published: January 2016

Water is essential not only for the survival of all living beings but also for socio-economic development of households, communities and nations all over the world. It contributes to achieve the goal of sustainable development through ensuring the survival of all living beings, food security, ecological security and health and hygiene of people. Its judicious management is a prerequisite for sustainable development. At present, it is not managed at all; in fact, it is grossly mismanaged. It is estimated that India’s total utilizable water resources would barely match the water requirement in the year 2050, and that the gap between the water requirement and availability will widen over time. The most serious challenge of the twenty-first century for India will be how to meet the deficit or demand–supply gap, especially the regional and seasonal deficits, and to mitigate the problems of increasing overexploitation and pollution of both surface and groundwater and recurrent droughts and floods. To meet these challenges, it is necessary that India’s water resources are managed judiciously. For this, we need cost-effective and practicable interventions in both the water supply and demand management. The main instruments of water management include: (a) rationalizing of water prices; (b) drought and flood proofing; (c) use of water saving micro irrigation technologies; (d) internalizing of externalities in the use of water; and (e) enactment of ideal water laws by all state governments.