bluuebunny/crossref_metadata_2025 huggingface dataset:
Healing the heart of recovery
Authors: Liggins Jackie
Published: August 2018

Background and Aim:

Medicine is traditionally considered a healing profession, yet concepts of healing are rarely applied to mental illness, recovery being the dominant discourse. This article reports one aspect of the results of a broader exploration, through a service user lens, of aspects of place that facilitate healing in mental health care, with a resulting conceptualisation of healing.

Method:

The research material comprised the author’s historical writings of her experience of mental illness and recovery and in-depth individual interviews with 10 mental health service users. Analysed thematically, emerging ideas were further developed through an autoethnographically informed, reflexive and iterative process.

Results:

Healing is necessary when there has been a disruption of integrity and wholeness, experienced as suffering. Offering opportunities for connection, integration and transformation, and acquiring wisdom along the way, healing is a journey of exploration that takes time and is hard work.

Discussion:

Healing is conceptualised as the intensely personal experience at the heart of recovery, reminding us of the fundamental personal processes at the heart of our journeys. As a universal human experience, healing potentially removes the sense of othering that is at the heart of mental illness stigma.
Migration, Ethnicity-based Movements and State’s Response
Authors: Singha Komol
Published: August 2018

Following reclamation of Assamese ethnic identity, the movements for making Assam a nation province started in the 1960s. The caveat, however, was the ever-growing Bengali migrants from Bangladesh. The Assamese movement, bolstered by the exclusivity and dominance, caused resentment from the non-Assamese communities and this ostracism was manifested in the form of counter movements. After restoring normalcy for a few years, armed movement for secession kicked-off in the early 1980s and intensified in the 1990s. Unfortunately, State’s intervention failed to contain protracted conflicts, rather compounded the situation and gave rise to hybrid ethnic identities in the 2000s. This further led to demands for ethnicity-based autonomy movements.
India and the BRICS A Cautious and Limited Engagement
Authors: Kumar Rajan
Published: August 2018

This article seeks to explore the core interests of India at the BRICS (Brazil, Russia, India, China and South Africa). It argues that India joined this organization as a part of its broad strategy to engage with all the major powers. It foresaw significant geopolitical and economic dividends from its association with other emerging states in a multilateral forum. New Delhi actively participated in the BRICS summits and has contributed significantly to its agenda setting and institutionalization. The article also shows how the BRICS has departed from the Non-Aligned Movement (NAM) and India’s traditional policy towards the Global South. By entering into a privileged club, India seeks to upgrade its rank and status. Finally, the article discusses the way preponderance of China in this organization and its border conflicts with India have impacted the potential of the BRICS.
India and its Diaspora
Authors: Pande Amba
Published: August 2018

The opening up of India’s economy in the early 1990s brought several shifts in its policy approaches. One such definite and visible shift was in India’s approach towards the Indian diaspora. Indians have been migrating since time immemorial. However, the emergence of transnational diaspora communities which had effective participation in the countries of settlement, while at the same time having strong connections with the homeland, was baffling not only for India but in general also for all the countries which had large-scale populations beyond their borders. Although the multiple belongingness of diasporas has its both perils and rewards, very soon they became valuable partners in the developmental processes of their home lands. India was a bit late in realizing this hidden potential. Since the 1990s, New Delhi has adopted a proactive policy to engage with the diaspora which has opened up vast avenues of cooperation.
Unnatural Enhancements
Authors: Jensen Steven J. , Widow José Luis
Published: August 2018

This paper claims that the distinction between therapy and enhancement, which has played a significant role in the discussion of the moral implications of human enhancements, is of only secondary and subordinate importance. Of much greater importance is the distinction between natural and unnatural enhancements, or rather between natural and unnatural means of enhancing. After briefly indicating the moral significance of the distinction between what is natural and unnatural, the paper focuses on the difficult task of discriminating between those means of enhancing that are natural and those that are unnatural.
The Influence of Decision Task on the Magnitude of Decoy and Compromise Effects in a Travel Decision
Authors: Kim Jungkeun , Kim Peter Beomcheol , Lee Jin-Soo , Kim Seongseop (Sam) , Hyde Kenneth F.
Published: August 2018

This research assesses the effects of choice alternatives on the travel destination decisions of travelers. The decoy effect involves the addition of a new inferior alternative into a choice set, thereby increasing the choice of an existing option. Meanwhile, the compromise effect involves the addition of a new alternative into a choice set that increases selection of an existing option with nonextreme attributes, and decreases selection of options with extreme attributes. In this study, a series of scenario-based experiments is performed to determine if the decoy and compromise effects influence travel destination decisions. Results show that the decoy effect is stronger in a choice (vs. rejection) task, whereas the compromise effect is stronger in a rejection (vs. choice) task when deciding travel destinations.
Impact of Moral Ethics on Consumers’ Boycott Intentions: A Cross-Cultural Study of Crisis Perceptions and Responses in the United States, South Korea, and Singapore
Authors: Shim Kyujin , Cho Hichang , Kim Soojin , Yeo Su Lin
Published: August 2018

This study investigates the effects of individuals’ moral foundations on perceptions and responses to a company’s crisis. Drawing on moral foundations theory, it empirically tests a theoretical model of crisis attribution and moral outrage with two antecedents (i.e., individualizing moral and binding moral) on three outcomes (i.e., crisis attribution, anger, and boycott intentions), using more than 3,000 respondents from three culturally diverse countries—the United States, South Korea, and Singapore. The study finds that individualizing and binding moral foundations have significant effects on attribution, emotional reaction (i.e., anger), and behavioral intentions related to corporate irresponsibility, although their effects are distinct and varied across countries. While individualizing moral foundations lead to boycott intentions, the effects of binding moral foundations are multifaceted. Implications for communication professionals practicing in a highly globalized business environment today to recognize variations in morality among different publics in times of crisis are discussed.
Revisiting the Islamist–Secular divide: Parties and voters in the Arab world
Authors: Wegner Eva , Cavatorta Francesco
Published: August 2018

Electoral politics in the Arab world are either portrayed as clientelistic affairs void of content or as highly ideological clashes between Islamist and Secular Left forces. Although both arguments are intuitively appealing, the empirical evidence to date is limited. This article seeks to contribute to the debate by investigating the extent of programmatic voter support for Islamist and Secular Left parties in seven Arab countries with data from recent surveys by the Arab Barometer, Afrobarometer and World Values Survey. Ideological congruence between voters and parties exists but is limited to the Islamist–Secular core divide with regard to the role of religion in politics and gender values. In contrast, there are virtually no differences in economic attitudes between respondents and there is no evidence of class-based voting, with Islamist and Secular Left parties sharing the same voter base of better-off, more educated voters. Core results are robust across surveys.
Cross Talk from Tubules to Glomeruli
Authors: Wang Jiayi , Zhong Jianyong , Yang Hai-Chun , Fogo Agnes B.
Published: August 2018

Tubular injury sensitizes glomeruli to injury. We review potential mechanisms of this tubuloglomerular cross talk. In the same nephron, tubular injury can cause stenosis of the glomerulotubular junction and finally result in atubular glomeruli. Tubular injury also affects glomerular filtration function through tubuloglomerular feedback. Progenitor cells, that is, parietal epithelial cells and renin positive cells, can be involved in repair of injured glomeruli and also may be modulated by tubular injury. Loss of nephrons induces additional workload and stress on remaining nephrons. Hypoxia and activation of the renin–angiotensin–aldosterone system induced by tubular injury also modulate tubuloglomerular cross talk. Therefore, effective therapies in chronic kidney disease may need to aim to interrupt this deleterious tubuloglomerular cross talk.
Immunogenicity and Immune Complex Disease in Preclinical Safety Studies
Authors: Vahle John L.
Published: August 2018

This article summarizes a continuing education presentation on immunogenicity that was part of a continuing education course entitled, “Clinical Pathology of Biotherapeutics.” Immunogenicity of a biotherapeutic can have diverse impacts including altered systemic exposure and pharmacologic responses and, in a fraction of the cases, safety concerns including cross-reactive neutralization of endogenous proteins or sequela related to immune complex disease (ICD). In most cases, immune complexes are readily cleared from circulation; however, based on physiochemical properties, insoluble complexes form, activate complement, and deposit in tissues. Using published information and personal experience, a set of repeat-dose monkey toxicity studies with manifestations suggestive of ICD was reviewed to summarize the spectrum of clinical and pathology findings. The most common live-phase observation linked to ICD was an acute postdosing reaction following multiple dose administrations characterized by generalized collapse and attributed to acute complement activation. Less common live-phase observations were related to syndromes such as a consumptive coagulopathy or a protein losing nephropathy. The most common histologic change attributed to ICD was multi-organ vascular/perivascular inflammation followed by glomerulonephritis. The presentation concluded with a description of the challenges in assessing the relevance of immunogenicity-related reaction in monkey to human clinical use.
Nothing Will Be the Same Again After the Stade de France Attack: Reflections of Association Football Fans on Terrorism, Security and Surveillance
Authors: Cleland Jamie , Cashmore Ellis
Published: August 2018

Following the attempted terrorist attack at the friendly match between France and Germany at the Stade de France on November 13, 2015, this article draws on the response of 1,500 association football fans to the threat of terrorism in the world’s most popular sport. Its primary focus was to ask fans to reflect on their own experiences of security and surveillance and what extent the attempted attack on the Stade de France will have on the management of football crowds. Drawing on the themes of surveillance devised by Michel Foucault, the results outline how some fans accept additional measures of security and surveillance as a means of protecting their safety but others resist this as overly excessive and intrusive and argue it negatively affects their match-day experience. The article concludes by reflecting on the management of football crowds given the response by fans and the changes already taking place since November 2015.
Marketing Systems and Market Failure
Authors: Redmond William
Published: August 2018

The paper seeks to re-examine a classic piece of macromarketing scholarship which dealt with market failures. That analysis was based on a transactional approach to markets, rather than a systems approach. Having become more prominent in the macromarketing literature since that time, marketing systems are the focus of the present analysis. The paper looks at six types of market failure: imperfect competition, entry barriers, externalities, imperfect information, inequality, and transaction costs. Definitions, politics and political economy are discussed, as is a more systems-oriented approach to the assessment of market failures.
Outcome of infants born at < 32 weeks’ gestation in a single-centre level III neonatology unit – relation to feeding strategy
Authors: Kiechl-Kohlendorfer Ursula , Biermayr Marlene , Pupp Peglow Ulrike , Griesmaier Elke
Published: August 2018

Objective

This study aimed to determine survival, neonatal morbidity, and outcomes at 1 and 2 years in children who were born very preterm, and to analyse any relation to enteral feeding.

Methods

We performed a prospective, observational study on very preterm infants (range: 23–31 weeks’ gestation) born at Innsbruck Medical University Hospital, Austria, between 2007 and 2014 (n = 557).

Results

The overall survival rate was 94.6%. Survival rates were 77.8%, 78.6%, 90.9%, and 90.9% among those born at 24, 25, 26, and 27 weeks, and 97.3%, 95.3%, 98.3%, and 100% among those born at 28, 29, 30, and 31 weeks of gestation, respectively. The overall prevalence of chronic lung disease among survivors was 7.3%. The prevalence of necrotizing enterocolitis requiring surgery, intraventricular haemorrhage grades 3 and 4, and severe retinopathy of prematurity was 3.1%, 2.1%, and 6.2%, respectively. There was no difference in short-term morbidity or neurodevelopmental outcome at 1 or 2 years of corrected age between infants who were fed with human milk at discharge and those who were formula-fed.

Conclusion

In the current study, mortality and short-term morbidity rates were low. No differences regarding feeding strategy were detected.
Association between angiopoietin-like protein 2 and lectin-like oxidized low-density lipoprotein receptor 1 ligand containing apolipoprotein B in patients with type 2 diabetes
Authors: Suzuki Tatsuhiko , Takebayashi Kohzo , Hara Kenji , Tsuchiya Takafumi , Inukai Toshihiko
Published: August 2018

Objective

This study was performed to evaluate the association of the serum level of angiopoietin-like protein 2 (ANGPTL2) with circulating inflammatory markers and oxidized and modified low-density lipoprotein (LDL) cholesterol as evaluated by lectin-like oxidized LDL receptor 1 ligand containing apolipoprotein B (LAB) in patients with type 2 diabetes.

Methods

The study included 70 patients with type 2 diabetes hospitalized for glycemic control and 9 control subjects.

Results

The serum level of ANGPTL2 was significantly higher in the patients with type 2 diabetes than in the healthy controls. There was a significant positive correlation between ANGPTL2 and the high-sensitivity C-reactive protein, fibrinogen, and LAB levels and a significant negative correlation between ANGPTL2 and the estimated glomerular filtration rate (eGFR).

Conclusions

These results suggest that the serum ANGPTL2 level has a close positive association with inflammatory markers, especially fibrinogen and oxidized and modified LDL as evaluated by LAB. The data also suggest that the serum ANGPTL2 level is influenced by renal function as reflected by the eGFR.
The Demesne Farm at Inch, 1738–56
Authors: Fitzpatrick Richard
Published: August 2018

During the 1770s, Arthur Young dismissed demesne farming as a source of income for Irish landlords, and instead he observed how such farms were geared towards supplying domestic requirements. This article provides a more nuanced consideration of demesne farming during the first half of the eighteenth century through a case study of the example belonging to the Tipperary estate of Daniel Ryan of Inch from 1738 to 1756. It will be shown that this farm acted as an important source of income for its owner, while also highlighting the responsiveness of the farming practices at Inch to price signals and changing market conditions.
Overcoming Older Adult Barriers to Learning Through an Understanding of Perspectives on Human Information Processing
Authors: Sharit Joseph , Czaja Sara J.
Published: August 2018

The importance to older adults of being able to learn to perform activities related to leisure, work, or daily living for maintaining independence and a good quality of life is unquestionable. An appreciation of the challenges that older adults face during learning, as well as insights into ways to help them overcome these challenges, whether through design or instruction, can be obtained through a basic understanding of human information processing. The purpose of this article is to facilitate this understanding within the context of older adult learning. The article begins with an overview of the human information-processing system and cognitive limitations and capabilities associated with aging. Critical components of the information-processing system are then revisited in greater detail from the perspective of older adult information-processing capabilities. Concepts are illustrated through examples to demonstrate how older adults could make more efficient use of their information-processing resources during learning.
Associations of Emotional, Physical, or Sexual Intimate Partner Violence and Depression Symptoms Among South African Women in a Prospective Cohort Study
Authors: Okafor Chukwuemeka N. , Barnett Whitney , Zar Heather J. , Nhapi Raymond , Koen Nastassja , Shoptaw Steve , Stein Dan J.
Published: August 2018

Violence against women remains a significant public health problem globally. The majority of longitudinal studies documenting the negative impact of intimate partner violence (IPV) on the mental health of women come from high-income countries. The aim of this study was to investigate the longitudinal association between emotional, physical, or sexual IPV and depression symptoms among South African women in a prospective cohort study. Participants were 981 South African women enrolled in the Drakenstein Child Health Study—a cohort study investigating the early life determinants of child health. Interview data from four time-points (antenatal care visit, 6 months, 12 months, and 18 months postpartum) were included. The primary independent variable was self-reported emotional, physical, and sexual IPV in the past 12 months. Depressive symptoms were assessed at each time-point with the Edinburgh Postnatal Depression Scale (EPDS); a cutoff score of ⩾13 was used to define significant depression symptoms. We used pooled-multivariable logistic regression models to determine associations between the three different forms of IPV and significant depression symptoms while adjusting for time-fixed and time-updated covariates. The mean age of the sample at antenatal care visit was 27 years (standard deviation = 6.0). In the adjusted model including all forms of IPV and adjusting for sociodemographic and clinical characteristics, substance use, and childhood trauma, emotional (adjusted odds ratio [aOR] =1.55, 95% confidence interval (CI): [1.02, 2.34]; p = .039)] and sexual (aOR = 2.02, 95% CI: [1.10, 3.72]; p < .001) IPV were significantly associated with significant depression symptoms. The relationship between physical IPV and significant depression symptoms was not statistically significant (aOR = 0.68, 95% CI: [0.44, 1.05]; p = .485). Our study confirms findings from high-income countries of the association between IPV and depressive symptoms among women in South Africa. Routine screening for IPV, including emotional IPV and intervention programs for IPV among women, is needed in South Africa.
Succinylcholine-Induced Rhabdomyolysis in Adults: Case Report and Review of the Literature
Authors: Barrons Robert William , Nguyen Liem T.
Published: August 2018

Purpose:

A case of succinylcholine (SCh) and sevoflurane as a probable cause of rhabdomyolysis in an adult is presented, along with a review of the relevant literature and strategies for prevention.

A nondiabetic, morbidly obese 32-year-old female developed rhabdomyolysis after administration of SCh and sevoflurane for diagnostic procedures of 30 minutes’ duration. Thirty-three hours following anesthesia, the patient developed diffuse muscle tenderness and progressive weakness with a creatinine kinase (CK) of 4319 U/L. Urinalysis findings indicated contamination, a white blood cells of 12.1 × 103/μL was stress induced, while all other labs were normal. Following 26 hours of intravenous fluids, the patient’s CK decreased to 1243 U/L, with pain responsive to acetaminophen and improved mobility, resulting in discharge. With a lack of reasonable alternative causes and a temporal association of symptoms, procedural medication–induced rhabdomyolysis was suspected. Based on Naranjo scale evaluation, SCh and sevoflurane were probable causes of rhabdomyolysis. We reviewed the literature for SCh-induced rhabdomyolysis among adults and found 10 cases. The majority of patients received halogenated anesthesia (HA) and prophylaxis for SCh myopathy, with no known personal or family history of neuromuscular disorders (NMD) reported.

Conclusion:

Rhabdomyolysis was observed in a woman following the administration of SCh and sevoflurane for diagnostic procedures lasting 30 minutes. While avoidance is possible in adults with histories of NMDs, a high index of suspicion for occurrence of rhabdomyolysis is needed whenever combining SCh with HA in all adults.
Implementing Yoga Into the Management of Patients With Refractory Low Back Pain in an Outpatient Clinic Setting
Authors: Lewis Karen , Metcalfe Sharon , Pearson Tamera , Whichello Ramona
Published: August 2018

Purpose: To evaluate the effectiveness of implementing yoga into the treatment of patients with chronic low back pain. Design: Quantitative analysis with opportunity for qualitative feedback. Method: Effectiveness of this complementary treatment was assessed using a pretest/posttest design of patients who volunteered to participate in yoga classes as part of their back pain management. Measurements included low back pain rating, perception of back pain interference with daily activities, and self-efficacy in dealing with chronic low back pain. Findings: Although no statistically significant findings were found due to the small sample size, most participants demonstrated improved individual scores on all measurement surveys including qualitative comments. Conclusion: Based on the findings of this pilot study, further studies on implementing yoga into the treatment of chronic low back pain are encouraged.
Portraits of Women’s Paid Domestic-Care Labour
Authors: Grover Shalini , Chambers Thomas , Jeffery Patricia
Published: August 2018

Our introduction to this Special Issue draws out themes from all four articles which focus on India’s domestic-care economy: women’s paid domestic labour, care work and surrogacy. Through fine-grained ethnographic detail, all the articles nuance questions around agency and resistance, and actively challenge the ‘passive victim’ stereotype that continues to be the primary imaginary in many representations of domestic-care workers. We describe how the articles detail the intimacy, emotional labour and complex spatial dynamics inherent within a sector that often involves working in the homes of others, caring for children, and complex relationships with employers. Additionally, we show how care workers encounter quotidian forms of bodily control, distancing, segregation, authority, stigma, coercion, punitive sanctions and exploitation embedded in the intersections of class, race, caste, gender and ethnicity. To provide a wider framing for the articles, we utilize this introduction to situate them within broader historical and geographical contexts. Thus, we consider how global care chains (GCCs), labour markets, migration, and colonial/postcolonial considerations interplay in shaping the everyday lives of domestic-care workers in contemporary globalizing India.
Improved Supervision and Safety of Discharges Through Formal Discharge Education
Authors: Ackermann Lily L. , Stewart Emily A. , Riggio Jeffrey M.
Published: August 2018

The goal of this study is to evaluate change in residents’ assessment of supervision and safety of the discharge process after formal discharge instruction education. An educational lecture and workshop addressing high-risk medications, medication reconciliation, follow-up, and handoffs were provided to internal medicine residents. Residents were given a longitudinal survey before and after the discharge education session. Significant improvement in perception was demonstrated in review of discharge instructions ( P < .001), review of new medications/side effects with patients ( P < .001), and review of discharge instructions with and receiving feedback from attending physicians ( P < .001). On review of 40 discharge instructions pre and post intervention, there was an improvement in completion of instructions for high-risk medications ( P < .05 [14 insulin, 26 anticoagulation]). This intervention was viewed positively by residents; more than two thirds of all residents favored a process of formal training over the current model of “training by doing.”
Frequency domain-based analysis of floor vibrations using the dynamic stiffness matrix method
Authors: Guo Tong , Cao Zhiliang , Zhang Zhiqiang , Li Aiqun
Published: August 2018

Buildings may experience excessive floor vibrations due to inner excitations such as walking people and running machines, or ground motion caused by the road traffic. Therefore, it is often necessary to evaluate the vibration level at the design stage. In this paper, a frequency domain-based model for predicting vertical vibrations of a building floor is provided, where the floor is simplified as a rectangular plate stiffened by beams in two orthogonal directions, while vertical motion and rotation of the slab–column joints are viewed as the unknown degrees of freedom. The dynamic stiffness matrix of the whole structure is obtained from those of the floor and column elements. To validate the proposed solution, a five-story building was analyzed, and frequency spectra were compared with those from the finite element method. Besides, a prototype building was analyzed and validated based on field measured data. It is found that the proposed solution could predict vibration responses with satisfactory accuracy, and is more computationally efficient than finite element analysis.
Fate, Transformation, and Toxicological Impacts of Pharmaceutical and Personal Care Products in Surface Waters
Authors: Maldonado-Torres Sabino , Gurung Rubi , Rijal Hom , Chan Andrew , Acharya Shishir , Rogelj Snezna , Piyasena Menake , Rubasinghege Gayan
Published: August 2018

With the growth of the human population, a greater quantity of pharmaceutical and personal care products (PPCPs) have been released into the environment. Although research has addressed the levels and the impact of PPCPs in the environment, the fate of these compounds in surface waters is neither well known nor characterized. In the environment, PPCPs can undergo various transformations that are critically dependent on environmental factors such as solar radiation and the presence of soil particles. Given that the degradation products of PPCPs are poorly characterized, these “secondary residues” can be a significant environmental health hazard due to their drastically different toxicologic effects when compared with the parent compounds. To better understand the fate of PPCPs, we studied the degradation of selected PPCPs, including ibuprofen and clofibric acid, in aqueous solutions that contained kaolinite clay and were irradiated with a solar simulator. The most abundant degradation products were identified and assessed for their toxicologic impact on selected microorganisms. The degraded mixtures showed lower toxicity than the starting compounds; however, as these degradation products are capable of further transformation and interaction with other PPCPs in natural waters, our work highlights the importance of additionally characterizing the PPCP degradation products.
When the team’s jersey is what matters: Network analysis of party cohesion and structure in the Canadian House of Commons
Authors: Chartash David , Caruana Nicholas J , Dickinson Markus , Stephenson Laura B
Published: August 2018

Are parties “high discipline, low cohesion” in Westminster legislatures? This study applies network analysis to voting behavior among members of parliament (MPs), a novel approach that measures not deviation from party-line voting, but rather whether MPs with similar voting patterns are co-partisans. We study the Canadian Parliament from 2006 to 2015, during which time the governing party under Prime Minister Stephen Harper maintained tight central control and discipline, a likely source of elevated cohesion. We find that “low cohesion” generally holds, and parties do not always conform to commonsense expectations about how cohesively they “should” behave in various parliamentary situations, though they show themselves capable of learning over time. Moreover, we find that party cohesion stems less from shared voting behaviors and more from simple partisan identity. Further research should consider to what extent parliamentary behavior is based mainly on party alignment.
Organizing Health Inequalities? Employee-Driven Innovation and the Transformation of Care
Authors: Halford Susan , Fuller Alison , Lyle Kate , Taylor Rebecca
Published: August 2018

This article responds to calls for new approaches to understanding and intervening in health inequalities and, in particular, for attention to the processes and relations that mediate structural inequality and everyday outcomes. Our contribution focuses on the part that healthcare organizations play in this. We draw on organizational sociology, which theorizes that while organizational structures, cultures, and practices may appear neutral – and rely for their legitimacy on this – they may, in fact, operate in the interests of some social groups and less in the interests of others. This proposition is worked through new empirical research on employee-driven innovation in the UK National Health Service. In both our case studies, front-line staff working with some of the most vulnerable citizens had identified the organization of care as both part of the problem and – potentially – part of the solution. In tracing their efforts to change the organization of care, we learn more about what it might take to mobilize resources in support of those whose lives are most affected by health inequalities.
Representing the “invisible crime” of climate change in an age of post-truth
Authors: Brisman Avi
Published: August 2018

This article builds on prior writing on the ophthalmological aspects of climate change to argue that in an age of climate change denial and “post-truth”—which Oxford Dictionaries defines as “relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief”—developing a visual language of climate change becomes of paramount importance. This article suggests that while media representations of climate change may serve to reduce climate change to a stock set of visual clichés certain art may improve our visual acuity of climate change. Accordingly, this article looks at select examples of artwork on the causes and consequences of climate change and considers the capacity of such work to inspire personal and political action.
Employing the enhanced Regional Tourism Sustainable Adaptation Framework with a case study of climate change vulnerability in Mombasa, Kenya
Authors: Njoroge Joseph Muiruri , Ratter Beate MW , Atieno Lucy , Mugabe Innocent M
Published: August 2018

This paper attempts to provide an empirical application of the enhanced Regional Tourism Sustainable Adaptation Framework using a case study of Mombasa Kenya. Climate variability is a challenge to tourism destinations, especially coastal and Island destinations, categories under which Mombasa, our study site falls under. Mombasa has limited capacity to adapt to climate change considering its socio economic conditions and weak institutions, thus making it necessary to explore the possible sustainable pathways for the city using the enhanced Regional Tourism Sustainable Adaptation Framework. Earlier frameworks for tourism adaptation to climate change lacked focus on regional dynamics as well as sustainability aspects, and their implementation pose the risk of mal adaptation to some extent. Using secondary data and data from interviews with tourism stakeholders in Mombasa, the enhanced Regional Tourism Sustainable Adaptation Framework guides our assessment of vulnerability and resilience of the destination, as well as identification of region specific adaptation options for the city within the context of sustainable practice. Based on climate change perceived impacts, risks and vulnerability various adaptation options are presented and discussed as provided in literature. The usefulness of the framework in guiding regional tourism destination managers and policy makers in their pursuit for a regional adaptation options within the tourism sector in order to reduce destinations vulnerability, increase resilience and take advantage of opportunities presented by climate change is underscored.
A Weibull-count approach for handling under- and overdispersed longitudinal/clustered data structures
Authors: Luyts Martial , Molenberghs Geert , Verbeke Geert , Matthijs Koen , Ribeiro Jr Eduardo E , Demétrio Clarice GB , Hinde John
Published: August 2018

A Weibull-model-based approach is examined to handle under- and overdispersed discrete data in a hierarchical framework. This methodology was first introduced by Nakagawa and Osaki (1975, IEEE Transactions on Reliability, 24, 300–301), and later examined for under- and overdispersion by Klakattawi et al. (2018, Entropy, 20, 142) in the univariate case. Extensions to hierarchical approaches with under- and overdispersion were left unnoted, even though they can be obtained in a simple manner. This is of particular interest when analysing clustered/longitudinal data structures, where the underlying correlation structure is often more complex compared to cross-sectional studies. In this article, a random-effects extension of the Weibull-count model is proposed and applied to two motivating case studies, originating from the clinical and sociological research fields. A goodness-of-fit evaluation of the model is provided through a comparison of some well-known count models, that is, the negative binomial, Conway–Maxwell–Poisson and double Poisson models. Empirical results show that the proposed extension flexibly fits the data, more specifically, for heavy-tailed, zero-inflated, overdispersed and correlated count data. Discrete left-skewed time-to-event data structures are also flexibly modelled using the approach, with the ability to derive direct interpretations on the median scale, provided the complementary log–log link is used. Finally, a large simulated set of data is created to examine other characteristics such as computational ease and orthogonality properties of the model, with the conclusion that the approach behaves best for highly overdispersed cases.
Computational Feasibility Analysis of Electrochemotherapy With Novel Needle-Electrode Arrays for the Treatment of Invasive Breast Ductal Carcinoma
Authors: Vera-Tizatl Adriana Leticia , Vera-Tizatl Claudia Elizabeth , Vera-Hernández Arturo , Leija-Salas Lorenzo , Rodríguez Sergio , Miklavčič Damijan , Kos Bor
Published: August 2018

Breast cancer represents a rising problem concerning public health worldwide. Current efforts are aimed to the development of new minimally invasive and conservative treatment procedures for this disease. A treatment approach for invasive breast ductal carcinoma could be based on electroporation. Hence, in order to determine the effectiveness of electrochemotherapy in the treatment of this disease, 12 electrode models were investigated on realistic patient-specific computational breast models of 3 patients diagnosed by Digital Breast Tomosynthesis imaging. The electrode models exhibit 4, 5, and 6 needles arranged in 4 geometric configurations (delta, diamond, and star) and 3 different needle spacing resulting in a total of 12 needle-electrode arrays. Electric field distribution in the tumors and a surrounding safety margin of 1 cm around the tumor edge is computed using the finite element method. Efficiency of the electrode arrays was determined hierarchically based on (1) percentage of tumor volume reversibly electroporated, (2) percentage of tumor volume irreversibly electroporated, (3) percentage of treated safety margin volume, (4) minimal invasiveness, that is, minimal number of electrodes used, (5) minimal activated electrode pairs, and (6) minimal electric current. Results show that 3 electrode arrays (4 needle-delta, 5 needle-diamond, and 6 needle-star) with fixed-geometry configuration could be used in the treatment with electrochemotherapy of invasive breast ductal carcinomas ranging from 1 to 5 cm3 along with a surrounding safety margin of 1 cm.
Modulation of Cerebellar Cortical Plasticity Using Low-Intensity Focused Ultrasound for Poststroke Sensorimotor Function Recovery
Authors: Baek Hongchae , Pahk Ki Joo , Kim Min-Ju , Youn Inchan , Kim Hyungmin
Published: August 2018

Background. Stroke affects widespread brain regions through interhemispheric connections by influencing bilateral motor activity. Several noninvasive brain stimulation techniques have proved their capacity to compensate the functional loss by manipulating the neural activity of alternative pathways. Over the past few decades, brain stimulation therapies have been tailored within the theoretical framework of modulation of cortical excitability to enhance adaptive plasticity after stroke. Objective. However, considering the vast difference between animal and human cerebral cortical structures, it is important to approach specific neuronal target starting from the higher order brain structure for human translation. The present study focuses on stimulating the lateral cerebellar nucleus (LCN), which sends major cerebellar output to extensive cortical regions. Methods. In this study, in vivo stroke mouse LCN was exposed to low-intensity focused ultrasound (LIFU). After the LIFU exposure, animals underwent 4 weeks of rehabilitative training. Results. During the cerebellar LIFU session, motor-evoked potentials (MEPs) were generated in both forelimbs accompanying excitatory sonication parameter. LCN stimulation group on day 1 after stroke significantly enhanced sensorimotor recovery compared with the group without stimulation. The recovery has maintained for a 4-week period in 2 behavior tests. Furthermore, we observed a significantly decreased level of brain edema and tissue swelling in the affected hemisphere 3 days after the stroke. Conclusions. This study provides the first evidence showing that LIFU-induced cerebellar modulation could be an important strategy for poststroke recovery. A longer follow-up study is, however, necessary in order to fully confirm the effects of LIFU on poststroke recovery.
Stigma and Shame Experiences by MSM Who Take PrEP for HIV Prevention: A Qualitative Study
Authors: Dubov Alex , Galbo Phillip , Altice Frederick L. , Fraenkel Liana
Published: August 2018

Pre-exposure prophylaxis (PrEP) uptake has been extremely low among key groups. PrEP-related stigma and shaming are potential barriers to uptake and retention in PrEP programs. There is a lack of literature describing PrEP stigma. In order to fill this gap, we recruited online 43 HIV-negative Men who have Sex with Men (MSM) who use PrEP. Semistructured interviews were conducted to explore their perceptions and experience of stigma related to PrEP use. Data were analyzed using Strauss and Corbin’s grounded theory and constant comparison techniques to enhance understanding of the lived experiences of MSM who use PrEP. The participants experienced PrEP stigma as rejection by potential/actual partners, stereotypes of promiscuity or chemsex, and labeling of both the user and the medication. They connected PrEP stigma with HIV stigma, generational differences, moralization of condom use, and inability to embrace one’s own sexuality. These findings point to a need to develop tailored interventions to address PrEP-related stigma and shaming for individuals, health-care professionals, and the MSM community-at-large.
Outcomes of minor amputations in patients with peripheral vascular disease over a 10-year period at a tertiary care institution
Authors: Chan Amy S , Montbriand Janice , Eisenberg Naomi , Roche-Nagle Graham
Published: August 2018

Objectives

Choosing an optimal amputation level requires balance between maximizing limb salvage while minimizing chances of non-healing wounds and re-amputation. Our aim was to assess the long-term outcome for minor amputations in patients with peripheral vascular disease.

Methods

A retrospective study of minor amputations between January 1, 2005 and December 31, 2015 was performed. Electronic medical records of eligible patients were examined to extract demographics, co morbidities and clinical data.

Results

Within the study period, 220 patients underwent 296 primary minor amputations in 244 lower extremities. Wound healing was achieved in 18.2% (54 of 296 amputations) and 43.6% (129 of 296 amputations) at 90 days and 365 days, respectively. Rates of progression to major amputation were 16.4% (40 or 244 limbs) and 21.7% (53 of 244 limbs) at 90 days and 365 days, respectively. In the final multivariate model, lower ipsilateral posterior tibial waveforms predicted poor 90-day healing (OR = 2.22, p = 0.01) as well as limb loss (OR = 3.02, p = 0.02) in a dose-response manner. In the final logistic regression model, emergency department admission (OR = 0.20, p < 0.01), ipsilateral posterior tibial waveform (OR = 2.63, p < 0.01), and post-operative infection (OR = 0.30, p < 0.01) were predictors of poor healing status at study endpoint.

Conclusion

This study shows that a majority of foot amputees require ongoing care for non-healing wounds and a proportion necessitate conversion to major amputation. Adequate vascularization is essential to promote and maintain healing.
Think, could this be sepsis?
Authors: Allen Gina
Published: August 2018

Sepsis is a leading cause of death in the UK; the source is often a community-acquired infection. Early detection and treatment has significant positive impacts on mortality rates. Despite campaigns to improve education around sepsis, there is a significant shortfall in public awareness of the condition. This article aims to aid GPs in recognising this life-threatening condition early, supporting decision making and instigating the appropriate management for patients.
Practice Patterns of Systemic Corticosteroid Use in Complicated Acute Rhinosinusitis Among Rhinologists and Pediatric Otolaryngologist
Authors: Wu Derek , Wasserman Jason , Boruk Marina
Published: August 2018

Background

The use of systemic corticosteroids remains controversial in the treatment of orbital complications of sinusitis.

Objective

To compare and contrast the current practice patterns of the use of systemic corticosteroid in the management of orbital complications of acute bacterial rhinosinusitis (ABRS) among fellowship-trained members of American Society of Pediatric Otolaryngology (ASPO) and American Rhinologic Society (ARS).

Study Design

Cross-sectional survey.

Methods

A web-based survey was electronically distributed to 497 members of ASPO and 845 members of ARS focusing on the practice habits and opinions regarding the use of systemic corticosteroids in the treatment of ABRS with orbital complications in children and adults.

Results

Survey completion rate was 19.1% among ASPO membership and 10.3% from ARS; 45% of respondents utilized steroids almost always or frequently in children and 36% of the time in adults. Most commonly reported indication for the use of steroid was vision change. Fellowship-trained pediatric otolaryngologists are 2.88 times more likely to prescribe corticosteroids for children than rhinologists ( P < .02). The perceived level of evidence in the literature was split between expert opinions and cohort studies.

Conclusion

In orbital complications of ABRS, practice patterns of the use of steroid differ significantly between fellowship-trained ASPO and ARS members with respect to its use in children. Overall, corticosteroids are administered with significant frequency, although there is little actual or perceived evidence to support their safety or efficacy. In alignment of practicing evidence-based medicine, further studies are needed to guide the use of steroids in complicated ABRS with respect to timing, dosing, route, duration, and indication.
Associations of leisure-time physical activity with cardiovascular mortality: A systematic review and meta-analysis of 44 prospective cohort studies
Authors: Cheng Wenke , Zhang Zhen , Cheng Wensi , Yang Chong , Diao Linlin , Liu Weijun
Published: August 2018

Background

Many cohort studies within the past few decades have shown the protective effect of leisure-time physical activity on cardiovascular mortality. To summarise the evidence from prospective cohort studies on the relationship between the amount of leisure-time physical activity and the risk of cardiovascular mortality, a dose–response meta-analysis was conducted in this study.

Methods and results

Electronic databases, including PubMed and Embase databases, Scopus and Cochrane Library, were systemically retrieved by two investigators from inception to 14 June 2018 for related studies. The maximum adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted, and a dose–response analysis was conducted using the restricted cubic splines. Finally, a total of 44 studies comprising 1,584,181 participants was enrolled into this meta-analysis. The HRs of cardiovascular mortality for moderate and high leisure-time physical activity were 0.77 (95% CI 0.74–0.81) and 0.73 (95% CI 0.69–0.77), respectively. Among these 44 studies, 19 were eligible for the dose–response meta-analysis, which suggested a linear negative correlation of leisure-time physical activity with cardiovascular mortality, regardless of age, gender and the presence of underlying cardiovascular disease or not.

Conclusions

Leisure-time physical activity shows a linear negative correlation with the risk of cardiovascular mortality regardless of age, gender and the presence of cardiovascular disease or not. However, the cardiovascular benefits of leisure-time physical activity is decreased for those aged over 65 years or those with a history of cardiovascular disease. Moreover, leisure-time physical activity displays more cardiovascular benefits to people followed up for over 10 years than to those followed up for less than 10 years. Besides, high-intensity leisure-time physical activity has more obvious cardiovascular benefits than those of moderate-intensity leisure-time physical activity.