bluuebunny/crossref_metadata_2025 huggingface dataset:
Methodologic Issues in Palliative Care Psychosocial Research
Authors: Cassileth Barrie R. , Lusk Edward J.
Published: April 2019

The conduct of psychosocial research with palliative care patients or staff presents a major investigative challenge. The fragility of patients and their physical or cognitive limitations severely curtail the types of studies that are possible and the research methods that can be applied. A major limitation is that randomization, a critical experimental design feature, is rarely possible or ethical as a means of evaluating palliative care. However, even given the practical limitations of constructing a randomized experimental design, methodologically acceptable studies are possible, and methodologically inappropriate approaches can be avoided. Case reports (anecdotal studies) produce data that cannot be generalized to other patients. Single-test, no control group studies should be avoided for similar reasons. Acceptable research techniques that are feasible in the palliative care setting are renewed: careful research questions and associated hypotheses; determining appropriate sample sizes; developing comparison groups; selecting and evaluating an appropriate interview guide or questionnaire; avoiding interviewing bias, and so on. Moreover, it is necessary for the professional standing of palliative care that the exchange of information between palliative care staff and other health professionals be based upon scientifically sound studies.
Rejecting Criminal Liability for Life-Shortening Palliative Care
Authors: Casswell Donald G.
Published: April 2019

It is possible that a physician who administers life-shortening palliative care, even to a terminally ill patient with the patient's consent, commits murder. The Law Reform Commission of Canada, as part of its proposals on recodifying criminal law, has recommended that criminal liability not attach to the administration of life-shortening palliative care “appropriate in the circumstances”. The author submits that while the aim of the Commission's recommendation is good, the phrase “appropriate in the circumstances” should be replaced with more specific criteria for determining when life-shortening palliative care may be administered. Failure to do so would leave physicians in almost as uncertain a situation as is presently the case, preventing them from administering such care without fear of criminal liability.
Social and Demographic Characteristics of Patients Admitted to a Palliative Care Unit
Authors: Bruera Eduardo , Kuehn Norma , Emery Bette , Macmillan Karen , Hanson John
Published: April 2019

In this retrospective study we reviewed the charts of 169 consecutive admissions to the Palliative Care Unit, Edmonton General Hospital. Demographic and social characteristics of patients were assessed in order to determine the likelihood that the patients could be managed at home according to currently available services. The mean age of the population was 65 ± 12 years, 97 (57%) were women, they had a variety of cancers with major prevelance of the most frequent adult tumors, and 72% of patients were coming from acute care hospitals. Each patient had an average of 2.7 ± 1.8 children (median = 3), a mean of 0.18 ± 0.6 dependents (median = 0), a mean of 1 ± 0.9 support persons at home (median = 1), and a mean of 2.6 ± 1 support persons outside the household (median = 2). Of a total of 119 main caregivers who lived in the same household as the patient, 69 (58%) were not able to take care of the patient. Only 27 patients (16%) considered that there were major financial problems, and all 169 patients had universal health care available (95 patients had additional private health care coverage). Of 125 patients who were asked where they preferred to die, 112 (90%) stated that they did not want to die at home. Our data suggest that the lack of family'support and lack of intensive home care services are the main obstacles to home care of terminally ill cancer patients in our province. Home care services as currently available are not able to care for a large number of patients with terminal cancer. More prospective research into this subject is badly needed.
Death Late in the 20th Century
Authors: Roy David J.
Published: April 2019

A question: “Is ‘to be’ the same as ‘to be alive'?”

An answer: “In death what is called a ‘man’ simply ceases to exist: ‘man’ in the full and unadulterated sense of the word exists only as a living being.” Yet, “We must not relinquish the truth that the spiritual soul is indestructible.” Joseph Pieper (1).

A question: “Is, then, being a ‘man’ just a phase of one's being?”
Work Stress and Job Satisfaction in Hospital-Based Home Care
Authors: Beck-Friis Barbro , Strang Peter , Sjödén Per-Olof
Published: April 2019

The entire staff of the hospital-based home care (HBHC) at Motala (n=35) participated in a study concerning work stress and job satisfaction. A significant number of the patients in the HBHC have advanced malignancies and most of them are terminally ill. A total of 219 questions about stress and job satisfaction were asked in a self-administered questionnaire. Only 3%–17% of the staff often or very often experienced stress factors such as high expectations, confusing orders, or lack of information. Instead, a majority stated that they often/very often experienced different aspects of job satisfaction, such as meaningfulness, security, and stimulation. Staff members stating that they often were proud/very proud of their jobs, members feeling that their skill and experience were needed, as well as staff members who often received praise from their superiors, were less prone to look for other jobs (p<0.01, p<0.05, and p<0.05, respectively). Those who often /very often were allowed to take initiatives of their own more often regarded their jobs as non-monotonous (p<0.05) and stimulating to their personal development (p<0.001). Despite demanding jobs with severely ill patients, most of the staff gave high ratings for different aspects of job satisfaction. This positive spirit was also reflected in the exceptionally low job turnover among them. Possible explanations may be a careful selection of personnel and an organization which both stimulates the staff's own initiatives and provides support when necessary.
The Bologna Eubiosia Project: Hospital-at-Home Care for Advanced Cancer Patients
Authors: Pannuti Franco , Tanneberger Stephan
Published: April 2019

Since 1985 the Associazione Nazionale per lo Studio e la Cura dei Tumori Solidi (ANT), an Italian nonprofit anticancer organization, has provided a hospital-at-home care program for advanced and very advanced cancer patients. This program is part of the Eubiosia Project which also includes a number of complementary services. Teams of doctors, nurses, and psychologists work round-the-clock in the region and on hospital wards, assisted by diagnostic and therapeutic facilities applicable at home and by a round-the-clock on-call service seven days a week. The patients who were treated between December 1985 and December 1991 numbered 5603, of whom 2130 received treatment in 1991 alone, with 702 patients on line at the end of the period. The mean duration of home care for the first 2803 deceased patients was 62 days, and the percentage of deaths at home was 70%. We analyzed control of the main symptoms and the residual survival in three groups of patients—stomach, lung, and breast cancer sufferers — and found that acceptable pain control was achieved in 95% of cases. From the retrospective analysis of our data it can be seen that the eligibility criteria for entry to home care should not only depend upon performance status and the presence of symptoms, but should also take into account the factors that are inherent to the natural history of any kind of tumor as well as the social, domestic, and psychological characteristics of the patients.
Vancouver General Hospital Palliative Care Unit Utilization Review
Authors: Tong Kevin L. , Porterfield Pat , Mills Isobel
Published: April 2019

This paper describes the utilization pattern in the Palliative Care Unit at Vancouver General Hospital for a six-month period (1 April – 30 September 1991) and relates the information provided to the mandate of the palliative care program. It is a retrospective study of 139 patients discharged during this period. Data were collected from the Hospital Medical Records Institute (HMRI), the Medical Records Department of Vancouver General Hospital, patients’ charts, the palliative care unit admission/discharge book, and palliative care consultation statistics.
Results of Antiemetic Management in Terminal Illness
Authors: Lichter Ivan
Published: April 2019

A wide variety of causes may be responsible for nausea and vomiting in terminal illness. The different emetic stimuli reach the vomiting centre by a variety of pathways and can be blocked by specific antiemetics that act at the neurotransmitter receptor sites in these pathways. A knowledge of the neurotransmitter receptor antagonist potency of the different antiemetics allows the choice of the most appropriate antiemetic for the relief of the nausea and vomiting caused by a particular emetic stimulus. To demonstrate the efficacy of this approach to the management of nausea and vomiting in terminal illness, the outcome of antiemetic choice in 100 consecutive episodes is recorded.
The Problematic Nature of Education in Palliative Care
Authors: James Christopher R. , Macleod Roderick D.
Published: April 2019

As the need for palliative care increases, palliative care is emerging as a field of medical care in its own right. At the same time there are many aspects of palliative care that are problematic, particularly in palliative care education. The aspects reviewed here include: (a) the lack of a long tradition and adequate concep-tualization of palliative care; (b) the significance of psychological, emotional, and spiritual aspects; (c) the importance of but inadequate understanding of symptom control; (d) the fact that palliative care is not curative in the accepted sense; (e) its multiprofessional nature; (f) the range of different settings of palliative care; and (g) the fact that palliative caregivers have to perform their duties in situations where the emotional and psychological demands on them may be immense. A number of general issues relevant to palliative care education are also reviewed.
A Severity Index Designed as an Indicator of Acuity in Palliative Care
Authors: Strause Linda , Herbst Laurel , Ryndes True , Callaghan Mary , Piro Lawrence
Published: April 2019

Patients who are facing terminal illness frequently experience changes in health care settings which are necessitated by acute events during palliative care. This pilot study evaluates the reliability, criterion validity, and appropriateness of the San Diego Severity Index (SDSI) in a population of advanced cancer patients in different care settings. The SDSI includes diagnostic, acuity, and psychosocial assessments. Cancer patients were evaluated in an outpatient oncology clinic (SCRF), a hospice home care (HC) program, and an acute care hospital/hospice centre (ACC). Scores were lowest for SCRF (9.51 ± 3.7), HC was intermediate (24.04 ± 8.8), while patients at the ACC scored the highest (29.33 ± 7.0). Patients admitted to the ACC were significantly more acute, as assessed by the SDSI, than those utilizing outpatient services. This instrument may be useful as an indicator of appropriate transitions between health care settings.
Pain Control with Morphine for Vertebral Metastases and Sciatica in Advanced Cancer Patients
Authors: Yoshioka Hideo , Tsuneto Satoru , Kashiwagi Tetsuo
Published: April 2019

Morphine was administered to 56 advanced cancer patients; of that number spinal metastases had induced bone pain in 28 and malignant tumors had induced sciatica in 28. The sciatica was caused in 16 patients by direct invasion of the sacral plexus, in four by lumbar bone metastases, and in eight by pelvic bone metastases. Spinal bone pain was controlled adequately with morphine. However, sciatica required larger dosages of morphine than did bone pain. Among the group with sciatica, rectal cancer patients needed larger dosages of morphine than the other cancer patients. Even with high doses of morphine, it was occasionally difficult to control neuropathic pain of the sciatic nerve caused by intrapelvic cancer.
Directions for Palliative Care Nursing in Canada: Report of a National Survey
Authors: Kristjanson Linda J. , Balneaves Lynda
Published: April 2019

This paper reports the results of a national survey of palliative care nurses conducted following a meeting of nurses at the Fifth Canadian Palliative Care Association Conference in 1993. The intent of the survey was to obtain information about Canadian palliative care nurses's perceptions of practice and professional issues. Eighty percent of respondents believed that palliative care nurses should form a palliative care nurses’ organization, with the majority recommending that this occur under the auspices of the Canadian Palliative Care Association. Key issues of importance to palliative care nurses were identified. The two major issues of concern were (a) the need to develop standards of practice and (b) educational needs of palliative care nurses. Respondents also emphasized the importance of maintaining and fostering an interdisciplinary approach to palliative care. Results of this survey are to be further discussed at the Sixth Canadian Palliative Care Association Conference to be held in Halifax in October 1995.
Evaluation of Bereavement Anniversary Cards
Authors: Hutchison Stephen M.W.
Published: April 2019

The anniversary of a death is perceived as a difficult time by the majority of closely bereaved relatives and friends. Bereavement anniversary cards are supportive and useful in the context of wider follow-up. This study identified no strong predictors to indicate those for whom such a card would be inappropriate. Several recipients thought that the card solicited financial support for the hospice.
Palliative Performance Scale (PPS): A New Tool
Authors: Anderson Fern , Downing G. Michael , Hill Jan , Casorso Lynn , Lerch Noreen
Published: April 2019

The Palliative Performance Scale (PPS), a modification of the Karnofsky Performance Scale, is presented as a new tool for measurement of physical status in palliative care. Its initial uses in Victoria include communication, analysis of home nursing care workload, profiling admissions and discharges to the hospice unit, and, possibly, prognostication. We assessed 119 patients at home, of whom 87 (73%) had a PPS rating between 40% and 70%. Of 213 patients admitted to the hospice unit, 175 (83%) were PPS 20%-50% on admission. The average period until death for 129 patients who died on the unit was 1.88 days at 10% PPS upon admission, 2.62 days at 20%, 6.70 days at 30%, 10.30 days at 40%, 13.87 days at 50%. Only two patients at 60% or higher died in the unit. The PPS may become a basis for comparing drug costs at home and for studying the effects of treatments (e.g. hypodermoclysis) at various levels of physical performance. Validity and reliability testing are currently being undertaken.
Life Expectancy in Hospitalized Patients with AIDS: Prognostic Factors on Admission
Authors: Gérard Laurence , Flandre Philippe , Raguin Gilles , Le Gall Jean-Roger , Vilde Jean-Louis , Leport Catherine
Published: April 2019

In the course of the inevitable hospitalizations of AIDS patients, many difficult questions concerning curative and palliative approaches to care have to be answered. In order to guide these strategies, we conducted a prospective study to identify those variables which can be easily quantified on admission which might be predictive of patient outcomes. Between 1 June 1990 and 25 April 1991, 140 consecutive hospitalizations of 83 AIDS patients were recorded. Demographic, clinical, and biological data were collected within 48 hours of admission. Probable (p<0.10) or definite (p<0.05) factors contributing to a higher mortality included type of opportunistic infections, serum albumin level, total lymphocyte count, weight, CD4 cell count, and neurological manifestations. In the multivariate proportional hazards model, two factors were significantly and independently predictive of lower survival: body weight less than 90% of ideal body weight and neurologic manifestations. The probability of survival was significantly affected by the number of predictive factors present on admission, and patients were significantly more likely to die when these latter two factors were present concomitantly. These factors might be useful to define the optimal mode of care for hospitalized AIDS patients, considering both patients’ wishes and an objective assessment of the prognosis.
Decreased Opioid doses used on a Palliative Care Unit
Authors: Fainsinger Robin L. , Louie Karen , Belzile Michelle , Bruera Eduardo , Hanson John
Published: April 2019

We have previously published data on our use of opioids in the last week of life. A change in our pattern of opioid use, i.e. switching opioids more frequently and using high-dose methadone suppositories, appears to have resulted in a decrease in the number of patients requiring high-dose opioids. A retrospective chart review of 100 consecutive patients treated on our palliative care unit during 1992 was completed and compared to the original data from 1990. Results confirmed a decrease in the range of opioids used, as well as a statistically significant decrease in the daily opioid dose in the last week of life. We believe that this difference is most likely due to the use of methadone in patients showing either a poor response to other opioids or a rapid development of tolerance, as well as switching opioids more frequently to take advantage of incomplete cross-tolerance.
Communicating with Patients with Advanced Cancer
Authors: Chan Arlene , Woodruff Roger K.
Published: April 2019

We conducted a prospective study of 130 unselected adults admitted to hospital with advanced malignancy. The study assessed how patients perceived information conveyed to them by physicians and the level of communication between patients and health care staff on questions relating to patients’ understanding, pain control, and sense of well-being. Nearly 10% of patients were unaware of a diagnosis of cancer. Of those who knew their diagnosis, one quarter stated that the diagnosis was not disclosed in a clear or caring manner. One third of patients had an incomplete understanding of their prognosis, and patients generally overestimated their understanding when compared to hospital medical officers (HMOs) and nurses. The severity of pain was underestimated by the HMOs in 63% to 89% of patients. Thus HMOs require specific training in communication skills and the management of chronic cancer-related pain in patients with incurable cancer. Professional interpreters should be employed for all patients who are not fluent in English.
The Edmonton Symptom Assessment Scale (ESAS) as an Audit Tool
Authors: Dudgeon Deborah J. , Harlos Michael , Clinch Jennifer J.
Published: April 2019

To ensure quality of care, palliative care programs need to document the effectiveness of their relief of physical and psychological distress. The Edmonton Symptom Assessment Scale (ESAS) is a validated, reliable instrument developed to measure 9 different symptoms in palliative care patients. To see if symptom management could be compared across institutions, we first reviewed the charts of 188 successive admissions to the palliative care unit at St. Boniface General Hospital, Winnipeg, Manitoba. Our study showed that the ESAS is a useful audit tool for assessing patterns of palliative symptom control that allows for institutional comparisons. Procedures that ensure completeness of data collection remain to be developed.
Genetic or Other Causation Should Not Change the Clinical Diagnosis of Cerebral Palsy
Authors: MacLennan Alastair H. , Lewis Sara , Moreno-De-Luca Andres , Fahey Michael , Leventer Richard J. , McIntyre Sarah , Ben-Pazi Hilla , Corbett Mark , Wang Xiaoyang , Baynam Gareth , Fehlings Darcy , Kurian Manju A. , Zhu Changlian , Himmelmann Kate , Smithers-Sheedy Hayley , Wilson Yana , Ocaña Carlos Santos , van Eyk Clare , Badawi Nadia , Wintle Richard F. , Jacobsson Bo , Amor David J. , Mallard Carina , Pérez-Jurado Luis A. , Hallman Mikko , Rosenbaum Peter J. , Kruer Michael C. , Gecz Jozef
Published: April 2019

High throughput sequencing is discovering many likely causative genetic variants in individuals with cerebral palsy. Some investigators have suggested that this changes the clinical diagnosis of cerebral palsy and that these individuals should be removed from this diagnostic category. Cerebral palsy is a neurodevelopmental disorder diagnosed on clinical signs, not etiology. All nonprogressive permanent disorders of movement and posture attributed to disturbances that occurred in the developing fetal and infant brain can be described as “cerebral palsy.” This definition of cerebral palsy should not be changed, whatever the cause. Reasons include stability, utility and accuracy of cerebral palsy registers, direct access to services, financial and social support specifically offered to families with cerebral palsy, and community understanding of the clinical diagnosis. Other neurodevelopmental disorders, for example, epilepsy, have not changed the diagnosis when genomic causes are found. The clinical diagnosis of cerebral palsy should remain, should prompt appropriate genetic studies and can subsequently be subclassified by etiology.
“You Just Come to School, If You Made It, Its Grace”: Young Black Women’s Experiences of Violence in Utilizing Public “Minibus Taxi” Transport in Johannesburg, South Africa
Authors: Eagle Gillian , Kwele Kgomotso
Published: April 2019

The “minibus taxi” industry in South Africa is a dominant transport provider for many scholars and students. The industry is characterized by a misogynistic culture and high risk of exposure to violence. What forms of violence are young Black women students in Johannesburg, South Africa, exposed to as commuters compelled to use “minibus taxis” to travel to university? What is the psychological impact of this exposure” What coping mechanisms are employed to manage in this environment? Ten Black female students aged between 19 and 24 registered at a Johannesburg-based university were interviewed. All used “minibus taxis” to travel to and from campus on a daily basis. A qualitative method was employed entailing data collection by means of individual face-to-face interviews conducted by the second author. Data were analyzed according to Braun and Clarke’s guidelines for thematic analysis. Key themes related to exposure, impact, and coping were identified and elaborated. Interviewees commonly reported polyvictimization entailing exposure to several different forms of violence, including accident risk and dangerous driving, abuse and aggression by and between drivers, street crime, and sexual harassment and violation. Impact took the form of anxiety and fear, evidenced in conjunction with “thought blocking” and resignation, and showed features consistent with continuous traumatic stress. Both emotion-focused coping, in the form of prayer, and problem-focused coping, in the form of considered choices about conduct within the commuting space, were employed. Greater attention should be paid to the enduringly stressful impact of minibus taxi commuting for young women as exposure to interpersonal violence in public space is commonplace and has significant psychological costs. Policy makers concerned with public safety should intensify the focus on risks of interpersonal violence for women compelled to use public transport systems.
Neurocognitive Predictors of Understanding of Intentions in Parkinson Disease
Authors: Kosutzka Zuzana , Kralova Maria , Kusnirova Alice , Papayova Mariana , Valkovic Peter , Csefalvay Zsolt , Hajduk Michal
Published: April 2019

Objectives:

Theory of Mind (ToM), the ability to understand other people’s mental states, is essential in everyday social interactions. The relationship between cognitive domains and ToM impairment in Parkinson disease (PD) has been receiving growing attention with ambiguous findings. The objective of the current study was to ascertain which cognitive domain predicts understanding of intentions and the impact of PD-specific clinical measures on ToM performance. A secondary aim was to evaluate whether cognitive impairment mediates the relationship between severity of illness and ToM impairment.

Methods:

Fifty-one nondemented patients with idiopathic PD, ranging from early to advanced stages, were enrolled. A comprehensive neurocognitive battery and 2 ToM tasks (Hinting Task and Comic Strip Task) were administered during the patients’ best “on” medication state.

Results:

Only the task of measuring working memory capacity was significantly associated with both ToM tasks (Hinting Task Spearman rank correlation [ rs] = 0.309, P ≤ .05; Comic Strip Task rs = 0.595, P ≤ .01). Patients with more progressed disease and higher doses of dopaminergic medication performed significantly worse in the Comic Strip Task. Based on the mediation analysis, relationship between the severity of the illness and understanding of intentions was mediated by cognitive flexibility.

Conclusion:

In PD, understanding of intentions is related to neurocognition, with working memory and cognitive flexibility playing a crucial role. The severity of PD predicts ToM performance.
Investigation of carbon fiber–reinforced thermoplastic polymers using thermogravimetric analysis
Authors: Giżyński Maciej , Romelczyk-Baishya Barbara
Published: April 2019

The high chemical resistance of the advanced thermoplastic polymers, such as polyether ether ketone (PEEK), polystyrene (PS), or polyamide (PA), makes methods of the composites’ composition evaluation based on chemical etching difficult and tedious. Wider application of the composites with thermoplastic matrix creates a need to find more capable, faster, and easier method of fiber and void content determination. Thermogravimetric analysis (TGA) is known to be one of the most promising candidates. Numerous reports have shown that TGA could be successfully applied for glass-reinforced composites. In this study, carbon fiber/PEEK composite was investigated. Initial tests showed that a simple method based on total burn-up of the matrix cannot be used for such advanced composites due to the high thermal resistance of PEEK. Tests carried with various parameters and microscopic investigation of the degradation process allowed to propose an analysis method that can give a satisfactory outcome. Results obtained with carbon fiber/PEEK composite using TGA-based method matched those obtained by chemical etching. Supplementary investigation of PA-based and epoxy resin composites showed the applicability of the method to a wider group of both thermoplastics- and thermoset-based carbon fiber–reinforced composites.
Adaptation and Validation of Active Aging Index Among Older Vietnamese Adults
Authors: Pham Vu Tuan , Chen Ya-Mei , Van Duong Tuyen , Nguyen Thao Phuong Thi , Chie Wei-Chu
Published: April 2019

Objective: The objective of this study was to adapt and validate the Vietnamese version of Active Aging Index (AAI). Method: We conducted an expert panel, focus groups, test–retest and examination of internal consistency, and construct and concurrent validity among 804 older Vietnamese adults. Results: Scale content validity index (CVI) was 0.98. Test–retest coefficients ranged from 0.70 to 1.00. The Cronbach’s alphas of well-being, voluntary, affordability, and politics were 0.94, 0.70, 0.65, and 0.16, respectively. Voluntary and well-being had good construct validity. Regarding politics, only one of four items had good test–retest reliability (Kappa 0.84), while other three had low variance in both test–retest and field study. In exploratory factor analysis, items assessing affordability loaded on three components. AAI was positively associated with perceived health, life satisfaction, and quality of life; it was negatively associated with falls, loneliness, and frailty. Discussion: In adapting AAI, researchers should consider cultural sensitivity. Key modifications, findings, explanations, and suggestions are presented here.
Simulation and experiment study of the self-excited oscillating mixer with abrasive jet used for the descaling of rusty steel
Authors: Ji Hui , Cao Xiurong , Nie Songlin , Yin Fanglong
Published: April 2019

A novel self-excited oscillating mixer is developed for the descaling of strip steel, which synthesizes the post-mixed abrasive water jet and self-excited oscillation. The realizable k-ɛ model is selected to investigate the effects of different abrasive entrance, inlet pressure, mixing chamber diameter, and length on the jet characteristics. Meanwhile, the effects of different inlet pressure and target distance on the outlet velocities for two kinds of mixers (including the developed mixer and conventional post-mixing mixer) with or without abrasive jet are investigated through simulation. Experiment as well as simulation results exhibited: (1) The oblique abrasive entrance can accelerate the mixture of water and abrasive due to its larger turbulent kinetic energy, and its outlet velocity is larger than that of radial and axial abrasive entrances. (2) For the developed mixer, the outlet velocity is preferable when the mixing chamber diameter is about 40–50 mm and the mixing chamber length is 20 mm. (3) The descaling efficiency of the developed mixer is superior to that of conventional post-mixing mixer. The research will lay foundation to optimize the structure of self-excited oscillating mixer for the descaling of rusty steel.
Optimization of the high-speed train head using the radial basis function morphing method
Authors: Li Rui , Xu Ping , Yao Shuguang
Published: April 2019

Aerodynamic drag reduction is one of the most important issues in the development of high-speed trains. This study focused on the aerodynamic optimization of the train by modifying the shape of the head car and tail car. Three shape parameters were studied in this paper: the angle of cab-window, nose-length, and nose-width of the train. The effects of shape parameters on the aerodynamic drag coefficients of the head car and tail car were discussed, respectively. It can be concluded that the flat surface of the window region, long and sharp nose are the distinguishing characters of a high-speed train with low resistance. Response surface models of the shape parameters and the aerodynamic drag of the head car and tail car were obtained, respectively. Based on these models, an aerodynamic optimization was performed to achieve the optimal shape. As a result, the total aerodynamic drag of the optimal train decreased by 2.05% compared with the original value.
A frequency domain model for analysing vibrations in large-scale integrated building–bridge structures induced by running trains
Authors: Zhang Xun , Ruan Linghui , Zhao Yu , Zhou Xiaogang , Li Xiaozhen
Published: April 2019

Integrated building–bridge structures are increasingly common in high-speed railway stations, where the elevated track floor is directly subjected to train–track dynamic forces that result in excessive vibrations. The common methods of predicting the train-induced vibrations in large-scale IBBS are implemented in the time domain and can have prohibitively long computation times. This paper presents a frequency domain model for the vibration analysis of large-scale IBBS, with the aim of reducing the computation time while retaining sufficient accuracy. The model consists of three coupled subsystems: train, track, and IBBS. The train and track subsystems are investigated analytically, and the IBBS subsystem is solved numerically using a finite element method. The receptance technique is introduced to obtain the wheel/rail force. The force transmitted to the floor slab is treated as the vibration source of the IBBS subsystem. The simulated vibration levels in the IBBS subsystem are compared with those obtained from in situ measurements, and a good agreement is observed in terms of both magnitude and frequency dependence. The vibration responses of the IBBS subsystem at different locations of the track floor and the waiting floor are compared, and the influence of the track position is investigated. Finally, a parametric analysis is conducted with the aim of formulating anti-vibration measures, in which the carbody acceleration, rail displacement, and ballast acceleration are considered as key indicators. The force transmission, vibration transmission and IBBS vibrations are also investigated. The results indicate that using a ballast mat and enlarging the column cross-section are the two most promising measures for reducing the vibration levels.
Drug interaction after ritonavir discontinuation: considerations for antiretroviral therapy changes in renal transplant recipients
Authors: Jimenez Humberto R , Natali Kayla M , Zahran Ali Abdel Rahman
Published: April 2019

Organ transplantation among people living with human immunodeficiency virus (PLHIV) is increasing. Guidelines recommend any changes in antiretroviral therapy (ART) prior to transplantation, but there are limited data regarding ART changes post transplantation. We report a case where an ART switch from a protease inhibitor-based regimen to dolutegravir plus emtricitabine/tenofovir alafenamide in a renal transplant recipient led to subtherapeutic tacrolimus concentrations and an increased serum creatinine (SCr). A workup for graft rejection was performed (including kidney biopsy and cytomegalovirus and BK virus polymerase chain reaction) following the rise in SCr, which was higher than expected from dolutegravir initiation (via organ cation transporter 2 inhibition). This case highlights the potential challenges of switching ART regimens in PLHIV post transplantation.
Micro-power generation using micro-turbine (moving) and thermophotovoltaic (non-moving) systems
Authors: Hosseini Seyed Ehsan
Published: April 2019

Combustion-based micro-power generation is a serious candidate for substitution of traditional batteries. As the volume of combustion system decreases to small-scale combustors, ignition and combustion stability are becoming considerable challenges due to short residence time and large heat loss. To overcome these shortages, several experimental investigations have been implemented to generate micro-power using both moving (micro-turbines) and non-moving (thermophotovoltaic) systems. Although the goal of both systems is to generate micro-power via combustion phenomenon, the approaches to the goal is different. Nevertheless, combustion instability and various shortages in burner and combustor have been noticed by several researchers regardless of the micro-power generation method. In this paper, a review about recent development in application of small-scale combustion in micro-power generation and micro-thruster systems using micro-turbine and thermophotovoltaic systems is presented. The special focus of this paper is on flame regimes, fuel/oxidizer mixing, flame stability conditions, heat recirculation, non-equilibrium transport, flame-wall thermal and kinetic couplings, and improvement of energy conversion efficiency.
Integration of elicited expert information via a power prior in Bayesian variable selection: Application to colon cancer data
Authors: Boulet Sandrine , Ursino Moreno , Thall Peter , Landi Bruno , Lepère Céline , Pernot Simon , Burgun Anita , Taieb Julien , Zaanan Aziz , Zohar Sarah , Jannot Anne-Sophie
Published: April 2019

Background

Building tools to support personalized medicine needs to model medical decision-making. For this purpose, both expert and real world data provide a rich source of information. Currently, machine learning techniques are developing to select relevant variables for decision-making. Rather than using data-driven analysis alone, eliciting prior information from physicians related to their medical decision-making processes can be useful in variable selection. Our framework is electronic health records data on repeated dose adjustment of Irinotecan for the treatment of metastatic colorectal cancer. We propose a method that incorporates elicited expert weights associated with variables involved in dose reduction decisions into the Stochastic Search Variable Selection (SSVS), a Bayesian variable selection method, by using a power prior.

Methods

Clinician experts were first asked to provide numerical clinical relevance weights to express their beliefs about the importance of each variable in their medical decision making. Then, we modeled the link between repeated dose reduction, patient characteristics, and toxicities by assuming a logistic mixed-effects model. Simulated data were generated based on the elicited weights and combined with the observed dose reduction data via a power prior. We compared the Bayesian power prior-based SSVS performance to the usual SSVS in our case study, including a sensitivity analysis using the power prior parameter.

Results

The selected variables differ when using only expert knowledge, only the usual SSVS, or combining both. Our method enables one to select rare variables that may be missed using only the observed data and to discard variables that appear to be relevant based on the data but not relevant from the expert perspective.

Conclusion

We introduce an innovative Bayesian variable selection method that adaptively combines elicited expert information and real world data. The method selects a set of variables relevant to model medical decision process.
War craft: The embodied politics of making war
Authors: Tidy Joanna
Published: April 2019

This article makes the case for examining war from what Stephanie Bunn calls a ‘making point of view’. Makers and their material production of and for war have been neglected in our accounts of war, security and international relations. An attention to processes of making for war can reveal important things about how such processes are lived and undertaken at the level of the body. The article focuses on the particular phenomena of martial craft labour – the recreational making of ‘stuff’, including hats and pillowcases, by civilians for soldiers. To explore embodiment within this social site, an ethnographic method is outlined that enables the reading of objects as embodied texts, the observation of others in processes of making, and the undertaking of making by the researcher. Analysing embodied registers of aesthetic expression and the social values that attend such crafting for war reveals how this making is a space through which intimate embodied, emotional circulations undertake work for liberal-state and military-institutional logics and objectives, obscure violence, normalize war, and produce the military as an abstract social cause. Beyond the immediate empirical focus of this article, a much wider political entanglement of violence, embodiment and material production necessitates a concerted research agenda.
The role of responsibility in oncological emergency telephone calls
Authors: Pedersen Birgith , Uhrenfeldt Lisbeth , Jacobsen Heidi Ramlov , Jørgensen Lone
Published: April 2019

Background:

Patients and their caregivers are expected to take joint responsibility for reporting symptoms and seeking medical assistance, for example, by calling oncology emergency telephones or other helplines during a cancer trajectory.

Research objective:

The aim was to explore the meaning of responsibility as it appeared in patients’ or caregivers’ experiences of calling an oncological emergency telephone.

Design, participants and context:

Inspired by qualitative description and qualitative content analysis, a secondary analysis of data from interviews with 12 participants calling the oncological emergency telephone at a Danish university hospital was performed.

Ethical considerations:

The project observes demands for safekeeping data and all regulations concerning research ethics in agreement with the Nordic Nurses Federation and the Danish Health Act.

Findings:

Two main themes emerged: (1) to act responsibly as a patient or caregiver was to ‘be watchful and alert’, ‘report symptoms the right way’ and ‘do crosschecking’ and (2) to deal with the burden of responsibility was to ‘feel safe when dealing with the burden of responsibility’ and ‘be relieved from the burden of responsibility’.

Discussion:

Too much responsibility and a potential imbalance between healthcare professionals’ expectations and callers’ knowledge and capacity to act may place additional burdens on the callers, which may be eased by person-centred care.

Conclusion:

The meaning of responsibility appeared in the participants’ capacity to act, where they observed, assessed and reported symptoms and controlled prescribed treatments as well as shared or handed over the responsibility to the healthcare providers. Thus, the analysis provided essential knowledge for healthcare professionals on how patients and caregivers handle this responsibility when faced with a cancer disease that is treated on an outpatient basis.
Do Country ETFs Influence Foreign Stock Market Index? Evidence from India ETFs
Authors: Narend S. , Thenmozhi M.
Published: April 2019

We examine the influence of country exchange traded funds (ETFs) on the country’s stock market indices, irrespective of their underlying benchmark. A pooled ordinary least square (OLS) analysis of a sample of 28 India ETFs listed in the US, UK, Canada, France, Japan, Israel and Singapore reveals that India ETFs have a significant impact on the country’s stock indices. We also document reverse causal dynamics between country ETFs and the country’s stock indices. The results are robust even after controlling for global effects, stock market volatility, foreign institutional investor (FII) flows, foreign exchange rate and asset size of India ETFs. The findings of the study have implications for global investors and policymakers in both emerging and developed markets. Policymakers would find it compelling to monitor country ETFs’ fund flows into the underlying country, as withdrawal of country ETFs could have a cascading effect on the economy.

JEL Classification: G11, G15, G23
Quality of Informal Jobs in India’s Banking Sector: A Primary Study Through the “Decent Work” Framework
Authors: Jaiswal Nitu
Published: April 2019

“Decent Work” is International Labour Organization’s (ILO) umbrella strategy to promote the “quality of work/job” for all, which is aimed at more productive, well-remunerative and better quality jobs. However, the prevalence of informal employment and growing “informalization” of jobs indicate a general deterioration in the quality of work. The present study, based on a primary survey of employees in banking sector, shows that the “decent work” framework has had limited influence on the growing non-standard forms of employment (NSFE) in India. Even in a sector like banking, which is considered more formal and regulated, jobs fell short of “decent work” criteria. This article explores various indicators that have been used to gauge “quality of jobs” from the literature and shows how the prevailing NSFE in the Indian banking sector lack almost all of them. Analysis of the primary data shows that workers in NSFEs have lower levels of job satisfaction and receive low wages and minimal or no training. The findings of the study confirm that NSFEs do not ensure basic labour rights and decent standard of living and are also not desirable when compared to permanent jobs.
A Foxtail-Shaped Vermilion Flap to Reconstruct the Medial Tubercle in Asymmetric Bilateral Cleft Lip With Contralateral Lesser Form Defect
Authors: Nakajima Yuta , Yuzuriha Shunsuke , Nagai Fumio , Fujita Kenya , Noguchi Masahiko
Published: April 2019

Objective:

There have been few reports addressing asymmetric bilateral cleft lip repair with contralateral lesser form defects. Two studies have described the thin medial tubercle as the most common remaining labial deformity. In this study, we aimed to evaluate the use of a foxtail-shaped vermilion flap to reconstruct the median tubercle in primary repair.

Design:

A blinded retrospective study of photography and chart review.

Setting:

Shinshu University Hospital, tertiary care. Private practice.

Patients:

Forty-nine patients with asymmetric bilateral cleft lip with lesser form defects treated using a primary “unilateral” repair by the senior author (S.Y.) between 2007 and 2017.

Interventions:

The foxtail-shaped vermilion flap was applied at the time of the primary nasolabial repair. This flap is similar to Noordhoff laterally based triangular vermilion flap but with modifications to the shape and length. The body of the flap is wider than the pedicle to add tissue to the center of the vermilion, and the length is sufficiently elongated to reach the lesser side.

Main Outcome Measure:

Lip shape was graded on a 4-point scale when patients were 1 year old.

Results:

Twenty-two patients were treated with the foxtail-shaped vermilion flap (group A) and 27 patients with Noordhoff triangular vermilion flap (group B). Group A had a better lip shape than group B ( P = .006).

Conclusions:

The foxtail-shaped vermilion flap is useful to reconstruct the median tubercle in asymmetric bilateral cleft lip repair with contralateral lesser form defects.
When “Journalism Kids” Do Better: A Reassessment of Secondary and Postsecondary Achievement and Activities
Authors: Bobkowski Piotr S. , Cavanah Sarah B.
Published: April 2019

Using data from the nationally representative Education Longitudinal Study of 2002, this study examined how journalism participation in high school relates to subsequent academic outcomes. The analysis statistically controlled for a host of correlates of academic achievement, isolating the associations between journalism participation and subsequent outcomes. Results indicated that students who take more journalism in high school score higher than their peers on standardized tests of English; are more likely to major in journalism or related fields; and when they do, have higher grades in college English. Students who participate in extracurricular journalism also see some of these gains.
Enhancing the electrical and thermal conductivities of polymer composites via curvilinear fibers: An analytical study
Authors: Salviato Marco , Phenisee Sean E
Published: April 2019

The new generation of manufacturing technologies such as additive manufacturing and automated fiber placement has enabled the development of material systems with desired functional and mechanical properties via particular designs of inhomogeneities and their mesostructural arrangement. Among these systems, particularly interesting are materials exhibiting curvilinear transverse isotropy (CTI), in which the inhomogeneities take the form of continuous fibers following curvilinear paths designed to, for example, optimize the electric and thermal conductivity, and the mechanical performance of the system. In this context, the present work proposes a general framework for the exact, closed-form solution of electrostatic problems in materials featuring CTI. First, the general equations for the fiber paths that optimize the electric conductivity are derived, leveraging a proper conformal coordinate system. Then, the continuity equation for the curvilinear transversely isotropic system is derived in terms of electrostatic potential. A general exact, closed-form expression for the electrostatic potential and electric field is derived and validated by finite element analysis. Finally, potential avenues for the development of materials with superior electric conductivity and damage sensing capabilities are discussed.