bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimating local need for mental healthcare to inform fair resource allocation in the NHS in England: cross-sectional analysis of national administrative data linked at person level
Authors: Anselmi Laura , Everton Anna , Shaw Robert , Suzuki Wataru , Burrows Jeremy , Weir Richard , Tatarek-Gintowt Roman , Sutton Matt , Lorrimer Stephen
Published: August 2019

Background

Equitable access to mental healthcare is a priority for many countries. The National Health Service in England uses a weighted capitation formula to ensure that the geographical distribution of resources reflects need.

Aims

To produce a revised formula for estimating local need for secondary mental health, learning disability (intellectual disability) and psychological therapies services for adults in England.

Method

We used demographic records for 43 751 535 adults registered with a primary care practitioner in England linked with service use, ethnicity, physical health diagnoses and type of household, from multiple data-sets. Using linear regression, we estimated the individual cost of care in 2015 as a function of individual- and area-level need and supply variables in 2013 and 2014. We sterilised the effects of the supply variables to obtain individual-need estimates. We aggregated these by general practitioner practice, age and gender to derive weights for the national capitation formula.

Results

Higher costs were associated with: being 30–50 years old, compared with 20–24; being Irish, Black African, Black Caribbean or of mixed ethnicity, compared with White British; having been admitted for specific physical health conditions, including drug poisoning; living alone, in a care home or in a communal environment; and living in areas with a higher percentage of out-of-work benefit recipients and higher prevalence of severe mental illness. Longer distance from a provider was associated with lower cost.

Conclusions

The resulting needs weights were higher in more deprived areas and informed the distribution of some 12% (£9 bn in 2019/20) of the health budget allocated to local organisations for 2019/20 to 2023/24.
Impact of Peer Review in the Radiation Treatment Planning Process: Experience of a Tertiary Care University Hospital in Pakistan
Authors: Qureshi Bilal Mazhar , Mansha Muhammad Atif , Karim Muneeb Uddin , Hafiz Asim , Ali Nasir , Mirkhan Benazir , Shaukat Fatima , Tariq Maria , Abbasi Ahmed Nadeem
Published: August 2019

PURPOSE

To evaluate and report the frequency of changes in radiation therapy treatment plans after peer review in a simulation review meeting once a week.

MATERIALS AND METHODS

Between July 1 and August 31, 2016, the radiation plans of 116 patients were discussed in departmental simulation review meetings. All plans were finalized by the primary radiation oncologist before presenting them in the meeting. A team of radiation oncologists reviewed each plan, and their suggestions were documented as no change, major change, minor change, or missing contour. Changes were further classified as changes in clinical target volume, treatment field, or dose. All recommendations were stratified on the basis of treatment intent, site, and technique. Data were analyzed by Statistical Package for the Social Sciences and are presented descriptively.

RESULTS

Out of 116 plans, 26 (22.4%) were recommended for changes. Minor changes were suggested in 15 treatment plans (12.9%) and a major change in 10 (8.6%), and only one plan was suggested for missing contour. The frequency of change recommendations was greater in radical radiation plans than in palliative plans (92.3% v 7.7%). The head and neck was the most common treatment site recommended for any changes (42.3%). Most of the changes were recommended in the technique planned with three-dimensional conformal radiation therapy (50%). Clinical target volume (73.1%) was identified as the most frequent parameter suggested for any change, followed by treatment field (19.2%) and dose (0.08%).

CONCLUSION

Peer review is an important tool that can be used to overcome deficiencies in radiation treatment plans, with a goal of improved and individualized patient care. Our study reports changes in up to a quarter of radiotherapy plans.
High-Deductible Health Plans and Cancer Survivorship: What Is the Association With Access to Care and Hospital Emergency Department Use?
Authors: Zheng Zhiyuan , Jemal Ahmedin , Banegas Matthew P. , Han Xuesong , Yabroff K. Robin
Published: August 2019

PURPOSE:

To examine the associations among high-deductible health plan (HDHP) enrollment, cancer survivorship, and access to care and utilization.

MATERIALS AND METHODS:

The 2010 to 2017 National Health Interview Survey was used to identify privately insured adults ages 18 to 64 years (cancer survivors, n = 4,321; individuals without a cancer history, n = 95,316). We used multivariable logistic regressions to evaluate the associations among HDHP/health savings account (HSA) status, delayed/forgone care for financial reasons, and hospital emergency department (ED) visits among cancer survivors compared with individuals without a cancer history.

RESULTS:

Among cancer survivors, HDHPs with or without HSA (8.9% and 13.9%, respectively; both P < .05) were associated with more delayed/forgone care compared with low-deductible health plans (LDHPs) (7.9%). HSA enrollment was associated with less delayed/forgone care among HDHP cancer survivors ( P < .05). ED visits were similar by insurance type. Among individuals without a cancer history, HDHP with or without HSA (9.5% and 10.8%, respectively; both P < .05) were both associated with more delayed/forgone care compared with LDHPs (5.9%). HSA enrollment also was associated with less delayed/forgone care among HDHP enrollees without a cancer history. A small difference in ED visits was observed between HDHPs without HSA (15.3%) and LDHPs (14.1%; P < .05) or HDHPs with HSA (13.4%; P < .05) among individuals without a cancer history.

CONCLUSION:

HDHP enrollment and HSA status affect access to care and hospital ED visits similarly by cancer history. HDHP enrollment may serve as a barrier to access to care among cancer survivors, although HSA enrollment coupled with an HDHP may mitigate the impact on access. HDHPs and HSA status were not associated with ED visits among cancer survivors. Improvement to care coordination efforts may be needed to reduce ED visits among privately insured cancer survivors.
A Narrative Review of Placental Contribution to Adverse Pregnancy Outcomes in Women With Polycystic Ovary Syndrome
Authors: Kelley Angela S , Smith Yolanda R , Padmanabhan Vasantha
Published: August 2019

Context

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy of reproductive-aged women. In pregnancy, women with PCOS experience increased risk of miscarriage, gestational diabetes, preeclampsia, and extremes of fetal birth weight, and their offspring are predisposed to reproductive and cardiometabolic dysfunction in adulthood. Pregnancy complications, adverse fetal outcomes, and developmental programming of long-term health risks are known to have placental origins. These findings highlight the plausibility of placental compromise in pregnancies of women with PCOS.

Evidence Synthesis

A comprehensive PubMed search was performed using terms “polycystic ovary syndrome,” “placenta,” “developmental programming,” “hyperandrogenism,” “androgen excess,” “insulin resistance,” “hyperinsulinemia,” “pregnancy,” and “pregnancy complications” in both human and animal experimental models.

Conclusions

There is limited human placental research specific to pregnancy of women with PCOS. Gestational androgen excess and insulin resistance are two clinical hallmarks of PCOS that may contribute to placental dysfunction and underlie the higher rates of maternal–fetal complications observed in pregnancies of women with PCOS. Additional research is needed to prevent adverse maternal and developmental outcomes in women with PCOS and their offspring.
Longitudinal Changes in Fasting and Glucose-Stimulated GLP-1 and GIP in Healthy Older Subjects
Authors: Pham Hung , Marathe Chinmay S , Phillips Liza K , Trahair Laurence G , Hatzinikolas Seva , Huynh Lian , Wu Tongzhi , Nauck Michael A , Rayner Christopher K , Horowitz Michael , Jones Karen L
Published: August 2019

Context

It is not known whether glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) levels correlate within individuals, nor whether levels change with age. Previous studies have all been cross-sectional in design.

Objective

To evaluate longitudinal changes in fasting and glucose-stimulated incretin hormone concentrations in healthy older subjects.

Patients and Design

Forty-one healthy older subjects had measurements of plasma GLP-1 and GIP while fasting and after a 75-g oral glucose load on two occasions separated by 5.9 ± 0.1 years [mean age at the initial study: 71.2 ± 3.8 (SD) years]. Breath samples were collected to calculate the gastric 50% emptying time (T50).

Results

For GLP-1, both fasting concentrations (P < 0.001) and area under the curve 0 to 120 minutes (P = 0.001) were decreased at followup. Fasting GIP was also lower (P = 0.03) at follow up, but there was no change in the area under the curve 0 to 120 minutes (P = 0.26). The gastric emptying T50 was slower at followup (P = 0.008). Neither the change in T50 nor the body mass index at the initial study was a determinant of the change in incretin responses. Between the two study days, fasting GIP (r = 0.72, P < 0.001) correlated well, but not fasting GLP-1 (r = 0.23, P = 0.18). However, both glucose-stimulated GLP-1 (r = 0.50, P = 0.002) and GIP (r = 0.60, P < 0.001) showed correlations between the initial and follow-up studies.

Conclusions

Fasting GIP and glucose-stimulated GLP-1 and GIP concentrations correlate within individuals over a follow-up period of ∼5.9 years. Aging is associated with reductions in fasting GLP-1 and GIP, and glucose-stimulated GLP-1, which may predispose to the development of glucose intolerance and type 2 diabetes.
Apolipoprotein(a) Kinetics in Statin-Treated Patients With Elevated Plasma Lipoprotein(a) Concentration
Authors: Ma Louis , Chan Dick C , Ooi Esther M M , Marcovina Santica M , Barrett P Hugh R , Watts Gerald F
Published: August 2019

Background

Lipoprotein(a) [Lp(a)] is a low-density lipoprotein‒like particle containing apolipoprotein(a) [apo(a)]. Patients with elevated Lp(a), even when treated with statins, are at increased risk of cardiovascular disease. We investigated the kinetic basis for elevated Lp(a) in these patients.

Objectives

Apo(a) production rate (PR) and fractional catabolic rate (FCR) were compared between statin-treated patients with and without elevated Lp(a).

Methods

The kinetics of apo(a) were investigated in 14 patients with elevated Lp(a) and 15 patients with normal Lp(a) levels matched for age, sex, and body mass index using stable isotope techniques and compartmental modeling. All 29 patients were on background statin treatment. Plasma apo(a) concentration was measured using liquid chromatography–mass spectrometry.

Results

The plasma concentration and PR of apo(a) were significantly higher in patients with elevated Lp(a) than in patients with normal Lp(a) concentration (all P < 0.01). The FCR of apo(a) was not significantly different between the groups. In univariate analysis, plasma concentration of apo(a) was significantly associated with apo(a) PR in both patient groups (r = 0.699 and r = 0.949, respectively; all P < 0.01). There was no significant association between plasma apo(a) concentration and FCR in either of the groups (r = 0.160 and r = −0.137, respectively).

Conclusion

Elevated plasma Lp(a) concentration is a consequence of increased hepatic production of Lp(a) particles in these patients. Our findings provide a kinetic rationale for the use of therapies that target the synthesis of apo(a) and production of Lp(a) particles in patients with elevated Lp(a).
Region-specific changes inMus musculusbrain size and cell composition under chronic nutrient restriction
Authors: Barbeito-Andrés Jimena , Castro-Fonseca Emily , Qiu Lily R. , Bernal Valeria , Lent Roberto , Henkelman Mark , Lukowiak Kenneth , Gleiser Pablo M. , Hallgrimsson Benedikt , Gonzalez Paula N.
Published: August 2019

Nutrition is one of the most influential environmental factors affecting the development of different tissues and organs. It is suggested that under nutrient restriction the growth of the brain is relatively spared due to differential allocation of resources from other organs. However, it is not clear whether this sparing occurs brain-wide. Here, we analyze morphological changes and cell composition in different regions of the offspring mouse brain after maternal exposure to nutrient restriction during pregnancy and lactation. Using high resolution magnetic resonance imaging, we found that brain regions were differentially sensitive to maternal protein restriction and exhibited particular patterns of volume reduction. The cerebellum was reduced in absolute and relative volume, while cortex volume was relatively preserved. Alterations in cell composition (examined by the isotropic fractionator method) and organization of white matter (measured by diffusor tensor images) were also region-specific. These changes were not related to the metabolic rate of the regions and were only partially explained by their specific growth trajectories. This study is a first step towards understanding the mechanisms of regional brain sparing at micro and macrostructural levels resulting from undernutrition.
The interaction between suction feeding performance and prey escape response determines feeding success in larval fish
Authors: Sommerfeld Noam , Holzman Roi
Published: August 2019

The survival of larval marine fishes during early development depends on their ability to capture prey. Most larval fish capture prey by expanding their mouth, generating a “suction flow” that draws the prey into it. These larvae dwell in a hydrodynamic regime of intermediate Reynolds numbers, shown to impede their ability to capture non-evasive prey. However, the marine environment is characterized by an abundance of evasive prey, such as Copepods. These organisms sense the hydrodynamic disturbance created by approaching predators and perform high-acceleration escape maneuvers. Using a 3D high-speed video system, we characterized the interaction between Sparus aurata larvae and prey from a natural zooplankton assemblage that contained evasive prey, and assessed the factors that determine the outcome of these interactions. 8-33 day post hatching larvae preferentially attacked large prey that was moving prior to the initialization of the strike, however feeding success was lower for larger, more evasive prey. Thus, larvae were challenged in capturing their preferred prey. Larval feeding success increased with increasing Reynolds numbers, but decreased sharply when the prey performed an escape maneuver. The kinematics of successful strikes resulted in a shorter response time but higher hydrodynamic signature available for the prey, suggesting that strike success in our experiments was determined by brevity rather than stealth, i.e. executing a fast strike eliminated a potential escape response by the prey. Our observations of prey selectivity as it happens, reveal that larval performance, rather than preferences, determines their diet during early development.
Properties of predictive gain modulation in a dragonfly visual neuron
Authors: Fabian Joseph M. , Dunbier James R. , O'Carroll David C. , Wiederman Steven D.
Published: August 2019

Dragonflies pursue and capture tiny prey and conspecifics with extremely high success rates. These moving targets represent a small visual signal on the retina and successful chases require accurate detection and amplification by downstream neuronal circuits. This amplification has been observed in a population of neurons called Small Target Motion Detectors (STMDs), through a mechanism we termed predictive gain modulation. As targets drift through the neuron's receptive field, spike frequency builds slowly over time. This increased likelihood of spiking or gain is modulated across the receptive field, enhancing sensitivity just ahead of the target's path, with suppression of activity in the remaining surround. Whilst some properties of this mechanism have been described, it is not yet known which stimulus parameters modulate the amount of response gain. Previous work suggested that the strength of gain enhancement was predominantly determined by the duration of the target's prior path. Here we show that predictive gain modulation is more than a slow build-up of responses over time. Rather, the strength of gain is dependent on the velocity of a prior stimulus combined with the current stimulus attributes (e.g. angular size). We also describe response variability as a major challenge of target detecting neurons and propose that the predictive gain modulation's role is to drive neurons towards response saturation, thus minimising neuronal variability despite noisy visual input signals.
Hemodynamic responses to warming in euryhaline rainbow trout -implications of the osmo-respiratory compromise
Authors: Morgenroth Daniel , Ekström Andreas , Hjelmstedt Per , Gräns Albin , Axelsson Michael , Sandblom Erik
Published: August 2019

In seawater, rainbow trout (Oncorhynchus mykiss) drink and absorb water through the gastrointestinal tract to compensate for water passively lost to the hyperosmotic environment. Concomitantly, they exhibit elevated cardiac output and a doubling of gastrointestinal blood flow to provide additional O2 to the gut and increase convective flux of absorbed ions and water. Yet, it is unknown how warming waters, which elevates tissue O2 demand and the rate of diffusion of ions and water across the gills (i.e. the osmo-respiratory compromise), affects these processes. We measured cardiovascular and blood variables of rainbow trout acclimated to freshwater and seawater during acute warming from 11 to 17°C. Relative to freshwater-acclimated trout, cardiac output was 34% and 55% higher in seawater-acclimated trout at 11 and 17°C, respectively, which allowed them to increase gastrointestinal blood flow significantly more during warming (increases of 75% in seawater vs. 31% in freshwater). These adjustments likely served to mitigate the impact of warming on osmotic balance, as changes in ionic and osmotic blood composition were minor. Furthermore, seawater-acclimated trout seemingly had a lower tissue O2 extraction, explaining why trout acclimated to freshwater and seawater often exhibit similar metabolic rates, despite a higher cardiac output in seawater. Our results highlight a novel role of gastrointestinal blood perfusion in the osmo-respiratory compromise in fish, and improve our understanding of the physiological changes euryhaline fishes must undergo when faced with interacting environmental challenges such as transient warming events.
Adult anthropometry in Type 2 diabetic population: A case-control study
Authors: Qureshi Sarah Shoaib , Amer Wasim , Kaleem Maryam , Mahmood Bilal
Published: August 2019

Objectives: This study was aimed to compare the body mass index (BMI) and waist-to-hip ratio (WHR) in their ability to predict type 2 diabetes risk in a large prospective cohort of men and women in Pakistan.

Methods: This was a case-control study conducted at Diabetic and medical OPD of GTTH. Anthropometric measures including BMI and WHR were analyzed. Student’s t-test, Chi-squared test along with Cramer’s V value, was applied to evaluate association between variables. Receiver operating curve (ROC) was used to assess anthropometric measures.

Results: The study included 804 diabetics and 396 non-diabetics between 30–60 years of age. Comparing the BMI parameters it was found that 717 (89·2%) in diabetic group were overweight or obese (p-value < 0·001). On comparing the WHR, 97·9% diabetics had increased WHR (p-value <0·001). Both BMI & WHR were further compared using ROC curve which found out that WHR had an area under ROC of 0·720 & BMI has 0·680, suggesting that WHR is more better predictor of diabetes as compared to BMI.

Conclusions: Both BMI and WHR were strong discriminators of T2DM but WHR was found superior according to ROC value. Family history is significantly associated in patients with diabetes.

doi: https://doi.org/10.12669/pjms.35.5.759

How to cite this:Qureshi SS, Amer W, Kaleem M, Beg BM. Adult anthropometry in Type 2 diabetic population: A case-control study. Pak J Med Sci. 2019;35(5):1284-1289. doi: https://doi.org/10.12669/pjms.35.5.759

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Dismal situation of cardio pulmonary resuscitation knowledge and skills among junior doctors in twin cities of Pakistan
Authors: Ghauri Sanniya  Khan , Javaeed Arslaan , Shah Faiza , Ghani Misbah-ul-Hasan
Published: August 2019

Objective: To assess the knowledge, attitude, and practice of cardio pulmonary resuscitation (CPR) among junior doctors in 13 tertiary care hospitals of Rawalpindi and Islamabad.

Methods: A total of 317 junior doctors from 13 tertiary care hospitals in Rawalpindi and Islamabad in Pakistan were included in this cross-sectional study. Data were collected using a 37-item interviewer-administered structured questionnaire by the researchers. Informed consent and ethical approval were secured. Doctors’ knowledge, attitude, and practice regarding CPR were presented and compared across the demographic variables (age, gender, CPR training etc.). Data analysis was done using SPSS V 23 at an alpha level of 5%.

Results: Response rate for this study was 87.08%. Abbreviations of BLS, AED, and EMS were known by 94.3%, 36.0%, and 41.0% doctors respectively. No doctor had complete knowledge of CPR. Less than half of the participants knew the proper compression depths. Overall knowledge regarding CPR steps was poor. Out of 31 CPR knowledge, attitude, and practice related questions 21 correct answers were given by two doctors which was the highest score. The mean KAP score was 14.18 ± 0.15.

Conclusion: Awareness regarding CPR is essential for all doctors. Many authorities in developed countries are giving CPR training to the general population whereas in Pakistan, many of the doctors never had CPR training. The current study showed the clear majority wants hands-on CPR training. Hospital authorities may find this as an opportunity to improve the knowledege and skills of health workers.

doi: https://doi.org/10.12669/pjms.35.5.785

How to cite this:Ghauri SK, Javaeed A, Shah F, Ghani MH. Dismal situation of cardio pulmonary resuscitation knowledge and skills among junior doctors in twin cities of Pakistan. Pak J Med Sci. 2019;35(5):1295-1300. doi: https://doi.org/10.12669/pjms.35.5.785

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Malaria elimination transmission and costing in the Asia-Pacific: a multi-species dynamic transmission model
Authors: Silal Sheetal Prakash , Shretta Rima , Celhay Olivier J. , Gran Mercado Chris Erwin , Saralamba Sompob , Maude Richard James , White Lisa Jane
Published: August 2019

Background: The Asia-Pacific region has made significant progress in combatting malaria since 2000 and a regional goal for a malaria-free Asia Pacific by 2030 has been recognised at the highest levels. External financing has recently plateaued and with competing health risks, countries face the risk of withdrawal of funding as malaria is perceived as less of a threat. An investment case was developed to provide economic evidence to inform policy and increase sustainable financing.

Methods: A dynamic epidemiological-economic model was developed to project rates of decline to elimination by 2030 and determine the costs for elimination in the Asia-Pacific region. The compartmental model was used to capture the dynamics of Plasmodium falciparum and Plasmodium vivax malaria for the 22 countries in the region in a metapopulation framework. This paper presents the model development and epidemiological results of the simulation exercise.

Results: The model predicted that all 22 countries could achieve Plasmodium falciparum and Plasmodium vivax elimination by 2030, with the People’s Democratic Republic of China, Sri Lanka and the Republic of Korea predicted to do so without scaling up current interventions. Elimination was predicted to be possible in Bangladesh, Bhutan, Malaysia, Nepal, Philippines, Timor-Leste and Vietnam through an increase in long-lasting insecticidal nets (and/or indoor residual spraying) and health system strengthening, and in the Democratic People’s Republic of Korea, India and Thailand with the addition of innovations in drug therapy and vector control. Elimination was predicted to occur by 2030 in all other countries only through the addition of mass drug administration to scale-up and/or innovative activities.

Conclusions: This study predicts that it is possible to have a malaria-free region by 2030. When computed into benefits and costs, the investment case can be used to advocate for sustained financing to realise the goal of malaria elimination in Asia-Pacific by 2030.
Culture as education: From transmediality to transdisciplinary pedagogy
Authors: Ojamaa Maarja , Torop Peeter , Fadeev Alexandr , Milyakina Alexandra , Pilipovec Tatjana , Rickberg Merit
Published: August 2019

For the past three years, the Transmedia Research Group at the Department of Semiotics, University of Tartu, has been developing open access online materials for supporting the teaching of humanities-related subjects in Estonian- and Russianlanguage secondary schools. This paper maps the theoretical and conceptual starting points of these materials. The overarching goal of the educational platforms is to support cultural coherence and autocommunication by cultivating literacies necessary for holding meaningful dialogues with cultural heritage. To achieve the goal, the authors have been seeking ways of purposeful harnessing of transmedial, crossmedial and other tools offered by the contemporary digital communication space. We have started with an understanding of culture as education – a model which is grounded in cultural semiotics and highlights the role of cultural experience and cultural self-description in learning literacies. From these premises we proceed to explicating the value of a transdisciplinary pedagogy for methodical translation of the theoretical concepts into practical solutions in teaching and learning culture.
Urban trees as social triggers: The case of the Ginkgo biloba specimen in Tallinn, Estonia
Authors: Magnus Riin , Sander Heldur
Published: August 2019

Urban trees are considered to be essential and integral to urban environments, to contribute to the biodiversity of cities as well as to the well-being of their inhabitants. In addition, urban trees may also serve as living memorials, helping to remember major social eruptions and to cement continuity with the past, but also as social disruptors that can induce clashes between different ideals of culture. In this paper, we focus on a specific case, a Ginkgo biloba specimen growing at Süda Street in the centre of Tallinn, in order to demonstrate how the shifts in the meaning attributed to a non-human organism can shape cultural memory and underlie social confrontations. Integrating an ecosemiotic approach to human-non-human interactions with Juri Lotman’s approach to cultural memory and cultural space, we point out how non-human organisms can delimit cultural space at different times and how the ideal of culture is shaped by different ways of incorporating or other species in the human cultural ideal or excluding them from it.
Medical Tourism and Inclusive Growth: Significance of Ayurveda Sector
Authors: John Jacob , Chelat Seema
Published: August 2019

Medical tourism has emerged as a critical component of tourism  in  India.    Medical  tourism,  a  subset  of  health tourism, is an emerging segment of tourism industry and there  are  only  a  few  serious  studies  conducted  on  the topic. With the growing importance of medical tourism and the thrust given by central and state governments to promote tourism, the paper explores the potential role of Ayurveda  in  medical  tourism  sector. A  survey  of practitioners, manufacturers, researchers, representatives of various associations in Ayurveda sector was carried out and the findings of the  survey, which have policy implications, have been used to explore the possibilities of promoting Ayurveda sector in the medical tourism with the  participation  of  local  government  institutions  and community in  order  to  achieve  inclusive  growth.  The dominance of small and medium enterprises, individual researchers  and  practitioners, and labour  intensive operations in Ayurveda based medical tourism and its impact on inclusive growth is highlighted. The paper also aims to formulate an action plan to address the critical issues of Ayurveda sector to enable it to play a central role in medical tourism.
A Study on the Prospects and Potential Threats to the Hospitality Industry in India
Authors: Abraham Sherry , Kumar C Rajesh
Published: August 2019

The hospitality sector in India plays a vital role in terms of contributions to the economy of the country as an employment generator. The much wanted growth in the tourism sector of the country is in fact dependent on the growth and development of the hospitality sector. However, the ability of the hospitality sector to remain viable, profitable and competitive in the years to come will depend on its ability to foresee emerging trends and then capitalize on them. This is most essential, given that India, despite having high tourist potential, attracts far lesser foreign tourists as compared to smaller countries like Singapore, Thailand and Malaysia. This paper examines the key trends that are set to emerge in the hospitality sector in the country over the next decade. An exploratory methodology was used in this research including both theoretical and empirical methods. From the theoretical studies, it was found that these key trends include the growth of domestic tourism, the emergence of medical tourism as the key attraction in India, the development of tier 2 and tier 3 cities as important tourist hubs and the shift in tourist traffic away from luxury formats which have hitherto dominated the hotel industry and towards economically priced mid – level and budget hotels.
The Green Souvenir Industry of Kerala – A Comprehensive Analysis
Authors: Robinet Jacob , Mahadevan P , Anita T A
Published: August 2019

Handicrafts and souvenirs have a long and glorious tradition behind them. They represent the culture of the people and from a great heritage of art. Souvenirs are a manifestation of the creative impulse of people. The specialty of the handicraft is that it reflects the craftsmanship of each and every part of the country. Souvenirs always remind a traveller of a particular place that it was purchased from. Souvenir trade improves the local economy and even serves as a brand image or icon of the destination visited by tourists while providing easy visibility. Souvenirs also help in the word of mouth marketing of a destination. The souvenir trade worldwide is part of a rich handicraft tradition that evolved over the years. India has a diversity of souvenirs, and so does Kerala. The uniqueness of Kerala isits abundance of plant or natural fibre-based souvenirs. But, little research has been done on the process of production or the potential it provides in promoting tourism. This study is an attempt to look into the problems and prospects of plant or natural fibre based - ‘green souvenirs’ of Kerala and to offer suggestions for improving its market.
Editorial
Authors: Thomas Joby
Published: August 2019

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Assessment of Carrying Capacity of Tourist Destinations in Dakshina Kannada District, Karnataka
Authors: Kumar Tiriveedhi Dileep , Kumar Hatkar Sathish
Published: August 2019

In recent times, tourism has emerged as one of the most popular economic activities. In view of the economic production of Dakshina Kannada District, tourism plays a vital role. Dakshina Kannada District boasts of various activities like beach tourism, cultural, religious, education, and eco-tourism. Though enriched with tourism resources, this region has not utilised them enough to convert them into economic resources. This research is done to understand and find out the carrying capacity of tourist destinations in Dakshina Kannada District that will help us make tourism plans and strategic development activities so as to make the most of the resources available.
Strategic Use of Social Media in Tourism Marketing: A Comparative Analysis of Official Tourism Boards
Authors: Choudhury Rashmiranjan , Mohanty Priyakrushna
Published: August 2019

Marketing has reached new heights with social media platforms. In the changing scenario of the service industry, tourism is seen to receive the most attention from customers, stakeholders and other sectors through social media. The development of communication technology has enriched social media marketing. In India, Facebook has taken a lead role because of its market outreach and user count. Different tourism associates use this medium to showcase their products and services. In this context, Kerala is way ahead in social media marketing strategies while Odisha is in the niece states. This paper aims to analyse the social media marketing strategies adopted by the Odisha tourism board and other tourism boards through a comparative analysis. The study suggests some strategic measures for Odisha tourism board to ensure the effective use of social media in tourism.
Ecotourism in Eaglesnest, West Kameng, Arunachal Pradesh: A Case Study
Authors: Lobo Peter
Published: August 2019

This study was aimed at exploring tourism resources and Ecotourism  behaviour of  tourists  and  local  people to provide  guidelines  for  Ecotourism  development  of Eaglesnest,  West  Kameng, Arunachal Pradesh.  Tourists were  selected  by  applying  the  method  of  convenience sampling,  wherein, local  people  were  interviewed in depth to gather local information. Results of the research showed  that  Eaglesnest had  an  outstanding  tourism resource  which  was Bird  watching, especially after  the discovery of the new species of bird to the world, which is known as Bugun Liochicla, which attracted tourists from all over the world. Most of the tourists received tourism information from trip reports and advertising. They were normally grouped visitors who visited the destination for wildlife, especially Bird watching. On an average, they stayed over seven nights at different campsites. Nearly all tourists were aware of Ecotourism. The most attractive resource  was  Bird  watching.  They  also admired  the landscapes, the scenery of the forest and mountains
Emergency care for children in the prehospital phase
Authors: Строзенко Людмила , Strozenko Lyudmila , Лобанов Юрий , Lobanov Yuri , Иванов Игорь , Ivanov Igor' , Морозова Ольга , Morozova Ol'ga , Зиновьева Людмила , Zinov'eva Lyudmila
Published: August 2019

The training manual provides definitions of the main emergency conditions in children, the criteria for clinical diagnosis and the sequence of actions of a pediatrician to provide emergency care at the prehospital stage and to decide on the further place of treatment.
Minimising pain and medical adhesive related skin injuries in vulnerable patients
Authors: Collier Mark
Published: August 2019

The skin is the largest and one of the most important organs of the body and as such it is essential that skin integrity is maintained to preserve normal body functions as much as possible at all times. Health professionals must endeavour to minimise any pain and trauma likely to be encountered by their patients through the use of a variety of medical products and devices that are designed to adhere to the skin, especially as the use of dermatological and wound-management products in particular, that incorporate adhesives to help keep them secure and in place, has grown in line with the increasingly ageing population and changing demographics throughout the UK. This article reviews the literature related to the causes of medical-adhesive-related skin injuries (MARSIs) and the reported patient effects, in particular pain and skin trauma and highlight some ‘at-risk’ patient groups and potential actions to minimise risk. A sterile silicone medical adhesive remover—Appeel Sterile—is introduced and the clinical benefits highlighted through the discussion of clinical evidence and case studies undertaken on a range of patients with varied aetiologies.
The incidence and prevalence of medical device-related pressure ulcers in intensive care: a systematic review
Authors: Barakat-Johnson Michelle , Lai Michelle , Wand Timothy , Li Mengbo , White Kathryn , Coyer Fiona
Published: August 2019

Objective:

The objective of this review was to synthesise the literature and evaluate the incidence, prevalence and severity of medical device-related pressure ulcers (MDRPU) in adult intensive care patients.

Method:

Electronic databases and additional grey literature were searched for publications between 2000 and 2017. Outcome measures included cumulative incidence or incidence rate, point prevalence or period prevalence as a primary outcome and the severity and location of the pressure ulcer (PU) as secondary outcome measures. Included studies were assessed for risk of bias using a nine-item checklist for prevalence studies. The heterogeneity was evaluated using 12 statistic.

Results:

We included 13 studies in this review. Prevalence was reported more frequently than incidence. Pooled data demonstrated a high variation in the incidence and prevalence rates ranging from 0.9% to 41.2% in incidence and 1.4% to 121% in prevalence. Heterogeneity was high. Mucosal pressure injuries were the most common stage reported in the incidence studies whereas category II followed by category I were most commonly reported in the prevalence studies. In the incidence studies, the most common location was the ear and in the prevalence studies it was the nose.

Conclusion:

While MDRPU are common in intensive care patients, it is an understudied area. Inconsistency in the staging of MDRPU, along with variations in data collection methods, study design and reporting affect the reported incidence and prevalence rates. Standardisation of data reporting and collection method is essential for pooling of future studies.
A Celiac Disease Phenotype After Checkpoint Inhibitor Exposure: An Example of Immune Dysregulation After Immunotherapy
Authors: Arnouk Joud , Mathew Don , Nulton Ethan , Rachakonda Vikrant
Published: August 2019

Celiac disease is characterized by duodenal inflammation after exposure to gluten. Checkpoint inhibitors are antibodies that inhibit the inhibitory signals of the cytotoxic T lymphocytes to enhance antitumor responses. A 79-year-old man with an unknown history of celiac disease underwent treatment with pembrolizumab for recurrent left maxillary melanoma. He subsequently developed diarrhea and weight loss. Serology was positive for anti-tissue transglutaminase immunoglobulin A. Upper endoscopy revealed duodenal villous atrophy, which was confirmed on biopsy. A gluten-free diet was not tolerated, and symptoms resolved with withdrawal of pembrolizumab and steroid administration for another medical reason.
Multicenter Validation Study of a Diagnostic Algorithm to Detect NASH and Fibrosis in NAFLD Patients With Low NAFLD Fibrosis Score or Liver Stiffness
Authors: Liebig Stephanie , Stoeckmann Neele , Geier Andreas , Rau Monika , Schattenberg Joern M. , Bahr Matthias J. , Manns Michael P. , Jaeckel Elmar , Schulze-Osthoff Klaus , Bantel Heike
Published: August 2019

OBJECTIVES:

Nonalcoholic steatohepatitis (NASH) and fibrosis play critical roles for the prognosis of patients with nonalcoholic fatty liver disease (NAFLD). Identification of patients at risk of NASH and fibrosis is therefore critical for disease management. NAFLD Fibrosis Score (NFS) and transient elastography (TE) have been suggested to exclude advanced fibrosis. However, there is increasing evidence that also patients with NASH and early fibrosis are at risk of disease progression and complications, emphasizing the need for improved noninvasive risk stratification in NAFLD.

METHODS:

Because hepatocyte apoptosis plays an early role in NASH pathogenesis, we evaluated whether the apoptosis biomarker M30 might identify NAFLD patients who are at risk of NASH and fibrosis despite low NFS or TE values. Serum M30 levels were assessed by enzyme-linked immunosorbent assay in combination with NFS and/or TE in an exploration (n = 103) and validation (n = 100) cohort of patients with biopsy-proven NAFLD.

RESULTS:

Most patients with low NFS (cutoff value < −1.455) revealed increased M30 levels (>200 U/L) in the exploration (62%) and validation (67%) cohort, and more than 70% of them had NASH, mostly with histological fibrosis. Vice versa, most patients with NFS < −1.455 but nonelevated M30 levels showed no NASH. NASH was also detected in most patients with indeterminate NFS (−1.455 to 0.676) but elevated M30 levels, from which ∼90% showed fibrosis. Similar results were obtained when using TE instead of NFS.

DISCUSSION:

The combination of the M30 biomarker with NFS or TE enables a more reliable identification of patients with an increased risk of progressed NAFLD and improves patient stratification.
Believe It or Not: Strategic Licensing Makes R&D Alliance Profitable
Authors: Banerjee Tannista , Sengupta Aditi
Published: August 2019

We consider a market where firms (that compete in the product market) invest in the research and development (R&D) activities with no guaranteed success and engage in a patent race for intellectual property rights. We analyze the effects of a strategic (ex ante) licensing contract on the equilibrium investment behavior of competing firms that form a research and development (R&D) alliance to win a patent race. We show that the R&D alliance members that sign strategic licensing contract invest more in the R&D and earn higher expected profits compared to the firms in an R&D cartel and R&D joint venture cartel without any strategic licensing as well as the firms that aggressively compete in the innovation market to win the patent race.
Proposed pedagogies for teaching and learning chemical bonding in secondary education
Authors: Tsaparlis Georgios , Pappa Eleni T. , Byers Bill
Published: August 2019

In a preceding publication (Tsaparlis, G., Pappa, E. T., & Byers, B. (2018). Teaching and learning chemical bonding: Research-based evidence for misconceptions and conceptual difficulties experienced by students in upper secondary schools and the effect of an enriched text.Chemistry Education Research and Practice,19(4), 1253–1269), we reviewed previous studies on students’ misconceptions and conceptual difficulties with the topic of chemical bonding and tested the knowledge of tenth-grade Greek students on certain key aspects of bonding. In addition, we presented an enriched teaching text on this topic for the tenth grade and examined its effectiveness with regard to the same aspects of bonding. In the present study, we review earlier studies, which made proposals concerning the teaching of this topic, and provide some proposals of our own, based on the findings of our previous study. We recommend that a spiral curriculum spanning all three upper-secondary grades should be adopted. A learning progressions approach, employing lower and upper anchors of relevant scientific knowledge is considered, and a proposed list of potential core concepts, lever concepts, and stepping-stones are presented. Finally, the pros and cons of a modern qualitative quantum mechanical approach to bonding are considered.
Preparation and performance of polypropylene separator modified by SiO2/PVA layer for lithium batteries
Authors: Wang Xiaodong , Hu Yuan , Li Lei , Fang Haiyan , Fan Xu , Li Shengfei
Published: August 2019

An aqueous silica (SiO2) dispersion was prepared by using silica as ceramic particles, polyvinyl alcohol (PVA) as a binder and deionized water as a dispersion medium. A SiO2 ceramic layer was applied to the surface of the polypropylene (PP) separator by dip coating. The separators before and after modification were characterized by XRD, SEM, DTA, lyophilic performance test, contact angle test and heat resistance test. The separators were assembled into lithium-ion batteries for electrochemical performance test. The results show that after the successful introduction of SiO2/PVA coating on the surface of PP separator, the lyophilic and heat resistance and electrochemical performance of PP separator have been improved significantly. The battery rate performance and cycle performance are significantly improved. Especially the capacity retention rate of the original separator was only 75.79% at 100 charge-discharge times, and that of the modified separator was as high as 87.18%.
Word form shapes are selected to be morphotactically indicative
Authors: Baumann Andreas , Prömer Christina , Ritt Nikolaus
Published: August 2019

This paper explores the hypothesis that morphotactically ambiguous segment sequences should be dispreferred and selected against in the evolution of languages. We define morphotactically ambiguous sequences as sequences that can occur both within morphemes and across boundaries, such as final /nd/ or /mz/ in ModE, which occur in simple forms likewindoralmsand in complex ones likesinnedorseems. We test the hypothesis in two diachronic corpus studies of Middle and Early Modern English word forms ending in clusters of sonorants followed by /d/ or /t/ and /s/ or /z/. These clusters became highly frequent after the loss of unstressed vowels in final syllables and were highly ambiguous when they emerged. Our data show that the ambiguity of these final clusters was indeed reduced so that the distribution of the final clusters became increasingly skewed: clusters ending in voiceless coronals became significantly clearly indicative of simple forms, while clusters ending in voiced ones came to signal inflectional complexity more reliably.
The history of /-n/ loss in English: Phonotactic change with lexical and grammatical specificity
Authors: Minkova Donka , Lefkowitz Michael
Published: August 2019

In Old English, /-n/ loss started in early Northumbrian and spread to the southern dialects after about 1050. An important diagnostic of the transition to Middle English, the loss is commonly assumed to be morphologically driven. However, /-n/ loss in atonic syllables could also be phonologically-conditioned:aweġ‘away’<onweġ,abūtan‘about’<onbūtan. In Middle English, the loss proceeded rapidly, but the triggers behind the different rates of change and the different results for the various categories have not been fully explored. UsingLAEME, we survey all attestations of /-n/ loss, enriching the empirical data-base on the change. The findings show significant differences within word-classes, and differences between inflectional and derivational suffixes. This raises a set of theoretical questions: why did only /-n/ inflections lose their codas, why was the productivity of verbal derivational /-n/ phonotactically restricted, what justifies the loss or retention of /-n/ in stems? We look into the interplay of phonological and morphological factors, isolate the sets in which the results appear to be phonotactically driven, and address the phonotactic dimension in relation to other factors, both within and above the word level. In noun plurals, /-n/ loss emerges as the clearest case of avoidance of phonotactically suboptimal sequences at the word level. A statistical comparison of the end-points of the change reveals that overall frequency has stayed constant and has no obvious direct bearing on the process, while the presence of /-n/ as a morphological marker has changed significantly. The paper ends by identifying aspects of the history of /-n/ that remain uncharted.