bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Methods for Measurement Error Detection in Serial 24-h Hormonal Data
Authors: van der Spoel Evie , Choi Jungyeon , Roelfsema Ferdinand , Cessie Saskia le , van Heemst Diana , Dekkers Olaf M.
Published: June 2019

Measurement errors commonly occur in 24-h hormonal data and may affect the outcomes of such studies. Measurement errors often appear as outliers in such data sets; however, no well-established method is available for their automatic detection. In this study, we aimed to compare performances of different methods for outlier detection in hormonal serial data. Hormones (glucose, insulin, thyroid-stimulating hormone, cortisol, and growth hormone) were measured in blood sampled every 10 min for 24 h in 38 participants of the Leiden Longevity Study. Four methods for detecting outliers were compared: (1) eyeballing, (2) Tukey’s fences, (3) stepwise approach, and (4) the expectation-maximization (EM) algorithm. Eyeballing detects outliers based on experts’ knowledge, and the stepwise approach incorporates physiological knowledge with a statistical algorithm. Tukey’s fences and the EM algorithm are data-driven methods, using interquartile range and a mathematical algorithm to identify the underlying distribution, respectively. The performance of the methods was evaluated based on the number of outliers detected and the change in statistical outcomes after removing detected outliers. Eyeballing resulted in the lowest number of outliers detected (1.0% of all data points), followed by Tukey’s fences (2.3%), the stepwise approach (2.7%), and the EM algorithm (11.0%). In all methods, the mean hormone levels did not change materially after removing outliers. However, their minima were affected by outlier removal. Although removing outliers affected the correlation between glucose and insulin on the individual level, when averaged over all participants, none of the 4 methods influenced the correlation. Based on our results, the EM algorithm is not recommended given the high number of outliers detected, even where data points are physiologically plausible. Since Tukey’s fences is not suitable for all types of data and eyeballing is time-consuming, we recommend the stepwise approach for outlier detection, which combines physiological knowledge and an automated process.
Medically Assisted Dying in Canada: “Beautiful Death” Is Transforming Nurses’ Experiences of Suffering
Authors: Bruce Anne , Beuthin Rosanne
Published: June 2019

Background

Nurses witness pain and distress up close and consequently experience their own suffering. A narrative study of Canadian nurses’ participating in medical assistance in dying found nurses’ previous witnessing of unresolved end-of-life suffering has shaped their acceptance of medical assistance in dying. Little is known about the impact of participating in medically assisted dying on nurses’ suffering.

Purpose

To explore how nurses’ overall experience of suffering is shaped by participating in medical assistance in dying.

Methods

Qualitative secondary analysis using narrative inquiry and thematic analysis.

Results

Nurses’ narratives are chronologically organized addressing experiences of suffering before medical assistance in dying was a legal option and after its implementation. An overarching narrative before the availability of medical assistance in dying is (1) a culture of nurses’ taken-for-granted suffering: feeling terrible. After medical assistance in dying, two key narratives describe (2) transformational feelings of a beautiful death and (3) residual discomfort. Nurses found their suffering transformed when participating in medical assistance in dying; end-of-life care was satisfying and gratifying. And yet, unanswered questions due to worries of becoming desensitized and ongoing deeper questioning remain.

Conclusions

Participating in medical assistance in dying has positively impacted nurses and starkly contrasts their previous experiences caring for those with unbearable suffering. Further research is needed to explore becoming desensitized and long-term emotional impact for nurses.
Clinical Characteristics and Nonconvulsive Seizures in Young Children With Abusive Head Trauma
Authors: Oh Ahyuda , Olson Larry D. , Chern Joshua J. , Kim Hyunmi
Published: June 2019

Aim:

We aimed to evaluate putative predictors of symptoms and signs at admission for nonconvulsive seizure and to examine the impact of nonconvulsive seizures on short-term outcomes.

Method:

We retrospectively collected consecutive abusive head trauma patients (<36 months of age) from the trauma registry at Children’s Healthcare of Atlanta between 2009 and 2014. Multiple logistic regression was performed to assess the putative predictors for the occurrence of nonconvulsive seizures including clinical seizures, altered mental status, respiratory difficulty, and cardiac arrest at admission, while controlling for age, sex, and injury severity. The Mann-Whitney U test and the Fisher exact test were used to compare the short-term outcomes between patients with and without nonconvulsive seizures.

Results:

Two hundred seventy patients with abusive head trauma were identified (male = 55.6%). The median age was 4 months (interquartile range = 2-8 months). Among 70 patients who underwent continuous electroencephalography (EEG), 40 had nonconvulsive seizures (57%) and 21 developed nonconvulsive status epilepticus (30%). Altered mental status at admission was associated with the occurrence of nonconvulsive seizures (odds ratio = 6.8, 95% confidence interval = 1.2-38.2, P = .03). Comparing patients with no seizures, those with nonconvulsive seizures were more likely to stay longer at hospital (9 days vs 14 days, P = .04) and to need rehabilitation (50.0% vs 63.2%, P = .03).

Conclusions:

Nonconvulsive seizures and nonconvulsive status epilepticus was highly prevalent in young pediatric patients with abusive head trauma. Presenting with altered mental status at admission was found to predict the occurrence of nonconvulsive seizures. Nonconvulsive seizures had an unfavorable impact on short-term outcomes.
Secular Trends in Sedentary Behavior Among High School Students in the United States, 2003 to 2015
Authors: Ryu Seungho , Kim Heontae , Kang Minsoo , Pedisic Zeljko , Loprinzi Paul D.
Published: June 2019

Purpose:

To evaluate secular trends in recreational sedentary behavior among high school students in the United States between 2003 and 2015.

Design:

A series of cross-sectional assessments over a 12-year period.

Setting:

Data from the 2003 to 2015 Youth Risk Behavior Surveillance System was used.

Participants:

Samples of 10 978 to 14 894 adolescents, drawn every 2 years: 2003 to 2015.

Measures:

The evaluated recreational self-reported sedentary behaviors included TV hours and computer hours that are not schoolwork.

Results:

For the entire sample, and using polynomial orthogonal coefficients via regression modeling, there was an upward linear trend for total sedentary behavior hours (β = 0.03; p = .001), a downward linear trend in TV watching (β = −0.06; p < .001), and an upward linear trend in computer use (β = 0.08; p < .001) from 2003 to 2015. Similar linear trends ( p < .001) were observed across several subpopulations, including the groups by gender, race/ethnicity, and body mass index. However, various subpopulations differed in TV watching, with black or African American, and obese adolescents having the highest TV watching hours, respectively (eg, 3.82 h/d vs 3.13 h/d in 2015; blacks vs whites; p < .05). Various subpopulations also differed in computer use, with obese adolescents (4.26 h/d in 2015) having the highest computer use.

Conclusion:

There were significant changes from 2003 to 2015 in sedentary behavior patterns in the US adolescent population. Total recreational sedentary behavior increased in this period. Specifically, TV viewing decreased while computer use increased. Continued monitoring of sedentary behavior trends is needed to better understand the changing behaviors of American adolescents and how they relate to changes chronic disease risk.
Using Attention Testing to Select Crowdsourced Workers and Research Participants
Authors: Göritz Anja S. , Borchert Kathrin , Hirth Matthias
Published: June 2019

Crowdsourcing offers fast and cost-effective access to human labor for business projects as well as to research participants for scientific projects. Due to the loose links between crowdsourcing employers and workers, quality control is even more important than in the off-line realm. We developed and validated the web-delivered attention test attentiveWeb in two versions (1) to come up with advance filters to identify workers who produce low-quality results and (2) to gauge the attention of workers who pass the advance filter. We apply attentiveWeb in three parallel user studies: one in the crowdsource Microworkers ( N = 539), another one in Figure Eight ( N = 333), and a third one in the online panel WiSoPanel ( N = 1,837). The user studies confirm that it is useful to apply advance filtering to screen out poor workers. We propose an easily computed filter based on objective user behavior involving attentiveWeb. With regard to attention, despite the more severe advance filtering with Microworkers, their attention was lowest, followed by workers from Figure Eight, and it was highest in WiSoPanel. The platform differences in attention were not entirely explained by known differences—demographic and others—among the users of the three platforms. The attention test attentiveWeb has high Cronbach’s α and split-half reliability. The first version of attentiveWeb predicted performance of the same crowdworkers in the second version of attentiveWeb 2 years later. We release attentiveWeb for assessing crowdworkers’ attention into the research community and the wider public domain. The attention test attentiveWeb is open-source and can be used for free.
Development of a subarctic peatland linked to slope dynamics at Lac Wiyâshâkimî (Nunavik, Canada)
Authors: Bhiry Najat , Decaulne Armelle , Bourgon-Desroches Myosotis
Published: June 2019

A palaeoecological study of a subarctic minerotrophic peatland was undertaken to reconstruct the formation of the site as an archive of slope geomorphological processes. The study peatland is located about 400 m from Caribou slope (unofficial name) on Lepage Island, Lac Wiyâshâkimî, Nunavik (northern Québec, Canada). The site is close to the lakeshore and receives runoff directly from Caribou slope and its catchment. Gravity processes have been active on Caribou slope since the deglaciation of the region at approximately 6000 cal. yr BP. These processes may be differentiated in terms of Holocene stages of intensity. The objective of our study was to detect evidence of gravity processes in the peatland and to note their frequency since its establishment using loss-on-ignition testing, macrofossil analysis and radiocarbon dating. Our results indicate that peat began to accumulate over the sandy-gravelly sediments at around 4900 cal. yr BP. Larix Laricina, Carex aquatilis and Carex rostrata were present at this time until 4660 cal. yr BP, at which point these taxa were replaced by aquatic taxa such as Hippuris vulgaris and Daphnia (aquatic invertebrates). The percentage of mineral sediments (sand) remained high during this period, which could be linked to slope activity. After 4660 cal. yr BP, sandy sediments diminished while episodes of aquatic conditions and sand inflow occurred on at least three occasions (at 4660, 3905 and 3130 cal. yr BP). The increase in water flow and the introduction of more medium to fine sand into the peatland could be linked to slope movements and the long-distance runout of debris flow that we observed in the field. Given these factors, conditions at the study site remained wet from the earliest phases until the present. Unlike the subarctic permafrost peatlands in northern Québec, permafrost did not become established at the study site.
Depressive and anxiety symptom prevalence in childhood-onset systemic lupus erythematosus: A systematic review
Authors: Quilter MC , Hiraki LT , Korczak DJ
Published: June 2019

Background

Depressive and anxiety symptoms are common in children and youth and may impact outcomes for individuals with childhood-onset systemic lupus erythematosus. Research into the prevalence of depressive and anxiety symptoms and childhood-onset systemic lupus erythematosus comorbidity has reported conflicting results.

Objective

To synthesize current knowledge regarding the prevalence of depressive and anxiety symptoms in childhood-onset systemic lupus erythematosus.

Methods

Studies were identified through a comprehensive search of MEDLINE, EMBASE, PsychINFO, LILACS and Web of Science (from database inception to July 2018) using MESH headings and keywords for ‘lupus erythematosus’, and ‘depression’ or ‘anxiety’. Included studies measured depressive and/or anxiety symptoms prospectively among children and youth aged 8 to 21 years with a diagnosis of childhood-onset systemic lupus erythematosus. Neuropsychiatric systemic lupus erythematosus was included. Studies without use of validated screening tools for major depressive disorder or anxiety disorders were excluded, as were studies where diagnosis was by retrospective analysis of patient charts. Data were extracted by two independent coders and where discrepancies occurred, agreement was reached by consensus.

Results

In total, 70 studies met the criteria for full text review and of these, 14 were included in the final analysis. The majority (70%) of studies were of cross-sectional design, with sample sizes ranging from 20 to 100 (mean = 48) participants. The mean age of participants was 15.9 years and participants were predominantly female. Prevalence rates for depressive symptoms ranged from 6.7% to 59%. Anxiety symptom prevalence was 34% to 37%. All studies employed self-report instruments to assess depressive and anxiety symptoms; none of the studies utilized a semi-structured diagnostic interview to make psychiatric diagnoses. Significant heterogeneity precluded meta-analysis of the data.

Conclusions

Depressive and anxiety symptoms may be common comorbidities of childhood-onset systemic lupus erythematosus; however, current research is limited by a paucity of studies, small sample sizes and an inability to confirm psychiatric diagnoses. Future research addressing these limitations is needed.
Processes toward the end of life and dialysis withdrawal Physicians’ and nurses’ perspectives
Authors: Axelsson Lena , Benzein Eva , Lindberg Jenny , Persson Carina
Published: June 2019

Background:

Nurses and physicians in nephrology settings provide care for patients with end-stage kidney disease receiving hemodialysis treatment along a complex illness trajectory.

Aim:

The aim was to explore physicians’ and nurses’ perspectives on the trajectories toward the end of life involving decisions regarding hemodialysis withdrawal for patients with end-stage kidney disease.

Research design and participants:

A qualitative research approach was used. Four mixed focus group interviews were conducted with renal physicians (5) and nurses (17) in Sweden. Qualitative content analysis was used to analyse data.

Ethical considerations:

Ethical approval was obtained (Dnr 2014/304-31).

Findings and discussion:

Findings illuminated multi-faceted, intertwined processes encompassing healthcare professionals, patients, and family members. The analysis resulted in four themes: Complexities of initiating end-of-life conversations, Genuine attentiveness to the patient’s decision-making process, The challenge awaiting the family members’ processes, and Negotiating different professional responsibilities. Findings showed complexities and challenges when striving to provide good, ethical care which are related to beneficence, nonmaleficence, and self-determination, and which can give rise to moral distress.

Conclusion:

There are ethical challenges and strains in the dialysis context that healthcare professionals may not always be prepared for. Supporting healthcare professionals in not allowing complexities to hinder the patient’s possibilities for shared decision-making seems important. An open and continual communication, including family meetings, from dialysis initiation could serve to make conversations involving decisions about hemodialysis withdrawal a more natural routine, as well as build up a relationship of trust necessary for the advance care planning about the end of life. Healthcare professionals should also receive support in ethical reasoning to meet these challenges and handle potential moral distress in the dialysis context.
Managing Internal Marketing Channel Conflict: A Proposal for Narrative Epistemology
Authors: Aman Asad
Published: June 2019

This article calls for extending the understanding and management of the channel conflict that occurs between competing sales teams inside a manufacturer organization. This internal battle occurs as the sales teams try to sell manufacturer products to two different channel members (e.g., retailers, wholesalers, etc.) in the same market and, as a result, compete for quotas, sales targets, promotional budgets, etc. The article argues that by drawing on narrative epistemology, which has extensively been applied in management research, marketing scholars and practitioners can gain novel insights through which understanding and management of internal channel conflict could be enhanced. An epistemological review of the extant literature on the topic in the field of Industrial Marketing is presented. Drawing on the narrative method, three narratives told by competing groups in the context of Pakistan’s evolving fast moving consumer goods (FMCG) distribution channel are constructed, and an empirical model is developed for narrative analysis. It is shown that the understanding of various narrative logics and alignments can help in positive interventions in the channel story network.
Global Financial Crisis: Dynamics of Liquidity Risk in Emerging Asia
Authors: Kumar Suraj , Prasanna Krishna
Published: June 2019

This study investigates the dynamic impact of global and regional liquidity along with volatility on the liquidity of emerging Asian equity markets. Further, we empirically disentangle the effects of volatility and liquidity. We find that the external liquidity factors have a higher impact on domestic liquidity as compared to volatility. The impact of global volatility shocks was witnessed only during the Global Financial Crisis. Global factors have a higher influence on developed markets such as Japan and Singapore, while regional factors have a higher influence on emerging markets. These results indicate that liquidity serves as the channel of regional integration in Asia. The findings of this study provide useful insights to cross-sections of stakeholders in the investment industry.

JEL Classification: G15, F21, F36
How to Deal with Inequality: What Policymakers Should Know
Authors: Ahluwalia Montek S.
Published: June 2019

High and rising levels of inequality have become a hot topic of discussion in both industrialized and developing countries in recent years. In this article, the author focuses on four different aspects. The first section provides a brief commentary on how inequality has moved to the center stage and different elements that drove this process in industrialized and developing countries. The second section presents an assessment of the available data that suggest what has happened to income distribution in a select group of industrialized and developing countries. The third section discusses some of the determinants of income distribution, which we need to understand if we want to reduce the degree of inequality. The fourth section discusses the scope for corrective action in this area with special reference to emerging market countries.
Disruption in Global Economic Governance
Authors: Bayer Kurt
Published: June 2019

This article is concerned with problems and with the future of global economic governance. It does not deal with political, military or security questions, even though many of those are closely related to economic conditions. Recent decades have seen an increasing deterioration in the multilateral system of economic cooperation: its long-term dominant movers, the OECD (“Western”) countries, have not allowed the system to adjust adequately to the economic rise of emerging and developing countries; globalization, based on “Western” economic thinking and the concomitant unleashing of the forces of cross-border financial flows, has contributed (together with technological innovations) to gross inequalities and social disruption within countries; and the environmental damages caused by the global order (trade and investment) have led to massive degradation and climate change which threatens our way of life. Recent actions by the US president and nationalist tendencies in large parts of the world have further eroded the necessary spirit of cooperation.

This article argues that in order to provide an adequate supply of global public goods, a regime of global rules is worth “saving,” if with both restructured content and institutional adjustments. Today, however, political developments do not favor a systematic re-ordering of global institutions. A multi-polar world will at best permit smaller cooperative agreements on individual issues by “coalitions of the willing,” based on countries’ and regions’ respective strategic interests. Plurilateralism, instead of multilateralism, will be the most likely, but more chaotic, organizing principle in the foreseeable future. Provision of global public goods, and the interests of smaller and weaker countries, and with that world stability, will suffer.
How Status-seeking States Can Cooperate: Explaining India–China Rapprochement After the Doklam Standoff
Authors: Xie Chao
Published: June 2019

Noticing the gap in the existing literature, this article attempts to argue that status-seeking motives do not necessarily result in zero-sum games and hence tries to summarise conditions for status-seekers to manage conflicts and realise cooperation with one another through creative use of social mobility and creativity strategies. As a case study, this article examines the evolving relations between India and China since 2013 and demonstrates how relations between these two status-seeking states can become confrontational with conflicting status-seeking incentives. For some time, the status competition seemingly dominated their interactions, when India was not willing to accept China’s power status second only to the USA, and China reluctant to recognise India as another rising power with nuclear capabilities. After the Donglang (Doklam) standoff, both governments are finding ways to manage an indirect path for cooperation through a newly discovered multilateral framework. The elements contributing to the stability of their relations lie in their choice of international identity and political calculations in which they can engage with the other based on their shared interests in fostering solidary among developing countries.
Literature Review: Design Thinking and Place
Authors: Overmyer Trinity , Carlson Erin Brock
Published: June 2019

Design-thinking frameworks help professionals to design solutions for complex problems. Design processes take into account the context of a problem, and among these contextual factors is place. Because place is relational, capturing dynamic relationships between other factors of design problems, it deserves special attention from stakeholders trying to tackle wicked problems. This literature review elaborates on the relationship between place and design thinking, focusing on the importance of privileging place in user-centered design processes.
Physical exercise and social interaction in complex environments reverse memory deficits induced by inhalants
Authors: Mercadillo Roberto E , Mosco-Aquino Ricardo , Páez-Martínez Nayeli
Published: June 2019

Inhalant abuse is a global issue with major behavioral, cognitive, and social consequences. Some effects of this abuse are observed in memory deficits, but the organism–environment interactions are poorly understood. We propose that studying environmental enrichment (EE) in animal models allows the elucidation of adaptive behavior mechanisms to face harmful effects, as well as plausible translational interventions; however, the effects of the different elements that comprise the complexity of EE must be determined. In this work, we measured the effects of housing under five environments for 4 weeks on memory impairments induced by the repeated administration of toluene in mice (4000 ppm, 30 min/day for 4 weeks). Recognition memory was recovered after housing in a complete enriched environment involving voluntary exercise with running wheels, cognitive stimulation with objects to explore, and social interaction. However, enrichment with only voluntary exercise in social conditions produced a significant memory recovery. In addition, EE in isolation showed fewer beneficial effects, while cognitive stimulation, even under social conditions, did not reverse the memory impairment by itself. We argue that physical exercise and social interaction could derive in cognitive enhancement and be used to advise on psychosocial interventions.
Diagnosis of Papillary Breast Lesions on Core Needle Biopsy: Upgrade Rates and Interobserver Variability
Authors: Qiu Lianqun , Mais Daniel D. , Nicolas Marlo , Nanyes Jennifer , Kist Kenneth , Nazarullah Alia
Published: June 2019

The histologic distinction between papillary breast lesions remains challenging, especially with core biopsy (CB) specimens. A retrospective review of the clinical, imaging, and histologic findings was performed for patients with papillary breast lesions on CB from 2013 to 2017. The interpretation accuracy was expressed as upgrade rate relative to the excision diagnosis. Diagnostic reproducibility with and without immunohistochemistry was analyzed as interobserver variability among 3 board-certified pathologists. Among 57 papillary lesions with biopsies and excisions available for review, the upgrade rates were 0% for benign papilloma, 30% for papilloma with atypical ductal hyperplasia, and 25% for papilloma with ductal carcinoma in situ, resulting in an overall upgrade rate of 11.1%. There were no statistical differences between patients in an upgrade group and others, when comparing the patient age, clinical presentation, BI-RADS (Breast Imaging Reporting and Database System) category, location, and histologic grade. The overall interobserver variability of the 60 consecutive core biopsies of papillary breast lesions by morphology alone was in the “substantial” agreement range (κ = 0.79, 86% agreement), with an excellent κ score of 0.88 for papilloma (92% agreement). “Substantial” and “fair” κ values were seen for papilloma with atypical ductal hyperplasia/ductal carcinoma in situ (0.74, 84% agreement) and invasive carcinoma (0.40, 60% agreement). Use of immunohistochemical stains improved the κ values into “excellent” range (0.92, 94% agreement). Our study favors a conservative approach in the management of benign papillomas, at least in cases of good radiologic-pathologic concordance. Papillary breast lesions with atypia/malignancy show lower diagnostic reproducibility on CB, and utility of immunohistochemistry is recommended in challenging cases.
Serous Cystadenoma of the Pancreas With Complex Florid Papillary Architecture: A Case Report and Review of the Literature
Authors: Tracht Jessica , Reid Michelle D. , Hissong Erika , Sekhar Aarti , Sarmiento Juan , Krasinskas Alyssa , Xue Yue
Published: June 2019

Serous cystadenoma (SCA) is a relatively rare benign pancreatic neoplasm. It has a very distinctive gross and microscopic appearance including pure and mixed microcystic and macrocystic patterns as well as rare solid architectural pattern. In this article, we present a rare case of SCA with a complex florid papillary architecture. A 40-year-old man was diagnosed with a 3.5 cm SCA of the uncinate process of the pancreas based on abdominal computed tomography scan. The tumor was monitored radiographically until recent magnetic resonance imaging showed a new 1.0-cm eccentric mural nodule within the tumor with multiple arterial enhancing septations and features suspicious for a neuroendocrine tumor. A pylorus-preserving Whipple procedure was subsequently performed and the mass was resected. Gross examination confirmed the radiological findings of a well-demarcated, 3.5 cm multicystic pancreatic lesion with a 1.0 cm circumscribed, tan solid nodule at its periphery. Microscopic evaluation revealed a predominantly microcystic pattern classical of SCA with occasional macrocysts. The 1.0 cm discrete nodule was also a SCA, but showed unusually exuberant complex papillary growth. To our knowledge, this is the first reported case describing this morphologic variant. Recognition of this rare and unusual pattern is important to avoid misdiagnosis, especially on small biopsy specimens.
Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium
Authors: Rivera-Lebron Belinda , McDaniel Michael , Ahrar Kamran , Alrifai Abdulah , Dudzinski David M. , Fanola Christina , Blais Danielle , Janicke David , Melamed Roman , Mohrien Kerry , Rozycki Elizabeth , Ross Charles B. , Klein Andrew J. , Rali Parth , Teman Nicholas R. , Yarboro Leoara , Ichinose Eugene , Sharma Aditya M. , Bartos Jason A. , Elder Mahir , Keeling Brent , Palevsky Harold , Naydenov Soophia , Sen Parijat , Amoroso Nancy , Rodriguez-Lopez Josanna M. , Davis George A. , Rosovsky Rachel , Rosenfield Kenneth , Kabrhel Christopher , Horowitz James , Giri Jay S. , Tapson Victor , Channick Richard ,   the PERT Consortium
Published: June 2019

Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients.
Adaptive global sliding mode control of underactuated systems using a super-twisting scheme: an experimental study
Authors: Mobayen Saleh
Published: June 2019

The control problem of underactuated systems with external perturbations is investigating in this paper. Using the super-twisting-based global sliding mode control (GSMC) method, an original control law is proposed to guarantee removal of the reaching mode and obtain the robustness and exponential stability of the underactuated systems. Via the offered scheme, a robust control law is designed so that the state trajectories of the underactuated systems are convergent to the global sliding surface in an exponential manner. Moreover, this article develops an adaptive super-twisting algorithm for these systems. The adaptive-tuning controller eliminates the need of the knowledge about upper bound of the exterior disturbance. The discontinuous sign function appears in the controller derivative; as a result, the actual control signal reached after integration is continuous and free of chattering. Demonstrative simulations on a cart–inverted pendulum system as well as an experimental study are presented to show the effectiveness and applicability of the proposed technique.
Rethinking the Gold Standard With Multi-armed Bandits: Machine Learning Allocation Algorithms for Experiments
Authors: Kaibel Chris , Biemann Torsten
Published: June 2019

In experiments, researchers commonly allocate subjects randomly and equally to the different treatment conditions before the experiment starts. While this approach is intuitive, it means that new information gathered during the experiment is not utilized until after the experiment has ended. Based on methodological approaches from other scientific disciplines such as computer science and medicine, we suggest machine learning algorithms for subject allocation in experiments. Specifically, we discuss a Bayesian multi-armed bandit algorithm for randomized controlled trials and use Monte Carlo simulations to compare its efficiency with randomized controlled trials that have a fixed and balanced subject allocation. Our findings indicate that a randomized allocation based on Bayesian multi-armed bandits is more efficient and ethical in most settings. We develop recommendations for researchers and discuss the limitations of our approach.
Differences in Cardiovascular Risk Factors in College Students: Midwest Versus Southwest
Authors: Herlosky Kristen N. , Tran Dieu-My T.
Published: June 2019

Purpose:

This study was designed to identify underlying cardiovascular risk factors among college students including lifestyle characteristics, health behaviors and knowledge, and perception of the risk factors.

Method:

College students ( N = 293), aged 19–36 years, enrolled at either a Midwestern or a Southwestern University in the United States, responded to three questionnaires: sociodemographic, knowledge of cardiovascular risk factors, and perception of cardiovascular risk factors. Anthropometric measures collected included blood pressure (BP), glucose, lipid panel, height, weight, and body mass index (BMI).

Results:

There were significant regional and gender differences in cardiovascular disease (CVD) risk among Southwestern and Midwestern college students. Students from the Southwest had a higher risk of developing CVD in 30 years compared to those in the Midwest; they also had a higher perceived risk. Males were more at risk of developing CVD than females but had a lower perceived risk than females. Dietary habits were similar between the two populations, and we found no significant differences in BMI. The two regions varied in BP levels, but the Midwestern students had significantly higher prevalence of elevated BP and Stage 2 hypertension.

Conclusion:

Our data suggest that college students are a high-risk population and tend to underestimate and misperceive their risk for developing CVD.
Final versus referral diagnosis of childhood visual impairment in an Italian tertiary low vision rehabilitation centre
Authors: Longhin Evelyn , Segalina Sara , Pilotto Elisabetta , Convento Enrica , Midena Edoardo , Bini Silvia
Published: June 2019

Purpose:

To compare the final diagnosis of the causes of low vision in children attending a tertiary rehabilitation centre for visually impaired children versus referral diagnosis.

Methods:

Retrospective review of clinical charts of all children referred to the Robert Hollman Foundation, a tertiary centre for visually impaired children, between January 2010 and June 2011. The following clinical data were analysed: entry diagnosis made by the referral ophthalmologist and final diagnosis made at Robert Hollman Foundation based on a complete ophthalmic evaluation.

Results:

Ninety-two consecutive children (mean age = 2.37 ± 1.98 years, range = 0–9) were included. A referral diagnosis was retrieved in 76 cases (82.6%), including cerebral visual impairment (14.1%), retinopathy of prematurity (14.1%), hereditary retinal diseases (10.9%), nystagmus (8.7%) and other rarer diseases (34.8%). In the remaining 16 children (17.4%), a precise referral diagnosis was unavailable. Final clinical diagnosis made at Robert Hollman Foundation was normal visual function in 8.7%, cerebral visual impairment in 30.4%, retinopathy of prematurity in 10.9%, hereditary retinal disease in 9.8% and other in 40.2%. In 17 cases (18.5%), the diagnosis made at the Robert Hollman Foundation did not confirm the entry diagnosis. Among patients where measurement of visual acuity was possible (84), 66.7% were blind or seriously visual impaired, and the main causes were cerebral visual impairment (32.1%) and retinopathy of prematurity (16.1%).

Conclusion:

The most frequent diseases were cerebral visual impairment, retinopathy of prematurity and hereditary retinal diseases. Approximately one-third of referred children had not a correct diagnosis at baseline. The activity of an ophthalmic tertiary centre is essential to offer a precise diagnosis to visually impaired (sometimes with other deficits) children.
Comparison of axillary-atrial and axillary-iliac arteriovenous grafts for hemodialysis access creation
Authors: Lopez-Pena Gabriel , Anaya-Ayala Javier E , Garcia-Alva Ramon , Luna Lizeth , Lizola Rene , Cuen-Ojeda Cesar , Arzola Luis H , Hinojosa Carlos A
Published: June 2019

Objective:

The aim of this study was to compare two complex vascular access techniques that utilize the axillary artery as inflow and accesses were created with early cannulation grafts: the axillary-atrial arteriovenous graft versus axillary-iliac arteriovenous graft.

Methods:

This is a retrospective study of end-stage renal disease patients with occluded intrathoracic central veins that underwent complex hemodialysis access creation in our institution after failed endovascular recanalization attempts. Patients’ demographics, comorbidities, number and types of previous accesses, intraoperative variables, and clinical outcomes were collected and compared.

Results:

Four patients underwent axillary-atrial arteriovenous graft creation with Flixene™ (Atrium™, Hudson, NH, USA) grafts, through a midline sternotomy to expose the right atrium; all were successfully implanted and used for hemodialysis within the first 72 h; one patient developed a pseudoaneurysm in the mid-graft portion, requiring surgical repair, and it is currently functional. Eight axillary-iliac arteriovenous grafts were created; all grafts were patent and were utilized within 96 h after placement. At 6 months of follow-up period, five (62 %) of our patients underwent graft thrombectomy, one (12 %) balloon angioplasty at the vein anastomosis secondary to stenosis, and two (25 %) grafts were removed due to infectious complications. Axillary-atrial arteriovenous graft and axillary-iliac arteriovenous graft primary patency rates at 6 months were 75% and 48%, respectively; 6-month secondary patency of the axillary-atrial arteriovenous graft compares favorably against that of axillary-iliac arteriovenous graft (100% vs 75%, respectively).

Conclusion:

Despite the invasiveness, direct atrial outflow procedures remain a valid alternative in carefully selected patients with adequate cardiopulmonary reserve.
Candidate nomination rules and party leader strategies
Authors: Tromborg Mathias Wessel
Published: June 2019

Parliamentary party leaders have an electoral incentive to protect the informational value of their party's label by promoting unity, but recent research has shown that parties can also benefit electorally from appealing broadly through a wide distribution of candidate positions on political issues. This article suggests that party leaders with formal candidate nomination powers balance these incentives by nominating new candidates who are more congruent with the party when the distribution of issue positions among the senior candidates is wide, and, conversely, by nominating new candidates who are more divergent from the party when the senior candidate position distribution is narrow. These possibilities are tested with candidate survey data from six parliamentary democracies, and the results show that new party leader nominations are indeed conditional on the senior candidate distribution, but only on issues that are salient to the party’s electoral brand.
Parent–Child Interaction Therapy for children with autism spectrum disorder and a matched case-control sample
Authors: Parladé Meaghan V , Weinstein Allison , Garcia Dainelys , Rowley Amelia M , Ginn Nicole C , Jent Jason F
Published: June 2019

Parent–Child Interaction Therapy is an empirically based, behavioral parent training program for young children exhibiting disruptive behaviors. Parent–Child Interaction Therapy shows promise for treating disruptive behaviors in children with autism spectrum disorder. Treatment processes (i.e. treatment length and homework compliance), parenting skills, parenting stress, and behavioral outcomes (i.e. disruptive and externalizing behaviors and executive functioning) were compared in 16 children with autism spectrum disorder and 16 children without autism spectrum disorder matched on gender, age, and initial intensity of disruptive behaviors. Samples were statistically similar in terms of child receptive language, child race and ethnicity, parent age, gender and education, and number of two-parent families in treatment. Families received standard, mastery-based Parent–Child Interaction Therapy. Both groups demonstrated significant and clinically meaningful improvements in child disruptive and externalizing behavior and executive functioning, parenting skills, and parenting stress. Length of treatment, homework compliance, and parent and child outcomes did not differ significantly between groups. A subset of children with autism spectrum disorder also showed significant improvements in social responsiveness, adaptive skills, and restricted/repetitive behaviors. This study replicates and extends prior research by demonstrating that children with and without autism spectrum disorder experience similar benefits following Parent–Child Interaction Therapy. Findings may expand the availability and dissemination of time-limited, evidence-based interventions for autism spectrum disorder and comorbid disruptive behaviors.
Adapted cognitive behavior therapy for obsessive–compulsive disorder with co-occurring autism spectrum disorder: A clinical effectiveness study
Authors: Flygare Oskar , Andersson Erik , Ringberg Helene , Hellstadius Anna-Clara , Edbacken Johan , Enander Jesper , Dahl Matti , Aspvall Kristina , Windh Indra , Russell Ailsa , Mataix-Cols David , Rück Christian
Published: June 2019

Obsessive–compulsive disorder and autism spectrum disorder commonly co-occur. Adapted cognitive behavior therapy for obsessive–compulsive disorder in adults with autism spectrum disorder has not previously been evaluated outside the United Kingdom. In this study, 19 adults with obsessive–compulsive disorder and autism spectrum disorder were treated using an adapted cognitive behavior therapy protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale–Brown Obsessive–Compulsive Scale. Participants were assessed up to 3 months after treatment. There were significant reductions on the Yale–Brown Obsessive–Compulsive Scale at post-treatment (d = 1.5), and improvements were sustained at follow-up (d = 1.2). Self-rated obsessive–compulsive disorder and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from obsessive–compulsive disorder. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted cognitive behavior therapy for obsessive–compulsive disorder in adults with co-occurring autism spectrum disorder is associated with reductions in obsessive–compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.
Secondary traumatic stress in Norwegian SUD-therapists: Symptoms and related factors
Authors: Johansen Ayna B , Kristiansen Eva , Bjelland Ingerid , Tavakoli Shedeh
Published: June 2019

This study examined the prevalence of secondary traumatic stress (STS) among substance-abuse therapists in relation to burnout, work-related stressors, as well as peer and leader support.

Methods:

A quantitative cross-sectional design examining 383 Norwegian substance-abuse therapists. Electronic surveys were distributed to practitioners in Norway via email and social media.

Results:

A total 22% of the respondents reported experience of secondary trauma, with the most frequently reported symptoms being flashbacks (13%) and intrusive thoughts (13%). More than 72% of therapists had also been exposed to patient direct threats. Female therapists estimated the level of trauma among their patients as higher than did male therapists. Male therapists (32%) were more likely to report secondary trauma than females (19%).

Conclusions:

The findings indicate a high prevalence of trauma symptoms in substance-abuse therapists, and suggest increased focus on the role of patient direct threats when treating patients with substance-abuse disorder. The study also highlights the need for research that examines variables that interact with gender in predicting STS in therapists treating substance abuse, as well as trauma.
Three-dimensional semi-analytical solutions for the transient response of functionally graded material cylindrical panels with various boundary conditions
Authors: Liang Xu , Deng Yu , Jiang Xue , Cao Zeng , Ruan Yongdu , Leng Jianxing , Wang Titao , Zha Xing
Published: June 2019

In this paper, a 3D semi-analytical method is proposed by introducing the Durbin’s Laplace transform, as well as its numerical inversion method, state space approach and differential quadrature method to analyse the transient behaviour of functionally graded material cylindrical panels. Moreover, to investigate the effectiveness of the proposed semi-analytical solution, four boundary conditions are used to undertake the analyses. Comparing the proposed approach with other theoretical methods from the literatures, we see better agreements in the natural frequencies. Besides, the semi-analytical solution acquires nearly the same transient response as those obtained by ANSYS. Convergence studies indicate that the proposed method has a quick convergence rate with growing sample point numbers along the length direction, so do layer numbers increase along the radial direction. The effects of thickness/outer radius ratio, length/outer radius ratio and functionally graded indexes are also studied. When carbon nanotube is added to functionally graded material cylindrical panel, the composite structures have been reinforced greatly. The proposed 3D semi-analytical method has high accuracy for the analysis of composite structures. This study can serve as a foundation for solving more complicated environments such as fluid–structure interaction of flexible pipe or thermal effect analysis of functionally graded material in aerospace field.
Tourists and Buddhist heritage sites: An integrative analysis of visitors’ experience and happiness through positive psychology constructs
Authors: Huang Keji , Pearce Philip L , Wu Mao-Ying , Wang Xiong-Zhi
Published: June 2019

The influence of visiting Buddhist heritage sites on happiness is the core concern of this article. China’s four sacred Buddhist mountains provided the setting for the study. Sixty semi-structured interviews were conducted to examine the positive effects of Buddhism on visitors. Thematic analysis was first undertaken to understand the Buddhism-induced happiness. In the terms of Buddhism, the visitors’ happiness was related to the law of karma, impermanence and reincarnation. The PERMA model from positive psychology was then utilized as a second interpretive framework, in which positive changes in visitors’ attitudes, behaviours and life were noted. The links between the core values of Buddhism and the PERMA model were then established and portrayed. The study makes a theoretical contribution by connecting the positive psychology constructs and the effects of Buddhism in the tourism context. In addition, this study provides insightful suggestions for local communities to manage religious heritage sites sustainably.