bluuebunny/crossref_metadata_2025 huggingface dataset:
Online labour markets: an inquiry into oDesk providers
Authors: Brett Caraway
Published: December 2015

This study is an institutional ethnography of oDesk workers. The research makes use of an online questionnaire and semi-structured interviews to identify the ways in which the oDesk platform functions as the medium and expression of the activities of online workers. I analyse the marketplace along the structural dimensions of visibility, community, and economics and conclude by arguing that these structures are recursively ordered through various activities occurring as part of the contingent reproduction of the oDesk Marketplace.
Social movement unionism or professionalism? the union movement of Taiwanese documentary makers
Authors: Chang-de Liu
Published: December 2015

Taiwanese documentaries have grown rapidly in terms of local consumption and production since the 2000s, despite the dominance of Hollywood in the local film market. However, most documentary workers still suffer from poor working conditions because of a lack of sufficient resources for local productions. In response to this situation, Taiwanese documentary makers founded a labour union in 2006 to protect their basic working rights. This paper describes this union movement as well as analysing the challenges that it encounters. These challenges include a very low degree of participation in unions among Taiwanese cultural workers, anti-union sentiment among professionals and freelancers and the ‘association-prone’, as opposed to ‘union-prone’ nature of Taiwanese occupational unions. Despite these obstacles, the strong traditional linkages between Taiwanese documentary-makers and dissenting social and political movements has enabled the documentary workers' union to pursue a form of ‘social movement unionism’, which opens up opportunities for revitalisation even when there is a general decline of the trade union movement.
‘Everywhere in chains’: Work, commodity chain analysis, and the subversion of accountability
Authors: James Lawson
Published: December 2015

‘Chain’ literatures analyse the production and exchange linkages that bind nodes of production into a linear sequence. These chains typically extend beyond the remit of any one jurisdiction, firm, or civil-societal institution. Conventional treatments of accountability are informative, but rarely have chains in mind The concept of an accountability chain addresses these gaps. A central consideration in governance and accountability along a chain is the necessary bias in communications introduced by the very media that make accountability relations possible. This article addresses some basic strategic considerations that arise when accountability relations are viewed this way. It also addresses accountability itself and its worrisome degree of ‘modesty’ When the activities that are supposed to be monitored occur too much beyond the direct observation or control of the monitors.
Skirting Regulation? Trade Liberalisation, Retailers and the Informalisation of South Africa's Clothing industry
Authors: Marlea Clarke  , Shane Godfrey
Published: December 2015

This article explores the recent history of South Africa's clothing industry, focusing on the rapid decline of formal sector employment and parallel growth in informal work, including small, home-based producers. We show that although the changing global regulatory regime and other external factors have shaped employment patterns in the sector, it is internal factors, particularly the country's powerful domestic retail industry and related changes in domestic sourcing patterns, which are largely responsible for informalisation and the current crisis facing the sector. The article concludes by suggesting that the various ‘low-road’ strategies adopted by manufactures aimed at competing with imports based on price are unsustainable.
Temporary agency work in the Finnish health care sector: Greater flexibility and freedom in the workplace?
Authors: Hannele Palukka  , Tiina Tiilikka
Published: December 2015

This article explores the views of temporary agency workers on their positions and roles in Finnish health care organisations. It aims to answer the question of how agency doctors and nurses perceive the content and social dimensions of agency work as well as their exercise of self-determination in agency work. The article is based on a questionnaire survey carried out in 2006, which found that agency employment in the health care sector is regarded as a flexible way of working that allows for considerable freedom. Doctors, in particular, have made the conscious choice to take up agency work, which fits in well with their personal life situations. However, there are definite limits to agency work that do not always favour the young worker or the patient. Agency employment does not provide adequate opportunities for guidance and support. Furthermore, young doctors and nurses do not have enough influence over the design of patient care. Even though flexible agency work is a voluntary choice for many health care professionals, it is necessary to ask whether it severs the connections with previous experiences and circumstances on which practical health care provision is based.
Freeze-dried flexibility: a new morphology of labour, casualisation and value
Authors: Ricardo Antunes
Published: December 2015

In recent decades, capitalist society has witnessed profound changes, including in the sphere of labour. Neoliberalism, the restructuring of production and economic expansion shaped through instantly-available, ‘freeze-dried’ flexibility have led to far-reaching transformations in the world of work. As a result of this composite and heterogeneous set of transformations, there has been widespread speculation that we may be witnessing the end of the working class, or at least that labour has lost its central position in society. Recent history has been ruthless in relation to such (mis)constructions: the appearance of finitude has actually been part of a process whereby labour has been redesigned, leading to new modalities of labour and the emergence of a new morphology: a new way of being for labour, that coexists with and combines with its past (and still existing) arrangements. It seems that the more labour appears to dwindle, the broader and more diversified are the forms in which it can rise again (in this context it is irrelevant whether these new forms are more or less precarious or more or less provided with rights than those they replace). This article aims to pursue two of the key polysemic trends that are present in this framework: the casualisation of labour and the development of new forms of labour. It also addresses the implications of these interrelated connections for the law of value.
Exhausted bodies and precious products: women's work in a Special Economic Zone for the electronics industry in Poland
Authors: Malgorzata Maciejewska
Published: December 2015

This article presents case study research conducted by participant observation in an electronics assembly plant based in one of the Special Economic Zones (SEZs) in Poland. The study was part of a broader research project on women workers' lives and SEZs development run by Feminist Think Tank, during which the author was author was employed as a temporary worker and worked on the production line for three months, from October to December 2011, during a production peak in the zone. Embedded in the context of industrial and labour market changes over the last decade, the case study illustrates the interrelated processes of neoliberal economic restructuring, development of SEZs and their consequences for women workers' lives in one Polish region.
Offshoring Danish jobs to Germany: regional effects and challenges to workers' organisation in the slaughterhouse industry
Authors: Bjarke Refslund
Published: December 2015

Increasing internationalisation of production is often seen as causing an erosion of West European social systems and, in particular, the worker's position, but the macro-level empirical evidence is often flawed. This article provides evidence based on a case study of Danish slaughterhouses that offshoring strongly affects the power relations within the industry. These changes in industrial relations can largely be explained by developments in the German slaughterhouse industry and changes in European legislation which have greatly influenced a shift towards more precarious employment in slaughterhouses, using the work of subcontracted workers from Eastern Europe. This article analyses the significant role played by European integration and globalisation in altering the international division of labour and employer-employee relations.
Forced to go virtual? Distributed cooperation of small software firms
Authors: Annika Schönauer  , Ruth Kasper  , Jörg Flecker  , Ursula Holtgrewe
Published: December 2015

Within the service sector, the software industry has been among the prime movers in the process of offshoring work to new destinations. This is facilitated by the immaterial character of the products and their components and by the industry's inclination to use new technical opportunities for its own purposes as well. This paper investigates practices of virtual cooperation and team work in small and start-up software companies based in Austria. Evidence indicates that because of their niche strategies and the related conditions of their national context, these companies often depend on international cooperation which, in turn, often takes on a ‘virtual’ form.
Automating amateurs in the 3D printing community: connecting the dots between ‘deskilling’ and ‘user-friendliness’
Authors: Johan Söderberg
Published: December 2015

In this paper a case study of an open source, home-built 3D printer called ‘Rep-rap’ serves as an entry point to the deskilling debate. This debate has centred on Harry Braverman's proposition that deskilling is a general trend, given the prevalence of capitalist relations of production, or, differently put, contractual employment relations. The origins of 3D printing can be traced back to numerically controlled (NC) and computerised numerically-controlled (CNC) machinery and can even be seen to incorporate ‘material traces’ of these. Both technologies are based on the same principle: guiding a machine tool with the help of software. NC and CNC machines were introduced in the midst of industrial conflicts and served as a touchstone in academic debates for and against the deskilling thesis during the 1970s. The open source, home-built 3D printer, in contrast, is being developed by a community of hobbyists. By definition, these hobbyists are located outside of contractual employment relations. Still, they are striving to make the 3D printer user-friendly, or, in other words, to deskill the user. Reflecting on this difference, this paper sets out to incorporate some of the critiques of the deskilling thesis in order to advance an updated, Bravermanian position on user-friendly technology.
Regressive safety practices in the globalised shipping industry
Authors: Suresh Bhardwaj
Published: December 2015

The highly fragmented structure of the globalised shipping industry necessitates a regulatory-driven environment for its basic administration. This is a highly safety-critical industry, but regulatory updates only take place after an accident has taken place, based on a retrospective analysis of incidents and accident investigations. This leads to the goal of avoiding the recurrence of past incidents (and arguably newer occurrences too) through regulatory updates of the instruments of the International Maritime Organisation (IMO). This paper highlights the limitations of such an approach and shows how existing health and safety practices in the shipping industry are inadequate to cope with work environments that are changing rapidly as a result of economic and technological pressures. Paradoxically, while safety requires attention to how workers negotiate risks and uncertainties in everyday practice, in the contemporary shipping industry workers are increasingly denied the opportunities for socialisation, rest and organisational support that make such negotiation possible. As a consequence, interpretations of accidents by ‘experts’ as matters of human error by the crew acquire the status of fact, further compounding the disempowered position of workers. This leads to a general downward spiral in safety practices. The paper draws on an exhaustive review of the relevant literature as well as empirical evidence obtained from interviews. It critiques the current operational definition of safety in the industry and concludes that the progress the shipping industry believes it is making, mainly, at present, through technology integration, is tardy and may even be regressive and counterproductive.
Sorption of Neptunium on Clays and Clay Minerals — A Review
Authors: Fröhlich Daniel R.
Published: December 2015

During recent decades, the search for possible repositories for high-level nuclear waste has yielded large amounts of sorption data for actinides on different minerals. Clays and clay minerals are of special interest as potential host-rock formations and backfill materials, by virtue of their good retardation properties. Neptunium (Np) is one of the actinides which is considered in long-term scenarios due to its long-lived nuclide 237Np (t1/2 = 2.1 × 106 y). Because neptunium sorption is heavily dependent on the experimental conditions, comparison of sorption data from different experiments is challenging. Normalizing reported data with respect to the surface area of the sorbent enables conversion of conventional distribution coefficients (Kd) to normalized (Ka) values, which improves comparability among the results of different experiments. The present review gives a detailed summary of sorption data of Np on clays and clay minerals and examines critically the applicability of the Ka approach.
Differentiating Aging Among Adults With Down Syndrome and Comorbid Dementia or Psychopathology
Authors: Esbensen Anna J. , Johnson Emily Boshkoff , Amaral Joseph L. , Tan Christine M. , Macks Ryan
Published: December 2015

Differences were examined between three groups of adults with Down syndrome in their behavioral presentation, social life/activities, health, and support needs. We compared those with comorbid dementia, with comorbid psychopathology, and with no comorbid conditions. Adults with comorbid dementia were more likely to be older, have lower functional abilities, have worse health and more health conditions, and need more support in self-care. Adults with comorbid psychopathology were more likely to exhibit more behavior problems and to be living at home with their families. Adults with no comorbidities were most likely to be involved in community employment. Differences in behavioral presentation can help facilitate clinical diagnoses in aging in Down syndrome, and implications for differential diagnosis and service supports are discussed.
Children With Autism Show Reduced Information Seeking When Learning New Tasks
Authors: Young Nicole , Hudry Kristelle , Trembath David , Vivanti Giacomo
Published: December 2015

Information-seeking behaviours occur when children look to adults in order to gain further information about a novel stimulus/situation. The current study investigated information seeking in children with developmental delays (DD) and those with autism spectrum disorders (ASD) during a simulated teaching situation. Twenty preschool-aged children with ASD and 15 children with DD were exposed to a series of videos where a teacher provided novel instructions and demonstrated novel actions. We found that children with DD, but not those with ASD, demonstrated information-seeking behaviours in response to instructions that exceeded their level of understanding. This suggests that children with DD may use information-seeking behaviours to compensate for their cognitive and language difficulties when novel actions are being taught, while the same is not true for children with ASD.
Bridging the gap between human knowledge and machine learning
Authors: Alvarado-Pérez Juan Carlos , Peluffo-Ordóñez Diego H. , Therón Roberto
Published: December 2015

Nowadays, great amount of data is being created by several sources from academic, scientific, business and industrial activities. Such data intrinsically contains meaningful information allowing for developing techniques, and have scientific validity to explore the information thereof. In this connection, the aim of artificial intelligence (AI) is getting new knowledge to make decisions properly. AI has taken an important place in scientific and technology development communities, and recently develops computer-based processing devices for modern machines. Under the premise, the premise that the feedback provided by human reasoning -which is holistic, flexible and parallel- may enhance the data analysis, the need for the integration of natural and artificial intelligence has emerged. Such an integration makes the process of knowledge discovery more effective, providing the ability to easily find hidden trends and patterns belonging to the database predictive model. As well, allowing for new observations and considerations from beforehand known data by using both data analysis methods and knowledge and skills from human reasoning. In this work, we review main basics and recent works on artificial and natural intelligence integration in order to introduce users and researchers on this emergent field. As well, key aspects to conceptually compare them are provided.
Impactos de investimentos em infraestruturas rodoviárias sobre o desenvolvimento regional no Brasil - possibilidades e limitações
Authors: Andrade Mauricio Oliveira , Maia Maria Leonor Alves , Lima Neto Oswaldo Cavalcanti da Costa
Published: December 2015

Este artigo objetiva analisar as possibilidades e as limitações dos impactos produzidos por investimentos em infraestruturas rodoviárias sobre o crescimento econômico em nível local e regional. A discussão está apoiada em conceitos e experiências relatadas na literatura sobre as relações entre infraestruturas de transportes rodoviários e a dinâmica econômica regional, sob a ótica da economia espacial, mais especificamente sobre a teoria da decisão da localização de empresas; e sob a abordagem da economia dos transportes, que relaciona o tráfego gerado e induzido com as atividades econômicas. Como objeto empírico foram analisados os resultados, em nível regional, dos efeitos da duplicação da BR-232-PE, trecho Recife-São Caetano com 150 km de extensão, aberta ao tráfego em 2004, com período de avaliação até o final de 2010. As conclusões enfatizam a capacidade das infraestruturas rodoviárias em impactar positivamente na região diretamente beneficiada com relação ao crescimento da produção agregada, à geração de empregos, à abertura de novas empresas e ao crescimento da massa salarial. No entanto, observa-se também, que este projeto não foi capaz de: (i) produzir um crescimento equilibrado na região; (ii) alterar as relações hierárquicas entre as cidades; (iii) estimular a distribuição da renda; e (iv) ajudar a promover a sustentabilidade fiscal no nível das finanças públicas dos municípios beneficiados. 
Avaliação retrorrefletiva de pintura de demarcação horizontal: peculiaridades e considerações sobre a norma e os requisitos mínimos nacionais
Authors: De Salles Lucio Salles , Pereira Deividi Da Silva , Teixeira Daniel Luis Krachefski , Specht Luciano Pivoto
Published: December 2015

A retrorrefletividade das pinturas de demarcações horizontais permite a visibilidade da sinalização viária durante a noite, impactando diretamente a segurança da via. O Brasil emprega normas e requisitos mínimos internacionas que foram parcialmente adaptados para as condições do país. De maneira geral, tais adaptações reduziram os níveis de segurança exigidos por estes importantes dispositivos, fato que pode acarretar prejuízos à condição de segurança e conforto. A partir da avaliação ao longo de dois anos de três segmentos experimentais, um rodoviário e dois urbanos, com diferentes tipos de demarcações e materiais, buscou-se fazer uma análise crítica da pertinência da forma de avaliação normativa no Brasil, bem como estudar o impacto da chuva, do acúmulo de sujeira e da geometria dos retrorrefletômetros sobre o desempenho da sinalização horizontal. Como esperado, demarcações empregando material termoplástico apresentaram um desempenho superior àquelas com tinta acrílica. O efeito abrasivo da interação pneu-pavimento desgasta tais dispositivos, reduzindo o número de elementos retrorrefletivos (microesferas); entretanto, a combinação tráfego mais precipitação mostrou-se positiva por permitir a limpeza “natural” da sinalização. Para o trecho urbano, o efeito da sujeira foi tão prejudicial quanto à abrasão causada por veículos pesados. A análise da retrorrefletividade, obtida com diferentes geometrias, perante limites mínimos nacionais e internacionais, demonstrou que os índices mínimos de retrorrefletividade aplicados no Brasil são pouco exigentes, merecendo, portanto, serem rediscutidos para melhor atender aos quesitos de segurança viária.
Procedimento para coleta dinâmica embarcada de emissões provenientes de veículos transportadores de carga em área urbana
Authors: Fontenele Dias Helry Luvillany , Bertoncini Bruno Vieira , Moura de Oliveira Mona Lisa , Ávila Cavalcante Francisco Sales , Araújo Rinaldo Dos Santos
Published: December 2015

O presente artigo insere-se no estudo das emissões de poluentes atmosféricos provenientes do tráfego de veículos transportadores de carga em áreas urbanas. A motivação desta pesquisa deve-se ao fato de que as análises de emissões são, geralmente, realizadas de maneira estática, não representando com adequada precisão o comportamento das emissões geradas em um percurso comum. Assim, buscou-se construir um procedimento de coleta de emissões capaz de ser aplicada com o veículo em movimento, considerando as particularidades dos poluentes provenientes de motores ciclo diesel, comumente utilizados em veículos de carga. Para tal, um sistema formado por equipamentos já existentes e outros desenvolvidos na pesquisa foi proposto. Tal sistema é capaz de realizar, de maneira embarcada, a coleta dos poluentes liberados no escapamento enquanto o veículo realiza normalmente sua operação e seus movimentos, sobretudo considerando os principais poluentes advindos de motores a diesel, como NOx e Materiais Particulados. Os dados coletados indicam que a legislação em vigor não está sendo respeitada em termos de Material Particulado, cujo valor coletado está acima da referência.
Avaliação em laboratório e em campo da deformação permanente de pavimentos asfálticos do Ceará e de São Paulo
Authors: Bastos Juceline Batista dos Santos , Borges Rômulo Luiz , Soares Jorge Barbosa , Klinsky Luis Miguel Gutiérrez
Published: December 2015

A deformação permanente é um dos defeitos mais comuns que ocorrem em pavimentos asfálticos brasileiros, reduzindo o conforto ao rolamento, a segurança do usuário, e aumentando custos operacionais. O presente trabalho tem como objetivo principal investigar um trecho monitorado (300 metros) da BR-222, localizado no Estado do Ceará, e um trecho monitorado da BR-116, no Estado de São Paulo. Para tanto, verificou-se o comportamento das misturas asfálticas adotadas nessas rodovias, tanto em laboratório por meio dos ensaios uniaxial de carga repetida e Triaxial Stress Sweep (TSS), como em campo por meio da verificação do afundamento de trilha de roda. A mistura cearense foi dosada pelo método Marshall e foi utilizado o CAP 50/70 da Lubnor. A mistura paulista foi dosada pela metodologia Superpave e foi utilizado o CAP 30/45 da Replan. Os resultados apontam que, em campo, quatro meses após liberação do trecho, a mistura asfáltica do Ceará apresentou afundamentos de trilha de roda. Em laboratório, a mesma mistura também se mostrou frágil para os dois ensaios de deformação permanente analisados. A mistura asfáltica de São Paulo apresentou até abril de 2015 (período investigado), após 3,5 anos da execução, um bom desempenho em campo, sem afundamento de trilha de roda. Em laboratório, de acordo com o ensaio uniaxial de carga repetida essa mistura apresentou um Flow Number (FN) adequado para um tráfego pesado, na extensão em que é válida a aplicação dos limites sugeridos nacionalmente. Porém, no ensaio TSS, essa mistura não ultrapassou o ensaio de referência, impossibilitando a previsão da evolução dessa falha e sugerindo fragilidade quanto à deformação permanente, em desacordo com o resultado apresentado em campo até o momento.
Avaliação dos aeroportos das cidades-sedes da Copa de 2014 através do método AHP
Authors: Feuser Fernandes Helen , Carvalho Hadassa Pereira de , Alves Cláudio Jorge Pinto , Correia Anderson Ribeiro
Published: December 2015

Esse estudo busca apresentar um método de classificação dos aeroportos das cidades-sedes da Copa de 2014, de acordo com critérios prioritários na opinião dos passageiros. O intuito é contribuir com as autoridades aeroportuárias, a fim de identificar oportunidades de melhoria e gargalos operacionais. Para isso foram utilizados dois levantamentos de opinião dos passageiros: um desenvolvido pelo Ministério da Aviação Civil no Brasil em 2013, que foi aplicado em 12 aeroportos internacionais, e uma pesquisa desenvolvida em um grande aeroporto internacional no Brasil, que foi aplicado para obter os pesos de relevância de instalações. O Processo de Análise Hierárquica (AHP) foi utilizado para consolidar os resultados destas duas pesquisas, fornecendo um índice de qualidade global para cada um dos aeroportos pesquisados. Os resultados indicam que o Aeroporto de Curitiba possui a melhor infraestrutura dentre os aeroportos analisados, e que o Aeroporto de Manaus é o que necessita de mais adequações. 
Fish and amphibians as bat predators
Authors: Mikula Peter
Published: December 2015

Although bats (Chiroptera) belong to the most diverse mammalian orders, study of diversity of their natural predators has been seriously neglected for a long time. While some recent reviews contain comprehensive overviews of our recent knowledge on these phenomena for some animal groups, such work is still lacking for anamniotes - fishes and amphibians. Here, I am summarising bat predation incidences by anamniotes that were published in scientific journals and public web domains. I found out that at least 14 species of fishes and 14 species of frogs were observed as feeding on bats. Moreover, 7 and 16 species of bats were recorded as victims of hunting activity of fishes and frogs, respectively. Majority of localised incidences came from the New World; frog (between latitude 49°N to 28°S) attacks were distributed mainly in tropical or subtropical areas < 30° from equator (70% of all records), fish (44°N to 20°S) incidences reach same proportion in colder areas (> 30° from equator) and warmer areas. In some cases, these predators can regularly feed on bats, especially when hunting near roosting places of bats; however, with respect to number of recorded cases (21 for fishes and 37 for amphibians), bat predation by anamniotes seems to be very rare and opportunistic with only very limited influence on bat populations or their behaviour.
Discrimination Revised: Reviewing the Relationship between Social Groups, Disparate Treatment, and Disparate Impact
Authors: Cook Ryan
Published: December 2015

It is usually accepted that whether or not indirect discrimination is a form of immoral discrimination, it appears to be structurally different from direct discrimination. First, it seems that either one involves the agent focusing on different things while making a decision. Second, it seems that the victim’s group membership is relevant to the outcomes of either sort of action in different ways. In virtue of these two facts, it is usually concluded that indirect discrimination is structurally different from direct discrimination. I argue against the notion that indirect discrimination and direct discrimination have significantly different structures. I first argue that both kinds of discrimination involve similar decision-making processes. Second, I analyze how being in a social group affects personal identity, and from there argue that indirect discrimination and direct discrimination are about group membership similarly. In virtue of these two arguments, I conclude that direct and indirect discrimination are structurally similar.
The Boom List
Authors: Staff Boom
Published: December 2015

Boom’s quarterly guide to new books to read, art exhibits to see, and things to do in California this winter.
Thinking Outside the Mosque
Authors: Challet Anna
Published: December 2015

This article discusses how the community at Zaytuna College, the first and only accredited Muslim college in the United States, is charting the future of Islam in America. The college is located in Berkeley, California and admitted its first class in 2010. The article gives an overview of the school and its curriculum, which combines Islamic scholarship with Western teachings. The piece then profiles four members of the school community–a female student who was raised as a Muslim, a male student who converted to Islam, and two faculty members (both of whom are also converts).
Golden State of Grace?
Authors: Lorentzen Lois Ann
Published: December 2015

Non-Californians rarely refer to the Golden State as a sacred place or religious landscape. Yet, California fascinates, in part, due to its religious extravagance–think Jim Jones, Heavens Gate, the Crystal Cathedral, Harold Camping’s predicted end of the world, the Grateful Dead. Everything is here, and then some. This essay looks at California as an epicenter of religious expression and a global microcosm for hybrid religions, new religions, and experimental religious practices. The essay analyzes migration, the California/Mexico border, genders/sexualities, race/ethnicity, commercialization, embodiment/disembodiment, and the natural world as lenses on California’s religious landscape.
Biomarkers In Acute Heart Failure — Cardiac And Kidney
Authors: Richards A Mark ,   Christchurch Heart Institute, University of Otago, Christchurch, New Zealand,   Cardiovascular Research Institute, National University of Singapore, Singapore
Published: December 2015

Natriuretic peptides (NP) are well-validated aids in the diagnosis of acute decompensated heart failure (ADHF). In acute presentations, both brain natriuretic peptide (BNP) and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) offer high sensitivity (>90 %) and negative predictive values (>95 %) for ruling out ADHF at thresholds of 100 and 300 pg/ml, respectively. Plasma NP rise with age. For added rule-in performance age-adjusted thresholds (450 pg/ml for under 50 years, 900 pg/ml for 50—75 years and 1,800 pg/ml for those >75 years) can be applied to NT-proBNP results. Test performance (specificity and accuracy but not sensitivity) is clearly reduced by renal dysfunction and atrial fibrillation. Obesity offsets the threshold downwards (to ~50 pg/ml for BNP), but overall discrimination is preserved. Reliable markers for impending acute kidney injury in ADHF constitute an unmet need, with candidates, such as kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin, failing to perform sufficiently well, and new possibilities, including the cell cycle markers insulin growth factor binding protein 7 and tissue inhibitor of metalloproteinases type 2, remain the subject of research.
Managing Heart Failure Patients with Multivessel Disease — Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention
Authors: Pepper John ,   National Institute for Health Research, Royal Brompton Hospital, London, UK
Published: December 2015

The foundation of treatment for heart failure with reduced ejection fraction is guideline-directed medical treatment. However, surgical revascularisation offers improved survival and quality of life for patients with more extensive coronary disease and the greatest degree of left ventricular systolic dysfunction and remodelling. The most commonly considered surgical interventions for patients with heart failure with reduced ejection fraction are coronary artery bypass surgery, sometimes combined with surgical ventricular reconstruction and surgery for mitral regurgitation. In this review, the author considers the risks and benefits of coronary artery bypass graft versus percutaneous coronary intervention in the management of heart failure patients with multivessel disease.
Patient Self-Management In Chronic Heart Failure — Establishing Concordance Between Guidelines And Practice
Authors: Toukhsati Samia R ,   Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia,   Department of Cardiology, Austin Health, Heidelberg, Australia, Driscoll Andrea ,   Department of Cardiology, Austin Health, Heidelberg, Australia,   School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Australia, Hare David L ,   Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia,   Department of Cardiology, Austin Health, Heidelberg, Australia
Published: December 2015

Chronic heart failure (CHF) is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. CHF patients are encouraged to self-manage their illness, such as adhering to medical regimens and monitoring symptoms, to optimise health outcomes and quality of life. In so doing, patients are asked to collaborate with their health service providers with regard to their care. However, patients generally do not self-manage well, even with specialist support. Moreover, self-management interventions are yet to demonstrate morbidity or mortality benefits. Social network approaches to self-management consider the availability and mobilisation of all resources, beyond those of only the patient and healthcare providers. Used in conjunction with e-health platforms, social network approaches may offer a means by which to optimise self-management programmes of the future.
How To Improve Time To Diagnosis In Acute Heart Failure — Clinical Signs And Chest X-Ray
Authors: Allen Christopher J ,   Cardiology Department, Royal Brompton Hospital, London, UK, Guha Kaushik ,   Cardiology Department, Royal Brompton Hospital, London, UK,   National Heart and Lung Institute, Imperial College, London, UK, Sharma Rakesh ,   Cardiology Department, Royal Brompton Hospital, London, UK,   National Heart and Lung Institute, Imperial College, London, UK
Published: December 2015

Acute heart failure (AHF) is a leading cause of hospitalisation in developed nations with stubbornly poor outcomes in both the short and long term. Furthermore, alongside an ageing population the incidence continues to increase. Contemporary practice guidelines accordingly emphasise the importance of early recognition of heart failure in the acute setting to facilitate the timely instigation of key investigations, appropriate management and access to specialist care; all of which improve outcome. However, the diagnosis of AHF is often challenging, with no gold standard diagnostic test and presenting clinical features that may be non-specific, particularly in the elderly where they may be atypical, or masked by co-morbidity. This short review explores the main clinical signs and radiographic changes in patients with AHF relevant to clinical practice in accordance with the best available evidence.
Shock Management For Cardio-Surgical ICU Patients — The Golden Hours
Authors: Hauffe Till ,   Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland, Krüger Bernard ,   Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland, Bettex Dominique ,   Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland, Rudiger Alain ,   Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
Published: December 2015

Postoperative shock following cardiac surgery is a serious condition with a high morbidity and mortality. There are four types of shock: cardiogenic, hypovolemic, obstructive and distributive and these can occur alone or in combination. Early identification of the underlying diseases and understanding of the mechanisms at play are key for successful management of shock. Prompt resuscitation measures are necessary to reverse the shock state and avoid permanent organ dysfunction or death. In this review, the authors focus on the management during the first 6 hours of shock (the ‘golden hours’). They discuss how to optimise preload, vascular tone, contractility, heart rate and oxygen delivery. The review incorporates the findings of recent trials on early goal-directed therapy and includes practical recommendations in areas in which the evidence is scare or controversial. While the review focuses on cardio-surgical patients, the suggested treatment algorithms might be usefully expanded to other critically ill patients with shock arising from other causes.
Fluid Management In Patients With Chronic Heart Failure
Authors: Pellicori Pierpaolo ,   Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK, Kaur Kuldeep ,   Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK, Clark Andrew L ,   Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston upon Hull, UK
Published: December 2015

Congestion, or fluid overload, is a classic clinical feature of patients presenting with heart failure patients, and its presence is associated with adverse outcome. However, congestion is not always clinically evident, and more objective measures of congestion than simple clinical examination may be helpful. Although diuretics are the mainstay of treatment for congestion, no randomised trials have shown the effects of diuretics on mortality in chronic heart failure patients. Furthermore, appropriate titration of diuretics in this population is unclear. Research is required to determine whether a robust method of detecting — and then treating — subclinical congestion improves outcomes.
Home Orthostatic Training In Elderly Patients With Vasovagal Syncope — A Prospective Randomised Controlled Trial
Authors: Podd Steven ,   Eastbourne District General Hospital, East Sussex, United Kingdom, Hunt Jacqueline ,   Eastbourne District General Hospital, East Sussex, United Kingdom, Sulke Neil ,   Eastbourne District General Hospital, East Sussex, United Kingdom
Published: December 2015

Aim: The aim of this study was to assess the effect of home orthostatic training (HOT) on autonomic reflexes in elderly patients with vasovagal syncope (VVS). Methods: Design and Setting: A single-blind randomised control trial was conducted at Eastbourne District General Hospital, East Sussex NHS Trust. Patients: Individuals with recurrent syncope underwent tilt-table testing between August 2007 and October 2009.Those with at least two syncopal episodes and tilt-test proven VVS were recruited. Participants were divided into those aged >65 years (O65) and those aged <65 years (U65). Interventions: Patients in the O65 group were randomised 1:1 to receive active HOT (O65+) or sham HOT (O65–). The U65 group received active HOT. Participants performed HOT/sham HOT and recorded their training and symptoms. Patients had a repeat tilt test at 3 months. Outcome Measures: Time to syncope at repeat tilt-table testing, low-frequency heart rate variability (LF-HRV), high-frequency heart rate variability (HF-HRV), mean upslope baroreflex sensitivity (BRS) and mean downslope BRS were assessed. Results: A total of 106 patients with recurrent syncope underwent tilt-table testing. Of these, 45 consecutive patients (30 in the O65 group and 15 in the U65 group) were recruited. Two, one and three patients withdrew or were lost-to-follow-up in the O65+, O65–, and U65 groups, respectively. Symptomatic benefit occurred in four (31 %) of the O65+, four (29 %) of the O65–, and six (50 %) of the U65. None of the autonomic measures changed significantly in any group. No difference was seen with HF-HRV, LF-HRV mean upslope BRS and mean downslope BRS. Fifty per-cent of the O65+ group stopped training because of back pain. Time constraint (25 %) was the most common reason for cessation in the U65 group. Conclusions: Despite good tilt training compliance, no improvement in autonomic measures in any group was shown. The most common reason for cessation of training was back pain in the elderly groups. This study does not support the use of HOT in elderly patients.
A Practical Clinical Approach To The Diagnosis And Treatment Of Patients With Pulmonary Hypertension
Authors: Madden Brendan P ,   St Georges Hospital, London, United Kingdom
Published: December 2015

Pulmonary hypertension is defined by a mean pulmonary artery pressure of >25 mmHg at rest or 30 mmHg during exercise. There are many causes and currently diseases causing the condition are classified into five groups. The greatest elevation in pulmonary arterial pressure is found among those disorders in group 1 (known as pulmonary arterial hypertension [PAH]) and research and targeted therapy has focused on this group in particular, although patients in group 4 (chronic thromboembolic PH [CTEPH]) also receive advanced pulmonary vasodilator therapy. The symptoms of PH are often vague and the diagnosis is frequently missed or delayed. Efforts are therefore being made to improve awareness of PH among clinicians to enable prompt referral to a PH unit to confirm the diagnosis and instigate appropriate therapy. Multi-disciplinary team (MDT) discussion is necessary if patients with PH require surgical intervention or become pregnant. For patients in the other PH groups, treatment is usually concentrated on the primary disorder. A small number of patients with PAH will respond to calcium-channel-blocking agents. Specific targeted therapy is often given in combination depending on the patients functional performance status. Available agents include phosphodiesterase type V inhibitors, endothelin receptor antagonists, prostglandin analogues and nitric oxide. Many novel agents are under review. For carefully selected patients surgical options, include lung transplantation, pulmonary thromboendarterectomy and atrial septostomy.
Sleep-Disordered Breathing In Heart Failure
Authors: Pearse Simon G ,   Royal Brompton and Harefield NHS Trust and Imperial College London, London, United Kingdom, Cowie Martin R ,   Royal Brompton and Harefield NHS Trust and Imperial College London, London, United Kingdom, Sharma Rakesh ,   Royal Brompton and Harefield NHS Trust and Imperial College London, London, United Kingdom, Vazir Ali ,   Royal Brompton and Harefield NHS Trust and Imperial College London, London, United Kingdom
Published: December 2015

Sleep-disordered breathing affects over half of patients with heart failure (HF) and is associated with a poor prognosis. It is an under-diagnosed condition and may be a missed therapeutic target. Obstructive sleep apnoea is caused by collapse of the pharynx, exacerbated by rostral fluid shift during sleep. The consequent negative intrathoracic pressure, hypoxaemia, sympathetic nervous system activation and arousals have deleterious cardiovascular effects. Treatment with continuous positive airway pressure may confer symptomatic and prognostic benefit in this group. In central sleep apnoea, the abnormality is with regulation of breathing in the brainstem, often causing a waxing-waning Cheyne Stokes respiration pattern. Non-invasive ventilation has not been shown to improve prognosis in these patients and the recently published SERVE-HF trial found increased mortality in those treated with adaptive servoventilation. The management of sleep-disordered breathing in patients with HF is evolving rapidly with significant implications for clinicians involved in their care.
Home Blood Pressure Monitoring
Authors: George Jacob ,   Senior Clinical Lecturer, Honorary Consultant Physician, Clinical Pharmacology/Acute Medicine, University of Dundee Medical School/NHS Tayside, Dundee, Scotland, MacDonald Thomas ,   Professor of Clinical Pharmacology, Medicines Monitoring Unit and Hypertension Research Centre, Division of Medical Sciences, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland
Published: December 2015

Hypertension is the most common preventable cause of cardiovascular disease. Home blood pressure monitoring (HBPM) is a self-monitoring tool that can be incorporated into the care for patients with hypertension and is recommended by major guidelines. A growing body of evidence supports the benefits of patient HBPM compared with office-based monitoring: these include improved control of BP, diagnosis of white-coat hypertension and prediction of cardiovascular risk. Furthermore, HBPM is cheaper and easier to perform than 24-hour ambulatory BP monitoring (ABPM). All HBPM devices require validation, however, as inaccurate readings have been found in a high proportion of monitors. New technology features a longer inflatable area within the cuff that wraps all the way round the arm, increasing the ‘acceptable range’ of placement and thus reducing the impact of cuff placement on reading accuracy, thereby overcoming the limitations of current devices.
Nothing Will Ever Be The Same Again
Authors: Peters Jasper
Published: December 2015

Often in the universe of Doctor Who, our best means for understanding the Doctor is through the lens of his companion. Almost always present, the role of the companion is a central narrative of the Doctor. Furthermore, a comprehension of the role of the companion is essential in an effort to understand the motivation and nature of the Doctor. In this paper I argue that the relationship between the Doctor and his companion corresponds to that of Christ and Christian, especially in regards to issues of faith and doubt. This is seen through the arc of character development of each companion, especially in his or her moments of confusion and frustration with the antics of the Doctor. We will also find some relief, if not resolution, through concepts of faith given by Tillich. Though the exploration of the Doctor as a Soteriological actor have been drawn, this article addresses the interplay of Doctor as Soter and that of a Companion who may vacillate between dedication and confusion. Such an exploration will give us unique tools for understanding both individual and collective relationships with the Doctor and insight into the often counterintuitive decision to embark on a mystifying journey.
Doctor Who and Immortality
Authors: Vuolteenaho Leena
Published: December 2015

This article serves as an introduction to an examination of how Christian and Buddhist ethics have influenced the depiction of immortality in Doctor Who. Both Christianity and Buddhism could be said to have clearly defined stances regarding immortality—simply put, both generally regard the human pursuit of eternal life as reprehensible, albeit for somewhat different reasons. During its run, Doctor Who has tackled a variety of ethical issues, the problematic aspects of immortality being a recurring theme. As an overview of selected Doctor Who episodes illustrates, the series tends to agree on viewing immortality as ethically questionable, and furthermore, to reflect the views of both Christianity and Buddhism in how it communicates its own approach. Whether the emphasis is on Christian or Buddhist ideas (such as an authoritative concept of law or the essential nature of life as suffering, respectively) varies from one story to another, but it appears that both have played, and continue to play, an integral part in how narratives regarding immortality are shaped and dealt with in the series. The findings from Doctor Who suggest that the series is a fruitful source in terms of examining the role of religious influences in the discussion regarding ethical dilemmas.