bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of the Community–Academia Student Tutoring (CAST) program in enhancing students’ practice placement readiness
Authors: Tal-Saban Miri , Weintraub Naomi
Published: October 2018

Introduction

Occupational therapy programs include practice education, which is a vital aspect of professional practice preparation. We evaluated the effectiveness of the Community–Academia Student Tutoring program for enhancing occupational therapy students’ perceived readiness for their practice placement, thus reducing their feelings of anxiety.

Method

The study included 84 first-year undergraduate occupational therapy students aged 21–35 years, of whom 43 participated in the Community–Academia Student Tutoring group program and the rest comprised the control group. Participants completed the Student Self-Competency and Readiness for Fieldwork questionnaire prior to their first practice placement.

Findings

Anxiety was related to the Student Self-Competency and Readiness for Fieldwork’s components and total score. The Community–Academia Student Tutoring group scored significantly higher ( p < .05) than the controls in the Evaluation and Communication with Patients components of the questionnaire, after controlling for anxiety level.

Implications

It appears that it is possible to enhance students’ readiness for their practice placement through a structured and intensive community-based mentoring program that is guided by faculty and includes activities of briefing and debriefing, such as the Community–Academia Student Tutoring program.
Simulation Games to Study Transportation Issues and Solutions: Studies on Synchromodality
Authors: Kourounioti Ioanna , Kurapati Shalini , Lukosch Heide , Tavasszy Lóránt , Verbraeck Alexander
Published: October 2018

In this paper we discuss the application of simulation gaming to study the behavior and decision making of stakeholders when confronted with complex transportation problems. The problem we tackle is synchromodal transportation. Synchromodality requires the vertical and horizontal collaboration of stakeholders in all the levels of decision making. To facilitate this, we develop four games designed in a way that meets the needs of decision makers in each level. We present both board and digital games and the results from the first gaming sessions with Dutch supply chain and logistics professionals.
Managing difficult and violent adolescents (adolescents difficiles) in France: a genealogical approach
Authors: Gansel Yannis
Published: October 2018

‘Difficult adolescent’ is a clinical category defined by psychiatrists’ expertise. Since the end of the 1990s, it has been extensively used to describe a population of disruptive, violent yet vulnerable adolescents, at the margins of public institutions that manage youth deviancy in France. For the present study, an interconnected network of 49 documents was analysed using a genealogical method in order to provide comprehensive elements in the results. This category found its ecological niche in the 1960s, revealing a moral tension in the use of constraint. It addressed new problems of intractable individuals, whose dangerousness and vulnerability require coordination between penal, social and psychiatric institutions. It defines an ambiguous condition, suspended between the trouble experienced by the caregivers and an adolescent’s individual disorder.
Evaluation of Advanced Combined Cycle Power Plants
Authors: Kail C
Published: October 2018

This report will analyse and evaluate the most recent and significant trends in combined cycle gas turbine (CCGT) power plant configurations. The various enhancements will be compared with the ‘simple’ gas turbine.

The first trend, a gas turbine with reheat, cannot convert its better efficiency and higher output into a lower cost of electrical power. The additional investments required as well as increased maintenance costs will neutralize all the thermodynamic performance advantages.

The second concept of cooling the turbine blades with steam puts very stringent requirements on the blade materials, the steam quality and the steam cooling system design. Closed-loop steam cooling of turbine blades offers cost advantages only if all its technical problems can be solved and the potential risks associated with the process can be eliminated through long demonstration programmes in the field.

The third configuration, a gas turbine with a closed-loop combustion chamber cooling system, appears to be less problematic than the previous, steam-cooled turbine blades. In comparison with an open combustion chamber cooling system, this solution is more attractive due to better thermal performance and lower emissions. Either air or steam can be used as the cooling fluid.
Modelling and experimental validation of 1-degree-of-freedom impacting oscillator
Authors: Witkowski Krzysztof , Kudra Grzegorz , Wasilewski Grzegorz , Awrejcewicz Jan
Published: October 2018

In this article, a mechanical 1-degree-of-freedom oscillator with harmonic forcing and impacts was analysed both numerically and experimentally. A special attention was paid to the mathematical modelling and realistic numerical simulations of a real system. The developed experimental rig consists of a cart mounted on a guide, connected with springs to the support, and equipped with one-sided stiff limiter of motion. The cart was excited by an unbalanced disc mounted on the shaft of a stepper motor. Modelling was focused on the mathematical description of the impact process, where soft obstacle with Hertzian stiffness was assumed and different forms of non-linear damping were tested, including original modifications of the already used models. Model parameters are identified based on two experimental solutions corresponding to free vibrations – with and without impacts. Then, the model was validated by means of experimental and numerical analysis of bifurcation dynamics of the forced system.
The anti-thrombotic effects of vitamin D and their possible relationship with antiphospholipid syndrome
Authors: García-Carrasco M , Jiménez-Herrera E A , Gálvez-Romero J L , Mendoza-Pinto C , Méndez-Martínez S , Etchegaray-Morales I , Munguía-Realpozo P , Vázquez de Lara-Cisneros L , Santa Cruz F J , Cervera R
Published: October 2018

The importance of the immunomodulatory effects of vitamin D has recently been associated with autoimmune and chronic inflammatory diseases. Vitamin D deficiency has been linked to the development of autoimmune conditions. Antiphospholipid syndrome is an autoimmune disease characterized by thrombotic events and obstetric complications in patients with antiphospholipid antibodies. Current data show that patients with antiphospholipid syndrome have a high prevalence of vitamin D deficiency even without classic risk factors. Several studies have suggested vitamin D may have anti-thrombotic functions. In antiphospholipid syndrome, low vitamin D serum levels have been associated with thrombotic manifestations, suggesting a possible protective role of vitamin D in antiphospholipid syndrome. This literature review presents current evidence on the haemostatic functions of vitamin D and their possible relationship with the clinical manifestations of antiphospholipid syndrome.
Effects of sample handling on the detection of porcine reproductive and respiratory syndrome virus in oral fluids by reverse-transcription real-time PCR
Authors: Weiser Ashley C. , Poonsuk Korakrit , Bade Sarah A. , Gauger Phillip C. , Rotolo Marisa , Harmon Karen , Gonzalez Wendy M. , Wang Chong , Main Rodger , Zimmerman Jeffrey J.
Published: October 2018

We evaluated effects of handling procedures on detection of porcine reproductive and respiratory syndrome virus (PRRSV) in oral fluids (OFs) by reverse-transcription real-time PCR (RT-rtPCR). The experiments were conducted using a composite sample of PRRSV-positive OF collected from 5-wk-old pigs vaccinated 15 d earlier with a modified-live PRRSV vaccine. Five pre-extraction sample-handling steps and all combinations thereof were evaluated: 1) thaw temperature (4°C or 25°C); 2) sample diluent (1:1 dilution with nuclease-free water or guanidinium thiocyanate–phenol); 3a) sonication of the sample (yes or no); 3b) temperature (4°C or 25°C) at which step 3a was conducted; and 4) temperature at which the sample was maintained after step 3b and until RNA extraction was initiated (4°C or 25°C). All combinations of the 5 sample-handling steps (i.e., 32 unique treatments) were tested in a completely randomized factorial design with 4 replicates and 1 negative control for each treatment. The entire experiment was repeated on 5 separate days to produce a total of 800 PRRSV RT-rtPCR results. Binary (positive or negative) data were analyzed by logistic regression and results (Ct) were analyzed using a generalized linear model. Overall, 1 false-positive result was observed among 160 negative controls (99.4% specificity), and 85 false-negative results were observed among the 640 known-positive samples (86.7% sensitivity). The most significant factor affecting test outcome was thaw temperature (4°C or 25°C); samples thawed at 4°C had higher positivity rate (94% vs. 80%, p < 0.0001) and lower Ct (36.2 vs. 37.5, p < 0.0001).
Clinical Outcomes Following Minimally Invasive Dorsal Cheilectomy for Hallux Rigidus
Authors: Teoh Kar Hao , Tan Wei Teen , Atiyah Zeid , Ahmad Aziz , Tanaka Hiro , Hariharan Kartik
Published: October 2018

Background:

Following failure of conservative treatment, a dorsal cheilectomy can be performed for patients in early stages of hallux rigidus by a traditional open approach or by a minimally invasive technique. We report our clinical outcomes following minimally invasive dorsal cheilectomy (MIDC).

Methods:

Eighty-nine patients (98 feet) with symptomatic hallux rigidus treated between 2011 and 2016 were included in this study. The average age was 54 years. Manchester-Oxford Foot Questionnaire (MOxFQ) scores and visual analog scale (VAS) pain scores were collected. The mean follow-up was 50 months.

Results:

The average VAS score improved from 8.0 preoperatively to 3 postoperatively. The mean MOxFQ summary index score decreased from 58.6 preoperatively to 30.5 postoperatively. All 3 MOxFQ domains also improved. Swelling took an average of 5.3 weeks to settle. There were 2 wound infections and 2 delayed wound healings. Two patients had transient nerve paraesthesia, while 2 patients had permanent numbness in the dorsomedial cutaneous nerve distribution. Twelve patients (12%) underwent reoperation, of which 7 had a first metatarsophalangeal joint arthrodesis for ongoing pain, 4 had repeat cheilectomy for residual impingement, and 1 had an open removal of loose bone.

Conclusion:

Our results suggest that MIDC resulted in improvement in patient-reported outcome measures and was a safe technique with minimal complications. The complications were similar to open cheilectomy. There was an associated learning curve as 5 of our reoperations were due to incomplete cheilectomy. Coughlin grade 1 did well with MIDC as with open cheilectomy as none went onto an arthrodesis. However, 10% (7/65) of our grade 2 and 3 cases went on to an arthrodesis.

Level of Evidence:

Level IV, retrospective case series.
Refractive predictability and visual outcomes of an extended range of vision intraocular lens in eyes with previous myopic laser in situ keratomileusis
Authors: Palomino-Bautista Carlos , Carmona-González David , Sánchez-Jean Rubén , Castillo-Gómez Alfredo , Romero-Domínguez Marta , Elías de Tejada Macarena , Piñero David P
Published: October 2018

Purpose:

To evaluate the refractive predictability obtained with an extended range of vision intraocular lens in eyes with previous myopic laser in situ keratomileusis, confirming which intraocular lens power formula provides the most accurate calculation.

Methods:

The study enrolled 71 eyes with previous successful myopic laser in situ keratomileusis surgery of 43 patients undergoing cataract surgery with implantation of the extended range of vision intraocular lens TECNIS Symfony (Johnson and Johnson Vision). Intraocular lens power was calculated using all American Society of Cataract and Refractive Surgeons formulas, and their average value was selected for implantation. Refractive outcomes were evaluated at 3 months postoperatively.

Results:

Postoperative spherical equivalent within ±0.50 and ±1.00 D was found in 61.6% and 86.3% of eyes, respectively. In eyes with pre-laser in situ keratomileusis data available, no significant correlation was found between pre-laser in situ keratomileusis spherical equivalent and post-cataract surgery spherical equivalent (r = 0.237, p = 0.114). A postoperative spherical equivalent within ±0.50 D was found in 65.2% and 55.6% of eyes in the subgroups with and without pre-laser in situ keratomileusis data available, respectively (p = 0.480). Statistically significantly higher differences between the intraocular lens power implanted and the calculation provided by the Potvin–Hill (p = 0.028) and Barrett True K No History formulas (p = 0.022) were found in those eyes with postoperative spherical equivalent > 0.50 D.

Conclusion:

The extended range of vision intraocular lens evaluated can provide a predictable refractive correction in eyes with previous laser in situ keratomileusis surgery. The Potvin–Hill and Barrett True K No History are the most adequate formulas to perform intraocular lens power calculations in these cases.
Effects of results-based financing of maternal and child health services on patient satisfaction in Afghanistan
Authors: Tawfiq Essa , Desai Jaikishan , Hyslop Dean
Published: October 2018

Objective

To examine the impact of a results-based financing programme on patient satisfaction in Afghanistan.

Methods

We analysed data collected from over 3000 patients from a stratified sample of 112 health facilities (56 results-based financing and 56 non-results-based financing) in 11 out of the 34 provinces of Afghanistan over a three-year period. The 112 facilities were part of 442 primary care facilities that were stratified on facility type and randomly assigned to the results-based financing (intervention) and non-results-based financing (control) groups in the 11 provinces. Data were obtained from the National Health Service Performance Assessment, a baseline survey of patients conducted in 2010, and two follow-up surveys in 2011 and 2012. Measurement of patient satisfaction used a questionnaire comprising 11 questions concerning overall satisfaction, and satisfaction with specific aspects of care, from provider behaviour (e.g. respectfulness, communication) to cleanliness, opening hours and waiting times of facilities. We used a regression adjusted difference-in-differences estimator to investigate the treatment effect on patient satisfaction at facility level.

Results

There were some improvements in patient satisfaction in results-based financing facilities but these were not statistically significant. In 2011, 2 out of 11 aspects of satisfaction showed 5% improvement: satisfaction with the way health care providers explained the patient’s condition and treatment. In 2012, patient satisfaction was higher for almost all aspects of care in results-based financing facilities, including the two aspects on health care provider respectfulness and facility opening hours, which had been 5% lower in results-based financing facilities than in non-results-based financing facilities in 2011. Overall satisfaction was almost 10% higher in results-based financing facilities than in non-results-based financing facilities in 2012.

Conclusion

Even if not statistically significant, observed trends suggest some positive impacts of the results-based financing programme on patient satisfaction.
Nye bruksmønstre i et tobakksmarked i endring – kombinert bruk av sigaretter, snus og e-sigaretter blant ungdom
Authors: Lundberg Camilla Stub , Kvaavik Elisabeth , Tokle Rikke
Published: October 2018

Objectives:

There is limited research on combined use of cigarettes, snus and e-cigarettes in the Nordic countries. This study will investigate whether this pattern of use occurs among adolescents in Norway. In addition, we will investigate the association between combined use of several tobacco products, e-cigarettes and socio-demographic and psychosocial factors (SPF).

Method:

A school-based cross-sectional survey of adolescents in the 8th to the 12th grade ( N = 875) in 2014. Information on the use of cigarettes, snus, e-cigarettes and SPF was collected using an electronic questionnaire.

Results:

Of the adolescents, 31% reported having tried or used one or more tobacco product and/or e-cigarette. Of these, over half reported having tried or used one product, 1/3 two products and 1/10 three products. There were more boys among poly-users (63%) than among single-users (44%). Compared to single-users, poly-users also reported weaker school performance (30% and 11%, respectively), more often reported drinking alcohol to intoxication (91% and 75%, respectively), and having tried cannabis (28% and 9%, respectively). Poly-users also scored higher on impulsivity, sensation-seeking and depression.

Conclusion:

The study shows that combined use of tobacco products and e-cigarettes occurs among young people in Norway. Such use was associated with psychosocial and socio-demographic risk factors. There is a need to investigate this phenomenon in more details in representative samples.
Comprehensive analyses of the elasto-plastic oblique contact-impact with vibration response
Authors: Meng Wenjun , Wang Yao
Published: October 2018

Contact-impact between different surfaces is a ubiquitous phenomenon especially in the mechanical systems. Previous work of authors indicated that the effect of longitudinal and/or transverse vibration response during the motion and dynamic modeling cannot be neglected for the elasto-plastic contact-impact events. In this study, further analyses were performed to characterize the contribution of longitudinal and transverse vibration responses during the elasto-plastic oblique contact-impact, and the formula to calculate the influence factor of vibration, ξ, was proposed based on the contact force with different vibrations during the impact. The momentum theorem and assumed mode method were used to develop the equations of motion of a flexible bar with a solid flat surface. Simulation results were compared with experimental results reported in the literature to verify the accuracy of the established model. The tangential and normal velocities of the contact point after the impact were compared with the simulations for different vibration cases, and the comparison between the simulations and the experimental results had yield encourage results. For different elasto-plastic materials, three critical initial impact angles had been found from the simulation to determine whether the flexible bar slides or sticks the flat surface. Although considering the effect of vibration response during the motion and dynamic modeling is very significant, increasing the number of shape functions did not effect the result significantly. The longitudinal and transverse vibration responses were found to effect the normal and tangential velocities of the contact point after the impact, respectively. Moreover, it had been shown that for the oblique contact-impact with sliding, considering the response of longitudinal and transverse vibration at the same time is more reasonable than other cases, which also reveals that, in this case, there is a good agreement between the simulation and experimental results. Besides, the mathematical expression on the influence factor of vibration depending on the initial velocity also had been obtained by a numerical analysis. This work can provide useful insights for dynamic modeling of complex multi-body systems during the contact-impact.
Meta-Analysis of the Effect of Red on Perceived Attractiveness
Authors: Lehmann Gabrielle K. , Elliot Andrew J. , Calin-Jageman Robert J.
Published: October 2018

We conducted meta-analyses of studies that test the red-romance hypothesis, which is that the color red enhances heterosexual attraction in romantic contexts. For men rating women, we found a small, statistically significant effect ( d = 0.26 [0.12, 0.40], p = .0004, N = 2,961), with substantial heterogeneity, Q(44) = 172.5, pQ < .0001, I2 = 89% [82, 94], and equivocal results regarding the possibility of upward bias in the estimate. For women rating men, we found a very small effect ( d = 0.13 [0.01, 0.25], p = .03, N = 2,739), with substantial heterogeneity, Q(35) = 73.0, pQ = .0002, I2 = 53% [33, 80], and evidence of upward bias in the estimate. Moderator analyses suggest effect sizes may have declined over time (both genders), may be largest when an original shade of red is used (men only), and may be smaller in preregistered studies (women only). We present contrasting interpretations and suggestions for future research.
Under a magnifying glass: On the use of experiments in strategy research
Authors: Di Stefano Giada , Gutierrez Cédric
Published: October 2018

The rate at which experimental studies are published in the field of strategy has steadily increased over the past few years. Still, experimental papers account for only a small fraction of strategy papers. This may not come as a surprise given the skepticism surrounding the experimental method, which is often seen as uninterested in establishing external validity, and too “micro” for a field in which the level of analysis is primarily organizational and inter-organizational. Is this skepticism founded? To what extent can experiments be a useful tool for strategy research? To answer this question, we start by examining experimental strategy papers published between 1980 and 2016. Results from the analysis alleviate doubts about the suitability of experimental methods for the study of questions of strategic interest to firms. We next discuss the main advantages associated with the use of experiments and why they make strategy an exciting field in which to be an experimentalist today.
Multi-objective optimization using parallel simulation for space situational awareness
Authors: Felten Michael S , Colombi John M , Cobb Richard G , Meyer David W
Published: October 2018

Improving space situational awareness (SSA) remains one of the Department of Defense’s (DoD) top priorities. Current research has shown that the modeling of geosynchronous orbit (GEO) SSA architectures can help identify optimal combinations of ground- and space-based sensors. This paper extends previous research by expanding design boundaries and refining the methodology. A multi-objective genetic algorithm was used to examine this increased trade-space containing 1022 possible design combinations. The results of the optimizer clearly favor 1.0 m aperture ground telescopes combined with 0.15 m aperture sensors in a 12-satellite geosynchronous polar orbit (GPO) constellation. The GPO regime offers increased access to GEO resident space objects (RSO) since other orbits are restricted by a 40° solar exclusion angle. When performance is held constant, a GPO satellite constellation offers a 22.4% reduction in total system cost when compared to Sun synchronous orbit (SSO), equatorial low earth orbit (LEO), and near-GEO constellations. Parallel high-performance computing provides the possibility of solving an entirely new class of complex problems of interest to the DoD. The results of this research can educate national policy makers on the benefits of proposed upgrades to current and future SSA systems.
Study on similarity indices for link prediction in opportunistic networks
Authors: Cai Xulin , Shu Jian , Liu Linlan
Published: October 2018

Link prediction aims to estimate the existence of links between nodes, using information of network structures and node properties. According to the characteristics of node mobility, node intermittent contact, and high delay of opportunistic network, novel similarity indices are constructed based on CN, AA, and RA. The indices CN, AA, and RA do not consider the historic information of networks. Similarity indices, T_CN, T_AA, and T_RA, based on temporal characteristics are proposed. These take the historic information of network evolution into consideration. Using historic information of the evolution of opportunistic networks and 2-hop neighbor information of the nodes, similarity indices based on the temporal-spatial characteristics, O_CN, O_AA, and O_RA, are proposed. Based on the imote traces cambridge (ITC) and detected social network (DSN) datasets, the experimental results indicate that similarity indices O_CN, O_AA, and O_RA outperform CN, AA, and RA. Furthermore, index O_AA has superior performance.
Top-down attentional factors modulate action priming in reach-to-grasp action
Authors: Sparks Samuel , Lyons Maxwell , Kritikos Ada
Published: October 2018

Previous studies report that viewing exaggerated, high-lifting reaches (versus direct reaches) primes higher vertical deviation in wrist trajectory in the observer’s subsequent reaches (trajectory priming), but it is unclear to what extent this effect depends upon task instructions relevant to top-down attention. In two experiments, participants were instructed to gaze at a dot presented on a large monitor for a colour-change go signal that cued them to execute a direct reach to a target. In the background, the monitor also displayed life-sized films of a human model. The films were of the model either remaining still or reaching to grasp a target with either a direct trajectory or an exaggerated, high-lifting trajectory. When the dot traced the human model’s wrist throughout her movement, a robust trajectory priming effect emerged. When the dot remained stationary in a central location but the human model reached in the background, the human model’s trajectory did not alter the participants’ trajectories. Finally, when the dot traced exaggerated and direct trajectories and the human model remained stationary, the dot’s movement produced an attenuated, non-significant trajectory priming effect. These findings show that top-down attentional factors modulate trajectory priming. In addition, a moving non-human stimulus does not produce the same degree of action priming when contextual factors make salient its independence of human agency and/or intention.
Feature binding in short-term memory and long-term learning
Authors: Shimi Andria , Logie Robert H
Published: October 2018

In everyday experience, we encounter visual feature combinations. Some combinations are learned to support object recognition, and some are arbitrary and rapidly changing, so are retained briefly to complete ongoing tasks before being updated or forgotten. However, the boundary conditions between temporary retention of fleeting feature combinations and learning of feature bindings are unclear. Logie, Brockmole, and Vandenbroucke demonstrated that 60 repetitions of the same feature bindings for change detection resulted in no learning, but clear learning occurred with cued recall of the feature names. We extended those studies in two new experiments with the same array of colour–shape–location combinations repeated for 120 trials. In Experiment 1, change detection was well above chance from Trial 1, but improved only after 40 to 60 trials for participants who subsequently reported becoming aware of the repetition, and after 100 to 120 trials for participants reporting no awareness. Performance improved rapidly in Experiment 2 when participants reconstructed the array by selecting individual features from sets of colours, shapes, and locations. All participants subsequently reported becoming aware of the repetition. We conclude that change detection involves a visual cache memory that functions from the first trial, and retains feature bindings only for the duration of a trial. In addition, a weak residual episodic memory trace accumulates slowly across repetitions, eventually resulting in learning. Reconstructing feature combinations generates a much stronger episodic memory trace from trial to trial, and so learning is faster with performance supported both by the limited capacity visual cache and learning of the array.
Decay of internal reference information in duration discrimination: Intertrial interval modulates the Type B effect
Authors: Ellinghaus Ruben , Gick Mareike , Ulrich Rolf , Bausenhart Karin M
Published: October 2018

Psychophysical evidence suggests that human perception of a stimulus is assimilated towards previous stimuli. The internal reference model (IRM) explains such assimilation through an internal reference (IR), which integrates past and present stimulus representations and thus might be conceived as a form of perceptual memory. In this study, we investigated whether the IR decays with time, as previously shown for perceptual memory representations in general. One specific prediction of IRM is higher discrimination sensitivity when a constant standard precedes rather than follows a variable comparison in a two-alternative forced-choice (2AFC) discrimination task. Furthermore, the magnitude of this so-called negative Type B effect should decrease with decreasing weighting of past stimulus information in the integration process. Therefore, decay of the IR should result in a reduced Type B effect. To examine this prediction, we carried out a 2AFC duration discrimination experiment with a short (1,600 ms) and a long (3,200 ms) intertrial interval (ITI). As expected, a reduced negative Type B effect was observed at the long compared with the short ITI, consistent with the idea that humans rely on the immediate past when evaluating current sensory input, however, less so when the IR incorporating the perceptual short-term memory representation of these past stimuli has already decayed.
Can federations expel member states? On the political theory of expulsion
Authors: Hausteiner Eva Marlene
Published: October 2018

When, if at all, can a federal political order expel a member state against its will? In political theory, expulsion has—unlike the scenario of secession as voluntary separation—so far received no systematic attention; an omission that is reinforced by the paucity of historical precedent. However, current debates around the potential disintegration of the European Union show that expulsion, as a theoretical and political possibility, deserves a more careful analysis. The article sets out to consider a route toward theorizing expulsion in systematic and realist terms. It outlines possible motivational constellations, feasibility constraints, legitimacy issues, as well as procedural dimensions. The resulting claim—that expulsion may be feasible in some circumstances but that its legitimacy is bound to remain contested—is applied to the case of the European Union.
Young people and substance misuse
Authors: Hernandez Sanchez Irene
Published: October 2018

In the UK in 2017, 9% of pupils aged 11–15 reported having drunk alcohol in the previous week, which is the lowest rate since the 1980s. Illegal drug use in the previous year reported by 15-year olds halved between 2001 and 2014. Despite these promising figures, adolescence is deemed to be decisive for future biopsychosocial development and performance. Initiation during adolescence may therefore have long-term implications, affecting mental performance and educational outcomes. This article focuses on patterns of drug misuse in teenagers. The warning signs of drug misuse and useful assessment tools are also introduced. For the purposes of this article, alcohol will be defined as a drug.
A role for traditional doctors in health promotion: experience from a trial of HIV prevention in Botswana
Authors: Cockcroft Anne , Kgakole Leagajang , Marokoane Nobantu , Andersson Neil
Published: October 2018

Traditional doctors have been largely ignored in HIV prevention, particularly primary prevention. As part of a structural intervention programme to reduce HIV risk among young women in Botswana, we trained 147 traditional doctors in four districts as well as government health education assistants (HEAs) and teachers to run discussion groups in the community and schools, using an evidence-based eight-episode audio-drama, covering gender roles, gender violence, and how these are related to HIV risk. One year later, we contacted 43 of the 87 trained traditional doctors in two districts. Most (32) were running discussion groups with men and women, with links to the local HEAs and teachers. They were adept at recruiting men to their groups, often a challenge with community interventions, and reported positive changes in attitudes and behaviour of group participants. Traditional doctors can play an important role in primary prevention of gender violence and HIV.
How to boost the Western response to Russian hostile influence operations
Authors: Janda Jakub
Published: October 2018

The Russian Federation has become a rogue state in international relations, invading and occupying the territories of three European countries (Moldova, Georgia and Ukraine), waging war in the Ukrainian territory, producing massive disinformation campaigns against the West, threatening the Baltic republics, and interfering in various elections and referendums. Despite Russia’s aggressive behaviour, the West’s response to it has been significantly limited, particularly when it comes to non-military deterrence by Continental Europe. The US and the UK are leading the punishment of Russia’s aggression, while many countries, mainly in Western and Southern Europe, are hesitant to respond to this threat. This article makes recommendations as to what should be done in practical terms to boost the European portion of the Western response to Russian aggression from the political and policy points of view.
The Glycosaminoglycan Content of Hip Cartilage in Osteonecrosis of Femoral Head: Evaluation with Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage
Authors: Zhang Qidong , Guo Wanshou , Chen Yan , Zhao Qichao , Liu Zhaohui , Wang Weiguo
Published: October 2018

Objective

Hip cartilage quality is essential for the success of joint-preserving surgery for osteonecrosis. This study aimed to characterize cartilage changes in osteonecrosis of femoral head (ONFH) using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC).

Design

Fifteen asymptomatic (control) and 60 ONFH subjects were included in this study. The ONFH subjects were stratified in accordance with the Association Research Circulation Osseous (ARCO) classification ( n = 15 hips per ARCO stage). All participant hips were investigated using dGEMRIC and theT1Gd data were collected and analyzed.

Results

T1Gd value was significantly lower in the ONFH group (365.1 ± 90.5 ms; range 200-498 ms) compared with the control group (546.1 ± 26.0 ms; range 504-580 ms) ( P < 0.001). The T1Gd values of ARCO stage I-IV ONFH were 460.2 ± 17.3 ms (439-498 ms), 408.9 ± 43.4 ms (337-472 ms), 359.9 ± 34.5 ms (303-412 ms), 231.5 ± 15.1 ms (200-253 ms), respectively. Decreased T1Gd value was found to correlate significantly with increased ONFH severity ( P < 0.001). T1Gd value in collapse stage was significantly lower than that of noncollapse stage (295.7 ± 70.3 ms [range 200-412 ms] vs. 434.6 ± 41.7 ms [range 337-498 ms]; P < 0.001).

Conclusions

dGEMRIC identified hip cartilage as abnormal in ONFH, even at early-stage, as represented by decreased T1Gd, and this was further aggravated by ONFH collapse.
Are anticoagulants still indicated in pulmonary arterial hypertension?
Authors: Olschewski Horst , Rich Stuart
Published: October 2018

Pulmonary arterial hypertension (PAH) is a type of pulmonary hypertension that is a progressive, fatal disease. Multiple underlying mechanisms for PAH have been identified, including vasoconstriction, intimal proliferation, medial hypertrophy, inflammation, mitochondrial dysfunction, and in situ thrombosis. Because it is an uncommon disease, it has been challenging to identify a specific treatment that targets the dominant disease mechanism in a given patient. Early success demonstrating that some patients (approximately 10%) possess pulmonary vasoreactivity at diagnosis has driven the development of pulmonary vasodilators as the mainstay of treatment. However, while they improve exercise tolerance in clinical trials, their effect on survival is limited. Therapies that target underlying disease mechanisms that affect a majority of patients are clearly needed if we are to significantly improve overall survival.

In the actual guidelines, chronic anticoagulation is no longer recommended in patients with idiopathic, hereditary, and drug‐induced PAH although there is much indirect evidence for this.

There are data from over 40 years which include: (1) pathology studies showing the presence of thrombotic lesions in a majority of patients with PAH, both idiopathic and associated with many other conditions; (2) a similar frequency of thrombotic lesions in patients treated with pulmonary vasodilators as was seen in the years before their use; (3) mechanistic studies showing that procoagulant conditions predispose to the development of intraluminal thrombosis that contributes to vascular remodeling and the progressive nature of the pathologic changes; and (4) observational studies that, with one exception, have demonstrated a substantial survival advantage in patients with PAH treated with oral anticoagulation.

Acknowledging that no prospective randomized trial with anticoagulants has ever been done, we recommend a pragmatic approach to the use of anticoagulants in PAH. We suggest that the risks and benefits of chronic anticoagulation be considered in individual patients, and that warfarin be prescribed in patients with PAH, unless they have an increased risk of bleeding.

The question of whether direct oral anticoagulants (DOACs) would provide the same benefit as vitamin K antagonists is valid, but presently there are no data at all regarding their use in PAH. However, in patients with PAH in whom warfarin anticoagulation management proves problematic, it is reasonable to switch the patient to a DOAC as is current practice for other conditions.
Predicting 3-Year Survival in Patients Receiving Maintenance Dialysis: An External Validation of iChoose Kidney in Ontario, Canada
Authors: Tan Vivian S. , Garg Amit X. , McArthur Eric , Patzer Rachel E. , Gander Jennifer , Roshanov Pavel , Kim S. Joseph , Knoll Greg A. , Yohanna Seychelle , McCallum Megan K. , Naylor Kyla L.
Published: October 2018

Background:

Many patients with end-stage kidney disease (ESKD) do not appreciate how their survival may differ if treated with a kidney transplant compared with dialysis. A risk calculator (iChoose Kidney) developed and validated in the United States provides individualized mortality estimates for different treatment options (dialysis vs living or deceased donor kidney transplantation). The calculator can be used with patients and families to help patients make more educated treatment decisions.

Objective:

To validate the iChoose Kidney risk calculator in Ontario, Canada.

Design:

External validation study.

Setting:

We used several linked administrative health care databases from Ontario, Canada.

Patients:

We included 22 520 maintenance dialysis patients and 4505 kidney transplant recipients. Patients entered the cohort between 2004 and 2014.

Measurements:

Three-year all-cause mortality.

Methods:

We assessed model discrimination using the C-statistic. We assessed model calibration by comparing the observed versus predicted mortality risk and by using smoothed calibration plots. We used multivariable logistic regression modeling to recalibrate model intercepts using a correction factor, when appropriate.

Results:

In our final version of the iChoose Kidney model, we included the following variables: age (18-80 years), sex (male, female), race (white, black, other), time on dialysis (<6 months, 6-12 months, >12 months), and patient comorbidities (hypertension, diabetes, and/or cardiovascular disease). Over the 3-year follow-up period, 33.3% of dialysis patients and 6.2% of kidney transplant recipients died. The discriminatory ability was moderate (C-statistic for dialysis: 0.70, 95% confidence interval [CI]: 0.69-0.70, and C-statistic for transplant: 0.72, 95% CI: 0.69-0.75). The 3-year observed and predicted mortality estimates were comparable and even more so after we recalibrated the intercepts in 2 of our models (dialysis and deceased donor kidney transplantation). As done in the United States, we developed a Canadian Web site and an iOS application called Dialysis vs. Kidney Transplant- Estimated Survival in Ontario.

Limitations:

Missing data in our databases precluded the inclusion of all variables that were in the original iChoose Kidney (ie, patient ethnicity and low albumin). We were unable to perform all preplanned analyses due to the limited sample size.

Conclusions:

The original iChoose Kidney risk calculator was able to adequately predict mortality in this Canadian (Ontario) cohort of ESKD patients. After minor modifications, the predictive accuracy improved. The Dialysis vs. Kidney Transplant- Estimated Survival in Ontario risk calculator may be a valuable resource to help ESKD patients make an informed decision on pursuing kidney transplantation.
Microprocessor knees with ‘standing support’ and articulating, hydraulic ankles improve balance control and inter-limb loading during quiet standing
Authors: McGrath Michael , Laszczak Piotr , Zahedi Saeed , Moser David
Published: October 2018

Introduction

Trans-femoral amputees are at risk of musculoskeletal problems that are in part caused by loading asymmetry during activities, such as prolonged standing, particularly on uneven or sloped ground.

Methods

Four prosthetic conditions were tested; microprocessor knee ‘standing support’ mode activated (ON) and deactivated (OFF), combined with a rigidly attached foot (RA) and with an articulating, hydraulic ankle-foot (HA). Five trans-femoral amputees and five able-bodied controls were measured using a motion capture system and a force plate while standing, facing down a 5° slope. Ground reaction force distributions and centre-of-pressure root-mean-square (COP RMS) were calculated as outcome measures.

Results

Compensatory kinematic adjustments were observed for RA conditions but not for HA conditions. HA-OFF reduced ground reaction force degree-of-asymmetry for all five amputees, compared to RA-OFF. RA-ON reduced ground reaction force degree-of-asymmetry for four amputees, compared to RA-OFF. In terms of balance, the HA conditions reduced the mean inter-limb COP RMS by 24–25% compared to equivalent RA conditions, while ON conditions reduced it by 9–11%, compared to equivalent OFF conditions.

Conclusions

It is important to consider both prosthetic knee and ankle technologies when prescribing devices to trans-femoral amputees. The combination of hydraulic ankle and knee standing support technologies produced outcomes closest to normal biomechanics.
Effects of Advanced Cardiac Procedure Simulator Training on Learning and Performance in Cardiovascular Medicine Fellows
Authors: Young Michael N , Markley Roshanak , Leo Troy , Coffin Samuel , Davidson Mario A , Salloum Joseph , Mendes Lisa A , Damp Julie B
Published: October 2018

Background:

Simulation-based training has been used in medical training environments to facilitate the learning of surgical and minimally invasive techniques. We hypothesized that integration of a procedural simulation curriculum into a cardiology fellowship program may be educationally beneficial.

Methods:

We conducted an 18-month prospective study of cardiology trainees at Vanderbilt University Medical Center. Two consecutive classes of first-year fellows (n = 17) underwent a teaching protocol facilitated by simulated cases and equipment. We performed knowledge and skills evaluations for 3 procedures (transvenous pacing [TVP] wire, intra-aortic balloon pump [IABP], and pericardiocentesis [PC]). The index class of fellows was reevaluated at 18 months postintervention to measure retention. Using nonparametric statistical tests, we compared assessments of the intervention group, at the time of intervention and 18 months, with those of third-year fellows (n = 7) who did not receive simulator-based training.

Results:

Compared with controls, the intervention cohort had higher scores on the postsimulator written assessment, TVP skills assessment, and IABP skills assessment ( P = .04, .007, and .02, respectively). However, there was no statistically significant difference in scores on the PC skills assessment between intervention and control groups ( P = .08). Skills assessment scores for the intervention group remained higher than the controls at 18 months ( P = .01, .004, and .002 for TVP, IABP, and PC, respectively). Participation rate was 100% (24/24).

Conclusions:

Procedural simulation training may be an effective tool to enhance the acquisition of knowledge and technical skills for cardiology trainees. Future studies may address methods to improve performance retention over time.
Anti-CD37 chimeric antigen receptor T cells are active against B- and T-cell lymphomas
Authors: Scarfò Irene , Ormhøj Maria , Frigault Matthew J. , Castano Ana P. , Lorrey Selena , Bouffard Amanda A. , van Scoyk Alexandria , Rodig Scott J. , Shay Alexandra J. , Aster Jon C. , Preffer Frederic I. , Weinstock David M. , Maus Marcela V.
Published: October 2018

Chimeric antigen receptor (CAR) T cells have emerged as a novel form of treatment of patients with B-cell malignancies. In particular, anti-CD19 CAR T-cell therapy has effected impressive clinical responses in B-cell acute lymphoblastic leukemia and diffuse large B-cell lymphoma. However, not all patients respond, and relapse with antigen loss has been observed in all patient subsets. Here, we report on the design and optimization of a novel CAR directed to the surface antigen CD37, which is expressed in B-cell non-Hodgkin lymphomas, in chronic lymphocytic leukemia, and in some cases of cutaneous and peripheral T-cell lymphomas. We found that CAR-37 T cells demonstrated antigen-specific activation, cytokine production, and cytotoxic activity in models of B- and T-cell lymphomas in vitro and in vivo, including patient-derived xenografts. Taken together, these results are the first showing that T cells expressing anti-CD37 CAR have substantial activity against 2 different lymphoid lineages, without evidence of significant T-cell fratricide. Furthermore, anti-CD37 CARs were readily combined with anti-CD19 CARs to generate dual-specific CAR T cells capable of recognizing CD19 and CD37 alone or in combination. Our findings indicate that CD37-CAR T cells represent a novel therapeutic agent for the treatment of patients with CD37-expressing lymphoid malignancies.
Erythroferrone inhibits the induction of hepcidin by BMP6
Authors: Arezes João , Foy Niall , McHugh Kirsty , Sawant Anagha , Quinkert Doris , Terraube Virginie , Brinth Alette , Tam May , LaVallie Edward R. , Taylor Stephen , Armitage Andrew E. , Pasricha Sant-Rayn , Cunningham Orla , Lambert Matthew , Draper Simon J. , Jasuja Reema , Drakesmith Hal
Published: October 2018

Key Points

ERFE suppresses BMP/SMAD signaling in vitro and in vivo. ERFE inhibits hepcidin induction by BMP5, BMP6, and BMP7.
Use of the false discovery rate for evaluating clinical safety data
Authors: Mehrotra Devan V , Heyse Joseph F
Published: October 2018

Clinical adverse experience (AE) data are routinely evaluated using between group P values for every AE encountered within each of several body systems. If the P values are reported and interpreted without multiplicity considerations, there is a potential for an excess of false positive findings. Procedures based on confidence interval estimates of treatment effects have the same potential for false positive findings as P value methods. Excess false positive findings can needlessly complicate the safety profile of a safe drug or vaccine. Accordingly, we propose a novel method for addressing multiplicity in the evaluation of adverse experience data arising in clinical trial settings. The method involves a two-step application of adjusted P values based on the Benjamini and Hochberg1 false discovery rate (FDR). Data from three moderate to large vaccine trials are used to illustrate our proposed ‘Double FDR’ approach, and to reinforce the potential impact of failing to account for multiplicity. This work was in collaboration with the late Professor John W. Tukey who coined the term ‘Double FDR’.