bluuebunny/crossref_metadata_2025 huggingface dataset:
A model of electoral competition between national and regional parties
Authors: Bhattacharya Mihir
Published: May 2018

We consider a one-dimensional model of electoral competition with national and regional parties. There are two regions and three parties—one national party and one regional party for each region. We divide the paper into two parts— homogeneous and heterogeneous regions. In the former, the policy positions of the national party and the regional party of the region with the greater number of constituencies coincide with the favorite policy position of the region-wide median voter. In the latter, the national party chooses a policy position in a maximal isolation set, while the two regional parties choose policies on the same side of the national party’s policy as their own respective region-wide medians. For a given outcome function, the national party performs better when the regions are heterogeneous. In the homogeneous regions case, the national party can at best do as well as the regional party of the region with the greater number of constituencies. Our results are broadly consistent with intuition and evidence.
A simulation-based case study for powertrain efficiency improvement by automated driving functions
Authors: Plum Thorsten , Wegener Marius , Eisenbarth Markus , Ye Ziqi , Etzold Konstantin , Pischinger Stefan , Andert Jakob
Published: May 2018

An increasing level of driving automation and a successive electrification of modern powertrains enable a higher degree of freedom to improve vehicle fuel efficiency and reduce pollutant emissions. Currently, both domains themselves, driving automation as well as powertrain electrification, face the challenge of a rising development complexity with extensive use of virtual testing environments. However, state-of-the-art virtual testing environments typically strictly focus on just one domain and neglect the other. This paper shows the results of a simulation-based case study considering both domains simultaneously. The influence of energy saving automated functionalities on a conventional, a hybrid, and a pure electric powertrain is investigated for a carefully selected inner-city driving scenario. The vehicle simulation models for the different powertrain configurations are calibrated using test bench results and vehicle measurements. A model predictive acceleration controller is developed for realizing the speed optimization function. By considering traffic conditions such as traffic light schedules and a preceding vehicle as the boundary conditions, unnecessary accelerations and decelerations are avoided to reduce the energy demand. The case study is realized by applying this function to the three powertrains variants. As a final result, a clear difference in energy demand is observed: the hybrid powertrain benefits the most in terms of energy demand reduction in the given use case. The results clearly underscore that in future vehicle development programs, the powertrain and the real-world driving functionalities have to be optimized simultaneously to minimize the energy demand during everyday vehicle operation.
Propagation characteristics of rotating detonation wave in plane–radial structure with different pressure conditions
Authors: Xia Zhenjuan , Ma Hu , Zhuo Changfei , Zhou Changsheng
Published: May 2018

This paper simulates the propagation characteristics of rotating detonation wave in the plane–radial structure for mixtures of 2H2 + O2 + 3.76N2. Two-dimensional numerical simulation was modeled, and two kinds of typical flow field and corresponding operating range were obtained under various pressure conditions. Due to the influence of curvature, the detonation wave is strengthened near the outer concave boundary and weakened near the inner convex one. The pressure ratio was varied from 1.6 to 10 by varying both stagnation and back pressure for detonation parameters and flow parameters. It is found that these parameters are dependent only on stagnation pressure for higher pressure ratio. While the pressure ratio is low, the back pressure also has an effect on them. The detonation wave height initially increases and then decreases as stagnation pressure increases, and the pressure ratio has a significant effect on it for lower pressure ratio. The inlet block ratio varies slightly from 14% to 21%. The exit average Mach number has small fluctuations between 0.89 and 1.05. The exit supersonic flow ratio varies from 14% to 74%, and the peak value is gained when pressure ratio is 6. The exit pressure amplifying ratio varies from 1.45 to 1.95, and the maximum value is obtained when pressure ratio is 2.5.
Uses and Perspectives of Aging Well Terminology in Taiwanese and International Literature: A Systematic Review
Authors: Chen Shih-Ni , Riner Mary Elizabeth , Stocker Joel F. , Hsu Min-Tao
Published: May 2018

The aim of this study is to examine aging well (AW) terminology in Taiwan in its local and global contexts, and to suggest ways of communication by Taiwanese professionals that is sensitive to the lay public’s preferences. Researchers conducted a systematic review using Khan et al.’s strategy, and Harden and Thomas’ method, to sift through seven databases and synthesize diverse studies on AW. Primary aging well terms used in English and Chinese, their usage frequency in Taiwanese academia, and one term uniquely used by lay people in Taiwan were identified. The synthesized literature illustrated commonality as well as diversity in use and interpretation of aging well terms within Taiwanese society and compared with the Western-based research. More qualitative research is needed to explore how AW is experienced, interpreted, and expected from lay perspectives in Taiwan and other countries have primarily relied on translation and adaptation of Western terms in their scientific research.
Interdisciplinary Approach to Complexity in Simulation Game Design and Implementation
Authors: Wardaszko Marcin
Published: May 2018

Background. This article offers another look at the complexity in simulation game design and implementation. Although, the topic is not new or undiscovered the growing volatility of socio-economic environments and changes to the way we design simulation games nowadays call for better research and design methods.

Aim. The aim of this article is to look into the current state of understanding complexity in simulation gaming and put it in the context of learning with and through complexity.

Methodology. The nature and understanding of complexity are simultaneously field-specific and interdisciplinary. Analyzing understanding and role of complexity in different fields associated with simulation game design and implementation. Thoughtful theoretical analysis has been applied in order to deconstruct the complexity theory and reconstruct it further as higher-order models.

Results and recommendations. This article offers an interdisciplinary look at the role and place of complexity from two perspectives. The first perspective is knowledge building and dissemination about complexity in simulation gaming. Second, perspective is the role the complexity plays in building and implementation of the simulation gaming as a design process.
Effect of a Structured Pharmaceutical Care Intervention Versus Usual Care on Cardiovascular Risk in HIV Patients on Antiretroviral Therapy: INFAMERICA Study
Authors: Morillo-Verdugo Ramón , Robustillo-Cortés María de las Aguas , Martín-Conde María Teresa , Callejón-Callejón Gador , Cid-Silva Purificación , Moriel-Sánchez Carmen , Tortajada-Goitia Begoña , Almeida-González Carmen Victoria
Published: May 2018

Background: HIV+ patients have increased their life expectancy with a parallel increase in age-associated comorbidities. Objective: To determine the effectiveness of an intensive pharmaceutical care follow-up program in comparison to a traditional model among HIV-infected patients with moderate/high cardiovascular risk. Method: This was a multicenter, prospective, randomized study of a structured health intervention conducted between January-2014 and June-2015 with 12 months of follow-up at outpatient pharmacy services. The selected patients were randomized to a control group (usual care) or intervention group (intensive pharmaceutical care). The interventional program included follow-up of all medication taken by the patient to detect and work toward the achievement of pharmacotherapeutic objectives related to cardiovascular risk and making recommendations for improving diet, exercising, and smoking cessation. Individual motivational interview and periodic contact by text messages about health promotion were used. The primary end point was the percentage of patients who had reduced the cardiovascular risk index, according to the Framingham-score. Results: A total of 53 patients were included. As regards the main variable, 20.7% of patients reduced their Framingham-score from high/very high to moderate/low cardiovascular risk versus 12.5% in the control group ( P=0.016). In the intervention group, the number of patients with controlled blood pressure increased by 32.1% ( P=0.012); 37.9% of patients overall stopped smoking ( P=0.001), and concomitant medication adherence increased by 39.4% at the 48-week follow-up ( P=0.002). Conclusion and Relevance: Tailored pharmaceutical care based on risk stratification, motivational interviewing, and new technologies might lead to improved health outcomes in HIV+ patients at greater cardiovascular risk.
A Review of ACE Inhibitors and ARBs in Black Patients With Hypertension
Authors: Helmer Allison , Slater Nicole , Smithgall Sean
Published: May 2018

Objective: To review current guidelines and recent data evaluating the efficacy and safety of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in black hypertensive patients. Data Sources: Articles evaluating race-specific outcomes in hypertension were gathered using a MEDLINE search with keywords black, African American, ACE inhibitor, angiotensin receptor blocker, angiotensin system, and hypertension. Studies published from 2000 through April 2018 were reviewed. Study Selection and Data Extraction: Six guidelines, 8 monotherapy publications, and 5 combination therapy publications included race-specific results and were included in the review. The authors individually compared and contrasted the results from each publication. Data Synthesis: Numerous monotherapy trials indicate that black patients may have a reduced blood pressure (BP) response with ACE inhibitors or ARBs compared with white patients. Conversely, additional studies propose that race may not be the primary predictor of BP response. Reduced efficacy is not observed in trials involving combination therapy. Some studies suggest increased cardiovascular and cerebrovascular morbidity and mortality with ACE inhibitor or ARB monotherapy in black patients; however, data are conflicting. Relevance to Patient Care and Clinical Practice: This article clarifies vague guideline statements and informs clinicians on the appropriate use of ACE inhibitors or ARBs for hypertension treatment in black patients through an in-depth look into the evidence. Conclusions: Potentially reduced efficacy and limited outcomes data indicate that ACE inhibitors or ARBs should not routinely be initiated as monotherapy in black hypertensive patients. Use in combination with a calcium channel blocker or thiazide diuretic is efficacious in black patients, and there are no data showing that this increases or decreases cardiovascular or cerebrovascular outcomes.
“Get Out of My Home and Don’t Come Back!” Empowering Women Through Self-Defense
Authors: Jordan Jan , Mossman Elaine
Published: May 2018

Can self-defense courses empower those already victimized? This article explores the potential for self-defense courses to have specific efficacy in the prevention of intimate partner violence (IPV). It draws on interview ( n = 36) and pre- and postevaluation ( n = 44) data from two studies: (a) evaluation of a pilot study of a feminist empowerment self-defense course designed specifically for women’s refuge/shelter clients (Violence Prevention Project [VPP]) and (b) evaluation of women’s self-defense courses collected as part of a larger evaluation study (Skills for Safety). The overwhelmingly positive findings from both studies suggest greater consideration be offered to providing further collaborative refuge/self-defense courses for women victimized by IPV.
Reasonable Suspicion in the Eye of the Beholder: Routine Policing in Racially Different Disadvantaged Neighborhoods
Authors: Gaston Shytierra , Brunson Rod K.
Published: May 2018

This study extends Brunson and Weitzer’s 2009 endeavor to elucidate the influence of race and place in policing by reexamining enforcement practices across disadvantaged urban neighborhoods but from the purview of police. We investigate the impact of race and neighborhood context on officer decision making and routine enforcement practices by analyzing 144 official reports of drug arrests made between 2009 and 2013 in a similarly disadvantaged majority White, majority Black, and racially mixed neighborhood in St. Louis. Our analysis reveals the importance of place and race for helping to shape officers’ decision making and investigation practices. In particular, proactive traffic and pedestrian stops, motivated by officers’ views of criminogenic neighborhood conditions, drove most drug arrests in the three study settings. Enforcement practices differed, however, in the racially mixed neighborhood where proactive encounters were more frequent, capricious, and seemingly driven by race. Our findings have important implications for research and policy.
A Systematic Review of Function-Modified Check-In/Check-Out
Authors: Klingbeil David A. , Dart Evan H. , Schramm Amber L.
Published: May 2018

Check-in/check-out (CICO) is widely used as a Tier 2 intervention within school-wide positive behavior interventions and supports. Evidence suggests that traditional CICO is primarily effective for students demonstrating problem behavior maintained by adult attention. A growing body of research has investigated function-modified CICO to address behaviors maintained by other consequences. The purpose of this review was to examine the evidence-base for function-modified versions of CICO to identify (a) the procedures used to assess students’ behavior function and (b) the types of modifications and additions to CICO that have been empirically evaluated. We systematically reviewed 11 studies that examined the effects of function-based CICO. Researchers determined behavior function using a combination of direct observations and indirect assessments. These methods were more involved than a brief behavior screening. The modifications and additions to traditional CICO included changes that were functionally relevant and functionally independent. Based on the results of this review, more research is needed before function-based CICO can be considered an evidence-based practice. Moreover, the extent to which educators can implement function-based CICO without researcher support is also unknown. The implications of this review are discussed in terms of future research and practice.
The perils of PROMs: question 5 of the Oxford Hip Score is ambiguous to 10% of English-speaking patients: a survey of 135 patients
Authors: Péchon Pierre H M , Butler Katherine , Murphy George , Singer Gian C
Published: May 2018

Introduction:

The Oxford Hip Score (OHS) is a commonly used patient-reported outcome measure (PROM), comprising 12 questions. We present the incidental finding that one of the 12 questions is ambiguous.

Materials and methods:

As part of a 10-year follow-up of patients treated with hip resurfacing the OHS was posted to 148 patients; 135 (91%) replied. Scores were read by 2 orthopaedic surgery trainees and entered into a database. It was noted that Question 5 was frequently mis-interpreted.

Results:

Thirteen patients’ questionnaires (10%) showed the same inconsistency: question 5 was scored as 0 points but the other 11 questions were scored as either 3 or 4 in 97% of cases. The ethnic group of all 13 patients was recorded in hospital data as being White-British.

Conclusion:

Question 5 of the OHS is ambiguous to 10% of native English-speakers. These patients rated their hip function highly, as reflected by the fact that 97% of the questions other than question 5 scored 3 or 4, indeed 87% of them scored 4. We hypothesise that the wording of the zero score option “Not at all” is being mis-interpreted as a response indicating that the patient does not suffer any pain at all. The effect is an error of 4 points out of 48 (8%); this may under-estimate the patient’s hip score. Surgeons are under great scrutiny to prove efficacy of surgical interventions; this is often provided by PROMs. We should strive to formulate the most accurate, reproducible and least ambiguous PROMs questionnaires.
Adopted children’s co-production and use of ‘trove’ (a digitally enhanced memory box) to better understand their care histories through precious objects
Authors: Watson Debbie , Meineck Chloe , Lancaster Beth
Published: May 2018

This article presents an innovative project to develop and trial a prototype product called ‘trove’ to start to address challenges identified regarding current practice of life story work with children who are looked after and adopted. trove is a digitally enhanced memory box that utilises raspberry pi (a small single board computer) and radio-frequency identification (RFID) technologies to enable children to record their memories and to attach these to their precious objects using an electronic tag: providing a safe ‘container’ for their mementoes and memories. Located in theories of narrative identity and object attachment and drawing on Brodinsky’s concept of communicative openness, we describe the children’s engagements in the design and report the results of a small trial of 10 troves with adopted children in England.
The effects of instructor language choice on second language vocabulary learning and listening comprehension
Authors: Lee Jang Ho , Levine Glenn S.
Published: May 2018

The present study examined the interaction effects between teachers’ choice of language in lexical explanation and second language (L2) learners’ proficiency level on the learning of phrasal verbs and listening comprehension in a meaning-focused listening activity. Undergraduate L2 learners with two different levels of proficiency (intermediate and advanced) were assigned to three different conditions. These conditions included (1) code-switching, in which teachers briefly switched to learners’ first language for vocabulary teaching purposes, (2) L2-only, in which teachers maintained L2 for overall instruction and vocabulary teaching, and (3) control condition, in which learners were not given instruction about target vocabulary. The results revealed that teachers’ instruction about target vocabulary brought about more gains in learning of phrasal verbs than lack thereof. In addition, teachers’ use of code-switching benefited intermediate-level learners most, who were able to gain similar levels of vocabulary learning and listening comprehension to advanced learners.
A Critical Examination of Inter-temporal Spatial Poverty Trends in Bangladesh
Authors: Rahman Shadlee
Published: May 2018

This article examines the nature of spatial dimensions of poverty in Bangladesh by undertaking an in-depth investigation of inter-temporal divergence and convergence in poverty levels. Based on the estimations of Alkire–Foster Multidimensional Poverty Index (A–F MPI) for selected years, the article compares trends in broader dimensions of spatial poverty in Bangladesh with income poverty trends available for corresponding periods. The article scrutinizes the validity of the so-called ‘East–West divide’ in view of poverty levels in Bangladesh. The results evince a number of interesting insights. First, trends of income poverty in Bangladesh are not aligned with those of multidimensional poverty. Second, the levels of inter-temporal poverty as per MPI are relatively higher for the rural–urban divide and also at sub-national (division) levels. Third, inter-temporal trends of divergence–convergence in terms of income poverty relating to the East–West divide do not match corresponding movements in MPI. It is argued that while income poverty dimensions remain important, policymakers should pay more attention to broader issues of deprivations to address challenges of poverty in Bangladesh. Therefore, addressing causes of deprivations as captured in MPIs will help achieve balanced spatial development, accelerated poverty reduction and lower income inequality in Bangladesh.

JEL: R11, R12, I32, C22
Being a refugee or having a refugee status? Birthweight and gestational age outcomes among offspring of immigrant mothers in Sweden
Authors: Juárez Sol , Mussino Eleonora , Hjern Anders
Published: May 2018

Aims: to evaluate whether the information on refugee status based on the residence permit is a useful source of information for perinatal health surveillance. Methods: Using the Swedish population registers (1997-2012), we use multinomial regression models to assess the associations between migration status (refugee and non-refugee) and birth outcomes derived from birthweight and gestational age: low birthweight (LBW) (<2500 g), macrosomia (≥4000 g); preterm: (<37 w) and post-term (≥42 w). The Swedish-born population was used as a reference group. Results: Compared to the Swedish-born population, an increased OR (odds ratio) of LBW and post-term was found among migrants with and without refugee status (respectively: OR for refugees: 1.47 [95% CI: 1.33-1.63] and non-refugees:1.27 [95% CI: 1.18-1.38], for refugees: 1.41 [95% CI: 1.35-1.49] and non-refugees:1.04 [95% CI: 1.00-1.08]) with statistically significant differences between these two migrant categories. However, when looking at specific regions of origin, few regions show differences by refugee status. Compared to Swedes, lower or equal ORs of preterm and macrosomia are observed regardless of migratory status. Conclusions: Small or no differences were observed in birth outcomes among offspring of women coming from the same origin with different migratory status, compared to their Swedish counterparts. This suggests that information on migration status is not a relevant piece of information to identify immigrant women at higher risk of experiencing adverse reproductive outcomes. Our results however might be explained by the large proportion of women coming to Sweden for family reunification who are classified as non-refugee migrants.
The making of the professional criminal in Turkey
Authors: Mercan Boran Ali
Published: May 2018

This article explores how the subject becomes a professional criminal, setting out the life experiences of a group of (ex-)offenders in Turkey who have desisted from crime for 15 years. By analysing the socially-individuated trajectories of offenders, it analytically traces out how the primary habitus inherited from lower-class, migrant, doorkeeper cosmology fits in with the secondary criminal habitus: a bodily-mental, informally-trained capacity to carry out burglary. The formation of criminal habitus is dissected into conative, cognitive and affective components to demonstrate how specialist (physical) breaking and entering skills, maintaining composure, self-confidence, resourcefulness and fluency in the Turkish subcultural language of the street are developed in such a way as to professionalise the modus operandi of burglary. Undertaking the dispositional theory of action, the primary contribution lies in exploring the formative principles of the bodily and mental dispositions necessary to commit a criminal action in a non-Western context.
Evolutionary algorithms for generating urban morphology: Variations and multiple objectives
Authors: Makki Mohammed , Showkatbakhsh Milad , Tabony Aiman , Weinstock Michael
Published: May 2018

Morphological variation of urban tissues, which evolve through the optimisation of multiple conflicting objectives, benefit significantly from the application of robust metaheuristic search processes that utilise search and optimisation mechanisms for design problems that have no clear single optimal solution, as well as a solution search space that is too large for a ‘brute-force’ manual approach. As such, and within the context of the experiments presented within this article, the rapidly changing environmental, climatic and demographic global conditions necessitates the utilisation of stochastic search processes for generating design solutions that optimise for multiple conflicting objectives by means of controlled and directed morphological variation within the urban fabric.
Evaluating the Effectiveness of Graduated Stress Exposure in Virtual Spaceflight Hazard Training
Authors: Finseth Tor T. , Keren Nir , Dorneich Michael C. , Franke Warren D. , Anderson Clayton C. , Shelley Mack C.
Published: May 2018

Psychological and physiological stress experienced by astronauts can pose risks to mission success. In clinical settings, gradually increasing stressors help patients develop resilience. It is unclear whether graduated stress exposure can affect responses to acute stressors during spaceflight. This study evaluated psychophysiological responses to potentially catastrophic spaceflight operation, with and without graduated stress exposure, using a virtual reality environment. Twenty healthy participants were tasked with locating a fire on a virtual International Space Station (VR-ISS). After orientation, the treatment group ( n = 10) practiced searching for a fire while exposed to a low-level stressor (light smoke), while the control group ( n = 10) practiced without smoke. In the testing session, both groups responded to a fire while the VR-ISS unexpectedly filled with heavy smoke. Heart rate variability and blood pressure were measured continuously. Subjective workload was evaluated with the NASA Task Load Index, stress with the Short Stress State Questionnaire, and stress exposure with time-to-complete. During the heavy smoke condition, the control group showed parasympathetic withdrawal, indicating a mild stress response. The treatment group retained parasympathetic control. Thus, graduated stress exposure may enhance allostasis and relaxation behavior when confronted with a subsequent stressful condition.
Impacts of a Documentary about Masculinity and Men’s Health
Authors: King Kylie , Schlichthorst Marisa , Reifels Lennart , Keogh Louise , Spittal Matthew J. , Phelps Andrea , Pirkis Jane
Published: May 2018

As part of a larger study, we developed a three-part documentary called Man Up that explored the relationship between masculinity, mental health, and suicide. In this study, we examine in detail the qualitative feedback provided by those who viewed Man Up, in order to gain a more in-depth understanding of its impact on them. A total of 169 participants provided qualitative feedback via an online survey 4 weeks after viewing Man Up. We examined their opinions about the show and whether they reported any changes in their attitudes and/or behaviors as a result of watching it. All the men who provided feedback on Man Up were overwhelmingly positive about it. The majority reported significant and profound impacts of viewing the documentary. They reported being more aware of others, more willing to help others, and more open about their emotions and problems, as well as demonstrating associated behavioral changes related to helping others and being more emotionally expressive. The data presented here demonstrate the potential for men’s health outcomes to be positively impacted by novel, media-based public health interventions.
A fast template matching algorithm based on principal orientation difference
Authors: Jiao Jichao , Wang Xin , Deng Zhongliang , Cao Jichang , Tang Weihua
Published: May 2018

In the case that the background scene is dense map regularization complex and the detected objects are low texture, the method of matching according to the feature points is not applicable. Usually, the template matching method is used. When training samples are insufficient, the template matching method gets a worse detection result. In order to resolve the problem stably in real time, we propose a fast template matching algorithm based on the principal orientation difference feature. The algorithm firstly obtains the edge direction information by comparing the images that are binary. Then, the template area is divided where the different features are extracted. Finally, the matching positions are searched around the template. Experiments on the videos whose speed is 30 frames/s show that our algorithm detects the low-texture objects in real time with a matching rate of 95%. Compared with other state-of-art methods, our proposed method reduces the training samples significantly and is more robust to the illumination changes.
Use of romiplostim in pregnancy for refractory idiopathic thrombocytopenic purpura: Two case reports with maternal and fetal outcomes and literature review
Authors: Chua Su J , Morton Mark R , Svigos John , Ross David M , Kane Simon
Published: May 2018

Idiopathic thrombocytopenic purpura is a relatively rare complication occurring in pregnancy, with the potential for serious maternal and fetal outcomes. Rarely, the poor response to established first-line therapies results in consideration of second-line therapies, which may have poorly understood risks to the fetus. We report two women with severe idiopathic thrombocytopenic purpura during pregnancy unresponsive to corticosteroids and intravenous immunoglobulin who were treated with romiplostim, a thrombopoietin receptor agonist. One woman with chronic idiopathic thrombocytopenic purpura had a partial response to romiplostim and suffered a post-partum haemorrhage related to uterine atony. The second woman developed severe idiopathic thrombocytopenic purpura in pregnancy and initially responded well to romiplostim. However, a lower segment Caesarean section was performed at 37 weeks for pre-eclampsia. The newborn suffered from severe idiopathic thrombocytopenic purpura and a grade 1 cerebral haemorrhage requiring intravenous immunoglobulin and platelet transfusions. Romiplostim might be a useful therapy for severe idiopathic thrombocytopenic purpura in pregnancy but requires further study.
Chlamydia screening
Authors: Aftab Rabia
Published: May 2018

Sexually transmitted infections (STIs) are a major public health problem worldwide, affecting quality of life, adding economic burden and causing serious morbidity. Chlamydia infection is the most common bacterial STI, making up a large proportion of the over 1 000 000 STIs acquired every day. Although easily cured with antibiotics, untreated chlamydial infection can have serious consequences affecting reproductive health and the unborn child. Since chlamydia infection is typically asymptomatic, screening provides an opportunity to prevent complications and reduce transmission. With long waits for genitourinary medicine appointments and busy sexual health clinics, screening in primary care can help to improve chlamydia detection and treatment rates.
Brexit Announcement: Immediate Impact on British Tourism in Spain
Authors: Perles-Ribes José Francisco , Ramón-Rodríguez Ana Belén , Ortuño Padilla Armando
Published: May 2018

The United Kingdom constitutes the principal tourist source market for Spain. This research note analyzes the immediate impact of the Brexit on British tourism in Spain using the Bayesian structural time series models framework. The results obtained show that between July 2016 and September 2017, Brexit has not produced any initial negative effect on the arrival of British tourists or on their spending in Spain.
Isolated systolic hypertension of the young and its association with central blood pressure in a large multi-ethnic population. The HELIUS study
Authors: Eeftinck Schattenkerk Daan W , van Gorp Jacqueline , Vogt Liffert , Peters Ron JG , van den Born Bert-Jan H
Published: May 2018

Background

Isolated systolic hypertension (ISH) of the young has been associated with both normal and increased cardiovascular risk, which has been attributed to differences in central systolic blood pressure and arterial stiffness.

Methods

We assessed the prevalence of ISH of the young and compared differences in central systolic blood pressure and arterial stiffness between ISH and other hypertensive phenotypes in a multi-ethnic population of 3744 subjects (44% men), aged <40 years, participating in the HELIUS study.

Results

The overall prevalence of ISH was 2.7% (5.2% in men and 1.0% in women) with the highest prevalence in individuals of African descent. Subjects with ISH had lower central systolic blood pressure and pulse wave velocity compared with those with isolated diastolic or systolic-diastolic hypertension, resembling central systolic blood pressure and pulse wave velocity values observed in subjects with high-normal blood pressure. In addition, they had a lower augmentation index and larger stroke volume compared with all other hypertensive phenotypes. In subjects with ISH, increased systolic blood pressure amplification was associated with male gender, Dutch origin, lower age, taller stature, lower augmentation index and larger stroke volume.

Conclusion

ISH of the young is a heterogeneous condition with average central systolic blood pressure values comparable to individuals with high-normal blood pressure. On an individual level ISH was associated with both normal and raised central systolic blood pressure. In subjects with ISH of the young, measurement of central systolic blood pressure may aid in discriminating high from low cardiovascular risk.
Efficacy of renin–angiotensin system inhibitors for patients with heart failure with preserved ejection fraction and mild to moderate chronic kidney disease
Authors: Tsujimoto Tetsuro , Kajio Hiroshi
Published: May 2018

Background

Renin–angiotensin system (RAS) inhibitors are first-line treatments for chronic kidney disease, but it is not known if these agents can improve outcome in patients with heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease.

Design

This was a post-hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial.

Methods

The primary outcome was a composite endpoint of all-cause death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for heart failure. We analyzed hazard ratios in patients taking RAS inhibitors compared with those not taking RAS inhibitors using Cox proportional hazard models.

Results

A total of 1465 HFpEF patients with mild to moderate chronic kidney disease was included. The mean follow-up period was 2.8 years; 502 patients experienced at least one confirmed primary outcome event. The primary outcome event rates in patients not taking and taking RAS inhibitors were 175.4 and 112.8 per 1000 person-years, respectively. The risks of primary outcome events and all-cause death were significantly lower in patients taking RAS inhibitors than in those not taking RAS inhibitors (adjusted hazard ratio (95% confidence interval) for primary outcome events: 0.75 (0.60–0.95), p = 0.01; adjusted hazard ratio for all-cause death: 0.69 (0.52–0.93), p = 0.01). Among propensity score-matched patients, these risks were also significantly lower in those taking RAS inhibitors than in those not taking RAS inhibitors (hazard ratio: 0.67 (0.50–0.90), p = 0.008; hazard ratio: 0.60 (0.41–0.88), p = 0.01).

Conclusion

Use of RAS inhibitors was associated with reduced risks of adverse cardiovascular outcomes in HFpEF patients with mild to moderate chronic kidney disease.
The Vampire Study: Significant elevation of faecal calprotectin in healthy volunteers after 300 ml blood ingestion mimicking upper gastrointestinal bleeding
Authors: Vavricka Stephan R , Heinrich Henriette , Buetikofer Simon , Breitenmoser Flavia , Burri Emanuel , Schneider-Yin Xiaoye , Barman-Aksoezen Jasmin , Biedermann Luc , Scharl Michael , Zeitz Jonas , Rogler Gerhard , Misselwitz Benjamin , Sauter Matthias
Published: May 2018

Background

Faecal calprotectin correlates with histological and clinical activity in inflammatory bowel disease. Gastrointestinal bleeding might also increase faecal calprotectin levels, erroneously implying intestinal inflammation; however, this possibility has not been systematically assessed.

Methods

Sixteen healthy volunteers without gastrointestinal disease and normal faecal calprotectin baseline values ingested their own blood twice, either by drinking or via nasogastric tube. Quantities of 100 ml and 300 ml blood were ingested in a randomised order, with a 28‐day wash‐out period. Faecal calprotectin, faecal occult blood test, and the occurrence of melaena were assessed. Faecal calprotectin ≥ 50 µg/g was considered elevated.

Results

Melaena was reported by all healthy volunteers after 300 ml and by 11/15 healthy volunteers (71%) after 100 ml blood ingestion. One day after ingestion of 300 ml blood, 8/16 faecal calprotectin tests were positive compared to 1/16 at baseline (p = 0.016). Faecal calprotectin levels above > 200 µg/g were rarely observed. There was a trend for faecal calprotectin test positivity also after ingestion of 100 ml.

Conclusion

Ingestion of blood resulted in an increase in faecal calprotectin‐positive tests. Gastrointestinal bleeding should be considered as a potential cause of mild faecal calprotectin elevation > 50 µg/g; however, increased faecal calprotectin above > 250–300 µg/g, the established cut‐off for relevant intestinal inflammation in patients with inflammatory bowel disease, is rare.
Histopathology findings of non-mass cancers on breast ultrasound
Authors: Kim Hye Rin , Jung Hae Kyoung
Published: May 2018

Background

There is little research done on non-mass cancers (NMCs) on breast ultrasound (US).

Purpose

To evaluate large-sectional histopathology findings of NMCs on breast US.

Material and Methods

The mammographic and histopathology features of biopsy proven 36 breast cancers which showed pure non-mass lesions on US were retrospectively reviewed.

Results

The most common mammographic finding was microcalcification (23/35, 65.7%); fine pleomorphic microcalcification was predominant (18/23, 78.3%). The main tumor type was pure ductal carcinoma in situ (DCIS) (14/36, 38.9%) and DCIS with micro- or minimal invasion (11/36, 30.6%). Among the 25 DCIS, histologic grade was high in 15 (60.0%) and intermediate in nine (36%); comedo necrosis was seen in 17 (68%). Immunohistochemical analysis was available in 27 lesions and showed HER2-overexpression in 12 (44.4%) and triple-negative in two (7.4%).

Conclusion

According to our limited patient sample, NMCs on breast US were mainly associated with high-grade DCIS.
Changes in circulating microRNA-126 levels are associated with immune imbalance in children with acute asthma
Authors: Tian Man , Ji Yong , Wang Tingting , Zhang Wenxin , Zhou Ying , Cui Yubao
Published: May 2018

Regulation of the immune response in asthma is complex. MicroRNA-126 (miR-126) expression has been implicated in this response, so we sought to determine the clinical significance of miR-126 measured in the peripheral blood. A total of 80 children with acute asthma were selected to participate in the study and were compared to 80 healthy children. The relative circulating miR-126 levels, interleukin (IL)-4 levels, and the Th17 cell percentage in the peripheral blood of children in the case group were significantly higher than those in the control group, while the interferon (IFN)-γ levels and the CD4+CD25+Treg cell percentage were significantly lower than those in the control group. Along with the aggravation of the disease, the relative levels of miR-126 and IL-4 and the percentage of Th17 cells increased gradually, while the IFN-γ levels and the CD4+CD25+Treg cell percentage decreased. The relative level of miR-126 in the peripheral blood of children with asthma was positively correlated with IL-4 and the Th17 cell percentage and was negatively correlated with IFN-γ levels, CD4+CD25+Treg cell percentage and lung function indicators. The relative level of miR-126 was correlated with the Th17 cell percentage in the peripheral blood, forced vital capacity (FVC), and forced expiratory flow (FEF)75% of the children with asthma. The relative levels of miR-126 and IL-4 and the Th17 cell percentage were positively correlated with the severity of the asthma, while IFN-γ levels and the CD4+CD25+Treg cell percentage were negatively correlated with the severity of the asthma. CD4+CD25+Treg cell percentage and relative miR-126 levels were of the most predictive value in the diagnosis of asthma. Our findings show that the overexpression of miR-126 in acute asthma is correlated with signs of immune imbalance and is predictive of the severity of the disease, suggesting that it could be used as a potential serological marker for asthma diagnosis and evaluation.
TNF-α serum levels are elevated in women with clinically symptomatic uterine fibroids
Authors: Ciebiera Michał , Włodarczyk Marta , Wrzosek Małgorzata , Wojtyła Cezary , Męczekalski Błażej , Nowicka Grażyna , Łukaszuk Krzysztof , Jakiel Grzegorz
Published: May 2018

Uterine fibroids (UFs) are one of the most common pathologies of the female genital tract. The incidence of UFs has been estimated at 25–80%. Tumor necrosis factor (TNF)-α is a cell-signaling protein involved in systemic inflammation and is one of the cytokines responsible for the acute phase reaction. The aim of the study was to evaluate the impact of clinically symptomatic UFs on TNF-α serum levels. A total of 149 Caucasian women were included: 85 patients admitted for surgery due to clinically symptomatic UFs (n = 85; study group) and 64 age-matched UF-free controls (n = 64). TNF-α serum concentrations between the groups were compared. Receiver operating characteristic (ROC) curves were also used as a statistical model to evaluate TNF-α as a marker for UFs. Mean TNF-α serum concentration in the study group was 0.34 ± 0.14 pg/mL; (in half of the subjects, the level did not exceed 0.39 pg/mL. Mean TNF-α serum concentration in the control group was 0.17 ± 0.09 pg/mL; in half of the subjects, the level did not exceed 0.14 pg/mL. The difference was statistically significant. Using the area under the ROC curve, we found that TNF-α serum concentration of 0.34 pg/mL can be used as a predictor for UFs in selected populations. In our study, we confirmed higher TNF-α serum concentrations in women with clinically symptomatic UFs.
Pediatric Arterial Ischemic Stroke
Authors: Hidalgo María José , Muñoz Daniela , Balut Fernanda , Troncoso Mónica , Lara Susana , Barrios Andrés , Parra Patricia
Published: May 2018

Stroke is an important cause of morbidity and mortality in children. Clinical presentation is diverse, and multiple risk factors have been described. The aim of this retrospective study is to describe the clinical presentation, risk factors, and the Pediatric National Institute of Health Stroke Scale (PedNIHSS) in a series of pediatric Chilean patients with the diagnosis of arterial ischemic stroke (AIS). Children diagnosed with AIS aged between 29 d and 18 y were enrolled (1989 to 2016). Clinical characteristics and risk factors were described. PedNIHSS severity score was estimated for patients older than 4 mo of age. Sixty-two patients were included, 66% were male, and the mean age of presentation was 3.5 y. Seventy-nine percent presented motor deficit, 45% seizures, and 15% consciousness impairment. Eighty-two percent had a unilateral stroke and 73% had anterior circulation territory affected. The main risk factors were arteriopathy (63%) and infection (43%). The PedNIHSS mean was 7.6, ranging between 0 and 17. In the categories in which it was possible to apply χ2 test, only the acute systemic conditions category was statistically significant ( P = 0.03), being higher in the group of patients younger than 3 y old. We confirmed male predominance in AIS and the most frequent presenting symptom was motor deficit. We found at least 1 risk factor in all patients with complete information. We confirmed arteriopathy as the most frequent risk factor, and acute systemic conditions were higher in patients younger than 3 y old with statistical significance ( P = 0.03). The majority of patients presented mild to moderate severity in the PedNIHSS score.
The Future of Intervention Science: Process-Based Therapy
Authors: Hofmann Stefan G. , Hayes Steven C.
Published: May 2018

Clinical science seems to have reached a tipping point. It appears that a new paradigm is beginning to emerge that is questioning the validity and utility of the medical illness model, which assumes that latent disease entities are targeted with specific therapy protocols. A new generation of evidence-based care has begun to move toward process-based therapies to target core mediators and moderators based on testable theories. This could represent a paradigm shift in clinical science with far-reaching implications. Clinical science might see a decline of named therapies defined by set technologies, a decline of broad schools, a rise of testable models, a rise of mediation and moderation studies, the emergence of new forms of diagnosis based on functional analysis, a move from nomothetic to idiographic approaches, and a move toward processes that specify modifiable elements. These changes could integrate or bridge different treatment orientations, settings, and even cultures.
Assessing Cognitive Ethical Logics for Commercial Emotions
Authors: Mukherjee Tuheena , Bhal Kanika T.
Published: May 2018

The usefulness of cognitive ethical logic in understanding the ethicality of emotional labour at commercial establishments cannot be undermined, and drawing on this perspective, the present study explores the derived moral logics for commercialized emotions especially in the context of call centres in two distinct subsets of professionals: potential working professionals and working professionals with experience. A sample of 129 respondents has been used for collecting data through open-ended questions and vignettes, which were designed to extract the perception of ethicality for emotional labour. The content of the responses were analysed by using cues from the grounded theory framework. Results indicate that both the respondent subgroups present equally strong consideration of emotional labour as unethical and not- unethical (rather than ethical). Threatened employee dignity emerges as the most important logic for considering emotional labour as unethical, while for the same to be considered not-unethical, the role of job description and compensatory justice gain significance. The results of the study have been discussed with the help of various frameworks of business ethics.
Continuing Legal Education: Rethinking Professional Ethics and Responsibility in India
Authors: Sharma Prakash
Published: May 2018

The declining standards in legal profession, coupled with loss of public trust and confidence, call for emphasis on a deeper understanding of professional ethics among lawyers and perhaps articulate a different notion of professional responsibility that extends beyond the standards of professional conduct and etiquette for lawyers. The 266th Report of Law Commission of India highlighted the need to structure legal education and to bring ethical standards in legal profession. In this regard, the article proposes to mandate continuing legal education (CLE) for legal professionals. The purpose of introduction of CLE programme is to emphasize upon the quality of advocacy. Further, it was to implement the concept of professional responsibility, which provides that a lawyer should represent a client competently. In this regard, CLE programme might help lawyers to re-inform, re-imagine and reconstruct the legal profession in India in ethical and responsible ways. This article discusses the considerations and the process that must led to the adoption of the CLE plan.