bluuebunny/crossref_metadata_2025 huggingface dataset:
Intensive Care Unit Rotations and Predictors of Career Choice in Pulmonary/Critical Care Medicine: A Survey of Internal Medicine Residency Directors
Authors: Minter Daniel J. , Levy Sean D. , Rao Sowmya R. , Currier Paul F.
Published: March 2018

Background. The United States (US) is experiencing a growing shortage of critical care medicine (CCM) trained physicians. Little is known about the exposures to CCM experienced by internal medicine (IM) residents or factors that may influence their decision to pursue a career in pulmonary/critical care medicine (PCCM). Methods. We conducted a survey of US IM residency program directors (PDs) and then used multivariable logistic regression to identify factors that were predictive of residency programs with a higher percentage of graduates pursuing careers in PCCM. Results. Of the 249 PDs contacted, 107 (43%) completed our survey. University-sponsored programs more commonly had large ICUs (62.3% versus 42.2%, p=0.05), primary medical ICUs (63.9% versus 41.3%, p=0.03), and closed staffing models (88.5% versus 41.3%, p<0.001). Residents from university-sponsored programs were more likely to pursue specialty fellowship training (p<0.001) overall but equally likely to pursue careers in PCCM as those from community-sponsored programs. Factors predictive of residencies with a higher percentage of graduates pursuing training in PCCM included larger ICUs (>20 beds), residents serving as code leaders, and greater proportion of graduates pursuing specialization. Conclusions. While numerous differences exist between the ICU rotations at community- and university-sponsored IM residencies, the percentage of graduates specializing in PCCM was similar. Exposure to larger ICUs, serving as code leaders, and higher rates of specialization were predictive of a career choice in PCCM.
Toxicity and Efficacy of a Novel GADD34-expressing Oncolytic HSV-1 for the Treatment of Experimental Glioblastoma
Authors: Nakashima Hiroshi , Nguyen Tran , Kasai Kazue , Passaro Carmela , Ito Hirotaka , Goins William F. , Shaikh Imran , Erdelyi Ronald , Nishihara Reiko , Nakano Ichiro , Reardon David A. , Anderson Ana C. , Kuchroo Vijay , Chiocca E. Antonio
Published: March 2018

Purpose: Glioblastoma (GBM) is the most common primary central nervous system cancer in adults. Oncolytic HSV-1 (oHSV) is the first FDA-approved gene therapy approach for the treatment of malignant melanoma. For GBM, oHSVs need to be engineered to replicate within and be toxic to the glial tumor but not to normal brain parenchymal cells. We have thus engineered a novel oHSV to achieve these objectives.

Experimental Design: NG34 is an attenuated HSV-1 with deletions in the genes encoding viral ICP6 and ICP34.5. These mutations suppress virus replication in nondividing brain neurons. NG34 expresses the human GADD34 gene under transcriptional control of a cellular Nestin gene promoter/enhancer element, whose expression occurs selectively in GBM. In vitro cytotoxicity assay and survival studies with mouse models were performed to evaluate therapeutic potency of NG34 against glioblastoma. In vivo neurotoxicity evaluation of NG34 was tested by intracerebral inoculation.

Results: NG34 replicates in GBM cells in vitro with similar kinetics as those exhibited by an oHSV that is currently in clinical trials (rQNestin34.5). Dose–response cytotoxicity of NG34 in human GBM panels was equivalent to or improved compared with rQNestin34.5. The in vivo efficacy of NG34 against two human orthotopic GBM models in athymic mice was similar to that of rQNestin34.5, whereas intracerebral injection of NG34 in the brains of immunocompetent and athymic mice showed significantly better tolerability. NG34 was also effective in a syngeneic mouse glioblastoma model.

Conclusions: A novel oHSV encoding GADD34 is efficacious and relatively nontoxic in mouse models of GBM. Clin Cancer Res; 24(11); 2574–84. ©2018 AACR.
Endocrine Treatment with 2 Years of Tamoxifen versus 2 Years of Exemestane in Postmenopausal Patients with High-Risk Early Breast Cancer and Persisting Circulating Tumor Cells - First Results of the SUCCESS C Endocrine Treatment Sub-Study
Authors: Schochter Fabienne , Rack Brigitte , Tzschaschel Marie , Polasik Arkadius , Andergassen Ulrich , Trapp Elisabeth , Alunni-Fabbroni Marianna , Schneeweiss Andreas , Müller Volkmar , Pantel Klaus , Gade Jörg , Lorenz Ralf , Rezai Mahdi , Tesch Hans , Soeling Ulrike , Fehm Tanja , Mahner Sven , Schindlbeck Christian , Lichtenegger Werner , Beckmann Matthias W. , Fasching Peter A. , Janni Wolfgang , Friedl Thomas W.P. ,   on behalf of the SUCCESS Study Group
Published: March 2018

Background: Optimal choice and sequence of endocrine treatment following adjuvant chemotherapy in postmenopausal early breast cancer patients are still under discussion and treatment stratification factors are missing. Patients and Methods: Postmenopausal women with HER2-negative, hormone receptor-positive tumors and persisting circulating tumor cells (CTCs; assessed using the FDA-approved CellSearch® System, Janssen Diagnostics, LLC) after chemotherapy were randomized to 2 years of tamoxifen followed by 3 years of exemestane (tamoxifen-exemestane group, n = 54) or 5 years of exemestane (exemestane-only group, n = 54). CTCs were again assessed after the first 2 years of endocrine treatment. In addition, safety data were compared between the 2 groups. Results: The 2 groups were well-balanced with regard to baseline characteristics. The CTC clearance rate after 2 years was 89% in the exemestane-only group and 97% in the tamoxifen-exemestane group (exact Fisher test, p = 0.36). The safety profile showed good tolerability with few grade 3 or 4 adverse events in both groups. Conclusion: The similar CTC clearance rate after 2 years of endocrine therapy with exemestane or tamoxifen, and the safety profiles obtained may indicate comparable efficacy and tolerability of both endocrine treatment regimens. However, these results have to be confirmed by final survival and safety analysis.
Immune Gene Expression Profile in Hepatocellular Carcinoma and Surrounding Tissue Predicts Time to Tumor Recurrence
Authors: Carone Chiara , Olivani Andrea , Dalla Valle Raffaele , Manuguerra Roberta , Silini Enrico Maria , Trenti Tommaso , Missale Gabriele , Cariani Elisabetta
Published: March 2018

Background: The antitumor immune response may play a major role in the clinical outcome of hepatocellular carcinoma (HCC). We characterized the liver immune microenvironment by direct hybridization of RNA extracted from HCC and nontumorous tissues. Methods: RNA was extracted from frozen liver tissue samples of HCC (T; n = 30) and nontumorous tissues (NT; n = 33) obtained from 38 patients. Matched samples were available for 25 patients. The immune gene expression profile was analyzed with the nCounter GX Human Immunology v2 system (NanoString Technologies), which detects the expression levels of 579 immune response-related genes simultaneously. Results: Since the immune gene expression profile of T and NT tissues was significantly different, the prognostic relevance of the liver immune microenvironment was evaluated in the T and NT samples separately. Unsupervised clustering detected two main clusters of immune gene expression both in T and in NT liver samples. In both cases, the expression clusters identified groups of patients with a significantly different median time to HCC recurrence (TTR) but similar overall survival. Based on T tissue, two groups with median TTR of 19 and 127 months, respectively, were detected (p < 0.005). Expression of genes related to T-cell activation was associated with longer TTR. The analysis of NT tissue discriminated subsets of patients with median TTR of 22 and 68 months (p < 0.05). In contrast to T tissue, a predominant inflammatory immune environment was associated with shorter TTR. Conclusions: Immune gene expression profiles predictive of TTR could be identified both in HCC and in adjacent cirrhotic tissues. Longer TTR was associated with overexpression in T tissue and downregulation in NT tissue of the immune response and of inflammation-related genes.
The Neuroprotective Effects of Hypothermia on Bilirubin-Induced Neurotoxicity in vitro
Authors: Kuter Nazli , Aysit-Altuncu Nese , Ozturk Gurkan , Ozek Eren
Published: March 2018

Background: In high-risk newborns indirect hyperbilirubinemia can lead to acute bilirubin encephalopathy and kernicterus. Despite the current therapeutic modalities, preventing or reversing the neurotoxicity cannot be achieved in all infants. Objective: To investigate the neuroprotective effects of hypothermia on bilirubin-induced toxicity in primary mouse neuronal cell cultures. Methods: Hippocampal cell cultures, isolated from newborn mouse brains, were incubated with unconjugated bilirubin (UCB) at 3 days in vitro (DIV) and immediately exposed to varying degrees of hypothermia. Neuronal viability and mitochondrial health were compared between the normothermia (37°C), mild (34°C), moderate (32°C) and severe (29°C) hypothermia groups. Confocal microscopy and fluorescent dyes (propidium iodide and JC-1) were used for cell evaluation. To determine the late effects of hypothermia, the cultures were also examined at 7 DIV after returning to normothermic conditions. Results: Induction of any degree of hypothermia increased the neuronal survival after 24 h of UCB treatment. Neuronal death rate and mitochondrial membrane potential loss were lowest in the neurons exposed to moderate hypothermia. We also observed that mild to moderate hypothermia had late protective effects on neuronal cell viability, whereas deep hypothermia did not improve neuronal survival. Conclusions: We conclude that hypothermia reduces the cell death induced by bilirubin toxicity in neuronal cells. Although moderate hypothermia has a better outcome than mild hypothermia, deep hypothermia as low as 29°C has adverse effects on neuronal cell viability.
Qiliqiangxin Attenuates Cardiac Remodeling via Inhibition of TGF-β1/Smad3 and NF-κB Signaling Pathways in a Rat Model of Myocardial Infarction
Authors: Han Anbang , Lu Yingdong , Zheng Qi , Zhang Jian , Zhao YiZhou , Zhao Mingjing , Cui Xiangning
Published: March 2018

Background/Aims: Qiliqiangxin (QL), a traditional Chinese medicine, has been demonstrated to be effective and safe for the treatment of chronic heart failure. Left ventricular (LV) remodeling causes depressed cardiac performance and is an independent determinant of morbidity and mortality after myocardial infarction (MI). Our previous studies have shown that QL exhibits cardiac protective effects against heart failure after MI. The objective of this study was to explore the effects of QL on myocardial fibrosis in rats with MI and to investigate the underlying mechanism of these effects. Methods: A rat model of acute myocardial infarction was induced by ligating the left anterior descending coronary artery. The rats were treated with QL (1.0 g/kg/day) for 4 weeks after surgery. Echocardiography and histology examination were performed to evaluate heart function and fibrosis, respectively. Protein levels of transforming growth factor-β1 (TGF-β1), phosphorylated Smad3 (p-Smad3), phosphorylated Smad7 (p-Smad7), collagen I (Col- I), alpha smooth muscle actin (a-SMA), tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), nuclear factor κB (NF-κB), and phosphorylated inhibitor of kappa B alpha (p-IκBα) were measured by western blot analysis. Results: QL treatment ameliorated adverse cardiac remodeling 8 weeks after AMI, including better preservation of cardiac function, decreased inflammation, and reduced fibrosis. In addition, QL treatment reduced Col-I, a-SMA, TGF-β1, and p-Smad3 expression levels but increased p-Smad7 levels in postmyocardial infarct rat hearts. QL administration also reduced the elevated levels of cardiac inflammation mediators, such as TNF-α and IL-6, as well as NF-κB and p-IκBα expression. Conclusions: QL therapy exerted protective effects against cardiac remodeling potentially by inhibiting TGF-β1/Smad3 and NF-κB signaling pathways, thereby preserving cardiac function, as well as reducing myocardial inflammation and fibrosis.
ADAM17-Mediated Ectodomain Shedding of Toll-Like Receptor 4 as a Negative Feedback Regulation in Lipopolysaccharide-Activated Aortic Endothelial Cells
Authors: Yang Won Seok , Kim Jin Ju , Lee Mee Jeong , Lee Eun Kyoung , Park Su-Kil
Published: March 2018

Background/Aims: Lipopolysaccharide (LPS)-activated monocytes/macrophages develop endotoxin tolerance in part by reducing cell surface toll-like receptor 4 (TLR4) through cluster of differentiation 14 (CD14)-dependent endocytosis. In case of endothelial cells, CD14 is expressed in low copy numbers as compared with monocytes/macrophages. Thus, we explored how endothelial cells regulate TLR4 expression after LPS stimulation. Methods: Cultured human aortic endothelial cells (HAECs) were treated with LPS. TLR4 expression was analyzed by Western blot analysis and immunofluorescence staining. A disintegrin and metalloprotease 17 (ADAM17) activity was measured using a fluorescent substrate. Results: TLR4 in cell lysate began to decrease within 30 min of LPS treatment with a maximal reduction at 2 h, and it was accompanied by an increase of N-terminal fragment of TLR4 in culture supernatant, indicating ectodomain shedding of the receptor. LPS activated p38 mitogen-activated protein kinase (p38 MAPK) and ADAM17, while LPS-induced ADAM17 activation was inhibited by SB203580, a p38 MAPK inhibitor. LPS-induced ectodomain shedding of TLR4 was attenuated by siRNA depletion of ADAM17 as well as TAPI-2 (an inhibitor of ADAM family) and SB203580. LPS pretreatment resulted in a blunted response of p38 MAPK activation to further LPS stimulation. In the cells depleted of ADAM17, LPS-induced p38 MAPK activation was prolonged and LPS-induced intercellular adhesion molecule-1 expression was potentiated. Conclusion: HAECs respond to LPS by rapid shedding of the ectodomain of TLR4 and thereby reduce the responsiveness to subsequent LPS exposure. ADAM17, downstream of p38 MAPK, is implicated in the ectodomain cleavage of TLR4.
Risk Factors for and Clinical Consequences of Multiple Intracranial Aneurysms
Authors: Jabbarli Ramazan , Dinger Thiemo Florin , Darkwah Oppong Marvin , Pierscianek Daniela , Dammann Philipp , Wrede Karsten H. , Kaier Klaus , Köhrmann Martin , Forsting Michael , Kleinschnitz Christoph , Sure Ulrich
Published: March 2018

Background and Purpose—

Multiple intracranial aneurysms (MIAs) are common findings of cerebral angiographies; however, MIA prevalence varies in different patient cohorts. We sought to elucidate risk factors influencing MIA prevalence and the clinical consequences.

Methods—

We systematically searched PubMed, Scopus, Embase, and Cochrane Library databases for publications before January 15, 2017, reporting MIA prevalence and risk factors. We used random-effects meta-analysis and multivariate regression analysis to assess the impacts of individual, study, and population characteristics.

Results—

We included 174 studies reporting on MIA (mean overall prevalence, 20.1%; range, 2%–44.9%) in 134 study populations with 86 989 intracranial aneurysm (IA) patients enrolled between 1950 and 2015. Studies from Europe and North America (
P
<0.001) and more recent enrolment years (
P
=0.046) were independently associated with higher MIA prevalence. In meta-analysis, MIA correlated with female sex (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.4–1.8), higher patient age (>40 years; OR, 1.6; 95% CI, 1.14–2.25), arterial hypertension (OR, 1.51; 95% CI, 1.17–1.94), smoking (OR, 1.89; 95% CI, 1.37–2.6) and familial IA (OR, 2.02; 95% CI, 1.47–2.77), and formation of de novo (OR, 3.92; 95% CI, 1.95–7.87) and growth of initial IA (OR, 3.47; 95% CI, 1.87–6.45). Risk of subarachnoid hemorrhage in MIA patients was higher only in longitudinal studies from Japan and Korea (OR, 2.08; 95% CI, 1.46–2.96).

Conclusions—

Female sex, higher age, arterial hypertension, smoking, and familial IA are major risk factors for MIA. In addition, MIA patients are at risk for enhanced IA formation. Further studies are needed to evaluate rupture risk and the role of ethnicity, especially in the context of increased MIA identification with improved neurovascular imaging.
Solitary Confinement within Juvenile Detention Centres in Western Australia
Authors: Nunez Llifen Palacios , Copeland Anna
Published: March 2018

This article examines the use of solitary confinement of juveniles within the Western Australian justice system. Examining the legal framework, it points to the issues of inadequate accountability and oversight. Often manifesting itself under different names such as regression or simply confinement, it still results in extended periods of social isolation, minimal environmental stimulation and minimal opportunity for social interaction.

The negative consequences of such confinement on children and young people are briefly examined before it is considered within the international human rights framework, specifically, in light of Australia’s international obligations and their stated commitment to the Convention on the Rights of the Child, the Beijing Rules and Havana Guidelines.
The Holy See: The Government of the Catholic Church
Authors: Hailu Tseday Gizaw
Published: March 2018

The Holy See ratified the United Nations Convention on the Rights of the Child (crc) in its dual personae as the government of the Catholic Church, and as the government of Vatican City State (vcs). The extent of the Holy See’s obligations under the crc in its former capacity is a current international debate, and the focus of this paper. The Committee on the Rights of the Child in its recent review process concluded that by ratifying the crc, the Holy See committed to its implementation, not only within the territory of vcs, but worldwide on behalf of Catholics “under its authority.” Conversely, the Holy See restricts its duty to that of the transmission of moral principles recognised in the crc to all people. This paper critically reviews the Committee’s concluding observations on the Holy See’s second periodic report, and ends by presenting possible alternatives to the Committee’s recommendations.
First report of a wingless species of Ornebius—a scaly cricket usually with winged males (Orthoptera: Mogoplistidae: Mogoplistinae)
Authors: HE ZHU-QING , LU HUI , LIU YU-QING , WANG HAN-QIANG , LI KAI
Published: March 2018

A new species, Ornebius apterus sp. nov., is described from Guangdong, China. This wingless species is monophyletic with Ornebius spp., which are all singing species. The type specimens are deposited in East China Normal University, Biology of History Museum (ECNU).
3. The Philosophy and Science of Consciousness
Authors: Gamez David
Published: March 2018

Chapter 3 tackles some of the ‘hard’ problems with consciousness. First, it is impossible to imagine the relationship between consciousness and the invisible physical world. Second, we find it difficult to imagine the connection between conscious experiences of brain activity and other conscious experiences. Third, there are brute regularities between consciousness and the physical world that cannot be broken down or further explained. None of these problems are unique to consciousness research. They can also be found in physics, and they do not affect our ability to study consciousness scientifically. We can measure consciousness, measure the physical world and look for mathematical relationships between these measurements.
7. Information Theories of Consciousness
Authors: Gamez David
Published: March 2018

A number of people have claimed that information patterns are linked to consciousness regardless of whether they occur in a brain, a computer or a pile of sand. The seventh chapter shows that this approach fails because information is not a property of the physical world and any given information pattern can be extracted from both the conscious and unconscious brain. Information theories of consciousness should be reinterpreted as physical theories of consciousness.
9. Predictions and Deductions about Consciousness
Authors: Gamez David
Published: March 2018

Chapter 9 explains how theories of consciousness can be experimentally tested. This can only be done on systems that we assume are conscious, such as normally functioning adult human brains. We can also use theories of consciousness to make deductions about the consciousness of brain damaged people, animals and robots. These deductions cannot be verified because we cannot measure the consciousness of these systems.
Guidelines on treatment of perinatal depression with antidepressants: An international review
Authors: Molenaar Nina M , Kamperman Astrid M , Boyce Philip , Bergink Veerle
Published: March 2018

Objective:

Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice.

Methods:

An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients.

Results:

Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines.

Conclusion:

During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged.
Occupational transition in the process of becoming housed following chronic homelessness
Authors: Marshall Carrie Anne , Lysaght Rosemary , Krupa Terry
Published: March 2018

Background.

Studying the occupations of formerly homeless persons as they transition to becoming housed following long-term homelessness has the potential to offer a meaningful contribution to the ongoing dialogue on homelessness.

Purpose.

Occupational transition was explored with a sample of persons with a history of chronic homelessness to contribute an occupational perspective to current scholarship on homelessness and to inform the practice of occupational therapists who support this population.

Method.

Interpretive phenomenology guided the study. Eleven persons with a history of chronic homelessness were engaged in semistructured interviews 3 to 24 months after becoming housed.

Findings.

Six themes emerged that highlighted occupation as a means of promoting social and psychological integration, and the meaning and experience of occupational transition.

Implications.

A more comprehensive support strategy acknowledging the occupations of chronically homeless persons is essential to incorporate into future research and practice aimed at promoting community inclusion and housing retention.
The Influence of Measurement Error Associated With Oral Reading Progress Monitoring Measures on the Consistency and Accuracy of Nonparametric Single-Case Design Effect Size Outcomes
Authors: Van Norman Ethan R. , Klingbeil David A. , McLendon Katherine E.
Published: March 2018

Researchers and practitioners frequently use curriculum-based measures of reading (CBM-R) within single-case design (SCD) frameworks to evaluate the effects of reading interventions with individual students. Effect sizes (ESs) developed specifically for SCDs are often used as a supplement to visual analysis to gauge treatment effects. The degree to which measurement error associated with academic measures like CBM-R influences said ESs has not been fully explored. We used simulation methodology to evaluate how common magnitudes of error influenced the consistency and accuracy of outcomes from two nonparametric SCD ESs, percentage of data exceeding baseline trend and TauU. After accounting for other data characteristics, measurement error accounted for a statistically and practically significant amount of variance in the consistency and accuracy of outcomes from both ESs. This article suggests that the psychometric properties of academic measures are important to consider when interpreting ESs from SCDs.
Skin mechanical properties and modeling: A review
Authors: Joodaki Hamed , Panzer Matthew B
Published: March 2018

The mechanical properties of the skin are important for various applications. Numerous tests have been conducted to characterize the mechanical behavior of this tissue, and this article presents a review on different experimental methods used. A discussion on the general mechanical behavior of the skin, including nonlinearity, viscoelasticity, anisotropy, loading history dependency, failure properties, and aging effects, is presented. Finally, commonly used constitutive models for simulating the mechanical response of skin are discussed in the context of representing the empirically observed behavior.
KASB Bank Limited: Capital Shortage
Authors: Ahmed Muntazar Bashir
Published: March 2018

KASB Bank Limited was a small sized bank in Pakistan. Its operations did not generate sufficient profits and over the years it was unable to meet the regulatory capital as specified by the State Bank of Pakistan. The bank’s loan portfolio was infected with poor quality borrowers and this resulted in very high non performing loans which required loan loss provisions. The bank sponsor had other group companies which the KASB Bank acquired in order to meet the capital needs. The State Bank as part of compliance with BASEL rules required higher amounts of capital to protect the banking sector and had allowed KASB Bank extra time to meet the capital needs. However, the State Bank ultimately used its regulatory authority to put the bank under its supervision. The State Bank placed KASB Bank under a moratoriam so that the KASB Bank customer deposits were frozen and only withdrawls up to PKR300,000 were allowed from each account. The State Bank wanted another bank to take over the KASB Bank operations and allowed other interested banks to conduct due diligence so as to review the financial status of the bank with a view to take over the troubled bank. There were very few banks interested in taking over because KASB Bank had negative equity estimated at PKR12 to PKR14 billion. The State Bank in order to protect the interests of the 150,000 depositors and the stability of the banking system gave a concessionary loan of PKR20 billion as part of the scheme of amalgamation of KASB Bank with Bank Islami.
Training Delivery and Evaluationfor a Government Regulatory Firm (C)
Authors: Karve Shailaja , Aggarwal-Gupta Meenakshi
Published: March 2018

Western State Electricity Regulatory Commission (WSERC) had launched a series of trainings to enhance the managerial capabilities of its employees. This case presents the challenges of designing and conducting trainings for a rapidly expanding small organization. In order to conduct the trainings, training groups were formed and a training plan was made to sequence the trainings based on the objectives and expected outcomes. Training modules incorporated a mix of methods such as lecture, presentation, videos, games, cases, activities, instruments and hand-outs. There were many hindrances to the implementation of the training programme as per the plan. New entrants to the firm were also made a part of the training groups without TNA. There were inordinate delays and interruptions that at times had to be escalated to the senior levels. Over a period of time, the trainings were appreciated but differences and challenges emerged causing roadblocks in the journey of WSERC to become a learning organization. This case focuses on the challenges faced by an organization when the commitment and buy-in from the employees is not sustained. It brings to the fore the role of senior management to have continued focus on any intervention.
Free, partial, and fully constrained recovery analysis of cold-programmed shape memory epoxy/carbon nanotube nanocomposites: Experiments and predictions
Authors: Abishera R , Velmurugan R , Nagendra Gopal KV
Published: March 2018

Thermally activated shape memory polymers are typically programmed by initially heating the material above the glass transition temperature ( Tg), deforming to the desired shape, cooling below Tg, and unloading to fix the temporary shape. This process of deforming at high temperatures becomes a time-, labor-, and energy-expensive process while applying to large structures. Alternatively, materials with reversible plasticity shape memory property can be programmed at temperatures well below the glass transition temperature which offers several advantages over conventional programming. Here, the free, partial, and fully constrained recovery analysis of cold-programmed multi-walled carbon nanotube–reinforced epoxy nanocomposites is presented. The free recovery analysis involves heating the temporary shape above Tg without any constraints (zero stress), and for fully constrained recovery analysis, the temporary shape is held constant while heating. The partially constrained recovery behavior is studied by applying a constant stress of 10%, 25%, and 50% of the maximum recovery stress obtained from the completely constrained recovery analysis. The samples are also characterized for their thermal, morphological, and mechanical properties. A non-contact optical strain measurement method is used to measure the strains during cold-programming and shape recovery. The different recovery behaviors are analyzed by using a thermo-viscoelastic–viscoplastic model, and the predictions are compared with the experimental results.
A transcultural study of hoarding disorder: Insights from the United Kingdom, Spain, Japan, and Brazil
Authors: Nordsletten Ashley E. , Fernández de la Cruz Lorena , Aluco Elena , Alonso Pino , López-Solà Clara , Menchón José M. , Nakao Tomohiro , Kuwano Masumi , Yamada Satoshi , Fontenelle Leonardo F. , Campos-Lima André Luís , Mataix-Cols David
Published: March 2018

Though problematic hoarding is believed to be a universal human behavior, investigations of clinically-defined hoarding disorder (HD) have been confined almost exclusively to Western countries. The current investigation sought to describe and directly compare the features of individuals meeting diagnostic criteria for HD across four distinct cultural settings. Participants were 82 individuals meeting DSM-5 diagnostic criteria for HD, recruited and assessed by trained clinicians at one of four project sites: London, Barcelona, Fukuoka, and Rio de Janeiro. A series of semi-structured interviews and self-report scales were administered, including assessments of socio-demographic characteristics, psychiatric comorbidity, and severity of hoarding and related features. Results indicate that the severity and core features of HD, as well as the cognitions and behaviors commonly associated with this condition, are largely stable across cultures. However, some differences in patient demographics—in particular age, marital status, and clinical expression—as well as comorbid psychiatric features also emerged. These findings confirm that HD, as defined in DSM-5, exists and presents with similar phenomenology across the studied cultures. Future, more fine-grained, research will be needed to study the features of the disorder in additional cultures (e.g., non-industrialized nations) and to evaluate the impact of these cultural aspects on the design of interventions for the disorder.
Left Superior Vena Cava Draining Into Left Atrium in Tetralogy of Fallot—Four Cases of a Rare Association
Authors: Ramman Tarun Raina , Dutta Nilanjan , Chowdhuri Kuntal Roy , Agrawal Sunny , Girotra Sumir , Azad Sushil , Radhakrishnan Sitaraman , Iyer Parvathi Unninayar , Iyer Krishna Subramony
Published: March 2018

Persistent left superior vena cava is a common congenital anomaly of the thoracic venous system. Left superior vena cava draining into left atrium is a malformation of sinus venosus and caval system. The anomaly may be a cause of unexplained hypoxia even in adults. It may give rise to various diagnostic and technical challenges during cardiac catheterization and open-heart surgery. It is often detected serendipitously during diagnostic workup. Isolated left superior vena cava opening into left atrium is very commonly associated with other congenital heart defects. But tetralogy of Fallot is very rarely associated with persistent left superior vena cava which drains into left atrium. We report four such cases who underwent surgical correction successfully.
Nature, Culture and Humans: Patterns and Effects of Urbanization in Lesser Himalayan Mountainous Historic Urban Landscape of Chamba, India
Authors: Potdar Komal , Namrata Nimmy , Sami Anam
Published: March 2018

Historic urban landscapes are bio-physical imprints of past generation’s activities as well as a matrix for those of current and future generations. Pressures of economic development, while benefitting modernization, have led to loss of traditional practices in cultural landscapes, which reflected customs, values and belief systems of communities. This article explores alternative ways of seeing historic cities particularly with respect to the historic urban landscape paradigm.

Chamba town, Himachal Pradesh, a pilgrim centre, market town and historic capital of the Chamba region, recently celebrated the millennium of its establishment. This historic town has distinctive location and is characterized by exceptional cultural and natural resources, landforms, bio-diversity and intangible cultural heritage. With a current population of 25,000, it is growing as a major town centre and pushing the boundaries of town limits and residential areas. Unregulated new development which is not designed for earthquake resistance, absence of delineation of ecologically sensitive zones, marginalization of traditional knowledge and aspirations of the primary custodians have resulted in fragile state of being, both naturally and culturally, and have altered the traditional regime of this historic town.

This article examines the fragile relation between humans, nature and culture of Chamba and need for sustainable planning and management system for heritage resources within mountainous regions, with responsiveness to constraints and challenges. The authors reflect upon economic shifts, cultural transformations and infrastructure development, which adapt traditional knowledge designs to address urban needs for historic urban landscapes.
Urban Cultural Heritage: Managing and Preserving a Local Global Common in the Twenty-first Century
Authors: Sadowski Mirosław M.
Published: March 2018

As we approach the end of the second decade of the twenty-first century—at the moment when more people live in the cities than anywhere else—there comes a time to ponder on the role and the condition of urban cultural heritage. In times of growth, urbanization and rapid development, the city may be described as a modern battlefield of cultural heritage protection, often faced with the choice between protection and conservation, or destruction and redevelopment. This article seeks to analyse the means of protection of urban cultural heritage—a common, which is local (it takes a vital part in the creation of identity) and global (it is a part of a universal heritage) at the same time—in the international law, and to look into ways of its successful management. The first part of the article looks at the concept of the urban cultural heritage, and the second part examines the two main UNESCO conventions concerning cultural heritage protection, namely, Convention Concerning the Protection of the World Cultural and Natural Heritage and Convention for the Safeguarding of the Intangible Cultural Heritage, to establish whether or not they are successful tools in protecting the urban cultural heritage. The third part focuses on analysing a new approach towards urban cultural heritage advocated by UNESCO, based on the 2011 recommendation on the Historic Urban Landscape (HUL), giving examples of its successful (Amsterdam, Ballarat, Cuenca) and unsuccessful application (Stockholm, Hong Kong, Macau). In the fourth part, the author suggests ways of effective governance of the urban cultural heritage in the twenty-first century, from the viewpoint of sustainable urban development, focusing on the role of cultural heritage in the city’s growth, and in the creation of identity and collective memories. The concluding part of the article seeks for an answer to the question of a need for a new UNESCO convention.
Impact of district mental health care plans on symptom severity and functioning of patients with priority mental health conditions: the Programme for Improving Mental Health Care (PRIME) cohort protocol
Authors: Baron Emily C. , Rathod Sujit D. , Hanlon Charlotte , Prince Martin , Fedaku Abebaw , Kigozi Fred , Jordans Mark , Luitel Nagendra P. , Medhin Girmay , Murhar Vaibhav , Nakku Juliet , Patel Vikram , Petersen Inge , Selohilwe One , Shidhaye Rahul , Ssebunnya Joshua , Tomlinson Mark , Lund Crick , De Silva Mary
Published: March 2018

Background

The Programme for Improving Mental Health Care (PRIME) sought to implement mental health care plans (MHCP) for four priority mental disorders (depression, alcohol use disorder, psychosis and epilepsy) into routine primary care in five low- and middle-income country districts. The impact of the MHCPs on disability was evaluated through establishment of priority disorder treatment cohorts. This paper describes the methodology of these PRIME cohorts.

Methods

One cohort for each disorder was recruited across some or all five districts: Sodo (Ethiopia), Sehore (India), Chitwan (Nepal), Dr. Kenneth Kaunda (South Africa) and Kamuli (Uganda), comprising 17 treatment cohorts in total (N = 2182). Participants were adults residing in the districts who were eligible to receive mental health treatment according to primary health care staff, trained by PRIME facilitators as per the district MHCP. Patients who screened positive for depression or AUD and who were not given a diagnosis by their clinicians (N = 709) were also recruited into comparison cohorts in Ethiopia, India, Nepal and South Africa. Caregivers of patients with epilepsy or psychosis were also recruited (N = 953), together with or on behalf of the person with a mental disorder, depending on the district. The target sample size was 200 (depression and AUD), or 150 (psychosis and epilepsy) patients initiating treatment in each recruiting district. Data collection activities were conducted by PRIME research teams. Participants completed follow-up assessments after 3 months (AUD and depression) or 6 months (psychosis and epilepsy), and after 12 months. Primary outcomes were impaired functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and symptom severity, assessed using the Patient Health Questionnaire (depression), the Alcohol Use Disorder Identification Test (AUD), and number of seizures (epilepsy).

Discussion

Cohort recruitment was a function of the clinical detection rate by primary health care staff, and did not meet all planned targets. The cross-country methodology reflected the pragmatic nature of the PRIME cohorts: while the heterogeneity in methods of recruitment was a consequence of differences in health systems and MHCPs, the use of the WHODAS as primary outcome measure will allow for comparison of functioning recovery across sites and disorders.
Supporting Transformation through Delivery System Reform Incentive Payment Programs: Lessons from New York State
Authors: Roby Dylan H. , Louis Christopher J. , Cole Mallory M. Johnson , Chau Natalie , Wiefling Bridgette , Salsberry David C. , King Evan , Miller Allen
Published: March 2018

The New York Delivery System Reform Incentive Payment (DSRIP) waiver was viewed as a prototype for Medicaid and safety net redesign waivers in the Affordable Care Act (ACA) era. After the insurance expansions of the ACA were implemented, it was apparent that accountability, value, and quality improvement would be priorities in future waivers in many states. Despite New York's distinct provider relationships, previous coverage expansions, and local and state politics, it is important to understand the key characteristics of the waiver so that other states can learn how to better incorporate value-based arrangements into future waivers or attempts to limit spending under proposed Medicaid per-capita caps or block grants. In this article, we examine the New York DSRIP waiver by drawing on its design, early experiences, and evolution to inform recommendations for the future renewal, implementation, and expansion of redesigned or transformational Medicaid waivers.
Muscle Fiber Hypertrophy and Myonuclei Addition: A Systematic Review and Meta-analysis
Authors: CONCEIÇÃO MIGUEL S. , VECHIN FELIPE C. , LIXANDRÃO MANOEL , DAMAS FELIPE , LIBARDI CLEITON A. , TRICOLI VALMOR , ROSCHEL HAMILTON , CAMERA DONNY , UGRINOWITSCH CARLOS
Published: March 2018

Introduction

The myonuclear domain theory postulates that myonuclei are added to muscle fibers when increases in fiber cross-sectional area (i.e., hypertrophy) are ≥26%. However, recent studies have reported increased myonuclear content with lower levels (e.g., 12%) of muscle fiber hypertrophy.

Purpose

This study aimed to determine whether a muscle fiber hypertrophy “threshold” is required to drive the addition of new myonuclei to existing muscle fibers.

Methods

Studies of resistance training endurance training with or without nutrient (i.e., protein) supplementation and steroid administration with measures of muscle fiber hypertrophy and myonuclei number as primary or secondary outcomes were considered. Twenty-seven studies incorporating 62 treatment groups and 903 subjects fulfilled the inclusion criteria and were included in the analyses.

Results

Muscle fiber hypertrophy of ≤10% induces increases in myonuclear content, although a significantly higher number of myonuclei are observed when muscle hypertrophy is ~22%. Additional analyses showed that age, sex, and muscle fiber type do not influence muscle fiber hypertrophy or myonuclei addition.

Conclusions

Although a more consistent myonuclei addition occurs when muscle fiber hypertrophy is >22%, our results challenge the concept of a muscle hypertrophy threshold as significant myonuclei addition occurs with lower muscle hypertrophy (i.e., <10%).
Dehydration Impairs Cycling Performance, Independently of Thirst: A Blinded Study
Authors: ADAMS J. D. , SEKIGUCHI YASUKI , SUH HYUN-GYU , SEAL ADAM D. , SPRONG CAMERON A. , KIRKLAND TRACIE W. , KAVOURAS STAVROS A.
Published: March 2018

Purpose

The aim of the present study was to examine the effect of dehydration on exercise performance independently of thirst with subjects blinded of their hydration status.

Methods

Seven male cyclists (weight, 72 ± 9 kg; body fat, 14% ± 6%; peak oxygen uptake, 59.4 ± 6 mL·kg−1·min−1) exercised for 2 h on a cycle ergometer at 55% peak oxygen uptake, in a hot-dry environment (35°C, 30% relative humidity), with a nasogastric tube under euhydrated–non-thirst (EUH-NT) and dehydrated–non-thirst (DEH-NT) conditions. In both trials, thirst was matched by drinking 25 mL of water every 5 min (300 mL·h−1). In the EUH-NT trial, sweat losses were fully replaced by water via the nasogastric tube (calculated from the familiarization trial). After the 2 h of steady state, the subjects completed a 5-km cycling time trial at 4% grade.

Results

Body mass loss for the EUH-NT and DEH-NT after the 2 h was −0.2% ± 0.6% and −2.2% ± 0.4%, whereas after the 5-km time trial, it was −0.7% ± 0.5% and 2.9% ± 0.4%, respectively. Thirst (35 ± 30 vs 42 ± 31 mm) and stomach fullness (46 ± 21 vs 35 ± 20 mm) did not differ at the end of the 2 h of steady state between EUH-NT and DEH-NT trials (P > 0.05). Subjects cycled faster during the 5-km time trial in the EUH-NT trial compared with the DEH-NT trial (23.2 ± 1.5 vs 22.3 ± 1.8 km·h−1, P < 0.05), by producing higher-power output (295 ± 29 vs 276 ± 29 W, P < 0.05). During the 5-km time trial, core temperature was higher in the DEH-NT trial (39.2°C ± 0.7°C) compared with the EUH-NT trial (38.8°C ± 0.2°C; P > 0.05).

Conclusions

These data indicated that hypohydration decreased cycling performance and impaired thermoregulation independently of thirst, while the subjects were unaware of their hydration status.
Mesocycles with Different Training Intensity Distribution in Recreational Runners
Authors: ZINNER CHRISTOPH , SCHÄFER OLSTAD DANIELA , SPERLICH BILLY
Published: March 2018

Purpose

The aim was to compare mesocycles with progressively increasing workloads and varied training intensity distribution (TID), that is, high-intensity (HIGH, > 4 mmol·L−1 blood lactate), low-intensity (LOW, < 2 mmol·L−1 blood lactate) or a combination of HIGH and LOW (referred to as “polarized” [POL]) on 5000-m running time and key components of endurance performance in recreational runners.

Methods

Forty-two runners (peak oxygen uptake (V˙O2peak): 45.2 ± 5.8 mL·min−1·kg−1) were systematically parallelized to one of three groups performing a 4-wk mesocycle with equal TID (two to four training sessions) followed by a 3-wk mesocycle with increased weekly training impulse (i.e., 50% increase compared to the first 4-wk mesocycle) of either HIGH, LOW, or POL and 1 wk tapering. V˙O2peak, velocity at lactate threshold and running economy were assessed at baseline (T0), after 4 wk (T1), 7 wk (T2), and 8 wk (T3).

Results

The 5000-m time decreased in all groups from T0 to T2 and T3. V˙O2peak increased from T0 to T2 and T3 (P < 0.03) with HIGH and from T0 to T2 (P = 0.02) in LOW and from T0 to T3 (P = 0.006) with POL. Running economy improved only from T1 to T3 and from T2 to T3 (P < 0.04) with LOW. An individual mean response analysis indicated a high number of responders (n = 13 of 16) in LOW, with less in HIGH (n = 6/13) and POL (n = 8/16).

Conclusions

On a group level, HIGH, LOW, and POL improve 5000-m time and V˙O2peak. Changes in running economy occurred only with LOW. Based on the individual response of recreational runners the relative risk of nonresponding is greater with HIGH and POL compared with LOW.