bluuebunny/crossref_metadata_2025 huggingface dataset:
Crafting a Democratic Enclave on the Cyberspace: Case Studies of Malaysia, Indonesia, and Singapore
Authors: Yangyue Liu
Published: February 2019

As an antithesis of “authoritarian enclave” which has been well-established in the comparative politics literature, “democratic enclave” points to the institution of a state or the unambiguous regulatory space in society “where the authoritarian regime's writ is substantively limited and is replaced by an adherence to recognizably democratic norms and procedures” (Gilley 2010). In this sense, the Internet space, embodied by information and communication technologies, has great potential to play such a role, since its “inherited” properties of decentralization and anonymity would inevitably breach the authoritarian rules. However, a closer look at three Southeast Asian states, Malaysia, Singapore and the “New Order” Indonesia whose regimes were characterized by authoritarianism when Internet was initially developed, reveals different trajectories. In the “New Order” Indonesia and Malaysia, the governments consciously left the Internet space uncontrolled; the online media developed independently, vibrantly, and professionally, especially in the Malaysian case; and there were strong connections between online and offline contentious politics. These elements made the Internet space in Indonesia and Malaysia a successful case of democratic enclave. Based on these criteria, however, the Internet space in Singapore has not achieved similar status. This paper analyses the different outcomes of enclave creation on the cyberspace among these countries. It argues that elite conflict and the strength of civil society are the two major factors that shape the differences. In this sense, the political contexts are of great importance for the understanding of Internet's political impacts.
Myanmar in Contemporary Chinese Foreign Policy – Strengthening Common Ground, Managing Differences
Authors: Sutter Robert
Published: February 2019

This assessment first briefly examines recent features of China's approach to foreign affairs, and then examines in greater detail features in China's approach to relations with its neighbours, especially in Southeast Asia. It does so in order to discern prevailing patterns in Chinese foreign relations and to determine in the review of salient recent China–Myanmar developments in the concluding section how China's approach to Myanmar compares with Chinese relations with other regional countries and more broadly. The assessment shows that the strengths and weaknesses of China's recent relations with Myanmar are more or less consistent with the strengths and weaknesses of China's broader approach to Southeast Asia and international affairs more generally. On the one hand, China's approach to Myanmar, like its approach to most of the states around its periphery, has witnessed significant advances and growing interdependence in the post-Cold War period. On the other hand, mutual suspicions stemming from negative historical experiences and salient differences require attentive management by Chinese officials and appear unlikely to fade soon.
China–Myanmar Comprehensive Strategic Cooperative Partnership: A Regional Threat?
Authors: Chenyang LI
Published: February 2019

This paper analyses the China-Myanmar ‘comprehensive strategic cooperative partnership’ in the framework of China's diplomacy in the post-Cold War era and concludes that the partnership has no ‘significant negative impact’ on regional relations. China pursues its partnerships with Myanmar and other states to create a ‘stable’ and ‘harmonious’ surrounding environment, itself a ‘major’ prerequisite for China's peaceful development. The author argues that China has not focused its diplomacy on Myanmar at the expense of other states; rather, he notes that in fact China established a ‘comprehensive strategic cooperative partnership’ with three other ASEAN states (Vietnam in 2008, Laos in 2009, and Cambodia in 2010) before it did so with Myanmar in May 2011. The article argues that the scope and depth of China's partnerships with states such as Vietnam, Laos, and Cambodia are actually above that of its partnership with Myanmar. It also argues that Myanmar's strong nationalism will prevent China from, for example, building a base on Myanmar's soil. The author also asserts that China does not seek to use Myanmar as an ally to weaken or dilute ASEAN or its unity on the South China Sea issue.
Malaysian Extraversion towards the Muslim World: Ideological Positioning for a “Mirror Effect”
Authors: Delfolie David
Published: February 2019

Despite being ambitious, the solidarity expressed by Malaysia toward the global ummah has almost always remained tied to the strategic priorities of the country and been subject to non-religious factors. In this light, the changes throughout history in the Federation of Malaysia's policies regarding Muslim minorities in Asian countries illustrate the variable external use of Islamic themes by Malaysian officials. In order for Malaysian governments to reconcile opposing positions whose configurations emphasize the ambiguities inherent to their actions, throughout history these governments have been obliged to continually re-evaluate their positions according to the relevant contingencies. For example, they have occasionally delegated to third parties the mission of conducting, under their close monitoring, projects that they had taken on with reservations. In addition, the strongly promoted claim by the United Malays National Organisation (UMNO, the leading Malay party of the governing coalition) – that it could offer a universal development model for Islamic society -has never really been convincing. This model has never been able to go beyond its initial local origins, which has greatly limited its ability to be replicated in other countries. However, beyond their opportunistic dimension (even if they are not without ideological aspects), Malaysia's diplomatic positions toward the Muslim world are marked by different inspirations. They have also been guided by an underlying search for the legitimation and international recognition of the country's broad domestic socio-political model, thereby appealing to a “mirror effect” to foster the reshaping of a postcolonial Malay identity within the framework of globalisation.
The Initial Purging Policies after the 1965 Incident at Lubang Buaya
Authors: Djakababa Yosef
Published: February 2019

After the Lubang Buaya incident on 1 October 1965 in which six top Indonesian Army generals and a lieutenant were killed, the Army began to implement a nationwide purging campaign with the assistance of civilian anti-communist groups. Thousands of PKI members, supporters and pro-Sukarno groups/individuals immediately became the target of this purge. For organisational purposes, several purging policies were released and then strictly enforced. The official purging policies that are highlighted in this paper are a series of initial directives that were released within days of the generals’ executions. They do not explicitly translate into orders to kill, but are more of a guideline to help anti-communist officials classify and contain communists and other PKI followers. This article attempts to show how these initial directives evolved and also discusses competing purge policies from non-military sources. The co-existence and overlapping nature of the various directives indicate that a power struggle existed between the anti-communist group led by General Soeharto and the presidium of the Dwikora Cabinet who were loyal to President Soekarno.
Jakartans, Institutionally Volatile
Authors: Masaaki Okamoto
Published: February 2019

Jakarta recently has gained even more central political attention in Indonesia since Joko Widodo (Jokowi) and Basuki Purnama (Ahok) became, respectively, the province's governor and vice-governor in 2012. They started a series of eye-catching and populist programmes, drawing popular support from not only the people of Jakarta, but also among Indonesians in general. Jokowi is now even the most popular candidate for the presidential election in 2014. Their rise is phenomenal in this sense, but it is understandable if we look at Jakartan voters’ behaviour and the institutional arrangement that leads to it. Jakarta, as the national capital, has a unique arrangement in that the province has no autonomous regency or city. This paper argues that this arrangement causes Jakartans to be more politically volatile and describes how this institutional arrangement was created by analysing the minutes of the meeting to discuss the laws concerning Jakarta Province.
The Role of Religion and Ethnicity in Jakarta's 2012 Gubernatorial Election
Authors: Miichi Ken
Published: February 2019

The victory of Joko Widodo (‘Jokowi’) in Jakarta's 2012 gubernatorial election has been described as a “triumph of democracy” as Joko and his running mate Basuki Tjahaja Purnama (‘Ahok’), a Chinese Christian, successfully won the election despite negative ethno-religious campaigns against them. How exactly did the ethno-religious boundary influence the election? By analysing the results of the election in relation to ethnicities and religions using the 2000 National Census, the author reveals an ethnopolitical map of Jakarta, for political analysis a potentially important but still under-researched area. The article then proceeds to examine the ‘religionisation’ process of the election campaign. The incumbent governor, Fauzi Bowo, carefully established his religious image and tried to mobilise support through religious symbols and persuasion, even though the electoral results seemed to be divided along ethnic lines. Joko also participated in a number of religious campaigns, albeit in a different way that was more subtle. Because ideological differences between Islamic and secular nationalist parties have become blurred and the general ‘religionisation’ of Indonesian society has continued, religious campaigns are becoming more important in domestic politics, even for ‘less-Islamic’ politicians like Joko.
Jokowi's Populism in the 2012 Jakarta Gubernatorial Election
Authors: Hamid Abdul
Published: February 2019

Joko Widodo's victory in the 2012 Jakarta Gubernatorial Election could be seen as a populist phenomenon. An outsider to Jakarta politics, Joko Widodo (Jokowi) beat the incumbent, Fauzi Bowo (Foke), who had received strong support from political parties. Using populism as an analytical tool, this paper argues that the following four factors enabled Jokowi to emerge as an alternative leader in Indonesia's capital: (1) social breakdown and declining capability of the government; (2) corrupt, draining political traditions and a negative image of political parties; (3) societal changes; and (4) the emergence of forms of political representation outside of traditional political institutions. Those situations led Jakarta voters to more easily accept Jokowi's offer – “New Jakarta” ( Jakarta Baru) – as a new identity against the established regime. Populism can help explain Jokowi's victory in the election, but also the leadership of his administration after he was elected.
Legislators in Myanmar's First “Post-Junta” National Parliament (2010–2015): A Sociological Analysis
Authors: Egreteau Renaud
Published: February 2019

In an attempt to better grasp the realities of Myanmar's national legislature, which was formed after the 2010 elections, this paper examines the personal profiles and social backgrounds of its elected and appointed members. I have sought to record data on the social composition of Myanmar's first “post-junta” parliament and provide a dataset for further comparative research on the resurgence of legislative affairs in the country. The study draws on official publications containing the biographies of 658 national parliamentarians. Focusing on six socio-demographic variables, the findings suggest that the typical Burmese legislator still closely mirrors the conventional image of Myanmar's characteristic postcolonial leader: a man, in his mid-fifties, ethnically Bamar, Buddhist, holding a Myanmar university degree, engaged in business activities or in the education sector (in the case of the 492 elected legislators) or in the security sector (for the 166 military appointees). However, I argue that the profile of Myanmar's first post-junta legislature offers a quite unexpected level of diversity that may augur well for the emergence of a new civilian policymaking elite in Myanmar.
Betwixt Droughts and Floods: Flood Management Politics in Thailand
Authors: Maier-Knapp Naila
Published: February 2019

Attempting to create greater understanding of the political dynamics that influence domestic disaster relief and management (DRM) in Thailand, this article takes a closer look at these dynamics by outlining the main actors involved in flood-related DRM. It acknowledges the importance of international and military actors but emphasises the role of national and subnational authorities. The article then identifies the central issues of DRM governance as capacity and bureaucracy and discusses these through a chronological assessment of the flood crisis in Thailand in 2011, interweaving the colourful domestic politics with various political cleavages and dichotomies, and thereby distinguishing between three main dichotomies which it considers as the central drivers of the political dynamics and institutional development of DRM. These issues can be summarised as old versus new institutions, technocracy versus bureaucracy and centralised (but with direct people-orientation through greater channels of citizenry participation) versus decentralised bureaucracy with an indirect orientation towards people.
Japan's Development Ambitions for Myanmar: The Problem of “Economics before Politics”
Authors: Seekins Donald M.
Published: February 2019

Myanmar and Japan have had an important shared history since the Pacific War, when Japan occupied the British colony of Burma and established the country's first postcolonial state and army. The period from 1941 to 1945 also witnessed the “militarization” of Myanmar as the country was turned into a battlefield by the Japanese, the Allies and indigenous insurgents. After independence from Britain in 1948, the Union of Burma continued to suffer insurgency and became a deeply conflicted society, especially under the isolationist socialist regime of General Ne Win (1962–1988). However, Japan played a major role in Myanmar's economic development through its allocation of war reparations and official development assistance (ODA), especially yen loans.

During the period of martial law from 1988 to 2011, Tokyo exercised some self-restraint in giving aid due to pressure from its major ally, the United States, with its human rights agenda. However, with the transition from junta rule to constitutional government in 2011 came a dramatic increase in Japanese ODA, as Tokyo forgave large amounts of debt and invested in ambitious new special economic zones (SEZ). Japan will no doubt benefit from Myanmar as close ties are expanded: Not only will Japanese companies profit, but Japan will have access to Myanmar's raw materials and gain ability to compete more effectively with an economically expansive China. On Myanmar's side, though, it is unlikely that anyone other than the military and crony capitalist elites will benefit from the flood of new yen loans and infrastructure projects. This paper argues that without a political resolution of Myanmar's many conflicts, including the establishment of genuinely open political institutions, the aid of Japan (and other countries) is likely to make these deep-rooted social and ethnic conflicts even worse.
Beyond Democratic Tolerance: Witch Killings in Timor-Leste
Authors: Strating Rebecca , Edmondson Beth
Published: February 2019

Newly democratising states experience challenges in reconciling “traditional” or “customary” dispute resolution practices with newly established state-based legal systems based on the rule of law. For Timor-Leste, these tensions are pronounced in continuing debates concerning the killing or injuring of women accused of witchcraft. Defences of extrajudicial punishments tend to conflate democracy with local support and fail to deal with the key institutions of democratic systems, including the rule of law, political equality, and civil rights. In Timor-Leste's case, where equality and social rights were incorporated into the Constitution as fundamental governmental obligations, localised extrajudicial punishments threaten internal and external state legitimacy and highlight the difficulties of ensuring the primacy of state-based institutions. Extrajudicial punishments challenge Timor-Leste's capacity to consolidate new liberal democratic political institutions.
Networking Alone? Digital Communications and Collective Action in Vietnam
Authors: Kurfürst Sandra
Published: February 2019

This article explores the potential for the formation of collective action in Vietnam. Referring to land and labour protests, bauxite mining, anti-China demonstrations, as well as the revision of the 1992 Constitution, the article examines the social movement repertoires diverse groups have adopted to reach their objectives. Drawing on social movement theory and communication power, this contribution shows that apart from access to the technology, citizens’ opportunities to participate in digital networks as well as access to the default communication network of the state are necessary prerequisites in order to attain public attention and possibly to achieve social change. Moreover, this article shows that existing power differentials in Vietnam are reproduced in digital space. It concludes that for different collective behaviours to result in a social movement, it is essential to “switch” and to connect the different networks. For the moment, the call to protect Vietnam's sovereignty offers common ground for collective action.
Regional Commonalities and Regional Identities: Forging a Normative Understanding of Southeast Asian Identity
Authors: Baba Gürol
Published: February 2019

In the last two decades, most of the IR academia's attention on Southeast Asian regionalism utilised constructivism and/or realism and has focused on ASEAN and its derivatives. This article aims to skew this angle by elaborating a possible relationship between Asian values and a normative understanding of Southeast Asian identity. The major reason for this article's focus on a normative interpretation is that a practical application of Southeast Asian identity is not very achievable due to various ethnic, cultural, political, territorial, and historical diversities. While the region is diverse, there are also a number of commonalities among its states. Asian values, from a Confucian perspective, account for some of these commonalities. By using constructivists’ claims on both the links between norms and identity and the dynamic interaction between values and norms, this article argues that Asian values could contribute to the development of Amitav Acharya's widely cited normative/ideational format of Southeast Asian identity. The article takes ASEAN identity as a case study and aims to show why a normative identity is more achievable than a practical identity among Southeast Asians, and how Asian values might contribute to the creation of this shared identity.
Politics of Anxiety, Politics of Hope: Penal Populism and Duterte's Rise to Power
Authors: Curato Nicole
Published: February 2019

Citizens who support populist leaders are often portrayed in negative terms. They are disparaged for their prejudice and naiveté, some even earning the label “basket of deplorables” from Hillary Clinton. Rodrigo Duterte's supporters were not exempted from such criticism. In the 2016 Philippine presidential race, they were pejoratively labelled Dutertards, which pathologised their fervent and unrelenting support for the controversial candidate. This article interrogates such depictions by examining the logics that underpin Duterte's strong public support. I argue that part of Duterte's appeal hinges on “penal populism,” built on two political logics that reinforce each other: the politics of anxiety and the politics of hope. While the former foregrounds the language of crisis, danger and uncertainty, the latter reclaims democratic agency. The article examines the articulations of these logics among Duterte's supporters based on ethnographic fieldwork in disaster-affected communities where Duterte enjoyed decisive victories.
The Spectacle of Violence in Duterte's “War on Drugs”
Authors: Reyes Danilo Andres
Published: February 2019

This article argues that, in Duterte's “war on drugs”, state power is exercised through the body in a spectacle of humiliation and violence. The analysis draws from the work of Foucault (1979) on the political value of a spectacle of the body to explain the distinctive character of Duterte's violent war on drugs; of Feldman (1991) on the use of the body as an object in which violence is embodied to send political messages; of Agamben (1995) on eliminating life supposedly devoid of value; and on Mumford et al. (2007), who pointed to the popularity of “violent ideological leaders.” I argue that, under the Duterte administration, criminals are humiliated and killed in a spectacle of violence that politicises their lives, sending a message that intimidates others. In the process, law-abiding citizens are meant to feel safe, which is seen as likely to increase the newly elected president's popularity and his power as chief executive. Duterte has thereby politicised life, not only putting criminals outside the benefit of state protection but actively targeting them. Duterte is the first mayor and president to have actively targeted criminals and, in doing so has encouraged other politicians to follow his example. The politicisation of the bodies of criminals is distinctive in Duterte's form of violence. This article is drawn from data sets of individual killings when Duterte was either serving as or acting behind the mayor of Davao, and compared with cases of drug-related killings since he became president on 30 June 2016.
Territorial Disputes and Nationalism: A Comparative Case Study of China and Vietnam
Authors: Cotillon Hannah
Published: February 2019

In autocracies, nationalism appears to have merged with geopolitical thinking. In light of this geopoliticisation of nationalism, it is surprising that the literature has paid virtually no attention to the role of territorial disputes as a conditioning factor. The present study seeks to further enhance the field by factoring in the role of territorial disputes in triggering different expressions of nationalism. It develops an analytical framework for typologies of nationalism according to four territorial disputes: China's dispute with Vietnam over maritime territory in the South China Sea, China's dispute with Japan over maritime territory in the East China Sea, Vietnam's dispute with Cambodia over territorial border demarcations, and Vietnam's dispute with China over maritime territory in the South China Sea. The respective disputes of China and Vietnam are analysed and tested against criteria of expressions of nationalism in autocracies. We find that territorial disputes and therefore external context are important conditioning factors of nationalism in autocracies.
Mechanisms of Vietnam's Multidirectional Foreign Policy
Authors: Chapman Nicholas
Published: February 2019

It has been nearly 30 years since Vietnam shifted to a multidirectional foreign policy that places greater emphasis on cultivating friends and engaging with the international community. Vietnam has moved from being an isolated country, largely dependent on Soviet aid, to a country that bolsters its standing in bilateral and multilateral forums whilst reaping the economic benefits of greater integration into the global economy. Since the start of the 21st century, China's more assertive posture, along with an increasingly complex, interdependent and multipolar world, has provided Vietnam with a host of problems. This article formulates a definition for a multidirectional foreign policy using Vietnam as a case study and argues that multidirectionalism allows Vietnam to reap economic benefits whilst safeguarding against uncertainty. Furthermore, the article tracks the three principal mechanisms through which Vietnam implements its multidirectional foreign policy: strategic and comprehensive partnerships, trade agreements, and multilateralism.
From Impediment to Adaptation: Chinese Investments in Myanmar's New Regulatory Environment
Authors: Mark SiuSue , Zhang Youyi
Published: February 2019

Myanmar's political transition of 2011 was followed by changes in the political and economic realms of society. The transition emboldened social activism, expressed as protests regarding the injustices suffered by people under the military regime. Many of these protests were related to large-scale extractive investments that had little regard for local communities and the environment. After the West lifted most of its sanctions, transnational capital actors who had been absent for the previous two decades returned to the country, many of them offering higher investment standards. In response to the “push” of public pressure and the “pull” of new investments, reformists in the Government of Myanmar (GoM) are now attempting to implement a stronger investment regulatory framework. The GoM's new demands on foreign investments to comply with higher investment standards are strengthened by Chinese state reformers’ own nascent efforts to curtail the excesses of that country's state-owned enterprises globally. As a result, prominent SOEs are being pressured to adapt to the new operating environment, resulting in observable changes in investment behaviour. We conclude that reform efforts are challenged by limitations on reformist state actors’ autonomy and capacity to regulate investments.
Adaptive design of a clinical decision support tool: What the impact on utilization rates means for future CDS research
Authors: Mann Devin , Hess Rachel , McGinn Thomas , Mishuris Rebecca , Chokshi Sara , McCullagh Lauren , Smith Paul D. , Palmisano Joseph , Richardson Safiya , Feldstein David A.
Published: February 2019

OBJECTIVE

We employed an agile, user-centered approach to the design of a clinical decision support tool in our prior integrated clinical prediction rule study, which achieved high adoption rates. To understand if applying this user-centered process to adapt clinical decision support tools is effective in improving the use of clinical prediction rules, we examined utilization rates of a clinical decision support tool adapted from the original integrated clinical prediction rule study tool to determine if applying this user-centered process to design yields enhanced utilization rates similar to the integrated clinical prediction rule study. MATERIALS & METHODS: We conducted pre-deployment usability testing and semi-structured group interviews at 6 months post-deployment with 75 providers at 14 intervention clinics across the two sites to collect user feedback. Qualitative data analysis is bifurcated into immediate and delayed stages; we reported on immediate-stage findings from real-time field notes used to generate a set of rapid, pragmatic recommendations for iterative refinement. Monthly utilization rates were calculated and examined over 12 months.

RESULTS

We hypothesized a well-validated, user-centered clinical decision support tool would lead to relatively high adoption rates. Then 6 months post-deployment, integrated clinical prediction rule study tool utilization rates were substantially lower than anticipated based on the original integrated clinical prediction rule study trial (68%) at 17% (Health System A) and 5% (Health System B). User feedback at 6 months resulted in recommendations for tool refinement, which were incorporated when possible into tool design; however, utilization rates at 12 months post-deployment remained low at 14% and 4% respectively.

DISCUSSION

Although valuable, findings demonstrate the limitations of a user-centered approach given the complexity of clinical decision support.

CONCLUSION

Strategies for addressing persistent external factors impacting clinical decision support adoption should be considered in addition to the user-centered design and implementation of clinical decision support.
A virtual reality tool for measuring and shaping trunk compensation for persons with stroke: Design and initial feasibility testing
Authors: Foreman Matthew H , Engsberg Jack R
Published: February 2019

Background: Compensatory movement, such as flexing the trunk during reaching, may negatively affect motor improvement during task-based practice for persons with stroke. Shaping, or incrementally decreasing, the amount of compensation used during rehabilitation may be a viable strategy with methods using virtual reality.

Methods: A virtual reality tool was designed to (1) monitor upper extremity movement kinematics with an off-the-shelf motion sensor (Microsoft Kinect V2), (2) convert movements into control of widely available computer games, and (3) provide real-time feedback to shape trunk compensation. This system was tested for feasibility by a small cohort of participants with chronic stroke ( n = 5) during a 1-h session involving 40 min of virtual reality interaction. Outcomes related to repetitions, compensation, movement kinematics, usability, motivation, and sense of presence were collected.

Results: Participants achieved a very high dose of reaching repetitions (461 ± 184), with an average of 81% being successful and 19% involving compensatory trunk flexion. Participants rated the system as highly usable, motivating, engaging, and safe.

Conclusions: VRShape is feasible to use as a tool for increasing repetition rates, measuring and shaping compensation, and enhancing motivation for upper extremity therapy. Future research should focus on software improvements and investigation of efficacy during a virtual reality-based motor intervention.
Neurologic Disease Is a Risk Factor for Revision After Lumbar Spine Fusion
Authors: Glassman Steven D. , Carreon Leah Y. , Dimar John R. , Gum Jeffrey L. , Djurasovic Mladen
Published: February 2019

Study Design:

Medicare database analysis.

Objective:

The purpose of this study was to investigate whether neurologic disorders represent a risk factor for revision after lumbar spine surgery.

Methods:

Patients who underwent lumbar spine surgery were identified from 5% Medicare Part B claims between 2005 and 2008. Cox regression analysis was used to evaluate risk factors for revision within the 7 years after the index lumbar surgery. Covariates included age, gender, race, census region, Medicare buy-in status, Charlson score, year, prior lumbar fusion within 2 years of index surgery, prior diagnosis of cervical spondylotic myelopathy treated with or without cervical spine surgery, and diagnoses of other neuromuscular conditions.

Results:

Of 8665 cases who had decompression only, 401 (5%) had a revision within 7 years after the index surgery. Factors predictive of revision were prior lumbar fusion (hazard ratio [HR] = 2.78, confidence interval [CI] = 1.43-5.37, P = .002) and being female (HR = 1.61, CI = 1.31-1.97, P < .001). Of 5501 cases who had a decompression and fusion, 752 (14%) had a revision surgery within 7 years after the index surgery. Factors predictive of revision were the presence of a neurologic disorder (HR = 1.24, CI = 1.05-1.46, P = .010), prior lumbar fusion (HR = 3.09, CI = 2.05-4.63, P < .001), and being female (HR = 1.35, CI = 1.15-1.57, P < .001).

Conclusions:

An increase in revision rate ( P = 0.01, HR = 1.24) was seen in patients with neurologic disorders undergoing lumbar decompression and fusion, although not for patients undergoing decompression alone. This suggests an opportunity to improve clinical outcome and reduce revision rate through improved surgical decision making or treatment of the neurologic disorder.
Patient Reported Experience in a Pediatric Emergency Department
Authors: Bal Chandan , AlNajjar Mohammad , Thull-Freedman Jennifer , Pols Erin , McFetridge Ashley , Stang Antonia S
Published: February 2019

Objectives:

To describe patient-reported experience in a pediatric emergency department (ED) and determine: ( 1 ) whether there are differences between the experience children report in comparison to their parents; and ( 2 ) whether factors such as time of visit (day, evening, night) and ED census are associated with patient experience.

Methods:

We conducted a prospective cross-sectional survey of children ≥8 years of age and the parents/guardians of children 0 to 17 years who visited a pediatric ED using a validated patient experience measure. The proportion of respondents for each question indicating that an aspect of their care could have been improved was calculated as problem scores for each survey item. The primary outcome was the overall problem scores for all respondents combined and for children and parents separately.

Results:

A total of 237 parents and 109 children completed surveys. The areas with the highest problem scores identified by both parents and children were: having enough to do while waiting to be seen (53.5; 95% confidence interval [CI]: 48.1, 58.8) and when to restart usual activities (34.7; 95% CI: 29.7, 40.0). There were meaningful differences in problem scores between children and parents including: doctors and nurses explaining what they were doing (parents: 19; 95% CI: 14.3, 24.7, child 40.4; 95% CI: 31.2, 50.2) and privacy when examined and treated (parents: 17.3; 95% CI: 12.8, 22.9, child: 36.7; 95% CI: 27.8, 46.5).

Conclusion:

There are differences in reported experience between children and their parents. This highlights the importance of including children when assessing patient experience in a pediatric setting.
Mouse acute leukemia develops independent of self-renewal and differentiation potentials in hematopoietic stem and progenitor cells
Authors: Dong Fang , Bai Haitao , Wang Xiaofang , Zhang Shanshan , Wang Zhao , Xie Miner , Zhang Sen , Wang Jinhong , Hao Sha , Cheng Tao , Ema Hideo
Published: February 2019

The cell of origin, defined as the normal cell in which the transformation event first occurs, is poorly identified in leukemia, despite its importance in understanding of leukemogenesis and improving leukemia therapy. Although hematopoietic stem cells (HSCs) and hematopoietic progenitor cells (HPCs) were used for leukemia models, whether their self-renewal and differentiation potentials influence the initiation and development of leukemia is largely unknown. In this study, the self-renewal and differentiation potentials in 2 distinct types of HSCs (HSC1 [CD150+CD41−CD34−Lineage−Sca-1+c-Kit+ cells] and HSC2 [CD150−CD41−CD34−Lineage−Sca-1+c-Kit+ cells]) and 3 distinct types of HPCs (HPC1 [CD150+CD41+CD34−Lineage−Sca-1+c-Kit+ cells], HPC2 [CD150+CD41+CD34+Lineage−Sca-1+c-Kit+ cells], and HPC3 [CD150−CD41−CD34+Lineage−Sca-1+c-Kit+ cells]) were isolated from adult mouse bone marrow, and examined by competitive repopulation assay. Then, cells from each population were retrovirally transduced to initiate MLL-AF9 acute myelogenous leukemia (AML) and the intracellular domain of NOTCH-1 T-cell acute lymphoblastic leukemia (T-ALL). AML and T-ALL similarly developed from all HSC and HPC populations, suggesting multiple cellular origins of leukemia. New leukemic stem cells (LSCs) were also identified in these AML and T-ALL models. Notably, switching between immunophenotypical immature and mature LSCs was observed, suggesting that heterogeneous LSCs play a role in the expansion and maintenance of leukemia. Based on this mouse model study, we propose that acute leukemia arises from multiple cells of origin independent of the self-renewal and differentiation potentials in hematopoietic stem and progenitor cells and is amplified by LSC switchover.
Development of a prognostic model of respiratory insufficiency or death in amyotrophic lateral sclerosis
Authors: Ackrivo Jason , Hansen-Flaschen John , Wileyto E. Paul , Schwab Richard J. , Elman Lauren , Kawut Steven M.
Published: February 2019

A clinically useful model to prognose onset of respiratory insufficiency in amyotrophic lateral sclerosis (ALS) would inform disease interventions, communication and clinical trial design. We aimed to derive and validate a clinical prognostic model for respiratory insufficiency within 6 months of presentation to an outpatient ALS clinic.

We used multivariable logistic regression and internal cross-validation to derive a clinical prognostic model using a single-centre cohort of 765 ALS patients who presented between 2006 and 2015. External validation was performed using the multicentre Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database with 7083 ALS patients. Predictors included baseline characteristics at first outpatient visit. The primary outcome was respiratory insufficiency within 6 months, defined by initiation of noninvasive ventilation, forced vital capacity (FVC) <50% predicted, tracheostomy, or death.

Of 765 patients in our centre, 300 (39%) had respiratory insufficiency or death within 6 months. Six baseline characteristics (diagnosis age, delay between symptom onset and diagnosis, FVC, symptom onset site, amyotrophic lateral sclerosis functional rating scale-revised (ALSFRS-R) total score and ALSFRS-R dyspnoea score) were used to prognose the risk of the primary outcome. The derivation cohort c-statistic was 0.86 (95% CI 0.84–0.89) and internal cross-validation produced a c-statistic of 0.86 (95% CI 0.85–0.87). External validation of the model using the PRO-ACT cohort produced a c-statistic of 0.74 (95% CI 0.72–0.75).

We derived and externally validated a clinical prognostic rule for respiratory insufficiency in ALS. Future studies should investigate interventions on equivalent high-risk patients.
Least-squares reverse time migration using analytic-signal-based wavefield decomposition
Authors: Kim Young Seo , Almomin Ali , Jeong Woodon , Tsingas Constantine
Published: February 2019

An intrinsic problem during migration and imaging of seismic wavefields using the two-way wave equation is the crosstalk interference between the up/down propagation of the corresponding source and receiver wavefields. To mitigate this crosstalk, the downgoing source and upgoing receiver wavefield imaging condition (IC) is adopted at an early stage of the inversion process, improving convergence and obtaining cleaner reflection images. A wavefield decomposition methodology can also be incorporated into a least-squares reverse time migration (LSRTM) algorithm. The separation of wavefields based on the propagation direction in the early iterations of LSRTM is to reduce interference noise during the inversion process given that the IC considers only primary reflections. Wavefields decomposed with respect to the vertical direction can be easily obtained by Fourier transforms on the time and vertical axes; however, they usually require significantly higher computational effort especially for 3D applications. Vertical wavefield decomposition by a complex-valued analytic signal is an alternative method implemented by the Hilbert transform, which can be conducted by 1D Fourier transform only on the vertical axis. An LSRTM algorithm adopting this decomposition method has a disadvantage in that it requires two additional wave modelings at each iteration. However, by adapting the deprimary IC into LSRTM, only one more modeling is additionally required in the backward wavefield propagation as compared with conventional LSRTM. Our LSRTM using wavefield decomposition has the ability to produce broader band reflectivity images than conventional LSRTM. This is demonstrated with numerical examples using synthetic and real data resulting artifact-free migration results and broadband reflectivity images.
Decision Support Systems in Oncology
Authors: Walsh Seán , de Jong Evelyn E.C. , van Timmeren Janna E. , Ibrahim Abdalla , Compter Inge , Peerlings Jurgen , Sanduleanu Sebastian , Refaee Turkey , Keek Simon , Larue Ruben T.H.M. , van Wijk Yvonka , Even Aniek J.G. , Jochems Arthur , Barakat Mohamed S. , Leijenaar Ralph T.H. , Lambin Philippe
Published: February 2019

Precision medicine is the future of health care: please watch the animation at https://vimeo.com/241154708 . As a technology-intensive and -dependent medical discipline, oncology will be at the vanguard of this impending change. However, to bring about precision medicine, a fundamental conundrum must be solved: Human cognitive capacity, typically constrained to five variables for decision making in the context of the increasing number of available biomarkers and therapeutic options, is a limiting factor to the realization of precision medicine. Given this level of complexity and the restriction of human decision making, current methods are untenable. A solution to this challenge is multifactorial decision support systems (DSSs), continuously learning artificial intelligence platforms that integrate all available data—clinical, imaging, biologic, genetic, cost—to produce validated predictive models. DSSs compare the personalized probable outcomes—toxicity, tumor control, quality of life, cost effectiveness—of various care pathway decisions to ensure optimal efficacy and economy. DSSs can be integrated into the workflows both strategically (at the multidisciplinary tumor board level to support treatment choice, eg, surgery or radiotherapy) and tactically (at the specialist level to support treatment technique, eg, prostate spacer or not). In some countries, the reimbursement of certain treatments, such as proton therapy, is already conditional on the basis that a DSS is used. DSSs have many stakeholders—clinicians, medical directors, medical insurers, patient advocacy groups—and are a natural consequence of big data in health care. Here, we provide an overview of DSSs, their challenges, opportunities, and capacity to improve clinical decision making, with an emphasis on the utility in oncology.
Postnatal liver functional maturation requires Cnot complex-mediated decay of mRNAs encoding cell cycle and immature liver genes
Authors: Suzuki Toru , Kikuguchi Chisato , Nishijima Saori , Nagashima Takeshi , Takahashi Akinori , Okada Mariko , Yamamoto Tadashi
Published: February 2019

Liver development involves dramatic gene expression changes mediated by transcriptional and post-transcriptional control. Here, we show that the Cnot deadenylase complex plays a crucial role in liver functional maturation. The Cnot3 gene encodes an essential subunit of the Cnot complex. Mice lacking Cnot3 in liver have reduced body and liver masses, and they display anemia and severe liver damage. Histological analyses indicate that Cnot3-deficient (Cnot3−/−) hepatocytes are irregular in size and morphology, resulting in formation of abnormal sinusoids. We observe hepatocyte death, increased abundance of mitotic and mononucleate hepatocytes, and inflammation. Cnot3−/− livers show increased expression of immune response-related, cell cycle-regulating and immature liver genes, while many genes relevant to liver functions, such as oxidation-reduction, lipid metabolism and mitochondrial function, decrease, indicating impaired liver functional maturation. Highly expressed mRNAs possess elongated poly(A) tails and are stabilized in Cnot3−/− livers, concomitant with an increase of the proteins they encode. In contrast, transcription of liver function-related mRNAs was lower in Cnot3−/− livers. We detect efficient suppression of Cnot3 protein postnatally, demonstrating the crucial contribution of mRNA decay to postnatal liver functional maturation.
Sound localization behavior inDrosophila melanogasterdepends on inter-antenna vibration amplitude comparisons
Authors: Batchelor Alexandra V. , Wilson Rachel I.
Published: February 2019

Drosophila melanogaster hear with their antennae: sound evokes vibration of the distal antennal segment, and this vibration is transduced by specialized mechanoreceptor cells. The left and right antennae vibrate preferentially in response to sounds arising from different azimuthal angles. Therefore, by comparing signals from the two antennae, it should be possible to obtain information about the azimuthal angle of a sound source. However, behavioral evidence of sound localization has not been reported in Drosophila. Here, we show that walking D. melanogaster do indeed turn in response to lateralized sounds. We confirm that this behavior is evoked by vibrations of the distal antennal segment. The rule for turning is different for sounds arriving from different locations: flies turn toward sounds in their front hemifield, but they turn away from sounds in their rear hemifield, and they do not turn at all in response to sounds from 90 or −90 deg. All of these findings can be explained by a simple rule: the fly steers away from the antenna with the larger vibration amplitude. Finally, we show that these behaviors generalize to sound stimuli with diverse spectro-temporal features, and that these behaviors are found in both sexes. Our findings demonstrate the behavioral relevance of the antenna's directional tuning properties. They also pave the way for investigating the neural implementation of sound localization, as well as the potential roles of sound-guided steering in courtship and exploration.
Apoptosis induction on human breast cancer T47D cell line by extracts of Ancorina sp.
Authors: Tunjung Woro Anindito Sri , Sayekti Puspa Restu
Published: February 2019

Background:Breast cancer is the second leading cause of death in women. Alternative medicine with high efficacy is needed for breast cancer treatments, for example induction of apoptosis using natural products. It has been found that many natural apoptosis-inducing compounds are isolated from marine sponge. The objective of this study is to analyze the ability of extracts of the spongeAncorinasp. to induce apoptosis on human breast cancer T47D cell line and find out its mechanism.

Methods:T47D cells were treated with crude extracts of methanol, dichloromethane:methanol (1:1) and dichloromethaneAncorinasp. for 24 h, and doxorubicin was used as a positive control. Methods used for this study were MTT assay to examine cell viability and determine IC50of the three extracts, while the percentage of apoptosis and caspase-3 were investigated by flow cytometry.

Results:IC50values of methanol, dichloromethane:methanol (1:1), and dichloromethane extract were 84.25, 121.45, and 99.85μg/mL respectively. The percentages of apoptotic cells after treatment with methanol, dichloromethane:methanol (1:1), and dichloromethane extracts were 88.68, 27.54 and 53.63% respectively, whereas the percentage of caspase-3 was 77.87, 12.66 and 12.97%, respectively.

Conclusions:These results revealed that all extracts ofAncorinasp. have strong or moderate cytotoxicity and have the ability to induce apoptosis on T47D human breast cancer cell line. However, methanol crude extract has high efficacy to induce apoptosis through caspase-3 activation compared to the other extracts. Hence methanol extract warrants further investigation as a natural medicine for human breast cancer.
Examining the (Lack of) Effects Associated with Leadership Training Participation in Higher Education
Authors: Rosch David M.
Published: February 2019

This study examined the differences between a multi-campus sample of university students who reported consistent participation in formal leadership development programs (n=414) and a comparison sample (n=153) with no prior experience across three diverse post- secondary institutions in the United States. Both samples were matched with regard to gender and racial identity, prior self-reported high school leadership training experience, and self- reported possession of formal leadership positions in co-curricular student organizations. Results suggest that students who report past consistent participation in postsecondary leadership training report levels of leadership capacity no different than those with no training. In addition, like their peers they also possess a cognitive model of leadership capacity that fails to differentiate leader self-efficacy, motivation to lead, and leadership skill.