bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of the selection of medicines for the Brazilian primary health care
Authors: Karnikowski Margô Gomes de Oliveira , Galato Dayani , Meiners Micheline Marie Milward de Azevedo , Silva Emília Vitória da , Gerlack Letícia Farias , Bós Ângelo José Gonçalves , Leite Silvana Nair , Álvares Juliana , Guibu Ione Aquemi , Soeiro Orlando Mario , Costa Karen Sarmento , Costa Ediná Alves , Guerra Junior Augusto Afonso , Acurcio Francisco de Assis
Published: October 2017

OBJECTIVE: To characterize the process of selection of medicines for primary health care in the Brazilian regions. METHODS: This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. RESULTS: The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. CONCLUSIONS: As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil
Conceptions on pharmaceutical services in Brazilian primary health care
Authors: Costa Ediná Alves , Araújo Patrícia Sodré , Penaforte Thais Rodrigues , Barreto Joslene Lacerda , Guerra Junior Augusto Afonso , Acurcio Francisco de Assis , Guibu Ione Aquemi , Alvares Juliana , Costa Karen Sarmento , Karnikowski Margô Gomes de Oliveira , Soeiro Orlando Mario , Leite Silvana Nair
Published: October 2017

OBJECTIVE: To identify and discuss the conceptions of pharmaceutical services in Brazilian Primary Health Care, according to different subjects. METHODS: This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015), which is composed of an information survey in a representative sample of cities, stratified according to Brazilian regions, and a subsample of primary health care services. Municipal secretaries of health, those responsible for pharmaceutical services, and those responsible for medicine delivery in pharmacies/dispensing units of the selected services were interviewed. The questionnaires included one question about the understanding of the interviewee regarding pharmaceutical services. The content analysis technique was used to apprehend, in the statements, the meanings attributed to pharmaceutical services, which were subsequently classified into categories according to their main conceptions. RESULTS: Among the wide diversity of conceptions on pharmaceutical services (PS), we highlight the ones focused on 1) logistic control of medicines with activities concerning guidance or information on their use and 2) guidance or information to users on the use of medicine. The findings reveal a shifting tendency from a medicine-focused conception to one that considers the users and their needs as the final recipient of these actions. However, the lack of references to conceptions regarding care management and integrality point out the slowness of this change; after all, this is a social and historical process that comprises the production of meanings that transcend legal, logistic, and technical arrangements in pharmaceutical services. CONCLUSIONS: The diversity of conceptions expresses the several meanings attributed to pharmaceutical services; we also identified, in their reorientation process, a movement that reflects a gradual shift in the technical paradigm, from the focus on medicine logistics to a user-oriented approach of health services
Indicators related to the rational use of medicines and its associated factors
Authors: Lima Marina Guimarães , Álvares Juliana , Guerra Junior Augusto Afonso , Costa Ediná Alves , Guibu Ione Aquemi , Soeiro Orlando Mario , Leite Silvana Nair , Karnikowski Margô Gomes de Oliveira , Costa Karen Sarmento , Acurcio Francisco de Assis
Published: October 2017

OBJECTIVE: To evaluate indicators related to the rational use of medicines and its associated factors in Basic Health Units. METHOD: This is a cross-sectional study carried out in a representative sample of Brazilian cities included in the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). The data were collected by interviews with users, medicine dispensing professionals, and prescribers; and described by prescription, dispensing, and health services indicators. We analyzed the association between human resources characteristics of pharmaceutical services and dispensing indicators. RESULTS: At national level, the average number of medicines prescribed was 2.4. Among the users, 5.8% had antibiotic prescription, 74.8% received guidance on how to use the medicines at the pharmacy and, for 45.1% of users, all prescribed medicines were from the national list of essential medicines. All the indicators presented statistically significant differences between the regions of Brazil. The dispensing professionals that reported the presence of a pharmacist in the unit with a working load of 40 hours or more per week presented 1.82 more chance of transmitting information on the way of using the medicines in the dispensing process. CONCLUSION: The analysis of prescription, dispensing, and health services indicators in the basic health units showed an unsatisfactory proportion of essential medicines prescription and limitations in the correct identification of the medicine, orientation to the patients on medicines, and availability of therapeutic protocols in the health services
Contemporary Risk Stratification After Myocardial Infarction in the Community: Performance of Scores and Incremental Value of Soluble Suppression of Tumorigenicity‐2
Authors: Gerber Yariv , Weston Susan A. , Enriquez‐Sarano Maurice , Jaffe Allan S. , Manemann Sheila M. , Jiang Ruoxiang , Roger Véronique L.
Published: October 2017

Background

Current American Heart Association/American College of Cardiology guidelines recommend the
GRACE
(Global Registry of Acute Coronary Events) and
TIMI
(Thrombolysis in Myocardial Infarction) scores to assess myocardial infarction (
MI
) prognosis. Changes in the epidemiological characteristics of
MI
and the availability of new biomarkers warrant an assessment of the performance of these scores in contemporary practice. We assessed the following: (1) the performance of
GRACE
and
TIMI
to predict 1‐year mortality in a cohort of patients stratified by
ST
‐segment elevation MI (STEMI) and non‐STEMI (
NSTEMI
) and (2) the incremental discriminatory power of soluble suppression of tumorigenicity‐2, a myocardial fibrosis biomarker.

Methods and Results

Olmsted County, Minnesota, residents with incident
MI
(N=1401) were recruited prospectively from November 1, 2002 to December 31, 2012 (mean age, 67 years; 61% men; 79% with
NSTEMI
). Baseline data were used to calculate risk scores; soluble suppression of tumorigenicity‐2 was measured in stored plasma samples obtained at index
MI
.
C
‐statistics adapted to survival data were used to assess the discriminatory power of the risk scores and the improvement gained by adding other markers. During the first year of follow‐up, 190 patients (14%) died. The discriminatory performance to predict death was reasonable for
GRACE
and poor for
TIMI
, and was generally worse in those with NSTEMI versus those with STEMI. In people with
NSTEMI
, sequential addition of comorbidities and soluble suppression of tumorigenicity‐2 substantially improved the
c
‐statistic over
GRACE
(from 0.78 to 0.80 to 0.84) and
TIMI
(from 0.61 to 0.73 to 0.81), respectively (all
P
≤0.05).

Conclusions

Guideline‐recommended scores for risk assessment after
MI
underperform in contemporary community patients, particularly those with NSTEMI, which now represents most infarcts. Incorporating comorbidities and soluble suppression of tumorigenicity‐2 substantially improves risk prediction, thereby delineating opportunities to improve clinical care.
The Problem of the Unity of the Representative Assembly in Hobbes’s Leviathan
Authors: Wadle Douglas C.
Published: October 2017

In Leviathan, Hobbes embraces three seemingly inconsistent claims: (1) the unity of a multitude is secured only by the unity of its representer, (2) assemblies can represent other multitudes, and (3) assemblies are, or are constituted by, multitudes. Together these claims require that a representative assembly, itself, be represented. If that representer is another assembly, it too will need a unifying representer, and so on. To stop a regress, we will need an already unified representer (i.e., one that is not an assembly). But a multitude can only speak or act through its representer, and an assembly is a multitude, so any representing done by the assembly is actually done by this already unified, regress-stopping representer. That is, if (1) and (3) are true, (2) cannot be. I will argue that this inconsistency is only apparent and that we can resolve it without rejecting any of these three claims (and so without imputing error to Hobbes). We do this by appealing to a representer-as-decision-procedure meeting certain criteria. Such a procedural representer breaks the transitivity of representation such that the assembly it represents (and unifies) can properly represent (and unify) some further multitude. I proceed in my defense of the procedural representer view by addressing a series of problems it faces, the solutions to which give us a progressively clearer picture of the criteria this representer must meet.
“That Giant Monster Call’d a Multitude”
Authors: Tootalian Jacob
Published: October 2017

Scholarship on Leviathan has not fully explored the distinctive pattern of language that Hobbes used to invoke the central conceit of the treatise—“that great Leviathan called a Commonwealth.” This note highlights an earlier instance of that rare linguistic construction, one that presented a similar image of political monstrosity several years before Hobbes’s metaphor was published. Verses in Honour of the Reverend and Learned Judge of the Law, Judge Jenkin (1648) celebrated the jurist David Jenkins as a royalist martyr in the fight against “That Giant monster call’d a multitude.” It is possible that the pamphlet might have circulated among the network of English exiles in France, offering Hobbes a linguistic model with which to reconceptualize the early modern understanding of political community.
The Books of Tho. Hobbes
Authors: Auger Peter
Published: October 2017

There are four books that have been advertised in sales catalogues as possessing the inscription ‘Tho. Hobbes’ and having once been owned by Thomas Hobbes. But how confident can we be that they belonged to the famous philosopher? This research note gathers evidence for assessing whether or not this quartet of books were once in the possession of Hobbes of Malmesbury, with particular attention given to a previously undiscussed edition of Josuah Sylvester’s Devine Weekes and Workes (1611) sold to the University of Illinois in 1951 as Hobbes’s copy. The evidence is insufficient to connect any of the four books to Hobbes securely, and in at least one case an Oxford undergraduate of the same name emerges as a stronger candidate. This conclusion confirms that the catalogues at Chatsworth are our principal source for knowing which books Hobbes might have read.
The Forgotten Surrender
Authors: Trifković Gaj
Published: October 2017

English-language historiography has paid scant attention to the events in Yugoslavia in spring 1945, despite the fact that the combined strength of the armies pitted against each other amounted to around 800,000 men, and that it was the only front in Europe which was held independently by a junior member of the anti-Hitler coalition. This article provides an analysis of both the capitulation of the German Army Group E, and the widely diverging descriptions of the same event offered by German and Yugoslav authors. The main argument presented here is that the Yugoslav leadership, prompted by both internal and foreign policy considerations, did not shirk from using less-than-honourable methods to achieve its aims. In doing this, the article will also provide insights into the functioning of the historiography of the socialist era when dealing with potentially embarrassing issues.
Extratropical Response to the MJO: Nonlinearity and Sensitivity to the Initial State
Authors: Lin Hai , Brunet Gilbert
Published: October 2017

Previous studies have shown that the Madden–Julian oscillation (MJO) has a global impact that may provide an important source of skill for subseasonal predictions. The extratropical response was found to be the strongest when the tropical diabatic heating has a dipole structure with convection anomaly centers of opposite sign in the eastern Indian Ocean and the western Pacific. A positive (negative) MJO dipole heating refers to that with heating (cooling) in the eastern Indian Ocean and cooling (heating) in the western Pacific. In this study, two aspects of the extratropical response to the MJO are examined: 1) nonlinearity, which answers the question of whether the response to a positive MJO dipole heating is the mirror image of that to a negative MJO, and 2) sensitivity to the initial state, which explores the dependence of the extratropical response on the initial condition of the westerly jet.

Ensemble integrations using a primitive-equation global atmospheric circulation model are performed with anomalous tropical thermal forcings that resemble a positive MJO (+MJO) and a negative MJO (−MJO). The response in the first week is largely linear. After that, significant asymmetry is found between the response in the positive MJO and the negative MJO. The 500-hPa negative geopotential height response in the North Pacific of the −MJO run is located about 30° east of the positive height response of the +MJO run. There is also an eastward shift of the extratropical wave train in the Pacific–North American region. This simulated nonlinearity is in agreement with the observations. The two leading response patterns among the ensemble members are identified by an empirical orthogonal function (EOF) analysis. EOF1 represents an eastward shift of the wave train, which is positively correlated with strengthening of the East Asian subtropical upper-troposphere westerly jet in the initial condition. On the other hand, EOF2 represents an amplification of the response, which is associated with a southward shift of the westerly jet in the initial state.
Characteristics of a Convective-Scale Weather Forecasting System for the European Arctic
Authors: Müller Malte , Batrak Yurii , Kristiansen Jørn , Køltzow Morten A. Ø. , Noer Gunnar , Korosov Anton
Published: October 2017

In this study a 1-yr dataset of a convective-scale atmospheric prediction system of the European Arctic (AROME-Arctic) is compared with the ECMWF’s medium-range forecasting, ensemble forecasting, and reanalysis systems, by using surface and radiosonde observations of wind and temperature. The focus is on the characteristics of the model systems in the very short-term forecast range (6–15 h), but without a specific focus on lead-time dependencies. In general, AROME-Arctic adds value to the representation of the surface characteristics. The atmospheric boundary layer thickness, during stable conditions, is overestimated in the global models, presumably because of a too diffusive turbulence scheme. Instead, AROME-Arctic shows a realistic mean thickness compared to the radiosonde observations. All models behave similarly for the upper-air verification and surprisingly, as well, in forecasting the location of a polar low in the short-range forecasts. However, when comparing with the largest wind speeds from ocean surface winds and at coastal synoptic weather stations during landfall of a polar low, AROME-Arctic shows the most realistic values. In addition to the model intercomparison, the limitation of the representation of sea ice and ocean surface characteristics on kilometer scales are discussed in detail. This major challenge is illustrated by showing the rapid drift and development of sea ice leads during a cold-air outbreak. As well, the available sea surface temperature products and a high-resolution ocean model result are compared qualitatively. New developments of satellite products, ocean–sea ice prediction models, or parameterizations, tailored toward high-resolution atmospheric Arctic prediction, are necessary to overcome this limitation.
MRPL53, a New Candidate Gene for Orofacial Clefting, Identified Using an eQTL Approach
Authors: Masotti C. , Brito L.A. , Nica A.C. , Ludwig K.U. , Nunes K. , Savastano C.P. , Malcher C. , Ferreira S.G. , Kobayashi G.S. , Bueno D.F. , Alonso N. , Franco D. , Rojas-Martinez A. , dos Santos S.E. , Galante P.A. , Meyer D. , Hünemeier T. , Mangold E. , Dermitzakis E.T. , Passos-Bueno M.R.
Published: October 2017

A valuable approach to understand how individual and population genetic differences can predispose to disease is to assess the impact of genetic variants on cellular functions (e.g., gene expression) of cell and tissue types related to pathological states. To understand the genetic basis of nonsyndromic cleft lip with or without cleft palate (NSCL/P) susceptibility, a complex and highly prevalent congenital malformation, we searched for genetic variants with a regulatory role in a disease-related tissue, the lip muscle (orbicularis oris muscle [OOM]), of affected individuals. From 46 OOM samples, which are frequently discarded during routine corrective surgeries on patients with orofacial clefts, we derived mesenchymal stem cells and correlated the individual genetic variants with gene expression from these cultured cells. Through this strategy, we detected significant cis-eQTLs (i.e., DNA variants affecting gene expression) and selected a few candidates to conduct an association study in a large Brazilian cohort (624 patients and 668 controls). This resulted in the discovery of a novel susceptibility locus for NSCL/P, rs1063588, the best eQTL for the MRPL53 gene, where evidence for association was mostly driven by the Native American ancestry component of our Brazilian sample. MRPL53 (2p13.1) encodes a 39S protein subunit of mitochondrial ribosomes and interacts with MYC, a transcription factor required for normal facial morphogenesis. Our study illustrates not only the importance of sampling admixed populations but also the relevance of measuring the functional effects of genetic variants over gene expression to dissect the complexity of disease phenotypes.
Social media is the new player in the politics of education
Authors: Supovitz Jonathan
Published: October 2017

Political debate about the Common Core State Standards (the first major education policy initiative in the social media age) ramped up quickly on social media, particularly on Twitter. However, while the increased and intense conversation influenced many states to disavow Common Core in name, those states ended up adopting standards that were essentially the same. More important, the author argues, the Twitter-based conflict over Common Core served as a proxy war for other concerns and revealed lasting changes in the nature of political advocacy in education.
Washington View
Authors: Ferguson Maria
Published: October 2017

Some of education secretary Betsy DeVos’s policy positions — particularly her advocacy for school choice and her decision to limit her department’s regulatory stance — are out of step with public opinion. A bipartisan response from Congress would be welcome on at least three important issues: protecting DACA (Deferred Action for Childhood Arrivals), providing strong oversight of for-profit colleges, and defining a strong federal commitment to public education.
Backtalk
Authors: Schneider Jack
Published: October 2017

Scholars can make significant contributions to the work of teachers and schools. But they know they’re often viewed as being little more than frivolous add-ons who are distracting educators from doing the real work of teaching and learning.
Use Value as a Cultural Strategy against Over-Commodification: A Durkheimian Analysis of Craft Consumption within Virtual Communities
Authors: Cole Steven James
Published: October 2017

Craft consumption is a precarious practice since consuming mass commodities can inadvertently reinforce the overly commodified world craft consumers are seeking to balance and address. Conceptualizing guitar players as craft consumers, this article illustrates the struggle for balance within musical virtual communities. Virtual communities’ commodity discussions can fuel commodity desire and foster a type of consumptive anomie that members call ‘GAS’ (Gear Acquisition Syndrome). This anomie is countered by images, norms, and evaluative standards that critically invoke ‘use value’ to regulate member’s consumption. Using Durkheim’s concepts of ‘social facts’ and ‘discipline’, the article examines how online actors ‘use use value’ to curb their anomic consumption, differentiate craft from mass consumption, and critique problematic consumptive acts. Durkheim’s work, however, illuminates how Campbell’s individualistic and psychological account of consumptive desire limits his own analysis of craft consumption, for such an individualistic understanding cannot account for the collective phenomenon witnessed throughout this article.
Post-recurrence survival analysis of stage I non-small-cell lung cancer
Authors: Lee Kanghoon , Kim Hyeong Ryul , Kim Dong Kwan , Kim Yong-Hee , Park Seung-Ill , Choi Se Hoon , Han Junhee
Published: October 2017

Background

The aim of this retrospective study was to review recurrence patterns of stage I non-small-cell lung cancer and identify prognostic factors for post-recurrence survival.

Methods

Among 940 patients with pathological stage I non-small-cell lung cancer who underwent curative resection, 261 experienced a recurrence; of these, 188 had adenocarcinoma and 62 had squamous cell carcinoma. Oligo-recurrence was defined as 1–3 recurrent lesions restricted to a single organ. Potentially curative local treatment included surgery, stereotactic radiotherapy, and photodynamic therapy.

Results

The median follow-up duration was 65 months (range 4–186 months). The most common site of recurrence was the lung in 145 patients, followed by mediastinal lymph nodes in 49, pleura in 30, and brain in 27. Local treatment for recurrent tumors included surgery in 59 patients, stereotactic radiotherapy in 46, photodynamic therapy in 2, and other radiotherapy in 41. Seventy-eight patients received chemotherapy only, and 35 received conservative treatment. Among 125 patients who were evaluated for an epidermal growth factor receptor gene mutation, 31 were treated with epidermal growth factor receptor-tyrosine kinase inhibitor. The 3- and 5-year post-recurrence survival rates were 49.1% and 33.8%, respectively. Age at recurrence, adenocarcinoma cell type, disease-free interval, epidermal growth factor receptor-tyrosine kinase inhibitor treatment, and potentially curative local treatment were independent prognostic factors for survival in multivariate analysis.

Conclusions

Local treatment for recurrence should be considered in selected candidates, and use of epidermal growth factor receptor-tyrosine kinase inhibitor I is reasonable if an epidermal growth factor receptor mutation is detected.
Inflammatory myofibroblastic tumor of heart in a 4-month-old infant
Authors: Syed Aitizaz U , Al Mutairi Mansour B , Al Muhaya Mustafa , Morsey Mofeed , Al Hujailey Ahmed , al Najjar Abdulhameed
Published: October 2017

Primary tumors of heart are rare in infants. We report a case of inflammatory myofibroblastic tumor in a 4-month-old baby girl who presented with a massive pericardial effusion. She underwent complete surgical excision of the tumor. This is the first reported case from the Middle Eastern region. The clinical behavior and management of these rare infantile cardiac tumors are discussed briefly in this report.
Patients’ perspectives on the development of HIV services to accommodate ageing with HIV: a qualitative study
Authors: Pollard Alex , Llewellyn Carrie , Cooper Vanessa , Sachikonye Memory , Perry Nicky , Nixon Eileen , Miners Alec , Youssef Elaney , Sabin Caroline
Published: October 2017

The objective of this study was to identify the aspects of healthcare that are most valued by people with HIV and to describe their concerns and preferences for the future delivery of services for non-HIV-related illness. Twelve focus groups of people receiving HIV care were conducted in community settings in South-East England. Groups were quota sampled based on age, gender, sexual orientation and ethnicity. Data were analysed using Framework Analysis. The results showed that among the 74 respondents (61% male), a preference for maintaining all care within specialist HIV clinics was commonplace, but was highest among participants with more extensive histories of HIV and comorbidities. Participants valued care-coordination, inter-service communication and timely updates to medical notes. There were high levels of concern around HIV skills in general practices and the capacity of general practitioners to manage patient confidentiality or deal appropriately with the emotional and social challenges of living with HIV. Participants valued, and had an overall preference for, the specialist knowledge and skills of HIV services, suggesting that non-HIV-specialist services will need to build their appeal if they are to have a greater future role in the care of people with HIV. Particular concerns that should be addressed include: patient confidence in the HIV knowledge and skills of non-specialist service providers; clear processes for prescribing and referrals; improved levels of care-coordination and communication between services and increased patient confidence in the capacity of primary care to maintain confidentiality and to appreciate the stigma associated with HIV.
Conflict Resolution and Civil Society: Experiences of Nepal in Post-Maoist Revolution
Authors: Islam Mohammad Tarikul
Published: October 2017

Peacemaking involves a set of goals, policies, and strategies, and those are directed to prevent the occurrence of armed conflicts and to avoid violence. Peacemaking solicits a legitimate framework through which all actors could peacefully participate in social, economic, and political life of the nation. The role of civil society groups in peacebuilding has not been adequately discussed in both academic writings and policy analysis of Nepal. The pro-democracy movement jointly launched by the Seven Party Alliance (SPA) and the Communist Party of Nepal (Maoist) (CPN-M) witnessed a shift in the political landscape of Nepal, bringing an end to the decade-old Maoist insurgency as King Gyanendra stepped down on April 24, 2006. Therefore, the study carefully exemplifies the various activities which different civil society groups performed and attempted to analyze their roles in the prolonged process of peacebuilding. The responsibilities of civil society in Nepal, particularly in the aftermath of Maoist Revolution, are found to be focused and calculated, and effective to some extent. Collective efforts of different civil society groups helped to restart searching common ground for conflict mediation and peace in Nepal after a decade-long Maoist conflict. The underlying community interests for conflict resolution have been the business for all and where civil society has a spirited stake.
Macro Stress Testing of Indian Bank Groups
Authors: Dua Pami , Kapur Hema
Published: October 2017

This study examines how various bank groups operating in India have fared macro stress events and conduct macro stress testing (MST) to trace the impact of certain macroeconomic stress scenarios on the credit quality of five Indian bank groups, that is, the State Bank of India (SBI) and its associates (SBGs), nationalised banks (NBs), old private sector banks (OPBs), new private sector banks (NPBs) and foreign banks (FBs), using panel data from 1997 to 2014.

Credit quality is modelled as a function of both macroeconomic variables (output growth, interest rate, inflation rate and exchange rate) and idiosyncratic variables (profitability and size indicator of bank business activity). The model is estimated by employing a panel cointegration approach, and the impact of adverse scenarios on the estimated credit quality is computed.

Empirical findings show that credit quality is pro-cyclical in nature and rises in the event of a slowdown in the economy. In general, the credit quality of Indian bank groups is found to be inversely and significantly related to the economy’s growth rate, inflation rate, exchange rate and profits of banks and positively and significantly related to the interest rate. Shock analysis also reveals that a downturn in the economy through certain adverse scenarios has a significant adverse impact on the credit quality. The shocks are quickly propagated across banks with substantial heterogeneities present in different bank groups. Thus, macroeconomic policy measures promoting growth with price stability are expected to impact credit quality positively. Further, measures at the bank level can improve credit quality by enhancing their profitability.

JEL Classifications: C32, C58, E170, G21
A neural network modeling and sliding mode control of self-sensing ionic polymer–metal composite actuator
Authors: Nakshatharan S Sunjai , Punning Andres , Aabloo Alvo
Published: October 2017

This work reports on the development of integrated sensing and feedback control system for self-sensing ionic polymer–metal composite actuator. Integrated sensing is accomplished by crafting discrete sensing and actuation sections over a single device by patterning the surface electrodes. A control scheme and estimation technique is implemented for self-sensing feedback control that uses the electrode resistance change during deformation. Experiments are conducted to investigate the relation between the changes in electrode resistance of patterned sensor part to that of actual tip displacement of the device. Due to the large hysteresis and associated nonlinearity, artificial neural network is used as a computational tool to model their relation and to estimate the actual tip displacement of the device. The need for stable control to overcome nonlinearity and inherent back relaxation behavior of the material is accomplished using robust sliding mode controller. The experimental results based on the proposed method achieves good performance in terms of tracking control without the need for separate position sensor and makes the device to perform as a self-sensing actuator.
Introduction of a dose-banding system for parenteral chemotherapy on a haematology–oncology day ward
Authors: O’Leary Caoimhe E , Collins Aisling , Henman Martin C , King Fionnuala
Published: October 2017

Introduction

The increasing incidence of cancer and the finite capacity of hospital aseptic compounding units pose a serious challenge to the provision of cancer care. Chemotherapy dose-banding is a method of rationalising parenteral chemotherapy dosing and supply, whereby patient-individualised doses are rounded to predetermined banded doses. The banded doses may be outsourced as stock items which increases the supply capacity of the aseptic compounding unit.

Methods

Kotter’s 8-step change management model was used to structure the implementation of dose-banding of 5-fluorouracil 46-h infusers on the haematology–oncology day ward in St. James’s Hospital, Dublin. The impact of dose-banding on local practice was assessed through pre- and post-implementation surveys of stakeholders.

Results

In-house surveys of pharmacy, medical and nursing staff identified a generally favourable attitude towards implementing changes in the parenteral chemotherapy supply system, with some resistance to change evident. Dose-banding of 5-fluorouracil 46-h infusers was implemented successfully on the haematology–oncology day ward. Dose rationalisation and flexibility of re-allocation of standard banded doses between patients were the primary benefits of dose-banding found. Post-implementation surveys showed that clinical staff were in favour of adopting dose-banding into standard practice; however, they were cautious about the degree to which the results of this limited study would be translated into substantive benefits if dose-banding was adopted for all suitable preparations.

Conclusion

The success of the implementation process and the favourable opinions of stakeholders shown in the post-implementation survey enabled the dose-banding service to be extended to a further nine drugs. Kotter’s 8-step change management model was a useful tool for structuring this process change in St. James’s Hospital.
The Risks and Benefits of Cannabis in the Dermatology Clinic
Authors: Dhadwal Gurbir , Kirchhof Mark G.
Published: October 2017

Cannabis ( Cannabis sativa/indica), also known as marijuana, has been used for medicinal and recreational purposes for millennia. There has been a recent trend to legalize the use of cannabis, as illustrated by the recent legalization votes in numerous states in the United States and legislation in Canada to allow recreational cannabis use. With this increasing consumption of cannabis, dermatologists will see increased pressure to prescribe cannabis and will see the side effects of cannabis use with greater frequency. There are several approved medical indications for cannabis use, including psoriasis, lupus, nail-patella syndrome, and severe pain. In addition, very preliminary studies have suggested cannabis and its derivatives might have use in acne, dermatitis, pruritus, wound healing, and skin cancer. Further well-controlled studies are required to explore these potential uses. Conversely, the side effects of cannabis use are relatively well documented, and dermatologists should be aware of these presentations. Side effects of cannabis use include cannabis allergy manifesting as urticaria and pruritus, cannabis arteritis presenting with necrosis and ulcers, and oral cancers from cannabis smoke. In this review, we summarize some of the studies and reports regarding the medicinal uses of cannabis in the dermatology clinic and some of the side effects that might present more often to dermatologists as the use of cannabis increases.
Monoclonal antibodies for chronic pain: A practical review of mechanisms and clinical applications
Authors: Yeh Ju-Fen , Akinci Aysen , Al Shaker Mohammed , Chang Ming Hong , Danilov Andrei , Guillen Rocio , Johnson Kirk W , Kim Yong-Chul , El-Shafei Ahmed A , Skljarevski Vladimir , Dueñas Héctor J , Tassanawipas Warat
Published: October 2017

Context

Monoclonal antibodies are being investigated for chronic pain to overcome the shortcomings of current treatment options.

Objective

To provide a practical overview of monoclonal antibodies in clinical development for use in chronic pain conditions, with a focus on mechanisms of action and relevance to specific classes.

Methods

Qualitative review using a systematic strategy to search for randomized controlled trials, systematic and nonsystematic (narrative) reviews, observational studies, nonclinical studies, and case reports for inclusion. Studies were identified via relevant search terms using an electronic search of MEDLINE via PubMed (1990 to June 2017) in addition to hand-searching reference lists of retrieved systematic and nonsystematic reviews.

Results

Monoclonal antibodies targeting nerve growth factor, calcitonin gene-related peptide pathways, various ion channels, tumor necrosis factor-α, and epidermal growth factor receptor are in different stages of development. Mechanisms of action are dependent on specific signaling pathways, which commonly involve those related to peripheral neurogenic inflammation. In clinical studies, there has been a mixed response to different monoclonal antibodies in several chronic pain conditions, including migraine, neuropathic pain conditions (e.g., diabetic peripheral neuropathy), osteoarthritis, chronic back pain, ankylosing spondylitis, and cancer. Adverse events observed to date have generally been mild, although further studies are needed to ensure safety of monoclonal antibodies in early stages of development, especially where there is an overlap with non-pain-related pathways. High acquisition cost remains another treatment limitation.

Conclusion

Monoclonal antibodies for chronic pain have the potential to overcome the limitations of current treatment options, but strategies to ensure their appropriate use need to be determined.
Increased arterial stiffness in children with congenital heart disease
Authors: Häcker Anna-Luisa , Reiner Barbara , Oberhoffer Renate , Hager Alfred , Ewert Peter , Müller Jan
Published: October 2017

Objective

Central systolic blood pressure (SBP) is a measure of arterial stiffness and strongly associated with atherosclerosis and end-organ damage. It is a stronger predictor of cardiovascular events and all-cause mortality than peripheral SBP. In particular, for children with congenital heart disease, a higher central SBP might impose a greater threat of cardiac damage. The aim of the study was to analyse and compare central SBP in children with congenital heart disease and in healthy counterparts.

Patients and methods

Central SBP was measured using an oscillometric method in 417 children (38.9% girls, 13.0 ± 3.2 years) with various congenital heart diseases between July 2014 and February 2017. The test results were compared with a recent healthy reference cohort of 1466 children (49.5% girls, 12.9 ± 2.5 years).

Results

After correction for several covariates in a general linear model, central SBP of children with congenital heart disease was significantly increased (congenital heart disease: 102.1 ± 10.2 vs. healthy reference cohort: 100.4 ± 8.6, p < .001). The analysis of congenital heart disease subgroups revealed higher central SBP in children with left heart obstructions (mean difference: 3.6 mmHg, p < .001), transpositions of the great arteries after arterial switch (mean difference: 2.2 mmHg, p = .017) and univentricular hearts after total cavopulmonary connection (mean difference: 2.1 mmHg, p = .015) compared with the reference.

Conclusion

Children with congenital heart disease have significantly higher central SBP compared with healthy peers, predisposing them to premature heart failure. Screening and long-term observations of central SBP in children with congenital heart disease seems warranted in order to evaluate the need for treatment.
Cyclosporine or steroids as an adjunct to plasma exchange in the treatment of immune-mediated thrombotic thrombocytopenic purpura
Authors: Cataland Spero R. , Kourlas Peter J. , Yang Shangbin , Geyer Susan , Witkoff Leslie , Wu Haiwa , Masias Camila , George James N. , Wu Haifeng M.
Published: October 2017

Key Points

Prednisone, as an adjunct to PEX, effectively suppresses the autoantibody inhibitor of ADAMTS13 in the treatment of iTTP.
Cadherin 17 mutation associated with leaky severe combined immune deficiency is corrected by HSCT
Authors: Smith Angela R. , Rota Ioanna A. , Maio Stefano , Massaad Michel J. , Lund Troy C. , Notarangelo Luigi D. , Holländer Georg A. , Blazar Bruce R.
Published: October 2017

Key Points

CDH17 is expressed in human thymic epithelial cells. CDH17 mutations may be a rare cause of leaky severe combined immune deficiency that can be corrected by HSCT.
Enhancing Diversity in Undergraduate Science: Self-Efficacy Drives Performance Gains with Active Learning
Authors: Ballen Cissy J. , Wieman Carl , Salehi Shima , Searle Jeremy B. , Zamudio Kelly R.
Published: October 2017

Efforts to retain underrepresented minority (URM) students in science, technology, engineering, and mathematics (STEM) have shown only limited success in higher education, due in part to a persistent achievement gap between students from historically underrepresented and well-represented backgrounds. To test the hypothesis that active learning disproportionately benefits URM students, we quantified the effects of traditional versus active learning on student academic performance, science self-efficacy, and sense of social belonging in a large (more than 250 students) introductory STEM course. A transition to active learning closed the gap in learning gains between non-URM and URM students and led to an increase in science self-efficacy for all students. Sense of social belonging also increased significantly with active learning, but only for non-URM students. Through structural equation modeling, we demonstrate that, for URM students, the increase in self-efficacy mediated the positive effect of active-learning pedagogy on two metrics of student performance. Our results add to a growing body of research that supports varied and inclusive teaching as one pathway to a diversified STEM workforce.
Identification of Clinical and Biologic Correlates Associated With Outcome in Children With Adrenocortical Tumors Without Germline TP53 Mutations: A St Jude Adrenocortical Tumor Registry and Children’s Oncology Group Study
Authors: Pinto Emilia Modolo , Rodriguez-Galindo Carlos , Pounds Stanley B. , Wang Lei , Clay Michael R. , Neale Geoffrey , Garfinkle Elizabeth A.R. , Lam Catherine G. , Levy Carolyn Fein , Pappo Alberto S. , Zambetti Gerard P. , Ribeiro Raul C.
Published: October 2017

Purpose

The clinical features, pathogenesis, and outcomes in children with adrenocortical tumors (ACTs) without germline TP53 mutations have not been systematically studied. Herein, we describe these correlates and analyze their association with outcome.

Patients and Methods

Genomic DNA was analyzed for TP53, CTNNB1, CDKN1C, ATRX, and chromosome 11p15 abnormalities. β-catenin expression and Ki-67 labeling index (LI) were evaluated by immunostaining. Primary end points were progression-free (PFS) and overall survival.

Results

Median age of 42 girls and 18 boys was 3.3 years (range, 0.25 to 21.7 years). Complete resection (stages I and II) was achieved in 32 patients, and 28 patients had stage III or IV disease. Constitutional abnormalities of chromosome 11p15 occurred in nine of 40 patients, with six patients not showing phenotype of Beckwith-Wiedemann syndrome. Three-year PFS and overall survival for all patients were 71.4% and 80.5%, respectively. In single-predictor Cox regression analysis, age, disease stage, tumor weight, somatic TP53 mutations, and Ki-67 LI were associated with prognosis. Ki-67 LI and age remained significantly associated with PFS after adjusting for stage and tumor weight. Three-year PFS for 27 patients with Ki-67 LI ≥ 15% was 48.5% compared with 96.2% for 29 patients with Ki-67 LI < 15% (log-rank P = .002), and the rate of relapse increased by 24% with each 1-year increase in age at diagnosis (hazard ratio, 1.24; P = .0057).

Conclusion

Clinicopathologic features and outcomes of children with ACTs without germline TP53 mutations overlapped those reported for children with germline TP53 mutations. Our findings highlight the central role of genetic or epigenetic alterations on chromosome 11p15 in pediatric ACTs. Ki-67 LI is a strong prognostic indicator and should be investigated to improve the histologic classification of pediatric ACTs.
Good Neighbors and Lost Cities
Authors: Rice Mark
Published: October 2017

This article examines how the policies and institutions of the Good Neighbor era in the 1930s and 1940s promoted the Inca archaeological site of Machu Picchu as a tourist destination and a national symbol of Peru. The article investigates the transnational effort that linked US goals to foment hemispheric solidarity with activities of the Peruvian state, as well as local aims to promote the Cuzco region, the former heart of the Inca empire where Machu Picchu is located. The rise of Machu Picchu during the Good Neighbor era points to the importance of understanding how tourism development in Latin America served the aims of US foreign policy while creating a transnational space for national and local actors to assert their own cultural and political goals.
If Many Seek, Ye Shall Find: Search Externalities and New Goods
Authors: Kotowski Maciej H. , Zeckhauser Richard J.
Published: October 2017

Consumer search serves productive roles in an economy with multiple goods. In equilibrium, search promotes the sorting of consumers among producers, thereby enabling the market for new goods, and potentially increasing welfare and profits above the benchmark case (an economy with a single good, hence, no search). When competitors are few, additional direct competitors may benefit a firm, as more sellers may encourage more consumers to search. In return, consumer search entices producers of new goods to enter. Neither of these externalities, nor the coordination problems faced by consumers and producers, is appropriately recognized in the literature. (JEL D11, D43, D62, D82, D83, G22)
Management Quality and Firm Hierarchy in Industry Equilibrium
Authors: Chen Cheng
Published: October 2017

I incorporate a monitoring-based firm hierarchy into an industry equilibrium model with heterogeneous firms. I then use the theory to study aggregate impacts of an economy-wide improvement in monitoring efficiency. This shock generates a selection effect, which favors more hierarchical (i.e., more layers) firms. Interestingly, these implications depend on firms' heterogeneous choices about their hierarchy and completely disappear when firms are homogeneous in terms of the number of layers inside the hierarchy. (JEL D21, L23, L25, M12, M54)
Παραγωγή κατοικίας και ιδιοκτησία γης στην Αλβανία της μετάβασης. Κοινωνικές πτυχές των μεταλλαγών στην πόλη του Αργυροκάστρου
Authors: Βαταβάλη Φερενίκη
Published: October 2017

Η κατάρρευση του κρατικού σοσιαλισμού το 1989 και η μετάβαση της Αλβανίας στην οικονομία της ελεύθερης αγοράς αποτελεί αφετηρία μεγάλων αλλαγών στην ιδιοκτησία της γης και την παραγωγή κατοικίας, άμεσα συναρτημένων με ευρύτερες διεργασίες που σημειώνονται σε παγκόσμιο επίπεδο. Στόχος του άρθρου είναι η διερεύνηση των διαδικασιών με τις οποίες η ιδιοκτησία της γης μεταβαίνει από μια κεντρικά σχεδιασμένη οικονομία στην ελεύθερη αγορά το διάστημα μετά το 1989 και έως το 2007, εστιάζοντας στις διαδικασίες παραγωγής κατοικίας στην πόλη του Αργυροκάστρου. Κεντρικός ισχυρισμός του άρθρου είναι ότι η δυναμική που αναπτύσσεται γύρω από την ιδιοκτησία της γης και την κατοικία, αν και εμφανίζει σημαντικές ανισότητες, διαχέει τα οφέλη από τη γαιοπρόσοδο σε πλατειά κοινωνικά στρώματα.