bluuebunny/crossref_metadata_2025 huggingface dataset:
Investments, Market Timing and Portfolio Performance across Indian Bull and Bear Markets
Authors: Kanojia Sunaina , Arora Neha
Published: July 2018

The returns generated from an investment alternative are exponentially higher when espoused with appropriate timings. This article expound on the market timing used by investors to formulate profitable investment strategies in the stock market, which requires gathering of information at both micro- and macro-levels along with market trends to make timely decisions and evaluating the universe of stocks available. The market trends are been broadly classified into bull and bear phases, which have dynamic influence on buying and selling in the stock market. Further, the study supports the retail investors’ participation in the market for long-term to generate higher returns as compared to other conventional alternatives. The study attempts to identify bull and bear market turning points using a formal turning point identification procedure and formulate a profitable investment strategy in bull or bear market phases to maximise the returns. Hence, the present study provides to understand how the two phases influence investment decisions and determine the implications of bull and bear market phases on investors’ investment strategy.
Security as an Extension to TAM Model: Consumers’ Intention to Use a Single Platform E-Payment
Authors: Lai P. C.
Published: July 2018

This article summarises an explorative study of the security that contributes to consumers’ adoption of an integrated, single platform payment system encompassing card, Internet and mobile technologies in the ASEAN. The attempt to survey these areas in an integrated fashion is a novel approach that differs from existing studies which mainly focus on adoption factors of these technologies in isolation as well as focuses on the security elements as an extension as Technology Acceptance Model (TAM). The empirical results from the quantitative analysis suggest that security, perceived usefulness as well as perceived ease of use are significant factors that contribute to consumers’ intention to utilise a single platform payment system. Organisations will be able to utilise the study information for developing products and services that meet the consumers’ single platform e-payment system while also fulfilling their objective of corporate social responsibility.
A Novel Case of Biliary Atresia in a Premature Neonate With 1p36 Deletion Syndrome
Authors: Chawla Vonita , Anagnost Miran Rhee , Eldemerdash Alaa-Eldin , Reyes Dahna , Scherr Rebecca , Ezeanolue Kanayo , Banfro Francis , Alhosh Rabea
Published: July 2018

We describe the case of a premature male neonate diagnosed with biliary atresia who was found to have chromosome 1p36 deletion syndrome. Our patient was born prematurely, at a gestational age of 28 weeks. Pregnancy was complicated by advanced maternal age, gestational hypertension, and intrauterine growth restriction. Physical examination revealed several dysmorphic features, prompting a genetic evaluation, which revealed chromosome 1p36 deletion syndrome. At week 7 of life, he was found to have acholic stools. Direct bilirubin was found to be elevated despite discontinuation of total parenteral nutrition at 3 weeks of life, thus raising the suspicion for biliary atresia. Biliary atresia was confirmed by constellation of clinical, imaging and intraoperative findings. First reported in 1996, 1p36 deletion syndrome has been researched increasingly and several new phenotypic associations have been reported over the years. While attempts at linking specific phenotypic abnormalities with individual gene(s) deletion(s) are being made, deletion patterns that would affect specific organ system or function remain to be fully understood. Thus, clinicians currently rely on reports of previously identified abnormalities. To our knowledge, our patient is the first report of biliary atresia in a patient with chromosome 1p36 deletion syndrome. It is important to determine the etiology of the cholestasis, when present, while caring for premature neonates with 1p36 deletion syndrome. This is necessary to avoid assuming that the cholestasis is arising from total parenteral nutrition administration and not from other gastrointestinal anomalies including biliary atresia, which is a time-sensitive diagnosis.
Effect of Concomitant Cartilage Lesions on Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: A Nationwide Cohort Study From Norway and Sweden of 8470 Patients With 5-Year Follow-up
Authors: Ulstein Svend , Årøen Asbjørn , Engebretsen Lars , Forssblad Magnus , Lygre Stein Håkon Låstad , Røtterud Jan Harald
Published: July 2018

Background:

The effect of concomitant focal cartilage lesions on patient-reported outcomes after anterior cruciate ligament reconstruction (ACLR) remains to be determined.

Purpose:

To evaluate the effect of concomitant partial-thickness (International Cartilage Repair Society [ICRS] grades 1-2) and full-thickness (ICRS grades 3-4) cartilage lesions on patient-reported outcomes 5 years after ACLR.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

All patients who underwent unilateral primary ACLR registered in the Norwegian and Swedish National Knee Ligament Registries from 2005 to 2008 (n = 15,783) were included in the study. At 5-year follow-up, 8470 (54%) patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS). Multivariable linear regression models were used to estimate the effect of concomitant partial-thickness and full-thickness cartilage lesions on patient-reported outcomes (KOOS) 5 years after ACLR.

Results:

Compared with no concomitant cartilage lesions, both partial-thickness and full-thickness cartilage lesions were indicators of statistically significant adverse effects on the KOOS in the adjusted regression analysis at 5-year follow-up after ACLR.

Conclusion:

ACL-injured patients with concomitant cartilage lesions reported worse outcomes and less improvement than those without cartilage lesions 5 years after ACLR.
Coerced Literacies: A Critical Discourse Analysis of Volunteered Skills Training in Prison
Authors: Litchfield Kathrina
Published: July 2018

Without standardized access to higher education, incarcerated learners take advantage of the opportunities provided by local and national volunteer organizations for their postsecondary education. Toastmasters International describes itself as an educational nonprofit organization that teaches public speaking and leadership skills, which now expands its clubs into state and federal prisons. A Midwest region’s district distributes a pamphlet that encourages Toastmaster members to volunteer time and money to support these prison clubs. Critical discourse analysis techniques are used to explore how language in this volunteer pamphlet appropriates social control, refigures prisoner identity, and positions learners through a deficit model of cognitive behavioral correctives. While this article examines only a single public text, my findings caution volunteer organizations to thoughtfully consider the assumptions and constructs they import when they enter the prison with intentions to rehabilitate or educate its residents.
Student Learning in an Accelerated Introductory Biology Course Is Significantly Enhanced by a Flipped-Learning Environment
Authors: Barral Ana Maria , Ardi-Pastores Veronica C. , Simmons Rachel E.
Published: July 2018

A flipped-classroom environment generally strives to create more in-class time for activities that enhance student learning, while shifting some content delivery to outside the classroom through the use of short didactic videos. We compared a flipped-classroom setting with the traditional (“control”) setting for an accelerated lower-division general biology course. Student self-reporting and video analytics functions showed ample and variable video viewing among individual students. Student learning was evaluated through quizzes administered after a set of concepts were covered (post 1) and at the end of the course (post 2). Students in the flipped sections had significantly higher quiz scores than students in the control sections for both post 1 and post 2. Analyses of variance analyzing the effect of and interactions between type of instruction, in-class activities, time, and Bloom’s level of the quiz questions found significant differences in the overall model and all the factors, except for the presence and level of activities. Significant differences between students in the flipped and control sections were observed for low-level Bloom’s questions only. Thus, the positive effect of the flipped-classroom approach on student learning may be due to improvements in recall of basic concepts and a better understanding of biology vocabulary in their first biology course.
Tackling obesity in mental health secure units: a mixed method synthesis of available evidence
Authors: Johnson Maxine , Day Matthew , Moholkar Rajesh , Gilluley Paul , Goyder Elizabeth
Published: July 2018

Background

The prevalence and incidence of obesity are high in people with severe mental illness (SMI). In England, around 6000 people with SMI access care from secure mental health units. There is currently no specific guidance on how to reduce the risk of obesity-related morbidity and mortality in this population.

Aims

To identify international evidence that addresses the issue of obesity in mental health secure units.

Method

A mixed method review of evidence (published 2000–2015) was carried out to assess obesity prevalence, intervention and policy change, as well as barriers to change.

Results

Evidence from 22 mainly small, non-comparator studies (reported in 21 papers) using a range of methods was reviewed. Dietary, physical activity and cultural interventions being implemented within secure units to address the problem of obesity showed some promising outcomes for physical health and health education. These were facilitated by adequate organisational resources, staff training and motivated staff. Holistic interventions that included a social and/or competitive element were more likely to be taken up. Involving patients in decision-making mediated the tension between facilitating behaviour change and imposing control. Barriers to successful outcomes included patient movement in and out of units, severity of mental health condition and resistance to change by patients and staff.

Conclusions

Despite the promising outcomes reported, further assessment is needed of the feasibility, acceptability and effectiveness of interventions and policies targeting the obesogenic environment, using robust research methods.

Declaration of interest

None.
Impact of the SPOP Mutant Subtype on the Interpretation of Clinical Parameters in Prostate Cancer
Authors: Liu Deli , Takhar Mandeep , Alshalalfa Mohammed , Erho Nicholas , Shoag Jonathan , Jenkins Robert B. , Karnes R. Jeffrey , Ross Ashley E. , Schaeffer Edward M. , Rubin Mark A. , Trock Bruce , Klein Eric A. , Den Robert B. , Tomlins Scott A. , Spratt Daniel E. , Davicioni Elai , Sboner Andrea , Barbieri Christopher E.
Published: July 2018

Purpose

Molecular characterization of prostate cancer, including The Cancer Genome Atlas, has revealed distinct subtypes with underlying genomic alterations. One of these core subtypes, SPOP (speckle-type POZ protein) mutant prostate cancer, has previously only been identifiable via DNA sequencing, which has made the impact on prognosis and routinely used risk stratification parameters unclear.

Methods

We have developed a novel gene expression signature, classifier (Subclass Predictor Based on Transcriptional Data), and decision tree to predict the SPOP mutant subclass from RNA gene expression data and classify common prostate cancer molecular subtypes. We then validated and further interrogated the association of prostate cancer molecular subtypes with pathologic and clinical outcomes in retrospective and prospective cohorts of 8,158 patients.

Results

The subclass predictor based on transcriptional data model showed high sensitivity and specificity in multiple cohorts across both RNA sequencing and microarray gene expression platforms. We predicted approximately 8% to 9% of cases to be SPOP mutant from both retrospective and prospective cohorts. We found that the SPOP mutant subclass was associated with lower frequency of positive margins, extraprostatic extension, and seminal vesicle invasion at prostatectomy; however, SPOP mutant cancers were associated with higher pretreatment serum prostate-specific antigen (PSA). The association between SPOP mutant status and higher PSA level was validated in three independent cohorts. Despite high pretreatment PSA, the SPOP mutant subtype was associated with a favorable prognosis with improved metastasis-free survival, particularly in patients with high-risk preoperative PSA levels.

Conclusion

Using a novel gene expression model and a decision tree algorithm to define prostate cancer molecular subclasses, we found that the SPOP mutant subclass is associated with higher preoperative PSA, less adverse pathologic features, and favorable prognosis. These findings suggest a paradigm in which the interpretation of common risk stratification parameters, particularly PSA, may be influenced by the underlying molecular subtype of prostate cancer.
Lin28a overexpression reveals the role of Erk signaling in articular cartilage development
Authors: Kobayashi Tatsuya , Kozlova Anastasia
Published: July 2018

Adult articular cartilage shows limited tissue turnover, and therefore development of the proper structure of articular cartilage is crucial for life-long joint function. However, the mechanism by which the articular cartilage structure is developmentally regulated is poorly understood. In this study, we show evidence that activation of extracellular signal-regulated kinases (Erk1/2) in articular chondrocyte progenitors during developmental stages control articular cartilage thickness. We found that overexpression of Lin28a, an RNA-binding protein that regulates organismal growth and metabolism, in articular chondrocyte progenitor cells upregulated Erk signaling and increased articular cartilage thickness. Overexpression of a constitutively active Kras mimicked Lin28a overexpression, and inhibition of Erk signaling during embryonic stages normalized the cartilage phenotype of both Kras- and Lin28a-overexpressing mice. These results suggest that articular cartilage thickness is mainly determined during the process of embryonic synovial joint development, which is positively regulated by Erk signaling.
Understanding human fetal pancreas development using subpopulation sorting, RNA sequencing and single-cell profiling
Authors: Ramond Cyrille , Beydag-Tasöz Belin Selcen , Azad Ajuna , van de Bunt Martijn , Petersen Maja Borup Kjær , Beer Nicola L. , Glaser Nicolas , Berthault Claire , Gloyn Anna L. , Hansson Mattias , McCarthy Mark I. , Honoré Christian , Grapin-Botton Anne , Scharfmann Raphael
Published: July 2018

To decipher the populations of cells present in the human fetal pancreas and their lineage relationships, we developed strategies to isolate pancreatic progenitors, endocrine progenitors and endocrine cells. Transcriptome analysis of the individual populations revealed a large degree of conservation among vertebrates in the drivers of gene expression changes occurring at different steps of differentiation, although notably, sometimes, different members of the same gene family are expressed. The transcriptome analysis establishes a resource to identify novel genes and pathways involved in human pancreas development. Single cell profiling further captured intermediate stages of differentiation and enabled us to decipher the sequence of transcriptional events occurring during human endocrine differentiation. Furthermore, we evaluate how well individual pancreatic cells derived in vitro from human pluripotent stem cells mirror the natural process occurring in human fetuses. This comparison uncovers a few differences at the progenitor steps, a convergence at the steps of endocrine induction and the current inability to fully resolve endocrine cell subtypes in vitro.
Two-Sided Investment and Matching with Multidimensional Cost Types and Attributes
Authors: Dizdar Deniz
Published: July 2018

Heterogeneous buyers and sellers must make investments before entering a continuum assignment market. I show that efficient ex post contracting equilibria (Cole, Mailath, and Postlewaite 2001b) exist in a general assignment game framework. I then shed light on what enables and what precludes coordination failures. A simple condition—absence of technological multiplicity—guarantees efficient investments for each pair, but a mismatch of agents may still occur. However, using optimal transport theory, I also show that mismatch is heavily constrained in certain multidimensional environments with differentiated agents and no technological multiplicity. Under technological multiplicity, even extreme ex ante heterogeneity need not preclude inefficiencies. (JEL C78, D41, D86)
A Pseudo-Market Approach to Allocation with Priorities
Authors: He Yinghua , Miralles Antonio , Pycia Marek , Yan Jianye
Published: July 2018

We propose a pseudo-market mechanism for no-monetary-transfer allocation of indivisible objects based on priorities such as those in school choice. Agents are given token money, face priority-specific prices, and buy utility-maximizing random assignments. The mechanism is asymptotically incentive compatible, and the resulting assignments are fair and constrained Pareto efficient. Hylland and Zeckhauser’s (1979) position-allocation problem is a special case of our framework, and our results on incentives and fairness are also new in their classical setting. (JEL D63, D82, H75, I21, I28)
Electoral Accountability and Interdistrict Competition
Authors: Zudenkova Galina
Published: July 2018

This paper analyzes a multidistrict game of electoral accountability in which constituencies compete over scarce resources by setting expectations for targeted spending. I build a political agency model in which a vote-maximizing politician is subject to the oversight of distinct constituencies. The voters’ demand for targeted spending in these constituencies is driven down by the competition among them. In order to make their constituency an attractive choice for discretionary spending, the voters adopt reelection standards below what they receive in equilibrium. They therefore tend to be satisfied with the distributive politics of the incumbent politician. The incumbent is then quite likely to win more than half of the votes. (JEL D72, D82)
When to Confront: The Role of Patience
Authors: Sandroni Alvaro , Urgun Can
Published: July 2018

This paper examines the effects of patience on ordinary conflicts such as divorce, price wars, and commercial litigation. Players optimally decide when, if ever, to start a destructive confrontation. In the unique equilibrium, there is a tight connection between patience, aggressiveness, and strength. In particular, patience may lead to immediate confrontation (the most inefficient outcome). This inefficiency is caused by preemptive moves that deny option values to the opponent. (JEL C73, D74)
Multiple Activities in Networks
Authors: Chen Ying-Ju , Zenou, Yves , Zhou Junjie
Published: July 2018

We consider a network model where individuals exert efforts in two types of activities that are interdependent. These activities can be either substitutes or complements. We provide a full characterization of the Nash equilibrium of this game for any network structure. We show, in particular, that quadratic games with linear best-reply functions aggregate nicely to multiple activities because equilibrium efforts obey similar formulas to that of the one-activity case. We then derive some comparative-statics results showing how own productivity affects equilibrium efforts and how network density impacts equilibrium outcomes. (JEL C72, D11, D85, Z13)
Why Voting? A Welfare Analysis
Authors: Drexl Moritz , Kleiner Andreas
Published: July 2018

A committee decides collectively whether to accept a given proposal or to maintain the status quo. Committee members are privately informed about their valuations and monetary transfers are possible. According to which rule should the committee make its decision? We consider strategy-proof and anonymous mechanisms and solve for the decision rule that maximizes utilitarian welfare, which takes monetary transfers to an external agency explicitly into account. For regular distributions of preferences, we find that it is optimal to exclude monetary transfers and to decide by qualified majority voting. This sheds new light on the common objection that criticizes voting for its inefficiency. (JEL D71, D72, D82)
Recent advances in understanding and managing dystonia
Authors: Tisch Stephen
Published: July 2018

Within the field of movement disorders, the conceptual understanding of dystonia has continued to evolve. Clinical advances have included improvements in recognition of certain features of dystonia, such as tremor, and understanding of phenotypic spectrums in the genetic dystonias and dystonia terminology and classification. Progress has also been made in the understanding of underlying biological processes which characterize dystonia from discoveries using approaches such as neurophysiology, functional imaging, genetics, and animal models. Important advances include the role of the cerebellum in dystonia, the concept of dystonia as an aberrant brain network disorder, additional evidence supporting the concept of dystonia endophenotypes, and new insights into psychogenic dystonia. These discoveries have begun to shape treatment approaches as, in parallel, important new treatment modalities, including magnetic resonance imaging-guided focused ultrasound, have emerged and existing interventions such as deep brain stimulation have been further refined. In this review, these topics are explored and discussed.
Combined approaches from physics, statistics, and computer science for ab initio protein structure prediction: ex unitate vires (unity is strength)?
Authors: Delarue Marc , Koehl Patrice
Published: July 2018

Connecting the dots among the amino acid sequence of a protein, its structure, and its function remains a central theme in molecular biology, as it would have many applications in the treatment of illnesses related to misfolding or protein instability. As a result of high-throughput sequencing methods, biologists currently live in a protein sequence-rich world. However, our knowledge of protein structure based on experimental data remains comparatively limited. As a consequence, protein structure prediction has established itself as a very active field of research to fill in this gap. This field, once thought to be reserved for theoretical biophysicists, is constantly reinventing itself, borrowing ideas informed by an ever-increasing assembly of scientific domains, from biology, chemistry, (statistical) physics, mathematics, computer science, statistics, bioinformatics, and more recently data sciences. We review the recent progress arising from this integration of knowledge, from the development of specific computer architecture to allow for longer timescales in physics-based simulations of protein folding to the recent advances in predicting contacts in proteins based on detection of coevolution using very large data sets of aligned protein sequences.
The Benefits of State Aggregation with Extreme-Point Weighting for Assemble-to-Order Systems
Authors: Nadar Emre , Akcay Alp , Akan Mustafa , Scheller-Wolf Alan
Published: July 2018

We provide a new method for solving a very general model of an assemble-to-order system: multiple products, multiple components that may be demanded in different quantities by different products, batch production, random lead times, and lost sales, modeled as a Markov decision process under the discounted cost criterion. A control policy specifies when a batch of components should be produced and whether an arriving demand for each product should be satisfied. As optimal solutions for our model are computationally intractable for even moderately sized systems, we approximate the optimal cost function by reformulating it on an aggregate state space and restricting each aggregate state to be represented by its extreme original states. Our aggregation drastically reduces the value iteration computational burden. We derive an upper bound on the distance between aggregate and optimal solutions. This guarantees that the value iteration algorithm for the original problem initialized with the aggregate solution converges to the optimal solution. We also establish the optimality of a lattice-dependent base-stock and rationing policy in the aggregate problem when certain product and component characteristics are incorporated into the aggregation/disaggregation schemes. This enables us to further alleviate the value iteration computational burden in the aggregate problem by eliminating suboptimal actions. Leveraging all of our results, we can solve the aggregate problem for systems of up to 22 components, with an average distance of 11.09% from the optimal cost in systems of up to 4 components (for which we could solve the original problem to optimality).

The e-companion is available at https://doi.org/10.1287/opre.2017.1710 .
A Nonasymptotic Approach to Analyzing Kidney Exchange Graphs
Authors: Ding Yichuan , Ge Dongdong , He Simai , Ryan Christopher Thomas
Published: July 2018

We propose a novel methodology to study kidney exchange. Using a random graph model of kidney exchange, we propose a nonasymptotic approach to quantifying the effectiveness of transplant chains in reducing the number of unmatched highly sensitized patients. Our approach is based on a two-phase random walk procedure where random walks are used to allocate chains, followed by allocation in cycles. The benefit of random walks is that they preserve the probabilistic structure of residual graphs, greatly facilitating analysis. Our approach allows us to analytically show the benefit of chains, as opposed to transplantation in cycles only, in nonasymptotic (medium-sized) graphs. We also derive useful analytical bounds that illustrate the performance of our proposed allocation procedure and more general kidney allocation procedures. Our results complement previous findings from analytical results in large (limit) graphs and empirical results based on data from fielded kidney exchanges demonstrating the benefits of chains. Moreover, our analysis sheds light on the relative importance of chains versus cycles in kidney allocation. In particular, our results show prioritizing chains over easy-to-transplant cycles, as opposed to prioritizing those cycles over chains, improves performance and provides analytical bounds on the associated benefits. A detailed simulation study numerically verifies our main results and provides additional insights.

The online appendix is available at https://doi.org/10.1287/opre.2017.1717 .
OLHARES CRUZADOS: DO ESPELHO À IDENTIFICAÇÃO?
Authors: Ribeiro - in memoriam Ana Clara Torres
Published: July 2018

É impossível iniciar esta exposição sem fazer referência à origem colonial do país e aos anseios de modernidade da sociedade brasileira. A origem colonial manifesta-se na força da urbanização litorânea e ao longo do curso dos rios. Já os anseios de modernidade estão diretamente relacionados com a intensidade e a escala do fenómeno urbano, a sua estrutura e a sua dinâmica. A macro urbanização brasileira expressa os determinantes da modernidade tardia e do capitalismo periférico, altamente concentrador das condições gerais da produção capitalista e aderente às inovações técnicas e culturais de última geração. O próprio ritmo da inovação e das mudanças culturais não se encontra determinado internamente ao país: mas, sim, sujeito à concorrência e à competitividade intercapitalistas instauradas na escala mundial.
EDITORIAL
Authors: Karol Eduardo
Published: July 2018

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Improving nutritional standards in the care home
Authors: Carter Lesley
Published: July 2018

Reports by the Care Quality Commission (CQC) have shown that a number of care homes fail to deliver on nutrition and hydration standards. Lesley Carter explains the effects of malnutrition and gives guidance on how to avoid bad nutrition practice.
Artisanal Enlightenment
Authors: Bertucci Paola
Published: July 2018

What would the Enlightenment look like from the perspective of artistes, the learned artisans with esprit, who presented themselves in contrast to philosophers, savants, and routine-bound craftsmen? Making a radical change of historical protagonists, this book places the mechanical arts and the world of making at the heart of the Enlightenment. At a time of great colonial, commercial, and imperial concerns, artistes planned encyclopedic projects and sought an official role in the administration of the French state. The Société des Arts, which they envisioned as a state institution that would foster France's colonial and economic expansion, was the most ambitious expression of their collective aspirations. This book provides the first in-depth study of the Société, and demonstrates its legacy in scientific programs, academies, and the making of Diderot and D'Alembert's Encyclopédie. Through insightful analysis of textual, visual, and material sources, the book provides a ground-breaking perspective on the politics of writing on the mechanical arts and the development of key Enlightenment concepts such as improvement, utility, and progress.
Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Authors: Baker Danial E.
Published: July 2018

This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at danial.baker@wsu.edu .
Bortezomib, Melphalan, and Prednisone (VMP) Regimen for Multiple Myeloma
Authors: Bryant Samantha , Solimando Dominic A. , Waddell J. Aubrey
Published: July 2018

The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases.
Tamsulosin: Ureteral Stones (Distal)
Authors: Rivard Renée
Published: July 2018

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu .
Adherence to and Outcomes Associated with a Clostridium difficile Guideline at a Large Teaching Institution
Authors: Wieczorkiewicz Sarah , Zatarski RaeAnna
Published: July 2018

Purpose

The incidence and virulence of Clostridium difficile infection (CDI) has recently increased. National CDI treatment guidelines stratify patients based on clinical symptoms and recommend treatment based on severity of illness. In 2009, Advocate Lutheran General Hospital (Park Ridge, Illinois) adopted guidelines with treatment algorithms identical to the national guidelines. The purpose of this study was to determine whether patients were being treated in accordance with the CDI guidelines and whether adherence impacted patient outcomes.

Methods

This was a retrospective, descriptive study. Subjects were identified by CDI-associated ICD-9 codes from July 1, 2009 to June 30, 2011 and stratified by disease severity. Guideline adherence was assessed based on initial treatment selection, and subjects were then further categorized as undertreated (UT), overtreated (OT), or appropriately treated (AT). Secondary endpoints included need for therapy escalation, clinical cure, recurrence rates, 90-day all-cause mortality, proton pump inhibitor (PPI), and antimicrobial use.

Results

Two hundred fifty subjects totaling 324 encounters were analyzed. Overall guideline adherence was 42.9%. Adherence rates by CDI severity were mild-moderate, 53.9%; severe, 39.0%; and severe-complicated, 17.9% ( P < .001). Of all the subjects, 42.9% were AT, 30.9% were OT, and 26.2% were UT. Clinical outcomes between UT versus AT subjects were as follows: therapy escalation required, 34.1% versus 27.5% ( P = .289); clinical cure, 41.2% versus 55.7% ( P = .033); mortality, 24.7% versus 10.1% ( P = .003); and recurrence, 44.7% versus 24.8% ( P < .02). Clinical outcomes between AT versus OT subjects were as follows: therapy escalation required 27.5% versus 14.4% ( P < .02); clinical cure, 55.7% versus 66.7% ( P = .089); mortality, 10.1% versus 7.8% ( P = .553); recurrence, 24.8% versus 27.8% ( P = .871).

Conclusions

The majority of subjects were not treated according to CDI guidelines, particularly those with severe and severe-complicated disease. UT subjects had worse clinical outcomes and OT subjects failed to show significant improvements in clinical outcomes compared to AT subjects. Emphasis should be placed on CDI guideline adherence as this may be associated with improved outcomes.
Comparison of Practice Patterns between Inpatient Cardiology Pharmacists with and without Added Qualifications in Cardiology
Authors: Lose Jennifer , Dorsch Michael P. , DiDomenico Robert J.
Published: July 2018

Background

There is a paucity of data comparing practice patterns between board-certified specialists with added qualifications in cardiology (AQCV) and cardiovascular pharmacists without these credentials.

Purpose

The purpose is to characterize differences in practice between inpatient pharmacists with and without AQCV.

Methods

We conducted a multicenter, retrospective, cross-sectional, case-controlled survey. An AQCV pharmacist list was extracted from the Board of Pharmacy Specialties Web site. Hospitals with AQCV pharmacists comprised the case group. Hospitals were excluded if the AQCV pharmacists did not provide direct patient care, practiced in the outpatient setting, or were in a Veterans Affairs hospital. Each case hospital was matched to hospitals without an AQCV pharmacist in a 1:3 ratio (case:control) by region, cardiovascular discharges, and teaching hospital status. Institutions completed a survey characterizing their pharmacy services.

Results

Fifty-six hospitals completed the survey (21 AQCV, 35 non-AQCV). More AQCV pharmacists participated on rounds (100% vs 82.9%, P = .04) and devoted more time performing administrative tasks (20.5% ± 15.3% vs 11.1% ± 8.1%, P = .001) than non-AQCV pharmacists. Conversely, AQCV pharmacists spent less time providing clinical care (52.4% ± 14.5% vs 66.2% ± 19.8%, P = .007), were less involved with drug protocol management (71.4% vs 91.4%, P = .05), and performed less order verification than non-AQCV pharmacists.

Conclusions

Practice patterns differ between inpatient pharmacists with and without AQCV. Further research is needed to determine whether AQCV credentialing improves patient outcomes and to delineate what specific tasks performed by inpatient cardiology pharmacists may improve patient outcomes.
Suvorexant
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E.
Published: July 2018

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. A drug class review is now published monthly with The Formulary Monograph Service. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, call The Formulary at 800-322-4349. The January 2015 monograph topics are ledipasvir/sofosbuvir, eliglustat, naloxegol, pembrolizumab, and dulaglutide injection. The Safety MUE is on ledipasvir/sofosbuvir.
Applying Leadership Qualities of Great People to Your Department: Sir Winston Churchill
Authors: Gibson Matthew , Weber Robert J.
Published: July 2018

As pharmacy leaders develop health-system pharmacy services, it is important for them to understand successful leadership behaviors and apply them effectively to be successful in managing the challenges of health care. Directors can learn various skills from leaders both in and outside of pharmacy. Learning from these great leaders can provide pharmacy directors with guidance on how to shape various aspects of their leadership style. Winston Churchill is considered to be one of history's greatest leaders; without his leadership, the outcome of World War II may have been completely different. Leadership qualities that made him successful include the use of clear and simple communication, decisiveness, willingness to take risks and learn from failure, commitment to self-improvement, and the ability to inspire and lead others. This article describes these leadership characteristics displayed by Winston Churchill and discusses ways these qualities can be used effectively by today's pharmacy leaders in building patient-centered services.
Compounded Pain Creams and Adverse Effects; Postanesthesia Care Unit ADC Selection Error; Docetaxel Product Has Unusual Concentration; Tragic Vaccine Diluent Mix-ups
Authors: Cohen Michael R. , Smetzer Judy L.
Published: July 2018

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers’ names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site ( www.ismp.org ), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters’ wishes as to the level of detail included in publications.
Advancements in Adherence Monitoring
Authors: Fox Brent I. , Felkey Bill G.
Published: July 2018

Some things really never change. For example, medication adherence remains a critical factor that influences the effectiveness of our modern health care system. Is there a magic bullet to solve the problem of nonadherence? We don't think there is. We do believe, however, that tools to monitor adherence continue to improve in their utility.
Open Repair of Thoracoabdominal Aortic Aneurysm in a 46-Year-Old Man with Pleural Adhesions and Aberrant Right Subclavian Artery
Authors: Kim Jae Hyun , Song Kyung Sub , Kim Jae Bum
Published: July 2018

Endovascular aortic treatment is being performed more often and offers some advantages over open surgery. Nevertheless, open repair of thoracoabdominal aortic aneurysms is still relevant in complex cases, including combined chronic aortic dissection, congenital aortic abnormalities such as aberrant right subclavian artery, and dense pleural adhesions after a previous thoracotomy. We describe our successful use of open repair in a 46-year-old man who had these multiple abnormalities.
New Insights into Predictors of Cardiac Implantable Electronic Device Infection
Authors: Sadeghi Hossein , Alizadehdiz Abolfath , Fazelifar Amirfarjam , Emkanjoo Zahra , Haghjoo Majid
Published: July 2018

Infection is an important complication of cardiac implantable electronic device procedures. To further study the factors associated with infection, we retrospectively reviewed the records of 3,205 consecutive patients who had undergone de novo or revision cardiac electronic device implantation at our institution from March 2011 through March 2015. We recorded all infections and specified whether they were related to the characteristics of the patient, device, or procedure. To identify predictors of infection, we performed multivariate analysis.

Device infections were identified in 85 patients (2.7%), at a mean follow-up time of 27 ± 11 months. The main predictors of device infection were use of an implantable cardioverter-defibrillator or a cardiac resynchronization therapy defibrillator device (odds ratio [OR]=16; 95% CI, 4.14–61.85; P=0.0001), stage 3 chronic kidney disease (OR=9.41; 95% CI, 1.77–50.04; P=0.009), a revision procedure (OR=8.8; 95% CI, 3.37–23.2; P=0.0001), or postoperative hematoma (OR=6.9; 95% CI, 1.58–30.2; P=0.01). We also identified 2 novel predictors of infection: a low body mass index of <20 kg/m2 (OR=1.03; 95% CI, 1.01–1.06; P=0.005), and use of povidone-iodine rather than chlorhexidine-alcohol for topical antisepsis (OR=4.4; 95% CI, 2.01–9.4; P=0.03).

We conclude that comorbidities, device characteristics, procedure types, and postoperative noninfective complications all increase the risk of device infection after a cardiac implantable electronic device procedure.
Peltier Effect in Cotton Fabric Treated with Doped Nanocellulose
Authors: Morgan Charles Jeffery , Sharma Suraj
Published: July 2018

It is hypothesized that two cotton fabrics treated with dissimilarly doped nanocellulose will display a thermal electric effect, similar to the “Peltier effect,” when a direct current is applied. Middleweight plain weave cotton fabric samples were pretreated by scouring, drying, and then dip-coated in a solution mixture of doping material and nanofibrillated cellulose. Two samples were prepared with silver nanowires and polypyrrole conductive polymer as conductive doping materials, respectively, and one sample only with nanofibrillated cellulose. Coated fabrics were dried and electrically characterized. Samples were paired and cross-tested. Temperature gradients and electrical currents were measured across conductive sample pairs, and the Peltier effect was demonstrated. The temperature range of the Peltier effect was limited by the Joule heat saturation of fabric.
Hybrid Method for Solution of Fractional Order Linear Differential Equation with Variable Coefficients
Authors: Ujlayan Amit , Dixit Ajay
Published: July 2018

In this paper, we proposed a new analytical hybrid methods for the solution of conformable fractional differential equations (CFDE), which are based on the recently proposed conformable fractional derivative (CFD) in R. Khalil, M. Al Horani, A. Yusuf and M. Sababhed, A New definition of fractional derivative, J. Comput. Appl. 264 (2014). Moreover, we use the method of variation of parameters and reduction of order based on CFD, for the CFDE. Furthermore, to show the efficiency of the proposed analytical hybrid method, some examples are also presented.
The inscriptions from the mound necropolis of Duvanlii (Thrace) and their socio-cultural context
Authors: Slavova Mirena
Published: July 2018

The article attempts to restore the socio-cultural context of four inscriptions found on various artifacts in graves from the mound necropolis at Duvanlii in Thrace (present day Bulgaria) dating back to the 5th century BC. They are written with a different technique - the erroneously transmitted graffito written in early Attic alphabet on the bottom of a plate ΙΠΠΟΜΑΧΣ, the depinti KOAΣ and ΚOMOΣ on a red-figure hydria, and the Thracian anthroponym ΔΑΔΑΛΕΜΕ engraved on four silver vases. The author focuses both on the interpretation of the single inscriptions (especially the placement of ΔΑΔΑΛΕΜΕ in a series with other known Thracian names, as well as with the newly published from Zoni) and on the contact zone of Thracians and Greeks in Thrace and Samothrace, whose specifics can explain the considered graphical practices.
A Greek reading of the “Pisidian” inscription N 30
Authors: Obrador-Cursach Bartomeu , Adiego Ignasi-Xavier
Published: July 2018

In this article, stele N 30 is removed from the Pisidian corpus because it is read as a plain Greek text containing the name of a man, Papas, said to be a gallus. Moreover, the relief of the same stele depicting a figure in woman’s clothing is interpreted as being Papas himself
Numerical Study on the Leakage Magnetic Field of Transverse Defect on T-Joint Fillet Weld
Authors: Pan Jiajing , Yang Lijun , Li Hang
Published: July 2018

A 3D finite element method model is established for yoke-magnetization detection of a transverse defect on T-joint fillet weld and solved by the finite element software ANSOFT Maxwell (ANSYS, Canonsburg, PA). The leakage magnetic field around the transverse defect is obtained. The relationship between the width of transverse defect and leakage magnetic field signals is identified. The researchers found that the tangential component of magnetic flux leakage density, BX1, tends to be a parabolic distribution and reaches the maximum value near the center of the defect along the length direction. While BX1 shows a bimodal distribution, featuring two peaks near the edge of the defect and one peak valley at the center along the width direction, the normal component of magnetic flux leakage density, BZ1, is very different than that of BX1 along the width direction, presenting an approximate N-shape as a whole. The leakage magnetic field signals of the transverse defect on the fillet weld of the T joint will decay obviously when the scanning line is perpendicular to the weld surface over 0.5 mm. The results of numerical simulation can provide a theoretical foundation to detect and characterize various defects in the fillet weld.
The Dreams of Nations
Authors: Kavoori Anandam
Published: July 2018

This postcolonial “Ethno-Story” narrative weaves through the unwilled constructs (dreams) of two protagonists/recent graduate students—an Indian Muslim man and a (Caucasian) American woman—working/living at the intersection of media, self, and nation. It explores the inner dynamics of personhood (and couplehood) through intersecting narratives of the self with those of mass-mediated images and realities in an age of terrorism and ethnoreligious confilct.
Poetic Possibilities
Authors: Colby Sherri Rae , Bodily Brett H.
Published: July 2018

Exploring Paul Ricoeur's hermeneutics, we craft a collection of generated and found poems reflecting Ricoeur's philosophies. Also, we represent transcripts of interviews with a graduate student as found poems to explore the nuances of her life as a student of qualitative research. We invite our readers into a coconstructed space of poetic interpretation.