bluuebunny/crossref_metadata_2025_split huggingface dataset:
Une impossible prohibition ?
Authors: Marchant Alexandre 
Published: March 2019

Les nébuleuses criminelles internationales ne sont pas exemptes de régulation. Les trafiquants de drogue mettant en place une filière d’acheminement vers un marché clandestin, à l’exemple des mafias italo-corses et asiatiques de l’héroïne en France dans les années 1970, produisent sur le terrain aussi une régulation informelle et empirique : réseaux hiérarchisés, division internationale du travail, mobilisation de diverses ressources pour sceller les affaires, pratiques formalisées pour échapper à la répression policière. De leur côté, les forces de l’ordre sont prisonnières d’une régulation formelle et procédurale, qui s’impose à eux d’en haut, dans un cadre national, entravant leur mouvement face à des criminels qui utilisent justement au nombre de leurs ressources les différences de juridiction nationale. De la confrontation entre ces deux échelles de régulation résulte hélas une impossible prohibition des économies illicites.
Peut-on encore parler de régulation ?
Authors: Commaille Jacques 
Published: March 2019

Dans le présent ouvrage, pour éprouver la notion, le concept, les théories de la régulation, il a été procédé à une large mobilisation de différentes disciplines de sciences sociales. Il ne s’est pas agi de simplement juxtaposer les constats qui en sont issus mais de multiplier les angles d’attaque, ceci suivant une grille d’analyse combinant l’espace et le temps. L’objectif était de tenter de dégager le sens général qu’il convient de donner au régime de régulation des sociétés contemporaines. Loin de la période historique où la science suscitait l’espérance d’une maîtrise de plus en plus grande du fonctionnement du monde, ce régime de régulation doit se penser désormais moins comme fait d’équilibres maintenus ou retrouvés mais comme constituée de tensions, de ruptures et de contradictions. Peut-on alors encore parler de régulation ?
Neurofibromatosis
Authors: VanDeCappelle Caitlin 
Published: March 2019

Neurofibromatosis type 1 (NF1) is an inherited tumor predisposition syndrome with multiple manifestations in children and adults. Due to the multisystemic nature of this syndrome there are multidisciplinary NF1 clinics in many major centres in the United States; however, this is not yet the trend in Canada. Our study seeks to gain understanding of the current state of health surveillance in children with NF1 in Southwestern Ontario, which medical disciplines are involved in their care and parental interest in a future multidisciplinary clinic at London Health Sciences Centre (LHSC).
Methods: 50 parents or guardians of pediatric NF1 patients completed a 39-question telephone interview pertaining to diagnosis, aspects of yearly screening and willingness to attend a multidisciplinary clinic. Responses were then compared to the current screening guidelines for the pediatric NF1 population as suggested by the American Academy of Pediatrics.
Results: Only 56% of patients receive an annual neurological exam, while over 87% are having yearly blood pressure screens. 40% of patients cite their medical geneticist as the main coordinator of their care, while 12% cite no coordination of care. 48% of families travel more than 50 km to LHSC, with the majority visiting >3 times per year. 96% of participants are interested in participating in a multidisciplinary clinic.
Conclusions: The results obtained from this study support the development of a multidisciplinary NF1 clinic at LHSC.
Lifestyle modification for the primary prevention of type 2 diabetes mellitus in the Canadian Aboriginal population
Authors: Meglei Gabriela , Guidolin Keegan 
Published: March 2019

Canada’s Aboriginal populations have significantly higher rates of type 2 diabetes compared to non-Aboriginal Canadians. In First Nations populations living on reserve, the rates are more than double. Large randomized controlled trials (RCTs) have shown that intensive lifestyle modification in individuals with impaired glucose tolerance can decrease the overall incidence of diabetes by up to 22%.
Implementing lifestyle interventions into clinical practice remains a significant challenge because of both limited resources and uncertainly about optimal program design. Most studies have focused on translation into the primary care setting, and have shown moderate benefits. However, there have been no trials examining the feasibility and effectiveness of RCT-based lifestyle modification in Canadian Aboriginal communities. Canadian initiatives have so far focused on school-based healthy lifestyle curriculum and community awareness, but have had little success in reducing weight.
Factors such as community remoteness, cultural diversity, poor retention of health care workers, and lack of access to healthy food are significant barriers to implementing lifestyle modification programs in Canadian Aboriginal communities. More importantly, these communities face systemic inequalities that must be addressed in order to achieve meaningful and sustained lifestyle changes.
Care and curriculum
Authors: Parchment Victor , Mudachi Naomi 
Published: March 2019

Background: Clinical empathy has been repeatedly shown to increase patient satisfaction and improve clinical outcomes; therefore it forms an important cornerstone of the physician-patient therapeutic relationship. While some studies have shown that empathy in medical students decreases over the course of their education, other studies have contested these findings.
Purpose: This paper reviews studies and relevant literature in order to explore the relationship between medical education and clinical empathy, and in particular, the difference in results between those studies that demonstrated a decline in clinical empathy and those studies that did not.
Conclusion: Study design and methodology, differences in clinical culture, and differences in curriculum were identified as three possible influences that explain the lack of consensus in the literature. This paper recommends a twofold approach to further research in the field of clinical empathy development. First, future studies examining this phenomenon should focus on longitudinal designs that incorporate objective measures and patient factors rather than relying exclusively on cross-sectional studies utilising self-assessment. Second, medical schools should be encouraged to adopt or develop techniques to assess the clinical empathy of their students and implement solutions to mitigate a decline in empathy if required.
Multimorbidity in family medicine clerkship
Authors: Harrison Emily 
Published: March 2019

PURPOSE: To document senior medical students’ experiences in caring for patients with multiple chronic illnesses in family medicine clerkship and explore their attitudes towards the inclusion of this topic in existing curricula.
METHODS: A cohort of third-year medical students from the Schulich School of Medicine and Dentistry at the University of Western Ontario were surveyed following their core family medicine clerkship.
RESULTS: One hundred percent of students surveyed participated in the care of patients with multiple chronic illnesses during their family medicine clerkship. However, only 28% percent reported receiving formal teaching on this topic while 89.5% felt that multimorbidity should be taught at the clerkship level. The majority of students surveyed felt comfortable caring for this patient population.
CONCLUSION: Patients with multiple chronic illnesses are common in family practice. All third-year medical students encountered patients with multimorbidity during their family medicine clerkship. This study contributes to a growing body of literature that suggests the need for a shift in medical education and health care delivery in order to better serve an increasingly complex patient population.
Community-acquired pneumonia and pneumococcal vaccination in the elderly
Authors: Yin Charles , Law Jeffrey 
Published: March 2019

Community-acquired pneumonia (CAP), most often caused by infection with the Gram-positive diplococcus Streptococcus pneumoniae, remains a leading cause of death in Canada amongst the elderly. With an aging population in Canada, CAP will soon be a significant challenge to the healthcare system in this country. In this article, we review the characteristics of CAP in the elderly, including its epidemiology, etiology and clinical features. We then provide an overview and history of pneumococcal vaccines and present current recommendations for S pneumoniae vaccination in Canada.
Cover art
Authors: Gudimella Rakesh 
Published: March 2019

Cover art by Rakesh Gudimella.
In 1964, Dorothy Hodgkin won the Nobel Prize for the discovery of the structure of penicillin using the emerging technique of x-ray crystallography. The original x-ray diffraction patterns and the subsequent molecular model she created is shown in the foreground. Although the chemical formula of penicillin was known, its structure was not, making it difficult to produce on a large scale. Her discovery set us on the path to understanding antibiotic mechanisms and opened the door for the synthesis of cephalosporins and other important medications. The background shows the chemical structures of several lifesaving and influential drugs on the WHO List of Essential Medicines.
Reducing medication errors
Authors: Thomas Benjamin , Shi Hao , Chow Anthony , Surujballi Julian 
Published: March 2019

Hospital readmissions place a heavy burden on healthcare in Canada. Communication errors often occur at vulnerable time points like peridischarge, and these can lead to downstream adverse drug events necessitating rehospitalization. Existing mechanisms to address this problem still have room for improvement. Discharge summaries, for example, may be late, erroneous, or incomplete. Medication reconciliation processes directly integrated with electronic medical records have demonstrated advantages in terms of legibility and timeliness but unfortunately encourage risky behaviours like indiscriminate copy and pasting, leading to new errors of a different sort.
A single unified medication list that could be kept on a patient’s person at all times can ensure that medication information is always present at medical appointments and is synchronously updated among all involved practitioners. Near-field communications (NFC) may facilitate the creation and maintenance of such a list. It is a relatively new wireless technology that has advantages over radio-frequency identification and Bluetooth. It allows information to be recorded to and read from objects as small and thin as a sticker. Technologies based on NFC may prove useful for consolidation patient health information into “one source of truth”.
Traditional Chinese medicine in cardiovascular disease prevention
Authors: Li Annie , Bobotsis Robert , Yildiz Christopher 
Published: March 2019

Aim: This review paper aims to familiarize the health practitioner with common components of Traditional Chinese Medicine (TCM) and to provide general clinical recommendations in the context of cardiovascular disease prevention.
Methods: Three databases (EMBASE, PubMed, and Web of Science) were searched for results relating to TCM, cardiovascular disease, and prevention. Clinically relevant results from systemic reviews as well as individual randomized controlled trials (RCTs) were reviewed and presented in this paper.
Conclusion: Currently there is insufficient or conflicting evidence for the use of TCM in cardiovascular disease prevention.
Pre-exposure prophylaxis in a new era of HIV prevention
Authors: Muzlera Carlos , Arseneau Nicole 
Published: March 2019

Linda is a healthy, 25-year-old married woman living in the city of Toronto who presents with questions about human immunodeficiency virus (HIV) prevention. Linda and her husband met on an online dating forum in 2011 and married each other one year later while they were both seronegative. She describes her and her husband as having an “open” marriage and have had 2 and 5 extramarital partners, respectively. In 2014, Linda’s husband was incidentally diagnosed with HIV infection after donating blood at a clinic, and Linda received testing shortly thereafter which came back negative for HIV. His viral load had reached 20 000 copies/mL and he immediately began highly active antiretroviral therapy (HAART). His infection has stabilized with undetectable viral loads and a CD4+ T-helper cell count of 1000 cells/μL; however, the risk of transmission has created damaging tensions within their marriage. Prior to his diagnosis Linda reports condom usage of less than 50% for both herself and her husband; however, the anxiety and fear of infection has prompted usage of over 90%. Linda wants to be at ease in her sexual endeavours but is motivated to remain uninfected so she can be healthy to take care of her husband. She read about a new drug on Twitter that can prevent HIV infection in non-infected people and requests your counsel on it. She has an unremarkable history with respect to sexually transmitted infections (STIs), drug use, smoking and hepatitis, and has had no recent symptoms of fever, malaise, or sore throat.
When the story doesn’t fit
Authors: Elzinga Jason L , Jian Charles 
Published: March 2019

Melanoma is an aggressive but easily preventable cancer. However, it may have a highly atypical presentation which makes early detection more difficult. This case report discusses a 25-year-old patient with a rare case of melanoma developing underneath the nail of the first toe. The case was originally diagnosed as trauma due to its rarity and epidemiological unlikeliness, however through the patient’s persistence for alternative opinions the correct diagnosis was eventually made. However, this led to an amputation as well as more intense, invasive treatment.
There were several points on history (duration of the lesion, appearance of the lesion, and lack of healing progress) which when combined with the lesion’s physical appearance should have made such a presentation suspicious for a more malignant cause. This case highlights the importance of early detection in the prognosis and treatment of patients with cancer, the importance of considering all aspects of a history and physical exam, and the importance of listening to and addressing a patient’s concerns. As always, more common diagnoses should be first considered, but when the story does not match up with the presentation, one should move past the horses to consider the zebras.
Exploring spatial nonstationary environmental effects on species distribution: a case study of Yellow Perch in Lake Erie
Authors: Liu Changdong , Liu Junchao , Jiao Yan , Tang Yanli 
Published: March 2019

Background: Global regression models under an implicit assumption of spatial stationarity were commonly applied to estimate the environmental effects on aquatic species distribution. However, the relationships between species distribution and environmental variables may change among spatial locations, especially at large spatial scales with complicated habitat. Local regression models are appropriate supplementary tools to explore species-environment relationships at finer scales.
Method: We applied geographically weighted regression (GWR) models on Yellow Perch in Lake Erie to estimate spatially-varying environmental effects on the presence probabilities of this species. Outputs from GWR were compared with those from generalized additive models (GAMs) in exploring the Yellow Perch distribution. Local regression coefficients from the GWR were mapped to visualize spatially-varying species-environment relationships. K-means cluster analyses based on the t-values of GWR local regression coefficients were used to characterize the distinct zones of ecological relationships.
Results: GWR resulted in a significant improvement over the GAM in goodness-of-fit and accuracy of model prediction. Results from the GWR revealed the magnitude and direction of environmental effects on Yellow Perch distribution changed among spatial location. Consistent species-environment relationships were found in the east basin for juveniles and in the west and east basins for adults. The different kinds of species-environment relationships found in the central management unit implied the variation of relationships at a scale finer than the management unit.
Conclusions: This study draws attention to the importance of accounting for spatial nonstationarity in exploring species-environment relationships. The superiority of GWR over the GAM highlights the limitations of using one global regression model to explore species-environment relationships at a large spatial scale and provides insights for managing Yellow Perch at finer scales.
Base Station Antenna with Enhanced Cross Polarization Discrimination Performance by Using Horizontal Meandered Dipole and Vertical Parasitic Elements
Authors: Kadagan O. M. , Turkmen C. , Secmen M. 
Published: March 2019

This study is related with the design of a ± 45° dual polarized base station antenna with improved cross-polarization discrimination (XPD) values. Parasitic elements are added to antenna design formed by orthogonal two compact meandered dipole above ground plane. The antenna designed with CST Microwave Studio program has VSWR ≤ 2 within 1.71-2.69 GHz frequency band, which covers GSM 1800/3G/LTE bands. The antenna has minimum of 0 dBi gain in the beamwidth of 120° ( 60°) at azimuth plane (ϕ = 0°) along the band, and XPD values being minimum of 2 dB at 1.71-2.4 GHz for 60° without parasitic elements are improved to 10 dB with parasitic elements. This design initially had two horizontal straight monopoles on the ground plane perpendicular to each other. Afterwards, antenna with microstrip balun feed applied but the XPD values were not appropriate to expected results. Because of that, by using image theory, vertical parasitic elements were added to get appropriate XPD values. Later, meandered structure used to make antenna smaller. Finally, according to base station applications, antenna frequencies optimized to 1.71 GHz and 2.69 GHz. The designed and optimized antenna produced and measured in laboratory environment. Return losses for port 1 and port 2 are measured above the 10 dB and isolation between the port 1 and port 2 are measured above the 20 dB. In addition, the maximum gain values are measured between 3 dB and 7 dB in 1.71 GHz and 2.69 GHz frequency band. Finally, XPD values are measured more than 10 dB in bandwidth.
Comparative Evaluation of the Reproductive Indices and Gonadal Development of Clarias gariepinus Fed Chicken Offal and Shrimp Based Diets
Authors: Ajang Raymond Odey , Joseph Akaninyene Paul , Ivon Ettah Akpang , Ayim Elvis Monfung 
Published: March 2019

The study on the reproductive indices and gonadal development of African catfish (Clarias gariepinus) fed shrimp based diet (SBD), chicken offal based diet (COBD) and coppens (commercial diet) was carried-out over a 22 weeks period in concrete tanks measuring 3.5 x 1.7 x 1.5 m3 (8.9 m3). Forty juveniles with average length of 9.15 ± 0.17 cm and weight of 20.00 ± 4.53 g were stored per group in triplicate, resulting in 360 juveniles in total. Fish were fed daily at 3% of their body weight through-out the duration of the experiment. The nutrient composition of the 3 nutrients differed significantly at p<0.05. The dissolved oxygen, temperature, pH and ammonia levels in the culture water with fish fed the 3 diets were within the required level for normal fish growth through-out the experiment. The gonadosomatic index (GSI) of the male C. gariepinus fed diet A (Coppens feed), diet B (SBD) and diet C (COBD) were 0.35 ± 0.03%, 0.41 ± 0.04% and 0.36 ± 0.02% respectively. Female C. gariepinus fed diet A, diet B and diet C had a mean GSI of 1.17 ± 0.26%, 0.88 ± 0.27% and 0.77 ± 0.06% respectively. The male gonad weight and GSI varied significantly between the treatment group fed coppens, shrimp based diet and chicken offal based diet (p<0.05), while female gonad weight and GSI did not vary significantly between treatment groups (p>0.05). The hepatosomatic index (HSI) of the male C. gariepinus fed diet A, diet B and diet C were 1.36 ± 0.07%, 1.18 ± 0.07% and 1.21 ± 0.06% respectively. Female C. gariepinus fed diet A, diet B and diet C had a mean HSI of 1.27 ± 0.09%, 1.20 ± 0.06% and 4.27 ± 0.38% respectively. The male and female HSI varied insignificantly between the treatment group at p>0.05. Fecundity was highest (3200 ± 717.90 eggs) in fish fed diet A, followed by fish fed diet B (2392 ± 749 eggs) and least in fish fed diet C (1973 ± 184 eggs). The mean fecundity varied significantly between the fish fed the 3 experimental diet at p<0.05. Normal arrangement of the oocytes, liver and testis was observed in fish fed COBD and SBD, just as in the case of the group fed coppens. Though coppens feed yielded better fecundity, the use of COBD and SBD is recommended for fish farmers in Nigeria. More researches should be carried out on using varying levels of chicken offals and shrimps in fish feed formulation.
Economic Burden of Rabies: An Experience from a Tertiary Care Hospital in Kashmir, India
Authors: Qurieshi Mariya Amin , Bashir Khalid , Qureshi Uruj , Khan S. M. Salim 
Published: March 2019

Background: Post-exposure prophylaxis (PEP) is the mainstay of prevention in suspected exposure to rabies virus. Exposed patients are able to obtain anti-rabies vaccine in the anti-rabies clinic pro bono but they have to pay for passive immunization and cover other associated costs.
Aim: To estimate and analyze the direct and indirect costs of rabies PEP.
Methods: This study was conducted on 429 patients, who were exposed to bites from various animals and reported to Shri Mahraja Hari Singh Hospital (SMHS), an associated tertiary hospital of Government Medical College, Srinagar, Kashmir. Patient socio-demographic profile, details of animal bite exposure, the cost incurred for PEP was collected. The data were analyzed using a descriptive statistic.
Results: The study revealed a total median cost incurred on patients for receiving a PEP as 29.3 USD (United States Dollar), with an Inter-quartile Range (IQR) of 0.2 USD to 43.1USD. The direct median cost was 20.5 USD with an IQR of 6.2 USD to 29.4USD, while the indirect median cost was 20.3USD with an IQR of 13.5USD to 24.4USD.
Conclusion: Post-exposure prophylaxis imposes a significant economic burden to bite victims especially those of low socio-economic strata for whom the cost is substantial.