bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Education in Nepal: Impact and Challenges of the COVID-19 Pandemic
Authors: Sigdel Shailendra , Ozaki Akihiko , Dhakal Rachana , Pradhan Bishwas , Tanimoto Tetsuya
Published: December 2020

During the COVID-19 pandemic, there has been a global shift toward online distance learning due to travel limitations and physical distancing requirements as well as medical school and university closures. In low- and middle-income countries like Nepal, where medical education faces a range of challenges—such as lack of infrastructure, well-trained educators, and advanced technologies—the abrupt changes in methodologies without adequate preparation are more challenging than in higher-income countries.

In this article, the authors discuss the COVID-19-related changes and challenges in Nepal that may have a drastic impact on the career progression of current medical students. Outside the major cities, Nepal lacks dependable Internet services to support medical education, which frequently requires access to and transmission of large files and audiovisual material. Thus, students who are poor, who are physically disadvantaged, and who do not have a home situation conducive to online study may be affected disproportionately. Further, the majority of teachers and students do not have sufficient logistical experience and knowledge to conduct or participate in online classes. Moreover, students and teachers are unsatisfied with the digital methodologies, which will ultimately hamper the quality of education. Students’ clinical skills development, research activities, and live and intimate interactions with other individuals are being affected.

Even though Nepal’s medical education system is struggling to adapt to the transformation of teaching methodologies in the wake of the pandemic, it is important not to postpone the education of current medical students and future physicians during this crisis. Looking ahead, medical schools in Nepal should ensure that mechanisms are proactively put into place to embrace new educational opportunities and technologies to guarantee a regular supply of high-quality physicians capable of both responding effectively to any future pandemic and satisfying the nation’s future health care needs.
Parents' Perceptions of Infants' Nighttime Sleep Patterns Predict Mothers' Negativity: A Longitudinal Study
Authors: Vertsberger Dana , Tikotzky Liat , Baruchi Oriya , Knafo-Noam Ariel
Published: December 2020

Objective:

Infants' sleeping patterns can influence parents' sleep and their well-being. Infants' sleeping problems can evoke negative emotions from their parents because of the influence the problems have on parents' lives. However, little is known regarding the associations between infants' night sleep patterns and parents' overall negativity toward their children. The objective of this study was to study this association.

Methods:

In a longitudinal design, we followed infants and their parents from 9 to 18 months. Overall, 392 families participated in the study. Parents' negativity and children's sleeping patterns were assessed with questionnaires.

Results:

Parents' negativity and children's sleeping problems showed moderate continuity through the study's 9-month period. Children's sleeping problems at 9 months predicted an increase in mothers' (but not fathers') negativity at 18 months. Parents' negativity was not associated with infants' sleep problems.

Conclusion:

The results of this study suggest that already in infancy, children's tendencies, in this case sleep, can evoke negative emotions in their mothers and highlight infants' roles in the intricate parent-child relationship.
Management of Malignant Colon Polyps
Authors: Pedraza Rodrigo , Siddharthan Ragavan
Published: December 2020

Case Summary:

A 54-year-old otherwise healthy woman presented for screening colonoscopy, during which 4 pedunculated 5- to 12-mm polyps distributed throughout the colon were found (Fig. 1). The 12-mm sigmoid polyp was removed with hot snare polypectomy in a nonpiecemeal fashion. Pathology demonstrated 3 tubular adenomas and a poorly differentiated invasive carcinoma in a sigmoid polyp without tumor budding, invading 0.8 mm into the submucosa, with lymphovascular invasion and with a deep margin of 0.6 mm. The next week, she underwent repeat flexible sigmoidoscopy with tattooing of the polypectomy site. She had a normal staging CT chest/abdomen/pelvis as well as CEA level and later underwent uneventful laparoscopic sigmoid resection, which included the area of endoscopic tattoo. Final pathology confirmed the presence of the tattooed area and polypectomy scar and showed no residual primary tumor and 2/18 positive lymph nodes (Fig, 2). She was referred to medical oncology for adjuvant chemotherapy.
Risk-adapted adjuvant therapy of luminal early breast cancer in 2020
Authors: Harbeck Nadia
Published: December 2020

Purpose of review

The present review summarizes recent original publications addressing the topic of risk-adapted adjuvant therapy in early breast cancer (EBC). As neoadjuvant therapy has become a standard for triple negative and HER2+ EBC, it focusses on luminal EBC.

Recent findings

Gene expression assays have become standard of care in luminal EBC, at least for patients with node negative disease. Two prospective randomized clinical trials, TAILORx (Oncotype DX) and MINDACT (MammaPrint) have presented additional analyses underlining the clinical utility of the tests. In times of COVID-19, immunohistochemically determined ER, PR, and Ki67 and early Ki67 response to endocrine therapy can be used to safely allocate patients for preoperative endocrine therapy and delay surgeries if resources are scarce. In patients with luminal high-risk disease, adding a CDK 4/6 inhibitor (abemaciclib) improves patient outcome already after short-term follow-up.

Determination of recurrence risk will remain important in luminal EBC for optimal therapy decisions. In the future, risk-adapted treatment concepts will include decision making for chemotherapy but also for endocrine-based approaches.
Optical Quality in Keratoconus Is Associated With Corneal Biomechanics
Authors: Shugyo Akiko , Koh Shizuka , Inoue Ryota , Ambrósio Renato , Miki Atsuya , Maeda Naoyuki , Nishida Kohji
Published: December 2020

Purpose:

To evaluate the correlations between corneal biomechanical indices from dynamic Scheimpflug assessment and optical quality assessed as higher-order aberrations (HOAs) using a Hartmann–Shack ocular wavefront sensor in patients with keratoconus (KC).

Methods:

In this prospective, observational case series, the eyes with KC or KC suspect (KCS) from Osaka University Hospital, Osaka, Japan, were analyzed. Corneal biomechanical assessment was performed using Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany), and ocular wavefront aberrations were measured using the KR-1W (Topcon Corp, Tokyo, Japan). Correlations between the biomechanical indices and ocular HOAs were assessed. Corneal biomechanical indices included the deformation amplitude ratio within 2 mm, integrated radius, stiffness parameter at the first applanation, and the linear Corvis Biomechanical Index. Wavefront data of the central 4-mm region were expanded up to the sixth order of Zernike polynomials. The magnitudes of trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration were calculated by Zernike vector analysis and then used as ocular HOA parameters along with total HOAs.

Results:

Thirty-four KC eyes and 37 KCS eyes were included. KC eyes showed significant correlations between ocular HOAs and biomechanics, whereas there were few significant correlations in KCS eyes. In KC eyes, deformation amplitude ratio within 2 mm, integrated radius, and Corvis Biomechanical Index beta showed stronger correlations with coma among the wavefront parameters.

Conclusions:

Corneal biomechanical indices correlated with ocular HOAs in patients with KC. In particular, there was a strong association with the increase in coma caused by inferosuperior asymmetry of the shape of the cornea in patients with KC.
Body Weight–Supported Treadmill Training in the Acute Care Setting
Authors: Bakowski (White) Roxanne L. , Hill Lauren , Goslar Pamela W.
Published: December 2020

Purpose:

While previous studies have investigated the use of body weight–supported treadmill training (BWSTT) at various stages post-stroke, a greater focus has been on subacute and chronic stroke populations and less on how this training intervention could be implemented in the acute stages post-stroke. The purpose of our study is to demonstrate the safety and feasibility of implementing BWSTT in the very early acute phase following ischemic stroke.

Methods:

One-hundred and two subjects participated in BWSTT in addition to conventional therapy sessions while in the acute care hospital. Training was initiated, on average, 3.15 days from diagnosis to the initial treadmill session. Outcome measures included heart rate, blood pressure, Mobility Scale for Acute Stroke, Trunk Control Test, gait speed, and the SF-12v2.

Results:

Three hundred and six sessions were completed with 102 participants. Of the sessions completed, 13 were stopped due to blood pressure measurements above set parameters and did not return to within parameters during provided rest breaks. One thousand one hundred and nineteen systolic blood pressures (SBPs) were obtained during the study. Twenty-eight SBPs fell below 100, with 2 of the 28 resulting in an adverse event. Three total adverse events occurred out of 306 individual sessions, including 2 vasovagal events and an age-indeterminate peroneal tendon tear. The adverse events noted were transient and without harmful effects, and patients could complete future BWSTT sessions. Therefore, we consider 3 stopped sessions out of 306, 0.98%, as an acceptable rate of adverse events for future studies in BWSTT in patients with very early poststroke.

Conclusions:

BWSTT is a safe and feasible intervention to assist with higher-level physical activity in the acute stroke population during the early recovery stages.
An Explanatory Model for the Relationship Between Physical Therapists' Self-perceptions of Value and Care Prioritization Decisions in the Acute Hospital
Authors: Johnson Joshua K. , Young Daniel L. , Marcus Robin L.
Published: December 2020

Purpose:

The aim of the study was to understand how acute care physical therapists' perceptions of the value of physical therapy inform their decisions regarding which patients to treat.

Methods:

This was a qualitative study using a grounded theory approach. Data were collected using semistructured interviews with a purposive sample of acute hospital physical therapists in the United States. Interview transcriptions were analyzed to derive codes and identify an explanatory model.

Results:

Participants included 16 physical therapists from 4 hospital systems. Their descriptions indicate that care prioritization is influenced by a self-perception of value informed by both patient- and system-driven thinking. Patient-driven thinking prioritizes factors considered most important to individual patients (eg, improved functional independence). System-driven thinking prioritizes factors most important to the health system (eg, a certain patient population or productivity expectation). The relative contribution of system- and patient-driven thinking in prioritization decisions was variable from one participant to another.

Conclusions:

In addition to the perceived value of physical therapy for individual patients, acute hospital physical therapists integrate organization-level factors into prioritization decisions. Future research should seek to understand how this may influence practice variation and identify practice patterns that simultaneously optimize outcomes considered important by both patients and organizations.
Objective Vestibular Test Battery and Patient Reported Outcomes in Cochlear Implant Recipients
Authors: West Niels , Tian Luchen , Vang Petersen Laura Katrine , Bille Michael , Klokker Mads , Cayé-Thomasen Per
Published: December 2020

Objective:

Cochlear implantation (CI) may have undesired effects on the vestibular apparatus. However, the literature holds no consensus on vestibular affection and the testing tools applied to test for vestibular dysfunction after cochlear implantation are inconsistent. We aimed to investigate the impact of CI on vestibular function by an extensive test battery including patient-reported outcomes.

Study Design:

Prospective observational study.

Setting:

University hospital.

Patients:

Forty adult unilateral first-time CI recipients.

Intervention:

Vestibular function was evaluated pre- and post-implantation with the video head impulse test (VHIT), the caloric test and cervical vestibular evoked myogenic potentials (cVEMPs), and the patient-reported dizziness handicap inventory (DHI).

Results:

Mean VHIT gain decreased from preoperative 0.92 to 0.84 postoperative (p = 0.018); mean caloric unilateral weakness increased from 20.5% preoperative to 42.9% postoperative (p < 0.0001); cVEMP responses were present on 10 operated ears preoperative and five ears postoperative, and compared with non-implanted ears, cVEMP responses on implanted ears were impaired (p = 0.023). 50% of patients reported early postoperative dizziness, but the mean DHI score remained unchanged (p = 0.94). The DHI scores correlated poorly with the objective outcomes (r
s = 0.19 and r
s = –0.22).

Conclusion:

Vestibular function is significantly affected after cochlear implantation, but vestibular hypofunction varies with the test used. Although early dizziness after implantation is common, later DHI scores are not significantly higher than before the implantation, indicating that central compensation plays a major role for these patients.
A roadmap of six different pathways to improve survival in laryngeal cancer patients
Authors: Bradley Patrick J. , Piazza Cesare , Paderno Alberto
Published: December 2020

Purpose of review

Laryngeal cancer continues to require improvement in earlier stage diagnosis and better imaging delineation of disease, and hence ‘more evidence-based’ selection of treatment, as recent evidence suggests that related mortality, in the last decades, has not significantly decreased worldwide. Even though the reasons are not fully understood, there persists an urgency for a review and development of future strategies to embrace such clinical and diagnostic challenges from a political, societal, as well as scientific and clinical points of view.

Recent findings

This review of the published literature suggests that survival improvement in laryngeal cancer may be achieved by fuelling and combining at least some or all of six targeted agendas: documentation of disease global incidence and national burden monitoring; development and implementation of high-quality cancer registries; education on risk factors and hazardous habits associated with laryngeal cancer for the general population; active modification of proven at-risk population lifestyles; centralization of treatment; and use of machine learning of gathered ‘big data’ and their integration into approaches for the optimization of prevention and treatments strategies.

Laryngeal cancer should be tackled on several fronts, commencing with disease monitoring and prevention, up to treatment optimisation. Available modern resources offer the possibility to generate significant advances in laryngeal cancer management. However, each nation needs to develop a comprehensive approach, which is an essential prerequisite to obtain meaningful improvement on results.
Repeated kidney re-transplantation in times of organ shortage – a critical review
Authors: Assfalg Volker , Hüser Norbert
Published: December 2020

Purpose of review

Organ shortage forces those responsible to streamline allocation rules to provide a maximum of candidates with a graft and to optimize transplant outcome. Recently, repeated kidney re-transplantation was investigated in several studies with different analytic settings concerning the control group, the donors, parameters influencing outcome, and demographic characteristics. This review gives an overview on the candidates awaiting a repeated re-transplantation, summarizes the outcome, and comments on the relevance of these findings in the context of sustained organ shortage.

Recent findings

Repeated kidney re-transplantation is technically and immunologically feasible and the recipients’ survival is better compared to candidates remaining on dialysis or on the waiting-list. However, the outcome is mainly reported to be worse as compared to first or second kidney transplantation. Kidneys from living donors seem to have a favorable impact on outcome in this setting.

The survival benefit of repeated re-transplantation recipients over patients on dialysis demands for continuation of this procedure. Comprehensive registries are essential to continuously optimize allocation. Governmental authorities are obliged to set the course to increase organ donation rather than forcing transplant decision makers to withhold a third or fourth graft from any candidate.
Antibiotic Prescribing Errors in Patients Discharged From the Pediatric Emergency Department
Authors: LaScala Elizabeth C. , Monroe Alexandra K. , Hall Gregory A. , Weant Kyle A.
Published: December 2020

Objectives

The pediatric emergency department (PED) is an especially high-risk setting for medication errors. Several factors contribute to this risk including the need to provide care to complex patients who are unknown to staff, the frequent use of verbal orders, and the necessity of weight-based dosing. This investigation sought to assess one potentially error-prone event, antibiotic prescriptions written for patients being discharged from the PED, and to characterize the occurrence of medication errors to identify opportunities for improvement.

Methods

This was a retrospective study of pediatric patients seen at a large academic medical center PED. All prescriptions written for an antibiotic for patients 18 years or younger that were discharged from the PED from 2015 to 2018 were evaluated for errors in directions, indication, dose, quantity, and refills. Because antibiotic dosing can vary based on indications, only disease states with guideline-specific dosing recommendations were evaluated for dosing errors.

Results

A total of 11,815 antibiotic prescriptions were analyzed for patients discharged from the PED, and 1986 (16.8%) errors were identified. Of all the prescriptions reviewed, 517 (4.4%) contained an incomplete prescription error. Discharge prescriptions written by off-service physicians were more likely to contain incomplete prescription errors (5.1%) when compared with emergency medicine physicians (3.9%; P = 0.022). A dosing error rate of 18.5% (1469 prescriptions) was identified for the 7930 disease state-specific prescriptions reviewed. Underdosing errors were significantly more common (51.6%) than overdosing errors (29.3%; P < 0.0001). Among the different agents, there was noted to be a significant difference in the antibiotics most commonly involved in dosing errors (P < 0.0001). Additionally, there was also a significant difference in the incidence of dosing errors between different disease states (P < 0.0001). No significant difference was found in the incidence of dosing errors across physician specialties (P = 0.872).

Conclusions

We identified 1986 (16.8%) total errors in this analysis of antibiotic prescriptions written on discharge from the PED. Among the disease states evaluated, dosing errors were identified in 18.5% of prescriptions with the most common error being underdosing. Literature evaluating pediatric prescription errors, and specifically antibiotic discharge prescriptions, is quite limited. Further investigation is necessary in this area, and strategies should be developed leveraging technology, enhancing education, and using pharmacy personnel to help reduce antibiotic prescribing errors for patients discharged from the PED.
Screening Electrocardiograms Have Low Utility in Medical Clearance Before Pediatric Inpatient Psychiatric Admission
Authors: Becker Sarah D. , Rochelson Ellis , Lienhard Michael , Silber David , Mowrey Wenzhu B. , Hutchison Lisa
Published: December 2020

Objectives

Children presenting to the emergency department (ED) requiring psychiatric admission often undergo screening electrocardiograms (ECG) as part of the medical clearance process. The diagnostic yield of screening ECGs for this purpose has not been reported. The purpose of this study was to determine the clinical utility of screening ECGs in children and adolescents requiring acute inpatient psychiatric admission.

Methods

A single-center retrospective study of patients aged 5 to 18 years who did not have documented indications for ECG and underwent screening ECG before psychiatric inpatient admission over a 2-year period was conducted. Abnormal ECGs were identified via chart review and were reinterpreted by a pediatric cardiologist to determine potential significance to psychiatric care. Impact on treatment and disposition was examined.

Results

From January 2018 through December 2019, 252 eligible pediatric patients had a screening ECG in the ED before psychiatric admission. Twenty-one (8.3%) of these ECGs were interpreted as abnormal, and 6 (2.4%) were determined to be potentially relevant to psychiatric care in the setting of specific medication use. The abnormal ECG interpretations resulted in additional workup and/or cardiology consultation for 7 (2.7%) patients but had no impact on psychiatric admission.

Conclusions

In the absence of concerning individual or family history or cardiac symptoms, routine screening ECGs as part of medical clearance for psychiatric admission are not warranted given the low yield of meaningful findings. The decision to obtain an ECG should be made with careful consideration of medical history and in the presence of specific indications.
A National US Survey of Pediatric Emergency Department Coronavirus Pandemic Preparedness
Authors: Auerbach Marc A. , Abulebda Kamal , Bona Anna Mary , Falvo Lauren , Hughes Patrick G. , Wagner Michael , Barach Paul R. , Ahmed Rami A.
Published: December 2020

Objective

We aim to describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a diverse set of pediatric emergency departments (PEDs) within the United States.

Methods

We conducted a prospective multicenter survey of PED medical director(s) from selected children’s hospitals recruited through a long established national research network. The questionnaire was developed by physicians with expertise in pediatric emergency medicine, disaster readiness, human factors, and survey development. Thirty-five children’s hospitals were identified for recruitment through an established national research network.

Results

We report on survey responses from 25 (71%) of 35 PEDs, of which 64% were located within academic children's hospitals. All PEDs witnessed decreases in non–COVID-19 patients, 60% had COVID-19–dedicated units, and 32% changed their unit pediatric patient age to include adult patients. All PEDs implemented changes to their staffing model, with the most common change impacting their physician staffing (80%) and triaging model (76%). All PEDs conducted training for appropriate donning and doffing of personal protective equipment (PPE), and 62% reported shortages in PPE. The majority implemented changes in the airway management protocols (84%) and cardiac arrest management in COVID patients (76%). The most common training modalities were video/teleconference (84%) and simulation-based training (72%). The most common learning objectives were team dynamics (60%), and PPE and individual procedural skills (56%).

Conclusions

This national survey provides insight into PED preparedness efforts, training innovations, and practice changes implemented during the start of COVID-19 pandemic. Pediatric emergency departments implemented broad strategies including modifications to staffing, workflow, and clinical practice while using video/teleconference and simulation as preferred training modalities. Further research is needed to advance the level of preparedness and support deep learning about which preparedness actions were effective for future pandemics.
Diagnostic Accuracy of Suspected Appendicitis
Authors: Staab Stephanie , Black Theodore , Leonard Jan , Bruny Jennifer , Bajaj Lalit , Grubenhoff Joseph A.
Published: December 2020

Objective

When evaluating suspected appendicitis, limited data support quality benchmarks for negative appendectomy (NA); none exist for delayed diagnosis of appendicitis (DDA). The objectives of this study are the following: (1) to provide preliminary evidence supporting a quality benchmark for DDA and 2) to compare presenting features and diagnostic evaluations of children with NA and DDA with those with pathology-confirmed appendicitis (PCA) diagnosed during initial emergency department (ED) encounter.

Methods

Secondary analysis of data from a QI project designed to reduce the use computed tomography when evaluating suspected appendicitis using a case-control design. Patients undergoing appendectomy in an academic tertiary care children's hospital system between January 1, 2015, and December 31, 2016 (n = 1,189) were eligible for inclusion in this case-control study. Negative appendectomy was defined as no pathologic change or findings consistent with a different diagnosis. Delayed diagnosis of appendicitis was defined as patients undergoing appendectomy within 7 days of a prior ED visit for a related complaint. Controls of PCA (n = 150) were randomly selected from all cases undergoing appendectomy.

Results

There were 42 NA (3.5%) and 31 DDA (2.6%). Cases of PCA and NA exhibited similar histories, examination findings, and underwent comparable diagnostic evaluations. Cases of PCA more frequently demonstrated a white blood cell count greater than 10 × 103/μL (85% vs 67%; P = 0.01), a left-shift (77% vs 45%; P < 0.001), and an ultrasound interpretation with high probability for appendicitis (73% vs 54%; P = 0.03). Numerous significant differences in history, examination findings, and diagnostic tests performed existed between cases of PCA and DDA.

Conclusions

Children with PCA and NA present similarly and undergo comparable evaluations resulting in appendectomy. A 3% to 4% NA rate may be unavoidable given these similarities. Presenting features in DDA significantly differ from those of PCA. An irreducible proportion of appendicitis diagnoses may be delayed.
What Can We Learn From the Past? Pandemic Health Care Workers’ Fears, Concerns, and Needs: A Review
Authors: Duffy Caoimhe C. , Bass Gary A. , Fitzpatrick Gerry , Doherty Eva M.
Published: December 2020

Background

Health care workers (HCWs) have been engaged in fighting dangerous epidemics for hundreds of years, more recently in severe acute respiratory syndrome, H1N1, Middle East respiratory syndrome, and now coronavirus disease 2019. A consistent feature of epidemic disease results is that health care systems and HCWs are placed under immense strain.

Methods

A focused narrative review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to examine the main concerns and anxieties faced by HCWs during recent epidemics and to determine the supports deemed most important to those HCWs to keep them at the frontline. PubMed, Web of Science, and the Cochrane Library were searched in March 2020 using terms “Healthcare” OR “Medical” AND “Staff” OR “Workers” OR “Front line” AND “Concerns” OR “Anxiety” OR “Stress” AND “Pandemic” Or “Epidemic.”

Results

Twenty-five studies that reported the concerns and expectations of an estimated 13,793 HCWs in 10 countries (Canada, China, Greece, Hong Kong, Japan, Liberia, Netherlands, Saudi Arabia, Singapore and Taiwan) during pandemic situations were identified. Health care workers identified personal and family safety, appreciation, and the provision of personal protective equipment and adequate rest as primary concerns. Informal psychological supports were favored over formal employment-based group interventions.

Discussion

Despite being hailed by the media as heroes, HCWs face social stigmatization and experienced high levels of anxiety and fear regarding personal safety and the health of their colleagues and family. Health care workers are more likely to seek peer-to-peer psychological support but also benefit from knowing that formal psychological supports are available to them.
A fully automated crystallization apparatus for small protein quantities
Authors: Kato Ryuichi , Hiraki Masahiko , Yamada Yusuke , Tanabe Mikio , Senda Toshiya
Published: December 2020

In 2003, a fully automated protein crystallization and monitoring system (PXS) was developed to support the structural genomics projects that were initiated in the early 2000s. In PXS, crystallization plates were automatically set up using the vapor-diffusion method, transferred to incubators and automatically observed according to a pre-set schedule. The captured images of each crystallization drop could be monitored through the internet using a web browser. While the screening throughput of PXS was very high, the demands of users have gradually changed over the ensuing years. To study difficult proteins, it has become important to screen crystallization conditions using small amounts of proteins. Moreover, membrane proteins have become one of the main targets for X-ray crystallography. Therefore, to meet the evolving demands of users, PXS was upgraded to PXS2. In PXS2, the minimum volume of the dispenser is reduced to 0.1 µl to minimize the amount of sample, and the resolution of the captured images is increased to five million pixels in order to observe small crystallization drops in detail. In addition to the 20°C incubators, a 4°C incubator was installed in PXS2 because crystallization results may vary with temperature. To support membrane-protein crystallization, PXS2 includes a procedure for the bicelle method. In addition, the system supports a lipidic cubic phase (LCP) method that uses a film sandwich plate and that was specifically designed for PXS2. These improvements expand the applicability of PXS2, reducing the bottleneck of X-ray protein crystallography.
Substrate binding in the bile acid transporter ASBTYffromYersinia frederiksenii
Authors: Wang Xiaodong , Lyu Ying , Ji Yujia , Sun Ziyi , Zhou Xiaoming
Published: December 2020

Apical sodium-dependent bile acid transporter (ASBT) retrieves bile acids from the small intestine and plays a pivotal role in enterohepatic circulation. Currently, high-resolution structures are available for two bacterial ASBT homologs (ASBTNMfromNeisseria meningitidesand ASBTYffromYersinia frederiksenii), from which an elevator-style alternating-access mechanism has been proposed for substrate transport. A key concept in this model is that the substrate binds to the central cavity of the transporter so that the elevator-like motion can expose the bound substrate alternatingly to either side of the membrane during a transport cycle. However, no structure of an ASBT has been solved with a substrate bound in its central cavity, so how a substrate binds to ASBT remains to be defined. In this study, molecular docking, structure determination and functional analysis were combined to define and validate the details of substrate binding in ASBTYf. The findings provide coherent evidence to provide a clearer picture of how the substrate binds in the central cavity of ASBTYfthat fits the alternating-access model.
High-performance macromolecular data delivery and visualization for the web. Corrigendum
Authors: Sehnal David , Svobodová Radka , Berka Karel , Rose Alexander S. , Burley Stephen K. , Velankar Sameer , Koča Jaroslav
Published: December 2020

Two citations in the article by Sehnal et al. [(2020), Acta Cryst. D76, 1167–1173] are corrected.
Ethyl α-L-sorboside
Authors: Nagayama Natsumi , Taniguchi Norito , Matsumoto Mao , Takeshita Kei , Ishii Tomohiko
Published: December 2020

Ethyl L-sorboside, C8H16O6, was prepared from the rare sugar L-sorbose, C6H12O6, and crystallized. It was confirmed that ethyl L-sorboside formed α-pyranose with a 2
C
5 conformation. In the crystal, molecules are linked by O—H...O hydrogen bonds, forming a three-dimensional network. The unit-cell volume of the title ethyl α-L-sorboside is 940.63 Å3 (Z = 4), which is about 194.69 Å3 (26.1%) bigger than that of L-sorbose [745.94 Å3 (Z = 4)].
Questioning the use of the balcony in apartments during the COVID-19 pandemic process
Authors: Aydin Dicle , Sayar Gevher
Published: December 2020

Purpose

The purpose of this paper is to assess using of balconies in apartment buildings. In the research, by questioning the use of balconies as to the coronavirus disease 2019 (COVID-19) process and before, the place and importance of the balcony in the apartment house were questioned.

Design/methodology/approach

Balcony performance dimensions and components, which were revealed based on the studies conducted, were analyzed with questions directed to the individuals living in the apartment (one person every flat). In the research in which behavioral and functional performance is questioned through users, the survey method was used and the data were analyzed in the Statistical Product and Service Solutions (SPSS) program. Apart from the performance dimensions, data on the characteristics of the balconies were also obtained from the answers of the users.

Findings

The use of balconies has increased during the pandemic process and has become more important in apartments. The size of the balcony is related to the size of the house. The functional performance of the balcony is linked to the size of the balcony, behavioral and environmental values. The balcony should be large enough to accommodate equipment for daily activities, the proximity to the surrounding buildings, view, noise affect the performance of the balcony.

Research limitations/implications

The research is limited to the questionnaire applied to apartment users in Konya (Turkey) city center. Male and female users participated in the study, and the use of the balcony was questioned.

Practical implications

Apartment design includes results that contribute to architects regarding the location and use of the balcony. It also includes the results that can be evaluated by local governments in terms of binding rules on balconies in zoning regulations.

Social implications

The balcony is one of the rooms of the house, which is mainly designed in connection with the kitchen and living room / living room and shared by the household. The balcony is used as a socializing place for the common actions of the house users. This space that opens to the outside is valuable in terms of providing communication with people outside.

Originality/value

The fact that no study has been conducted to question the use of the balcony over the user makes this study valuable. In addition, questioning the use of the balcony during the pandemic process is important in terms of revealing the importance of the need for open space in an apartment. The results will contribute to architects and local administrations in terms of binding rules in design regarding the location of the balcony in the house.
Well-coordinated: learner-focused coordination tactics beyond the pandemergency
Authors: Soccio Philippa , Tregloan Kate , Thompson James
Published: December 2020

Purpose

Post-pandemic education will be impacted by spatial and technological shockwaves, alongside other areas of society. Significant expansion of online learning will build on skills developed by educators and students in this tumultuous time, and in response to emerging challenges and structural transformations. This paper explores an oft-overlooked skill that underpins contemporary teaching, and posits that “coordination” will find its way to the centre of this new online world. The paper presents research investigating the translation of tactics for good subject coordination to an online context.

Design/methodology/approach

The authors reviewed academic literature that explored coordination in higher education settings, and recent grey literature identifying expected changes to post-pandemic university learning. The authors developed a survey instrument to investigate the translation of previously identified characteristics of good coordination, and tactics to achieve them, into the pandemic-driven online learning environment. Survey analysis explored the level of difficulty reported by subject coordinators for this translation online, as well as their suggestions of additional tactics or concerns.

Findings

While the low number of respondents limits these conclusions, initial analysis suggests that the identified Tactics for Coordination can be applied with relative ease to online learning environments. At the same time, the expected burgeoning of online education identified an expected increase in demand for these skills.

Originality/value

The authors identified a lack of literature addressing subject coordination as a key skill, or evaluating coordination tactics, as well as a lack of resources for focused skill development. This paper addresses this gap, and prompts further and urgent response.
A systematic review of scales for measuring information security culture
Authors: Orehek Špela , Petrič Gregor
Published: December 2020

Purpose

The concept of information security culture, which recently gained increased attention, aims to comprehensively grasp socio-cultural mechanisms that have an impact on organizational security. Different measurement instruments have been developed to measure and assess information security culture using survey-based tools. However, the content, breadth and face validity of these scales vary greatly. This study aims to identify and provide an overview of the scales that are used to measure information security culture and to evaluate the rigor of reported scale development and validation procedures.

Design/methodology/approach

Papers that introduce a new or adapt an existing scale of information security culture were systematically reviewed to evaluate scales of information security culture. A standard search strategy was applied to identify 19 relevant scales, which were evaluated based on the framework of 16 criteria pertaining to the rigor of reported operationalization and the reported validity and reliability of the identified scales.

Findings

The results show that the rigor with which scales of information security culture are validated varies greatly and that none of the scales meet all the evaluation criteria. Moreover, most of the studies provide somewhat limited evidence of the validation of scales, indicating room for further improvement. Particularly, critical issues seem to be the lack of evidence regarding discriminant and criterion validity and incomplete documentation of the operationalization process.

Research limitations/implications

Researchers focusing on the human factor in information security need to reach a certain level of agreement on the essential elements of the concept of information security culture. Future studies need to build on existing scales, address their limitations and gain further evidence regarding the validity of scales of information security culture. Further research should also investigate the quality of definitions and make expert assessments of the content fit between concepts and items.

Practical implications

Organizations that aim to assess the level of information security culture among employees can use the results of this systematic review to support the selection of an adequate measurement scale. However, caution is needed for scales that provide limited evidence of validation.

Originality/value

This is the first study that offers a critical evaluation of existing scales of information security culture. The results have decision-making value for researchers who intend to conduct survey-based examinations of information security culture.
A cloud-based approach to library management solution for college libraries
Authors: Shaw Jitendra Nath , De Sarkar Tanmay
Published: December 2020

Purpose

The study aims to focus on the present automation status of the college libraries with an objective to offer enhanced Web-based library service on an affordable virtualization on cloud computing model.

Design/methodology/approach

With Infrastructure as a Service (Infrastructure as a Service) delivery model, this study demonstrates how libraries of colleges/smaller institutes could be connected to cloud Library Management System infrastructure through internet or dedicated point-to-point WAN connectivity. The Software as a Service (SaaS) delivery model depicts how college libraries could form library consortium at its own private cloud environment with installation of the required LMS application, database, middleware and other prerequisites.

Findings

A cloud-based consortium approach for the college libraries will reduce the cost of purchasing hardware equipment and setting up of infrastructural facilities; relieve libraries of involving additional IT skilled manpower; foster collaborative approach with shared environment and minimise duplication in resource subscription.

Originality/value

To the best of the authors’ knowledge, the present study is the first of its kind in the light of shifting of infrastructure, software and hardware requirements of smaller libraries for cooperative sharing in both IaaS and SaaS cloud platform. The study delineates step by step how college libraries could effectively leverage the cooperative cloud architecture for enhanced library services to reach wider user community.
The influence of perceived fan orientation on satisfaction, loyalty and sport consumption behaviors
Authors: Köse Hüseyin , Argan Metin , Hedlund David P.
Published: December 2020

Purpose

The purpose of this research is to develop and validate a scale to measure the perceived orientation of sport organizations toward their fans, and subsequently, to test its relationship with six outcomes based on data from the fanbases of three distinct sport teams.

Design/methodology/approach

Using interviews and focus groups, important elements of fans' perceptions of their relationship with sport organizations are identified. After creating items based on the results of the interviews and focus groups, EFA, CFA and SEM procedures are used to create and test a multidimensional scale of perceived fan orientation.

Findings

Using EFA and CFA procedures, an 11-item, four-dimension scale of perceived fan orientation is validated, including components measuring (1) hosting events and campaigns for fans, (2) communicating information to fans, (3) interacting with fans when requests and problems arise and (4) providing preferential treatment to fans. The SEM results provide evidence of the impact of fan orientation on multiple measured outcomes for three professional football teams.

Research limitations/implications

This research is limited to three professional football teams in Turkey. However, the development of the multidimensional perceived fan orientation (PERFANOR) scale provides sport organizations' management and personnel with information about the relationship fans desire.

Practical implications

Sport managers, marketers and front-line staff are recommended to undertake activities to improve the relationship between the organization, team and its fans.

Originality/value

The principles and practices of relationship marketing and service quality often include discussions of the importance of “putting fans first,” however until now, no multidimensional scale existed in sport which measures the perceived fan orientation of a sport organization.
Predicting entrepreneurial opportunity recognition in higher education: a case from Iran
Authors: Mehdizadeh Hossein , Gholami Hesamedin , Shiri Nematollah , Khoshmaram Mojgan
Published: December 2020

Purpose

Although extensive governmental efforts have taken place to promote entrepreneurship in Iran, based on global entrepreneurship monitor report, the rate of perceived opportunities among young people, especially those with university education, has dropped. Since the perceived entrepreneurial opportunities are the first and most important step in the entrepreneurship process, this study identified the factors affecting the entrepreneurial opportunity recognition in Iranian higher education.

Design/methodology/approach

The statistical population included 127 senior undergraduate students in all majors of agriculture at Ilam University. The sample size was determined by using the Krejcie and Morgan’s (1970) sampling table to be 100 senior undergraduate agriculture students at Ilam University, Ilam province, Iran, selected through a stratified random sampling technique.

Findings

The results showed that the perceived entrepreneurial opportunity among students was moderately low. According to structural equation modeling, the alertness, human capital, social capital and environmental support variables had a positive and significant effect on the entrepreneurial opportunity recognition.

Research limitations/implications

Regarding the research implications, the present study, with providing and testing a model for developing the entrepreneurial opportunity recognition among students in a developing country (Iran) with diverse cultures and values, has improved the literature of entrepreneurship in higher education.

Practical implications

Based on results instructors in higher agricultural education can use active teaching and learning methods, such as creating ideas, experiential and service learning, teamwork and practical work, critical thinking and problem-solving in education. Also, financial, technical and consultative support of instructors and managers in agricultural colleges to implement, launch and commercialize agricultural students' entrepreneurial ideas and projects is needed.

Originality/value

The findings indicated the importance of alertness, human capital, social capital and environmental support on the entrepreneurial opportunity recognition among students. Findings showed that ecological approach could be used to develop students' entrepreneurial opportunity recognition.
Size effect and merger dominance in salesforce integration
Authors: Oh Joon-Hee
Published: December 2020

Purpose

This study aims to test the authors’ theory that in an integrated sales team, the larger team (either from the acquiring or acquired firm) dominates the smaller team, even though it may be less competent than the smaller one, and that the level of competence of the integrated entity with the dominant but inferior larger team is bound to deteriorate.

Design/methodology/approach

The study tests the theory by conducting a laboratory experiment.

Findings

The results from the experiment show that an asymmetrical employee composition structure creates merger dominance in the post-integration group and influences the integration performance.

Research limitations/implications

Considering the lack of mergers and acquisitions research in the marketing literature, the author believes that this study contributes new information to the literature. The finding that an integrated entity with a dominant but inferior larger partner will demonstrate a resulting degeneration of competence invites empirical research for validation.

Practical implications

The integration of sales teams is central to ensuring revenue growth and driving the value that mergers promise but often fail to realize. The study findings provide some practical insights in this regard.

Originality/value

Mergers between asymmetrical partners are common phenomena. However, few studies have investigated how an unequal size of sales teams in pre-merger firms influences the effective integration of different sales teams. To fill this research gap, this study examines whether the involvement of an unequal number of salespeople from pre-merger firms in a post-merger sales team may influence its post-merger performance.