bluuebunny/crossref_metadata_2025 huggingface dataset:
Interdependency analysis of lean manufacturing practices in case of Bulgarian SMEs: interpretive structural modelling and interpretive ranking modelling approach
Authors: Prasad Sarita , Baltov Milen , A. Neelakanteswara Rao , Lanka Krishnanand
Published: November 2020

Purpose

The paper aims to analyse the contextual relationship and dependency amongst enablers for lean manufacturing implementation in Bulgarian small and medium-sized enterprises (SMEs).

Design/methodology/approach

In this study, the interpretive structural modelling (ISM) technique was used to develop a hierarchical structural model for enablers. Also, the interpretive ranking process (IRP) was used to analyse and rank enablers with reference to performance variables. For the ISM approach, a structural self- integration matrix was developed with the help of experts’ suggestions and opinions. Cross-impact matrix multiplication applied to classification (MICMAC) analysis was used to analyse the relationship amongst enablers. A total of nine experts were chosen for collecting the primary data in which seven experts belong to the industry and two experts were academicians. The dominant relationship amongst the enablers was analysed through IRP modelling.

Findings

A total of 11 enablers were identified for the purpose of this study. The model shows that “leadership and commitment by management”, “human resource management”, “customer relation management”, “supplier relation management” and “information technology system” are the most significant enablers for lean implementation in Bulgarian SMEs as these are positioned at the bottom levels in ISM model. MICMAC analysis shows that five enablers fall in the independent factor, two enablers in linkage factor and four enablers in the dependant factor while there is no enabler in the autonomous factor. ISM and IRP models show that “continuous improvement” is an essential enabler for the successful implementation of lean in Bulgarian SMEs. This study also helps to explain the comparative analysis of ISM and IRP, which indicates that IRP is a more robust modelling approach than ISM, as it incorporates the relationship of enablers with performance variables.

Research limitations/implications

ISM and IRP modelling approaches are based solely on expert opinions and responses. This limitation can be overcome with the help of empirical study.

Practical implications

This study supports the professionals/experts to prioritise and manage enablers at strategic and tactical levels while implementing lean manufacturing practices in Bulgarian SMEs. The models developed in the study will be helpful for practitioners to understand and analyse the interdependence of enablers for lean manufacturing implementation.

Originality/value

This study helps to identify and prioritise enablers that affect lean manufacturing adoption using ISM and IRP approaches. Literature shows that numerous authors have used the ISM approach but the use of IRP approach is limited. The models were developed in the study, totally dependent on data collected from the experts to ensure their real-life validity.
Narratives of internal migration experiences, health/well-being issues among females working as head-porters (Kayayei) in Ghana
Authors: Kuyini Ahmed Bawa , Abukari Abdulai , Mohammed Abdulai Kuyini , Powell Hughlett Omris
Published: November 2020

Purpose

This study aims to explore the internal migration experiences and health/well-being issues of 38 girls and women working as Kayayei (head-porters) in Accra, Ghana.

Design/methodology/approach

Data were collected from seven focus group interview sessions, and thematic analysis was used to analyse the data.

Findings

The results revealed the geographic, structural and family issues that promote increased migration of females to the cities. The findings betray the potential negative effects of migration on the participants’ quality of life, including accessing health services. They also suggest that the Kayayei phenomenon is a significant child protection, health/well-being concern yet to be given adequate attention in ways that consider the implications of such large internal migration of females on the overall human resource development capacities of rural communities.

Originality/value

This is an original study with data collected to explore internal rural to urban migration and its effect on health and well-being of young girls and women.
Exposure to interbank investment and financing risk by Islamic banks: a dynamic panel analysis of Malaysia
Authors: Mohamad Mohammad Taqiuddin , Sulaiman Ahmad Azam , Achour Meguellati
Published: November 2020

Purpose

The Government of Malaysia has developed an Islamic Interbank Money Market since January 1994 with the objective to facilitate funding for the Islamic banking sector in the country. This platform also enables Islamic banks to obtain Sharīʿah-compliant funds from other Islamic banks. This study aims to examine the effects of interbank investment and financing risk on the financing decisions of Malaysia’s Islamic banks between 1994 and 2015. The financing decisions are used as financing measures to determine the effect of investing in the interbank market and financing risk indicators on financing.

Design/methodology/approach

The descriptive, correlation and dynamic panel analysis results are derived with the help of LIMDEP 9.0 software.

Findings

The study found a negative relationship between the interbank investment variable with the financing decisions of Islamic banks. This reflects that an increase in interbank investment leads Islamic banks to reduce their level of financing. These findings prove that the investment activities between Islamic banks had a “substitution effect” and decreased their capability of financing because of their tendency to maintain liquidity.

Originality/value

Islamic banks are confident that they will generate higher profits in the coming financial year. The economic conditions of Malaysia do not influence Islamic banks’ financing decisions, whereas Islamic banks in this study are more dependent on the balance sheet indicators.
The increasing popularity of private funds
Authors: Koh Jerry , Lee Jonathan
Published: November 2020

Purpose

To introduce the various private fund structuring options available in Singapore, an important fund management hub that has increasingly also come to be recognized as a popular fund domicile with its pro-business environment, transparent and robust regulatory regime and government support through tailored investment structures, tax incentives and extensive double taxation treaties.

Design/methodology/approach

This article provides an overview of the available private fund structures as well as the key legal issues and considerations that fund managers and investors should take into account when structuring a private fund. It also provides a brief summary of the available tax incentive schemes for funds in Singapore.

Findings

With growth in private market assets under management fueled by private equity funds over the last decade, the use of private investment funds established in Singapore has become a popular means to tap the large capital inflows into Asia. Singapore offers a wide range of fund structures to suit different fund strategies and considerations, including the variable capital company (“VCC”) structure, a legal structure tailored for use as investment funds that was introduced in January 2020.

Practical implications

There are a range of Singapore private fund structures available with different features, including the VCC, which is a corporate structure that allows for umbrella-sub-fund structures with segregated assets and liabilities, and the limited partnership, which is familiar to international investors and permits a large degree of contractual flexibility. Other structures such as unit trusts and private companies may also be suitable depending on the particular circumstances and objectives of the fund. Fund managers who are exploring setting up fund vehicles to tap Asian capital or to invest in Asia should be aware of the possible options, and their pros and cons.

Originality/value

Practical analysis and guidance and market commentary from experienced investment funds lawyers.
Investigating the effects of fire management on savanna biodiversity with grid‐based spatially explicit population simulations
Authors: Davies Hugh F. , Visintin Casey , Gillespie Graeme R. , Murphy Brett P.
Published: November 2020

The development of effective fire management for biodiversity conservation is a global challenge. The highly dynamic nature of fire, the difficulty in replicating ‘real‐world’ fire experiments and the need to understand population changes at large spatiotemporal scales make computer simulations particularly useful for identifying optimal fire management regimes for biodiversity conservation.

We aimed to develop a flexible modelling approach with which to investigate how the spatiotemporal application of fire (i.e. management scenarios) influences savanna biodiversity. We used existing data from a landscape‐scale fire experiment to develop population simulations for the common brushtail possumTrichosurus vulpecula, grassland melomysMelomys burtoniand northern brown bandicootIsoodon macrourusacross the Kapalga area of Kakadu National Park in northern Australia. We simulated how populations were expected to change between 1995 and 2015 in response to the fire patterns observed at Kapalga over this period, and under a hypothetical management scenario of extensive prescribed burning.

Our models predicted a substantial decline in all three species in response to the observed fire regime at Kapalga, suggesting that the fire patterns observed at Kapalga, with the associated mechanisms and interactions with other ecological processes, were not conducive with the persistence of native mammal populations.

Our prescribed burning scenario had little effect on the predicted population trajectory of the common brushtail possum and grassland melomys, but markedly improved the population trajectory of the northern brown bandicoot. These inconsistencies highlight the need for a nuanced approach to fire management across northern Australian savannas, that is tailored to local conditions and management objectives.

Synthesis and applications. The modelling approach outlined here provides a basis for identifying fire patterns that are beneficial for conserving biodiversity, thereby increasing our capacity to establish clear targets for prescribed fire management. Importantly, this approach is flexible and can be easily adapted to other taxa and fire‐prone ecosystems.
Associations between interpregnancy interval and preterm birth by previous preterm birth status in four high‐income countries: a cohort study
Authors: Marinovich ML , Regan AK , Gissler M , Magnus MC , Håberg SE , Mayo JA , Shaw GM , Bell J , Nassar N , Ball S , Gebremedhin AT , Marston C , de Klerk N , Betrán AP , Padula AM , Pereira G
Published: November 2020

Objective

To investigate the effect of interpregnancy interval (IPI) on preterm birth (PTB) according to whether the previous birth was preterm or term.

Design

Cohort study.

Setting

USA (California), Australia, Finland, Norway (1980–2017).

Population

Women who gave birth to first and second (n = 3 213 855) singleton livebirths.

Methods

Odds ratios (ORs) for PTB according to IPIs were modelled using logistic regression with prognostic score stratification for potential confounders. Within‐site ORs were pooled by random effects meta‐analysis.

Outcome measure

PTB (gestational age <37 weeks).

Results

Absolute risk of PTB for each IPI was 3–6% after a previous term birth and 17–22% after previous PTB. ORs for PTB differed between previous term and preterm births in all countries (P‐for‐interaction ≤ 0.001). For women with a previous term birth, pooled ORs were increased for IPI <6 months (OR 1.50, 95% CI 1.43–1.58); 6–11 months (OR 1.10, 95% CI 1.04–1.16); 24–59 months (OR 1.16, 95% CI 1.13–1.18); and ≥ 60 months (OR 1.72, 95%CI 1.60–1.86), compared with 18–23 months. For previous PTB, ORs were increased for <6 months (OR 1.30, 95% CI 1.18–1.42) and ≥60 months (OR 1.29, 95% CI 1.17–1.42), but were less than ORs among women with a previous term birth (P < 0.05).

Conclusions

Associations between IPI and PTB are modified by whether or not the previous pregnancy was preterm. ORs for short and long IPIs were higher among women with a previous term birth than a previous PTB, which for short IPI is consistent with the maternal depletion hypothesis. Given the high risk of recurrence and assuming a causal association between IPI and PTB, IPI remains a potentially modifiable risk factor for women with previous PTB.

Tweetable abstract

Short versus long interpregnancy intervals associated with higher ORs for preterm birth (PTB) after a previous PTB.
Discriminating lineages of Batrachochytrium dendrobatidis using quantitative PCR
Authors: Ghosh Pria N. , Verster Ruhan , Sewell Thomas R. , O’Hanlon Simon J. , Brookes Lola M. , Rieux Adrien , Garner Trenton W. J. , Weldon Ché , Fisher Matthew C.
Published: November 2020

The ability to detect and monitor infectious disease in a phylogenetically informative manner is critical for their management. Phylogenetically informative diagnostic tests enable patterns of pathogen introduction or changes in the distribution of genotypes to be measured, enabling research into the ecology of the pathogen. Batrachochytrium dendrobatidis (Bd), a causative agent of chytridiomycosis in amphibian populations, emerged worldwide in the 21st century and is composed of six lineages which are display varying levels of virulence in their hosts. Research into the distribution, ecology and pathogenicity of these lineages has been hampered by an inability to type lineage efficiently. Here, we describe a lineage‐specific TaqMan qPCR assay that differentiates the two lineages of Bd most commonly associated with chytridiomycosis: BdGPL and BdCAPE. We demonstrate how this assay can be used for the surveillance of wild populations of amphibians in Southern Africa using skin swabs, tissue samples and cultured isolates.
Locating large insects using automated VHF radio telemetry with a multi‐antennae array
Authors: Fisher Kelsey Elizabeth , Dixon Phil M. , Han Gang , Adelman James Stephen , Bradbury Steven P.
Published: November 2020

We describe an automated radio telemetry system (ARTS) designed for estimating the location of 0.50 g butterflies which was constructed with commercially available materials. Previously described systems were not designed to estimate fine‐scale locations of large insects within approximately 200 m2 study areas.

The ARTS consists of four receiving stations. Each receiving station has four 3‐element, directional Yagi antennae (separated by 60) connected to an automated receiver that records detected power sequentially from each antenna. To develop and evaluate the ARTS performance, four receiving stations were installed in the corners of 4 and 6.25‐ha square fields with varying heights of vegetative cover. The location of a 0.22 g transmitter was estimated with a statistical method implementing both distance‐and angle‐power relationships. Calibrated model parameters were based on power detected from transmitters at known locations. Using independently collected data, model performance was evaluated based on estimated locations of a georeferenced stationary transmitter, a moving transmitter with a known georeferenced path and a transmitter attached to a monarch butterfly Danaus plexippus. Estimated locations were calculated as frequently as every 5 s, which is at least 12 times greater than the sampling frequency previously reported for tracking insects.

When sufficient power data were received, the median estimated locations of a transmitter attached to an investigator's hat were <16 m from the true location. The median effective radius of the 95% confidence ellipse was 18.3 m for stationary targets and 15.9 m for a moving transmitter. Greater error in location estimation was expected when the transmitter was attached to a monarch butterfly due to interference from vegetation and variability in antenna orientation and transmitter height. As such, the median distance between the estimated and true locations was 72 m. After applying a correction for the effect of vegetation, median location error was reduced by 12 m.

While our ARTS has likely reached the limit of current technology, the system is still a substantial methodological advancement for locating butterflies. Our efforts should provide a benchmark as technology improves.
Comparing rivers to lakes: Implications for drowning prevention
Authors: Peden Amy E. , Willcox‐Pidgeon Stacey M. , Scarr Justin P. , Franklin Richard C.
Published: November 2020

Objective

To contrast unintentional fatal drowning in rivers with lakes to determine appropriateness for application of existing river drowning prevention strategies.

Design

A total population retrospective cross‐sectional analysis using coronial data.

Setting

Australia, 1 July 2013 to 30 June 2018.

Participants

Children and adults (n = 342) who died from unintentional drowning in a river or lake.

Main outcome measures

Incidence, crude fatality rates, relative risk (95% confidence interval) and chi‐square tests of independence for risk factors for unintentional fatal drowning. Subset analysis of land management for lake drowning locations.

Results

Four‐fifths (82%) occurred in rivers. Lake drowning was more likely among 0‐ to 17‐year‐olds, Aboriginal and Torres Strait Islander people and when swimming or using watercraft. River drowning most commonly occurred following a fall into water and with alcohol involvement. Drowning risk in very remote areas was elevated for both lakes (relative risk = 18.34; 95% confidence interval: 1.61‐209.44) and rivers (relative risk = 15.89; 95% confidence interval: 5.56‐45.37) compared to major cities. Those responsible for land and water management at lakes were primarily local government (59%), water authorities (32%) and parks and wildlife authorities (7%).

Conclusions

In contrast to a focus on adults and alcohol in existing river drowning prevention strategies, lake interventions must target children, Aboriginal and Torres Strait Islander peoples and recreational lake users. Fatal drowning rates are high for remote rivers and lakes, necessitating focused effort. There are opportunities to embed drowning prevention strategies within land and water management plans. Lake drowning prevention requires broader engagement with land and water managers and Aboriginal and Torres Strait Islander peoples.
Ten‐year outcomes of the first ‘one‐stop haematuria clinic’ in an Australian public hospital
Authors: Reynolds Bradley R. , McCombie Steve , Botha Erica , Hawks Cynthia , Brown Matthew , Hayne Dickon
Published: November 2020

Background

Urgent assessment of haematuria is critical to exclude malignancy. The utilization of haematuria clinics in Australia remains in its infancy. It is hoped that the streamlined investigative service will achieve earlier diagnosis of urological malignancy and subsequently decrease morbidity and mortality. We report the 10‐year prospectively collected outcomes from Australia's first dedicated one‐stop haematuria clinic (OSHC).

Methods

Since its commencement in May 2008 through to July 2018, all consecutive patients assessed in the OSHC were included in the analysis. Data collected included demographics, presentation, wait times, investigation, assessment, initial treatment, referral and histopathology.

Results

A total of 3008 patients were seen in the OSHC with non‐visible haematuria (1024, 34%) and visible haematuria (1984, 66%). Three hundred and twenty‐seven (10.9%) patients were diagnosed with urothelial malignancy. In all, 306 (10.2%) patients had lower tract disease and 21 (0.7%) had upper tract disease. Urothelial cases were compiled of 123 (37.6%) Ta LG, 39 (11.9%) Ta HG, 21 (6.4%) Tis, 67 (20.5%) T1 and 77 (23.6%) T2–4. Urothelial malignancy was diagnosed more often in males (odds ratio (OR) 1.74, 95% confidence interval (CI) 1.35–2.25), older patients elder than 60 years (OR 1.97, 95% CI 1.47–2.64) and patients with visible haematuria (OR 5.42, 95% CI 3.73–7.86). In all, 53.4% of patients were discharged after a single visit to the OSHC.

Conclusion

The OSHC has served as an effective tool for rapid, streamlined assessment of patients presenting with haematuria. This model of care has been subsequently adopted by numerous public centres across Australia. Current funding structures present a barrier to this excellent approach for rapid access diagnostics.
Design and experimental evaluation of an automated catheter operating system
Authors: Norouzi‐Ghazbi Somayeh , Mehrkish Ali , Abdulhafiz Ibrahim , Abbasi‐Hashemi Taha , Mahdi Anas , Janabi‐Sharifi Farrokh
Published: November 2020

Manual catheter‐based interventions (CBIs) suffer from exposure of the interventionalists to X‐ray, and dependence of their performance on the expertise and fatigue level of the interventionalists. Robot‐assisted catheterization systems (RACS) have been introduced in recent years to improve the efficiency of CBIs; however, using them is still associated with some difficulties such as set‐up dependency to a specific type of intervention instrument, not being portable, and offering limited options of operation modes. The objective of this research is to develop a new RACS to address these shortcomings. We propose Althea II as an improvement for our previously introduced RACS, Althea I. Althea II is designed for both research purposes and clinical applications including catheter‐based cardiovascular interventions. Althea II benefits from a novel structural design leading to a significantly reduced weight and making the device inclusive for a broader range of intervention instruments. Also, a tip detection algorithm is developed and integrated into the graphical user interface (GUI) to enable image‐based navigation, and accordingly, fully automatic navigation. Althea II has improved the outcome of catheter‐based interventions by increased accuracy and precision of the intervention. The system can navigate the catheter tip to a designated target with an accuracy higher than 90% in both velocity and positioning mode. The device is associated with an upgraded GUI equipped with a strong tip detection algorithm with an accuracy of 0.05 mm. Moreover, Althea II gains from a quicker assembly time (20 minutes, which equals five times faster). The independency from specific catheters, several modes of function, an imaged‐based feedback control, portability, and a remote function should allow operation even from beginners and reduce X‐ray exposure. The preliminary research studies verified the accuracy and repeatability of Althea II, demonstrated the feasibility and applicability of using the set‐up in multiple applications, and highlighted the improved set‐up capabilities over the currently available RACS.
Comparative assessment of biomechanics induced by hinge knee prostheses with two different motion axial system
Authors: Zhang Jing‐yu , Zhang Hao‐ran , Tian Dong‐mu , Wang Feng , Ren Zhi‐peng , Hu Yong‐cheng
Published: November 2020

We aimed to evaluate the biomechanical contact characteristics of rotating hinge knee (RHK) prostheses with different motion axial systems. We performed finite element (FE) analyses to investigate and compare the peak contact stress and contact location on tibial insert and bushing during a gait cycle. The biaxial (BA) system and spherical center axial (SA) system RHK prostheses were included in this study. The comparisons between experimental tests and FE analyses were performed to verify the validation of FE models. Decreased ISO loadings were then applied to the validated FE models to investigate the peak contact stress and contact location on tibial insert and bushing. The contact areas obtained from experimental tests and FE analyses were in a good agreement. The peak contact stresses on tibial insert and bushing of BA prosthesis were higher than those of SA prosthesis. The contact locations on the superior surface of tibial insert in SA and BA prostheses were at the middle‐posterior and posterior side, while those on the rotating axial surface were at the medial and lateral sides, respectively. This study indicate that the tibial insert and bushing of an SA prosthesis have lower peak contact stresses and better contact locations than those of a BA prosthesis during a gait cycle, which may decrease the risk of long‐term complications of RHK prostheses. Future studies should be performed to confirm the relationship between the contact characteristics and wear in RHK prostheses.
The tyrosine kinase inhibitor nilotinib inhibits SARS‐CoV‐2 in vitro
Authors: Cagno Valeria , Magliocco Gaelle , Tapparel Caroline , Daali Youssef
Published: November 2020

Since the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) at the end of 2019, no vaccine has been approved to counter this infection and the available treatments are mainly directed against the immune pathology caused by the infection. The coronavirus disease 2019 (COVID‐19) is currently causing a worldwide pandemic, pointing the urgent need for effective treatment. In such emergency, drug repurposing presents the best option for a rapid antiviral response. We assess here the in vitro activity of nilotinib, imatinib and dasatinib, three Abl tyrosine kinase inhibitors, against SARS‐CoV‐2. Although the last two compounds do not show antiviral efficacy, we observe inhibition with nilotinib in Vero‐E6 cells and Calu‐3 cells with EC50s of 1.44 μM and 3.06 μM, respectively. These values are close to the mean peak concentration of nilotinib observed at steady state in serum, making this compound a potential candidate for treatment of COVID‐19 in vivo.
Detailed Rigid Body Simulation with Extended Position Based Dynamics
Authors: Müller Matthias , Macklin Miles , Chentanez Nuttapong , Jeschke Stefan , Kim Tae‐Yong
Published: November 2020

We present a rigid body simulation method that can resolve small temporal and spatial details by using a quasi explicit integration scheme that is unconditionally stable. Traditional rigid body simulators linearize constraints because they operate on the velocity level or solve the equations of motion implicitly thereby freezing the constraint directions for multiple iterations. Our method always works with the most recent constraint directions. This allows us to trace high speed motion of objects colliding against curved geometry, to reduce the number of constraints, to increase the robustness of the simulation, and to simplify the formulation of the solver. In this paper we provide all the details to implement a fully fledged rigid body solver that handles contacts, a variety of joint types and the interaction with soft objects.
Treatment choice in single‐sided deafness and asymmetric hearing loss. A prospective, multicentre cohort study on 155 patients
Authors: Marx Mathieu , Mosnier Isabelle , Vincent Christophe , Bonne Nicolas‐Xavier , Bakhos David , Lescanne Emmanuel , Flament Jonathan , Bernardeschi Daniele , Sterkers Olivier , Fraysse Bernard , Lepage Benoit , Godey Benoit , Schmerber Sébastien , Uziel Alain , Mondain Michel , Venail Frédéric , Deguine Olivier
Published: November 2020

Objectives

To describe the treatment choice in a cohort of subjects with single‐sided deafness (SSD) and asymmetric hearing loss (AHL). To assess the reliability of the treatment trials.

Design

In this national, multicentre, prospective study, the choice of subjects was made after two consecutive trials of Contralateral Routing Of the Signal (CROS) hearing aids and a Bone Conduction Device (BCD) on a headband. Subjects could proceed with one of these two options, opt for cochlear implantation or decline all treatments.

Setting

Seven tertiary university hospitals.

Participants

One hundred fifty‐five subjects with SSD or AHL fulfilling the candidacy criteria for cochlear implantation, with or without associated tinnitus.

Main outcome measures

After the two trials, the number of subjects choosing each option was described. Repeated assessments of both generic and auditory‐specific quality of life were conducted, as well as hearing assessments (speech recognition in noise and horizontal localization).

Results

CROS was chosen by 75 subjects, followed by cochlear implantation (n = 51), BCD (n = 18) and abstention (n = 11). Patients who opted for cochlear implantation had a poorer quality of life (P = .03). The improvement of quality of life indices after each trial was significantly associated with the final treatment choice (P = .008 for generic indices, P = .002 for auditory‐specific indices). The follow‐up showed that this improvement had been overestimated in the CROS group, with a long‐term retention rate of 52.5%.

Conclusions

More than one third of SSD/AHL subjects are unsatisfied after CROS and BCD trials. Repeated quality of life assessments help counselling the patient for his/her treatment choice.
Financial Integration in Asia: A Macroeconomic Perspective
Authors: Guru Biplab Kumar , Yadav Inder Sekhar
Published: November 2020

This study examines the effect of financial integration on growth, total factor productivity, and capital accumulation using a dynamic panel system‐GMM for a dataset consisting of 43 Asian economies from 1995 to 2015. The impact of de jure financial openness on output, productivity, and capital stock growth is significant, while the effect of de facto financial integration is fuzzy. The disaggregate asset classes (namely, inflows of foreign direct investment and debt) are found to facilitate higher output while derivative inflows yield an undesirable effect. For developing countries, financial openness significantly boosts productivity and capital accumulation while for less developed countries it only enhances productivity. The negative impact of the currency crisis on growth and capital accumulation is found to be significant for more open economies. The currency crisis is more prominent for developed economies, partially effective for less developed countries, and partially ineffective for developing economies in Asia.
Cost‐effectiveness analysis of empagliflozin versus sitagliptin as second‐line therapy for treatment in patients with type 2 diabetes in the United States
Authors: Reifsnider Odette , Kansal Anuraag , Pimple Pratik , Aponte‐Ribero Valerie , Brand Sarah , Shetty Sharash
Published: November 2020

Aim

To estimate the cost‐effectiveness of sequential addition of empagliflozin versus sitagliptin after metformin in patients with type 2 diabetes (T2D) with or without cardiovascular disease (CVD) from the perspective of the US healthcare payer.

Methods

An individual simulation model predicted lifetime diabetes‐related complications, using UKPDS‐OM2 equations in patients without CVD, and EMPA‐REG OUTCOME equations in patients with CVD. Additional US‐based sources informed inputs for population characteristics, adverse events, non‐CV death, treatment escalation, quality of life and costs. Costs and quality‐adjusted life‐years (QALYs) were discounted 3.0% annually.

Results

The incremental cost‐effectiveness ratio (ICER) for second‐line empagliflozin versus sitagliptin in the overall T2D population was $6967/QALY. Empagliflozin led to longer CVD‐free survival (0.07 years) and an 11% reduction in CV death in patients with CVD compared with sitagliptin. Empagliflozin resulted in greater benefits with greater costs in patients with versus without baseline CVD, yielding ICERs of $3589/QALY versus $12 577/QALY, respectively. Results were consistent across a range of deterministic and probabilistic sensitivity analyses and scenarios.

Conclusion

Compared with sitagliptin, empagliflozin was cost‐effective (at $50 000/QALY US threshold) as a second‐line treatment to metformin for T2D patients with or without CVD in the United States. Our findings lend additional support for more widespread adoption of guidelines by healthcare decision‐makers for T2D treatment.
Myocardial strain pattern progress in patients with Coarctation of the Aorta undergoing aortic stenting
Authors: Aragão Natalia Freitas de Deus Vale , Borgo Juliana Nicchio Valentim , Jesus Carlos Alberto de , Davoglio Tathiane , Armstrong Anderson da Costa , Barretto Rodrigo Bellio de Mattos , Le Bihan David , Assef Jorge Eduardo , Pedra Carlos Augusto Cardoso , Pedra Simone Rolim Fernandes Fontes
Published: November 2020

Background and Aim

Ventricular function evaluation in coarctation of the aorta (CoA) has become more sophisticated and precise with speckle tracking, revealing subclinical changes. However, CoA stenting treatment effects in on myocardial strain are still controversial. This study aimed to estimate the extent to which changes in left ventricular global longitudinal strain (LV GLS) occur in patients with CoA who undergo stenting.

Methods

The study included 21 patients with CoA (median age: 15 years [8–39]) and 21 healthy individuals matched by age and gender. Clinical and echocardiographic evaluations were performed 1 day before, 6 months, and 1 year after stenting. Correlations between LV GLS and arm‐leg gradient, isthmus gradient on echocardiogram, age at intervention, left ventricular mass, and ejection fraction were tested.

Results

Before treatment, patients with CoA had lower LV GLS than the control group (−18.4% ± 1.96 vs −21.5% ± 1.37; P < .01), showing significant increase to −19.4% ± 2.1 at 6 months and −20.7% ± 2.19 at 1 year, P < .001. Only 28.5% (6 patients) had preserved GLS before treatment, improving to 80.9% (17 patients) in 1 year. The only variable correlated with low LV GLS values before treatment was age at intervention (Spearman's index = −0.571; P = .007).

Conclusion

Percutaneous therapy showed significant LV GLS improvement 12 months after aortic stenting. Older patients have lower GLS, suggesting that early intervention may have positive effects on preservation of LV systolic function.
The external wealth of Arab nations: Structure, trends, and policy implications
Authors: Mohieldin Mahmoud , Rostom Ahmed , Zaki Chahir
Published: November 2020

The paper makes two contributions. First, it analyzes net foreign assets (NFA) and liabilities in selected Arab countries. Second, the paper examines the effects of policy variables that affect the accumulation of NFA and its components, analyzing how the existence of a sovereign wealth fund (SWF), the country's exchange rate regime, and the development of its financial system affect its NFA. The main findings show that the presence of a SWF is positively and significantly associated with foreign direct investment in Arab countries. While financial development matters, intermediate exchange rate regimes are associated to more uncertainty compared to fixed or flexible ones. Our results remain robust even we control for the endogeneity between SWF and NFA components.
The Call for Intellectual Diversity on Campuses and the Problem of Willful Ignorance
Authors: Applebaum Barbara
Published: November 2020

Abstract

The call for intellectual diversity on college campuses reemerges every few years, fueled by objections to the political imbalance or the liberal slant that conservative commentators claim is characteristic of higher education today. In this article, Barbara Applebaum sets out to add to the debate around intellectual diversity in higher education by addressing it through the lens of epistemic injustice, in general, and, more specifically, willful ignorance. She begins by summarizing the scholarship around epistemic injustice and then provides conceptual resources that are popular on social media to help explain the experience of marginalized knowers. Next, Applebaum demonstrates that unless willful ignorance is taken seriously, these conceptual resources remain unintelligible to dominantly situated knowers. She follows this with a review of some of the scholarship on epistemic injustice and the remedies for this problem proposed in it. Through applying insights gleaned from this scholarship to the call for intellectual diversity, Applebaum concludes that if the call for intellectual diversity is to lead to greater understanding among those who disagree on issues of injustice, it is necessary to confront the problem of willful ignorance in a serious and sustained way.
A Problem with the Bookmark Procedure's Correction for Guessing
Authors: Baldwin Peter
Published: November 2020

In the Bookmark standard‐setting procedure, panelists are instructed to consider what examinees know rather than what they might attain by guessing; however, because examinees sometimes do guess, the procedure includes a correction for guessing. Like other corrections for guessing, the Bookmark's correction assumes that examinees either know the correct answer or guess. It is widely known that this assumption is not typically met in practice and while there may be applications that are robust to its violation, the Bookmark procedure is not one of them. Analytical results show that when this assumption is not met, the Bookmark procedure overcorrects and expected cut score estimates will be too high (stringent).
Self‐rated oral health and frailty index among older Americans
Authors: Hakeem Faisal F. , Bernabé Eduardo , Sabbah Wael
Published: November 2020

Objective

To assess the association between self‐rated oral health and frailty index among older American adults aged 60 years and over.

Materials and methods

Data from the National Health and Nutrition and Examination Survey from 2011 to 2014 were used. Self‐rated oral health was assessed based on a single question “rate the health of your teeth and gum”. A frailty index of 49‐items covering multiple systems was created. Age, gender, ethnicity, poverty‐income ratio, education, poor nutritional intake and smoking were used as covariates. Weighted negative binomial regression was used to test the association between self‐rated oral health and frailty index adjusting for the covariates.

Results

A dose response relationship was observed between self‐rated oral health and frailty index. The rate ratios (RR) of frailty index were 1.03 (95% CI 0.95‐1.13), 1.15 (95% CI 1.05‐1.25), 1.30 (95% CI 1.17‐1.45) and 1.41(95% CI 1.28‐1.54) for participants who rated their oral health very good, good, fair or poor, respectively, compared with those who rated their oral health excellent after adjusting for covariates.

Conclusion

Poorer self‐rated oral health is associated with higher rates of frailty index. This highlights the importance of oral health as a predictor of frailty and the adequacy of using self‐rated oral health in health surveys and clinical practices when conducting a comprehensive clinical oral examination is not feasible.
DEATHS FROM RENAL FAILURE IN ABUSERS OF PHENACETIN‐CONTAINING DRUGS
Authors: Nordenfelt Olof
Published: November 2020

Since Feb. 1961 all phenacetin‐ and paracetamol‐conlaining drugs have in Sweden been subject to prescription and thus less easily obtained. In 1961 a report has been published on the abusers of phenacetin‐containing drugs who had died of uraemia at the Medical department of the Central County Hospital in Jönköping between the years 1954–1960. As a direct continuation the present study has been made of 208 patients, 146 men and 62 women, who died of uraemia in 1960–1970. Among them, 64 men and 22 women were very certainly heavy abusers of phenacetin‐containing analgesics. Although phenacetin had been subject to prescription, the deaths of abusers did not decrease but were even doubled in 1966 (13 patients). In 1968 there was a clear regress and in 1970 there were only 3 deaths. A comparison between the two studies shows no changes in either clinical symptoms or patho‐anatomical alterations of the kidneys. The male predominance (unlike all other investigations) is due to the severe abuse among the male workers at a factory in Huskvarna. On microscopic examination it is verified that the most common findings are contraction with chronic interstitial nephritis, tubular damage, especially in the lower nephrons, and papillary necrosis or necrobiosis. The present study confirms the risk of renal damage and ensuing fatal uraemia from daily, protracted abuse of phenacetin‐containing analgesics. It also appears that, although the drug consumption was interrupted, fatal uraemia could develop seven to eight years later. In this study no support has been obtained for the view that bacterial infection is required for the development of renal damage in abusers of analgesics. The fact that Huskvarna workers are now abusing the powder containing 0.50 g phenazone and 0.10 g caffeine, and that during the last few years the number of deaths from uraemia among them has decreased, supports the opinion that this powder does not lead to kidney damage.
DIABETES MELLITUS AND DEFECTIVE PITUITARY RESERVE CAPACITY
Authors: Hedner Pavo
Published: November 2020

A case of diabetes mellitus with an incomplete Sheehan's syndrome, consisting of an almost complete loss of pituitary reserve capacity while the basal pituitary function seemed to remain unaffected, is presented. Menstruations were regular and basal plasma levels of cortisol, FSH, LH, and PBI were normal. There were no characteristic symptoms except for an extreme insulin sensitivity, so without the diabetes the patient's partial pituitary insufficiency may well have remained undetected. The present case illustrates that severe pituitary damage can take place without characteristic symptoms, causing a potentially dangerous state for the patient in a stressful situation, e.g. an operation. Some of the non‐specific symptoms in the present case (tiredness, weight loss) were relieved by substitution therapy.
ANTIBODIES TO THE EPSTEIN‐BARR VIRUS IN KIDNEY TRANSPLANT RECIPIENTS
Authors: Spencer Edwin S. , Andersen Hans K.
Published: November 2020

Changes in antibody titer against the Epstein‐Barr virus (EBV), the apparent cause of infectious mononucleosis, have been surveyed in 30 patients, randomly selected from kidney transplant recipients in Aarhus during the last five years. Sera taken at transplantation and at approximately 1, 2, 3 and 5 to 12 months post‐transplant were examined for antibodies against EBV using an indirect immunofluorescence technique with EB‐3 cells. Anti‐EBV antibody, and thereby evidence of past infection, was found in all but one set of sera. In three patients a significant, fourfold, rise in antibody titer was observed. One, a man of 31, had a transient illness with fever, sore throat and enlarged lymph nodes in association with antibody changes; another, a girl of 18, had two snort febrile periods of unexplained etiology; the third. a girl of 11, had no recorded symptoms.
CENTRAL HAEMODYNAMIC EFFECTS OF DIHYDROERGOTAMINE IN PATIENTS WITH ORTHOSTATIC HYPOTENSION
Authors: Nordenfelt Ivar , Mellander Stefan
Published: November 2020

The effects of dihydroergotamine (DHE) on heart rate, cardiac output, stroke volume, arterial and central venous pressures, systemic resistance, and central blood volume have been analysed in ten patients suffering from orthostatic hypotension. The patients were placed on a tilt‐table and studied in the supine as well as in the erect body position. In the supine position DHE caused a significant increase of cardiac output, stroke volume, arterial systolic and mean pressures, and central venous pressure. In the erect position DHE raised cardiac output, stroke volume, and central blood volume, and lowered heart rate. Systemic resistance was unaltered by the drug. The effects of DHE on the central circulation can largely be explained by its powerful and relatively selective constrictor action on the capacitance vessels in the peripheral circulation. The results indicate that DHE can have beneficial effects in patients with orthostatic hypotension.
ADIPOSE TISSUE CELLULARITY IN MATURITY ONSET DIABETES MELLITUS
Authors: Björntorp Per , Jonsson Anders , Berchtold Peter
Published: November 2020

Adipose tissue fat content and cellularity have been analysed in relation to glucose metabolism, plasma insulin and serum lipids in 24 patients with recently diagnosed maturity onset diabetes mellitus. Randomly selected middle‐aged men and women served as controls. The diabetic patients were characterized by an impaired glucose tolerance with insufficient although to some extent remaining insulin secretion. Plasma cholesterol was not different from controls, while plasma triglyceride was elevated. Adipose tissue variables were different only in the men, who had somewhat more body fat than the control men. Most of the diabetic patients had lost weight recently before their diabetes was diagnosed. With the assumption that reduction of body fat made a considerable contribution to this weight loss it could be presumed that maturity onset diabetes, when it manifests itself clinically, is characterized by enlarged fat cells. It was suggested that the main difference between maturity onset diabetes mellitus and endogenous hypcrtriglyceridemia is a higher remaining insulin secretion in the latter.
DIFFERENT SERUM INSULIN PATTERNS IN PORTAL, HEPATIC AND PERIPHERAL VENOUS BLOOD IN TWO CASES OF INSULOMA
Authors: Erwald R. , Hed R. , Marions O. , Nandorf R. , Nygren A. , Röjdmark S. , Sundblad L. , Wiechel K.‐L.
Published: November 2020

Insulin secretion has been studied in two cases of insuloma. In one of them neither fasting hyperinsulinemia nor excessive insulin release in response to glucose ingestion or tolbutamide administration could be demonstrated. This patient belonged to a family in which pronounced insulin responsiveness was observed. In the other case, with hypoglycemic attacks and hyperinsulinemia following β‐cell stimulation, a higher insulin level was observed in hepatic venous blood than in portal blood, indicating extrapancreatic insulin‐producing tissue.
HEMODYNAMIC EFFECTS OF METHOXAMINE IN PATIENTS WITH LEFT‐TO‐RIGHT SHUNTS
Authors: Abrahamsen Arne M. , Grendahl Helge , Müller Carsten
Published: November 2020

In nine patients with atrial septal defect (ASD), five with ventricular septal defect (VSD) and one with persistent ductus arteriosus (PDA) hemodynamic examinations have been performed before and after injection of the vasopressor agent methoxamine. On an average 8 mg methoxamine was injected into the pulmonary artery. An insignificant increase of the left‐to‐right shunt was observed. Significant changes were decrease of heart rate, increase of systemic systolic pressure, mean pulmonary capillary wedge pressure and arteriovenous O2‐difference. Stroke volume and systemic arteriolar resistance increased, and these changes were significant in ASD, insignificant in VSD. The rise in pulmonary arterial mean pressure and oxygen consumption, reduction in cardiac output and pulmonary arteriolar resistance were insignificant.