bluuebunny/crossref_metadata_2025 huggingface dataset:
Ankyrin-G Regulates Forebrain Connectivity and Network Synchronization via Interaction with GABARAP
Authors: Nelson AD , Caballero-Florán RN , Rodríguez Díaz JC , Li J , Chen K , Walder KK , Bennett V , Lopez-Santiago LF , McInnis MG , Isom LL , Wang C , Zhang M , Jones KS , Jenkins PM
Published: April 2018

GABAergic circuits are critical for the synchronization and higher order function of brain networks, and defects in this circuitry are linked to neuropsychiatric diseases, including bipolar disorder, schizophrenia, and autism. Work in cultured neurons has shown that ankyrin-G plays a key role in the regulation of GABAergic synapses on the axon initial segment and somatodendritic domain of pyramidal neurons where it interacts directly with the GABAA receptor associated protein (GABARAP) to stabilize cell surface GABAA receptors. Here, we generated a knock-in mouse model expressing a mutation that abolishes the ankyrin-G/GABARAP interaction (Ank3 W1989R) to understand how ankyrin-G and GABARAP regulate GABAergic circuitry in vivo. We found that Ank3 W1989R mice exhibit a striking reduction in forebrain GABAergic synapses resulting in pyramidal cell hyperexcitability and disruptions in network synchronization. In addition, we identified changes in pyramidal cell dendritic spines and axon initial segments consistent with compensation for hyperexcitability. Finally, we identified the ANK3 W1989R variant in a family with bipolar disorder, suggesting a potential role of this variant in disease. Our results highlight the importance of ankyrin-G in regulating forebrain circuitry and provide novel insights into how ANK3 loss-of-function variants may contribute to human disease.
Development of an X-ray imaging system to prevent scintillator degradation for white synchrotron radiation
Authors: Zhou Tunhe , Wang Hongchang , Connolley Thomas , Scott Steward , Baker Nick , Sawhney Kawal
Published: April 2018

The high flux of the white X-ray beams from third-generation synchrotron light sources can significantly benefit the development of high-speed X-ray imaging, but can also bring technical challenges to existing X-ray imaging systems. One prevalent problem is that the image quality deteriorates because of dust particles accumulating on the scintillator screen during exposure to intense X-ray radiation. Here, this problem has been solved by embedding the scintillator in a flowing inert-gas environment. It is also shown that the detector maintains the quality of the captured images even after days of X-ray exposure. This modification is cost-efficient and easy to implement. Representative examples of applications using the X-ray imaging system are also provided, including fast tomography and multimodal phase-contrast imaging for biomedical and geological samples.
Investigation of the multiplet features of SrTiO3in X-ray absorption spectra based on configuration interaction calculations
Authors: Wu M. , Xin Houlin L. , Wang J. O. , Li X. J. , Yuan X. B. , Zeng H. , Zheng J.-C. , Wang H.-Q.
Published: April 2018

Synchrotron-basedL2,3-edge absorption spectra show strong sensitivities to the local electronic structure and chemical environment. However, detailed physical information cannot be extracted easily without computational aids. Here, using the experimental TiL2,3-edges absorption spectrum of SrTiO3as a fingerprint and considering full multiplet effects, calculations yield different energy parameters characterizing local ground state properties. The peak splitting and intensity ratios of theL3andL2set of peaks are carefully analyzed quantitatively, giving rise to a small hybridization energy around 1.2 eV, and the different hybridization energy values reported in the literature are further addressed. Finally, absorption spectra with different linearly polarized photons under various tetragonal crystal fields are investigated, revealing a non-linear orbital–lattice interaction, and a theoretical guidance for material engineering of SrTiO3-based thin films and heterostructures is offered. Detailed analysis of spectrum shifts with different tetragonal crystal fields suggests that theegcrystal field splitting is a necessary parameter for a thorough analysis of the spectra, even though it is not relevant for the ground state properties.
Wavelet processing and digital interferometric contrast to improve reconstructions from X-ray Gabor holograms
Authors: Aguilar Juan C. , Misawa Masaki , Matsuda Kiyofumi , Suzuki Yoshio , Takeuchi Akihisa , Yasumoto Masato
Published: April 2018

In this work, the application of an undecimated wavelet transformation together with digital interferometric contrast to improve the resulting reconstructions in a digital hard X-ray Gabor holographic microscope is shown. Specifically, the starlet transform is used together with digital Zernike contrast. With this contrast, the results show that only a small set of scales from the hologram are, in effect, useful, and it is possible to enhance the details of the reconstruction.
Characterization of the surface contamination of deep X-ray lithography mirrors exposed to synchrotron radiation
Authors: Achenbach Sven , Wells Garth , Shen Chen
Published: April 2018

In deep X-ray lithography (DXRL), synchrotron radiation is applied to pattern polymer microstructures. At the Synchrotron Laboratory for Micro and Nano Devices (SyLMAND), Canadian Light Source, a chromium-coated grazing-incidence X-ray double-mirror system is applied as a tunable low-pass filter. In a systematic study, the surface conditions of the two mirrors are analyzed to determine the mirror reflectivity for DXRL process optimization, without the need for spectral analysis or surface probing: PMMA resist foils were homogeneously exposed and developed to determine development rates for mirror angles between 6 mrad and 12 mrad as well as for white light in the absence of the mirrors. Development rates cover almost five orders of magnitude for nominal exposure dose (deposited energy per volume) values of 1 kJ cm−3to 6 kJ cm−3. The rates vary from case to case, indicating that the actual mirror reflectivity deviates from that of clean chromium assumed for the experiments. Fitting the mirror-based development rates to the white-light case as a reference, reflectivity correction factors are identified, and verified by experimental and numerical results of beam calorimetry. The correction factors are related to possible combinations of a varied chromium density, chromium oxidation and a carbon contamination layer. The best fit for all angles is obtained assuming 7.19 g cm−3nominal chromium density, 0.5 nm roughness for all involved layers, and an oxide layer thickness of 25 nm with a carbon top coat of 50 nm to 100 nm. A simulation tool for DXRL exposure parameters was developed to verify that the development rates for all cases do coincide within a small error margin (achieving a reduction of the observed errors by more than two orders of magnitude) if the identified mirror surface conditions are considered when calculating the exposure dose.
Policy compliance of SGB members on their financial management roles in selected no-fee schools in Limpopo province of South Africa
Authors: Dibete Kgabo Johannes , Potokri Onoriode Collins
Published: April 2018

Purpose

The purpose of this paper is to investigate the perceptions of school governing bodies (SGBs) members’ role in financial management in no-fee schools so as to understand their compliance with policy frameworks when managing school finances. No-fee schools are schools in which the learners cannot be levied fees because of the poor socio-economic background of their parents, and are located in Quintiles 1-3 according to National Norms and Standards for School Funding Policy.

Design/methodology/approach

A qualitative research design/approach within the interpretive paradigm was adopted for the study. A sample of 22 participants from six selected no-fee schools was purposefully selected to participate in the study. The participants were principals, SGB chairpersons, SGB treasurers and finance officers. Data were collected through interviews and document analyses and were qualitatively analysed through coding and categorisation.

Findings

The findings reveal that the perceptions, experience and understanding of SGB members on their financial management roles differ. They lacked the proper knowledge to manage their funds effectively. This lack of knowledge is mainly because of the members’ literacy level and limited training.

Originality/value

This study offers a novel empirical and theoretical perspective on finance of no-fee schools and SGBs. This research subsequently recommends that rigorous training of chairpersons and treasurers should be done by department officials located in the finance section. Further, training should be conducted in a language that would be understood by the intended recipients.
Tacit knowledge-sharing behavior among the academic staff
Authors: Rahman Muhammad Sabbir , Mannan Mahafuz , Hossain Md Afnan , Zaman Mahmud Habib , Hassan Hasliza
Published: April 2018

Purpose

The purpose of this paper is to examine the critical success factor of tacit knowledge-sharing behavior among the academic staff of higher learning institutions.

Design/methodology/approach

A total of 200 questionnaires were distributed among the academic staff of higher learning institutions in Bangladesh. Collectively, 150 usable responses were returned. Apart from descriptive statistics, this research applied confirmatory factor analysis (CFA) and structural equation modeling (SEM) to assess the measurement model and test the research hypotheses.

Findings

The findings from this empirical examination show that all the Big Five personality traits affect tacit knowledge-sharing behavior among the academic staff of higher learning institutions, except conscientiousness personality trait. However, the role of motivation, self-efficacy and mutual trust are also playing a significant role in tacit knowledge-sharing behavior. The CFA, SEM analysis confirmed the proposed conceptual model with a good model fit.

Research limitations/implications

The findings of this research contribute to the understanding of the role of personality traits and other antecedents which play a significant role for the academic staff tacit knowledge-sharing behavior which are interesting for policymakers and authorities of higher learning institutions. As there was no sampling frame, the researchers applied convenient sampling technique in choosing the respondents.

Originality/value

This research plays a pioneering role where it contributes to the growing literature on the relationships between personality traits and other factors to construct a model for the tacit knowledge behavior by considering academic staff of higher learning institutions from a developing country’s perspective.
Professional identity of school teachers in the context of socio-historical dynamics of Russian society
Authors: Klimenko Ludmila , Posukhova Oxana
Published: April 2018

Purpose

The purpose of this paper is to describe the specific nature of school teacher’s professional identity in the context of its stability maintenance in the Soviet and modern periods of Russian society development.

Design/methodology/approach

A total of 618 teachers of state comprehensive secondary schools were interviewed with a standardized questionnaire. The survey was divided into four semantic blocks: analyzing how teachers percept their own socio-economic situation; studying the structure of teacher’s social identity and determining the significance of professional identity; determining the nature of teacher’s motivation and professional values; and assessing the degree of labor precariatization.

Findings

This paper shows that a school teacher job had public prestige, social-labor and material guarantees, as well as ideological support from the state in the Soviet Russia. The excessive administrative burden, high social demands for teacher’s performance in the context of deteriorating economic situation in the country create risks for positive professional identity of teachers and, as a consequence, for societal integrity.

Originality/value

This study is relevant as it provides empirical measurements and substantiates macro-social effects of teacher’s professional identity. The excessive administrative load and high social demands for teacher’s performance in the context of deteriorating economic situation in the country create risks for maintaining the positive professional identity of teachers and, as a consequence, for societal integrity.
Classifying elements of a typology of gated communities
Authors: La Grange Adrienne
Published: April 2018

Purpose

This paper aims to classify major elements in a typology of gated communities and develop a framework that can be used to promote international comparison of this built form.

Design/methodology/approach

The paper draws on a survey of 77 gated housing estates in Hong Kong and interviews with major stakeholders to develop and order a classification of elements of a typology of gated communities. Principle component analysis and regression analysis are used in conjunction with insights from 20 in-depth and about 70 open-ended face-to-face interviews.

Findings

This paper explores Hong Kong’s gated communities to evaluate the relationships between the four main elements of a typology of gated communities: supply, demand, features of gated estates and characteristics of built form. It is suggested that there is a hierarchical relationship between the elements, i.e. supply and demand are higher-order elements and features of gated housing and characteristics of the housing stock are lower-order elements. The paper additionally highlights the impact of definitional and conceptual drift in key concepts, such as security, privacy, prestige and lifestyle, on developing robust typologies.

Originality/value

The paper reviews the many and varied typologies of gated communities in the international literature, classifies the elements into four main groups and posits a hierarchical relationship between these elements. This paper proposes a robust methodology for further comparative research into gated communities.
Accountable care organizations: a strategy for future success?
Authors: Harrison Jeffrey , Spaulding Aaron , Harrison Debra A.
Published: April 2018

Purpose

The purpose of this paper is to assess the community dynamics and organizational characteristics of US hospitals that participate in accountable care organizations (ACO).

Design/methodology/approach

Data were obtained from the 2015 American Hospital Association annual survey and the 2015 medicare final rule standardizing file. The study evaluated 785 hospitals which operate ACO in contrast to 1,446 hospitals without an ACO.

Findings

In total, 89 percent of hospitals using ACO’s are located in urban communities and 87 percent are not-for-profit. Hospitals with a higher case mix index are more likely to have an ACO.

Practical implications

ACOs allow healthcare organizations to expand their geographic markets, achieve greater efficiencies, and enhance the development of new clinical services. They also shift the focus of care from acute care hospitalization to the full continuum of care.

Originality/value

This research found ACOs with hospital and physician networks are an effective mechanism to control healthcare costs and reduce medical errors.
Impact of health sector reforms on hospital productivity in Turkey
Authors: Mollahaliloglu Saleh , Kavuncubasi Sahin , Yilmaz Fikriye , Younis Mustafa Z. , Simsek Fatih , Kostak Mustafa , Yildirim Selami , Nwagwu Emeka
Published: April 2018

Purpose

Turkish Ministry of Health (MoH) has Health Transformation Program (HTP). The purpose of this program has been to modify the structure of the current system in order to enhance health system productivity, quality, and access in the Turkish health system. The paper aims to discuss these issues.

Design/methodology/approach

To measure the productivity, a data envelopment analysis-based Malmquist index approach was employed.

Findings

Results showed that the overall HTP have had a considerable positive impact on the productivity of general hospitals.

Research limitations/implications

The limitation is the availability of some data that might not be collected or reported to the MoH in Turkey.

Practical implications

This research’s findings will have an impact on reforming the health care system in Turkey to be competitive and efficient as possible.

Social implications

The research will have implication on reducing cost and provide value to the Turkish population.

Originality/value

This is one of the very few articles that targeted the efficiency of hospital system in Turkey.
The importance of urban rainwater harvesting in circular economy: the case of Guadalajara city
Authors: Gleason Espíndola José Arturo , Cordova Fernando , Casiano Flores Cesar
Published: April 2018

Purpose

This paper aims to associate two fields of research: circular economy and the restoration of water cycle through the implementation of rainwater catchment systems in urban zones.

Design/methodology/approach

This study considers the case of the metropolitan zone of Guadalajara, México. This urban concentration is the second largest in Mexico. It faces floods each year with a cost of over US$26m, while demand of water has a production cost over US$24m. At the same time, the aquifers are drying due to uncontrolled urbanization and increasing the impervious area over the recharge zones. In addition, rainwater is combined with wastewater, elevating the cost of the wastewater treatment because the amount and quality of water to treat exceeds the systems’ capacity. This situation causes floods and decreases the availability of ground water. These problems are reflected in the imbalance of parameters of water cycle and a new approach is needed. The circular economy model can help to preserve one of our most vital resources. Scarcity is already so pronounced that we cannot reach many of our desired economic, social and environmental goals. Technologies that help balance supply and demand can also help water (both stock and flow) to become part of a circular model. To prove this, the authors present a hypothetical scenario based on a pilot project and a basin modeling of Guadalajara, Mexico.

Findings

Through this paper, it is possible to demonstrate that rainwater harvesting can play an important role in circular economy. Using the rainwater catchment systems, the cost of damages caused by floods could be decreased, the demand of water could be reduced, cost of production can be reduced, the aquifers can be recharged and the wastewater treatments can be improved.

Originality/value

Few papers have been developed to associate two fields of research (circular economy and the restoration of water cycle), using rainwater catchment systems as the central element.
Group structural elements in e-Government strategy formulation at local municipal level in South Africa
Authors: Osah Joshua , Khene Caroline
Published: April 2018

Purpose

This study aims to identify group structural elements that should be assessed in e-Government strategy formulation processes at local government level for service delivery in South Africa. These elements influence the success or effectiveness of the strategy formulation process.

Design/methodology/approach

The theoretical framework of group structural elements by Asplund and nine other strategy formulation-related approaches are reflected upon. Weick’s approach of theory development is used to guide the theoretical analysis. A pragmatic approach is applied to conduct the empirical investigation using a case study of a digital citizen engagement project in South Africa.

Findings

The paper highlights the following group elements that influence the strategy formulation process: group member relations, degree of differentiation within the group and resources of the group. Not addressing these structural elements may result in a lack of creativity or a reluctance to participate in the context of public sector engagement.

Research limitations/implications

The paper does not provide an exhaustive list of all aspects that necessitate assessment before and during a strategy formulation process, for example, organisational and environment structural elements.

Practical implications

Assessing group structural elements provides valuable knowledge on how to engage stakeholders in a joint problem-solving activity. This is particularly pertinent where citizen engagement is fundamental to addressing basic service delivery concerns.

Originality/value

In the South African local municipal context, there is no existing literature that discusses the need to assess group structural elements influencing the outcome of an e-Government strategy formulation process.
Diagnostic criteria, severity classification and guidelines of localized scleroderma
Authors: Asano Yoshihide , Fujimoto Manabu , Ishikawa Osamu , Sato Shinichi , Jinnin Masatoshi , Takehara Kazuhiko , Hasegawa Minoru , Yamamoto Toshiyuki , Ihn Hironobu
Published: April 2018

We established diagnostic criteria and severity classification of localized scleroderma because there is no established diagnostic criteria or widely accepted severity classification of the disease. Also, there has been no clinical guideline for localized scleroderma, so we established its clinical guideline ahead of all over the world. In particular, the clinical guideline was established by clinical questions based on evidence‐based medicine according to the New Minds Clinical Practice Guideline Creation Manual (version 1.0). We aimed to make the guideline easy to use and reliable based on the newest evidence, and to present guidance as specific as possible for various clinical problems in treatment of localized scleroderma.
A host–parasite model explains variation in liana infestation among co‐occurring tree species
Authors: Visser Marco D. , Muller‐Landau Helene C. , Schnitzer Stefan A. , de Kroon Hans , Jongejans Eelke , Wright S. Joseph
Published: April 2018

Lianas are structural parasites of trees that reduce the growth, survival and reproduction of their hosts. Given that co‐occurring tree species differ strongly in the proportion of individuals that are infested by lianas (liana prevalence), lianas could differentially impact tree species and thereby influence tree community composition. Surprisingly, little is known about what governs variation in liana prevalence.

Here, we apply an approach inspired by disease ecology to investigate the dynamics of liana prevalence over 11 years on Barro Colorado Island, Panama. We followed the fate of 1,938 individual trees from 21 tree species, recording deaths and change in liana infestation status. With these data, we fit species‐specific Markov chain models to estimate four rates: colonization by lianas (analogous to disease transmission), shedding or loss of lianas (analogous to host recovery), baseline mortality of uninfested trees (baseline mortality) and additional mortality of infested trees (parasite lethality).

Models explained 58% of variation in liana prevalence among tree species, and revealed that host shedding of lianas and parasite lethality were the most important contributors to interspecific variation in liana prevalence at our site. These rates were also strongly related to shade tolerance, with light‐demanding species having greater rates of shedding and lethality, and lower rates of liana prevalence. An indirect path analysis with a structural equation model revealed that both greater rates of liana shedding and liana‐induced lethality contribute to the observed lower rates of liana prevalence for light‐demanding tree species.

Synthesis. Our approach revealed that the prevalence of liana infestation among tree species is driven via indirect pathways operating on the rates of shedding and lethality, which relate to the ability (or inability) of trees to shed and/or tolerate lianas. Shade‐tolerant trees have greater proportions of trees infested by lianas because they are both less able to shed lianas and more able to tolerate infestation.
Global diversity and distribution of close relatives of apicomplexan parasites
Authors: Mathur Varsha , del Campo Javier , Kolisko Martin , Keeling Patrick J.
Published: April 2018

Apicomplexans are a group of obligate intracellular parasites, but their retention of a relict non‐photosynthetic plastid reveals that they evolved from free‐living photosynthetic ancestors. The closest relatives of apicomplexans include photosynthetic chromerid algae (e.g., Chromera and Vitrella), non‐photosynthetic colpodellid predators (e.g., Colpodella) and several environmental clades collectively called Apicomplexan‐Related Lineages (ARLs). Here we investigate the global distribution and inferred ecology of the ARLs by expansively searching for apicomplexan‐related plastid small ribosomal subunit (SSU) genes in large‐scale high‐throughput bacterial amplicon surveys. Searching more than 220 million sequences from 224 geographical sites worldwide revealed 94 324 ARL plastid SSU sequences. Meta‐analyses confirm that all ARLs are coral reef associated and not to marine environments generally, but only a subset is actually associated with coral itself. Most unexpectedly, Chromera was found exclusively in coral biogenous sediments, and not within coral tissue, indicating that it is not a coral symbiont, as typically thought. In contrast, ARL‐V is the most diverse, geographically widespread and abundant of all ARL clades and is strictly associated with coral tissue and mucus. ARL‐V was found in 19 coral species in reefs, including azooxanthellate corals at depths greater than 500 m. We suggest this is indicative of a parasitic or commensal relationship, and not of photosynthetic symbiosis, further underscoring the importance of isolating ARL‐V and determining its relationship with the coral host.
Diversity of herbaceous plants and bacterial communities regulates soil resistome across forest biomes
Authors: Hu Hang‐Wei , Wang Jun‐Tao , Singh Brajesh K. , Liu Yu‐Rong , Chen Yong‐Liang , Zhang Yu‐Jing , He Ji‐Zheng
Published: April 2018

Antibiotic resistance is ancient and prevalent in natural ecosystems and evolved long before the utilization of synthetic antibiotics started, but factors influencing the large‐scale distribution patterns of natural antibiotic resistance genes (ARGs) remain largely unknown. Here, a large‐scale investigation over 4000 km was performed to profile soil ARGs, plant communities and bacterial communities from 300 quadrats across five forest biomes with minimal human impact. We detected diverse and abundant ARGs in forests, including over 160 genes conferring resistance to eight major categories of antibiotics. The diversity of ARGs was strongly and positively correlated with the diversity of bacteria, herbaceous plants and mobile genetic elements (MGEs). The ARG composition was strongly correlated with the taxonomic structure of bacteria and herbs. Consistent with this strong correlation, structural equation modelling demonstrated that the positive effects of bacterial and herb communities on ARG patterns were maintained even when simultaneously accounting for multiple drivers (climate, spatial predictors and edaphic factors). These findings suggest a paradigm that the interactions between aboveground and belowground communities shape the large‐scale distribution of soil resistomes, providing new knowledge for tackling the emerging environmental antibiotic resistance.
Genome plasticity in response to stress inTetrahymena thermophila: selective and reversible chromosome amplification and paralogous expansion of metallothionein genes
Authors: de Francisco Patricia , Martín‐González Ana , Turkewitz Aaron P. , Gutiérrez Juan Carlos
Published: April 2018

Extreme stress situations can induce genetic variations including genome reorganization. In ciliates likeTetrahymena thermophila, the approximately 45‐fold ploidy of the somatic macronucleus may enable adaptive responses that depend on genome plasticity. To identify potential genome‐level adaptations related to metal toxicity, we isolated threeTetrahymena thermophilastrains after an extended adaptation period to extreme metal concentrations (Cd2+, Cu2+or Pb2+). In the Cd‐adapted strain, we found a approximately five‐fold copy number increase of three genes located in the same macronuclear chromosome, including two metallothionein genes,MTT1andMTT3. The apparent amplification of this macronuclear chromosome was reversible and reproducible, depending on the presence of environmental metal. We also analysed three knockout (KO) and/or knockdown (KD) strains forMTT1 and/or MTT5. In the MTT5KD strain, we found at least two new genes arising from paralogous expansion ofMTT1, which encode truncated variants ofMTT1. The expansion can be explained by a model based on somatic recombination betweenMTT1genes on pairs of macronuclear chromosomes. At least two of the new paralogs are transcribed and upregulated in response to Cd2+. Altogether, we have thus identified two distinct mechanisms, both involving genomic plasticity in the polyploid macronucleus that may represent adaptive responses to metal‐related stress.
Laparoscopic radical cystectomy with intracorporeal ileal conduit diversion: Modified techniques and long‐term outcomes
Authors: Xu Yujie , Pan Feng , Liu Dong , Yang Xiong , Li Shuqiang , Zhang Qijun , Li Bing
Published: April 2018

Aim

The aim of the present study was to assess the efficacy and long‐term outcomes of laparoscopic radical cystectomy (LRC) with ileal conduit urinary diversion for organ‐confined bladder carcinoma, undertaken intracorporeally using our modified techniques.

Patients and Methods

Seven male patients underwent LRC with intracorporeal ileal conduit diversion only using pure laparoscopic techniques.

Results

All procedures were completed without open conversion or intraoperative complications. The surgical margins of the specimens were negative in all patients. The mean duration of surgery was 7 h (range: 6–8.5), the mean blood loss was 420 mL (range: 330–750) and the mean postoperative hospital stay was 9 days (range: 7–15). At a mean follow up of 44 months (range: 36–49), one patient developed intestinal obstruction requiring an operation after 32 months. Another developed local oncological recurrence in the posterior urethra. One patient had bilateral inguinal lymphatic metastases, and another had hydronephrosis of the right kidney without symptoms. These complications and oncological recurrences were all found after 2 years. No patient has port site metastases and distant metastases to date.

Conclusions

LRC with ileal conduit diversion undertaken completely intracorporeally is a safe and feasible option for organ‐confined bladder carcinoma. Our modified techniques are helpful to simplify the procedure.
Lymphoma of the sphenoid sinus presenting as abducens nerve palsy in a child
Authors: Stepan Lia , Shaw Chi‐Kee Leslie
Published: April 2018

Primary sphenoid sinus malignancy with abducens nerve palsy is rare in the paediatric population. We report the first case of bilateral isolated abducens nerve palsy secondary to primary T‐cell anaplastic lymphoma of the sphenoid sinus in the absence of radiological evidence of bony destruction or malignant invasion in an 8‐year‐old boy. This case highlights the importance of understanding surgical anatomy of the sphenoid sinuses and cavernous sinuses, and to maintain a high index of suspicion when a patient is presented with simultaneous palsy of any of the cranial nerves within the cavernous sinus and sphenoid sinus disease, despite possible disparities between clinical features and radiological findings. Prompt surgical exploration and biopsy of sphenoid sinus is imperative to establish the diagnosis and to initiate treatment in order to avoid further progression of disease or other complications.
Merkel cell carcinoma of the tongue base
Authors: Luk Tat‐Lam , Lam Wai‐Hung , Ngai Chi‐Man
Published: April 2018

Merkel cell carcinoma (MCC) is a rare but very aggressive tumour of neuroendocrine origin, usually seen in sun‐exposed parts of the body. Very few cases of MCC in the oral cavity have been reported. A new MCC case in the tongue base was reported in our hospital. Prompt diagnosis and early robotic surgery successfully removed the tumour with a clear margin for an early‐stage tumour.
The use of glucocorticoid hormones or leucocyte profiles to measure stress in vertebrates: What’s the difference?
Authors: Davis Andrew K. , Maney Donna L.
Published: April 2018

Measuring stress in animals is important in many ecological, zoological and veterinary research settings. A common method is to measure plasma levels of glucocorticoid hormones (cortisol, corticosterone, hereafter CORT). Over the past decade, an alternative method has become widely popular: assessing leucocyte profiles; in other words, the heterophil‐to‐lymphocyte ratio (H/L) in birds and reptiles or the neutrophil‐to‐lymphocyte ratio (N/L) in mammals, amphibians and fish. Recent studies have shown that although both indices reliably change after acute stress, they are not always correlated at baseline, and thus are not interchangeable. This lack of correlation has led to some confusion about which of these two measures is “better”; in other words, more biologically relevant and a truer readout of stress.

In this review, we first document the dramatic expansion of the use of leucocyte profiles to assess stress over the past decade. We then review published evidence that may explain the discrepancies between leucocyte profiles and plasma CORT. We argue that these discrepancies stem from the nature of the stress reaction and the role of corticosterone (or cortisol) versus leucocytes during the stress response.

The differing roles of the two responses translate to differences in the timing of each, which is important for researchers studying either acute or chronic stress. Although plasma glucocorticoids rise within minutes of the onset of acute stress and return to baseline within 1 or 2 hr after the stressor passes, H/L or N/L ratios remain low for at least 30–60 min or sometimes more.

The temporal nature of these metrics differs also in the context of long‐term chronic stress. The glucocorticoid response wanes in repeatedly stressed animals, or those exposed to chronic environmental stress, which can often (but not always) lead to low baseline levels and more typically, an attenuated acute stress response. Meanwhile, H/L or N/L ratios appear to remain high under the same conditions.

Understanding the temporal differences in the responses should help researchers decide which metric is the better method in their particular study, or whether both would be useful for elucidating different elements of the stress response.
Evaluation of avoralstat, an oral kallikrein inhibitor, in a Phase 3 hereditary angioedema prophylaxis trial: The OPuS‐2 study
Authors: Riedl M. A. , Aygören‐Pürsün E. , Baker J. , Farkas H. , Anderson J. , Bernstein J. A. , Bouillet L. , Busse P. , Manning M. , Magerl M. , Gompels M. , Huissoon A. P. , Longhurst H. , Lumry W. , Ritchie B. , Shapiro R. , Soteres D. , Banerji A. , Cancian M. , Johnston D. T. , Craig T. J. , Launay D. , Li H. H. , Liebhaber M. , Nickel T. , Offenberger J. , Rae W. , Schrijvers R. , Triggiani M. , Wedner H. J. , Dobo S. , Cornpropst M. , Clemons D. , Fang L. , Collis P. , Sheridan W. P. , Maurer M.
Published: April 2018

Background

Effective inhibition of plasma kallikrein may have significant benefits for patients with hereditary angioedema due to deficiency of C1 inhibitor (C1‐INH‐HAE) by reducing the frequency of angioedema attacks. Avoralstat is a small molecule inhibitor of plasma kallikrein. This study (OPuS‐2) evaluated the efficacy and safety of prophylactic avoralstat 300 or 500 mg compared with placebo.

Methods

OPuS‐2 was a Phase 3, multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group study. Subjects were administered avoralstat 300 mg, avoralstat 500 mg, or placebo orally 3 times per day for 12 weeks. The primary efficacy endpoint was the angioedema attack rate based on adjudicator‐confirmed attacks.

Results

A total of 110 subjects were randomized and dosed. The least squares (LS) mean attack rates per week were 0.589, 0.675, and 0.593 for subjects receiving avoralstat 500 mg, avoralstat 300 mg, and placebo, respectively. Overall, 1 subject in each of the avoralstat groups and no subjects in the placebo group were attack‐free during the 84‐day treatment period. The LS mean duration of all confirmed attacks was 25.4, 29.4, and 31.4 hours for the avoralstat 500 mg, avoralstat 300 mg, and placebo groups, respectively. Using the Angioedema Quality of Life Questionnaire (AE‐QoL), improved QoL was observed for the avoralstat 500 mg group compared with placebo. Avoralstat was generally safe and well tolerated.

Conclusions

Although this study did not demonstrate efficacy of avoralstat in preventing angioedema attacks in C1‐INH‐HAE, it provided evidence of shortened angioedema episodes and improved QoL in the avoralstat 500 mg treatment group compared with placebo.
Total 5‐mm port approach: a feasible technique for both elective and emergency laparoscopic cholecystectomy
Authors: Bender Kyle , Lewin Joel , O’Rourke Harriet , Hugh Freya C. , O’Rourke Nicholas , Hugh Thomas J.
Published: April 2018

Background

The laparoscopic approach is considered the standard of care for cholecystectomy. Attempts to minimize incisions with single site and natural orifice approaches have shown promise but also have limitations. Technological advances have facilitated decreased port size, which may have a variety of benefits. The aim of this study was to determine the feasibility of an all 5‐mm port approach for patients undergoing both elective and emergency laparoscopic cholecystectomy.

Methods

A consecutive series of laparoscopic cholecystectomies at three different hospitals using all 5‐mm ports was prospectively evaluated. Recorded outcomes included operative findings, procedural difficulties, the need to extend the umbilical incision during extraction, operative time, length of stay and post‐operative complications.

Results

A total of 101 patients were included and all had a successful cholecystectomy without the need for additional ports. The umbilical incision was extended for gallbladder extraction in 29 (29%) patients. Eight (8%) patients experienced minor post‐operative complications and there were no major complications. Cholangiography was performed in 98% of cases and three patients underwent successful common bile duct exploration without requiring additional ports. In a small number of cases, there was difficulty with the quality of the view through the 5‐mm laparoscope but this was rectified by removing old or damaged laparoscopes from the circulating stock.

Conclusion

This study demonstrates that laparoscopic cholecystectomy using all 5‐mm ports is both feasible and safe, and is comparable to published outcomes after conventional laparoscopic cholecystectomy. Further work is needed to determine whether this approach can also improve short‐ and long‐term outcomes.
Post‐SCS Arbitration Developments and Issues on Freedom of Navigation, Rights of Coastal States, and Environmental Protection in the “Area”
Authors: Mok Lay Yong , Aai Amy Sheau Ye , Permal Sumathy
Published: April 2018

On July 12, 2016, the Arbitral Tribunal constituted under Annex VII of the 1982 United Nations Convention on the Law of the Sea issued its Award on the case concerning the Philippines and China. The award places China, the South China Sea claimants, ASEAN, and external parties at a crossroads that opens up various possibilities and challenges. It has generated considerable uncertainty, anchoring the region's future on how the various stakeholders react to the ruling. While parties to the disputes, together with ASEAN and external players, may not be able to resolve what is essentially a very complex problem, there have been numerous efforts to find new approaches and innovative solutions to untangling them. This article discusses pertinent issues on the legal basis of maritime rights and entitlements in the South China Sea following the award. The first part of the article discusses the award as an effort in dispute resolution procedures, the second addresses how it is perceived as contributing to destabilization in the Asia Pacific region, and the third part explores new developments postarbitration including the legal effects on freedom of navigation and coastal states’ perceptions of navigational rights, rights of overflight in their exclusive economic zones, and environmental protection in the “Area.”
The Philippines: Hedging in a Post‐Arbitration South China Sea?
Authors: Quintos Mary Fides A.
Published: April 2018

One of the major foreign policy decisions that then newly sworn‐in Philippine President Rodrigo Duterte had to make was on the implementation of the 12 July 2016 Arbitral Tribunal's Award on the Philippines v. China case on the South China Sea, amid China's adamant position that it does not recognize the ruling of the tribunal. This article explores how the strategy of hedging is the optimal choice in pursuing the Philippines’ foreign policy particularly in a post‐arbitration environment, in light of current developments and geopolitical realities in the region. In particular, it provides insights on why betting on multiple alternative positions that include both returns‐maximizing and risk‐contingency measures can best serve the Philippines’ interests and be vehicles to promote compliance with the Award.
The South China Sea Arbitral Award: Evolving Post‐Arbitration Strategies, Implications and Challenges
Authors: Bautista Lowell
Published: April 2018

On 12 July 2016, the Arbitral Tribunal formed under Annex VII of the 1982 United Nations Convention on the Law of the Sea (UNCLOS) issued its award on the case brought by the Philippines against China over maritime claims in the South China Sea. The landmark victory categorically declared that China's nine‐dash line claim is incompatible with the UNCLOS. The award was also an authoritative interpretation of various important issues relating to UNCLOS including the legal status of maritime features, historic rights, and the duty to preserve the marine environment. However, despite the final and binding nature of the arbitral ruling, China continues to reject the ruling. The shift in Philippine foreign policy under the Duterte administration has led to setting aside the ruling in order to restore amicable diplomatic and economic relations with China. This Special Issue of Asian Politics & Policy explores and revisits the South China Sea arbitral award from a multi‐faceted perspective, focusing on challenges, implications, and post‐arbitration strategies.
Safe use of proton pump inhibitors in patients with cirrhosis
Authors: Weersink Rianne A. , Bouma Margriet , Burger David M. , Drenth Joost P.H. , Harkes‐Idzinga S. Froukje , Hunfeld Nicole G.M. , Metselaar Herold J. , Monster‐Simons Margje H. , van Putten Sandra A.W. , Taxis Katja , Borgsteede Sander D.
Published: April 2018

Aims

Proton pump inhibitors (PPIs) belong to the most frequently used drugs, also in patients with cirrhosis. PPIs are extensively metabolized by the liver, but practice guidance on prescribing in cirrhosis is lacking. We aim to develop practical guidance on the safe use of PPIs in patients with cirrhosis.

Methods

A systematic literature search identified studies on the safety (i.e. adverse events) and pharmacokinetics of PPIs in cirrhotic patients. This evidence and data from the product information was reviewed by an expert panel who classified drugs as safe; no additional risks known; additional risks known; unsafe; or unknown. Guidance was aimed at the oral use of PPIs and categorized by the severity of cirrhosis, using the Child–Turcotte–Pugh (CTP) classification.

Results

A total of 69 studies were included. Esomeprazole, omeprazole and rabeprazole were classified as having ‘no additional risks known’. A reduction in maximum dose of omeprazole and rabeprazole is recommended for CTP A and B patients. For patients with CTP C cirrhosis, the only PPI advised is esomeprazole at a maximum dosage of 20 mg per day. Pantoprazole and lansoprazole were classified as unsafe because of 4‐ to 8‐fold increased exposure. The use of PPIs in cirrhotic patients has been associated with the development of infections and hepatic encephalopathy and should be carefully considered.

Conclusions

We suggest using esomeprazole, omeprazole or rabeprazole in patients with CTP A or B cirrhosis and only esomeprazole in patients with CTP C. Pharmacokinetic changes are also important to consider when prescribing PPIs to vulnerable, cirrhotic patients.
Time to treatment is an independent prognostic factor in aggressive non‐Hodgkin lymphomas
Authors: Olszewski Adam J. , Ollila Thomas , Reagan John L.
Published: April 2018

In aggressive lymphomas, discrepancies in survival reported from experimental and observational studies may reflect selective non‐enrolment of high‐risk patients in trials. We examined the association between time from diagnosis to chemotherapy and overall survival in diffuse large B‐cell (DLBCL), Burkitt (BL), mantle cell (MCL) and peripheral T‐cell lymphoma (PTCL), using National Cancer Data Base records of 130 549 patients treated in 2004–2014. Across the histologies, patients who started chemotherapy within 7 days of diagnosis had more often high International Prognostic Index (IPI) or advanced‐stage disease. The discrepancy in 3‐year survival between groups treated within 7 or >30 days from diagnosis ranged from 14% in BL to 30% in MCL. After adjusting for the IPI, time to treatment was significantly associated with shorter overall survival. Using the group treated >30 days from diagnosis as reference, patients treated within 7 days had a hazard ratio of 1·38 [95% confidence interval (CI), 1·28–1·48] in DLBCL, 1·42 (95% CI, 1·22–1·66) in BL, 2·23 (95% CI, 1·79–2·78) in MCL and 1·46 (95% CI, 1·18–1·81) in PTCL. Time from diagnosis to treatment may reflect high‐risk features uncaptured by standard prognostic assessments. Clinical trials should accommodate patients who need urgent therapy to improve external validity and detect treatment effects in high‐risk groups.
Policies on bruises in premobile children: Why we need improved standards for policymaking
Authors: Bilson Andy
Published: April 2018

This review of the 91 English children's services departments with specific policies on bruising in premobile children found a major disjuncture between research evidence and its interpretation in guidance. Many policies require all premobile children found with a bruise to be seen urgently by a paediatrician, and in some, all bruised children are subject of a formal child protection investigation regardless of the explanations for the bruise or the views of front‐line practitioners. However, the research on bruises in premobile children on which these policies were based was found to be limited and contradictory and did not fully support the guidance given. National guidance given by the National Institute for Health and Care Excellence and many local policies state that bruising in premobile children is suggestive of physical abuse because accidental bruising is uncommon despite the only longitudinal study of bruising showing 27% of premobile children were bruised over an average of 7.6 weekly observations. The paper calls for an urgent review of these policies and guidance and improved standards for policymaking.