bluuebunny/crossref_metadata_2025 huggingface dataset:
Tackling money laundering in Tanzania: are private legal practitioners crime enablers or ineffectual and reluctant gatekeepers?
Authors: Mniwasa Eugene E.
Published: June 2020

Purpose

This paper aims to examine the money laundering vulnerability of private legal practitioners in Tanzania, the involvement of these practitioners in money laundering activities and their role in preventing, detecting and thwarting money laundering and its predicate crimes.

Design/methodology/approach

The paper applies the “black-letter” law research approach to describe, examine and analyze the anti-money laundering law in Tanzania. It also uses the “law-in-context” research approach to interrogate the anti-money laundering law and to provide an understanding of factors impacting on the efficacy and readiness of private legal practitioners in Tanzania to tackle money laundering. The review of literature and analysis of statutory instruments and case law, reports of the anti-money laundering authorities and agencies and media reports-generated data are used in this paper. This information was complemented by data from interviews of purposively selected private legal practitioners.

Findings

Private legal practitioners in Tanzania are vulnerable to money laundering. There is an emerging evidence that indicates the involvement of some private legal practitioners in the commission of money laundering and/or its predicate crimes. The law designates the legal practitioners as reporting persons and imposes on the obligation to fight against money laundering. Law-related factors and practical challenges undermine the capacity of the legal practitioners to curb money laundering. Additionally, certain hostile perceptions contribute to the legal practitioners’ unwillingness, indifference or opposition against the fight against money laundering.

Research limitations/implications

The paper underscores the need for Tanzania to reform its policy and legal frameworks to create enabling environment for anti-money laundering gatekeepers, including private legal practitioners to partake efficiently in the fight against money laundering. It also underlines the importance of incorporating the principles that govern the private legal practise to enable the practitioners to partake effectively in tackling money laundering.

Originality/value

This paper generates useful information to private legal practitioners, policy makers and academicians on issues relating to money laundering and its control in Tanzania and presents recommendations on possible policy and legal reforms that can be adopted and applied to augment the role of the legal practitioners in Tanzania to combat money laundering.
Investigating the ways prior experience informs the research approaches of returning and direct-pathway students in engineering PhD programs
Authors: Mosyjowski Erika A. , Daly Shanna R.
Published: June 2020

Purpose

The purpose of this paper is to explore the ways engineering doctoral students draw on prior experiences to inform their doctoral research. This study includes the experiences of “returners” – those who have worked as practitioners for five or more years before entering a PhD program – who have distinct experiences from “direct-pathway students,” which may inform how they engage in doctoral research. This study also explores the traits that distinguish varying levels of sophistication in the ways PhD students think about the research process and how prior experience may contribute.

Design/methodology/approach

This study draws on interview data from 52 returning and direct-pathway engineering doctoral students. A thematic analysis of this interview data highlights the primary ways participants’ prior professional, academic and life experiences inform their doctoral research. In addition, the authors conducted an iterative analysis process to sort participants’ responses about their management of a hypothetical research scenario into emergent categories of research thinking sophistication to understand what characterizes varying levels of sophistication in research thinking and explore how experience may contribute.

Findings

Participants identified past experiences as shaping their research, related to how they identify a research problem, considering what needs to and can be done to address the problem, identifying an appropriate research approach, managing unexpected challenges, responding to critical feedback, determining their comfort taking risks and using intuition to lead a project.

Originality/value

Outcomes of this research can inform how graduate education supports students throughout their degree by identifying key experiences that may contribute to students’ research approaches.
Performance of 96.5Sn–3Ag–0.5Cu/fullerene composite solder under isothermal ageing and high-current stressing
Authors: Chen Guang , Cui Xinzhan , Wu Yaofeng , Li Wei , Wu Fengshun
Published: June 2020

Purpose

The purpose of this paper is to investigate the effect of fullerene (FNS) reinforcements on the microstructure and mechanical properties of 96.5Sn3Ag0.5Cu (SAC305) lead-free solder joints under isothermal ageing and electrical-migration (EM) stressing.

Design/methodology/approach

In this paper, SAC305 solder alloy doped with 0.1 Wt.% FNS was prepared via the powder metallurgy method. A sandwich-like sample and a U-shaped sample were designed and prepared to conduct an isothermal ageing test and an EM test. The isothermal ageing test was implemented under vacuum atmosphere at 150°C, whereas the EM experiment was carried out with a current density of 1.5 × 104 A/cm2. The microstructural and mechanical evolutions of both plain and composite solder joints after thermal ageing and EM stressing were comparatively studied.

Findings

A growth of Ag3Sn intermetallic compounds (IMCs) in solder matrix and Cu-Sn interfacial IMCs in composite solder joints was notably suppressed under isothermal ageing condition, whereas the hardness and shear strength of composite solder joints significantly outperformed those of non-reinforced solder joints throughout the ageing period. The EM experimental results showed that for the SAC305 solder, the interfacial IMCs formulated a protrusion at the anode after 360 h of EM stressing, whereas the surface of the composite solder joint was relatively smooth. During the stressing period, the interfacial IMC on the anode side of the plain SAC305 solder showed a continuous increasing trend, whereas the IMC at the cathode presented a decreasing trend for its thickness as the stressing time increased; after 360 h of stressing, some cracks and voids had formed on the cathode side. For the SAC305/FNS composite solder, a continuous increase in the thickness of the interfacial IMC was found on both the anode and cathode sides; the growth rate of the interfacial IMC at the anode was higher than that at the cathode. The nanoindentation results showed that the hardness of the SAC305 solder joint presented a gradient distribution after EM stressing, whereas the hardness data showed a relatively homogeneous distribution in the SAC305/FNS solder joint.

Originality/value

The experimental results showed that the FNS reinforcement could effectively mitigate the failure risk in solder joints under isothermal ageing and high-current stressing. Specifically, the FNS particles in solder joints can work as a barrier to suppress the diffusion and migration of Sn and Cu atoms. In addition, the nanoidentation results also indicated that the addition of the FNS reinforcement was very helpful in maintaining the mechanical stability of the solder joint. These findings have provided a theoretical and experimental basis for the practical application of this novel composite solder with high-current densities.
Noisy neighbours and myna problems: Interaction webs and aggression around tree hollows in urban habitats
Authors: Rogers Andrew M. , Griffin Andrea S. , van Rensburg Berndt J. , Kark Salit
Published: June 2020

Interaction networks among native and invasive species in a community can inform both invasion impacts and applied management of invasive species. The intensity of aggressive interactions may be related to the overlap in species’ ecological niche and functional traits, especially in cavity‐breeding species, that often compete for limited nesting sites. Australia is home to over 100 native and introduced cavity‐nesting species, including several invasive species that are widespread globally, such as the common myna Acridotheres tristis. Here, we aimed to test the extent to which shared functional traits inform the intensity of aggression between cavity‐nesting birds.

We quantified the outcomes of aggressive interactions between birds in large hollow‐bearing trees in SE Queensland, Australia. We examined whether more similarly sized birds interacted more frequently, whether larger species won aggressive interactions more often, and whether cavity‐breeding species with similar preferences for nesting sites (breeding‐niche space) interacted more frequently.

We recorded a total of 410 aggressive interactions and 48 interacting bird species around tree hollows, including 20 cavity‐nesting bird species. These interactions were dominated by the invasive common myna, the native noisy miner (a non‐cavity‐breeder) and the native rainbow lorikeet Trichoglossus moluccanus, but the common myna won the largest total number of interspecific interactions. On average, larger birds won aggressive interactions more frequently, yet there were some important exceptions to this finding; the common myna (113 ± 30 g) won 26 of the 29 interactions against the larger native rainbow lorikeet (126 ± 44 g). Importantly, species with more similar nest‐site preferences were observed aggressively interacting more frequently.

Synthesis and applications. The impact of the invasive common myna was higher‐site preferences. Control efforts for the myna should focus on birds that nest in natural tree hollows. An analysis of shared traits by managers could be used to help identify how many local species would benefit from common myna control in a given area and test if further behavioural studies of common myna are warranted.
Biologically infallible? Men’s views on male age‐related fertility decline and sperm freezing
Authors: Law Caroline
Published: June 2020

Trends in people having children later in life and increasing evidence of male age‐related fertility decline (ARFD) has led some to propose sperm freezing as a suitable response. However, little consideration has been given to how men might respond to such a proposal, and there has been a paucity of empirical data to inform such a consideration. This paper arises from in‐depth, semi‐structured interviews with men (n = 25) who do not have children but want or expect to have them in the future. Data on men’s perceptions of male ARFD and sperm freezing are presented and discussed in accordance with theoretical and conceptual tools relating to reproductive masculinity, biomedicalisation, gendered risk perception and meanings of sperm and masculinity. It suggests that that men’s overall lack of concern regarding male ARFD and resistance towards ideas of sperm freezing result not only from a lack of exposure to evidence regarding male ARFD but are also shaped by ideals of reproductive masculinity, and may indicate resistance towards the idea of reproductive control. It argues that these positions perpetuate a gender unequal politicisation of ARFD and perpetuate particular gendered subjectivities relating to culpability and responsibility for guarding against risks of ARFD.
Feeling less alone online: patients’ ambivalent engagements with digital media
Authors: Petersen Alan , Schermuly Allegra , Anderson Alison
Published: June 2020

Digital media offer the chronically ill, especially those who experience related isolation, unparalleled opportunities to connect with others. This article asks, how do these individuals ascribe meaning to and use these media to manage their condition and related isolation? Using the concepts of affordance and emotional community, and drawing on the findings from an Australian study on patients’ use of digital media, we examine individuals’ ambivalent ascriptions of media, which are both feared and distrusted for the risks they present and embraced as invaluable tools of social connection. We argue that this ambivalence is explicable in terms of the communities to which the chronically ill belong which are founded on strong emotional bonds. In a context in which individuals tend to feel isolated through pain and/or stigmatisation, digital media may offer powerful means for sharing and affirming their experiences, the subjective benefits of which may outweigh the perceived risks. The article discusses the functions and features of digital media that the chronically ill value and distrust and concludes by considering the implications of our analysis for strategies to address the needs of people who feel isolated as a consequence of their condition.
Out‐of‐Network Air Ambulance Bills: Prevalence, Magnitude, and Policy Solutions
Authors: FUSE BROWN ERIN C. , TRISH ERIN , LY BICH , HALL MARK , ADLER LOREN
Published: June 2020

Policy Points

Out‐of‐network air ambulance bills are a type of surprise medical bill and are driven by many of the same market failures behind other surprise medical bills, including patients’ inability to choose in‐network providers in an emergency or to avoid potential balance billing by out‐of‐network providers.

The financial risk to consumers is high because more than three‐quarters of air ambulances are out‐of‐network and their prices are high and rising. Consumers facing out‐of‐network air ambulance bills have few legal protections owing to the Airline Deregulation Act's federal preemption of state laws.

Any federal policies for surprise medical bills should also address surprise air ambulance bills and should incorporate substantive consumer protections—not just billing transparency—and correct the market distortions for air ambulances.

Context

Out‐of‐network air ambulance bills are a growing problem for consumers. Because most air ambulance transports are out‐of‐network and prices are rising, patients are at risk of receiving large unexpected bills. This article estimates the prevalence and magnitude of privately insured persons’ out‐of‐network air ambulance bills, describes the legal barriers to curtailing surprise air ambulance bills, and proposes policies to protect consumers from out‐of‐network air ambulance bills.

Methods

We used the Health Care Cost Institute's 2014‐2017 data from three large national insurers to evaluate the share of air ambulance claims that are out‐of‐network and the prevalence and magnitude of potential surprise balance bills, focusing on rotary‐wing transports. We estimated the magnitude of potential balance bills for out‐of‐network air ambulance services by calculating the difference between the provider's billed charges and the insurer's out‐of‐network allowed amount, including the patient's cost‐sharing. For in‐network air ambulance transports, we calculated the average charges and allowed amounts, both in absolute magnitude and as a multiple of the rate that Medicare pays for the same service.

Findings

We found that less than one‐quarter of air ambulance transports of commercially insured patients were in‐network. Two‐in‐five transports resulted in a potential balance bill, averaging $19,851. In the latter years of our data, in‐network rates for transports by independent (non‐hospital‐based) carriers averaged $20,822, or 369% of the Medicare rate for the same service.

Conclusions

Because the states’ efforts to curtail air ambulance balance billing have been preempted by the Airline Deregulation Act, a federal solution is needed. Owing to the failure of market forces to discipline either prices or supply, out‐of‐network air ambulance rates should be benchmarked to a multiple of Medicare rates or, alternatively, air ambulance services could be delivered and financed through an approach that combines competitive bidding and public utility regulation.
Differentiation of Antemortem and Postmortem Appendicular Fractures Using Magnetic Resonance Imaging Signal Intensity Changes in Bone and Soft Tissues,
Authors: Oetelaar Garrett , Heng Hock Gan , Lim Chee Kin , Cox Abigail , Weng Hsin‐Yi
Published: June 2020

Intraosseous T1‐weighted (T1W) and short‐tau inversion recovery (STIR) magnetic resonance imaging (MRI) signal intensity changes—so‐called bone marrow edema—may be able to differentiate antemortem and postmortem fractures in human forensic imaging. The primary objective of this study was to investigate this hypothesis using an animal model. Three juvenile Landrace pigs were anesthetized and underwent MRI of both tibiae and both radii using a 1.5 T magnet. T1W, T2‐weighted (T2W), STIR, and T2* sequences were included. Antemortem fractures were induced in both tibiae and postmortem fractures in both radii, and MRI was repeated. Two board‐certified radiologists blinded to fracture group jointly evaluated the images for intraosseous and soft tissue signal intensity changes. Sensitivity (Se) and specificity (Sp) in identifying antemortem fractures were calculated based on intraosseous, soft tissue, and combined intraosseous and soft tissue signal intensity changes. Intraosseous and soft tissue signal intensity changes, when present, were hyperintense in all sequences. Intraosseous hyperintensity in T1W and T2W sequences yielded Sp of 100% for antemortem fractures. Regardless of sequence, soft tissue hyperintensity was comparatively more sensitive than intraosseous hyperintensity. Sensitivity for each sequence could be maximized by assessment of soft tissue and intraosseous hyperintense signals together; for the T1W sequence, such assessment optimized diagnostic utility yielding a Se of 100% and Sp of 83%. In summary, MRI—particularly the T1W sequence—can differentiate antemortem and postmortem fractures and may be a useful adjunct to the forensic analyses of fractures.
Safety and efficacy of single‐needle leukocyte apheresis for treatment of ulcerative colitis
Authors: Shindo Yoichiro , Mitsuyama Keiichi , Yamasaki Hiroshi , Imai Tetsuro , Yoshioka Shinichiro , Kuwaki Kotaro , Yamauchi Ryosuke , Yoshimura Tetsuhiro , Araki Toshihiro , Morita Masaru , Tsuruta Kozo , Yamasaki Sayo , Fukami Kei , Torimura Takuji
Published: June 2020

Leukocyte apheresis (LCAP) is a safe and effective treatment for active ulcerative colitis (UC) in Japan. Nevertheless, a limitation of LCAP is its requirement for two puncture sites (double‐needle [DN] apheresis), sometimes leading to problems with needle puncture. Single‐needle (SN) apheresis is useful in hemodialysis and reduces needle puncture pain. If SN apheresis were found to be useful in LCAP for UC, it may reduce patient burden. The aim of this study was to compare the safety and efficacy of SN apheresis with that of DN apheresis. Twenty‐four patients with active UC were retrospectively enrolled. They underwent either SN apheresis (n = 12) or conventional double‐needle (DN) apheresis (n = 12) at the Kurume University Hospital from February 2014 to March 2018. At each session, we recorded access problems defined by the time required to initiate apheresis and the frequency of puncture‐related problems, as well as blood circuit clotting, defined as clotting necessitating interruption of apheresis and changing of the circuit. Efficacy was assessed using partial Mayo scores. The number of apheresis sessions was comparable between SN and DN apheresis (9.0 ± 2.0 times vs 9.6 ± 1.4 times, mean ± SEM). SN significantly reduced the time required to start apheresis (10.0 ± 5.4 minutes vs 19.4 ± 11.9 minutes, P < .05) as well as needle puncture troubles (0.9% vs 11.5%, P < .05). SN had comparable frequency of blood clotting episodes (5.6% vs 8.7%). SN apheresis had similar clinical efficacy (P < .001 in SN and P < .01 in DN). The improvement and remission rates were comparable between groups. SN apheresis may be safe and effective and may reduce patient burden during UC treatment. Nevertheless, further comparative studies are needed.
Biochemical evaluation of processed ascites in patients undergoing cell‐free and concentrated ascites reinfusion therapy
Authors: Nakamura Hironori , Hanafusa Norio , Kitamura Kentaro , Nakamura Hiroaki , Sekihara Hiroyuki , Shimizu Kazuaki , Anayama Mariko , Makino Yasushi , Tamura Katsuhiko , Nagasawa Masaki
Published: June 2020

The biochemical composition of processed ascites is not well researched and may differ among institutions. This prospective study was conducted to evaluate the biochemical characteristics of processed ascites of 11 patients with liver cirrhosis and carcinoma who underwent cell‐free and concentrated ascites reinfusion therapy. The ascites due to carcinoma were more acidic and had higher lactate dehydrogenase activity than those due to liver cirrhosis. The ascites due to liver cirrhosis contained a higher amount of immunoglobulin than those due to carcinoma. Immunoglobulin preparations were approximately 2.95% IgG in liver cirrhosis ascites and 2.25% IgG in carcinoma ascites. Moreover, the concern about IgA infusion in the patient with IgA deficiency made it important to identify the source of the ascites. The present study provided fundamental information regarding the safety of cell‐free and concentrated ascites reinfusion therapy.
Low‐density‐lipoprotein apheresis‐mediated endothelial activation therapy to severe‐peripheral artery disease study: Rationale and study design
Authors: Ueda Eiko , Toya Yoshiyuki , Wakui Hiromichi , Kawai Yuki , Azushima Kengo , Fujita Takayuki , Saigusa Yusuke , Yamanaka Takeharu , Yabuki Yuichiro , Mikami Taro , Goda Motohiko , Sugano Teruyasu , Tamura Kouichi
Published: June 2020

A novel approach is required for standard therapy‐resistant peripheral arterial disease (PAD). This is a single‐center, single‐arm, interventional study (LDL Apheresis‐Mediated Endothelial Activation Therapy to Severe‐Peripheral Artery Disease study), which aims to evaluate the efficacy and safety of lipoprotein apheresis (LA) with a dextran sulfate cellulose column in PAD with controlled serum cholesterol levels. The study participants have standard therapy‐resistant PAD with controlled serum cholesterol levels. A total of 35 patients undergo 10 sessions of LA therapy. The ankle‐brachial index and vascular quality of life questionnaire are assessed before and after the treatment period as primary outcomes. Registration of patients began in November 2015 and is planned to be concluded in October 2020.
Risk Management as Passionate Imitation: The Interconnections Among Emotions, Performance Metrics, and Risk in a Global Technology Firm
Authors: Carlsson‐Wall Martin , Kaarbøe Katarina , Kraus Kalle , Meidell Anita
Published: June 2020

This paper traces the evolution of risk management practices in a global technology company between 2000 and 2015. We extend recent research that has highlighted the emotional aspects of riskwork. We detail how a passionate interest—‘we can do better at risk management’—emotionally ‘hooked’ the staff in the company's Sourcing Unit. Risk management, emotion, and management controls were intertwined. When top management singled out one of the key metrics clearly as a risk‐related metric for the Sourcing Unit, the employees felt a strong sense of relief, which gave rise to subsequent extensive risk measurement. We also contribute to the more general debate about accounting and its entanglement with emotions. Little is known about the ‘birth’ and the reasons for durability of passionate interests. Following Tarde (1903/2013), such ‘birth’ and endurance can be explained by analyzing how passionate imitation emerges as a result of a series of dislocal events—in our case a fire, new performance metrics, and natural disasters. These events triggered emotions that provided the necessary energy for three forms of passionate imitation: a) ‘we need to imitate our main competitor’ and risk mapping; b) ‘others in the organization are imitating us and our suppliers should imitate us’ and risk measurement; and c) ‘others in the organization (more specifically the Product Development Unit) should imitate us’ and proactive risk avoidance. This passionate imitation helped explain why the sourcing staff continued to be emotionally ‘hooked’ to risk management, that is, how the passionate interest endured and became vested.
Impact of Labeled Glasses in a Bar Laboratory Setting: No Effect on Ad Libitum Alcohol Consumption
Authors: Clarke Natasha , Rose Abigail K
Published: June 2020

Aims

Information provided on glass labels may be an effective method to reduce alcohol consumption. The aim of this study was to assess the impact of glass labels conveying unit information and a health warning in reducing ad libitum alcohol consumption.

Methods

A cluster‐randomized experimental study was conducted to measure the efficacy of a labeled glass in reducing alcohol consumption in a semi naturalistic bar laboratory setting, in a sample of 81 pairs (n = 162) of UK young adult drinkers. Pairs were randomized to receive two 340‐ml glasses of beer or wine: labeled or plain (control). Alcohol consumption was assessed in an ad libitum drinking period, and urge to drink was measured at baseline and postdrinking period. Focus groups (n = 2) were conducted, and thematic analysis was used to gain an insight into the acceptability and the perceived effectiveness of the glasses.

Results

Mean unit consumption was 1.62 (SD ± 0.83) units in the labeled glass condition and 1.69 (SD ± 0.82) units in the non labeled glass condition. There were no significant effects of the labeled glasses on ad libitum alcohol consumption (95% CI −0.25 to 0.37, p = 0.35), despite participants (85%) noticing the information. Qualitative analysis of focus groups indicated that although participants perceived the glasses as a useful tool for increasing awareness of units and guidelines, they were viewed as limited in their potential to change drinking behavior due to the unappealing design of the glass and a view that unit guidelines were not relevant to drinking patterns or contexts.

Conclusions

Labeled glasses did not change alcohol consumption in the current study, potentially due to ineffectiveness of this type of message in a young adult population. The information on the glasses was attended to, highlighting that glasses could be a feasible tool for providing information.
Alcohol Use Disorders Are Associated With a Unique Impact on Airway Epithelial Cell Gene Expression
Authors: Bailey Kristina L. , Smith Harry , Mathai Susan K. , Huber Jonathan , Yacoub Mark , Yang Ivana V. , Wyatt Todd A. , Kechris Katerina , Burnham Ellen L.
Published: June 2020

Background

Alcohol use disorders (AUDs) and cigarette smoking both increase risk for the development of community‐acquired pneumonia (CAP), likely through adverse effects on proximal airway mucociliary clearance and pathogen recognition. Smoking‐related alterations on airway gene expression are well described, but little is known about the impact of AUDs. We measured gene expression in human airway epithelial cells (AECs), hypothesizing that AUDs would be associated with novel differences in gene expression that could alter risk for CAP.

Methods

Bronchoscopy with airway brushings was performed in participants with AUDs and controls to obtain AECs. An AUD Identification Test was used to define AUD. RNA was extracted from AECs, and mRNA expression data were collected on an Agilent micro‐array. Differential expression analyses were performed on the filtered and normalized data with correction for multiple testing. Enrichment analyses were performed using clusterProfiler.

Results

Expression data from 19 control and 18 AUD participants were evaluated. After adjustment for smoking, AUDs were associated with significant differential expression of 520 AEC genes, including genes for ribosomal proteins and genes involved in protein folding. Enrichment analyses indicated significant differential expression of 24 pathways in AUDs, including those implicated in protein targeting to membrane and viral gene expression. Smoking‐associated AEC gene expression differences mirrored previous reports, but differed from those associated with AUDs.

Conclusions

AUDs have a distinct impact on AEC gene expression that may influence proximal airway function independent of smoking. Alcohol‐associated alterations may influence risk for CAP through modifying key mechanisms important in protecting proximal airway integrity.
Saving or tunnelling: value effects of tax avoidance in Chinese listed local government‐controlled firms
Authors: Qu Wenzhou , Kang Shaoqing , Wang Lihong
Published: June 2020

This paper investigates the value effect of tax avoidance and its underlying mechanisms among Chinese listed local government‐controlled (LG) firms. We show that tax avoidance does not promote firm value in LG firms with government ownership smaller than 40 percent and the above negative tunnelling effect is more pronounced when the control rights are concentrated in the local government and weaker when other large shareholders can act as a countervailing force. Finally, we observe a positive relation between tax avoidance and related‐party transactions as well as overinvestment, again indicating a tunnelling effect in LG firms with government ownership smaller than 40 percent.
When and how to use lithium
Authors: Barroilhet S. A. , Ghaemi S. N.
Published: June 2020

Background

Lithium is an old proven medication, but it is infrequently used in current practice. This review examines evidence for its benefits and risks and provides clinical guidance to its use.

Method

Narrative review.

Results

Besides its benefit in bipolar illness, lithium has important underappreciated proven benefits in prevention of unipolar depression and suicide. Emerging data support neurobiological benefits for cognition and possible dementia prevention. Likely benefits also exist in low doses for mood temperaments (cyclothymia and hyperthymia). High doses (over 1.0 mmol/L) should be avoided since they increase side effects, complications associated with long‐term use, and risk of toxicity. Conversely, low dosing can be legitimate, especially for suicide and dementia prevention. Nuisance side effects of lithium may affect adherence, and medically serious side‐effects can occur. Managing strategies are available for side effects.

Conclusion

Lithium is the most effective medication in psychiatry, because it has disease‐modifying, not just symptomatic, effects. It is effective not only for bipolar illness but also for prevention of suicide, episodes of unipolar depression, mood temperaments, and possibly dementia. Its many benefits need better appreciation, while lowered dosing can reduce risks.
Prenatal ultrasound and magnetic resonance evaluation and fetal outcome in high‐risk fetal tumors: A retrospective single‐center cohort study over 20 years
Authors: Ulm Barbara , Muin Dana , Scharrer Anke , Prayer Daniela , Dovjak Gregor , Kasprian Gregor
Published: June 2020

Introduction

Fetal tumors are rare and usually followed by poor outcome. We describe our single‐center experience with fetal tumors evaluated by ultrasound and magnetic resonance imaging (MRI). Our aims were to evaluate mortality and morbidity including long‐term outcome and to determine which ultrasound and MRI characteristics were helpful for pre‐ and perinatal management.

Material and methods

We conducted a retrospective analysis on prenatally diagnosed tumors between 1998 and 2018. Poor outcome included fetal or neonatal death and survival with serious illness. MRI addressed tumor morphology (sacrococcygeal teratomas), compromise of surrounding structures (head and neck tumors) and early depiction of brain alterations specific to tuberous sclerosis (rhabdomyomas).

Results

Of 68 pregnancies, 15 (22%) were terminated and eight children (8/53, 15%) died pre‐ or postnatally. Of the 45 survivors (45/68, 66%), 24 (24/45, 53%) were healthy, eight (8/45, 18%) had a minor illness and 13 (13/45, 29%) a serious illness. Diffusion‐ and T1‐weighted MRI reliably predicted tumor morphology in teratomas. To detect head and neck tumors critical to airway obstruction, MRI was superior to ultrasound in delivery planning. Rhabdomyomas were frequently associated with tuberous sclerosis, regardless of their number or size in ultrasound; MRI could depict specific brain alterations from the early third trimester onwards. For several rare tumors, MRI provided critical differential diagnoses that could not be clearly displayed in ultrasound.

Conclusions

The rate of survivors with serious long‐term illness among fetuses with prenatal diagnosis of a tumor was high. MRI is specifically helpful for risk stratification in fetal teratomas and delivery planning in head and neck tumors.
Cholestasis after very preterm birth was associated with adverse neonatal outcomes but no significant long‐term liver disease: A population‐based study
Authors: Teng Jonas , Bohlin Kajsa , Nemeth Antal , Fischler Björn
Published: June 2020

Aim

To describe outcome linked to neonatal cholestasis in a defined cohort of very preterm infants.

Methods

Population‐based retrospective case‐control study of preterm infants, gestational age <30 weeks, surviving for 28 days, in Stockholm County. Cholestasis was defined as conjugated bilirubin ≥30 μmol/L exceeding 20% of total level at least twice and graded as high if exceeding 100 μmol/L. Cholestatic cases were matched on gestational week with two non‐cholestatic controls.

Results

The incidence rate of cholestasis was 37/250 (14.8%), with increasing rates in lower gestational weeks. Perinatal factors associated with cholestasis were pre‐eclampsia and being born small for gestational age. Cholestatic infants had three times more bronchopulmonary dysplasia and eight times more retinopathy of prematurity. The mortality was 13.5% in cholestatic infants versus 2.7% in controls (P = .040). All deceased cholestatic infants had high‐grade cholestasis. No surviving infants developed chronic liver disease by 10 years of age.

Conclusion

Cholestasis was common in very preterm infants and linked to disease severity and adverse outcome. Cholestasis may be an independent risk factor for bronchopulmonary dysplasia and retinopathy of prematurity and more severe cholestasis associated with increased mortality. Cholestasis was not associated with chronic liver disease later in childhood.
Consequences of Supervisor Knowledge Hiding in Organizations: A Multilevel Mediation Analysis
Authors: Arain Ghulam Ali , Hameed Imran , Umrani Waheed Ali , Khan Abdul Karim , Sheikh Abdullah Zafar
Published: June 2020

Drawing on the theoretical framework of social cognitive theory, our study explores the multilevel mediation model in which moral disengagement (level‐1) mediates the direct relationships between knowledge hiding by supervisors from subordinates (KHSS: level‐2) and supervisor directed organizational citizenship behavior (SOCB: level‐1) and supervisor directed silence (SS: level‐1). Drawing on multi‐sourced, multi‐timed, and multilevel data of 306 subordinates nested within 83 supervisors, multilevel structural equation modeling (ML‐SEM) was used to test the proposed model. The results demonstrate that KHSS, first, fosters subordinates’ moral disengagement, which in turn reduces their SOCB and enhances their SS. Our findings offer several useful theoretical and managerial implications of the negative consequences of supervisor knowledge hiding in organizations. As one of the first studies to provide empirical evidence for the existence of supervisor knowledge hiding (i.e. KHSS), this research highlights the consequences of KHSS on subordinates’ moral disengagement, SOCB, and SS.
Osmium absorption after osmium tetroxide skin and eye exposure
Authors: Friedova Natalie , Pelclova Daniela , Obertova Nikola , Lach Karel , Kesslerova Katerina , Kohout Pavel
Published: June 2020

Osmium tetroxide is a strong oxidizing agent used in electron microscopy. Eye exposure may cause severe burns, and after inhalation or ingestion damage to the respiratory or gastrointestinal tract occurs. Exposure to osmium and its compounds is extremely rare. We present a case of a 32‐year‐old female stained by 9 mL of 2% osmium tetroxide in acetone during an accident in the laboratory, with rare dermal and ocular findings. Due to lack of data in toxicological databases and the absence of antidote, the therapy was symptomatic. Osmium was detected in serum 19 hours later (0.22 μg/L) and in urine during the 15‐hour collection (three samples—7.05, 1.65 and 8.45 μg/L). In blood serum on admission, after 1 and 2 days after exposure, the levels of iron (28.2, 39.8 and 50.5 μmol/L; reference range 5.8‐34.5 μmol/L) and transferrin receptor/ferritine were elevated. To our knowledge, this is the first paper documenting a significant absorption from the skin and potentially from the eye conjunctiva, based on serum and urine analysis. The relationship between increased iron in blood and exposure has not been described yet, and the mechanism remains unknown. The patient is being followed up for the unknown long‐term effects.
Management of lithium dosing around delivery: An observational study
Authors: Molenaar Nina M. , Poels Eline M. P. , Robakis Thalia , Wesseloo Richard , Bergink Veerle
Published: June 2020

Objectives

Recommendations on lithium dosing around delivery vary, with several guidelines suggesting that lithium should be discontinued prior to delivery. We aimed to evaluate the validity of these recommendations by investigating 1) maternal lithium blood level changes following delivery, and 2) the association between neonatal lithium blood levels at delivery and neonatal outcomes.

Methods

In this retrospective observational cohort study, we included women with at least one lithium blood level measurement during the final week of pregnancy and the first postpartum week. For aim 2, we included a subcohort of women with neonates for whom neonatal lithium blood levels (obtained from the umbilical cord or a neonatal vein puncture within 24 hours of delivery) were available.

Results

There were a total of 233 maternal lithium blood level measurements; 55 (23.6%) in the week before delivery and 178 (76.4%) in the week after. There was no association between time and lithium blood level/dose ratio (Pearson correlation coefficient −0.03, P = .63). Additionally, we included a total of 29 neonates for whom a lithium measurement was performed within 24 hours postpartum. Maternal and neonatal lithium blood levels were strongly correlated. We observed no associations between neonatal lithium blood levels at delivery and neonatal outcomes.

Conclusion

Based on our findings, we do not recommend lowering the dosage or discontinuation of lithium prior to delivery. Stable dosing can prevent subtherapeutic lithium serum levels, which is especially important in the postpartum period when relapse risks are highest.
Novel µ opioid antagonists derived from the µ opioid agonists endomorphin and [Dmt1]DALDA (H‐Dmt‐D‐Arg‐Phe‐Lys‐NH2)
Authors: Shi Saijian , Xu Jian , Feng LingLing , Fan Xin , Chen Zhen , Qin Yajuan , Chung Nga N. , Li Tingyou , Schiller Peter W.
Published: June 2020

Hybrid analogues of the µ opioid agonists endomorphin and [Dmt1]DALDA (H‐Dmt‐D‐Arg‐Phe‐Lys‐NH2, Dmt = 2′,6′‐dimethyltyrosine) containing cis‐4‐amino‐Pro, trans‐4‐amino‐Pro, cis‐4‐aminoethyl‐Pro or cis‐4‐guanidinylethyl‐Pro in the 2 position of the peptide sequence were synthesized. None of the compounds retained high µ opioid agonist activity and, unexpectedly, substitution of cis‐4‐amino‐Pro resulted in a novel class of potent µ opioid antagonists. In particular, the compound H‐Dmt‐cis‐4‐amino‐Pro‐Trp‐Lys‐NH2 (CZ‐1) turned out to be a highly selective µ opioid antagonist with ~1 nM µ receptor binding affinity.
Cumulative socio‐contextual risk and child abuse potential in parents of young children: Can social support buffer the impact?
Authors: McGoron Lucy , Riley Moira R. , Scaramella Laura V.
Published: June 2020

Child abuse potential refers to characteristics and practices closely linked to child abuse. Past investigations document that the number of risk factors parents experience is a correlate of child abuse potential. The purpose of this investigation was to test a model with multiple domains of risk including cumulative socio‐contextual risk, parenting locus of control, children's externalizing behaviour problems, social support, and child abuse potential. Using self‐report data from 87 mothers of children between the ages of 1 and 5 years old, bivariate correlations and linear regression analyses revealed that cumulative socio‐contextual risk was positively associated with child abuse potential and that this association remained statistically significant when controlling for parenting locus of control and child externalizing behaviour problems. Additionally, social support moderated the association between cumulative risk and child abuse potential.
A nationwide database study on colectomy and colorectal cancer in ulcerative colitis: what is the role of appendectomy?
Authors: Stellingwerf M. E. , Bemelman W.A. , Löwenberg M. , Ponsioen C. Y. , D'Haens G. R. , van Dieren S. , Buskens C. J. ,   the Parelsnoer Institute, the Dutch Initiative on Crohn, Colitis*a
Published: June 2020

Aim

Although has been suggested that an appendectomy has a positive effect on the disease course in patients with ulcerative colitis (UC), recent studies indicate a potential increase in risk of colectomy and colorectal cancer (CRC). This study aimed to evaluate the rates of colectomy and CRC after appendectomy in UC patients using a nationwide prospective database [the Initiative on Crohn and Colitis Parelsnoer Institute – Inflammatory Bowel Disease (ICC PSI‐IBD) database].

Method

All UC patients were retrieved from the ICC PSI‐IBD database between January 2007 and May 2018. Primary outcomes were colectomy and CRC. Outcomes were compared in patients with and without appendectomy, with a separate analysis for timing of appendectomy (before or after UC diagnosis).

Results

A total of 826 UC patients (54.7% female; median age 46 years, range 18–89 years) were included. Sixty‐three (7.6%) patients had previously undergone appendectomy: 24 (38.1%) before and 33 (52.4%) after their diagnosis of UC. In multivariate analysis, appendectomy after UC diagnosis was associated with a significantly lower colectomy rate compared with no appendectomy [hazard ratio (HR) 0.16, 95% C: 0.04–0.66, P = 0.011], and the same nonsignificant trend was seen in patients with an appendectomy before UC diagnosis (HR 0.35, 95% CI 0.08–1.41, P = 0.138). Appendectomy was associated with delayed colectomy, particularly when it was performed after diagnosis of UC (P = 0.009). No significant differences were found in the CRC rate between patients with and without appendectomy (1.6% vs 1.2%; P = 0.555).

Conclusion

Appendectomy in established UC is associated with an 84% decreased risk of colectomy and a delay in surgery. Since the colon is in situ for longer, the risk of developing CRC remains, which underscores the importance of endoscopic surveillance programmes.
Screening for rheumatic heart disease: The reliability of anterior mitral valve leaflet thickness measurement
Authors: Hunter Luke D. , Lombard Carl J. , Monaghan Mark J. , Lloyd Guy W. , Franckeiss Brandon M. , Pecoraro Alfonso J.K. , Doubell Anton F. , Herbst Philip G.
Published: June 2020

Background

Studies determining the reliability of the World Heart Federation (WHF) anterior mitral valve leaflet (AMVL) measurement are limited by the introduction of bias in their test‐retest analyses. This study sought to determine the reliability of the current AMVL measurement while controlling for systematic bias.

Methods

Retrospective analysis of echocardiographic data from 16 patients with previous acute rheumatic fever was performed. Included in this study was an optimized cine loop of the mitral valve (MV) [reader‐optimized measurement (ROM]) in the parasternal long‐axis view and an optimized still image of the MV obtained from the same cine loop [specialist‐optimized image (SOI)]. Each still image and associated cine loop was quadruplicated and randomized to determine intra‐ and inter‐rater agreement and quantify the impact of zoom on AMVL measurement.

Results

Specialist‐optimized image without zoom reflected the highest degree of agreement in both cohorts with an ICC of 0.29 and 0.46. The agreement in ROM images without zoom was ICC of 0.23 and 0.45. The addition of zoom to SOI decreased agreement further to an ICC of 0.20 and 0.36. The setting associated with the poorest agreement profile was ROI with zoom with an ICC of 0.13 and 0.34, respectively. The intra‐rater agreement between readers in both cohorts was moderate across all settings with an ICC ranging between 0.64 and 0.86.

Conclusions

The WHF AMVL measurement is only moderately repeatable within readers and demonstrates poor reproducibility that was not improved by the addition of a zoom‐optimized protocol. Given our study findings, we cannot advocate the current WHF AMVL measurement as a reliable assessment for RHD.
First episode psychosis: A comparison of caregiving appraisals in parents caring for the same child
Authors: Onwumere Juliana , Wilson Sophie , Billings Jo , Brown Lucy , Floyd Caroline , Widuch Kaja , Lyons Natasha , Man Lai Chu , James Gareth , Afsharzadegan Roya , Khan Sanna , Padayatchi Mellisha , Souray Jonathan , Raune David
Published: June 2020

Background

The first onset of psychosis can be a traumatic event for diagnosed individuals but can also impact negatively on their families. Little is known about how parents of the same child make sense of the illness. In mothers and fathers caring for the same child with early psychosis, the current study assessed their similarities and differences in key areas of their caregiving role.

Methods

Using a cross‐sectional design, parental pairs caring for the same child treated within an early intervention in psychosis service, completed self‐report measures on their caregiving experiences, illness beliefs, coping styles and affect.

Results

Data from 44 mothers and fathers were analysed. Analyses confirmed that parents reported similar levels of emotional dysfunction and conceptualized the illness in broadly similar ways with regard to what they understood the illness to be, their emotional reactions to the illness, perceived illness consequences and beliefs about treatment. Significant differences were identified in their beliefs about the timeline of the illness and reported approaches to coping.

Conclusions

With exception of beliefs about illness timeline and an expressed preference for use of emotion‐based coping, parent caregivers of the same child in early psychosis services are likely to report similar illness beliefs and caregiving reactions. Efforts to ensure staff awareness of the potential areas of divergence in parental caregiving appraisals and exploring the implications of the divergence for the caregiving relationship and patient outcomes are indicated.