bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing customer satisfaction index in Iranian public higher education
Authors: Ebrahimzadeh Pezeshki Reza , Sabokro Mehdi , Jalilian Negar
Published: April 2020

Purpose

The present study seeks to design an index model of satisfaction among Iranian students who are studying at public universities in this country.

Design/methodology/approach

In this research, data were collected in two stages: in the first stage, the data related to satisfaction indices were collected from 62 experts on pedagogical science and marketing management. In the second step, the data were collected from 1,404 students and were analysed by fuzzy analytic hierarchical process method, interpretive structural modelling and structural equation modelling.

Findings

The results of this study showed that three variables “perceived quality”, “organization image” and “Student relationship management” are reliable as indicators of student satisfaction. Also, contrary to the results of previous studies, the variable of expectations cannot predict the satisfaction of the students.

Originality/value

Models of satisfaction have been designed in different fields. Also, in the measurement of satisfaction, attention to the field and customization is approved by researchers. Accordingly, the present study tries to design indices of satisfaction among students of state universities in Iran. It also pointed out the effect of customization on the formation of satisfaction at the Iranian and other universities.
Lecturers' commitment to teaching entrepreneurship: do transformational leadership, mindfulness and readiness for change matter?
Authors: Yeap Sock Beei , Abdullah Abdul Ghani Kanesan , Thien Lei Mee
Published: April 2020

Purpose

This study aims to examine the influence of transformational leadership and mindfulness on lecturers' commitment to teaching entrepreneurship with mediating effect of readiness for change in polytechnics.

Design/methodology/approach

The study used the cross-sectional survey method. The sample participants were 171 lecturers from polytechnics. Data were analysed by using partial least squares–structural equation modelling (PLS-SEM) approach.

Findings

Findings indicated that readiness for change mediated the relationship between transformational leadership and commitment to teaching entrepreneurship. Transformational leadership and mindfulness had no significant influence on commitment to teaching entrepreneurship. Readiness for change did not mediate the relationship between mindfulness and commitment to teaching entrepreneurship.

Practical implications

Higher education should be aware of the importance of lecturers' readiness for change. This is because readiness for change is the mediator of the relationship between transformational leadership and commitment to teaching entrepreneurship.

Originality/value

The study sheds light on the explanation of mediating effect of readiness for change to influence the relationship between transformational leadership and lecturers' commitment to teaching entrepreneurship in the Malaysian polytechnic context.
Family firms propensity to lean innovation in the emerging economy: a moderating role of executive's compensation
Authors: Zulfiqar Muhammad , Yousaf Muhammad Usman , Islam Md Rashidul , Ghafoor Sadeen
Published: April 2020

Purpose

The purpose of this study is to investigate the empirical relationship between family firms and lean innovation (i.e. generating more output with less input) as well as the moderating role of the executive's compensation.

Design/methodology/approach

Panel data for ten years (2007–2016) have been collected from the CSMAR database. This study concludes the findings using descriptive statistics, correlation and panel data analysis techniques applying statistical software STATA.

Findings

Results show that family firms are not motivated to follow lean innovation strategies until unless the executives are compensated well. We further find that family firms are more likely to pursue a lean innovation strategy, and they demonstrate a superior record of converting R&D inputs as granted patents, and; both input and output innovation are significantly affected by executive compensations. However, this study shows an insignificant negative relationship of propensity to patents with the moderating effects of executive compensation.

Research limitations/implications

This research has been conducted on the emerging Chinese market. The study is useful for policymakers and managers to devise such strategies which can make the role of executive's more effective to reduce the agency cost and reap the benefits of innovation input more effectively (Petersen, 2009). Also, family firms are heterogeneous, and the research outcome may be applicable for both advanced and emerging economies.

Originality/value

The previous family firm's research paid less attention to the role of the executive's compensation on the relationship of family firms and lean innovation. Moreover, they prioritize insight into how executive's compensation affects different proxies of innovation. This study sheds new light on the paradoxical findings of family firms and lean innovation by analyzing the significant role of executive compensation.
Why customers and peer service providers do not participate in collaborative consumption
Authors: Hazée Simon , Zwienenberg Thijs Johannes , Van Vaerenbergh Yves , Faseur Tine , Vandenberghe Audrey , Keutgens Olivier
Published: April 2020

Purpose

Technological innovations such as smart mobile devices and mobile applications gave rise to a new business model: collaborative consumption. This business model, which is receiving significant attention from researchers and practitioners, is characterized by an intermediating digital platform that facilitates exchanges between customers and peer service providers. However, many digital platform providers still fail to build a critical mass of demand and supply. Accordingly, the aim of this research is to develop a better understanding of the barriers perceived by both customers and peer service providers.

Design/methodology/approach

This study uses a mixed-method qualitative approach to develop a comprehensive understanding of the factors that explain the rejection of collaborative consumption. In particular, six focus groups and 14 in-depth interviews were conducted, totaling 50 Belgian participants (with a mean age of 33 years). In addition, 375 online critical incidents—retrieved from various sources, such as review websites and social networks—were used for triangulation purposes. All data were analyzed using a thematic analytic approach.

Findings

Customers and peer service providers reject collaborative consumption because of a complex set of multidimensional functional and psychological barriers. In particular, actors may perceive barriers related to complexity, value, risk, compatibility, contamination, image, and responsibility, which prevent them from participating in collaborative consumption.

Originality/value

This paper builds theory on the reasons why both customers and peer service providers reject collaborative consumption. The research identifies several barriers that were not captured in prior research. Digital platform providers can use the research findings to more fully understand actors' decision-making processes in collaborative consumption.
Visioning a hospitality-oriented patient experience (HOPE) framework in health care
Authors: Hunter-Jones Philippa , Line Nathaniel , Zhang Jie J. , Malthouse Edward C. , Witell Lars , Hollis Brooke
Published: April 2020

Purpose

This paper considers the question: what would happen if healthcare providers, like their counterparts in the hospitality industry, adopted the principles of customer experience management (CEM) in order to facilitate a more holistic and personalized patient experience? It proposes an alternative vision of the patient experience by adding to an emerging hospitality–healthcare literature base, this time focusing upon CEM. A hospitality-oriented patient experience (HOPE) framework is introduced, designed to enhance the patient experience across all the touchpoints of the healthcare journey.

Design/methodology/approach

This is a conceptual paper that draws upon three distinct literatures: hospitality literature; healthcare literature; and CEM literature. It utilizes this literature to develop a framework, the HOPE framework, designed to offer an alternative lens to understanding the patient experience. The paper utilizes descriptions of three unique patient experiences, one linked to chronic pain, a second to gastro issues and a third to orthopedic issues, to illustrate how adopting the principles of hospitality management, within a healthcare context, could promote an enhanced patient experience.

Findings

The main theoretical contribution is the development of the HOPE framework that brings together research on CEM with research on cocreative customer practices in health care. By selecting and connecting key ingredients of two separate research streams, this vision and paradigm provide an alternative lens into ways of addressing the key challenges in the implementation of person-centered care in healthcare services. The HOPE framework offers an actionable roadmap for healthcare organizations to realize greater understanding and to operationalize new ways of improving the patient experience.

Originality/value

This paper applies the principles of hospitality and CEM to the domain of health care. In so doing it adds value to a hospitality literature primarily focused upon extensive employee–customer relationships. To a healthcare literature seeking to more fully understand a person-centered care model typically delivered by a care team consisting of professionals and family/friends. And to a CEM literature in hospitality, which seeks to facilitate favorable employee–customer interactions. Connecting these separate literature streams enables an original conceptual framework, a HOPE framework, to be introduced.
Evaluating mental health literacy and help-seeking behaviours in UK university students: a country wide study
Authors: Gorczynski Paul , Sims-Schouten Wendy , Wilson Clare
Published: April 2020

Purpose

Despite a high prevalence of mental health problems, few students know where to turn for support. The purpose of this study was to gain a UK wide perspective on levels of mental health literacy amongst university students and to examine the relationship between mental health literacy and mental health help-seeking behaviours.

Design/methodology/approach

A total of 300 university students in the UK participated in this online cross-sectional study. Participants filled out the mental health literacy scale, the general help-seeking questionnaire, Kessler psychological distress scale 10, The Warwick-Edinburgh mental well-being scale and the self-compassion scale: short form.

Findings

Overall, 78 per cent of participants indicated mild or more severe symptoms of distress. Students reported lower levels of mental health literacy when compared to students in other nations. Women, bisexuals, and those with a history of mental disorders indicated high levels of mental health literacy. Participants indicated they were most likely to seek support from intimate partners and least likely to seek support from religious leaders. No significant correlations were found between mental health literacy and help-seeking behaviours. Mental health literacy was not correlated with distress, mental well-being or self-compassion. Help-seeking behaviours were only significantly positively correlated with mental well-being.

Originality/value

Universities should address strategies to improve help-seeking behaviours in an effort to address overall mental well-being. Programmes may wish to help provide students with information about accessing face-to-face support systems. Environmental strategies to foster mental well-being on campus should also be explored.
Chemical, optical and photovoltaic properties of TiO2/reduced graphene oxide photoanodes sensitized with Roselle and N719 dyes for dye-sensitized solar cell application
Authors: Omar Azimah , Fakir Muhamad Saipul , Hamdan Khairus Syifa , Rased Nurul Hidayah , Rahim Nasrudin Abd.
Published: April 2020

Purpose

The purpose of this paper is to investigate the chemical, optical and photovoltaic properties of titanium dioxide/reduced graphene oxide (TiO2/rGO) photoanodes immersed in natural Roselle and synthetic (N719) dyes for dye-sensitized solar cell (DSSC) application.

Design/methodology/approach

TiO2mixed with rGO were doctor-bladed on fluorine doped tin oxide (FTO) glass substrate. The chemical and optical properties of TiO2/rGO photoanodes immersed in Roselle and N719 dyes were characterized using Fourier-transformed infrared (FTIR) and ultraviolet–visible (UV–vis) spectroscopies, respectively. The DSSC’s photovoltaic performances were tested using Visiontec Solar I-V tester at standard illumination of AM1.5 and irradiance level of 100 mW/cm2.

Findings

The presence of anthocyanin dye from Roselle flower was detected at 604 nm and 718 nm. TiO2/rGO+Roselle dye sample revealed the smallest energy gap of 0.17 eV for ease of electron movement from valence band to conduction band. The TiO2/rGO-based DSSC fabricated with Roselle dye had a power conversion efficiency,ƞof 0.743 per cent higher than TiO2/rGO photoanode sensitized with N719 dye (0.334 per cent). The obtained J-V curves were analyzed by a single-diode model of Lambert W-function and manual optimization to determine the internal electrical parameters of the DSSC. The average and uncertainty values ofJscandƞwere evaluated at differentRshrange of 1362 Ω to 32 k Ω.

Research limitations/implications

Rsvalues were kept constant during optimization work.

Originality/value

New ideality factor of TiO2/rGO-based DSSC was re-determined around 0.9995.
An exploratory study on the components and quality of combined assurance in an integrated or a sustainability reporting setting
Authors: Prinsloo Andre , Maroun Warren
Published: April 2020

Purpose

This research complements the corporate reporting literature by exploring the different types of assurance, which companies are using to bolster the credibility of their integrated and sustainability reports. A composite quality measure is proposed and this study aims to provide evidence on how combined assurance quality (CAQ) varies among firms.

Design/methodology/approach

Content analysis is used to identify “elements” of combined assurance disclosed in integrated and sustainability reports and company webpages. Results are presented in tabular format and supported by non-parametric tests to evaluate differences in CAQ among firms in more detail.

Findings

Combined assurance is framed as a function of the responsibility of the board of directors to ensure accurate, complete and reliable reporting and the characteristics of different internal and external sources of assurance. Overall, combined assurance models are being designed conservatively. They focus mainly on specific disclosures and are guided by a limited number of assurance methodologies or frameworks instead of taking a more pluralistic approach to verification of integrated and sustainability reports as a whole.

Research limitations/implications

The study is based on combined assurance practices by a sample of large listed companies in a single jurisdiction. An international comparison of combined assurance and the calibration of the proposed quality measure is deferred for future research.

Practical implications

Limitations in existing assurance practices are identified for the consideration of preparers and assurance providers. The quality schematic also offers practitioners, standard-setters and academics an easy-to-apply technique for examining the different elements of a company’s combined assurance model.

Social implications

A better understanding of the quality of combined assurance is essential for users’ to place reliance on integrated and sustainability reports and for informing change to existing assurance practices.

Originality/value

The study is the first to examine the operation and quality of combined assurance. The method used to gauge assurance quality provides a useful basis for a more detailed empirical study on the relevance of combined assurance.
Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy—a multicentre randomised controlled trial (LAVA trial)
Authors: van IJsselmuiden MN , van Oudheusden AMJ , Veen J , van de Pol G , Vollebregt A , Radder CM , Housmans S , van Kuijk SMJ , Deprest J , Bongers MY , van Eijndhoven HWF
Published: April 2020

Objective

To investigate whether laparoscopic sacrohysteropexy (LSH) is non‐inferior to vaginal sacrospinous hysteropexy (SSHP) in the surgical treatment of uterine prolapse.

Design

Multicentre randomised controlled, non‐blinded non‐inferiority trial.

Setting

Five non‐university teaching hospitals in the Netherlands, one university hospital in Belgium.

Population

126 women with uterine prolapse stage 2 or higher undergoing surgery without previous pelvic floor surgery.

Methods

Randomisation in a 1:1 ratio to LSH or SSHP, stratified per centre and severity of the uterine prolapse. The predefined inferiority margin was an increase in surgical failure rate of 10%.

Main outcome measures

Primary outcome was surgical failure, defined as recurrence of uterine prolapse (POP‐Q ≥ 2) with bothersome bulging/protrusion symptoms and/or repeat surgery or pessary at 12 months postoperatively. Secondary outcomes were anatomical recurrence (any compartment), functional outcome and quality of life.

Results

Laparoscopic sacrohysteropexy was non‐inferior for surgical failure (n = 1, 1.6%) compared with SSHP (n = 2, 3.3%, difference −1.7%, 95% CI: −7.1 to 3.7) 12 months postoperatively. Overall, anatomical recurrences and quality of life did not differ. More bothersome symptoms of overactive bladder (OAB) and faecal incontinence were reported after LSH. Dyspareunia was more frequently reported after SSHP.

Conclusion

Laparoscopic sacrohysteropexy was non‐inferior to SSHP for surgical failure of the apical compartment at 12 months’ follow up. Following LSH, bothersome OAB and faecal incontinence were more frequent, but dyspareunia was less frequent.

Tweetable abstract

Laparoscopic sacrohysteropexy and vaginal sacrospinous hysteropexy have equally good short‐term outcomes.
Review article: Ketoacidosis in the emergency department
Authors: Morton Adam
Published: April 2020

Diabetic ketoacidosis, a life‐threatening complication of type 1 diabetes mellitus, is a common cause of presentation to EDs. Two new drug classes have been found to cause ketoacidosis with distinctive presentations. The sodium‐glucose transport protein 2 inhibitors used in the management of type 2 diabetes mellitus may present with ketoacidosis with normal glucose levels. Ketoacidosis with these medications may be prolonged and recur after initial resolution. Checkpoint inhibitors may present with fulminant diabetic ketoacidosis in individuals with previously normal glucose tolerance. Ketoacidosis may also occur as a result of starvation and alcohol excess, as well as a number of rare causes. Other causes of metabolic acidosis with both high and normal anion gap need to be considered in the differential diagnosis of ketoacidosis. Diabetic ketoacidosis may also present with biochemical changes suggestive of myocardial ischaemia and pancreatitis in the absence of these pathologies. The present paper reviews ketone body metabolism, ketone testing and the causes and differential diagnosis of ketoacidosis with particular relevance to emergency medicine.
The influence of crop insurance agents on coverage choices: The role of agent competition
Authors: DeLay Nathan D. , Chouinard Hayley H. , Walters Cory G. , Wandschneider Philip R.
Published: April 2020

We examine how competition among crop insurance agents affects coverage choice in the federal crop insurance program. Agents may influence producers’ insurance decisions to maximize their total compensation. We develop a theoretical model of producer–agent interaction to examine how loss potential, agent compensation mechanisms, and market competition affect the coverage level selected. Using crop insurance unit‐level datasets from five states, we find evidence that agent market concentration and agents’ market share matter in the insurance coverage decisions of producers but that the economic significance of the influence is relatively small. Agent influence over coverage level, premium, and liability choice is generally positive but inconsistent across states, which may be attributable to differences in loss risk and agent compensation mechanisms.
Do drain tubes help reduce risks of post‐operative complications in complex incisional hernia repair (as defined by a recent court ruling)?
Authors: Luo Yuchen , Masood Durr‐e‐Nayab , Mohammed Jinnaah Sara , Tacey Mark , Hodgson Russell
Published: April 2020

Background

A recent legal case described in the ANZ Journal of Surgery has sparked significant topical interest in drain tube use in incisional hernia repairs in Australia. This study reviews a single centre experience of drain tube use in incisional hernia repair.

Methods

Data from online clinical records was collected retrospectively from patients that underwent incisional hernia repair from 1 January 2013 to 31 December 2017. ‘Complexity’ factors of smoking, obesity and lower midline incision (as identified by the legal case) were also used to stratify groups.

Results

A total of 410 incisional hernia repair cases were identified during the 5‐year period. Median length of stay of the non‐drain placement group was significantly shorter than that of the drain placement group (2 versus 6 days, P < 0.001). In total, 10.8% of patients with drain suffered from post‐op wound infection compared to 3.6% in patients without a drain tube in‐situ (P = 0.005). Seroma rates were no different with or without a drain (15.7% versus 16.9% P = 0.78). When stratified by ‘complexity’, there was a trend towards increased complications when drains were used.

Conclusion

Drain tubes were placed in only a small proportion of patients during incisional hernia repairs and were associated with a higher post‐operative wound infection rate. When stratified by the ‘complexity’ factors outlined by the recent legal case, complications in more ‘complex’ patients may actually increase when a drain tube is used.
Investigation of pathology, expression and proteomic profiles in human TREM2 variant postmortem brains with and without Alzheimer’s disease
Authors: Toomey Christina E. , Heywood Wendy , Benson Bridget C. , Packham Georgia , Mills Kevin , Lashley Tammaryn
Published: April 2020

Triggering receptor expressed on myeloid cells 2 TREM2 was identified as a risk factor for late onset Alzheimer’s disease (AD). Here we compared TREM2 cases with a variant (TREM2+) and cases without a TREM2 variant (TREM2−), considering pathological burden, inflammatory response and altered canonical pathways and biochemical functions between the cohorts. We hypothesised that TREM2+ cases would have a loss of function, indicating an altered inflammatory profile compared to TREM2− cases. Immunohistochemistry was performed using antibodies against Aβ, tau and microglia markers in TREM2+ cases, with and without AD, which were compared to sporadic TREM2− AD, familial AD and neurologically normal control cases. Aβ and tau load were measured along with the composition of Aβ plaques, in addition to microglial load and circularity. Expression and proteomic profiles were determined from the frontal cortex of selected cases. TREM2+ control cases had no Aβ or tau deposition. No differences in the amount of Aβ or tau, or the composition of Aβ plaques were observed between TREM2+ and TREM2− SAD cases. There were no differences in microglial load observed between disease groups. However, the TREM2+ SAD cases showed more amoeboid microglia than the TREM2− SAD cases, although no differences in the spatial relationship of microglia and Aβ plaques were identified. Visualisation of the canonical pathways and biological functions showed differences between the disease groups and the normal controls, clearly showing a number of pathways upregulated in TREM2+ SAD, TREM2− SAD and FAD groups whilst, the TREM2+ controls cases showed a downregulation of the majority of the represented pathways. These findings suggest that the TREM2+ control group, although carrying the TREM2+ variant, have no pathological hallmarks of AD, have altered microglial and expression profiles compared to the TREM2+ SAD cases. This indicates that other unknown factors may initiate the onset of AD, with TREM2 influencing the microglial involvement in disease pathogenesis.
A semantically enriched text mining system for clinical decision support
Authors: Luque Carmen , Luna José M. , Ventura Sebastián
Published: April 2020

Existing systems to support decision‐taking process based on textual information of clinical reports are insufficient. Currently, there are few systems that unify different subtasks in a single and user‐friendly framework, easing therefore the clinical work by automating complex and arduous tasks such as the detection of clinical alerts as well as clinical information coding. To address this issue, MiNerDoc is proposed as a new text mining (TM) system whose main objective is to support clinical decision‐taking processes by analyzing textual clinical reports in a unified framework. MiNerDoc is a really alluring TM system that includes two relevant tasks in the medical field, that is, detection of risk factors according to five medical entities (disease, pharmacologic, region/part body, procedure/test, and finding/sign) and automatic prediction of standardized diagnostic codes (MeSH descriptors associated with diseases). MiNerDoc integrates a combination of techniques from the TM discipline along with the terminological and semantic enrichment provided by the MetaMap tool and UMLS metathesaurus. Some study cases as well as a wide experimental analysis on real clinical reports have been carried out to demonstrate the effectiveness and promising performance of MiNerDoc on two different tasks, that is, medical entities recognition (FMeasure 81.54%) and diagnostic classification (FMeasuremic 81.04%).
Assessing the spatial distribution of avian collision risks at wind turbine structures in Brandenburg, Germany
Authors: Bose Anushika , Dürr Tobias , Klenke Reinhard A. , Henle Klaus
Published: April 2020

The risk of collision with wind turbines remains a critical issue for bird conservation. Undoubtedly, for the continued development of wind farms to increase the energy capacity, wind farm locations must be carefully chosen going forward. This can be achieved not only by avoiding areas with higher bird densities but also by avoiding installations at sensitive distances from their ecologically important land‐use types. Through analyses of the Euclidean distances to the different land‐use types, we utilized the random forest (RF) machine learning algorithm to model the distance‐based impacts of wind turbine locations on detected bird collisions for the frequently‐hit groups of birds at WTs. Although, the predicted areas with potential collision risk in total had a small but highly dispersed expanse of ~2,130 km2 across the vast 29,479 km2 area of the federal state. Our results further segregated these assessed areas based on their different probabilities of collision thresholds (between 0 and 1) to only detect the areas with collision probabilities <.05, which were interpreted as the actual “no risk areas”. These “no risk areas” summed to a total of merely 754 km2 of the land space in Brandenburg, suggesting that any further planned additions of wind energy farms in the state that is, the proposed wind turbines, to be suitably positioned only in these safer areas. Additionally, the study also enabled the identification of any existing wind turbines already installed in the remaining less safe 28,725 km2 area of the state. These areas are also essential to be include in the collision detection surveys and bird population dynamic studies. This would further our understanding regarding the deleterious consequences of collisions at the population levels of birds, eventually helping in the formulation of adequate mitigation measures.
A Single and Multiple Ascending Dose Study of Toll‐Like Receptor 7 Agonist (RO7020531) in Chinese Healthy Volunteers
Authors: Luk Andrea , Jiang Qiudi , Glavini Katerina , Triyatni Miriam , Zhao Na , Racek Tomas , Zhu Yonghong , Grippo Joseph F.
Published: April 2020

Toll‐like receptor 7 (TLR7) agonists modulate broad spectrum immune activity and are evaluated in the treatment of human diseases, including cancer and chronic viral infection. RO7020531, an oral prodrug of a TLR7 agonist, is in clinical development as part of a curative regimen against chronic hepatitis B. We report the safety, tolerability, pharmacokinetics (PKs), and pharmacodynamics (PDs) of RO7020531 in healthy Chinese volunteers following single and multiple ascending doses (SAD and MAD). PK and PD samples were evaluated from four SAD cohorts and 3 MAD cohorts with 10 subjects each (8 active and 2 placebo). Safety and tolerability were monitored throughout the study. A total of 155 adverse events (AEs) were reported in 49 subjects. Fifty‐one AEs in 18 subjects were assessed as treatment‐related. Most of the AEs were mild; nine subjects experienced moderate AEs; there were no severe AEs. In two 150 mg MAD cohorts given every other day (q.o.d.), 7 of 20 subjects experienced pyrexia and were discontinued due to transient asymptomatic lymphopenia, which resolved 24–48 hours postdose. The PK of the active metabolite, RO7011785, increased linearly with dose from 40 mg to 170 mg. There was no PK accumulation following q.o.d. dosing. The PK profile is consistent with observations in white subjects in the global first‐in‐human study. SADs and MADs of RO7020531 resulted in dose‐dependent increases in TLR7 response markers at 100 mg or above. Flu‐like symptoms were associated with higher interferon‐α levels. RO7020531 was safe and acceptably tolerated in healthy Chinese volunteers with a multiple 150 mg q.o.d. dose regimen.
Quantification of Natural Growth of Two Strains of Mycobacterium Marinum for Translational Antituberculosis Drug Development
Authors: Van Wijk Rob C. , van der Sar Astrid M. , Krekels Elke H.J. , Verboom Theo , Spaink Herman P. , Simonsson Ulrika S.H. , van der Graaf Piet H.
Published: April 2020

The zebrafish infected with Mycobacterium marinum (M. marinum) is an attractive tuberculosis disease model, showing similar pathogenesis to Mycobacterium tuberculosis (M. tuberculosis) infections in humans. To translate pharmacological findings from this disease model to higher vertebrates, a quantitative understanding of the natural growth of M. marinum in comparison to the natural growth of M. tuberculosis is essential. Here, the natural growth of two strains of M. marinum, E11 and MUSA, is studied over an extended period using an established model‐based approach, the multistate tuberculosis pharmacometric (MTP) model, for comparison to that of M. tuberculosis. Poikilotherm‐derived strain E11 and human‐derived strain MUSA were grown undisturbed up to 221 days and viability of cultures (colony forming unit (CFU)/mL) was determined by plating at different time points. Nonlinear mixed effects modeling using the MTP model quantified the bacterial growth, the transfer among fast, slow, and non‐multiplying states, and the inoculi. Both strains showed initial logistic growth, reaching a maximum after 20–25 days for E11 and MUSA, respectively, followed by a decrease to a new plateau. Natural growth of both E11 and MUSA was best described with Gompertz growth functions. For E11, the inoculum was best described in the slow‐multiplying state, for MUSA in the fast‐multiplying state. Natural growth of E11 was most similar to that of M. tuberculosis, whereas MUSA showed more aggressive growth behavior. Characterization of natural growth of M. marinum and quantitative comparison with M. tuberculosis brings the zebrafish tuberculosis disease model closer to the quantitative translational pipeline of antituberculosis drug development.
A pragmatic study of mid‐mixture insulin and basal insulin treatment in patients with type 2 diabetes uncontrolled with oral antihyperglycaemic medications: A lesson from real‐world experience
Authors: Zhang Xiaomei , Ma Yujin , Chen Hong , Lou Ying , Ji Linong , Chen Lulu
Published: April 2020

Background

Chinese guidelines for the treatment of type 2 diabetes (T2D) recommend basal or premixed insulins as insulin starters after failed oral antihyperglycaemic medication (OAM). This pragmatic study compared effectiveness and safety of add‐on basal insulin analog (BI) and mid‐mixture insulin analog (MMI; 50:50 premixed insulin) as starter insulin regimens in Chinese patients with T2D in a real‐world setting.

Materials and Methods

This was a multicentre, open‐label, randomized, parallel, pragmatic trial. Patients receiving OAMs were randomized 1:1 to BI (n = 410) or MMI (n = 404) for 24 weeks. Insulin titration and OAM adjustment were determined by investigators following usual standard‐of‐care. The primary outcome was change in glycated haemoglobin (HbA1c) from baseline.

Results

Least‐squares mean changes in HbA1c from baseline to week 24 were −2.00% and −2.15% for BI and MMI groups, respectively (P = .13). The MMI group demonstrated a greater reduction in concomitant OAM therapies used than BI group (53.8% vs. 35.3%, respectively; P < .001). Very limited daily insulin dose increments were observed from baseline to week 24 in both BI and MMI groups (2.5 U/day and 1.8 U/day, respectively). Although both insulin analogs were well‐tolerated without severe hypoglycaemia, small weight gains were seen with both treatments. Higher total hypoglycaemia rates were noticed with the MMI group, while nocturnal hypoglycaemia events were comparable.

Conclusions

In real‐world settings, BI and MMI provided similar improvement in glucose control without conceding hypoglycaemia. The BI group received a greater number of OAMs in real‐world settings. Limited insulin dose titration was observed, while more adjustments occurred with OAM usage.
The worldwide impact of urbanisation on avian functional diversity
Authors: Sol Daniel , Trisos Christopher , Múrria Cesc , Jeliazkov Alienor , González‐Lagos Cesar , Pigot Alex L. , Ricotta Carlo , Swan Christopher M. , Tobias Joseph A. , Pavoine Sandrine
Published: April 2020

Urbanisation is driving rapid declines in species richness and abundance worldwide, but the general implications for ecosystem function and services remain poorly understood. Here, we integrate global data on bird communities with comprehensive information on traits associated with ecological processes to show that assemblages in highly urbanised environments have substantially different functional composition and 20% less functional diversity on average than surrounding natural habitats. These changes occur without significant decreases in functional dissimilarity between species; instead, they are caused by a decrease in species richness and abundance evenness, leading to declines in functional redundancy. The reconfiguration and decline of native functional diversity in cities are not compensated by the presence of exotic species but are less severe under moderate levels of urbanisation. Thus, urbanisation has substantial negative impacts on functional diversity, potentially resulting in impaired provision of ecosystem services, but these impacts can be reduced by less intensive urbanisation practices.
Dynamics of a human‐modified tropical peat swamp forest revealed by repeat lidar surveys
Authors: Wedeux Béatrice , Dalponte Michele , Schlund Michael , Hagen Stephen , Cochrane Mark , Graham Laura , Usup Aswin , Thomas Andri , Coomes David
Published: April 2020

Tropical peat swamp forests (PSFs) are globally important carbon stores under threat. In Southeast Asia, 35% of peatlands had been drained and converted to plantations by 2010, and much of the remaining forest had been logged, contributing significantly to global carbon emissions. Yet, tropical forests have the capacity to regain biomass quickly and forests on drained peatlands may grow faster in response to soil aeration, so the net effect of humans on forest biomass remains poorly understood. In this study, two lidar surveys (made in 2011 and 2014) are compared to map forest biomass dynamics across 96 km2 of PSF in Kalimantan, Indonesia. The peatland is now legally protected for conservation, but large expanses were logged under concessions until 1998 and illegal logging continues in accessible portions. It was hypothesized that historically logged areas would be recovering biomass while recently logged areas would be losing biomass. We found that historically logged forests were recovering biomass near old canals and railways used by the concessions. Lidar detected substantial illegal logging activity—579 km of logging canals were located beneath the canopy. Some patches close to these canals have been logged in the 2011–2104 period (i.e. substantial biomass loss) but, on aggregate, these illegally logged regions were also recovering. Unexpectedly, rapid growth was also observed in intact forest that had not been logged and was over a kilometre from the nearest known canal, perhaps in response to greater aeration of surface peat. Comparing these results with flux measurements taken at other nearby sites, we find that carbon sequestration in above‐ground biomass may have offset roughly half the carbon efflux from peat oxidation. This study demonstrates the power of repeat lidar survey to map fine‐scale forest dynamics in remote areas, revealing previously unrecognized impacts of anthropogenic global change.
Understanding minimum and ideal factor levels for participation in physical activities by people with haemophilia: An expert elicitation exercise
Authors: Martin Antony P. , Burke Tom , Asghar Sohaib , Noone Declan , Pedra Gabriel , O'Hara Jamie
Published: April 2020

Introduction

The benefits of physical activity (PA) for people with haemophilia (PWH) may include improvements in joint, bone and muscle health. However, the factor VIII activity level required to avoid a bleeding episode associated with PA is unknown.

Aim

To elicit the opinion of clinical experts on the minimum level and ideal factor VIII activity (‘level’) required to avoid a bleeding episode during participation in different types of PA for PWH.

Methods

Based on the 2017 National Hemophilia Foundation PA descriptions, clinical experts estimated a minimally acceptable and an ideal factor level at which a bleed could be avoided. The uncertainty around estimates was quantified using an approach to construct a probability distribution to represent expert opinion.

Results

Minimum and ideal factor level increased with higher risk PA, whether or not joint morbidity was present, as did the experts' uncertainty in their estimates (ie the range between lowest and highest estimates for minimum and ideal levels). Mean minimum levels ranged from 4% to 48% for low to high risk for people without joint morbidity, and from 7% to 47% for those with joint morbidity. For ideal factor levels, corresponding figures were 9%‐52% and 12%‐64%, respectively.

Conclusion

To support a patient‐centric outcome, expert opinion indicates that the clinical norm of 0.01 IU/mL (1%) trough level is insufficient. It is anticipated that introducing a more targeted approach to meet the needs of patients who are increasingly physically active will benefit patients further in addition to recent treatment advances.
Mechanical thrombectomy for emergent large vessel occlusion: an Australian primary stroke centre workflow analysis
Authors: Tiu Jeigh , Watson Tayler , Clissold Ben
Published: April 2020

Background

Time to successful reperfusion is a critical prognostic factor for acute ischaemic stroke. Mechanical thrombectomy has become the gold standard treatment for emergent large vessel occlusion stroke. The timely delivery of this highly specialised procedure to patients outside of metropolitan centres presents a dilemma of inequity, with limited workflow data hindering benchmarking and service optimisation.

Aims

To analyse key stroke treatment time parameters from a primary stroke centre existing in a regional centre within a hub‐and‐spoke delivery model in Victoria, Australia.

Methods

Retrospective cohort study of patients transferred from a regional primary stroke centre to a metropolitan comprehensive stroke centre for mechanical thrombectomy between July 2016 and December 2018. Time workflow analysis was conducted from symptom onset to primary stroke centre departure.

Results

A total of 55 patients was included in this study with an average age of 70.2 years. Median National Institutes of Health Stroke Scale score on admission was 13 (interquartile range (IQR) 7–17). Median pre‐hospital time was 68 min (IQR 56–137) and median door‐in‐door‐out time was 120.5 min (IQR 98–150), constituting 36.1% and 63.9% of total median time from symptom onset to primary stroke centre departure (188.5 min) respectively. There were no significant differences across observed cohort characteristics under linear regression analysis.

Conclusion

Protracted pre‐hospital and primary stroke centre workflow times can delay effective treatment for patients with acute ischaemic stroke in regional areas. A systems‐level approach to streamlining processes in these key areas is required to bridge this inequity in best practice care.
Does the pre‐emptive administration of paracetamol or ibuprofen reduce trans‐ and post‐operative pain in primary molar extraction? A randomized placebo‐controlled clinical trial
Authors: Santos Pablo Silveira , Massignan Carla , de Oliveira Elisa Varela , Miranda Santana Carla , Bolan Michele , Cardoso Mariane
Published: April 2020

Background

There is no consensus whether the pre‐emptive administration of analgesics reduces trans‐ and post‐operative pain in primary molar extraction.

Aim

Investigate whether the pre‐emptive administration of ibuprofen and paracetamol reduces trans‐ and post‐operative pain on primary molars extraction compared to placebo.

Design

A parallel, placebo‐controlled, triple‐blind, randomized clinical trial was conducted. Forty‐eight children who needed primary molar tooth extraction were selected and treated under local anaesthesia and pre‐emptive administration of placebo or analgesics. Self‐reported pain was evaluated during the anaesthesia, extraction, and 2, 6, and 24 hours of post‐operative period, using a visual analogue scale (VAS). Children's baseline anxiety, behaviour during the procedure, parents' anxiety, and post‐operative analgesia were also assessed. Data analysis included descriptive statistics and multiple linear regression.

Results

No association was found between the use of pre‐emptive analgesic and lower scores of trans‐ and post‐operative pain compared to placebo. Children who presented negative behaviour reported greater pain during anaesthesia (P = .04) regardless of pre‐emptive analgesia group. Children from the placebo group were more likely to need post‐operative analgesia at 2 hours of follow‐up (P = .03).

Conclusion

The pre‐emptive administration of analgesics did not significantly reduce trans‐ and post‐operative pain in children after primary molars extraction.
Treatment of glaucoma by prostaglandin agonists and beta‐blockers in combination directly reduces pro‐fibrotic gene expression in trabecular meshwork
Authors: Tejwani Sushma , Machiraju Praveen , Nair Archana Padmanabhan , Ghosh Anuprita , Das Raunak Kumar , Ghosh Arkasubhra , Sethu Swaminathan
Published: April 2020

Prostaglandin analogues (PG), beta‐blockers (BB) or their combination (PG+BB) are used primarily to reduce the intraocular pressure (IOP) pathologically associated with glaucoma. Since, fibrosis of the trabecular meshwork (TM) is a major aetiological factor in glaucoma, we studied the effect of these drugs on fibrosis‐associated gene expression in TM of primary glaucoma patients. In the present study, TM and iris of primary open‐angle (n = 32) and angle‐closure (n = 37) glaucoma patients were obtained surgically during trabeculectomy and categorized based on the type of IOP‐lowering medications use as PG, BB or PG+BB. mRNA expression of pro‐fibrotic and anti‐fibrotic genes was quantified using qPCR in these tissues. The gene expression levels of pro‐fibrotic genes were significantly lower in PG+BB as compared to other groups. These observations and underlying signalling validated in vitro in human TM cells also showed reduced fibrotic gene and protein expression levels following PG+BB treatment. In conclusion, it is observed that PG+BB combination rather than their lone use renders a reduced fibrotic status in TM. This further suggests that IOP‐lowering medications, in combination, would also modulate fibrosis‐associated molecular changes in the TM, which may be beneficial for maintaining aqueous out‐flow mechanisms over the clinical treatment duration.
Combined effect of diabetic retinopathy and diabetic kidney disease on all‐cause, cancer, vascular and non‐cancer non‐vascular mortality in patients with type 2 diabetes: A real‐world longitudinal study
Authors: Takao Toshiko , Suka Machi , Yanagisawa Hiroyuki , Kasuga Masato
Published: April 2020

Aims/Introduction

We assessed the relationship between diabetic retinopathy (DR) and/or diabetic kidney disease (DKD) according to their severity and all‐cause, cancer, vascular and non‐cancer non‐vascular mortality in real‐world patients with type 2 diabetes.

Materials and Methods

A total of 1,902 patients with type 2 diabetes were enrolled from 1995 to 1999 and followed to 2017. At baseline, DR was diagnosed in 374 patients, DKD in 529, vision‐threatening DR in 123 and advanced DKD in 287. Patients were classified by the status of DR and DKD. Multivariate Cox regression analysis was carried out.

Results

There were 266 deaths during a median follow‐up period of 18.6 years. Among these, 92 were from cancer, 78 were from vascular causes and 82 were from non‐cancer non‐vascular causes. DR and/or DKD predicted all‐cause, vascular and non‐cancer non‐vascular mortality, but not cancer mortality. Similarly, vision‐threatening DR and/or advanced DKD predicted all‐cause, vascular and non‐cancer non‐vascular mortality, but not cancer mortality. Hazard ratios for all‐cause, vascular and non‐cancer non‐vascular mortality were highest in the DR(+)DKD(+) group, and higher in the DR(−)DKD(+) and the DR(+)DKD(−) groups than in the DR(−)DKD(−) group. The results for vision‐threatening DR and advanced DKD were similar. The interaction for non‐cancer non‐vascular mortality, but not all‐cause and vascular mortality, between DR and DKD and between vision‐threatening DR and advanced DKD might be significant.

Conclusions

DR and DKD may be jointly and independently associated with all‐cause, vascular and non‐cancer non‐vascular mortality, but not cancer mortality, according to their severity in real‐world patients with type 2 diabetes.