bluuebunny/crossref_metadata_2025 huggingface dataset:
The “service excellence chain”: an empirical investigation in the healthcare field
Authors: Guglielmetti Mugion Roberta , Musella Flaminia , Di Pietro Laura , Toni Martina
Published: March 2020

Purpose

The linkage between internal and external satisfaction is an understudied topic in the service field. This study aims to address this gap by proposing an original research model, the service excellence chain (SEC), that connects the internal and external perspectives by conjoining performance-excellence models and the service-profit-chain approach. Theoretical assumptions and quantitative measures are proposed by using advanced statistical techniques.

Design/methodology/approach

The SEC is investigated through an empirical study in the healthcare sector, focusing on an Italian hospital and involving two of its core units. Qualitative and quantitative approaches were used. First, internal and external customer satisfaction were separately tested through structural equation modeling. The linkage between internal and external satisfaction is then proposed by mathematically defining a synthetic index, the internal and external customer satisfaction index (IEGSI), modeled through Bayesian networks (BNs) and object-oriented BNs to provide an overall measure able to predict organizational improvement.

Findings

The distinct measured models show good internal validity and adequate fit both for patients' and employees' perspectives. The IEGSI allows rigorously connecting internal and external satisfaction by developing conjoint scenarios for organizational improvement.

Originality/value

This study proposes the SEC model as an innovative way to connect internal and external satisfaction. The findings can be useful both for private and public organizations and may provide several useful insights for healthcare managers as well as for policy-makers in relation to developing strategies for improving service quality.
Structural validity and internal consistency of an ecological observation‐based assessment, the Activities of Daily Living Profile
Authors: Bottari Carolina , Dutil Élisabeth , Auger Claudine , Lamoureux Julie
Published: March 2020

Introduction

Direct observation of everyday task performance is considered the most accurate measure of independence for individuals with executive function impairments. However, few observation‐based measures have been shown to have sound psychometric qualities and be clinically applicable. The objective of this study was to investigate the Activities of Daily Living (ADL) Profile's structural validity using exploratory factor analyses and internal consistency in order to identify the minimum set of tasks required to achieve reliable scores in each of three ADL environments (personal, home and community).

Methods

Ninety‐one persons with a severe traumatic brain injury aged 16–40 years (convenience sample) were recruited from a university affiliated level 1 trauma hospital. The 17 observation‐based tasks of the ADL Profile were administered by one of five occupational therapists, either in the hospital or in the subjects’ home and community environments. This measure of independence considers goal formulation, planning, carrying out and verifying goal attainment.

Results

Exploratory factor analysis indicated the unidimensionality of the 17 tasks of the ADL Profile. A single factor explained more than 80% of the common variation, which in this case is the concept of independence. Internal consistency of task scores is very high (0.955), suggesting redundancy of the tasks. Approaches used to reduce the number of items, and to optimise the clinical applicability of the tool, showed that a minimum of two tasks per each of three environments (personal, home, community) is required to obtain reliable results that respect the tool's internal structure. Each assessment should contain both simple and familiar and more novel and complex tasks.

Conclusions

Findings show that the ADL Profile is a valid and clinically applicable observation‐based measure of independence that considers four important task‐related components: goal formulation, planning, carrying out and verifying goal attainment.
Factors shaping community patterns of protists and bacteria on a European scale
Authors: Bock Christina , Jensen Manfred , Forster Dominik , Marks Sabina , Nuy Julia , Psenner Roland , Beisser Daniela , Boenigk Jens
Published: March 2020

Factors shaping community patterns of microorganisms are controversially discussed. Physical and chemical factors certainly limit the survival of individual taxa and maintenance of diversity. In recent years, a contribution of geographic distance and dispersal barriers to distribution patterns of protists and bacteria has been demonstrated. Organismic interactions such as competition, predation and mutualism further modify community structure and maintenance of distinct taxa. Here, we address the relative importance of these different factors in shaping protists and bacterial communities on a European scale using high‐throughput sequencing data obtained from lentic freshwater ecosystems. We show that community patterns of protists are similar to those of bacteria. Our results indicate that cross‐domain organismic factors are important variables with a higher influence on protists as compared with bacteria. Abiotic physical and chemical factors also contributed significantly to community patterns. The contribution of these latter factors was higher for bacteria, which may reflect a stronger biogeochemical coupling. The contribution of geographical distance was similar for both microbial groups.
Kinship and a counter‐hegemonic social order: former revolutionaries in southern Oman
Authors: Wilson Alice
Published: March 2020

Critical reinterpretations of kinship studies questioned earlier ideas that kinship relations reflect and reproduce a dominant social order. ‘New’ kinship studies have nevertheless shown how even non‐traditional family forms can reproduce traditional ideas about relatedness, values, and social hierarchies. Promising grounds for resisting ongoing tendencies to link kinship with conservative social reproduction arise from better understanding the circumstances under which kinship relations reproduce a counter‐hegemonic social order. Kinship practices of former militants of a defeated revolutionary liberation movement in Dhufar, Oman, make visible veterans’ networks and relations which transgress dominant tribal, ethnic, racial, and gendered hierarchies. These practices show how, even in inauspicious circumstances of political defeat and marginalization, kinship relations can reproduce a counter‐hegemonic social order – as well as a social afterlife of defeated revolution.
A randomised trial of caesarean wound coverage: exposed versus dressed
Authors: Tan PC , Rohani E , Lim MCK , Win ST , Omar SZ
Published: March 2020

Objective

To evaluate the superficial surgical site infection (SSI) rate to 28 days and patient satisfaction with wound coverage management when their transverse suprapubic caesarean wound is left exposed compared with dressed after skin closure.

Design

Randomised trial.

Setting

University Hospital, Malaysia: April 2016–October 2016.

Population

331 women delivered by caesarean section.

Method

Participants were randomised to leaving their wound entirely exposed (n = 165) or dressed (n = 166) with a low adhesive dressing (next day removal).

Main outcome measures

Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on days 14 and 28) and patient satisfaction with wound coverage management before hospital discharge.

Results

The superficial SSI rates were 2/153 (1.3%) versus 5/157 (3.2%) (relative risk [RR] 0.4, 95% CI 0.1–2.1; P = 0.45) and patient satisfaction with wound management was 7 [5–8] versus 7 [5–8] (P = 0.81) in exposed compared with dressed study groups, respectively. In the wound‐exposed patients, stated preference for wound exposure significantly increased from 35.5 to 57.5%, whereas in the wound‐dressed patients, the stated preference for a dressed wound fell from 48.5 to 34.4% when assessed at recruitment (pre‐randomisation) to day 28. There were no significant differences in inpatient additional dressing or gauze use for wound care, post‐hospital discharge self‐reported wound issues of infection, antibiotics, redness and inflammation, swollen, painful, and fluid leakage to day 28 across trial groups.

Conclusion

The trial is underpowered as SSI rates were lower than expected. Nevertheless, leaving caesarean wounds exposed does not appear to have detrimental effects, provided patient counselling to manage expectations is undertaken.

Tweetable abstract

An exposed compared with a dressed caesarean wound has a similar superficial surgical site infection rate, patient satisfaction and appearance.
Voluntary Disclosure and Informed Trading*
Authors: Petrov Evgeny
Published: March 2020

This study analyzes the impact of informed trading on voluntary corporate disclosure in the presence of two factors: the cost of disclosure and the value of a manager's informedness. In the absence of both factors, informed trading has no impact on disclosure even when traders are not certain whether the manager has information. When disclosure is costly, informed trading serves as a free substitute for the disclosure of favorable information, and reduces disclosure. Surprisingly, when the manager's informedness is valuable for the firm, informed trading can also increase disclosure. Traders can discover unfavorable information about the firm, so managers with such information have less incentive to pool with uninformed managers and disclose to show that they are informed. The study also demonstrates that informed trading can have either a positive or a negative effect on firm value by crowding in or crowding out information production in the firm. These results hold for general information structures and are robust if traders can choose how much information can be acquired.
Does Public Country‐by‐Country Reporting Deter Tax Avoidance and Income Shifting? Evidence from the European Banking Industry*
Authors: Joshi Preetika , Outslay Edmund , Persson Anh , Shevlin Terry , Venkat Aruhn
Published: March 2020

In this study, we examine the effect of increased tax transparency on the tax planning behavior of European banks. In 2014, the European Union introduced public country‐by‐country reporting requirements to the banking industry. Treating this new requirement as an exogenous shock, we find limited evidence consistent with a decline in income shifting by the banks' financial affiliates in the post‐adoption period (starting from 2015). We do not, however, find robust evidence of a significant change in the consolidated book effective tax rates among the affected banks. Our findings suggest that increased transparency from public country‐by‐country reporting can deter tax‐motivated income shifting but that it did not appear to materially influence the banks' overall tax avoidance. Our findings have policy implications for the ongoing debate between the European Parliament, the Organisation for Economic Co‐operation and Development, and accounting standard‐setting bodies on whether to require multinationals to publish country‐by‐country reports.
Evaluation of a semi‐automated Seegene PCR workflow with MTB, MDR, and NTM detection for rapid screening of tuberculosis in a low‐prevalence setting
Authors: Luukinen Bruno Vincent , Vuento Risto , Hirvonen Jari Juhani
Published: March 2020

In areas of low tuberculosis (TB) prevalence, laboratory diagnosis of TB may essentially cover non‐tuberculous mycobacteria (NTM) in addition to Mycobacterium tuberculosis (MTB). In this study, a semi‐automated PCR workflow distinguishing MTB and NTM (Anyplex™ MTB/NTMe, Seegene) and subsequently detecting MTB isoniazid/rifampicin resistance (Allplex™ MTB/MDRe, Seegene) was evaluated for replacing smear microscopy of acid‐fast bacilli as the rapid screening method for TB. With 279 clinical samples, 47 cultures positive for MTB and 76 for NTM, the Anyplex™ MTB/NTMe assay and smear microscopy showed equal sensitivities (49.6% vs 50.8%, respectively) but Anyplex™ MTB/NTMe was more sensitive for MTB (63.8% vs 25.6%) than for NTM (40.8% vs 64.5%). Allplex™ MTB/MDRe showed a slightly higher sensitivity of 68.1% for MTB (32/47 positive, n = 222). Antibiotic resistance profiles were correctly identified for all MTB isolates (one MDR isolate). Specificity was 100% for both assays. Anyplex™ MTB/NTMe detected all the 18 NTM species present in the study. The analytical performance of the evaluated high‐throughput workflow was relatively weak compared to culture but potentially adequate as a rapid screening method analogous to smear microscopy with additional differentiation between TB, MDR‐TB, and NTM.
Comparison of growth performances, carcass characteristics, and meat qualities of Okinawan indigenous Agu pigs and crossbred pigs sired by Agu or Duroc boar
Authors: Touma Shihei , Oyadomari Motoharu
Published: March 2020

Indigenous Okinawa Agu pigs are crossed with Large White × Landrace (WL) pigs to improve their meat production, but there is little information regarding the crossbreeding effects. The study aims to compare growth, carcass characteristics, and meat qualities of Agu pigs with those of WL crossbreeds with Agu sires (WLA) or Duroc sires (WLD). WLA pigs showed better growth performance and carcass characteristics and less intramuscular fat (IMF) contents than Agu ones, but they had higher fat deposition, smaller longissimus dorsi muscle area, and higher IMF contents than WLD pigs. Agu pigs showed higher water holding capacity than the other two breeds. The inner layer of Agu backfat contains higher and lower proportions of monounsaturated fatty acids (MUFA) and polyunsaturated fatty acid (PUFA), respectively, than that in WLD animals. WLA animals had intermediate values for the fatty acid content in the inner backfat, although MUFA contents were equal to those of Agu pigs. Fatty acid profiles in IMF were similar to those in the backfat. These results indicate that crossbreeding of Agu with WL pigs improves growth performance and carcass quality. Particularly, WLA pigs have higher IMF contents and MUFA concentrations and lower PUFA concentrations than WLD pigs.
The Korean Medication Algorithm Project for Bipolar Disorder (KMAP‐BP): Changes in preferred treatment strategies and medications over 16 years and five editions
Authors: Jon Duk‐In , Woo Young Sup , Seo Jeong‐Seok , Lee Jung Goo , Jeong Jong‐Hyun , Kim Won , Shin Young Chul , Min Kyung Joon , Yoon Bo‐Hyun , Bahk Won‐Myong
Published: March 2020

Objectives

The Korean Medication Algorithm Project for Bipolar Disorder (KMAP‐BP) is based on expert consensus and has been revised five times since 2002. This study evaluated the changes in treatment strategies advocated by the KMAP‐BP over time.

Methods

The five editions of the KMAP‐BP were reviewed, and the recommendations of the KMAP‐BP were compared with those of other bipolar disorder (BP) treatment guidelines.

Results

The most preferred option for the initial treatment of mania was a combination of a mood stabilizer (MS) and an atypical antipsychotic (AAP). Either MS or AAP monotherapy was also considered a first‐line strategy for mania, but not for all types of episodes, including mixed/psychotic mania. In general, although lithium and valproic acid were commonly recommended, valproic acid has been increasingly preferred for all phases of BP. The most notable changes over time included the increasing preference for AAPs for all phases of BP, and lamotrigine for the depressive and maintenance phases. The use of antidepressants for BP has gradually decreased, but still represents a first‐line option for severe and psychotic depression.

Conclusions

In general, the recommended strategies of the KMAP‐BP were similar to those of other guidelines, but differed in terms of the emphasis on rapid effectiveness, which is often desirable in actual clinical situations. The major limitation of the KMAP‐BP is that it is a consensus‐based rather than an evidence‐based tool. Nevertheless, it may confer advantages in actual clinical practice.
Association between state‐level alcohol availability and taxation policies on the prevalence of alcohol‐related harms to persons other than the drinker in the USA, 2000–2015
Authors: Trangenstein Pamela J. , Subbaraman Meenakshi S. , Greenfield Thomas K. , Mulia Nina , Kerr William C. , Karriker‐Jaffe Katherine J.
Published: March 2020

Introduction and Aims

Alcohol‐related harms to others (AHTO) are consequences of alcohol use borne by persons other than the drinker. This study assessed whether the odds of experiencing AHTO are associated with alcohol availability and taxation policies.

Design and Methods

This study pooled data from four waves of the National Alcohol Survey (n= 20656 adults). We measured past‐year AHTO exposure using three binary variables:physical(pushed/hit/assaulted or property damage by someone who had been drinking),family or financial(family/marital problems or financial harms by someone who had been drinking) anddriving AHTO(riding in a vehicle with a drink‐driver or being in a drink‐driving crash). Policies included bar and off‐premise alcohol outlet density (separately), alcohol retail hours, beer and spirits taxes (separately) and monopoly on retail/wholesale alcohol purchases.

Results

Monopolies were associated with 41.2% lower odds of physical harms [adjusted odds ratio (aOR) = 0.59, 95% confidence interval (CI) 0.45, 0.77,q < 0.001 correcting for multiple analyses], and a 10% increase in bar density was associated with a 1.2% increase in odds of driving‐related harms(eln(1.1) * β=1.01, 95% CI 1.00, 1.02,q= 0.03). Among men, beer taxes were associated with lower odds of physical harms (eln(1.1) * β=0.93, 95% CI 0.88, 0.98q= 0.03) and monopolies were associated with lower odds of physical (aOR = 0.45, 95% CI 0.35, 0.59,q < 0.001) and driving harms (aOR = 0.66, 95% CI 1.00, 1.02,q= 0.03).

Discussion and Conclusions

Monopolies, taxes and outlet density are associated with odds of some AHTO. Future longitudinal research should test whether physical availability and taxation policies may be protective for bystanders as well as drinkers.
Negative effects of urbanisation on the physical condition of an endemic dung beetle from a neotropical hotspot
Authors: Salomão Renato Portela , Alvarado Fredy , Baena‐Díaz Fernanda , Favila Mario Enrique , Iannuzzi Luciana , Liberal Carolina Nunes , Santos Bráulio A. , Villegas‐Guzmán Gabriel Alfredo , González‐Tokman Daniel
Published: March 2020

1. Urbanisation causes important losses in biodiversity and ecosystem of animals. To test whether these negative effects are preceded by unhealthy individuals in urban populations, we evaluated the effects of urbanisation on the abundance and physical condition of the dung beetle Dichotomius guaribensis, an endemic species of the Brazilian Atlantic Forest.

2. We sampled beetles in nine forest fragments with different urbanisation degrees, embedded in the urban matrix of the city of João Pessoa. Besides testing the abundance in each fragment, we quantified four indicators of physical condition in males and females: body size, body mass, energetic condition, and mite load.

3. Females tended to be larger, and to have less lipid mass and more mites than males. Urbanisation had no effect on beetle abundance, but it negatively affected body mass and lipid content in males, but not females, revealing different sensitivities for both sexes. Body size and mite load were not affected by urbanisation in males or females. Fragment size had no effect on beetle abundance and physical condition in both sexes, suggesting that urbanisation has a greater impact than fragment size on beetle individual condition.

4. In this study, we show that individual deterioration precedes population declines in disturbed environments, and our study opens new insights into the proximate causes that leads to the loss of biodiversity and ecosystem services in urbanised regions.
Abdominal wall herniation in working Moroccan equids: 14 cases (2016–2017)
Authors: Khairoun A. , Kay G.
Published: March 2020

Hernia of the abdominal musculature was seen in 14 working equids (1% of total admissions) during the 14‐month period between October 2016 and December 2017. Animals with hernias of less than 2 months’ duration (six animals) were treated conservatively with compressive abdominal bandaging whereas those with hernias of more than 2 months’ duration (five animals) were treated surgically with a primary closure of the defect. Surgical repair was not possible in three individuals due to the large size of the defect, location and lack of availability of prosthetic mesh. Of the 11 equidae treated, all showed complete resolution of the hernia by the time of discharge, and follow‐up with owners, between 5 and 16 months post‐treatment, revealed that no recurrence of the ruptures.
Marching in step: The importance of matching model complexity to data availability in terrestrial biosphere models
Authors: Feng Xue
Published: March 2020

Building models to predict ecosystem responses to future rainfall changes requires closely matching model complexity to data availability. A new study by Paschalis et al. (Global Change Biology, 2020) examines opportunities to improve both data availability and model structure in 10 state‐of‐the‐art terrestrial biosphere models.

This is a Commentary on Paschalis et al. 26, 3336–3355
Spatial Regression with Multiple Dependent Variables: Principal Component Analysis and Spatial Autocorrelation
Authors: Lin Ge , Zhang Tonglin
Published: March 2020

Simultaneous studies of multiple health conditions over geographic areas can be enhanced by the principal component analysis (PCA). However, the presence of spatial autocorrelation may induce nonlinearity that compromises PCA. This article presents an approach that combines the residual standardization method in PCA with a spatial regression method to account for spatial autocorrelation. It first estimates a multivariate simultaneous autoregressive model for parameter estimates and residuals. It then uses the residuals to formulate a standardized matrix for singular value decomposition. Simulation in various scenarios demonstrates that the proposed approach can effectively remove spatial dependent effects between spatial units to capture pure correlation effects within spatial units. Two case studies examine hospitalization and cancer data in Nebraska. The first demonstrates a way to account for spatial dependency in 39 hospitalization conditions over 156 census tracts. The second applies regression residuals to PCA to evaluate potentially elevated cancer risks near two nuclear power plants. The results show that accounting for spatial dependency and explanatory variables can help reveal information about multiple health outcomes.
Sphenopalatine Ganglion Pulsed Radiofrequency for the Treatment of Refractory Chronic SUNCT and SUNA: A Prospective Case Series
Authors: Ornello Raffaele , Palmisani Stefano , Murphy Madeleine , Sacco Simona , Al‐Kaisy Adnan , Lambru Giorgio
Published: March 2020

Objectives

We aimed to evaluate the safety and effectiveness of sphenopalatine ganglion pulsed radiofrequency (SPG‐PRF) for the treatment of patients with refractory chronic short‐lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and with cranial autonomic symptoms (SUNA).

Background

SPG‐PRF is a minimally invasive, non‐neurodestructive procedure already tested in refractory chronic cluster headache with mixed outcomes. However, no data have been produced in SUNCT/SUNA.

Methods

This was a prospective clinical audit of outcomes. Consecutive patients with chronic SUNCT/SUNA refractory to medical treatments and treated with SPG‐PRF, were included in the analysis. The SPG‐PRF was performed percutaneously via a lateral, infra‐zygomatic approach. Responders were defined as patients with a reduction in number and/or severity of headache episodes by ≥30% for ≥3 months. Responders to the first procedure were offered to have the treatment repeated.

Results

Nine patients (6 female) were analyzed. After a median follow‐up of 30 months (range 2‐30), 7 patients were considered responders to the treatment (77.8%) for a median of 6 months (range: 4‐10), 1 patient obtained 40% improvement for 2 months, and 1 patient did experience any improvement. No procedure‐related immediate or delayed side effects were reported. Three patients (33.3%) experienced a worsening of the head pain for 2‐4 weeks immediately after the procedure. Four responders had SPG‐PRF repeated; a reproducible response was obtained in two of them.

Conclusions

In our small series of patients with refractory chronic SUNCT/SUNA, SPG‐PRF was a safe and effective treatment modality. The potential reproducible positive effect of subsequent treatments may prevent or delay the use of more invasive and costly interventions for at least a proportion of these patients.
Analysis of the optimal psoas muscle mass index cut‐off values, as measured by computed tomography, for the diagnosis of loss of skeletal muscle mass in Japanese people
Authors: Ohara Masatsugu , Suda Goki , Kimura Megumi , Maehara Osamu , Shimazaki Tomoe , Shigesawa Taku , Suzuki Kazuharu , Nakamura Akihisa , Kawagishi Naoki , Nakai Masato , Sho Takuya , Natsuizaka Mitsuteru , Morikawa Kenichi , Ogawa Koji , Kobayashi Tomoe , Uebayashi Minoru , Takagi Ryo , Yokota Isao , Shimamura Tsuyoshi , Sakamoto Naoya
Published: March 2020

Aim

This study aimed to determine the optimal psoas muscle mass index (PMI) cut‐off values for diagnosis of skeletal muscle mass loss.

Methods

We evaluated PMI in two groups of normal controls: a medical check‐up group and a liver donation candidate group. We analyzed two novel PMI cut‐off values, one based on the mean – two standard deviations (2SD) and one based on the lower 5%. Skeletal muscle mass index (SMI) evaluations using computed tomography (sliceOmatic; TomoVision) and bioelectrical impedance analysis and PMI evaluation were undertaken simultaneously. We analyzed the correlation between our PMI cut‐off values and the Japan Society of Hepatology‐defined SMI cut‐off values. The prevalence of skeletal muscle mass loss in patients with liver disease was assessed using the novel PMI cut‐off values.

Results

In 504 normal controls aged ≤50 years, the PMI cut‐off values based on mean –2SD and the lower 5% were set at 3.30 cm2/m2 for men and 1.69 cm2/m2 for women and 3.74 cm2/m2 for men and 2.29 cm2/m2 for women, respectively. The PMI cut‐off values based on the lower 5% alone showed that skeletal muscle mass loss increased with age. Furthermore, they correlated well with Japan Society of Hepatology‐defined SMI (sliceOmatic) cut‐off values and showed a significantly higher prevalence of skeletal muscle mass loss in patients with liver cirrhosis than those without liver cirrhosis.

Conclusions

We propose the following PMI cut‐off values: 3.74 cm2/m2 for male individuals and 2.29 cm2/m2 for female individuals. These cut‐off values can facilitate accurate diagnosis and management of sarcopenia in patients with chronic liver disease.
The Peppa Pig television series as input in pre‐primary EFL instruction: A corpus‐based study
Authors: Scheffler Paweł , Jones Christian , Domińska Anna
Published: March 2020

The provision of instruction in English as a foreign language (EFL) is constantly being extended to include ever younger learners. As one of the challenges for pre‐primary EFL instruction is the delivery of a sufficient amount of appropriate input, the main aim of this article is to investigate one potential source of such input, namely an animated television series, in terms of its linguistic features and its suitability for use in pre‐primary instruction. More specifically, the article examines a corpus of 88 episode transcripts of the Peppa Pig series. It analyses the extent to which the data contain linguistic features which can also be found in another corpus of spoken English. Following the analysis, recommendations for integrating the series into pre‐primary English instruction are presented.
A Non‐Proportional Hazards Model with Hazard Ratio Functions Free from Covariate Values
Authors: Kuk Anthony Y. C.
Published: March 2020

A brief survey on methods to handle non‐proportional hazards in survival analysis is given with emphasis on short‐term and long‐term hazard ratio modelling. A drawback of the existing model of this nature is that except at time zero or infinity, the hazard ratio for a unit increase in the value of a covariate depends on the starting value. With two or more covariates, the hazard ratio for a unit increase in one covariate with other covariates held fixed depends in an unintended way on the values of the other covariates. We propose an alternative way to model short‐term and long‐term hazard ratios without the above drawbacks through a judicious choice of covariate‐time interactions. Under the new model, it is easier to describe the time‐varying effect of each covariate on the hazard. Nonparametric maximum likelihood estimation for the new model can be carried out in the same way as for the existing model. We also propose a product version of the existing model, which overcomes its second drawback but not the first. The advocated covariate–time interaction model provides a better fit to the Veterans Administration lung cancer data set than the original and product versions of the existing model.
High temperature reduces photosynthesis in maize leaves by damaging chloroplast ultrastructure and photosystem II
Authors: Li Yu‐Ting , Xu Wei‐Wei , Ren Bai‐Zhao , Zhao Bin , Zhang Jiwang , Liu Peng , Zhang Zi‐Shan
Published: March 2020

Global warming has increased the frequency and duration of high temperature (HT) stress. Photosynthesis determines yield in maize and is extremely HT sensitive. The effects of HT on photosynthesis in maize leaves have been strongly examined under controlled conditions. Here, to explore the mechanism and primary inhibitory sites of HT to photosynthesis, the HT sensitivity of photosynthesis in XY335 and ZD958 maize hybrids was systematically studied in field by multiple methods. HT decreased leaf area and photosynthetic rate of unit leaf area and hence limited growth. HT disrupted chloroplast and mitochondrial membrane structure, possibly delaying photosynthetic recovery after HT. These changes were greater in XY335 than ZD958. Stomatal conductance decreased significantly under HT, and this did not restrict CO2 fixation but may weaken the heat dissipation through transpiration. HT caused photoinhibition of PSII but not PSI. HT damaged both the oxygen‐evolving complex, located at donor side of PSII, and electron transfer from QA to QB, located at acceptor side of PSII. Interference of electron transfer from QA to QB caused by degradation of QB‐binding (D1) protein was the primary site of PSII inhibition by HT in maize leaves. The different stomatal behaviour and photoinhibition sites under HT between maize and wheat were discussed.
UNIVERSITY OF GEORGIA ROUNDTABLE ON: Enterprise‐Wide Risk Management
Authors: Verbrugge James , Niehaus Greg , Coleman Walter , Lawder Keith , Smith Cliff , Briscoe Christie , Ramamurtie Sailesh , Chew Don
Published: March 2020

For many years, MBA students were taught that there was no good reason for companies that hedge large currency or commodity price exposures to have lower costs of capital, or trade at higher P/E multiples, than comparable companies that choose not to hedge such financial price risks. Corporate stockholders, just by holding well‐diversified portfolios, were said to neutralize any effects of currency and commodity price risks on corporate values. And corporate efforts to manage such risks were accordingly viewed as redundant, a waste of corporate resources on a function already performed by investors at far lower cost.

But as this discussion makes clear, both the theory and the corporate practice of risk management have moved well beyond this perfect markets framework. The academics and practitioners in this roundtable begin by suggesting that the most important reason to hedge financial risks—and risk management's largest potential contribution to firm value—is to ensure a company's ability to carry out its strategic plan and investment policy. As one widely cited example, Merck's use of FX options to hedge the currency risk associated with its overseas revenues is viewed as limiting management's temptation to cut R&D in response to large currency‐related shortfalls in reported earnings.

Nevertheless, one of the clear messages of the roundtable is that effective risk management has little to do with earnings management per se, and that companies that view risk management as primarily a tool for smoothing reported earnings have lost sight of its real economic function: maintaining access to low‐cost capital to fund long‐run investment. And a number of the panelists pointed out that a well‐executed risk management policy can be used to increase corporate debt capacity and, in so doing, reduce the cost of capital.

Moreover, in making decisions whether to retain or transfer risks, companies should generally be guided by the principle of comparative advantage. If an outside firm or investor is willing to bear a particular risk at a lower price than the cost to the firm of managing that risk internally, then it makes sense to lay off that risk. Along with the greater efficiency and return on capital promised by such an approach, several panelists also pointed to one less tangible benefit of an enterprise‐wide risk management program—a significant improvement in the internal corporate dialogue, leading to a better understanding of all the company's risks and how they are affected by the interactions among its business units.
Barriers and facilitators to seasonal influenza vaccination uptake among nurses: A mixed methods study
Authors: Flanagan Paula , Dowling Maura , Gethin Georgina
Published: March 2020

Aim

To identify the barriers and facilitators to seasonal influenza vaccination uptake among nurses.

Background

Seasonal influenza causes significant mortality and morbidity among older people and high‐risk groups. Vaccinating nurses against influenza is an essential public health measure to reduce the burden of disease. Yet despite annual recommendations, nurses’ influenza vaccine uptake rates remain low.

Design

An explanatory sequential mixed methods study design.

Data Sources

Qualified nurses attending mandatory training in two large acute hospitals in Ireland.

Methods

A paper‐based questionnaire assessing nurses’ knowledge, risk perception, health beliefs and influenza vaccination practices was distributed to a convenience sample of qualified nurses (N = 462) between September 2017 – February 2018. A self‐selected sample of 35 nurses who completed the questionnaire participated in five focus groups to explore in depth the barriers and facilitating factors associated with their vaccination practices between September 2018 – October 2018. The questionnaire data were analysed statistically and thematic analysis was applied to the qualitative data. The quantitative and qualitative findings were integrated using the Pillar Integration Process.

Results

Seven themes emerged: (a) the influence of nurses’ knowledge on vaccine uptake; (b) dissemination of information; (c) vaccine fears and concerns; (d) protection, risk and vulnerability: self and others; (e) influencers; (f) accessibility; and (g) organizational pressure.

Conclusion

Achieving high vaccine uptake rates among nurses through voluntary vaccination programmes remains a challenge. Multi‐faceted influenza campaigns based on the HBM should be prioritized to address dissemination of evidence‐based knowledge, accessibility, and external cues to action.

Impact

Low influenza vaccine uptake among nurses compromises patient safety and contributes to a significant burden on health services. This study identified factors associated with vaccine practices among nurses and will inform the development of specific tailored interventions for nurses.
Visual art therapy as a treatment option for cognitive decline among older adults. A systematic review and meta‐analysis
Authors: Masika Golden M. , Yu Doris S. F. , Li Polly W. C.
Published: March 2020

Aims

To investigate the effects of visual art therapy (VAT) on cognitive and psychological outcomes and explore the crucial design characteristics of VAT that might be associated with greater cognitive benefits among older adults.

Design

Systematic review and meta‐analysis.

Data sources

Peer reviewed articles were searched from Medline, EMBASE, Global Health, Cochrane Library, Ovid Nursing database, PsycINFO, British Nursing Index, and CINAHL Complete from inception of the databases to September 2019.

Review methods

This review and meta‐analysis was conducted and reported according to preferred reporting items for systematic reviews and meta‐analyses guidelines. The Cochrane risk of bias tool was used to examine the risk of bias of the studies. Narrative synthesis and quantitative meta‐analysis were performed.

Result

Twelve articles published between 2004–2019 involving 831 participants were identified. VAT significantly improved global cognitive function compared with different control groups (Hedges' g = 0.348 [95% CI = 0.026–0.671], p = .034, I2 = 66.570%). VAT also demonstrated psychological benefits in reducing depressive symptoms and anxiety. By systematic comparison of the intervention designs, it seems that those with greater cognitive benefit involved a higher level of creativity and optimized the use of essential components including art education, reminiscence, art processing, cognitive evaluation, art crafts/modelling, and socialization.

Conclusion

Visual art therapy could be effective in improving cognitive functions and the associated psychological symptoms. Therefore, it can be adopted as an effective non‐pharmacological intervention for preventing cognitive decline and dementia.

Impact

This review answers the key question about the pooled effect of VAT as nonpharmacological therapy on preventing or managing dementia. In addition, it informs on the design characteristics of an effective VAT for implementing among older adults. This research will have an impact on the gerontological care and support the evidence about non‐pharmacological approaches to prevent and manage dementia.
Co‐design of a patient and family‐initiated escalation of care intervention to detect and refer patient deterioration: Research protocol
Authors: McKinney Aidín , Fitzsimons Donna , Blackwood Bronagh , White Mark , McGaughey Jennifer
Published: March 2020

Aim

To co‐design a patient and family‐initiated intervention to improve the detection and escalation of patient deterioration on acute adult hospital wards in Northern Ireland and the Republic of Ireland.

Design

The design is a collective case study approach in an acute hospital in Northern Ireland and the Republic of Ireland using an adapted co‐design approach and Medical Research Council framework guidelines.

Methods

Data will be collected from key stakeholders (patients, relatives, and healthcare professionals) using individual and focus group interviews and a review of patients’ records. This will inform the development of a co‐designed intervention and implementation strategy. The developed prototype will be further refined and optimized following a feedback session with stakeholders from each hospital site. This study was funded in February 2018 and Research Ethics Committee approval was granted in March 2019.

Discussion

This study will contribute to the growing knowledge base in relation to the interventions that improve the escalation of patient deterioration. It will also contribute to the intelligence, evidence and understanding of the role of patient and family participation in the detection and referral of clinical deterioration in acute adult hospital settings.

Impact

There is an ongoing need to introduce systems or mechanisms in acute care hospital settings which allow patient or family members to have a greater role in escalating care when they are concerned about patient deterioration. To date there is limited evidence of rigorous studies examining this area and this study will use stakeholder engagement and involvement to co‐design an intervention which will provide patients and families with a mechanism to address concerns which can be tested in practice.
Identification of cancer hallmark‐associated gene and lncRNA cooperative regulation pairs and dictate lncRNA roles in oral squamous cell carcinoma
Authors: Lin Ken , Song Lin‐Jing , Ma Jing , Zhang Tie‐Song , You Ding‐Yun , He Yong‐Wen
Published: March 2020

Oral squamous cell carcinoma (OSCC) is the most common malignant tumour in the oral and maxillofacial region. Numerous cancers share ten common traits (“hallmarks”) that govern the transformation of normal cells into cancer cells. Long non‐coding RNAs (lncRNAs) are important factors that contribute to tumorigenesis. However, very little is known about the cooperative relationships between lncRNAs and cancer hallmark‐associated genes in OSCC. Through integrative analysis of cancer hallmarks, somatic mutations, copy number variants (CNVs) and expression, some OSCC‐specific cancer hallmark‐associated genes and lncRNAs are identified. A computational framework to identify gene and lncRNA cooperative regulation pairs (GLCRPs) associated with different cancer hallmarks is developed based on the co‐expression and co‐occurrence of mutations. The distinct and common features of ten cancer hallmarks based on GLCRPs are characterized in OSCC. Cancer hallmark insensitivity to antigrowth signals and self‐sufficiency in growth signals are shared by most GLCRPs in OSCC. Some key GLCRPs participate in many cancer hallmarks in OSCC. Cancer hallmark‐associated GLCRP networks have complex patterns and specific functions in OSCC. Specially, some key GLCRPs are associated with the prognosis of OSCC patients. In summary, we generate a comprehensive landscape of cancer hallmark‐associated GLCRPs that can act as a starting point for future functional explorations, the identification of biomarkers and lncRNA‐based targeted therapy in OSCC.
Cecal intubation time between the use of one‐channel and two‐channel water exchange colonoscopy: A randomized controlled trial
Authors: Tseng Chih‐Wei , Koo Malcolm , Hsieh Yu‐Hsi
Published: March 2020

Background and Aim

Water exchange (WE) colonoscopy is the least painful insertion technique with high adenoma detection rate but requires a longer intubation time. In the published literature, some investigators used the instrument channel for both infusing and suctioning of water (one channel), while others use colonoscopes with an integrated water‐jet channel specifically designed for infusing water (two channel). The aim of this study was to compare cecal intubation time between one‐channel and two‐channel WE.

Methods

A total 120 patients undergoing colonoscopy from May 2017 to April 2019 at a regional hospital in southern Taiwan were randomized to either a two‐channel group (n = 60) or a one‐channel group (n = 60). The primary outcome was cecal intubation time.

Results

The mean cecal intubation time was significantly shorter in the two‐channel group compared with the one‐channel group (14.0 ± 4.0 vs 17.4 ± 6.7 min, P < 0.001). The two‐channel group required less water infused during insertion (564.8 ± 232.4 vs 1213.3 ± 467.5 mL, P < 0.001) but achieved a significantly higher Boston Bowel Preparation Scale score (8.4 ± 0.8 vs 7.5 ± 1.1, P < 0.001) than did the one‐channel group. The adenoma detection rate was comparable in the two groups (50.0% vs 48.3%, P = 0.855).

Conclusions

In comparison with the one‐channel WE, two‐channel WE showed a shorter cecal intubation time, required less amount of water during insertion, and provided a better salvage cleansing effect. (NCT03279705)
Anatomy of avian rictal bristles in Caprimulgiformes reveals reduced tactile function in open‐habitat, partially diurnal foraging species
Authors: Delaunay Mariane G. , Larsen Carl , Lloyd Huw , Sullivan Matthew , Grant Robyn A.
Published: March 2020

Avian rictal bristles are present in many species of birds, especially in nocturnal species. Rictal bristles occur along the upper beak and are morphologically similar to mammalian whiskers. Mammalian whiskers are important tactile sensors, guiding locomotion, foraging and social interactions, and have a well‐characterised anatomy. However, it is not yet known whether avian rictal bristles have a sensory function, and their morphology, anatomy and function have also not been described in many species. Our study compares bristle morphology, follicle anatomy and their association with foraging traits, across 12 Caprimulgiform species. Rictal bristle morphology and follicle anatomy were diverse across the 12 species. Nine of the 12 species had mechanoreceptors around their bristle follicles; however, there was large variation in their musculature, mechanoreceptor numbers and bristle morphology. Overall, species with short, thin, branching bristles that lacked mechanoreceptors tended to forage pre‐dusk in open habitats, whereas species with mechanoreceptors around their bristle follicle tended to forage at night and in more closed habitats. We suggest that rictal bristles are likely to be tactile in many species and may aid in navigation, foraging and collision avoidance; however, identifying rictal bristle function is challenging and demands further investigation in many species.
Activating prior knowledge using multiple‐choice question distractors
Authors: Schimmelfing Liza C. , Persky Adam M.
Published: March 2020

Context

A student's academic success in graduate and professional school may depend on prior knowledge. However, these students may not see important and necessary material for extended periods of time between their pre‐requisites and their new course work. As such, they are more prone to being unable to access available information from memory when needed. This study investigated the use of multiple‐choice (MC) question examinations in stabilising or reactivating these students’ memories for material that is available in their memories, but currently inaccessible due to disuse.

Methods

A total of 156 incoming first‐year student‐pharmacists were recruited. These student‐pharmacists completed a baseline examination on physiology prior to coursework. This assessment contained fill‐in‐the‐blank (FIB) questions followed by MC versions of the FIB questions. In the experimental sets, 10 questions had MC distractor answers that were answers to a future FIB question; in the other condition, the MC distractors were not answers to future FIB questions. The primary outcome was performance on future or target FIB questions in the context of whether the prior or priming MC questions contained the answer within the distractors.

Results

Performance on target FIB questions improved when the distractors in the MC questions contained the relevant answer (29%) compared to when the distractors did not contain the correct answer (18%) (P < .001,d = 0.78). When students could not generate a correct response to the FIB question, the experimental condition outperforming the control condition (17% vs 30%,d = 0.76).

Conclusions

Multiple‐choice questions that contained a correct response as a distractor to a future question, improved student performance. As such, the use of MC may be an inexpensive way to reactivate prior knowledge, especially knowledge that has become inaccessible due to disuse.
Pragmatics and epistemic vigilance: A developmental perspective
Authors: Mazzarella Diana , Pouscoulous Nausicaa
Published: March 2020

Any form of overt communication, be it gestural or linguistic, involves pragmatic skills. This article investigates the social–cognitive foundations of pragmatic development from infancy to late childhood and argues that it is driven by, among other things, the emergence of the capacities to assess the communicator's competence (e.g. perceptual access, epistemic states) and honesty. We discuss the implications of this proposal and show how it sheds new light on the developmental trajectory of a series of pragmatic phenomena, with a specific focus on the development of irony comprehension.