bluuebunny/crossref_metadata_2025 huggingface dataset:
Submuscular Placement of Baclofen Infusion Pumps
Authors: Bogue Jarrod T. , Wald Gal , Iosim Sonia , Greenfield Jeffrey P. , Otterburn David M.
Published: March 2020

Background

Baclofen pumps provide treatment of symptoms of spasticity for disease processes such as cerebral palsy and traumatic brain injury. These devices provide continuous infusion or periodic dosing of intrathecal baclofen (ITB). Traditionally, these pumps have been placed subcutaneously. Subcutaneous device placement has been associated with infection and extrusion. Baclofen pumps are large and range from 8 to 10 cm in diameter and 4 to 8 cm in width. Patients requiring device placement typically have a paucity of subcutaneous tissue. Cachexia coupled with the size and bulk of these devices leads to increased protusion and friction. Submuscular placement provides a well-vascularized pocket that directs the device inward eliminating protrusion and decreasing the potential for soft tissue breakdown.

Methods

A retrospective chart review of ITB pump placement in a submuscular plane by a single plastic surgeon at a major academic center in conjunction with a neurosurgeon was performed. Inclusion criteria were cases of primary placement or replacement of ITB pumps and spasticity requiring ITB. Major complications included infection, extrusion, and reoperation.

Results

Five patients during a 5-month period were treated with submuscular placement of ITB pumps. Average age of patients included was 18.4 years. Average preoperative body mass index was 18.8 kg/m2, with values ranging from 15.8 to 20.1 kg/m2. Medical histories of patients included diagnoses of cerebral palsy and traumatic brain injury causing spasticity. The most frequently cited reason for plastic surgical consultation preoperatively was cachexia. Two patients had previous baclofen pumps placed subcutaneously. Average follow-up was 6 months and ranged from 3 to 13 months. There were no major complications. One patient had a small seroma that spontaneously resolved. No patient had wound healing problems, and there were no extrusions of implanted devices or reoperations.

Conclusion

Submuscular placement of baclofen pumps provides a well-vascularized and stable environment for device placement that minimizes the dangers of pump extrusion and infection. Patients who require treatment with ITB commonly have severe cachexia, which makes subcutaneous device placement high risk. Submuscular placement should be performed in all patients with body mass index less than 20 kg/m2.
How Is the Created Alveolar Space Finally Restored After Maxillary Anterior Segmental Distraction Osteogenesis?
Authors: Kim Da So Mi , Choi Eun Hack , Sha Ha Na , Cha Jung-Yul
Published: March 2020

Objective:

Maxillary anterior segmental distraction osteogenesis (MASDO) for cleft and palate patients is the alternative treatment option to correct malocclusion with maxillary arch deficiency and severe crowding. After MASDO, prosthetic considerations are crucial for patients with cleft lip and palate because it is related to facial esthetics and occlusal function. The objectives of this study were to investigate the final restoration type for created alveolar space by MASDO.

Methods:

Thirteen patients with cleft lip and palate who underwent MASDO and orthodontic treatment from the years 2000 to 2010 in Yonsei University were examined. Final restorations are classified as dental implants, conventional prosthesis, and orthodontic space closure. The relationship between the distracted areas and final restoration type was investigated. The authors evaluated lateral cephalograms obtained at predistraction osteogenesis (pre-DO; T1), postdistraction osteogenesis (post-DO; T2), and debond (T3), and measured changes from T1 to T2 and from T2 to T3.

Results:

There was no significant difference of final restoration percentage of dental implants, conventional prosthesis, and space closure with orthodontic treatment. However, dental implants and conventional prostheses were applied more frequently in the posterior area and in the anterior area, respectively. The relapse rate was observed as 36.7% and 22.4% in the values of N-A distance and ANB angulation in T2-T3 stage.

Conclusion:

The MASDO site should be decided, based on final restoration goal. Among the created alveolar spaces, implants were applied mainly to the posterior site and the conventional prostheses were mostly restored to the anterior site. For space closure by orthodontic approach, the area could be both anterior or posterior.
Multilevel Correlates of Immunosuppressive Nonadherence in Kidney Transplant Patients: The Multicenter ADHERE BRAZIL Study
Authors: Sanders-Pinheiro Helady , Colugnati Fernando A.B. , Denhaerynck Kris , Marsicano Elisa O. , Medina José O.P. , De Geest Sabina ,   ADHERE BRAZIL Study Team
Published: March 2020

Background.

Immunosuppressive nonadherence is a risk factor for worse outcomes after kidney transplantation (KT). Brazil, having the world’s largest public, fully covered transplantation system and the second-highest KT volume worldwide, provides a unique setting for studying multilevel correlates of nonadherence (patient, healthcare provider, transplant center, and healthcare system levels) independent of patients’ financial burden.

Methods.

By applying a multistage sampling approach, we included 1105 patients from 20 KT centers. Nonadherence to immunosuppressives (implementation phase) was defined as any deviation in taking or timing adherence and dose reduction assessed by the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Based on Bronfenbrenner’s ecological model, we assessed multilevel factors using established instruments and measures specifically developed for this study and analyzed their independent contribution to nonadherence by performing sequential logistic regression analysis.

Results.

The nonadherence prevalence rate was 39.7%. The following factors were independently associated with nonadherence: Patient level—having a stable partner (odds ratio [OR]: 0.75; confidence interval [CI]: 0.58-0.97), nonadherence to appointments (OR: 2.98; CI: 2.03-4.39), and nonadherence to physical activity recommendations (OR: 1.84; CI: 1.38-2.46); and transplant center level—satisfaction with the waiting room structure (OR: 0.54; CI: 0.42-0.71), consultation >30 minutes (OR: 1.60; CI: 1.19-2.14), adequacy of the consultation frequency (OR: 0.62; CI: 0.43-0.90), and centers with >500 beds (OR: 0.58; CI: 0.46-0.73).

Conclusions.

As the first multicenter study assessing multilevel correlates of nonadherence in KT, our findings point to the need for multilevel interventions beyond the patient level, targeting transplant center practice patterns as an approach to tackle nonadherence.
Exploring the forced closure of a brand community that is also a participatory culture
Authors: Burgess Jacqueline , Jones Christian
Published: March 2020

Purpose

The purpose of this study is to investigate members’ reactions to the forced closure of a narrative video game brand community and its participatory culture.

Design/methodology/approach

The BioWare Social Network forums closure was announced in a thread, which attracted 8,891 posts. These were analysed using thematic analysis, facilitated by the software program Leximancer and non-participatory netnography.

Findings

The brand community and participatory culture members were predominantly distressed because they would lose their relationships with each other and access to the participatory culture’s creative output.

Research limitations/implications

Previous research suggested that video game players cannot be fans and that player-generated content is exploitative. However, members, self-identified as fans, encouraged BioWare’s use of their player-created content for financial gain and articulated the community’s marketing benefits, all of which have implications for Fan and Game Studies’ researchers. Research using primary data could identify brand communities and participatory cultures’ specific benefits and their members’ attitudes about brands’ commercial use of their outputs. Further research is required to identify other products and brands not suitable for establishing brand communities on social media to determine the best ways to manage them.

Practical implications

Addressing narrative brand communities’ complaints quickly can prevent negative financial outcomes and using social media sites for brand communities may not be suitable structurally or because of members’ privacy concerns. Furthermore, consumers often have intense emotional bonds with narrative brands, their communities and participatory cultures, which marketers may underestimate or misunderstand.

Originality/value

This study of the unique phenomenon of the forced closure of a narrative brand community and its participatory culture increased understandings about them.
Selection of surrogates to assess social resilience in disaster management using multi-criteria decision analysis
Authors: Saja A.M. Aslam , Teo Melissa , Goonetilleke Ashantha , Ziyath A.M. , Gunatilake Jagath
Published: March 2020

Purpose

The purpose of this paper is to present a framework for evaluation and ranking of potential surrogates to select the optimum surrogates and test it for five selected social resilience indicators in a disaster context. Innovative resilience assessment approaches are required to capture key facets of resilience indicators to deepen the understanding of social resilience. Surrogates can adequately represent the target indicator that is difficult to measure, as surrogates are defined as key facets of a target indicator.

Design/methodology/approach

To optimize the selection of surrogates, five key evaluation criteria were used. Disaster management experts completed an online survey questionnaire and evaluated three potential surrogate options. Surrogates were then ranked using PROMETHEE, a multi-experts multi-criteria group decision analysis technique.

Findings

A framework was devised to evaluate and rank potential surrogates to assess social resilience in a disaster context. The findings revealed that the first ranked surrogate can be the most critical facet of a resilience indicator of measure. In most instances, highly experienced cohort of practitioners and policy makers have aligned their preferences of surrogates with the overall ranking of surrogates obtained in this study.

Research limitations/implications

The surrogate approach can also be tested in different disaster and geographic contexts. The resilience indicators used in this study to explore surrogates are largely applicable in all contexts. However, the preference of surrogates may also vary in different contexts.

Practical implications

Once the surrogate is selected through an evaluation process proposed in this paper, the resilience status can be updated regularly with the help of the selected surrogate. The first ranked surrogate for each of the social resilience indicator can be applied, since the findings revealed that the first ranked surrogate can be the most critical facet in the context of the social resilience indicator being measured.

Social implications

The framework and the selection of optimal surrogates will assist to overcome the conceptual and methodical challenges of social resilience assessment. The applicability of selected surrogates by practitioners and policymakers in disaster management will play a vital role in resilience investment decision-making at the community level.

Originality/value

The surrogate approach has been used in the fields of ecology and clinical medicine to overcome the challenges in measuring difficult to measure indicators. The use of surrogates in this study to measure social resilience indicators in a disaster context is innovative, which was not yet explored in resilience measurement in disaster management.

Graphical abstract
Open innovation ecosystems: toward low-cost wind energy startups
Authors: Alam Muhammad Aftab , Ansari Kashif Mateen
Published: March 2020

Purpose

The purpose of this paper is to demonstrate how an open innovation strategy of public management in the energy sector enables the creation of innovation ecosystems and how it reduces the cost of wind energy projects in energy-poor countries.

Design/methodology/approach

This research study reflects on seven wind energy startups (WESs) in Pakistan using quantitative and qualitative data following a sequential mixed-methods approach. First, it draws from growing literature on innovation and renewable energy management to conceptualize an open innovation ecosystem model around WESs. It then tests this model using cost analyses of wind projects and identifies possible cost-saving strategies. Finally, follow-up interviews with managers in investigated projects cross check study findings and validate the model.

Findings

Three noteworthy findings can help policymakers in developing countries to effectively meet the future energy challenges and get benefit from international funding opportunities: by protecting lenders on approved terms rather than offering sovereign guarantee to operating firms; by letting the government take control of the initial development phase; and by giving off-take guarantees to the manufacturers.

Practical implications

It offers policy recommendations to energy sector managers about guarantees, financing, regulators, governmental control, tariffs and transfer of technology that can significantly curtail outlays.

Originality/value

Results suggest that adopting an open innovation ecosystem model can potentially save around 6 per cent ($4-$7m) in the overall cost of a 50 MW wind energy project.
A comparison study of two fuzzy-based decision visiting systems (FBDVSs) for sightseeing spots
Authors: Liu Yi , Qafzezi Ermioni , Ohara Seiji , Bylykbashi Kevin , Barolli Leonard
Published: March 2020

Purpose

Discovering and recommending points of interest are drawing more attention to meet the increasing demand from personalized tours. This paper aims to propose and evaluate two fuzzy-based systems for decision of sightseeing spots considering different conditions.

Design/methodology/approach

In the system, the authors considered four input parameters as follows: ambient temperature (AT), air quality (AQ), noise level (NL) and the current number of people (CNP) to decide the sightseeing spots visit or not visit (VNV). The authors call the proposed system: fuzzy-based decision visiting systems (FBDVSs). The authors implemented two systems as follows: FBDVS1 (three input parameters) and FBDVS2 (four input parameters). The authors make a comparison study between FBDVS1 and FBDVS2. The authors evaluate the proposed systems by computer simulations.

Findings

From the simulations results, the authors conclude that when CNP is increased, the VNV is increased. However, when AQ and NL are increased, the VNV is decreased. Also, when the AT is around 18°C-26°C, the VNV is the best. Comparing the complexity, the FBDVS2 is more complex than FBDVS1. However, FBDVS2 considers also the AT, which makes the system more reliable.

Research limitations/implications

In the future, the authors would like to make extensive simulations to evaluate the proposed systems and compare the performance of the proposed systems with other systems.

Originality/value

By simulation results, the authors have shown that the proposed system has a good performance and can choose good sightseeing spots.
Gender identity assessment with trans individuals – findings of a systematic literature review of assessment instruments and ethical considerations
Authors: Henrich Sören
Published: March 2020

Purpose

In several Western legislations, trans individuals must frequently undergo some form of gender identity assessment, for example, to receive legal recognition of their gender or to access therapeutic interventions. Thus, a standardised and empirically supported assessment approach becomes necessary. The purpose of this paper is to critically reflect on the current international guidelines for assessments by the World Professional Association for Transgender Health, which will be compared to standards in secure forensic settings, illustrated by British prison policies.

Design/methodology/approach

Findings of a systematic literature review following preferred reporting items for systematic reviews and meta-analysis standards are presented, summarising the current state of research pertaining to gender identity assessment instruments. Studies were included, when they presented empirical details pertaining to assessment approaches and passed the quality appraisal, but were excluded when they did not use a trans sample or presented clinical assessments not linked to gender identity.

Findings

A total of 21 included English articles, which mostly have been published in the USA in the past 20 years, propose ten different assessment approaches. Most of the studies support the use of the Minnesota Multiphasic Personality Inventory-2, the Bem Sex-Role Inventory, Body Image Scale for Transsexuals and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults. The instruments are briefly summarised.

Practical implications

It becomes apparent that this field is severely understudied and that there is no consensus regarding the best assessment approach. Hence, any recommendations are only preliminary and are contextualised with further ethical considerations and suggestions for future research.

Originality/value

To the best of the author’s knowledge, this is the first systematic literature review pertaining to the (semi-)structured assessment of gender identity.
The unexplained wealth order: a boost for Trinidad and Tobago’s fight against money laundering?
Authors: Freckleton Marie
Published: March 2020

Purpose

This paper aims to explain the reasons for the introduction of unexplained wealth orders (UWOs) in Trinidad and Tobago and highlights potential obstacles to implementation.

Design/methodology/approach

The research is based on secondary sources. The Civil Asset Recovery and management and Unexplained Wealth Act (CARAMAUWA) (2019) and relevant reports were reviewed.

Findings

The CARAMAUWA provides two potentially powerful tools to confiscate the proceeds of crime. However, the UWOs have greater potential. Effective implementation will require adequate human and financial resources, as well as measures to reduce corruption.

Research limitations/implications

The CARAMAUWA became operational on 14 June 2019 so it was not possible to assess actual implementation.

Practical implications

UWO is a useful tool for controlling money laundering.

Social implications

Effective control of money laundering can reduce crime.

Originality/value

No other study has examined the reasons for the introduction of the UWO in Trinidad and Tobago and the potential challenges to implementation.
Supplier selection using SWARA and WASPAS – a case study of Indian cement industry
Authors: Singh Rohit Kumar , Modgil Sachin
Published: March 2020

Purpose

This paper aims to evaluate and prioritize the key supplier selection indicators and to establish the relationship between available alternatives and selected indicators by using step-wise weight assessment ratio analysis (SWARA) and weighted aggregated sum product assessment (WASPAS).

Design/methodology/approach

Authors have extracted the supplier selection criteria from literature and used a combined SWARA-WASPAS method to evaluate and rank the criteria’s. SWARA is applied for evaluating and weighting selection criteria, whereas WASPAS helped in evaluating different available alternatives based on supplier selection indicators.

Findings

Finding from SWARA suggests that supplier management is the high weighted criteria followed by information sharing and joint actions. WASPAS was used to evaluate the available alternatives and supplier A1 got the highest priority. Additionally, sensitivity analysis indicates the different scenarios for the best supplier selection.

Practical implications

Working executives can use the SWARA for assessment of weights of finalized indicators for their firm in the cement industry. Further, the calculated weights can be used for product and sum weightage through WASPAS to finalize the best supplier.

Originality/value

The originality of the manuscript lies in the sector and methodology. Author(s) applied the SWARA and WASPAS method for supplier selection in the Indian cement industry that will help working executives to evaluate their supply chain partners.
Traditional drink of blackcincau(Mesona palustrisBL)-basedwedang uwuhas immunomodulator on alloxan-induced diabetic rats
Authors: Widyaningsih Tri Dewanti , Siska Astri Iga , Fanani Roudlatul , Martati Erryana
Published: March 2020

Purpose

This study aims to evaluate the immunomodulatory effect of traditional drink of blackcincau-basedwedang uwuh(WUB) on alloxan-induced diabetic rats.

Design/methodology/approach

WUB consists of dried herbs such as blackcincauleaves (Mesona palustrisBL), red ginger (Zingiber officinaleRosc), cloves (Syzgium aromaticum), sappan wood (Caesalpinia sappanLin) and soursop leaves (Annona muricata). In this study, the rats were divided into five groups: normal control, diabetic control and three groups of WUB (WUB 13.5 mL/kg and WUB 27 mL/kg) orwedang uwuhcommercial (WUC) treated diabetic groups. WUB or WUC was administered by gavage for three days after rats were confirmed diabetic induced by alloxan; these injections were continued for 28 days. At the end of the experiment, the spleen of rats was analyzed using flow cytometry. Data were analyzed by ANOVA followed by Tukey test using Minitab version 16.0.

Findings

This study showed that WUB significantly inhibited the expression of pro-inflammatory cytokines (interferon-Y [IFN-ɣ] and tumor necrosis factor-α[TNF-a]) and anti-inflammatory cytokines (interleukin 10 [IL-10] and transforming growth factor-β [TGF-ß]), and achieved a balance between pro-inflammatory and anti-inflammatory cytokines that were not significantly different from normal controls. WUB 27 was able to regulate the production of relative average cytokines IFN-ɣ (7.6 ± 3.5;p= 0.010), TNF-a(8.7 ± 2.4;p= 0.018), IL-10 (6.3 ± 2.4;p= 0.001) and TGF-ß (7.4 ± 2.1;p= 0.004) that was significantly different from diabetic control. This study’s results validate that the use of WUB can result in immunomodulatory activity in diabetic rats.

Originality/value

To the best of the authors’ knowledge, this is the first study on the immunomodulatory effect of WUB which is developed based on WUC; WUB has been used by Indonesian people as a functional beverage which acts as an immune booster and body warmer.
Relationships between leadership, motivation and employee-level innovation: evidence from India
Authors: Gupta Vishal
Published: March 2020

Purpose

Integrating the behavioral theory of leadership, the componential theory of creativity and the self-determination theory (SDT), the study tests the relationships between leadership, work motivation (intrinsic motivation, integrated extrinsic motivation, extrinsic motivation) and employee-level innovation (innovative work behavior and innovation outcomes) in a work setting.

Design/methodology/approach

Data were collected using a survey questionnaire from 493 scientists working in India's largest civilian research and development (R&D) organization. The structural equation modeling (SEM) method was used to test the hypothesized relationships between the study variables.

Findings

The study found evidence for positive relationships between leadership, employee autonomous motivation (intrinsic and integrated extrinsic motivation) and employee-level innovation. The study shows that extrinsic motivation is positively related to innovation only when the value of rewards is integrated to one's sense of self (integrated extrinsic motivation). Extrinsic motivation, otherwise, is not related to innovation.

Research limitations

The study was cross-sectional, so inferences about causality are limited.

Practical implications

First, while extrinsic motivation is considered bad for innovation, the study provides evidence that integrated extrinsic motivation complements intrinsic motivation and encourages employee-level innovation. Second, the study shows that leaders can aid the process of development of autonomous motivation by displaying positive behaviors. Third, the study validates the mediating role of autonomous motivation for the leadership–innovation relationship.

Originality/value

The study provides an insight into the underlying process through which leaders can impact innovation at the workplace. To the best of the author's knowledge, such a study is the first of its kind undertaken in an organizational context.
Local implementation of global accounting reform: evidence from a developing country
Authors: Masum Mahmud Al , Parker Lee D.
Published: March 2020

Purpose

While the world-wide adoption of international financial reporting standards (IFRS) aims to eliminate differences in national accounting standards between countries, the socio-political institutions surrounding financial reporting practices remain localised. This paper aims to penetrate and reveal the manner in which local national context, stakeholder intentions and financial reporting practices can moderate the compliance with IFRS in a developing country.

Design/methodology/approach

An interview-based qualitative research framework was used to analyse the experience and attitudes of accountants, auditors and financial reporting regulators during a passage of accounting reform initiatives.

Findings

This paper provides a critical analysis of the financial reporting practices of a developing country that has ostensibly implemented accounting reforms prescribed by the World Bank. It has revealed the key firm- and field-level logics that are experienced and managed by regulators and corporate managers in their approaches to financial reporting and accountability. The World Bank-led accounting reform can be constrained by a complex mix of institutional logics originating from market and corporate structures, networks of institutionalised family and political relationships, professional and regulatory structure and resourcing limitations and cultural business conventions. This paper provides evidence of firm- and field-level logics that contest and influence the emergence of a financial reporting oversight body and lead to highly variable compliance with international accounting standards.

Originality/value

This paper aims to extend our knowledge beyond broad national-level elements of institutional orders. It presents a more penetrating examination of the existence and contestation of logics originating from various local and global actors and interests. It presents a theoretical mapping of institutional logics, which operate in international and local settings and also encompass firm- and field-level imperatives. Any effort to understand and improve accounting practices of a developing country need to consider the power, contestation and influence of multiple logics operating in its institutional environment.
The zoospores of the thraustochytrid Aurantiochytrium limacinum: Transcriptional reprogramming and lipid metabolism associated to their specific functions
Authors: Dellero Younès , Maës Cécile , Morabito Christian , Schuler Martin , Bournaud Caroline , Aiese Cigliano Riccardo , Maréchal Eric , Amato Alberto , Rébeillé Fabrice
Published: March 2020

Aurantiochytrium limacinum (Thraustochytriaceae, class Labyrinthulomycetes) is a marine Stramenopile and a pioneering mangrove decomposer. Its life cycle involves a non‐motile stage and zoospore production. We observed that the composition of the medium, the presence of amino acids in particular, affects the release of zoospores. Two opposite conditions were defined, one with a cell population mainly composed of zoospores and another one with almost only non‐motile cells. In silico allelic frequency analysis and flow cytometry suggest that zoospores and non‐motile cells share the same ploidy level and are diploid. Through an RNA‐seq approach, the transcriptional reprogramming accompanying the formation of zoospores was investigated, with a particular focus on their lipid metabolism. Based on a differential expression analysis, zoospores are characterized by high motility, very active signal transduction, an arrest of the cell division, a low amino acid metabolism and low glycolysis. Focusing on lipid metabolism, genes involved in lipase activities and peroxisomal β‐oxidation are upregulated. qRT‐PCR of selected lipid genes and lipid analyses during the life span of zoospores confirmed these observations. These results highlight the importance of the lipid dynamics in zoospores and show the metabolic processes required to use these energy‐dense molecules as fuel for zoospore survival during their quest of new territories.
Identification of structural and chemical traits in Juglans regia associated with host plant preference of Batocera horsfieldi
Authors: Lin Tiantian , Zhao Zhengbao , Zhou Shanshan , Chen Jiaping , Qin Siyu , Su Yang , Chen Gang , Xie Jiulong , Wan Xueqin , Zhang Fan
Published: March 2020

Common walnut Juglans regia L. suffered devastating damage from the white‐striped longhorn beetle Batocera horsfieldi (Hope) in southwest China, which resulted in a dramatic decrease of local walnut production. However, the control of this wood‐boring pest with traditional methods is difficult as a result of its cryptic feeding habit.

We proposed that developing host‐plant resistance is a more effective way of controlling this insect with long‐term benefits. One way of improving host‐plant resistance is to identify plant traits related to host‐plant preference of targeted insects.

In the present study, we investigated the differences in feeding and oviposition preferences of B. horsfieldi on four J. regia cultivars in the field and tested whether such preferences are associated with structural and chemical traits in plant branches.

The results obtained showed that the host‐plant resistance of J. regia cultivars to B. horsfieldi was related to increased wood density, higher amounts of cellulose and lignin, and higher contents of tannins, total flavonoids and total phenolics, whereas the susceptible cultivars were characterized by thicker bark, higher contents of water, sugar and soluble protein.

The identified traits involved in host‐plant preference can subsequently contribute to the selection and breeding of resistant J. regia cultivars to B. horsfieldi.
On the emergence of non‐profit orchestras
Authors: Mikami Kazuhiko
Published: March 2020

In the market for live classical music, a symphony orchestra typically has fixed costs that are high relative to demand, so that the demand curve lies entirely below the average cost curve (Baumol & Bowen, 1966)—a situation in which a for‐profit enterprise cannot survive. The present study aims to explain how a non‐profit orchestra can survive in such an adverse market environment by relying on private donations, even in the absence of altruism. We argue that a financially distressed orchestra may employ a strategy to impose a non‐profit distribution constraint on itself—thus becoming a non‐profit, tax‐deductible organization—and use its member musicians' worker surplus to produce donor privileges, which enables the orchestra to induce donations from an individually rational audience by taking advantage of a tax deduction scheme. With this strategy, the orchestra can successfully extract consumer surplus from the audience to offset its loss.
Randomised clinical trial: the safety and tolerability of fluticasone propionate orally disintegrating tablets versus placebo for eosinophilic oesophagitis
Authors: Hirano Ikuo , Safroneeva Ekaterina , Roumet Marie C. , Comer Gail M. , Eagle Gina , Schoepfer Alain , Falk Gary W.
Published: March 2020

Background

APT‐1011, a fluticasone propionate orally disintegrating tablet formulation, is under investigation for the treatment of eosinophilic oesophagitis (EoE).

Aims

To evaluate the safety and tolerability of APT‐1011 administered to patients with EoE and to assess the effect on clinical symptoms of EoE, endoscopic appearance and oesophageal eosinophilia.

Methods

A randomised, double‐blind, placebo‐controlled, multicentre, phase 1b/2a study was conducted at seven medical centres in the US to evaluate the safety and tolerability of APT‐1011 over 8 weeks in adults and adolescents with EoE. Participants were randomised to placebo (n = 8), 1.5 mg APT‐1011 BID (n = 8) or 3.0 mg APT‐1011 QD (n = 8). Safety and tolerability were assessed as the primary outcome; histologic and endoscopic measures were assessed as exploratory outcomes.

Results

There were no deaths, serious treatment‐emergent adverse events (TEAEs), severe TEAEs or discontinuations from the study related to a TEAE. In one participant randomised to 1.5 mg APT‐1011 BID, a reduction in cortisol was observed, but without evidence of adrenal insufficiency. Compared with placebo, treatment with APT‐1011 resulted in greater reductions in oesophageal eosinophil counts, EoE Endoscopic Reference Score, patient global assessment and symptom‐based EoE activity index from baseline to end of treatment (Week 8).

Conclusions

APT‐1011 was safe and well tolerated in adolescents and adults with EoE. Exploratory efficacy outcomes demonstrated improvement in histologic and endoscopic findings as well evidence of symptom improvement. The results of this study support the continued development of APT‐1011 for the treatment of EoE (NCT‐01386112).
Spillover effects of fiscal policy in a monetary union: Why do fiscal instruments matter?
Authors: Barbier‐Gauchard Amélie , Betti Thierry
Published: March 2020

Using a two‐country DSGE model, we analyse the spillover effects of fiscal policy in a monetary union. Based on a non‐Walrasian labour market with a labour force participation decision and involuntary unemployment and a detailed fiscal sector, we focus on the relative cross‐border effects of different kinds of fiscal shocks (government expenditure and tax shocks). Among the major lessons from this analysis, five general and striking results are worth highlighting : (1) spillover effects differ widely according to the fiscal instrument, (2) all fiscal instruments produce positive spillover effects on foreign GDP except a rise in government consumption, (3) the response of unemployment is not always negatively correlated with the response of output (4) the different fiscal shocks trigger different effects on foreign inflation and the term of trade, which implies heterogeneous interest‐rate and trade channels, and (5) a more accommodative monetary policy and a scenario of ‘fiscal dominance’ alter greatly the effects of fiscal policy shocks.
Neural and non‐neural contributions to ankle spasticity in children with cerebral palsy
Authors: Xu Dali , Wu Yi‐Ning , Gaebler‐Spira Deborah , Gao Fan , Clegg Nancy J , Delgado Mauricio R , Zhang Li‐Qun
Published: March 2020

Aim

To assess the neural and non‐neural contributions to spasticity in the impaired ankle of children with cerebral palsy (CP).

Method

Instrumented tapping of the Achilles tendon was done isometrically to minimize non‐neural contributions and elicit neural contributions. Robot‐controlled ankle stretching was done at various velocities, including slow stretching, with minimized neural contributions. Spasticity was assessed as having neural (phasic and tonic stretch reflex torque, tendon reflex gain, contraction rate, and half relaxation rate) and non‐neural origin (elastic stiffness and viscous damping) in 17 children with CP (six females and 11 males; mean age [SD] 10y 8mo [3y 11mo], range 4y–18y) and 17 typically developing children (six females and 11 males; mean age [SD] 12y 7mo [2y 9mo], range 7y–18y). All torques were normalized to weight×height.

Results

Children with CP showed increased phasic and tonic stretch reflex torque (p=0.004 and p=0.001 respectively), tendon reflex gain (p=0.02), contraction rate (p=0.038), half relaxation rate (p=0.02), elastic stiffness (p=0.01), and viscous damping (p=0.01) compared to typically developing children.

Interpretation

Controlled stretching and instrumented tendon tapping allow the systematic quantification of various neural and non‐neural changes in CP, which can be used to guide impairment‐specific treatment.

What this paper adds

Ankle spasticity is associated with increased phasic and tonic stretch reflexes, tendon reflex gain, and contraction and half relaxation rates.

Ankle spasticity is also associated with increased elastic stiffness and viscous damping.
The ecology and evolution of wildlife cancers: Applications for management and conservation
Authors: Hamede Rodrigo , Owen Rachel , Siddle Hannah , Peck Sarah , Jones Menna , Dujon Antoine M. , Giraudeau Mathieu , Roche Benjamin , Ujvari Beata , Thomas Frédéric
Published: March 2020

Ecological and evolutionary concepts have been widely adopted to understand host–pathogen dynamics, and more recently, integrated into wildlife disease management. Cancer is a ubiquitous disease that affects most metazoan species; however, the role of oncogenic phenomena in eco‐evolutionary processes and its implications for wildlife management and conservation remains undeveloped. Despite the pervasive nature of cancer across taxa, our ability to detect its occurrence, progression and prevalence in wildlife populations is constrained due to logistic and diagnostic limitations, which suggests that most cancers in the wild are unreported and understudied. Nevertheless, an increasing number of virus‐associated and directly transmissible cancers in terrestrial and aquatic environments have been detected. Furthermore, anthropogenic activities and sudden environmental changes are increasingly associated with cancer incidence in wildlife. This highlights the need to upscale surveillance efforts, collection of critical data and developing novel approaches for studying the emergence and evolution of cancers in the wild. Here, we discuss the relevance of malignant cells as important agents of selection and offer a holistic framework to understand the interplay of ecological, epidemiological and evolutionary dynamics of cancer in wildlife. We use a directly transmissible cancer (devil facial tumour disease) as a model system to reveal the potential evolutionary dynamics and broader ecological effects of cancer epidemics in wildlife. We provide further examples of tumour–host interactions and trade‐offs that may lead to changes in life histories, and epidemiological and population dynamics. Within this framework, we explore immunological strategies at the individual level as well as transgenerational adaptations at the population level. Then, we highlight the need to integrate multiple disciplines to undertake comparative cancer research at the human–domestic–wildlife interface and their environments. Finally, we suggest strategies for screening cancer incidence in wildlife and discuss how to integrate ecological and evolutionary concepts in the management of current and future cancer epizootics.
Barriers and challenges for the fast treatment of bleeds in the non‐haemophilia treatment centre hospital setting
Authors: de Moerloose Philippe , Davis Joanna A. , Benchikh El Fegoun Soraya , Habis Richard , Klamroth Robert
Published: March 2020

Introduction

Early treatment for acute bleeds in patients with haemophilia and inhibitors is feasible when patients are managed in haemophilia treatment centres (HTCs). Patients may need to attend non‐HTCs for out‐of‐hours emergency care, especially if HTCs are not local and/or transport is difficult.

Aim

We evaluated the barriers to the fast treatment of bleeds in patients with haemophilia and inhibitors presenting at non‐HTCs.

Methods

Healthcare professionals (HCPs) from non‐HTCs in the United States (n = 218) and Germany (n = 98) were selected from validated online panels and invited to participate in a survey (October‐November 2017).

Results

A mean of 6 (US) and 5 (German) patients with haemophilia and inhibitors were managed for bleeds by these HCPs over 12 months; patient characteristics were similar in both countries. The main HCPs involved in treating bleeds were emergency room specialists (94%) and haematologists (91%) (US); haematologists (79%) and anaesthesiologists (59%) (Germany). Only 26% (US) and 28% (Germany) of HCPs had access to treatment guidelines for these patients; access to bypassing agents was similarly limited: 44% (US) and 38% (Germany) of HCPs reported their institution did not stock these agents. In both countries, key reasons for delaying treatment were lack of bypassing agent availability, HCP experience/education of bleed disorders and internal process time.

Conclusion

Barriers to fast treatment of bleeds in patients with haemophilia and inhibitors were identified in non‐HTCs in the United States and Germany. These could be reduced by improving the availability of treatment guidelines, bypassing agents and HCP education/training.
Inhibition of PHLPP1 ameliorates cardiac dysfunction via activation of the PI3K/Akt/mTOR signalling pathway in diabetic cardiomyopathy
Authors: Zhang Mingjun , Wang Xuyang , Liu Ming , Liu Dian , Pan Jinyu , Tian Jingjing , Jin Tao , Xu Yunfan , An Fengshuang
Published: March 2020

Background

Pleckstrin homology (PH) domain leucine‐rich repeat protein phosphatase 1 (PHLPP1) is a kind of serine/threonine phosphatase, whose dysregulation is accompanied with numerous human diseases. However, its role in diabetic cardiomyopathy remains unclear. We explored the underlying function and mechanism of PHLPP1 in diabetic cardiomyopathy (DCM).

Method

In vivo, Type 1 diabetic rats were induced by intraperitoneal injection of 60 mg/kg streptozotocin (STZ). Lentivirus‐mediated short hairpin RNA (shRNA) was used to knock down the expression of PHLPP1. In vitro, primary neonatal rat cardiomyocytes and H9C2 cells were incubated in 5.5 mmol/L glucose (normal glucose, NG) or 33.3 mmol/L glucose (high glucose, HG). PHLPP1 expression was inhibited by PHLPP1‐siRNA to probe into the function of PHLPP1 in high glucose‐induced apoptosis in H9c2 cells.

Results

Diabetic rats showed up‐regulated PHLPP1 expression, left ventricular dysfunction, increased myocardial apoptosis and fibrosis. PHLPP1 inhibition alleviated cardiac dysfunction. Additionally, PHLPP1 inhibition significantly reduced HG‐induced apoptosis and restored PI3K/AKT/mTOR pathway activity in H9c2 cells. Furthermore, pretreatment with LY294002, an inhibitor of PI3K/Akt/mTOR pathway, abolished the anti‐apoptotic effect of PHLPP1 inhibition.

Conclusion

Our study indicated that PHLPP1 inhibition alleviated cardiac dysfunction via activating the PI3K/Akt/mTOR signalling pathway in DCM. Therefore, PHLPP1 may be a novel therapeutic target for human DCM.
Molecular insights into post‐mating immune response in a fish with internal fertilization
Authors: Pauletto Marianna , Cattelan Silvia , Pilastro Andrea , Babbucci Massimiliano , Bargelloni Luca , Gasparini Clelia
Published: March 2020

The tight connection between immunity and reproduction has been studied for decades. However, basic knowledge at the molecular level of the effect of mating on immune function is still lacking in many taxa. Determining whether and how the immune system is engaged after mating is a crucial step in understanding post‐mating mechanisms of reproduction and sexual selection. Here, we study the transcriptional changes in immunity‐related genes caused by the ejaculate in the female reproductive tract using a model species for sexual selection studies, the guppy Poecilia reticulata. To study changes triggered by the ejaculate only, rather than caused by mating, we used artificial inseminations to transfer ejaculate into females. We then compared gene expression in the reproductive tract (gonoduct and ovary) of females artificially inseminated either with ejaculate or with a control solution, after 1 hr and after 6 hr. Overall, contact with ejaculate caused short‐term changes in the expression of immune‐related genes in the female reproductive tract, with a complex pattern of up‐ and down‐regulation of immune‐related pathways, but with clear indication of a marked down‐regulation of the immune system shortly after ejaculate contact. This suggests a link between immune function and processes occurring between mating and fertilization in this species.
Clinical practice guidelines for monitoring children's behavioural development at the 18‐month well‐baby visit: A decision analysis comparing the expected benefit of two alternative strategies
Authors: Baillargeon Raymond H.
Published: March 2020

Rationale, aims and objectives

The current American Academy of Pediatrics policy calls for universal developmental screening (UDS) at the 18‐month well‐baby visit (18MWBV). In contrast, different clinical practice guidelines exist in other developed countries where only toddlers of concerned parents are referred for (selective) developmental screening (SDS). This study compares the expected benefit (EB) of these two strategies for monitoring children's behavioural development at the 18MWBV.

Method

A clinical decision analysis was performed, with EB defined as gain (probability of screening when appropriate + probability of not screening when appropriate) minus cost (probability of screening when not appropriate + probability of not screening when not appropriate). Accordingly, a strategy's EB referred to its efficiency at distinguishing between toddlers who need to be referred for screening and those who do not.

Results

The EB of the UDS strategy was estimated at −0.242. In contrast, the EB of the SDS strategy was much greater at 0.326. In fact, the EB of the UDS strategy could only equal or surpass that of the SDS strategy if screening toddlers with a problem was considered almost five times more important than not screening well toddlers. However, our monitoring effort should be more evenly distributed between these two imperatives. Also, the evidence in favour of the SDS strategy remained largely unchanged after considering a broad range of values for the (unique) probabilities in the decision tree.

Conclusion

There are many steps involved in the monitoring of children's early behavioural development, but when it comes to decide whether or not to use behavioural screening, there is evidence for adopting the SDS strategy, and screening only if a behavioural concern is being raised by parents.
Chinese and South Korean Families' Conceptualizations of a Fair Household Labor Distribution
Authors: Midgette Allegra J.
Published: March 2020

Objective

The present study set out to investigate how Chinese and South Korean families conceptualize fairness and a fair division of household labor.

Background

Previous cross‐cultural research has found that a good portion of women and men find the gendered division of household labor fair. In response, scholars have attempted to discover what factors lead to a greater likelihood of reporting a gendered division fair. However, the majority of the scholarship on fairness perceptions has been limited to survey methods, in which fairness is not defined, and the individual's reasons for their fairness perception is not investigated.

Method

This study employed thematic analysis of in‐depth interviews with the members of 12 Chinese (N = 39) and 12 Korean (N = 40) families.

Results

No participation in household labor was considered across families to be unfair. On the other hand, the majority of participants justified an unequal division to be fair based on gendered applications of differences in time‐availability and levels of tiredness, in which the amount of housework that each member should do was left unspecified.

Conclusion

Many adult participants believed that fairness should not apply to the family context. Instead, most participants argued that household labor should be divided based on emotional satisfaction, maintained through mechanisms of understanding and agreement.

Implications

Future studies on fairness perceptions should clearly define what they mean by “fairness,” and the gendering of gender‐neutral appearing justifications such as time availability should be further investigated.