bluuebunny/crossref_metadata_2025 huggingface dataset:
User entrepreneurship in the video game industry: the role of communities
Authors: Del Bosco Barbara , Chierici Roberto , Mazzucchelli Alice
Published: July 2020

Purpose

This paper investigates the user entrepreneurship process in the video game industry, and how this process is influenced by the interactions between user entrepreneurs and communities.

Design/methodology/approach

The paper presents an exploratory multiple case study on 17 firms founded in the video game industry by Italian users.

Findings

The findings show that in most of the cases analysed, innovation by users precedes identification of the entrepreneurial opportunity. This research identifies three categories of communities that provide different forms of support to user entrepreneurs: communities of (1) gamers/users, (2) developers/innovators and (3) entrepreneurs. Given the different role played, the three categories of communities have a different relevance during the various phases of the innovation and entrepreneurial path: communities of gamers/users and of developers/innovators affect innovation development and opportunity identification, while communities of entrepreneurs help users to evolve from opportunity recognition to the start-up of a firm.

Originality/value

This study investigates the video game industry, a context in which user entrepreneurship is under-researched and that is characterized by the intangible nature of the products (while previous studies have mainly focused on physical goods). It contributes to extant literature by revealing that, at the beginning of the end-user entrepreneurial process, there may be not only unmet needs but also “excitement-driven” innovations. Moreover, by analysing the whole entrepreneurial path, the study shows how three categories of communities (gamers/users, developers/innovators and entrepreneurs) provide different forms of support to user entrepreneurs in the different phases of the entrepreneurial process.
Consequences of top-down knowledge hiding: a multi-level exploratory study
Authors: Butt Atif Saleem
Published: July 2020

Purpose

The purpose of this paper is to explore the multi-level (individual, interpersonal and firm) consequences of top-down knowledge hiding in firms.

Design/methodology/approach

This study uses a multiple case study methodology by studying nine United Arab Emirates (UAE)-based firms. Furthermore, 26 semi-structured interviews with managers based in 9 different firms are undertaken.

Findings

Based on the qualitative interviews and comprehensive data analysis, four individual, one interpersonal and two firm-level consequences emerged. In addition, the consequences of top-down knowledge hiding are not multi-level, but multi-faceted too.

Research limitations/implications

This study has some limitations. First, the results of this study are not generalizable to a broader population. Second, this study explores behavioral patterns with respect to UAE culture only.

Practical implications

Firms can use the findings from this study to understand the multi-level and multi-faceted consequences of top-down knowledge hiding in firms. Also, this study provides some constructive guidelines to firms/senior management to mitigate the consequences of knowledge hiding in firms.

Originality/value

This study contributes to knowledge hiding literature by revealing multi-level and multi-faceted consequences of top-down knowledge hiding in firms.
Exploring the applicability of sustainable development goals in Costa Rica: case examples from Mastatal and Conchal
Authors: Kandler Rodríguez Juan Miguel
Published: July 2020

Purpose

This paper aims to investigate, which sustainable development goals (SDGs) are most mentioned in the sustainability programs of two hospitality companies, Rancho Mastatal and Reserva Conchal, in Costa Rica. In so doing, it is possible to evaluate the level of integration of sustainability principles with hospitality practice.

Design/methodology/approach

This paper features a case study based mainly on secondary information sourced from the corporate websites of the two companies, augmented by published studies about specific aspects of the SDGs, hospitality and news articles about both companies. Finally, the hotel-specific information was analyzed using studies about SDG progress, and also related frameworks, proposed by the United Nations (UN) and the United Nations World Tourism Organization (UNWTO).

Findings

Consistent with UNWTO studies, the two companies’ sustainable programs align the most with SDGs 11, 12 and 13. These are goals classified as difficult to achieve meaning that tourism has a pioneering and innovative role to play in this regard. Mastatal has fully implemented sustainability and Conchal demonstrates an advanced level of integration, using different types of technological solutions to increase sustainability. Finally, the advice is given for companies seeking to embrace the SDGs as a way of being innovative and better positioned in a highly competitive tourism market.

Originality/value

As SDG overviews exist for large global brands, this paper adds country-specific knowledge, that of Costa Rica a pioneer in tourism sustainability, of sustainable practices of a management company and also of an independent small company, broadening the scope of prior research.
Body temperature, heart rate, and activity patterns of two boreal homeotherms in winter: Homeostasis, allostasis, and ecological coexistence
Authors: Menzies Allyson K. , Studd Emily K. , Majchrzak Yasmine N. , Peers Michael J. L. , Boutin Stan , Dantzer Ben , Lane Jeffrey E. , McAdam Andrew G. , Humphries Murray M.
Published: July 2020

Organisms survive environmental variation by combining homeostatic regulation of critical states with allostatic variation of other traits, and species differences in these responses can contribute to coexistence in temporally variable environments.

In this paper, we simultaneously record variation in three functional traits—body temperature (Tb), heart rate and activity—in relation to three forms of environmental variation—air temperature (Ta), photoperiod and experimentally manipulated resource levels—in free‐ranging snowshoe hares and North American red squirrels to characterize distinctions in homeotherm responses to the extreme conditions of northern boreal winters.

Hares and squirrels differed in the level and precision ofTbregulation, but also in the allostatic pathways necessary to maintain thermal homeostasis. Hares demonstrated a stronger metabolic pathway (through heart rate variation reflective of the thermogenesis), while squirrels demonstrated a stronger behavioural pathway (through activity variation that minimizes cold exposure).

As intermediate‐sized, winter‐active homeotherms, hares and squirrels share many functional attributes, yet, through the integrated monitoring of multiple functional traits in response to shared environmental variation, our study reveals many pairwise species differences in homeostatic and allostatic traits, that both define and are defined by the natural history, functional niches and coexistence of sympatric species.

A freePlain Language Summarycan be found within the Supporting Information of this article.
A new genomic taxonomy system for the Synechococcus collective
Authors: Salazar Vinícius W. , Tschoeke Diogo A. , Swings Jean , Cosenza Carlos A. , Mattoso Marta , Thompson Cristiane C. , Thompson Fabiano L.
Published: July 2020

Cyanobacteria of the genus Synechococcus are major contributors to global primary productivity and are found in a wide range of aquatic ecosystems. This Synechococcus collective (SC) is metabolically diverse, with some lineages thriving in polar and nutrient‐rich locations and others in tropical or riverine waters. Although many studies have discussed the ecology and evolution of the SC, there is a paucity of knowledge on its taxonomic structure. Thus, we present a new taxonomic classification framework for the SC based on recent advances in microbial genomic taxonomy. Phylogenomic analyses of 1085 cyanobacterial genomes demonstrate that organisms classified as Synechococcus are polyphyletic at the order rank. The SC is classified into 15 genera, which are placed into five distinct orders within the phylum Cyanobacteria: (i) Synechococcales (Cyanobium, Inmanicoccus, Lacustricoccus gen. Nov., Parasynechococcus, Pseudosynechococcus, Regnicoccus, Synechospongium gen. nov., Synechococcus and Vulcanococcus); (ii) Cyanobacteriales (Limnothrix); (iii) Leptococcales (Brevicoccus and Leptococcus); (iv) Thermosynechococcales (Stenotopis and Thermosynechococcus) and (v) Neosynechococcales (Neosynechococcus). The newly proposed classification is consistent with habitat distribution patterns (seawater, freshwater, brackish and thermal environments) and reflects the ecological and evolutionary relationships of the SC.
Confessions in the Criminal Process
Authors: Ho Hock Lai
Published: July 2020

This article undertakes a theoretical exploration of the roles that confessions can play in the criminal process and of the importance that is placed on their voluntariness. It draws on contemporary and historical sources, as well as materials from different legal systems and traditions. Three possible perspectives on the topic are identified: the moral, the epistemic and the political. Adopting each of these perspectives in turn, I set out three distinct dimensions of confessions in the criminal process. In my account of each dimension, voluntariness is construed in the light of a particular understanding of confessions that is conceptually tied to a particular understanding of the criminal process. The conclusion remarks on the interplay of the three dimensions.
Variants of uncertain significance in prenatal microarrays: a retrospective cohort study
Authors: Mardy AH , Wiita AP , Wayman BV , Drexler K , Sparks TN , Norton ME
Published: July 2020

Objective

To categorise the variants of uncertain significance found with prenatal chromosomal microarray and determine the proportion of such variants that are associated with a well‐known phenotype in order to establish how often they remain truly of uncertain significance.

Design

Retrospective cohort study.

Setting

The University of California, San Francisco.

Population

All patients with a variant of uncertain significance on prenatal microarray between 2014 and 2018.

Methods

Each variant was classified as a copy number variant that (a) contains Online Mendelian Inheritance in Man (OMIM)‐annotated disease‐causing genes (‘OMIM morbid genes’); (b) confers autosomal recessive carrier status; (c) is associated with incomplete penetrance; (d) is >1 Mb in size without OMIM morbid genes; (e) demonstrates mosaicism; or (f) contains significant regions of homozygosity. For each variant of uncertain significance, we examined the existing literature to determine whether the predicted phenotype(s) was known.

Main outcome measure

Prevalence and classification of variants and how much information is available regarding the likelihood of an affected phenotype.

Results

Of 970 prenatal microarrays, 55 (5.8%) had at least one variant of uncertain significance. The most common were copy number variants containing OMIM morbid genes (36.8%). In all, 48 (84.2%) were associated with a known phenotype; 55 (96.5%) had data available regarding the likelihood of an affected phenotype.

Conclusions

The prevalence of variants of uncertain significance with prenatal microarray was 5.8%. In the large majority of cases, data were available regarding the predicted phenotype.

Tweetable abstract

Variants of uncertain significance occur in 5.8% of prenatal microarrays. In the overwhelming majority of cases, outcome information is available.
Public insurance expansions and mental health care availability
Authors: Blunt Elson Oshman , Maclean Johanna Catherine , Popovici Ioana , Marcus Steven C.
Published: July 2020

Objective

To provide new evidence on the effects of large‐scale public health insurance expansions, associated with the Affordable Care Act (ACA), on the availability of specialty mental health care treatment in the United States. We measure availability with the probability that a provider accepts Medicaid.

Data Source/Study Setting

The National Mental Health Services Survey (N‐MHSS) 2010‐2018.

Study Design

A quasi‐experimental differences‐in‐differences design using observational data.

Data Collection

The N‐MHSS provides administrative data on the universe of specialty mental health care providers in the United States. Response rates are above 90 percent in all years. Data cover 85 019 provider/year observations.

Principal Findings

ACA‐Medicaid expansion increases the probability that a provider accepts Medicaid by 1.69 percentage points, 95 percent confidence interval: [0.0017,0.0321], which corresponds to an increase from 87.27 percent pre‐expansion to 90.27 percent postexpansion in expansion states or a 1.94 percent increase. We observe spillovers to Medicare, although this finding is sensitive to specification.

Conclusions

This study provides evidence on the impact of ACA‐Medicaid expansion on accepted forms of payment for specialty mental health care treatment. Findings suggest that expansion increases availability of providers who deliver valuable care for enrollees with severe mental illness. These findings may help policy makers reflecting on the future directions of the US health care delivery system.
RTN4B‐mediated suppression of Sirtuin 2 activity ameliorates β‐amyloid pathology and cognitive impairment in Alzheimer's disease mouse model
Authors: Wang Yan , Yang Jing‐Qi , Hong Ting-Ting , Sun Yuan‐Hong , Huang Hai‐Li , Chen Feng , Chen Xiong‐Jin , Chen Hui‐Yi , Dong Shan‐Shan , Cui Li‐Li , Yang Tie‐Lin
Published: July 2020

Sirtuin 2 (SIRT2) is an NAD+ dependent deacetylase that is the most abundant sirtuin protein in the brain. Accumulating evidence revealed the role of SIRT2 in a wide range of biological processes and age‐related diseases. However, the pivotal mechanism of SIRT2 played in Alzheimer's disease (AD) remains unknown. Here, we report that pharmacological inactivation of SIRT2 has a beneficial effect in AD. The deacetylase inhibitor of SIRT2 rescued the cognitive impairment in amyloid precursor protein/presenilin 1 transgenic mouse (APP/PS1 mouse), and the BACE1 cleavage was weakened to reduce the β‐amyloid (Aβ) production in the hippocampus. Moreover, we firstly identified that Reticulon 4B (RTN4B) played a crucial role between SIRT2/BACE1 regulation in AD. RTN4B, as a deacetylation substrate for SIRT2, the deacetylation by SIRT2 drived the ubiquitination and degradation of RTN4B and then the disturbed RTN4B interacted with and influenced the expression of BACE1. When we overexpressed RTN4B in neurons of the hippocampus in the AD mouse model, the abnormal Aβ accumulation and cognitive impairment were ameliorated, consistent with the results of SIRT2 inhibition in vivo. Moreover, we showed that the regulatory effect of SIRT2 on BACE1 is dependent on RTN4B. When RTN4B was knocked down, the effects of SIRT2 inhibition on the BACE1 level, Aβ pathology, and AD‐liked behaviors were also blocked. Collectively, we provide evidence that SIRT2 may be a potential target for AD; the new found SIRT2/RTN4B/BACE1 pathological pathway is one of the critical mechanisms for the improvement of SIRT2 on AD.
Perceived safety of smoking a few cigarettes during pregnancy and provider advice in a sample of pregnant smokers from Romania
Authors: Jaber Rana , Blaga Oana M. , Dascal Marina D. , Meghea Cristian I.
Published: July 2020

Aims

To assess the prevalence of the perceived safety of smoking a few (generally fewer than five per day) cigarettes during pregnancy and identify associated factors in a sample of pregnant smokers in Romania, a middle‐income country.

Design and Setting

Cross‐sectional design with a convenience sample using a polled data set collected between 2016 and 2019 in the formative and baseline phases of the Quit Together randomized control trial (RCT) in Romania. Data were collected using a structured questionnaire administered by research assistants in clinics in the formative phase and self‐administered through the study website at the RCT baseline.

Participants

A total of 217 pregnant smokers (mean age = 28.5 ± 5.8) enrolled in the formative and RCT phases of the research project.

Measurements

The main outcome was the perceived safety of smoking a few cigarettes during pregnancy (generally fewer than five per day). Covariates included the health‐care providers’ advice towards smoking tobacco cigarettes during pregnancy, socio‐demographics, the presence of depression and anxiety symptoms and level of nicotine dependence.

Findings

More than 35% of participants agreed that smoking a few cigarettes during pregnancy was safe for them and their baby. The perceived safety of smoking a few cigarettes during pregnancy was significantly associated with being told by health‐care providers that it is acceptable to continue to smoke cigarettes in small amounts [odds ratio (OR) = 3.08; 95% CI = 1.35–6.99; P < 0.01], perceived harm reduction of smoking light cigarettes (OR = 2.67; 95% CI = 1.19–5.97; P = 0.02) and moderate to severe depression and anxiety score (OR = 0.34; 95% CI = 0.13–0.84; P = 0.02).

Conclusions

More than one‐third of pregnant Romanian women appear to believe that smoking ‘a few’ cigarettes during pregnancy is safe for them and their fetuses. Those who are told by their health‐care providers that it is acceptable to smoke in small amounts during pregnancy have higher odds of perceiving smoking ‘a few’ cigarettes during pregnancy as safe compared with other pregnant Romanian women.
Design, synthesis and antiamoebic activity of dysprosium‐based nanoparticles using contact lenses as carriers against Acanthamoeba sp.
Authors: Kusrini Eny , Sabira Klanita , Hashim Fatimah , Abdullah Nurul Aliah , Usman Anwar , Putra Nandy , Prasetyanto Eko Adi
Published: July 2020

Purpose

Contact lenses have direct contact with the corneal surface and can induce sight‐threatening infection of the cornea known as Acanthamoeba keratitis. The objective of this study was to evaluate the dysprosium‐based nanoparticles (Dy‐based NPs), namely Fe3O4‐PEG‐Dy2O3 nanocomposites and Dy(OH)3 nanorods, as an active component against Acanthamoeba sp., as well as the possibility of their loading onto contact lenses as the drug administering vehicle to treat Acanthamoeba keratitis (AK).

Methods

The Dy‐based NPs were synthesized, and they were loaded onto commercial contact lenses. The loading content of the NPs and their release kinetics was determined based on the absorbance of their colloidal solution before and after soaking the contact lenses. The cytotoxicity of the NPs was evaluated, and the IC50 values of their antiamoebic activity against Acanthamoeba sp. were determined by MTT colorimetric assay, followed by observation on the morphological changes by using light microscopy. The mechanism of action of the Dy‐based NPs against Acanthamoeba sp. was evaluated by DNA laddering assays.

Results

The loading efficiencies of the Dy‐based NPs onto the contact lens were in the range of 30.6–36.1% with respect to their initial concentration (0.5 mg ml–1). The Dy NPs were released with the flux approximately 5.5–11 μg cm–2 hr–1, and the release was completed within 10 hr. The emission of the NPs consistently showed a peak at 575 nm due to Dy3+ ion, offering the possible monitoring and tracking of the NPs. The SEM images indicated the NPs are aggregated on the surface of the contact lenses. The DNA ladder assay suggested that the cells underwent DNA fragmentation, and the cell death was due most probably to necrosis, rather than apoptosis. The cytotoxicity assay of Acanthamoeba sp. suggested that Fe3O4‐PEG, Fe3O4‐PEG‐Dy2O3, Dy(NO3)3.6H2O and Dy(OH)3 NPs have an antiamoebic activity with the IC50 value being 4.5, 5.0, 9.5 and 22.5 μg ml–1, respectively.

Conclusions

Overall findings in this study suggested that the Dy‐based NPs can be considered as active antiamoebic agents and possess the potential as drugs against Acanthamoeba sp. The NPs could be loaded onto the contact lenses; thus, they can be potentially utilized to treat Acanthamoeba keratitis (AK).
Reactions to male‐favouring versus female‐favouring sex differences: A pre‐registered experiment and Southeast Asian replication
Authors: Stewart‐Williams Steve , Chang Chern Yi Marybeth , Wong Xiu Ling , Blackburn Jesse D. , Thomas Andrew G.
Published: July 2020

Two studies investigated (1) how people react to research describing a sex difference, depending on whether that difference favours males or females, and (2) how accurately people can predict how the average man and woman will react. In Study 1, Western participants (N = 492) viewed a fictional popular‐science article describing either a male‐favouring or a female‐favouring sex difference (i.e., men/women draw better; women/men lie more). Both sexes reacted less positively to the male‐favouring differences, judging the findings to be less important, less credible, and more offensive, harmful, and upsetting. Participants predicted that the average man and woman would react more positively to sex differences favouring their own sex. This was true of the average woman, although the level of own‐sex favouritism was lower than participants predicted. It was not true, however, of the average man, who – like the average woman – reacted more positively to the female‐favouring differences. Study 2 replicated these findings in a Southeast Asian sample (N = 336). Our results are consistent with the idea that both sexes are more protective of women than men, but that both exaggerate the level of same‐sex favouritism within each sex – a misconception that could potentially harm relations between the sexes.
The fatigue crack growth behaviour of 2524‐T3 aluminium alloy in an Al2O3 particle environment
Authors: Chen Yuqiang , Tang Zhenheng , Pan Suping , Liu Wenhui , Song Yufeng , Liu Yang , Zhu Biwu
Published: July 2020

The effect of the Al2O3 dust environment on the crack propagation behaviour of 2524‐T3 Al alloy was investigated. The results show that the Al2O3 dust environment reduces the fatigue crack growth rate (FCGR) of alloy especially at low ΔK. Many Al2O3 particles are deposited and stuck in the crack during fatigue loading which promotes crack closure, while this effect is gradually weakened with the increase of ΔK. The deposited Al2O3 particles induce the disorderly arranged slip bands (SBs) ahead of the crack tip which deflects the crack path making it more tortuous in the Al2O3 dust.
Clinical characteristics and surgical treatment of haemophilic pseudotumor: A retrospective analysis of thirty‐four patients
Authors: Lin Shiyuan , Tong Kai , Wang Gang , Zhong Ziyi , Cao Shenglu , Feng Zihang
Published: July 2020

Aims

Haemophilic pseudotumor (HPT) is a rare but challenging complication of haemophilia. This study was intended to provide our experience about clinical characteristics and surgical treatment of HPT.

Methods

Clinical medical records were retrieved from the Hemophilia Center, Nanfang Hospital, to identify the patients who had been surgically treated from 1 January 2006 to 31 December 2017 with a definite diagnosis of HPT. Their clinical features, surgical management, outcomes and complications after surgery were analysed.

Results

We identified 34 patients with HPT who had surgical treatment over a 12‐year period and five of them had multiple HPTs. The incidence of HPT at this centre was 2.3% over the dozen years. A previous trauma leading to the development of HPT was reported in 18 cases (52.9%). The HPT affected only soft tissue in 7 patients, bone and soft tissue in 25 ones and joint in 2 ones. Preoperative infection and fistula formation happened in ten patients, two of whom were related to abdominal HPTs. Enterococcus faecalis was cultured in five cases with fistula formation. HPT associated with pathological fracture was observed in five cases, two of whom were treated by external fixation and 3 by HPT resection and metallic internal fixation. Amputation was performed for nine patients, 6 of whom had preoperative infection and fistula formation. Their follow‐up duration averaged 4.2 ± 2.9 years (range, from 1 to 13.5 years) after surgery. Of all our cases, three suffered from postoperative infection, five from recurrence of HPT and two with external fixation from fracture non‐union.

Conclusions

HPT patients with preoperative infection had worse prognosis than those without. Surgical treatment plus intensive replacement therapy was effective for HPT but with a high rate of complications. HPT resection and metallic internal fixation rather than external fixation should be recommended for HPT patients with pathological fracture.
Shared decision making in surgery: A scoping review of the literature
Authors: Niburski Kacper , Guadagno Elena , Mohtashami Sadaf , Poenaru Dan
Published: July 2020

Background

Shared decision making (SDM) has been increasingly implemented to improve health‐care outcomes. Despite the mixed efficacy of SDM to provide better patient‐guided care, its use in surgery has not been studied. The aim of this study was to systematically review SDM application in surgery.

Design

The search strategy, developed with a medical librarian, included nine databases from inception until June 2019. After a 2‐person title and abstract screen, full‐text publications were analysed. Data collected included author, year, surgical discipline, location, study duration, type of decision aid, survey methodology and variable outcomes. Quantitative and qualitative cross‐sectional studies, as well as RCTs, were included.

Results

A total of 6060 studies were retrieved. A total of 148 were included in the final review. The majority of the studies were in plastic surgery, followed by general surgery and orthopaedics. The use of SDM decreased surgical intervention rate (12 of 22), decisional conflict (25 of 29), and decisional regret (5 of 5), and increased decisional satisfaction (17 of 21), knowledge (33 of 35), SDM preference (13 of 16), and physician trust (4 of 6). Time increase per patient encounter was inconclusive. Cross‐sectional studies showed that patients prefer shared treatment and surgical treatment varied less. The results of SDM per type of decision aid vary in terms of their outcome.

Conclusion

SDM in surgery decreases decisional conflict, anxiety and surgical intervention rates, while increasing knowledge retained decisional satisfaction, quality and physician trust. Surgical patients also appear to prefer SDM paradigms. SDM appears beneficial in surgery and therefore worth promoting and expanding in use.
Is it worth it?: The experiences of persons with multiple sclerosis as they access health care to manage their condition
Authors: Pétrin Julie , Donnelly Catherine , McColl Mary‐Ann , Finlayson Marcia
Published: July 2020

Background

People with multiple sclerosis (MS) require complex care throughout life. Canadians with MS are high users of health‐care services, yet still report unmet health‐care needs and low satisfaction with services received.

Objective

This study aimed to investigate the health‐care access experiences of Ontarians with MS as they manage their condition.

Design and Participants

Interpretive description guided data collection and analysis. Forty‐eight people living across seven communities participated. Thirty‐eight participated in one of five focus groups; the remaining 10 participated in an individual semi‐structured interview.

Results

Participants described the experience of accessing care as a decisional process, guided by a form of cost‐benefit analysis. The process determined whether seeking conventional health‐care services ‘is worth it’. Most participants felt that the energy and resources required to access the health‐care system outweighed their expected outcomes, based on past experiences. Participants who did not see the benefit of care seeking turned to self‐treatment, use of complementary and alternative services, and engaged in patterns of health‐care avoidance until a crisis arose.

Discussion and Conclusion

Findings suggest that a renewed effort to promote patient‐centred care and a biopsychosocial approach may improve the health‐care access experiences of persons with MS and reduce service avoidance.
The need for and value of nurse and midwife prescribing: Findings from an Irish research investigation
Authors: Wilson Donna M. , Fahy Anne , Nam Mavis A. , Murphy Jill
Published: July 2020

Aim

The aim of this study is to determine the need for and value of nurse and midwife prescribing in Ireland as identified by these prescribers—the people most able to provide relevant insights and information.

Background

Since 2007, nurses and midwives in Ireland who have passed an additional educational program can prescribe medicinal products relative to their clinical practice areas. Research evidence of efficacy is needed now for prescribing sustainability in Ireland and to encourage, if successful, the adoption or expansion of frontline nurse/midwife prescribing rights in other countries.

Design

A qualitative study was undertaken.

Methods

Interviews with registered nurse and midwife prescribers were conducted in 2017 until data saturation. Constant‐comparative coding and categorization of data revealed themes and categories, with explanatory quotes for research trustworthiness and credibility purposes.

Results

Six data themes emerged: (a) more than just writing prescriptions; (b) highly individualized evidence‐based specialist care; (c) assured, timely and rapid accessibility to needed care; (d) health system and healthcare efficiency gains; (e) satisfaction with nurse/midwife prescriber services and (f) quality care improvements.

Conclusion

Nurse/midwife prescribing in Ireland was identified as needed, safe, effective and cost‐effective. Prescribing permitted accessible, thorough and proactive holistic health promotive care to be provided in nurse‐ or midwife‐led outpatient clinics.
An Extensive Comparison of Some Well‐Established Value at Risk Methods
Authors: Calmon Wilson , Ferioli Eduardo , Lettieri Davi , Soares Johann , Pizzinga Adrian
Published: July 2020

In the last two decades, several methods for estimating Value at Risk have been proposed in the literature. Four of the most successful approaches are conditional autoregressive Value at Risk, extreme value theory, filtered historical simulation and time‐varying higher order conditional moments. In this paper, we compare their performances under both an empirical investigation using 80 assets and a large Monte Carlo simulation. From our analysis, we conclude that most of the methods seem not to imply huge numerical difficulties and, according to usual backtests and performance measurements, extreme value theory presents the best results most of the times, followed by filtered historical simulation.
Efficient summary statistics for detecting lineage fusion from phylogeographic datasets
Authors: Garrick Ryan C. , Hyseni Chaz , Arantes Ísis C.
Published: July 2020

Aim

Lineage fusion (merging of two or more populations of a species resulting in a single panmictic group) is a special case of secondary contact. It has the potential to counteract diversification and speciation, or to facilitate it through creation of novel genotypes. Understanding the prevalence of lineage fusion in nature requires reliable detection of it, such that efficient summary statistics are needed. Here, we report on simulations that characterized the initial intensity and subsequent decay of signatures of past fusion for 17 summary statistics applicable to DNA sequence haplotype data.

Location

Global.

Taxa

Diploid out‐crossing species.

Methods

We considered a range of scenarios that could reveal the impacts of different combinations of read length versus number of loci (arrangement of DNA sequence data), and whether or not pre‐fusion populations experienced bottlenecks coinciding with their divergence (historical context of fusion). Post‐fusion gene pools were sampled along 10 successive time points representing increasing lag times following merging of sister populations, and summary statistic values were recalculated at each.

Results

Many summary statistics were able to detect signatures of complete merging of populations after a sampling lag time of 1.5 Ne generations, but the most informative ones included two neutrality tests and four diversity metrics, with ZnS (a linkage disequilibrium‐based neutrality test) being particularly powerful. Correlation was relatively low among the two neutrality tests and two of the diversity metrics. There were clear benefits of many short (200‐bp × 200) loci over a handful of long (4‐kb × 10) loci. Also, only the latter genetic dataset type showed impacts of bottlenecks during divergence upon the number of informative summary statistics.

Main conclusions

This work contributes to identifying cases of lineage fusion, and advances phylogeography by enabling more nuanced reconstructions of how individual species, or multiple members of an ecological community, responded to past environmental change.
Transgender and gender‐expansive youth: Assisting the nurse in providing culturally competent care for our clients and their families
Authors: Michels Susan , Kovar Cheryl L.
Published: July 2020

Topic

Society's blue and pink concept of gender has been under a dramatic and controversial shift over the last 10 years. While the general population has been given some latitude in slowly coming to terms with this new understanding, health care providers, specifically nurses, have been under the microscope to demonstrate a perfect blend of competency and compassion when caring for clients who present outside the gender binary.

Purpose

To clarify the areas of potential impact in the nurse's role and to discuss ways in which they can better equip themselves to promote effective communication and culturally competent care. Thus, we envision heightened empowerment for the nurse to take a more active role in decreasing risks for negative health outcomes such as psychological stress, depression, self‐harm, and suicidal ideation in our transgender and gender‐expansive youth.

Sources Used

Utilizing PubMed, nationally recognized websites, and current textbooks/pamphlets, a literature review was conducted to ascertain pertinent information related to transgender, gender‐expansive youth, and nursing education. Included references were from 2012 to the present.

Conclusions

Nurses have a unique and dynamic opportunity to provide support and education for our transgender youth and their families, yet often play a minimal role due to inexperience or lack of resources.
Electroanatomic guidance versus conventional fluoroscopy during transseptal puncture for atrial fibrillation ablation
Authors: Troisi Federica , Quadrini Federico , Di Monaco Antonio , Vitulano Nicola , Caruso Rosa , Guida Pietro , Langialonga Tommaso , Grimaldi Massimo
Published: July 2020

Introduction

Technological advancement in the setting of atrial fibrillation (AF) ablation has decreased radiation exposure and complications associated with the procedure. Yet, transseptal puncture (TSP) remains a challenging step that necessitates accurate guidance. We describe our experience performing TSP under electroanatomic (EA) guidance.

Methods and results

The analysis included 145 consecutive EA‐guided ablation procedures performed between June 2018 and April 2019 and 145 consecutive standard ablations performed before June 2018. EA guidance utilized the CARTO 3 three‐dimensional mapping system to reconstruct anatomic and electrical characteristics of the right atrium and fossa ovalis. Patients with a history of previous cardiac surgery were excluded. For EA‐guided procedures, the mean patient age was 60 ± 10 years, 75.2% were male, and 69.0% had paroxysmal AF. Similarly, the mean age for conventional procedures was 60 ± 11 years, 71.0% were male, and 71.7% had paroxysmal AF. The fossa ovalis was detected as a region of low voltage, <0.75 mV. EA guidance yielded shorter fluoroscopy times (EA vs. conventional, 3.6 ± 2.5 vs. 13.5 ± 10.5 min; p < .001) and a lower dose area product than conventional guidance (13 ± 11 Gy* cm2 vs. 28 ± 27  Gy* cm2; p < .001). The total procedure duration was similar between groups (146 ± 48 vs. 148 ± 54 min). There were no significant complications related to TSP.

Conclusion

During AF ablation, TSP with EA guidance facilitated safe access to the left atrium while reducing radiation risk to both patients and operators.
Evaluation of the QT interval in patients with drug‐induced QT prolongation and torsades de pointes
Authors: Krisai Philipp , Vlachos Konstantinos , Ramirez F. Daniel , Nakatani Yosuke , Nakashima Takashi , Takagi Takamitsu , Kamakura Tsukasa , Surget Elodie , André Clémentine , Cheniti Ghassen , Welte Nicolas , Chauvel Rémi , Tixier Romain , Duchateau Josselin , Pambrun Thomas , Derval Nicolas , Hocini Mélèze , Jaïs Pierre , Haïssaguerre Michel , Sacher Frédéric
Published: July 2020

Background

Data on the optimal location of the electrocardiogram (ECG) leads for the diagnosis of drug‐induced long QT syndrome (diLQTS) with torsades de pointes (TdP) are lacking.

Methods

We systematically reviewed the literature for the ECGs of patients with diLQTS and subsequent TdP. We assessed T wave morphology in each lead and measured the longest QT interval in the limb and chest leads in a standardized fashion.

Results

Of 84 patients, 61.9% were female and the mean age was 58.8 years. QTc was significantly longer in chest versus limb leads (mean (SD) 671 (102) vs. 655 (97) ms, p = .02). Using only limb leads for QT interpretation, 18 (21.4%) ECGs were noninterpretable: 10 (11.9%) due to too flat T waves, 7 (8.3%) due to frequent, early PVCs and 1 (1.2%) due to too low ECG recording quality. In the chest leads, ECGs were noninterpretable in nine (10.7%) patients: six (7.1%) due to frequent, early PVCs, one (1.2%) due to insufficient ECG quality, two (2.4%) due to missing chest leads but none due to too flat T waves. The most common T wave morphologies in the limb leads were flat (51.0%), broad (14.3%), and late peaking (12.6%) T waves. Corresponding chest lead morphologies were inverted (35.5%), flat (19.6%), and biphasic (15.2%) T waves.

Conclusions

Our results indicate that QT evaluation by limb leads only underestimates the incidence of diLQTS experiencing TdP and favors the screening using both limb and chest lead ECG.
Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient‐level meta‐analysis of three large clinical trials
Authors: Cheng Alan , Joung Boyoung , Brown Mark L. , Koehler Jodi , Lexcen Daniel R. , Sanders Prashanthan , Ellenbogen Kenneth A.
Published: July 2020

Background

Implantable cardioverter defibrillators (ICDs) reduce all‐cause mortality among cardiomyopathy patients. Whether or not antitachycardia pacing (ATP) is equally effective in ischemic (ICM) and nonischemic (NICM) cardiomyopathy patients remains poorly understood. We describe the distribution of monomorphic (MVT) and non‐monomorphic (polymorphic ventricular tachycardia/ventricular fibrillation [PVT/VF]) ventricular tachyarrhythmias among ICM and NICM primary prevention patients.

Methods

This patient‐level meta‐analysis included primary prevention patients from the Shock‐Less (n = 3519), PainFree SST (n = 1917), and PREPARE (n = 690) studies. Distribution of MVT and PVT/VF events were compared with χ2 tests. ATP success was estimated using a generalized estimating equation model to correct for multiple episodes for a patient between cohorts for slow (≥320 ms) and fast (240–310 ms) MVTs.

Results

Among 6126 patients, 714 (29% NICM, age 66 ± 13 years, female 18%, EF = 29 ± 12%) had a total of 4444 treated ventricular tachyarrhythmia episodes. The rate of individuals treated for MVT or PVT/VF was comparable between ICM (11.9%) and NICM (11.2%) over 21 ± 10 months. In addition, the distribution of MVT (76% ICM vs. 71% NICM) and PVT/VF (15% ICM vs. 20% NICM) was not significantly different (p = .28). Among MVT episodes, the average tachycardia cycle lengths (332 ± 58 ms ICM vs. 313 ± 40 ms NICM; p = .27) were similar, as was the likelihood of ATP‐associated termination (74.6% ICM vs. 76.4% NICM; p = .58). Overall, ATP success was higher for slow (≥320 ms) MVT versus faster (240–310 ms) episodes (84.1% vs. 69%; p < .001).

Conclusion

In a large cohort of primary prevention ICD patients, ICM and NICM patients have similar rates and proportions of MVT and PVT/VF episodes. ATP‐associated termination of MVT was comparable between the two groups.
Glucosamine protects against radiation‐induced lung injury via inhibition of epithelial‐mesenchymal transition
Authors: Lei Xiao , Ma Na , Liang Yanjie , Liu Junyan , Zhang Pei , Han Yanan , Chen Wei , Du Lehui , Qu Baolin
Published: July 2020

Radiotherapy is one of the most important treatments for chest tumours. Although there are plenty of strategies to prevent damage to normal lung tissues, it cannot be avoided with the emergence of radiation‐induced lung injury. The purpose of this study was to investigate the potential radioprotective effects of glucosamine, which exerted anti‐inflammatory activity in joint inflammation. In this study, we found glucosamine relieved inflammatory response and structural damages in lung tissues after radiation via HE staining. Then, we detected the level of epithelial‐mesenchymal transition marker in vitro and in vivo, which we could clearly observe that glucosamine treatment inhibited epithelial‐mesenchymal transition. Besides, we found glucosamine could inhibit apoptosis and promote proliferation of normal lung epithelial cells in vitro caused by radiation. In conclusion, our data showed that glucosamine alleviated radiation‐induced lung injury via inhibiting epithelial‐mesenchymal transition, which indicated glucosamine could be a novel potential radioprotector for radiation‐induced lung injury.
Prevalence, intensity and histopathology of Zeylanicobdella arugamensis infestation on groupers reared on different aquaculture systems
Authors: Mahasri Gunanti , Hafidloh Umi , Pratama Fungky P. , Rahmawan Dicky , Subekti Sri , Wulansari Putri D. , Amin Muhamad
Published: July 2020

The marine leech, Zeylanicobdella arugamensis, is a major threat to aquaculture in grouper‐producing countries including Indonesia. This study aimed at investigating prevalence, intensity and histopathology of the ectoparasite in humpback and hybrid groupers cultured in different rearing systems. A total of 260 groupers (60 humpback groupers and 200 hybrid groupers) were used for samples. The marine leech was observed on skin, fins, gills and mouth, followed by histopathological assay on the skin tissue. The results showed that prevalence of the leech in both groupers was higher when they were cultured in the floating net cages compared with the hatchery, p < .05. Furthermore, humpback grouper had a higher prevalence than hybrid grouper when they were cultured in a similar system, p < .05. Meanwhile, there was no significant difference in intensity between the two groupers, p > .05. Within the hybrid groupers, the highest prevalence was obtained from hybrid groupers reared in the earthen ponds. Histopathological studies showed that the infected groupers exhibited inflammation, congestion and erosion of the epidermis layer. Hybrid grouper had more severe histopathological lesions in the skin tissues. These results suggested that species and type of aquaculture system had significantly determined the prevalence, intensity and severity of lesion in Z. arugamensis infestation.
Age‐Friendly Ecosystems: An Aspirational Goal
Authors: Wetle Terrie T.
Published: July 2020

This editorial comments on the article by Fulmer et al. in this issue.
The Longitudinal Effects of Caregiver Grief in Dementia and the Modifying Effects of Social Services: A Prospective Cohort Study
Authors: Liew Tau Ming , Tai Bee Choo , Wee Shiou Liang , Koh Gerald Choon‐Huat , Yap Philip
Published: July 2020

BACKGROUND

Caregivers of persons with dementia (PWD) can experience loss and grief long before the death of the PWD, with such caregiver grief postulated to affect the well‐being of the PWD‐caregiver dyads. However, the longitudinal effects of caregiver grief and the moderating effects of social services are not yet clear.

OBJECTIVES

We investigated the longitudinal effects of caregiver grief on caregiver depression, caregivers' quality of life (QoL), and caregivers' perceived positive aspects of caregiving (PAC); and examined potential effect modification of social service utilization (dementia care services, caregiver programs, and paid caregivers).

DESIGN AND SETTING

A prospective cohort study with three time points of assessments (at 0, 6, and 12 months).

PARTICIPANTS

Family caregivers of community‐dwelling PWD (n = 178).

MEASUREMENTS

At time point 1 (baseline), participants completed questionnaires that captured caregiver grief, burden, and social service utilization. Outcomes that were captured over time were: depression (time points 1–3), QoL (time point 2), and PAC (time point 3). Caregiver grief as well as interaction terms with social service utilization were included in Tobit regression to examine the association with outcomes.

RESULTS

After accounting for the effect of caregiver burden, caregiver grief remained associated with depressive symptoms (P < .001) and poorer QoL (P < .001). However, compared with burden, grief contributed to larger magnitudes of the adverse effects. Grief, not burden, was associated with less PAC (P = .006 and P = .746, respectively). In contrast, burden, not grief, was associated with poorer physical health (P = .010 and P = .110, respectively). Dementia care services attenuated the effect of burden but not grief; caregiver programs did not affect burden but appeared to aggravate the effect of grief; and paid caregivers attenuated the effect of burden, and partially attenuated the effect of grief.

CONCLUSION

Caregiver grief has an impact on dementia caregivers, likely through a distinct mechanism from that of caregiver burden. However, prevailing social services may not be sufficient to address grief, highlighting the need to further train care workers in this respect. J Am Geriatr Soc 68:2348–2353, 2020.
Data representativeness in LCA: A framework for the systematic assessment of data quality relative to technology characteristics
Authors: Henriksen Trine , Astrup Thomas F. , Damgaard Anders
Published: July 2020

A shortcoming in current data quality assessment schemes is that the data quality information is not used systematically to identify the critical data in a life cycle inventory (LCI) model. In addition, existing criteria employed to evaluate representativeness lack relevance to the specific context of a study. A novel framework is proposed herein for the evaluation of the representativeness of LCI data, including an analysis of the importance of the data and a modification of quality criteria based on unit process characteristics. Temporal characteristics are analyzed by identifying the technology shift, because data generated before this time are considered outdated. Geographical and technological characteristics are analyzed by defining a “related area” and a “related technology,” which is done by identifying a number of relevant geographical and technical factors, and then comparing the collected data with these factors. The framework was illustrated in a case study on household waste incineration in Denmark. The results demonstrated the applicability of the method in practice, and they provided data quality criteria unique to waste incineration unit processes, for example, different time intervals to evaluate temporal representativeness. However, the proposed method is time demanding, and thus sector‐level characteristic analyses are feasible instead of the user having to do the analyses.