bluuebunny/crossref_metadata_2025 huggingface dataset:
Seclusion boundaries as interface in contemporary Istanbul housing
Authors: Tunçer Yıldırım Canay
Published: June 2019

Purpose

The purpose of this paper is to test and present the level of introversion/extroversion of the urban housing in Istanbul in three periods – traditional, modern and contemporary. It intends to examine changes in the boundaries between housing and urban environment in the city by evaluating housing interfaces and their components.

Design/methodology/approach

By adopting literature review, observation and comparison methods, the hypothesis that houses in Istanbul are becoming introvert in contemporary period is stated and tested. The qualifications of housing interfaces and their components are examined in the context of three different periods of housing – traditional, modern and contemporary. Common components of interfaces in all periods are identified and different housing types from all periods are compared accordingly.

Findings

The results of the comparison made within the study shows that contemporary housing units are much more introvert than previous periods in Istanbul, while housing units of modern period have the most potentiality to be extrovert. It is seen that the analysis method comparing interfacial components and its results are compatible with the hypothesis of the study.

Originality/value

Considering recent and great number of urban problems in Istanbul, the subject of introversion–extroversion in contemporary urban housing gains importance, which lacks in the literature and needs studying. Introversion of housing units affects both domestic life and their urban environment. Developing contemporary housing projects with a human ecological perspective would cure both interior and exterior of urban boundaries.
Re-defining the boundaries at schools
Authors: Baloğlu Yasemin Burcu
Published: June 2019

Purpose

Recognizing the close relation of educational philosophies and methods with the design of the built environment which accommodates them, the purpose of this paper is to bring insights to the issue through presenting the interpretations of one of the major user groups, educating staff, to determine the primary sources of the need for spatial change at primary schools in the local context.

Design/methodology/approach

A field study has been conducted with the participation of 142 teachers from 15 public primary schools located in a dense urban environment, in Bayrampasa district, Istanbul. Responses to the open-ended questions were analyzed through the use of the fuzzy analytic hierarchy process method.

Findings

The results indicate that the need for providing qualified spaces for physical activity and play as well as devoted subject-specific learning areas, utilization of outdoor spaces, accommodation of high numbers of students emerge as primary sources of the need for spatial change.

Practical implications

The contemporary child-centered and experience-based educational approaches of the twenty-first century, developed around carrying the learning activities beyond the traditional classrooms brought the formation of boundaries at schools under question. Regarding these ideas, flexibility and related concepts have become the common design aspects to come under focus for school architecture. In Turkey, there is an increasing trend in the production of educational facilities due to population growth and rapid changes in the educational system, which seems to proceed in the foreseeable future. The innovative proposals of school design indeed have the potential to contribute to the development of future school projects.

Originality/value

The study presents a unique contribution to the related literature through presenting empirical data from users’ perspective.
Sugar contents of ready-to-eat foods distributed at major amusement parks in Korea and their substitution with artificial sweeteners
Authors: Bae Dong-Ho
Published: June 2019

Purpose

The purpose of this paper is to analyse the sugar contents of ready-to-eat foods distributed at amusement parks and suggested an appropriate food safety management strategy for children.

Design/methodology/approach

Ready-to-eat food samples (n = 322) in 17 categories were collected from the major amusement parks in Korea, and their free sugar contents were determined. Substitution of sugars in high-sugar foods with appropriate artificial sweeteners is suggested to reduce sugar intake after comparing the estimated daily intakes (EDIs) of the sweeteners with the corresponding acceptable daily intakes (ADIs).

Findings

Samples in three categories (tteokbokki, muffins and waffles) were classified as high-sugar foods. The substitution of all sugar in the high-sugar foods with aspartame or sucralose, among the predominant artificial sweeteners in Korea, would not increase their EDIs to higher values than the corresponding ADIs for both children and adolescents. Consequently, substitutions of sugars in high-sugar foods with aspartame or sucralose are suggested. Partial substitutions (45 and 40 per cent, respectively) of sugar are recommended for muffin and waffle, considering their baking properties and current sugar contents.

Social implications

This paper reveals the necessity of an appropriate safety management system for ready-to-eat foods distributed at amusement parks.

Originality/value

The potential risks caused by sugar in ready-to-eat foods distributed at amusement parks and the substitution of sugar with artificial sweeteners has rarely been assessed. The approaches proposed in this paper minimise the risks posed by both sugar and artificial sweeteners simultaneously, and may be useful in the development of a food safety management system.
Leading change in a South African school
Authors: Ronnie Linda , Boyd Sarah
Published: June 2019

Subject area:

Human Resource Management

Study level/applicability:

Postgraduate business students

Learning outcomes

The learning objectives to be drawn from the case are as follows: To discuss the challenges of a leader within a resource-constrained environment. Students are required to highlight aspects of transformational leadership and assess the leader against those criteria. To highlight the connection between employee mindset, actions, and organisational performance. Students need to identify the key issues underlying the personnel challenges facing the leader. To explore the influence of leadership on employee engagement. Students should identify the actions taken by the leader to engage employees and analyse the intention behind them, as well as the actual outcomes. To discuss the potential solutions that the leader may institute to achieve the overall transformational objective for the organisation.

Case overview/synopsis

This case puts students in the shoes of Siya Zwane, the newly appointed principal of Green Acres Primary School in the South Africa’s Eastern Cape. Having recently completed her PhD in education after 10 years of teaching, Zwane is well versed in the best practices for organisational development and eager to apply them in a public school setting. Her leadership is particularly relevant in the context of a struggling school system that faces, among other issues, an economically disadvantaged population, overcrowding in classrooms, poor infrastructure, and a general lack of resources, including qualified staff. As a newcomer to this school system, Zwane learns quickly how these systemic issues manifest in her teaching team and realises that her first priority must be to empower her staff and enhance employee engagement.

Supplementary materials

Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Subject code

CSS 1: Accounting and Finance
Tracing hospitality and tourism graduates’ career mobility
Authors: Tolkach Denis , Tung Vincent Wing Sun
Published: June 2019

Purpose

This paper aims to evaluate the career patterns and global mobility trajectories of hospitality and tourism graduates that are relevant for global knowledge and local talent management.

Design/methodology/approach

This study maps and assesses the public profiles of over 2,000 hospitality and tourism graduates from five institutions each from a different territory using a popular online professional network.

Findings

The findings highlight a network of worldwide mobility from hospitality and tourism graduates of the five institutions. The findings also suggest five different types of mobility trajectories (i.e. stateside, intra-regional, continental, inter-regional and global) and career patterns (i.e. rooted, prospector, seeker, two-homes and wanderer).

Research limitations/implications

Geographical mobility of graduates in tourism and hospitality is one of the less studied phenomena; however, it is important to understand due to growing concerns regarding globalization of the workplace and internationalization of education.

Practical implications

This study provides insights into how knowledge transfer and talent management could be impacted by the global graduate movements.

Originality/value

This is one of the first studies to date to combine mobility trajectories with a classification of career patterns to provide implications relevant for global knowledge and local talent management.
Role of servant leadership in contemporary hospitality
Authors: Chon Kaye Kye-Sung , Zoltan Judit
Published: June 2019

Purpose

This study aims to determine the possible role of servant leadership (SL) in meliorating critical issues in the contemporary hospitality industry by synthesizing literature on SL, examining benefits and deriving future research propositions.

Design/methodology/approach

A systematic literature review of SL in hospitality was conducted to analyze, categorize and synthesize the state of research. A nomological framework of SL in hospitality was created, and research gaps were identified. Future directions and propositions were derived to investigate the antecedents of SL by applying the person-situation theoretical approach, and second, to address contemporary challenges in the industry.

Findings

SL theory in hospitality is examined across various themes with focus on outcome effects related to firm performance, and across different cultures, with observed dominance in Asia. All analyses demonstrate the positive effects on employers and firms and thus confirm the relevance of adopting SL in hospitality. A notable gap in hospitality research is the lack of empirical investigation of SL antecedents. Such an investigation is crucial in promoting related behaviors.

Practical implications

This study identifies the benefits of SL, especially in addressing contemporary issues, such as sustainability, talent shortage, competition, growing demand for experience and retention of hospitality graduates. Recommendations are elaborated for hospitality educators and industry managers to revise leadership practices.

Originality/value

This study is the first to review SL in hospitality and determine its role in ameliorating critical issues in the field.
Communities of innovation
Authors: Lim Michael , Ong Bee Yong
Published: June 2019

Purpose

This paper aims to increase our understanding of the nature and role of communities within organizations with regard to innovation management, the drivers of community innovation and macro-processes of community innovation management.

Design/methodology/approach

The authors first use an inductive qualitative technique to analyze data gathered from a UK university to build up the concept of communities of innovation and then refine the concept of communities of innovation by contrasting it to the more established literature on communities of practice. Finally, with the aid of existing literature on collaborative innovation and the innovation processes, the authors induce from the data the drivers of community innovation and the three macro-processes of community innovation management.

Findings

The research findings suggest communities of innovation play a central and pivotal role in contributing to the generation of innovations within organizations. Drivers of innovation included corporate culture, money and time, intellectual property management, motivation, knowledge facilitators, activists and maintenance and opportunities to interact. The three macro-processes of community innovation management are identified as divergence management, gateway management and convergence management.

Research limitations/implications

As this is an exploratory research into communities of innovation, all the 11 communities of innovation analyzed belong to ABC University. It is necessary to expand on this research within the education industry, as well as into other industries to further test the reliability of the findings in this paper.

Practical implications

Business executives who have a better understanding of communities of innovation, the drivers of community innovation and the macro-processes of community innovation management will be better able to promote innovation within their organizations.

Social implications

Governments that have a better understanding of communities of innovation, the drivers of innovation and the macro-processes of community innovation management will be better able to promote innovation within their countries.

Originality/value

To the best of the authors’ knowledge, this is one of the first research studies attempting to understand communities of innovation and the macro-processes of community innovation management.
Community capacity-building for sustainable development
Authors: Franco Isabel B. , Tracey James
Published: June 2019

Purpose

Although the value of community capacity building is widely accepted within scholarly literature, these initiatives thus far appear to have achieved very little impact in the achievement of community development aspirations. This paper aims to increase knowledge regarding specific priority areas which when targeted will result in more effective pathways towards sustainable development.

Design/methodology/approach

This study was performed through utilization of a qualitative strategy, which involved the combination of a number of qualitative methods and techniques including individual interviews, surveys, focus groups, literary review and policy analysis.

Findings

The investigation found that improving identified CSD priority areas, aligned with the sustainable development goals (SDGs), seems to be the most effective strategy to enhance the ability of local communities to overcome sustainability challenges over time. SDGs 9, 4, 15, 16, 17 and 8 were identified as the areas of greatest significance for practical community capacity building for sustainable development (CSD).

Originality/value

This paper answers scholarly literature’s call for greater investigation into bringing sustainability research closer to society, to clearly define research direction and agenda. It also recommends ways to action the global goals locally.
The role of service providers in 3D printing adoption
Authors: Chaudhuri Atanu , Rogers Helen , Soberg Peder , Pawar Kulwant S.
Published: June 2019

Purpose

The purpose of this paper is to identify challenges faced by industrial firms at different phases of adoption of 3D printing (3DP), and outline how 3DP service providers can help address these challenges.

Design/methodology/approach

Separate interview questionnaires for 3DP users and 3DP service providers were used to conduct semi-structured interviews.

Findings

The key 3DP adoption challenges are as follows: creating a business case; difficulty in using different materials; optimising the process for specific parts; lack of “plug and play” solutions offered by equipment manufacturers; limited availability of training and educational support; poor end product quality; machine breakdowns; and high cost of maintenance and spare components. Using the theoretical lens of the technology acceptance model, results show a lack of ease of use and technological turbulence impact companies’ decisions to adopt 3DP. 3DP service providers can indeed attempt to alleviate the above challenges faced by customers through providing multiple 3DP services across different stages of adoption.

Research limitations/implications

Future research should examine the role of 3DP equipment manufacturers and design and modeling software solutions providers in improving adoption and how 3DP equipment manufacturers could develop into more integrated service providers as the technology advances.

Practical implications

Service providers can help customers transition to 3DP and should develop a portfolio of services that fits different phases of adoption.

Originality/value

The paper outlines how 3DP service providers can help address customer challenges in adoption of 3DP across different stages of adoption.
Going beyond buildings: mindfulness and real estate user behavior
Authors: Seyler Nicolas Julian , Mutl Jan
Published: June 2019

Purpose

Building performance does not only depend on its efficiency but also on the behaviors of its occupants. Occupant behaviors can more than offset technological efficiency gains so, that corporate real estate (CRE) managers have to go beyond sustainable buildings. CRE managers need to understand occupants to effectively reduce the environmental impact of their building portfolio. This paper aims to investigate the effects of environmental attitudes and mindfulness on occupant behaviors at home and at the office. Thereby, the authors address numerous calls for research regarding the drivers of more environmental real estate user behaviors.

Design/methodology/approach

The authors use partial least squares structural equation modeling based on self-report data obtained for a representative German sample.

Findings

The results show that environmental attitudes and mindfulness have both positive effects on occupant behaviors. However, the effects tend to be weaker in the office context.

Research limitations/implications

This study relies on self-reports as an indicator of actual behaviors. Besides, the findings are limited by the cross-sectional nature of the data.

Practical implications

Environmental education and mindfulness training may be an effective way to promote more environmental occupant behaviors and help CRE managers to further reduce the environmental impact of their building portfolio.

Originality/value

The paper contributes to prior research about the antecedents of environmental behaviors and provides evidence for the positive impact of environmental attitudes and mindfulness on occupant behaviors. The author provide a new approach for CRE managers, which may improve occupant behaviors.
Flight or fight: a case study in resolving ethical issues
Authors: Christensen David S. , Schneider Paul , Orton Jeff
Published: June 2019

Theoretical basis

Students apply the new Institute of Management Accounting (IMA) ethics standard to “contribute to a positive ethical culture” and advice to “actively seek to resolve an ethical issue.” By learning and practicing how to voice concerns students gain confidence in this approach to resolve ethical issues. In addition, most students are inspired by the moral courage of the chief financial officer (CFO) and report an increased resolve to have moral courage.

Research methodology

The case was based on the CFO’s published account of his experience and supplemented with an interview. It has been gradually refined in an ethics course for accounting students over several years and evaluated from a sample of students who completed the course.

Case overview/synopsis

The CFO of a mining company was pressured to pledge collateral that was already pledged on another loan. The CFO courageously refused his supervisor’s request and resigned his position immediately (flight). In its ethics guidelines, the IMA requires its members to actively seek to resolve ethical issues internally before disassociating from the organization (fight). In addition, ethics writers Gentile (2010) and Badaracco (2001) suggest ways to communicate ethical concerns. In this case, accounting students learn how to resolve ethical issues using the ethics guidelines and suggestions by analyzing and writing about the experience of the CFO.

Complexity academic level

The case is used in a graduate ethics course. It may also be used in undergraduate accounting courses.
Effect of different coagulants on the yield, sensory, instrumental colour and textural characteristics of cow's milk Paneer
Authors: Kumar Ranjan , Mishra Diwakar , Sutariya Harinkumar , Chaudhary Madhabhai B , Rao Kulkarni J
Published: June 2019

Paneer was prepared from cow's milk (4.5% fat and 8.5% SNF) using five coagulants, viz. citric acid (CA), malic acid (MA), alum (AL), calcium lactate (Ca‐L) and glucono‐delta‐lactone (GDL). Among these, GDL and MA exhibited similar effects on colour and appearance, flavour as well as overall acceptability. The yields of Paneer were 158.09, 183.71, 201.11, 206.34 and 188.83 g/L of milk for the above coagulants, respectively. All Paneer samples showed higher values of hardness, cohesiveness, springiness and chewiness as compared to CA sample. Malic acid coagulated Paneer, however, had relatively lower value of hardness but exhibited higher instrumental lightness.
The Impact of Sourdough Fermentation on Non‐Nutritive Compounds and Antioxidant Activities of Flours from Different Phaseolus Vulgaris L. Genotypes
Authors: Gabriele Morena , Sparvoli Francesca , Bollini Roberto , Lubrano Valter , Longo Vincenzo , Pucci Laura
Published: June 2019

This study dealt with the effect of sourdough fermentation on antinutrients, phytochemicals, and antioxidant activities of flours from three Phaseoulus vulgaris L. genotypes with differing composition of lectins. Specifically, cultivar Lady Joy (LJ) devoid of phytohemagglutinin (PHA) and enriched in alfa‐amylase inhibitor (αAI), breeding line P500 low in PHA and devoid of αAI, and Taylor's horticultivar, containing normal levels of both proteins. Sourdough fermentation positively affects the nutritional values of all bean flours by reducing some antinutrients, for example, phytic acid while preserving αAI activity. It significantly increased total polyphenols, flavonols, and ascorbic acid content, while reducing flavonoids. No significant differences in antioxidant activity, measured by in vitro and ex vivo assays on human erythrocytes, were found. The kinetic profiles of conjugated dienes analysis showed a strong inhibitory effect on low‐density lipoproteins oxidation of all tested powders, with unfermented flours displaying the best antioxidant activity. Among bean powders, unfermented and fermented LJ showed the highest polyphenols level (4.21 ± 0.18 and 4.96 ± 0.15 mg GAE/g dw, respectively), oxygen radical absorbance capacity (ORAC) values (24.17 ± 0.14 and 24.02 ± 0.93 µmol TE/100g dw, respectively) and cellular antioxidant activity (71.6 ± 7.05 and 62.7 ± 3.3 units, respectively). Finally, since fermentation drastically reduces phytic acid content while preserving αAI activity, fermented LJ represents an important natural slimming supplement.
In Vitro Bioaccessibility of Low‐Crystallinity Phytosterol Nanoparticles Generated Using Nanoporous Starch Bioaerogels
Authors: Ubeyitogullari Ali , Moreau Régis , Rose Devin J. , Ciftci Ozan N.
Published: June 2019

Phytosterols are natural health‐promoting bioactive compounds; however, phytosterols have very limited bioavailability due to their crystalline lipophilic structure. With the aim of improving bioaccessibility, low‐crystallinity phytosterol nanoparticles were generated by supercritical carbon dioxide (SC‐CO2) impregnation of phytosterols into nanoporous starch aerogels (NSAs). The in vitro bioaccessibility of the phytosterol nanoparticles (35%) was significantly higher than that of the crude phytosterols (3%) after sequential oral, gastric, and intestinal digestion. The percentages of starch hydrolysis were not different among the various NSA preparations and reached to 64% after sequential digestion. The zeta potential of the phytosterol nanoparticles was higher compared to that of crude phytosterols in the micellar phase; indicating higher stability. The findings of this study support the use of NSA to produce nanoparticles of reduced crystallinity to improve the bioaccessibility of the lipophilic bioactive compounds.

Practical Applications

This novel process can decrease the size and crystallinity of phytosterols and thus improve phytosterols’ bioavailability. It is a blueprint to apply to other water insoluble food bioactives. This novel approach may (i) improve the health benefits of water‐insoluble bioactives; (ii) enable food manufacturers to add water‐insoluble bioactives into low‐ and high‐fat foods to produce health‐promoting foods; and (iii) enhance the cost‐benefit ratio of water insoluble bioactives.
Comparison of Physicochemical Characteristics of Garlic Produced from South Korea and China
Authors: Ahn Su‐Jin , Lee Ayoung , Min Seung‐sik , In Sangwhan , Kim Eunmi , Kim Hyung Joo
Published: June 2019

Garlic is widely cultivated and frequently used as a spice in South Korea, due to its characteristic flavor. It is rich in sulfur‐containing compounds (for example, allicin) and nonsulfur elements (for example, phosphorus and potassium). During the last few years, the cultivation area of garlic in South Korea has gradually decreased, one of the reasons being the increase in low‐priced imported garlic from China. Several studies have reported the discrimination of foods originating from different geographical areas by analyzing their physicochemical properties using various statistical methods. In this study, the differentiation of geographical origin of garlic between South Korea (60 samples) and China (41 samples) was performed by analyzing their physicochemical properties (for example, pH, soluble solid, moisture, free sugars, mineral elements, total flavonoid, and total phenolic contents) combined with statistical methods. The significant difference between domestic garlic from South Korea and imported garlic from China was investigated in terms of pH, moisture content, total flavonoid content, and all trace minerals except for manganese and magnesium. Logistic regression analysis was performed to determine the geographical origin (South Korea or China) of garlic after selecting the appropriate independent variables. As a result, the calculated logistic regression equation from the analysis of copper, iron, phosphorus, zinc, and sucrose contents could be used to determine whether the geographical origin of garlic was South Korea or China.

Practical Application

Despite being widely used in South Korea, the cultivation area of garlic in South Korea has gradually decreased over the last few years. One of the reasons is the increase in low‐priced imported garlic from China. To discriminate the geographical origin of garlic between South Korea and China, analyzed physicochemical properties (that is, Cu, Fe, P, Zn, and sucrose contents) of garlic in combination with logistic regression analysis can be helpful for scientists working on food forensics. This discrimination technique can help to maintain the quality of garlic and prevent economic fraud by confirming the authenticity of garlic from South Korea.
Integrated Use of Conventional Chest Radiography Cannot Rule Out Acute Aortic Syndromes in Emergency Department Patients at Low Clinical Probability
Authors: Nazerian Peiman , Pivetta Emanuele , Veglia Simona , Cavigli Edoardo , Mueller Christian , de Matos Soeiro Alexandre , Leidel Bernd A. , Lupia Enrico , Rutigliano Claudia , Wussler Desiree , Grifoni Stefano , Morello Fulvio ,   on behalf of the ADvISED Investigators
Published: June 2019

Objectives

Guidelines recommend chest radiography (CR) in the workup of suspected acute aortic syndromes (AASs) if the pretest clinical probability is low. However, the diagnostic impact of CR integration for the rule‐in and rule‐out of AASs is unknown.

Methods

We performed a secondary analysis of the ADvISED multicenter study. Emergency department outpatients were eligible if an AAS was clinically suspected. Clinical probability was defined with the aortic dissection detection risk score (ADD‐RS). CR was evaluated blindly by a radiologist, who judged on mediastinum enlargement (ME) and other signs.

Results

In 2014 through 2016, a total of 1,129 patients were enrolled and 1,030 were analyzed, including 48 (4.7%) with AASs. ADD‐RS/ME and ADD‐RS/any CR sign (aCRs) integration were more accurate than ADD‐RS alone (area under the curve = 0.8 and 0.78 vs. 0.66, p < 0.001). The sensitivity and specificity of the integrated strategies were 66.7% (95% confidence interval [CI] = 51.5% to 79.9%) and 82.5% (95% CI = 79.9% to 84.8%) for ADD‐RS/ME and 68.8% (95% CI = 53.6% to 80.9%) and 76.5% (95% CI = 73.7% to 79.1%) for ADD‐RS/aCRs, respectively. The sensitivity and specificity of CR per se were 54.2% (95% CI = 39.2% to 68.6%) and 92.4% (95% CI = 90.5% to 93.9%) for ME and 60.4% (95% CI = 45.3% to 74.2%) and 85.2% (95% CI = 82.9% to 87.4%) for aCRs. The agreement (κ) between attending physicians and radiologists for ME was 0.44 (95% CI = 0.35 to 0.54). ADD‐RS/ME rule‐in (ADD‐RS ≤ 1 and ME‐present, or ADD‐RS > 1) applied to 204 versus 130 patients with ADD‐RS > 1, including 14 with AAS and 60 false‐positives (FP). ADD‐RS/aCRs rule‐in (ADD‐RS ≤ 1 and aCRs‐present, or ADD‐RS > 1) applied to 264 patients, including 15 with AAS and 119 FP. ADD‐RS/ME rule‐out (ADD‐RS ≤ 1 and ME‐absent) applied to 826 (80.2%) patients, including 16 with AAS (33.3% of cases). ADD‐RS/aCRs rule‐out (ADD‐RS ≤ 1 and aCRs‐absent) applied to 766 patients (74.4%), including 15 with AAS (31.3% of cases).

Conclusions

CR integration with clinical probability assessment showed modest rule‐in efficiency and insufficient sensitivity for conclusive rule‐out.
A systematic review and meta‐analysis of clinical predictors of lithium response in bipolar disorder
Authors: Hui T. P. , Kandola A. , Shen L. , Lewis G. , Osborn D. P. J. , Geddes J. R. , Hayes J. F.
Published: June 2019

Objective

To determine clinical predictors of lithium response in bipolar disorder.

Methods

Systematic review of studies examining clinical predictors of lithium response was conducted. Meta‐analyses were performed when ≥2 studies examined the same potential predictor.

Results

A total of 71 studies, including over 12 000 patients, identified six predictors of good response: mania‐depression‐interval sequence [odds ratio (OR): 4.27; 95% CI: 2.61, 6.97; P < 0.001], absence of rapid cycling (OR for rapid cycling: 0.30; 95% CI: 0.17, 0.53; P < 0.001), absence of psychotic symptoms (OR for psychotic symptoms: 0.52; 95% CI: 0.34, 0.79; P = 0.002), family history of bipolar disorder (OR: 1.61; 95% CI: 1.03, 2.52; P = 0.036), shorter prelithium illness duration [standardised mean difference (SMD): −0.26; 95% CI: −0.41, −0.12; P < 0.001] and later age of onset (SMD: 0.17; 95% CI: 0.02, 0.36; P = 0.029). Additionally, higher body mass index was associated with poor response in two studies (SMD: −0.61; 95% CI: −0.90, −0.32; P < 0.001). There was weak evidence for number of episodes prior to lithium treatment (SMD: −0.42; 95% CI: −0.84, −0.01; P = 0.046), number of hospitalisations before lithium (SMD: −0.40; 95% CI: −0.81, 0.01; P = 0.055) and family history of lithium response (OR: 10.28; 95% CI: 0.66, 161.26; P = 0.097).

Conclusions

The relative importance of these clinical characteristics should be interpreted with caution because of potential biases and confounding.
Adverse events reported for Mirena levonorgestrel‐releasing intrauterine device in France and impact of media coverage
Authors: Langlade Claire , Gouverneur Amandine , Bosco‐Lévy Pauline , Gouraud Aurore , Pérault‐Pochat Marie‐Christine , Béné Johana , Miremont‐Salamé Ghada , Pariente Antoine ,   for the French Network of Pharmacovigilance Centres
Published: June 2019

Aims

In 2017, concerns regarding adverse events (AEs) associated with the Mirena levonorgestrel intrauterine device were largely echoed in the media in France. This resulted in a tremendous reporting of AEs to pharmacovigilance centres. The aim of this study was to describe the reporting of AEs regarding Mirena in France and to study the impact of media coverage on this reporting.

Methods

All cases reports involving Mirena recorded in the French national pharmacovigilance database from marketing (21 July 1995) until 04 August 2017 were extracted. To allow studying the influence of mediatisation, reports were described separately for the periods preceding and following the observed media coverage peak (15 May 2017).

Results

Overall, 3224 reports were considered, 510 (15.8%) recorded before the media coverage peak, and 2714 (84.2%) after. Before the peak, 76.5% of reports originated from health professionals; median time‐to‐report was of 5.5 months (interquartile range: 1.7–18.6), and median number of AEs per report was 1 (range: 1–17). After the peak, 98.6% originated from patients; median time‐to‐report was 21 months (interquartile range: 8.1–45.5), and median number of AEs per report was 6 (range: 1–37). After the peak, most reports mentioned anxio‐depressive disorders (38.8 vs 10.6% before) or sexual disorders (47.3 vs 6.9%). Other emphasised AEs were weight increase (42.3 vs 10.2%) and pain (gastrointestinal, 19.1 vs 3.5%; musculoskeletal, 22.2 vs 4.5%).

Conclusion

This study highlighted the importance of mediatisation impact on spontaneous reporting with changes concerning amounts of reports, type of reporter, and type of reported AEs. For Mirena, this led to generate signals regarding anxio‐depressive and sexual disorders.
Appropriateness of prescription of oral anticoagulant therapy in acutely hospitalized older people with atrial fibrillation. Secondary analysis of the SIM‐AF cluster randomized clinical trial
Authors: Antoniazzi Stefania , Ardoino Ilaria , Proietti Marco , Monzani Valter , Mannucci Pier Mannuccio , Nobili Alessandro , Franchi Carlotta ,   on behalf of SIM‐AF Collaborators
Published: June 2019

Aims

To assess the appropriateness of oral anticoagulant (OAC) prescription and its associated factors in acutely hospitalized elderly patients.

Methods

Data were obtained from the prospective phase of SIM‐AF (SIMulation‐based technologies to improve the appropriate use of oral anticoagulants in hospitalized elderly patients with Atrial Fibrillation) randomized controlled trial, aimed to test whether an educational intervention improved OAC prescription, compared to current clinical practice, in internal medicine wards. In this secondary analysis, appropriateness of OAC prescription was assessed at hospital admission and discharge.

Results

For 246 patients, no significant differences were found between arms (odds ratio 1.38, 95% confidence interval [CI] 0.84–2.28) in terms of appropriateness of OAC prescription. Globally, 92 patients (37.4%, 95% CI = 31.6–43.6%) were inappropriately prescribed or not prescribed at hospital discharge. Among 51 patients inappropriately prescribed, 82% showed errors on dosage, being mainly under‐dosed (n = 29, 56.9%), and among 41 inappropriately not prescribed, 98% were taking an antiplatelet drug. Factors independently associated with a lower probability of appropriateness at discharge were those related to a higher risk of bleeding (older age, higher levels of aspartate aminotransferase, history of falls, alcohol consumption) and antiplatelet prescription at admission. The prescription of OACs at admission was the strongest predictor of appropriateness at discharge (odds ratio = 7.43, 95% CI = 4.04–13.73).

Conclusions

A high proportion of hospitalized older patients with AF remains inappropriately prescribed or nonprescribed with OACs. The management of these patients at hospital admission is the strongest predictor of prescription appropriateness at discharge.
Current status of artificial intelligence applications in urology and their potential to influence clinical practice
Authors: Chen Jian , Remulla Daphne , Nguyen Jessica H. , Dua Aastha , Liu Yan , Dasgupta Prokar , Hung Andrew J.
Published: June 2019

Objective

To investigate the applications of artificial intelligence (AI) in diagnosis, treatment and outcome predictionin urologic diseases and evaluate its advantages over traditional models and methods.

Materials and methods

A literature search was performed after PROSPERO registration (CRD42018103701) and in compliance with Preferred Reported Items for Systematic Reviews and Meta‐Analyses (PRISMA) methods. Articles between 1994 and 2018 using the search terms “urology”, “artificial intelligence”, “machine learning” were included and categorized by the application of AI in urology. Review articles, editorial comments, articles with no full‐text access, and nonurologic studies were excluded.

Results

Initial search yielded 231 articles, but after excluding duplicates and following full‐text review and examination of article references, only 111 articles were included in the final analysis. AI applications in urology include: utilizing radiomic imaging or ultrasonic echo data to improve or automate cancer detection or outcome prediction, utilizing digitized tissue specimen images to automate detection of cancer on pathology slides, and combining patient clinical data, biomarkers, or gene expression to assist disease diagnosis or outcome prediction. Some studies employed AI to plan brachytherapy and radiation treatments while others used video based or robotic automated performance metrics to objectively evaluate surgical skill. Compared to conventional statistical analysis, 71.8% of studies concluded that AI is superior in diagnosis and outcome prediction.

Conclusion

AI has been widely adopted in urology. Compared to conventional statistics AI approaches are more accurate in prediction and more explorative for analyzing large data cohorts. With an increasing library of patient data accessible to clinicians, AI may help facilitate evidence‐based and individualized patient care.
Peri‐implant alveolar bone resorption in an innovative peri‐implantitis murine model: Effect of implant surface and onset of infection
Authors: Varon‐Shahar Einat , Shusterman Ariel , Piattelli Adriano , Iezzi Giovanna , Weiss Ervin I. , Houri‐Haddad Yael
Published: June 2019

Purpose

To compare the difference in alveolar bone resorption around implants after immediate placement in a bacterial induced experimental periimplantitis murine model. The various conditions that were examined were: Effect of implant surface characteristics and the onset of the induced infection.

Materials and Methods

Screw‐shaped titanium implants, smooth‐surface or sand‐blasted large‐grit acid‐etched (SLA) coated, were inserted immediately after extraction of the first upper left molar, in 90 5‐6‐week‐old BALB/c mice. The mice were infected with Porphyromonas gingivalis and Fusobacterium nucleatum 21 (early infection) or 42 days (delayed infection) after implantation. Six weeks post infection, bone volume around inserted implants was measured using micro‐CT, and was compared to alveolar bone level around teeth. Histological analysis was also performed.

Results

The level of bone loss was significantly higher around the implants compared to the teeth, for smooth surface implants the bone loss was higher than of the SLA surface in both control and infected groups with no statistical significance. The survival rate of the implants in immediate infection was 75% compared of the 100% survival of the delayed infection and control mice. There is no significant difference between the early and the delayed infection in alveolar bone loss level around the implants.

Conclusions

This model can assist in studying the differences in alveolar bone resorption in different implants and their effect on the development of the disease.
Incisional hernia and enterocutaneous fistula in patients with chronic intestinal failure: prevalence and risk factors in a cohort of patients referred to a tertiary centre
Authors: Hodgkinson J. D. , Oke S. M. , Warusavitarne J. , Hanna G. B. , Gabe S. M. , Vaizey C. J.
Published: June 2019

Aim

This study aims to determine the prevalence of incisional hernia (IH) and enterocutaneous fistula (ECF) in patients with intestinal failure (IF) referred to a tertiary centre and to identify factors associated with their development.

Method

A retrospective case note review was undertaken of a prospectively maintained database of all patients on home parenteral nutrition between 2011 and 2016 at a UK tertiary referral centre for IF. Risk factors were identified using binary logistic regression.

Results

The database search identified 447 patients, of whom 349 (78.1%) had surgery prior to developing IF. Eighty‐one (23.2%) patients had an IH and 123 (35.2%) had an ECF at the time of referral. Of these, 51 (14.6%) had both IH and ECF. IH was associated with a high body mass index (P = 0.05), a history of a major surgical complication resulting in IF (P = 0.01), previous emergency surgery (P = 0.04), increasing number of operations (P = 0.02) and surgical site infection (SSI; P = 0.01). ECF was associated with complications relating to earlier surgery. (P ≤ .001), previous treatment with an open abdomen (P = 0.03), SSI (P = 0.001), intra‐abdominal collection (P ≤ 0.001) and anastomotic leak (P = 0.02).

Conclusion

In this series, patients with IF had a prevalence of IH which was more than double that expected following elective laparotomy (about 10%) and one in three had an ECF. Risk factors for IH and ECF are discussed.
The prevalence, characteristics and effectiveness of Aichi Target 11′s “other effective area‐based conservation measures” (OECMs) in Key Biodiversity Areas
Authors: Donald Paul F. , Buchanan Graeme M. , Balmford Andrew , Bingham Heather , Couturier Andrew R. , de la Rosa Gregorio E. , Gacheru Paul , Herzog Sebastian K. , Jathar Girish , Kingston Naomi , Marnewick Daniel , Maurer Golo , Reaney Leeann , Shmygaleva Tatyana , Sklyarenko Sergey , Stevens Candice M.D. , Butchart Stuart H.M.
Published: June 2019

Aichi Target 11 of the CBD Strategic Plan for Biodiversity commits countries to the effective conservation of areas of importance for biodiversity, through protected areas and “other effective area‐based conservation measures” (OECMs). However, the prevalence and characteristics of OECMs are poorly known, particularly in sites of importance for biodiversity. We assess the prevalence of potential OECMs in 740 terrestrial Key Biodiversity Areas (KBAs) outside known or mapped protected areas across ten countries. A majority of unprotected KBAs (76.5%) were at least partly covered by one or more potential OECMs. The conservation of ecosystem services or biodiversity was a stated management aim in 73% of these OECMs. Local or central government bodies managed the highest number of potential OECMs, followed by local and indigenous communities and private landowners. There was no difference between unprotected KBAs with or without OECMs in forest loss or in a number of state‐pressure‐response metrics.
Cervical cytology in a woman with abdominal distension
Authors: Virk Harpreet , Gupta Parikshaa , Rai Bhavana , Rajwanshi Arvind
Published: June 2019

Exfoliated tumour cells from extra‐uterine origin are rarely identified in the cervical samples, however, may represent the first manifestation of an underlying malignancy. The present case describes the distinctive cytomorphologic features of a low‐grade ovarian serous carcinoma metastasising to the cervix.
Non‐cellular elements in a bronchoalveolar lavage cytology from an immuno‐depressed patient
Authors: Martínez‐Girón Rafael , Martínez‐Torre Cristina
Published: June 2019

A 53‐year‐old immunodepressed patient, who is being treated for acute leukaemia diagnosed 8 months ago, presented to the hospital with chest pain, non‐productive coughing and mild dyspnoea. The radiographic image showed some areas of bilateral infiltrates and small consolidations. Following suspicion of a pulmonary infection in an immunodepressed patient, a BAL was performed.
Deroofing followed by thorough sinus tract excision: a modified surgical approach for hidradenitis suppurativa
Authors: Dahmen Robert Artur , Gkalpakiotis Spyridon , Mardesicova Libuse , Arenberger Petr , Arenbergerova Monika
Published: June 2019

Background and objectives

Deroofing has proven to be an effective method to treat mild to moderate forms of hidradenitis suppurativa (HS). The basic procedure includes removal of the sinus roof, followed by secondary intention healing, while fibrotic tissue usually stays in situ. We have tried to establish a modified method of deroofing in which meticulous removal of the fibrotic tissue results in a low recurrence rate in moderate to severe HS patients.

Patients and methods

An open prospective study consisted of 96 deroofed lesions in 52 consecutive patients with moderate to severe HS. Patients were followed up for a minimum of 28 months.

Results

Recurrence occurred after a median time of 2.3 months in 14 % of locations. Recurrences according to location were as follows: 6 % in the axillary region and 25 % in the inguinal region. Postoperative bleeding was the only considerable complication and occurred in 7 % of treated locations. Seven patients were lost to follow‐up.

Conclusion

Modified deroofing followed by meticulous sinus tract removal is a surgical approach suitable for patients with moderate disease, especially in the axillary region. This results in a low recurrence rate and the same healing period as that of the standard deroofing procedure.
Basal ganglia contributions during the learning of a visuomotor rotation: Effect of dopamine, deep brain stimulation and reinforcement
Authors: Singh Puneet , Lenka Abhishek , Stezin Albert , Jhunjhunwala Ketan , Pal Pramod Kumar , Ghosal Ashitava , Murthy Aditya
Published: June 2019

It is commonly thought that visuomotor adaptation is mediated by the cerebellum while reinforcement learning is mediated by the basal ganglia. In contrast to this strict dichotomy, we demonstrate a role for the basal ganglia in visuomotor adaptation (error‐based motor learning) in patients with Parkinson's disease (PD) by comparing the degree of motor learning in the presence and absence of dopamine medication. We further show similar modulation of learning rates in the presence and absence of subthalamic deep brain stimulation. We also report that reinforcement is an essential component of visuomotor adaptation by demonstrating the lack of motor learning in patients with PD during the ON‐dopamine state relative to the OFF‐dopamine state in the absence of a reinforcement signal. Taken together, these results raise the possibility that the basal ganglia modulate the gain of visuomotor adaptation based on the reinforcement received at the end of the trial.