bluuebunny/crossref_metadata_2025 huggingface dataset:
Staff support procedures in a low-secure forensic service
Authors: Cooper Sarah , Inett Andy Colin
Published: February 2018

Purpose

Staff working in forensic inpatient settings are at increased risk of harm perpetrated by patients. Support offered in response to such incidents can have a significant impact on how staff recover. The purpose of this paper is to explore how staff support procedures implemented in one low-secure forensic service impacted on staff recovery.

Design/methodology/approach

In total, 11 members of staff who had direct patient contact volunteered from an opportunity sample. Semi-structured interviews were conducted with each participant, asking about experiences of abuse at work and subsequent staff support procedures. Interviews were analysed using thematic analysis.

Findings

Four overarching themes were identified; experiences of harm, supported recovery, missed opportunities and therapeutic relationships. This led to a better understanding of how staff coped with incidents of abuse at work and how support procedures impacted on their recovery.

Research limitations/implications

The service evaluation was limited by transferability of the findings. The process of sampling may have meant there were biases in those who volunteered to take part. Further projects such as this are required to develop the themes identified.

Practical implications

Findings led to the development of a new integrated model of staff support.

Originality/value

This was one of the first studies in the UK to formally evaluate a staff support procedure in forensic low-secure services and include experiences of both clinical and non-clinical staff who are regularly exposed to potentially harmful events.
Does intention translate into action? Investigating the impact of loyalty intention on future usage
Authors: Chatterjee Swagato , Shainesh G. , Sravanan C.N. Sai
Published: February 2018

Purpose

The purpose of the study is to develop a structural and a predictive model of the future purchase behavior of the consumers from value, quality and satisfaction and also finding the role of consumer loyalty in the above-mentioned model.

Design/methodology/approach

Based on survey and purchase data of a sample of 235 respondents, the authors have used structural equation modeling to develop a structural model and three-stage least square regression to develop and validate the predictive model.

Findings

In the structural model, the authors found that perceived service quality and network quality leads to customer satisfaction which also leads to loyalty intentions. However, neither past purchase behavior nor loyalty has significant predictive power to predict future usage. But the interaction effect of loyalty and past purchase predicts future purchase significantly.

Research limitations/implications

The study went beyond structural model and developed a behavioral predictive model which can overcome self-reporting bias. Also, the study focused on the moderating role of loyalty in predicting future purchase quantity, thus contributing toward the theoretical understanding of the effects of loyalty.

Practical implications

Other than providing a forecasting model, the study helps the service managers to understand the importance of the relational constructs than the tangible constructs. Moreover, it also suggests optimally target the big buyers through the loyalty programs to ensure higher future revenues.

Originality/value

The study provides new insight on the impact of loyalty intention of consumer’s purchase behavior and shows the boundary conditions of predictive power of loyalty intention and past purchase on future purchase. Moreover, this is one of the very few studies that have focused on these relationships in Indian context.
Researcher self-care in organizational ethnography
Authors: Vincett Joanne
Published: February 2018

Purpose

The purpose of this paper is to offer practical researcher self-care strategies to prepare for and manage the emotions involved in doing organizational ethnographic research. Institutional ethics policies or research training programs may not provide guidance, yet emotions are an integral part of research, particularly for ethnographers immersed in the field or those working with sensitive topics or vulnerable or marginalized people.

Design/methodology/approach

The paper draws on ethnographic fieldwork over nine months with a voluntary organization in the UK, Yarl’s Wood Befrienders, to explore the experiences and activities of volunteer visitors who offer emotional support to women detained indefinitely in an immigration removal center. The author is a “complete member researcher,” or “at-home ethnographer,” a volunteer visitor and a former detainee.

Findings

The author describes the emotional impact the research personally had on her and shares learning from overcoming “compassion fatigue.” Self-care strategies based on the literature are recommended, such as a researcher self-assessment, identification of the emotional risks of the research, and self-care plan formulated during project planning. Suggested resources and activities to support the well-being of researchers are explored.

Practical implications

This paper provides practical resources for researchers to prepare for and cope with emotional and mental health risks throughout the research process. It builds awareness of safeguarding researchers and supporting them with handling emotional disruptions. Without adequate support, they may be psychologically harmed and lose the potential to critically engage with emotions as data.

Originality/value

The literature on emotions in doing research rarely discusses self-care strategies. This paper offers an actionable plan for researchers to instil emotional and mental well-being into the research design to navigate emotional challenges in the field and build resilience.
Organizational identification and independent sales contractor performance in professional services
Authors: Finch David J. , Abeza Gashaw , O’Reilly Norm , Hillenbrand Carola
Published: February 2018

Purpose

The purpose of this paper is to examine the drivers of independent sales contractor (ISC) performance. As independently contracted sales agents, the ISC model is a growing method of non-permanent employment utilized in many sectors. Specifically, this study seeks to fill a gap in the literature related to the under-researched link between ISCs and organizational identification.

Design/methodology/approach

This study conducts an exploratory, mixed-methods study based on data collected from 189 ISCs from a professional services firm.

Findings

Results demonstrate that outcomes related to sales performance, retention and advocacy are influenced directly and indirectly by organizational identification. It also shows that tangible benefits related to financial and marketing values are the strongest predictors of ISC organizational identification. Intangible dimensions such as value congruence, management trust and embeddedness play a limited role in the model.

Research limitations/implications

Results show that ISC sales performance is enhanced when an ISC views their identity and the identity of the firm as highly interdependent. These findings suggest that organizational identification can be a key performance indicator when evaluating the return on marketing investment for a firm.

Practical implications

This study provides some important guidance to managers responsible for ISCs. First, the study identifies the primary drivers of organizational identification. Specifically, the study demonstrates that financial and marketing benefits are the primary relational antecedents of organizational identification. Both value congruence and operational benefits play relatively minor roles. Similarly, the results show that both organizational identification and historic sales performance are critical predictors of sales performance.

Originality/value

Few researchers have examined the link between ISCs and organizational identification. Organizational identification is of particular importance in the study of ISCs, as they possess the dual identity of an independent agent and that of a sales representative of the firm they are under contract. This study contributes to existing literature by extending previous studies that examine antecedents of sales performance.
Customer value co-creation over the relationship life cycle
Authors: Cambra-Fierro Jesus , Melero-Polo Iguacel , Sese F. Javier
Published: February 2018

Purpose

Drawing from the theory of relationship dynamics, the purpose of this paper is to investigate how the relationship life cycle moderates the link between relationship quality and customer value co-creation. As customer-firm relationships pass through different stages (exploration, buildup, maturity, and decline) characterized by distinct customer behaviors, this study proposes a dynamic conceptual framework.

Design/methodology/approach

A questionnaire was administered in financial services firms. The final valid sample comprised 2,000 individuals. Subjective customer information from the questionnaire was combined with objective data that the financial entity provided.

Findings

The results demonstrate that the relationship life cycle plays a key moderating role, revealing that, in the buildup and maturity stages, the influence of relationship quality on customer value co-creation is stronger than in the decline stage. However, for customers in the exploration stage, relationship quality does not lead to customer value co-creation behaviors.

Practical implications

As customer relationship stages are constantly evolving, this study provides companies with additional interesting tools to personalize business strategies and to adapt marketing investments to the specific situation of customers.

Originality/value

To the authors’ knowledge, this is the first study to consider how the relationship life cycle influences the strength with which relationship quality promotes customer value co-creation.
Ten‐year retrospective clinicohistological study of cutaneous lupus erythematosus in Korea
Authors: Oh Eui Hyun , Kim Eun Jin , Ro Young Suck , Ko Joo Yeon
Published: February 2018

An understanding of the differences in clinical manifestations and laboratory abnormalities between subtypes of cutaneous lupus erythematosus (CLE) is still lacking. The purpose of this study was to analyze demographic, clinical and histological features of CLE according to three main presentation subsets: acute (ACLE), subacute (SCLE) and chronic (CCLE). A 10‐year retrospective analysis was performed on data from patients who were diagnosed with CLE between March 2005 and September 2015 in a Korean tertiary referral dermatology clinic. We compared demographic data and clinical and histological findings between three different CLE groups. An overall sample of 220 patients with CLE consisted of 67 patients with ACLE, 25 patients with SCLE and 135 patients with CCLE. Patients with CCLE regardless of systemic lupus erythematosus (SLE) presence had lower prevalence of anemia, urinary abnormalities and elevated erythrocyte sedimentation rate. Furthermore, CCLE patients who only had skin lesions showed lower female predominance, lower extracutaneous manifestation, fewer laboratory and immunological abnormalities including low antinuclear antibody titers and the lowest positivity for C3, C4 and anti‐dsDNA, anti‐Ro, anti‐Sm and anti‐RNP antibodies, and more prominent perieccrine inflammation and dermal fibrosis in histological findings. Considering distinct cutaneous manifestations of LE, a comprehensive awareness of each CLE subtype is important for achieving a favorable prognosis through appropriate diagnosis and management. This study provides comparative clinical and histological profiles of patients with different CLE subtypes in Korea.
Functional diversity of Collembola is reduced in soils subjected to short‐term, but not long‐term, geothermal warming
Authors: Holmstrup Martin , Ehlers Bodil K. , Slotsbo Stine , Ilieva‐Makulec Krassimira , Sigurdsson Bjarni D. , Leblans Niki I. W. , Ellers Jacintha , Berg Matty P.
Published: February 2018

Human activities have caused global changes of atmospheric chemistry resulting in increased temperature especially in the colder regions of the northern hemisphere. Since warming of the environment can have drastic effects on terrestrial ecosystems it is important to experimentally evaluate the extent of such effects in long‐term field‐based experiments. In this study we make use of both recent (short‐term) and long‐term geothermal warming of Icelandic soils to examine the responses of Collembola, an ecologically important group of soil invertebrates, to warming.

On the basis of metabolic scaling theory, we hypothesized that species of small size would be more successful in warmed soils than species of larger size. Further we expected that top‐soil‐dwelling species would benefit more from warming than deep‐soil‐dwelling species. In order to test these hypotheses we sampled Collembola along replicated gradients of increasing temperature in areas that had been heated for about 6 years and more than 50 years respectively. Collembola were identified to species level, counted and the community‐weighted mean trait scores for six functional and ecological traits were calculated.

Results show that both short‐term and long‐term soil warming caused a shift towards a higher relative abundance of species with small body size. Furthermore, abundance of top‐soil‐dwelling Collembola tended to increase after short‐term warming, but the opposite was observed after long‐term warming.

Using trait‐based diversity indices (FRic and RaoQ), we show that functional richness and diversity of Collembola communities was significantly reduced (almost halved) as a result of short‐term soil warming to about 10°C above normal, but this effect was not detected in plots equally warmed for more than 50 years. This indicates that the functional diversity of Collembola communities have high resilience towards soil warming in a long‐term perspective.

Aplain language summaryis available for this article.
The relative importance of plant intraspecific diversity in structuring arthropod communities: A meta‐analysis
Authors: Koricheva Julia , Hayes Dexter
Published: February 2018

Understanding how plant diversity influences higher trophic levels is important for predicting the consequences of global biodiversity loss. While early studies have focused on the effects of plant species richness, more recently a growing number of experiments have explored the effects of plant intraspecific diversity by manipulating the genotypic richness of plant communities.

By combining 162 estimates of effect size from 60 experimental studies, we examined the effects of plant genotypic richness on arthropods, one of the most diverse and abundant taxa which play a crucial role in many ecosystem processes and services. We have also compared the effects of plant genetic and species diversity on arthropods when both were manipulated within the same study.

Species richness and abundance of most trophic groups of arthropods were higher in genetically diverse plant stands. Interestingly, the effects of plant genetic diversity on natural enemies of herbivores were stronger than the effects of plant genetic diversity on herbivores, suggesting that plant genetic diversity effects on predators might be driven by mechanisms independent of herbivores.

Herbivore and predator abundance increased with plant genetic diversity in studies using wild plants whereas predator abundance was unaffected and herbivore abundance was reduced by crop genetic diversity. Damage by generalist herbivores was reduced by plant genetic diversity whereas damage by specialist herbivores was not affected.

When the effects of plant genetic and species diversity on arthropods were compared within the same study, the magnitude of plant genetic diversity effects was comparable to that of plant species diversity.

Our results suggest that plant genetic diversity has significant effects on the diversity of arthropods across several trophic levels, thus highlighting the importance of maintaining high levels of both plant species and genetic diversity for arthropod conservation. However, the potential of using crop genetic mixtures in agriculture for pest control appears to be limited as even though herbivore abundance was reduced in genetically diverse plots, herbivore damage and predator abundance were not affected by crop genotypic richness.

A plain language summary is available for this article.
Atmospheric nitrogen deposition in terrestrial ecosystems: Its impact on plant communities and consequences across trophic levels
Authors: Stevens Carly J. , David Thomas I. , Storkey Jonathan
Published: February 2018

The global nitrogen cycle has been greatly perturbed by human activities resulting in elevated nitrogen deposition in many parts of the world. The threat nitrogen deposition poses to ecosystem function and biodiversity is increasingly recognised.

In terrestrial systems, impacts on the plant community are mainly through eutrophication and soil acidification. Interactions with secondary environmental drivers such as extreme weather and disease are also key mechanisms.

Impacts on consumers can be caused by changes in the quality or quantity of food as a result of changes in food plant chemistry or species composition, changes in vegetation structure leading to a change in the availability of prey species, nesting sites or cooled microclimates or changes in the phenology of plants leading to causing phenological asynchrony.

Primary consumers have received considerably less research attention than plants but negative impacts have been observed for both folivorous insects and pollinators. Mammal herbivores have received little research attention.

New analysis of changes in plant traits along a gradient of nitrogen deposition in the UK shows that plants pollinated by large bees were negatively associated with N deposition whilst low pH was associated with lower nectar production, reduced occurrence of plants pollinated by long‐tongued insects and a reduction in plants with larger floral units.

Very few studies have investigated the effects on secondary consumers, but those that have suggest that there are likely to be negative impacts.

This review identifies considerable knowledge gaps in the impacts of N deposition on higher tropic levels and highlights that for many groups, knowledge of N deposition impacts is patchy at best. Evidence that has been collected suggests that there are likely to be impacts on primary and secondary consumers making this a priority area for investigation.
Drug‐resistant epilepsy and topiramate: Plasma concentration and frequency of epileptic seizures
Authors: Marques Fabiana Angelo , Albuquerque Nayara Cristina Perez de , Campos Marília Silveira de Almeida , Freitas‐Lima Priscila , Baldoni André Oliveira , Alexandre Júnior Veriano , Sakamoto Américo Ceiki , Oliveira Anderson Rodrigo Moraes de , Pereira Leonardo Régis Leira
Published: February 2018

Topiramate (TPM) is a second‐generation antiepileptic drug (AED), acting on drug‐resistant epilepsy. The aim of the study was to evaluate the influence of the dose, use of other AEDs on TPM plasma concentration (Cp), and frequency of epileptic seizures. A cross‐sectional analytical study was developed with patients aged 18‐60 years, for diagnosis of drug‐resistant epilepsy, using TPM in monotherapy or associated with other AEDs. The following variables were analyzed: age, frequency of epileptic seizures, pharmacotherapeutic regimen with its respective doses, adherence to medication treatment, and adverse events score. Thirty‐seven patients were included, 83.8% of the patients presented Cp below the therapeutic range. Multiple linear regression estimated that the increase of 1.0 mg/kg/d promoted an increase of 0.68 μg/mL in TPMCp, while the use of inducers predicted a reduction of 2.97 μg/mL (P < .001). Multiple Poisson regression predicts that an increase of 1.0 μg/mL in TPMCp decreased the patient's chance of presenting seizures, and patients using AED inducers were about ten times more likely to present seizures than those who do not use (P < .001). In addition, for patients using AED inducers with Cp below the therapeutic range, the mean number of seizures per month was greater than those with Cp within the therapeutic range. The prescribed dose and the use of AED inducers influence Cp of TPM, likewise the low Cp of first‐line AEDs and of the adjuvant in the treatment, TPM, as well as low TPM dose seem to affect the control of epileptic seizures.
ACEM President response: Mandatory misrepresentation
Authors: Judkins Simon
Published: February 2018

With the challenges of modern media, political agendas and the power of special interest and pressure groups, specialist medical colleges increasingly have a significant role to play in health advocacy, and to stand up for human rights.
Beverage intake of Australian children and relationship with intake of fruit, vegetables, milk and body weight at 2, 3.7 and 5 years of age
Authors: Byrne Rebecca , Zhou Yi , Perry Rebecca , Mauch Chelsea , Magarey Anthea
Published: February 2018

Aim

Describe the type and amount of beverages consumed by Australian children at age 2, 3.7 and 5; investigate the longitudinal relationship between intake of sweet beverages with fruits and vegetables or milk/alternatives, and body mass index (BMI) z‐score.

Methods

Mothers in the NOURISH trial completed a single 24‐hour recall of their child's intake, at age 2 (n = 515), 3.7 (n = 426) and 5 (n = 405). Anthropometry was measured by study staff. At each time point, proportion of children consuming at least one beverage on 24‐hour recall from the following groups was determined; essential—cow's milk/alternatives, breast milk; non‐essential—formula, sweet beverages. For consumers, intake (grams) of each beverage and proportion total estimated energy intake was calculated. The longitudinal relationship between intake of sweet beverages, and fruit and vegetable intake (g/kg body weight), with BMI z‐score at 2, 3.7 and 5 years was examined using structural equation modelling. A second model investigated relationship with intake of milk/alternatives.

Results

Sweet beverages were consumed by 38, 55 and 47% of children at each time point. Intake of sweet beverages strongly correlated between two and five years; however, intake was not associated with BMIz and did not appear to displace fruit and vegetable intake. Intake of cow's milk declined over time and was negatively associated with intake of sweet beverages at two and five years.

Conclusions

Tracking of intake over time supports the notion that children's early experience of sweet tastes is a strong predictor of future intake. Limiting exposure to sweet beverages in early childhood remains an important strategy in the development of healthy food preferences and promotion of dietary quality.
Consumer obfuscation by a multiproduct firm
Authors: Petrikaitė Vaiva
Published: February 2018

This article shows that a multiproduct firm has incentives to obfuscate its products by using search costs to induce consumers to search through its products in a particular order. The consumers who draw high valuations of the first product terminate their search earlier than the consumers who draw low valuations. Thus, the firm has incentives to raise the price of the earlier searched product. The optimal search cost for an obfuscated product is such that consumers inspect the product only if the match values of the previously searched goods have been very poor.
When an Executive Departs: An Informational Content Story
Authors: Nam Seunghan , Ronen Joshua , Ronen Tavy
Published: February 2018

Information about an executive's decisions at his/her former employer can have a significant impact on the stock returns of his/her current employer, even after the job change occurs. In this article, we analyze transfers of information, which, we argue, reflect executive decision‐making ability as executives change jobs. We examine information about restructurings and write‐downs at the new employer emerging after the executive has left an employer that indicates the executive is of lower ability than investors had expected at the time of the hiring. Our results show that such signals are associated with significant negative returns to the current employer's shares, particularly for within‐industry job changes. We distinguish between restructurings at firms with and without departing executives and find that following an executive's departure, firms that had executives depart experience negative market reactions.
On Commitment Toward Knowledge Templates in Global Standard Setting: The Case of the FASB‐IASB Revenue Project
Authors: Baudot Lisa
Published: February 2018

This article explores commitment to knowledge templates, in this case competing measurement models, in global standard‐setting processes. In particular, I examine the positions of board members of the Financial Accounting Standards Board (FASB) and the International Accounting Standards Board (IASB) on a proposal to use fair value accounting in the measurement of revenue. The proposal to measure revenue at fair value was deliberated between 2002 and 2008 as part of the joint revenue project of the FASB and the IASB. I analyze narratives of the board proceedings on the revenue project, which reveal the positions of board members over the life of the proposal. To make sense of these positions, I use Durocher and Gendron's (2014) framework on epistemic commitment, which speaks to one's allegiance to knowledge templates. The analysis shows that individual board member commitment to different knowledge templates is fairly static despite dynamic and contentious debate on this particular proposal. While stable, board member reactions to the proposed shift toward fair value fall into recognizable patterns showing how commitment to different templates entails prioritizing of different core principles and appeals to higher authorities. Finally, the analysis shows how commitment to knowledge templates varies depending on the professional affiliations of board members. For instance, the analysis shows relatively greater consistency of commitment between board members affiliated with academia and corporate preparers than between auditors. Overall, the study indicates the importance of micro‐level features in explaining the development of macro‐level accounting policy. These features are crucial to enhancing our broader understanding of the way in which accounting standards and rules ultimately develop.
A splice site variant in the SUV39H2 gene in Greyhounds with nasal parakeratosis
Authors: Bauer A. , Nimmo J. , Newman R. , Brunner M. , Welle M. M. , Jagannathan V. , Leeb T.
Published: February 2018

Hereditary nasal parakeratosis (HNPK), described in the Labrador Retriever breed, is a monogenic autosomal recessive disorder that causes crusts and fissures on the nasal planum of otherwise healthy dogs. Our group previously showed that this genodermatosis may be caused by a missense variant located in the SUV39H2 gene encoding a histone 3 lysine 9 methyltransferase, a chromatin modifying enzyme with a potential role in keratinocyte differentiation. In the present study, we investigated a litter of Greyhounds in which six out of eight puppies were affected with parakeratotic lesions restricted to the nasal planum. Clinically and histologically, the lesions were comparable to HNPK in Labrador Retrievers. Whole genome sequencing of one affected Greyhound revealed a 4‐bp deletion at the 5′‐end of intron 4 of the SUV39H2 gene that was absent in 188 control dog and three wolf genomes. The variant was predicted to disrupt the 5′‐splice site with subsequent loss of SUV39H2 function. The six affected puppies were homozygous for the variant, whereas the two non‐affected littermates were heterozygous. Genotyping of a larger cohort of Greyhounds revealed that the variant is segregating in the breed and that this breed might benefit from genetic testing to avoid carrier × carrier matings.
Variability of perioperative mortality of hepatic resection in Australia
Authors: Stevens Claire L. , Babidge Wendy J. , Maddern Guy J.
Published: February 2018

Background

Hepatic resection is a relatively young and complex specialized procedure. A strong relationship between volume and perioperative mortality has been reported internationally. However, there has been no multicentre study into hepatic resection in Australia. This retrospective, population‐based cohort study was conducted to determine national, state and territory based volume and perioperative mortality rates (POMRs).

Methods

Australian Institute of Health and Welfare data was interrogated for the Australian Classification of Health Intervention codes for hepatic resection defined as extended hemi‐hepatectomy (30421), hemi‐hepatectomy (30418), segmental hepatic resection (30415) and sub‐segmental hepatic resection (30414). Logistic regression analysis was performed using the de‐identified data to investigate trends and differences between states/territories. Mortality rates were risk adjusted for age, gender and public or private admission. The data set included patients who underwent hepatic resection in the financial years 2005/2006 to 2012/2013.

Results

The overall POMR for all types of hepatic resection was 1.6% (201/12 562). There was no significant change in POMR over time. However, there was significant variation between the states and territories with two states having significantly higher POMR for major hepatic resections (regional range: 1.3–3.8%). POMRs increased with age with the highest mortality seen in the 75–79 year age group. The POMR was lower in private than in public hospitals.

Conclusion

The results of this study confirm that the overall Australian POMR for major hepatic resection is similar to results reported internationally. National and state/territory POMR has not varied significantly over time. The significant variation between states/territories warrants further investigation.
Usefulness of Rapiplug in nipple reconstruction to improve nipple projection
Authors: Lee Joon Seok , Kwon Joon Hyun , Lee Jeong Woo , Choi Kang Young , Chung Ho Yun , Cho Byung Chae , Yang Jung Dug
Published: February 2018

Background

The final stage of breast reconstruction after mastectomy for breast cancer is nipple reconstruction. However, a consistent and reliable method resulting in the most ideal aesthetic results has yet to be clarified. This study analysed the long‐term outcomes of nipple reconstruction using Rapiplug.

Methods

Forty‐one patients who underwent immediate breast reconstruction after mastectomy between January 2014 and February 2017 were enrolled. Nipple reconstruction was performed with C‐V flap and Hammond flap, and hat‐shaped Rapiplug was implanted at the flap core. Nipple projection and width were measured and nipple reduction rates were calculated immediately after and at 3, 6, and 12 months after surgery. Patient satisfaction was surveyed at the 12‐month follow‐up and compared with patient characteristics and other variables.

Results

Forty‐one nipple reconstructions were performed in 41 patients. Most post‐operative adverse events were resolved with conservative management, and revision was performed in only one case. The mean nipple projections were 8.9 ± 1.8, 7 ± 1.8, 5.6 ± 1.6 and 4.9 ± 1.6 mm immediately, and 3, 6 and 12 months after surgery, respectively, and the mean reduction rate of nipple size with reference to the size immediately after surgery was 22.2%, 37.2% and 44.7% at 3, 6 and 12 months after surgery, respectively. Patient satisfaction was 82.9% in overall outcome, and 85.3% of projection was good or excellent.

Conclusion

Rapiplug can improve the long‐term preservation of nipple projection after nipple reconstruction and is considered to be consistent and reliable with good aesthetic outcomes and no severe complications.
Implementing and Assessing a Standardized Protocol for Weaning Children Successfully From Extracorporeal Life Support
Authors: Kubicki Rouven , Höhn René , Grohmann Jochen , Fleck Thilo , Reineker Katja , Kroll Johannes , Siepe Matthias , Benk Christoph , Klemm Rolf , Humburger Frank , Stiller Brigitte
Published: February 2018

Extracorporeal life support (ECLS) weaning is a complex interdisciplinary process with no clear guidelines. To assess ventricular and pulmonary function as well as hemodynamics including end‐organ recovery during ECLS weaning, we developed a standardized weaning protocol. We reviewed our experience 2 years later to assess its feasibility and efficacy. In 2015 we established an inter‐professional, standardized, stepwise protocol for weaning from ECLS. If the patient did not require further surgery, weaning was conducted bedside in the intensive care unit (ICU). Most of the weaning procedures are guided via echocardiography. Data acquisition began at baseline level, followed by four‐step course (each step lasting 10 min), entailing flow‐reduction and ending 30 min after decannulation. Moreover, data from the preprotocol era are presented. Between May 2015 and 2017, 26 consecutive patients (18 male), median age 177 days (2 days–20 years) required ECLS with median support of 4 (2–11) days. Excluding eight not weanable patients, 21 standardized weaning procedures were protocolled in the remaining 18 children. Our generally successful protocol‐guided weaning rate (with at least 24‐h survival) was 89%, with a discharge home rate of 58%. Practical application of the novel standard protocol seems to facilitate ECLS weaning and to improve its success rate. The protocol can be administered as part of standard bedside ICU assessment.
Survey highlights important discrepancies between definitions of paediatric abnormal growth taught to medical students in 23 European countries
Authors: Scherdel Pauline , Hjelm Nils , Salaün Jean‐François ,   the EBGM IV study group, Heude Barbara , Chalumeau Martin
Published: February 2018

Aim

This study compared the definitions of abnormal growth that are taught across Europe to explain previously reported variations in growth‐monitoring practices.

Methods

We developed two online surveys in 2016 to obtain the definitions of abnormal growth in European countries and approached the national chairs of the European Confederation of Primary Care Paediatricians in 18 countries and the International Federation of Medical Students’ Associations in 33 countries.

Results

We obtained definitions from 10 of 18 paediatricians and 18 of 33 students, covering 23 of the 33 European countries surveyed. Abnormal faltering growth was always defined, either by a single parameter (24%) or combined parameters (76%). Four static parameters were used: standardised height (100%), standardised weight (60%), standardised body mass index (12%) and distance to target height (20%). Two dynamic parameters were used: growth deflection (28%) and growth velocity (32%). The thresholds used to define abnormal faltering growth varied slightly in some cases and widely in others. Abnormal accelerated growth appeared in 52% of the definitions, with important variations in parameters and thresholds.

Conclusion

There were important between‐country discrepancies in the definitions of paediatric abnormal growth that were taught in 23 European countries. Standardisation is vital.
Percutaneous endoscopic gastrostomy placement in paediatric Crohn's disease patients contributes to both improved nutrition and growth
Authors: Duncan H , Painesi A , Buchanan E , McGrogan P , Gerasimidis K , Walker G , Haddock G , Russell RK
Published: February 2018

Aim

This paper describes the outcomes of gastrostomy feeding in patients with Crohn's disease (CD).

Methods

Patients with CD who attended the Royal Hospital for Children, Glasgow and received gastrostomy feeding for at least two years between 2003 and 2010 were identified from the clinical database. The data recorded included the anthropometric data, CD phenotype, the surgical technique that was used, complications, medication, feed type, median feed, calories, volume and clinical outcomes.

Results

The study identified 16 patients (14 male) who had a gastrostomy inserted using a pull technique at a median age of 12.6 years. Of these two required laparoscopic placement. Short‐term complications lasting less than one month were experienced by nine (56%) patients and one (6%) experienced long‐term complications. Anthropometry significantly improved at follow‐up compared to baseline: at 12 months, the body mass index z‐score was 1.11 (p = 0.005) and the weight z‐score was 0.19 (p < 0.05). At 24 months, the height z‐score was ‐1.03 (p = 0.04). The daily median volume and calories from feeds increased significantly from baseline to post‐PEG insertion, from 400 to 738 mL and 705 to 860 kcal/day (p ≤ 0.01).

Conclusion

Gastrostomy feeding for paediatric patients with CD was associated with improved nutrition, weight gain and growth outcomes.
Prospective diagnostic study on the use of narrow‐band imaging on suspicious lesions during colonoscopy examination
Authors: Yaacob Huzairi , Ikhwan Sani Mohamad , Hashim Mohd Nizam , Syed Abd Aziz Syed Hassan , Wan Zain Wan Zainira , Tuan Sharif Sharifah Emilia , Hayati Firdaus , Zakaria Andee Dzulkarnaen
Published: February 2018

Introduction

Colonoscopy is the gold standard to detect colorectal neoplasm. Narrow‐band imaging (NBI) has a good diagnostic accuracy to differentiate between neoplastic and non‐neoplastic colorectal lesions. This study explores the diagnostic validity of NBI colonoscopy as well as its associated factors related to neoplastic and non‐neoplastic colorectal lesions.

Methods

This study enrolled 100 patients in a single‐center tertiary teaching hospital. Patients presented for screening colonoscopy, and those with suspicious colorectal lesions were included in this study. During colonoscopy, the most suspicious lesion in each patient was analyzed using the NBI system based on Sano’s classification. Each lesion was biopsied for histopathological analysis, the gold standard. Endoscopic images were captured electronically. The sensitivity, specificity, and diagnostic accuracy of NBI colonoscopy were assessed. Other associated factors related to neoplastic and non‐neoplastic lesions were analyzed accordingly.

Results

The sensitivity and specificity of the NBI were 88.2% and 71.9%, respectively. The area under the receiver–operator curve was 0.801, indicating that NBI has a good ability to differentiate between disease and non‐disease. There are significant associations between histopathological examination outcomes and both presenting symptoms, especially weight loss, and lesion site, even after other variables were controlled (P < 0.05).

Conclusion

The NBI system in colonoscopy was capable of distinguishing neoplastic from non‐neoplastic colorectal lesions. It indicates an acceptable level of agreement with histopathology, the gold standard. However, the role of NBI in screening and surveillance in Malaysia still needs further evaluation and exploration.
Use of trimethoprim–sulfamethoxazole during pregnancy and risk of spontaneous abortion: a nested case control study
Authors: Muanda Flory T. , Sheehy Odile , Bérard Anick
Published: February 2018

Aims

Data available on the fetal safety of trimethoprim–sulfamethoxazole (TMP‐SMX) exposure during pregnancy remains scarce and inconclusive. A previous study assessing the link between TMP‐SMX exposure during pregnancy and the risk of spontaneous abortion (SA) did not control for protopathic bias and indication bias.

Methods

We conducted a nested control study (n = 77 429 pregnancies including 7039 cases of SA and 70 390 controls) within the Quebec Pregnancy Cohort. For each case of SA, we selected 10 controls at the index date that were matched on gestational age and year of pregnancy. TMP‐SMX exposure was defined as either having filled at least one prescription between the first day of gestation (1DG) and the index date, or as having filled a prescription before pregnancy but with a duration overlapping the 1DG (102 pregnancies exposed to TMP‐SMX, including 25 cases of SA and 77 controls).

Results

Adjusting for potential confounders, TMP‐SMX exposure was associated with an increased risk of SA (AOR 2.94, 95% C 1.89–4.57, 25 exposed cases). Similar results were found after controlling for indication bias and protopathic bias.

Conclusion

Given that this drug is widely use in HIV patients to prevent opportunistic infections and malaria, there is an urgent need to identify potential data sources in Africa for analysis of early pregnancy exposure to TMP‐SMX.
Critical GIS: Distinguishing critical theory from critical thinking
Authors: Harvey Francis
Published: February 2018

This viewpoint offers a perspective on how critical GIS and critical GIScience can develop and go further in times of widespread concern and unease around the world. The basis for this is the distinction between critical theory and critical thinking. Revisiting this difference, especially in the many hybrids involving theories and applications with geographic information technologies, is important for thinking and reflecting on broader issues and assuring the integrity of our work.
Life after institutional care: Implications for research and practice
Authors: Diraditsile Kabo , Nyadza Mbongeni
Published: February 2018

This study sought to investigate the lived experiences of care leavers from institutional care facility in Botswana. The study objectives were to explore the challenges faced by children after leaving the institutional care and to identify services that can be offered to them in preparation for life in a society in general. The study adopted a cross‐sectional qualitative research approach, and data were collected through in‐depth interviews that were qualitatively analysed. Thirty participants was sampled, and there were divided into 2 sections comprising care leavers and key informants who were part of the institutional care staff. They were selected using purposive and snowball sampling methods. The findings confirm that institutional care has both positive and negative effects on care leavers in the sense that it provides children with educational opportunities, family, and strong interrelation skills. Furthermore, the study findings show that during children's stay in the institutional care, they are sometimes neglected by housemothers that affect their transition into mainstream society. Moreover, the study findings reveal that care leavers encounter many challenges ranging from finance management to unemployment, discrimination from the society, and poverty. Lastly, future research, policy direction, and implications are discussed.
Manhattan's Koreatown as a Transclave: The Emergence of a New Ethnic Enclave in a Global City
Authors: Kim Jinwon
Published: February 2018

This article critically challenges scholarship on ethnic enclaves, from Chicago School scholars to the ethnic enclave debates of the 1980s and 1990s, and introduces a new type of ethnic enclave in an era of globalization: the “transclave.” By using Manhattan's Koreatown as a case study, I define transclave as a commercialized ethnic space that exists exclusively for consumption, leisure, and entertainment, differentiating itself from traditional ethnic enclaves that offer housing and jobs for newer immigrants. Instead, transclaves are spaces where transnational consumer culture and brands from sending nations are transferred to, negotiated with, and anchored in a geographic space in a global city, and shape the landscape of that space. Based on archival research, in–depth interviews, and participant observation, this article investigates how and why Koreatown serves as an intersection of where Korea's political, economic, and sociocultural influences meet New York City's diverse cosmopolitan mosaic and tourism industry.
New and emerging techniques for endoscopic treatment of Zenker's diverticulum: State‐of‐the‐art review
Authors: Ishaq Sauid , Sultan Haleema , Siau Keith , Kuwai Toshio , Mulder Chris J , Neumann Helmut
Published: February 2018

Zenker's diverticulum (ZD), or pharyngeal pouch, is an anatomical defect characterized by herniation of the posterior pharyngeal wall through Killian's dehiscence, and may result in dysphagia and regurgitation. Multiple therapeutic modalities including surgery, rigid and flexible endoscopy have been developed to manage ZD. Although surgical management with open and endoscopically assisted techniques have historically been the mainstay of ZD treatment, minimally invasive flexible endoscopic techniques, carried out under conscious sedation, are increasingly favored. Over the last two decades, the advent of new accessories and techniques have changed the landscape of endotherapy for ZD, with the current armamentarium including, but not limited to, endoscopic stapling, CO2 laser, argon plasma coagulation, needle knife, bipolar forceps, hook knife, clutch cutter, stag beetle knife, and submucosal tunneling endoscopic septum division. We hereby review the latest evidence to support the endoscopic management of ZD.
Efficacy of traction‐assisted colorectal endoscopic submucosal dissection using a clip‐and‐thread technique: A prospective randomized study
Authors: Yamasaki Yasushi , Takeuchi Yoji , Uedo Noriya , Kanesaka Takashi , Kato Minoru , Hamada Kenta , Tonai Yusuke , Matsuura Noriko , Akasaka Tomofumi , Hanaoka Noboru , Higashino Koji , Ishihara Ryu , Okada Hiroyuki , Iishi Hiroyasu
Published: February 2018

Background and Aim

Colorectal endoscopic submucosal dissection (ESD) remains challenging because of technical difficulties, long procedure time, and high risk of adverse events. To facilitate colorectal ESD, we developed traction‐assisted colorectal ESD using a clip and thread (TAC‐ESD) and conducted a randomized controlled trial to evaluate its efficacy.

Methods

Patients with superficial colorectal neoplasms (SCN) ≥20 mm were enrolled and randomly assigned to the conventional‐ESD group or to the TAC‐ESD group. SCN ≤50 mm were treated by two intermediates, and SCN >50 mm were treated by two experts. Primary endpoint was procedure time. Secondary endpoints were TAC‐ESD success rate (sustained application of the clip and thread until the end of the procedure), self‐completion rate by the intermediates, and adverse events.

Results

Altogether, 42 SCN were analyzed in each ESD group (conventional and TAC). Procedure time (median [range]) for the TAC‐ESD group was significantly shorter than that for the conventional‐ESD group (40 [11–86] min vs 70 [30–180] min, respectively; P < 0.0001). Success rate of TAC‐ESD was 95% (40/42). The intermediates’ self‐completion rate was significantly higher for the TAC‐ESD group than for the conventional‐ESD group (100% [39/39] vs 90% [36/40], respectively; P = 0.04). Adverse events included one intraoperative perforation in the conventional‐ESD group and one delayed perforation in the TAC‐ESD group.

Conclusion

Traction‐assisted colorectal endoscopic submucosal dissection reduced the procedure time and increased the self‐completion rate by the intermediates (UMIN000018612).