bluuebunny/crossref_metadata_2025 huggingface dataset:
Do expansionary and contractionary monetary policy have a symmetric impact on housing permits across the USA?
Authors: Bahaman-Oskooee Mohsen , Ghodsi Hesam , Hadzic Muris , Marfatia Hardik
Published: April 2023

Purpose

The purpose of this paper is to assess the possibility of asymmetric impact of monetary policy on housing permits issued in each state of the USA.

Design/methodology/approach

The methodology and approach are based on the linear ARDL and nonlinear ARDL approach to error-correction modeling and asymmetric cointegration.

Findings

The linear models predict that money supply impact housing permits in 28 states in the short run and only nine states in the long run. However, the asymmetric effects are far more pervasive, highlighting the restrictive nature of the linear model. The results from the nonlinear model show at least one lag of positive and/or negative changes in money supply significantly impacts housing permits in nearly all states. Even in the long run, housing permits in 32 states share a long-run relationship with positive and/or negative changes in money supply. The authors also find contractionary monetary policy has a greater influence on housing permits in most states compared to expansionary policy.

Originality/value

For the first time, the authors use state-level data and asymmetric approach to assess the impact of monetary policy on house permits issued in each state of the USA.
Different shades of learning after entrepreneurial failure among Ghanaian micro women entrepreneurs
Authors: Quagrainie Fanny Adams , Dankwa Ama Abakoma
Published: April 2023

Purpose

The purpose of this paper is to explore the learning effects of entrepreneurial failure (EF) among micro-women entrepreneurship in Accra.

Design/methodology/approach

Using a qualitative research method, purposive sampling was used to identify 64 micro-women entrepreneurs, and data was collected using interviews.

Findings

Linked to the experiential learning theory, the study found that consequences of EF provide an entrepreneurial learning platform that influences micro-women entrepreneurs to acquire new skills and knowledge for their entrepreneurial development, incurred costs that negatively affect operations, acquired no knowledge or take a decision to opt-out of entrepreneurship as a carrier.

Research limitations/implications

The study was based on a relatively small sample size of 64 participants which made it difficult to generalize the findings despite the benefits of the research methods adopted in the study.

Originality/value

The study contributed to the EF literature with micro-women entrepreneurs in an African context. It highlights the possible additional learning consequences of EF which are being scared of entrepreneurial venturing as a result of their failure. This negatively impacts the desire to engage in entrepreneurship as a future career. The identification of irrelevant learning consequences of EF, suggests that the existing experiential learning theory may need to be revised to further enhance its applicability in micro-women entrepreneurship in different cultural contexts, as not all experiences result in learning.
Artificial intelligence service agents: a silver lining in rural India
Authors: Ravi Hariharan , Vedapradha R.
Published: April 2023

Purpose

The study aims to examine the impact of an artificial intelligent service agent (AISA) on customer services to the rural population provided by KAYA, Kotak Life's AI-enabled insurance chatbot avatar that offers quality insurance services.

Design/methodology/approach

Multi-stage cluster sampling method was adopted to collect the responses from the 707 customers across the rural population of southern states of India. SPSS V.2 and Smart PLS 4 were used to apply simple percentage analysis, multiple linear regression analysis, and structural equation modeling (SEM) to validate the hypothesis. The dependent variables are economic performance and market performance based on the independent variables: efficiency, security, availability, enjoyment and contact.

Findings

The study revealed that efficiency and security are the highest predictors and the most influencing variables in predicting the economic and market performance of the insurance companies in determining the quality of service when rendered through AISA among the customers. Efficiency, security, availability, contact and enjoyment are the critical dimensions of AISA. It has a more significant impact on quality service (claim processing) to the rural population. It improves the economic and market performance among the insurance companies and the rural population.

Originality/value

Customers need convenience when making claims. Even little challenges might lead to stress and unhappiness, depending on the situation. Restrictions on where customers can file claims may not be the most outstanding service insurance firms can offer, given rising travel and commuting costs and widening geographical borders. Customers value proactive communication from service providers about the status of their insurance claims.
Spatial correlation and influencing factors of the urban land transaction market in the Yangtze River Delta urban agglomeration
Authors: Jiang Changjun
Published: April 2023

Purpose

Land transactions are a key indicator of urban sustainable development and urban space expansion. Therefore, this paper aims to study the spatial correlation of different types of land transactions.

Design/methodology/approach

Based on the big data of land micro transactions in Yangtze River Delta urban agglomeration, this paper uses the generalized forecast error variance decomposition (GFEVD) method to measure the correlation level of urban land markets. Also, social network analysis (SNA) is used to describe spatial correlation network characteristics of an urban agglomeration land market. In the meantime, the factors that influence the spatial correlation of urban land markets are investigated through a quadratic assignment procedure (QAP).

Findings

The price growth rate of urban residential land was higher than that of industrial land and commercial land. The spatial relevance of urban residential land is the highest, while the spatial relevance of the urban commercial land market is the lowest. The urban industrial land market, commercial land market and residential land market all present a typical network structure. Population distance (POD) and Engel coefficient distance (EGD) are negatively correlated with the correlation degree of the urban residential land network; traffic distance (TRD) and economic distance (ECD) are negatively correlated with the correlation degree of the urban industrial land network and commercial land network.

Originality/value

This paper uses a systematically-integrated series of problem-solving models to better explain the development path of urban land markets and to realize the integration of the interdisciplinary methods of geography, statistics and big data analysis.
Physical therapists’ professional role identity in the clinician to leader transition
Authors: Wiedman Christopher
Published: April 2023

Purpose

The purpose of this study is to investigate how physical therapists make meaning of their professional role identity when transitioning from clinician to leadership positions. Despite the importance of professional role identity in the transition from health-care provider to health-care leader, research on this topic in physical therapy remains almost nonexistent.

Design/methodology/approach

A qualitative, phenomenological research approach was used in this study. Data was collected through a three-part, semistructured interview process. An open coding to focused coding process was used to analyze data and develop themes which answered the research question.

Findings

Physical therapists in this study engaged in identity work, making meaning of their professional role identity by referencing a professional role identity focused on more than clinical skills, accepting the role of discomfort, focusing on relationships, exercising agency over the construction of their leader identity, recognizing consistency between clinical and leader roles and establishing a professional role identity informed but no longer bound by their physical therapist identity.

Originality/value

To the best of the author’s knowledge, this study is the first to investigate how physical therapists make meaning of their professional role identity when transitioning into leadership positions. The findings of this study highlight uniquities in the physical therapy professional role identity and the manner in which physical therapists navigate this work role transition.
Behavioral strategy: A systematic literature review and research framework
Authors: Hesselbarth Imke , Alnoor Alhamzah , Tiberius Victor
Published: April 2023

Purpose

Behavioral strategy, as a cognitive- and social-psychological view on strategic management, has gained increased attention. However, its conceptualization is still fuzzy and deserves an in-depth investigation. The authors aim to provide a holistic overview and classification of previous research and identify gaps to be addressed in future research.

Design/methodology/approach

The authors conducted a systematic literature review on behavioral strategy. The final sample includes 46 articles from leading management journals, based on which the authors develop a research framework.

Findings

The results reveal cognition and traits as major internal factors. Besides, organizational and environmental contingencies are major external factors of behavioral strategy.

Originality/value

To the authors’ best knowledge, this is the first holistic systematic literature review on behavioral strategy, which categorizes previous research.
A new broom sweeps clean? Evidence from CEO tenure and global reporting initiative adoption in China
Authors: Hussain Muhammad Jameel , Nie Dongfang , Tian Gaoliang , Ashraf Adnan
Published: April 2023

Purpose

This paper aims to explore the relation between chief executive officer (CEO) tenure and the propensity to adopt the global reporting initiative (GRI) for corporate social responsibility reporting in Chinese firms.

Design/methodology/approach

This study used Chinese A-listed firms as sample during 2010–2020. Considering the binary nature of dependent variable, logistic regression model is applied. For robustness, lagged value of independent and control variables, additional control variables and two stage least square regression are used.

Findings

This paper finds that CEO tenure is negatively related to the adoption of GRI reporting standards. Furthermore, this paper finds that this association is less pronounced when CEOs are female and when CEOs have foreign experience. Furthermore, this paper finds that this association is not significant when CEOs are female and when CEOs have foreign experience. This paper also finds that the relationship between CEO tenure and GRI adoption is more pronounced in state-owned enterprises in China. The findings in this paper are robust after controlling for endogeneity.

Practical implications

The study results are important for understanding the development and implementation of GRI framework especially in China.

Originality/value

To the best of the authors’ knowledge, this is the first study to deeply investigate how CEO tenure can affect adoption of GRI in Chinese firms.
Financial effects of carbon risk and carbon disclosure: A review
Authors: Wang Qingxia (Jenny)
Published: April 2023

Carbon risk has generated significant adverse impacts on firms, investors and other stakeholders. Carbon disclosure may provide market participants with information to effectively manage risks and explore opportunities. We conduct a critical review of the growing literature in these fields and seek to examine the financial effects of carbon risk and carbon disclosure. A total of 78 papers, published in influential accounting, finance, business, economics and management journals between 2011 and 2021, are reviewed. We categorise the financial effects into four groups: financial performance, valuation relevance, cost of capital and risk profiles (measures). The proxies for carbon risk and carbon disclosure are summarised. This review demonstrates inconclusive relationships between carbon risk (carbon disclosure) and firms' financial measures. These inconclusive findings may result from different carbon risk (carbon disclosure) measures, financial performance measures, sample geographies, sizes and periods, and model specifications. This review further identifies and highlights future research opportunities in relevant areas and calls for more research work to understand the influence of climate change on firms' value and activities.
A first impression of the future
Authors: Sutherland Clare A. M. , Young Andrew W.
Published: April 2023

We offer a response to six commentaries on our target article ‘Understanding trait impressions from faces’. A broad consensus emerged with authors emphasizing the importance of increasing the diversity of faces and participants, integrating research on impressions beyond the face, and continuing to develop methods needed for data‐driven approaches. We propose future directions for the field based on these themes.
Human glabrous skin contains crystallized urea dendriform structures in the stratum corneum which affect the hydration levels
Authors: Infante Victor Hugo Pacagnelli , Bennewitz Roland , Kröger Marius , Meinke Martina C. , Darvin Maxim E.
Published: April 2023

Glabrous skin is hair‐free skin with a high density of sweat glands, which is found on the palms, and soles of mammalians, covered with a thick stratum corneum. Dry hands are often an occupational problem which deserves attention from dermatologists. Urea is found in the skin as a component of the natural moisturizing factor and of sweat. We report the discovery of dendrimer structures of crystalized urea in the stratum corneum of palmar glabrous skin using laser scanning microscopy. The chemical and structural nature of the urea crystallites was investigated in vivo by non‐invasive techniques. The relation of crystallization to skin hydration was explored. We analysed the index finger, small finger and tenar palmar area of 18 study participants using non‐invasive optical methods, such as laser scanning microscopy, Raman microspectroscopy and two‐photon tomography. Skin hydration was measured using corneometry. Crystalline urea structures were found in the stratum corneum of about two‐thirds of the participants. Participants with a higher density of crystallized urea structures exhibited a lower skin hydration. The chemical nature and the crystalline structure of the urea were confirmed by Raman microspectroscopy and by second harmonic generated signals in two‐photon tomography. The presence of urea dendrimer crystals in the glabrous skin seems to reduce the water binding capacity leading to dry hands. These findings highlight a new direction in understanding the mechanisms leading to dry hands and open opportunities for the development of better moisturizers and hand disinfection products and for diagnostic of dry skin.
Changes in children's dental fear after restorative treatment under different sedation types: Associations with parents' experiences and dental health
Authors: Heaton Lisa J. , Wallace Erin , Randall Cameron L. , Christiansen Matthew , Seminario Ana Lucia , Kim Amy , McKinney Christy M.
Published: April 2023

Background

Dentists often use sedative medications such as nitrous oxide inhaled sedation and general anesthesia (GA) to help decrease patient fear and manage paediatric patients' behavior during treatment.

Aim

The goal of this study was to examine factors associated with dental fear changes after restorative dental treatment under nitrous oxide or GA in children 4–12 years old.

Design

A prospective cohort study of 124 children examined changes in dental fear, number of treatment visits, and parental factors among children receiving restorative dental treatment under nitrous oxide (n = 68) or GA (n = 56) sedation. Data were collected at pretreatment (T1), 16 weeks post‐treatment (T2), and at 29‐month follow‐up (T3).

Results

Dental fear increased slightly, but not significantly, under both forms of sedation between T1 and T3. Children's dental fear was associated with parents' poor dental experiences and oral health, but not with number of treatment visits.

Conclusions

Progression of children's dental fear seems not dependent solely on the type of sedation used but is likely predicted by factors including pretreatment dental fear and dental needs. Dentists recommending sedation for children's dental care may consider pretreatment dental need, fear levels, and parental factors when determining which type of sedation to use.
Parental beliefs in and attitudes toward teething signs and symptoms: A systematic review
Authors: Pereira Thaís Salles , da Silva Camila Alvarenga , Quirino Emily Caroline Silva , Xavier Junior Gesner Francisco , Takeshita Eliana Mitsue , Oliveira Luciana Butini , De Luca Canto Graziela , Massignan Carla
Published: April 2023

Background

Parents believe that teething is associated with signs and symptoms, which may induce them to give medications that could harm their children. Some children may require alleviation of symptoms and overall attention.

Aim

To assess parents' beliefs in and attitudes toward teething.

Design

Through electronic databases and gray literature, this systematic review identified cross‐sectional studies reporting parents' beliefs in, knowledge about, and attitudes toward the signs and symptoms of primary tooth eruption in children aged between 0 and 36 months. Three reviewers independently selected the studies, collected the information, assessed methodological quality, and checked for accuracy with disagreements solved by a fourth reviewer. The Agency of Research and Quality in Health questionnaire for cross‐sectional studies was used for quality assessment. Descriptive analysis with median and interquartile ranges was adopted.

Results

Twenty‐nine studies comprising 10 524 participants from all geographic regions were included. The methodological quality of the studies was moderate. Most parents have beliefs in signs and symptoms during dentition, the most reported symptom being the desire to bite. Oral rehydration was the most exposed attitude in the studies included. Only a small proportion of parents reported no attitude.

Conclusions

The majority of parents believed in at least one sign or symptom associated with teething, and only few of them would do nothing or just wait for the signs or symptoms to pass, with no difference among countries (Protocol doi: 10.17605/OSF.IO/S2KZ3).
Differential protein expression in endothelial cells exposed to serum from patients with acute graft‐vs‐host disease, depending on steroid response
Authors: Martinez‐Sanchez Julia , Palomo Marta , Pedraza Alexandra , Moreno‐Castaño Ana Belén , Torramade‐Moix Sergi , Rovira Montserrat , Salas María Queralt , Cid Joan , Escolar Gines , Penack Olaf , Carreras Enric , Diaz‐Ricart Maribel
Published: April 2023

Graft‐versus‐host disease (GVHD) is a complication of allogeneic haematopoietic cell transplantation. Endothelial injury is crucial as pathophysiological substrate for GVHD. GVHD first‐line treatment is high‐dose corticosteroids, although some patients are steroid‐refractory. Through the present study, we compared the endothelial proteomic profiles in response to serum from steroid‐refractory acute GVHD (SR‐aGVHD) and steroid‐sensitive acute GVHD (SS‐aGVHD) patients. Blood samples from SR‐aGVHD (n = 4) and SS‐aGVHD (n = 8) patients were collected at aGVHD diagnosis. Endothelial cell cultures were exposed (48 h) to patients' serum. Protein extraction and proteomic analysis were performed. Differences were statistically evaluated by multivariate analysis. Forty‐four proteins contributed to separate all samples into the two study groups, among which 15 participated significantly (p < 0.05), 10 exhibiting a fold change >1.2. Differentially expressed proteins were mainly associated with oxidative phosphorylation (Cytochrome C oxidase subunit 6B1, CX6B1), inflammation and angiogenesis (Apolipoprotein D, APOD), cell survival (Rapamycin‐insensitive companion of mTOR, RICTR), and oxidative stress (Riboflavin kinase, RIFK). This pilot study used a novel approach to distinguish the aGVHD response to steroid treatment. The proteins differentially expressed could constitute potential biomarkers for steroid‐treatment response. These findings signify a step forward to identify the mechanisms of response to steroids, of high clinical relevance considering the SR‐aGVHD elevated mortality.
From Market Liberalism to Public Intervention: Digital Sovereignty and Changing European Union Digital Single Market Governance
Authors: Heidebrecht Sebastian
Published: April 2023

Against the backdrop of the ever‐increasing importance of digital services, the European Union (EU) is promoting deepening of its digital single market (DSM). Whilst the single market has often been portrayed as the Trojan horse of neoliberalism, recent rhetoric on digital sovereignty indicates a desire for more control over the digital sphere. A historical case study of key elements of the DSM, namely digital services regulation and data protection, shows that EU governance has become less market‐liberal and more public‐interventionist. In response to challenges associated with the digital economy, policy goals have been broadened to include further objectives in addition to competitiveness. Stakeholders and public authorities rather than business actors have become more important in governance processes, and more market‐correcting instruments have been introduced. These reforms have been made by adding more interventionist elements and also by redirecting the role of the European Commission to overseeing very large online platforms.
Philosophy and the real reasons for action: G. H. von Wright's understanding explanations
Authors: Ahlskog Jonas
Published: April 2023

According to the received view, philosophy of action took a justified turn towards causalism because anti‐causalists failed the causalist challenge about efficacious reasons. This paper contests that view by examining the ways in which Georg Henrik von Wright responded to causalism in his later philosophy. First, von Wright attacked the subjectivism of causalism by arguing for an objectivist view that construes reasons not as subjective mental states but as external facts of the agent's situation. Second, von Wright fundamentally disagreed with the view of philosophical inquiry that underpinned causalism. For von Wright, the task of philosophy was conceptual: to explicate what one is looking for when one is looking for the real reasons for action. In contrast, for causalists the task was ontological: to determine what kind of item in the world the real reason for action is. Examining von Wright's account contributes to contemporary assessments of the metaphilosophical dimension of the reasons/causes debate.
SPIRITUAL INTELLIGENCE: PROCESSING DIFFERENT INFORMATION OR PROCESSING INFORMATION DIFFERENTLY?
Authors: Dorobantu Marius , Watts Fraser
Published: April 2023

This article introduces the concept of spiritual intelligence in terms of a natural human ability to take a different perspective on reality rather than an extraordinary ability to engage with a different/supernatural reality. From a cognitive perspective, spiritual intelligence entails a re‐balancing of the two main modes of human cognition, with a prioritization of the holistic‐intuitive mind over the conceptual one. From the psychological and phenomenological perspectives, it involves a different kind of engagement with information: slower, more participatory, less objectifying, and not focused entirely on problem solving. The article ends with a reflection on the theological implications of the proposed model and how such an account of spiritual intelligence as knowing differently might relate to theological anthropology and the theology of the spirit and the spiritual.
Case in Point: Skating Into Sports Medicine
Authors: Kirillov Emily , Smith Mara , Driban Jeffrey B.
Published: April 2023

Patients deserve an opportunity to tell clinicians and researchers their views about how sports medicine could better address their needs. In our “Case in Point” article, we provide an internationally competitive figure skater with a chance to identify her community’s needs and suggest solutions. We then have a clinician who works with skaters provide their perspective on the skater’s call to action. Finally, a researcher shares suggestions based on the views of the skater and clinician. We hope this “Case in Point” article highlights how novel clinical and research ideas can be sparked by creating a forum for athletes/patients, providers, and researchers to share ideas.
Condensed but liquid-like domain organization of active chromatin regions in living human cells
Authors: Nozaki Tadasu , Shinkai Soya , Ide Satoru , Higashi Koichi , Tamura Sachiko , Shimazoe Masa A. , Nakagawa Masaki , Suzuki Yutaka , Okada Yasushi , Sasai Masaki , Onami Shuichi , Kurokawa Ken , Iida Shiori , Maeshima Kazuhiro
Published: April 2023

In eukaryotes, higher-order chromatin organization is spatiotemporally regulated as domains, for various cellular functions. However, their physical nature in living cells remains unclear (e.g., condensed domains or extended fiber loops; liquid-like or solid-like). Using novel approaches combining genomics, single-nucleosome imaging, and computational modeling, we investigated the physical organization and behavior of early DNA replicated regions in human cells, which correspond to Hi-C contact domains with active chromatin marks. Motion correlation analysis of two neighbor nucleosomes shows that nucleosomes form physically condensed domains with ~150-nm diameters, even in active chromatin regions. The mean-square displacement analysis between two neighbor nucleosomes demonstrates that nucleosomes behave like a liquid in the condensed domain on the ~150 nm/~0.5 s spatiotemporal scale, which facilitates chromatin accessibility. Beyond the micrometers/minutes scale, chromatin seems solid-like, which may contribute to maintaining genome integrity. Our study reveals the viscoelastic principle of the chromatin polymer; chromatin is locally dynamic and reactive but globally stable.
Draft Genome of the Entomopathogenic Fungus Metarhizium robertsii DSM 1490
Authors: Mazumdar Tilottama , Bartholomäus Alexander , McMahon Dino P.
Published: April 2023

Metarhizium robertsii
DSM 1490 is a generalist entomopathogenic fungus. The mechanisms of pathogenesis of such fungi in insects like termites are not completely understood. Here, we report the draft genome sequence, as sequenced on the Oxford Nanopore platform. The genome has a GC% of 47.82 and a size of 45,688,865 bp.
Assessing prevalence of missed laboratory-confirmed sexually transmitted infections among women in Kingston, Jamaica: results from a secondary analysis of the Sino-Implant clinical trial
Authors: Zia Yasaman , Wiener Jeffrey , Snead Margaret Christine , Papp John , Phillips Christi , Flowers Lisa , Medley-Singh Natalie , Costenbader Elizabeth C , Hylton-Kong Tina , Kourtis Athena P
Published: April 2023

Objectives

To assess potentially missed sexually transmitted infections (STIs), we compared clinically diagnosed STIs to laboratory-confirmed diagnoses of gonorrhoea (GC), chlamydia (CT) and trichomonas (Tvag).

Design

Secondary analysis of a randomised controlled trial.

Setting

We used data and specimens previously collected for the Sino-Implant Study in Kingston, Jamaica.

Participants

The Sino-Implant Study randomised 414 women to receive a levonorgestrel implant at either baseline or 3 months post-enrolment to evaluate unprotected sex after implant initiation. This analysis used 254 available vaginal swab samples.

Outcome measures

Clinically diagnosed STIs were determined from medical records by assessing clinical impressions and prescriptions. Laboratory-confirmed STIs included GC, CT and Tvag tested by Aptima Combo 2 for CT/GC and Aptima Tvag assays (Hologic, San Diego, California, USA). Log-binomial regression models fit with generalised estimating equations were used to estimate associations of clinically diagnosed STIs with laboratory-confirmed diagnoses and demographic and behavioural characteristics.

Results

Overall, 195 (76.8%) women had laboratory-confirmed STI (CT, GC or Tvag) while only 65 (25.6%) women had clinically diagnosed cervicitis and/or vaginitis during the study period. Clinical diagnosis missed 79.7% of laboratory-confirmed STIs: 85% of GC (n=17/20), 78.8% of CT (n=141/179) and 80.0% of Tvag (n=180/225). Hormonal contraceptive use in the month prior to the study visit was significantly associated with clinical diagnosis at any time point (prevalence ratio (PR): 1.65, 95% CI 1.07 to 2.54). As age increased, clinically missed infections significantly decreased (PR: 0.98 per year increase, 95% CI 0.97 to 1.00).

Conclusions

The prevalence of laboratory-confirmed STIs was much higher than what was captured by clinical diagnosis. GC, CT and Tvag were not accurately detected without lab confirmation. Missed diagnoses decreased with older age. Increased laboratory capacity and refinement of the syndromic approach are needed to protect the health of sexually active Jamaican women.

Trial registration number

NCT01684358.
Minimizing ICU Neurological Dysfunction with Dexmedetomidine-induced Sleep (MINDDS): protocol for a randomised, double-blind, parallel-arm, placebo-controlled trial
Authors: Shelton Kenneth T , Qu Jason , Bilotta Federico , Brown Emery N , Cudemus Gaston , D’Alessandro David A , Deng Hao , DiBiasio Alan , Gitlin Jacob A , Hahm Eunice Y , Hobbs Lauren E , Houle Timothy T , Ibala Reine , Loggia Marco , Pavone Kara J , Shaefi Shahzad , Tolis George , Westover M. Brandon , Akeju Oluwaseun
Published: April 2023

Introduction

Delirium, which is prevalent in postcardiac surgical patients, is an acute brain dysfunction characterised by disturbances in attention, awareness and cognition not explained by a pre-existing neurocognitive disorder. The pathophysiology of delirium remains poorly understood. However, basic science and clinical studies suggest that sleep disturbance may be a modifiable risk factor for the development of delirium. Dexmedetomidine is a α-2A adrenergic receptor agonist medication that patterns the activity of various arousal nuclei similar to sleep. A single night-time loading dose of dexmedetomidine promotes non-rapid eye movement sleep stages N2 and N3 sleep. This trial hypothesises dexmedetomidine-induced sleep as pre-emptive therapy for postoperative delirium.

Methods and analysis

The MINDDS (Minimizing ICU Neurological Dysfunction with Dexmedetomidine-induced Sleep) trial is a 370-patient block-randomised, placebo-controlled, double-blinded, single-site, parallel-arm superiority trial. Patients over 60 years old, undergoing cardiac surgery with planned cardiopulmonary bypass, will be randomised to receive a sleep-inducing dose of dexmedetomidine or placebo. The primary outcome is the incidence of delirium on postoperative day 1, assessed with the Confusion Assessment Method by staff blinded to the treatment assignment. To ensure that the study is appropriately powered for the primary outcome measure, patients will be recruited and randomised into the study until 370 patients receive the study intervention on postoperative day 0. Secondary outcomes will be evaluated by in-person assessments and medical record review for in-hospital end points, and by telephone interview for 30-day, 90-day and 180-day end points. All trial outcomes will be evaluated using an intention-to-treat analysis plan. Hypothesis testing will be performed using a two-sided significance level (type I error) of α=0.05. Sensitivity analyses using the actual treatment received will be performed and compared with the intention-to-treat analysis results. Additional sensitivity analyses will assess the potential impact of missing data due to loss of follow-up.

Ethics and dissemination

The Partners Human Research Committee approved the MINDDS trial. Recruitment began in March 2017. Dissemination plans include presentations at scientific conferences, scientific publications and popular media.

Trial registration number

NCT02856594.
Protocol of a randomised controlled trial of real-time continuous glucose monitoring in neonatal intensive care ‘REACT’
Authors: Beardsall Kathryn , Thomson Lynn , Guy Catherine , van Weissenbruch Mirjam M , Iglesias Isabel , Muthukumar Priya , Somisetty Sateesh Kumar , Bond Simon , Petrou Stavros , Dunger David
Published: April 2023

Introduction

Hyperglycaemia is common in the very preterm infant and has been associated with adverse outcomes. Preventing hyperglycaemia without increasing the risk of hypoglycaemia has proved challenging. The development of real-time continuous glucose monitors (CGM) to inform treatment decisions provides an opportunity to reduce this risk. This study aims to assess the feasibility of CGM combined with a specifically designed paper guideline to target glucose control in the preterm infant.

Methods and analyses

The Real Time Continuous Glucose Monitoring in Neonatal Intensive Care (REACT) trial is an international multicentre randomised controlled trial. 200 preterm infants ≤1200 g and ≤24 hours of age will be randomly allocated to either real-time CGM or standard care (with blinded CGM data collection). The primary outcome is time in target 2.6–10 mmol/L during the study intervention assessed using CGM. Secondary outcomes include efficacy relating to glucose control, utility including staff acceptability, safety outcomes relating to incidence and prevalence of hypoglycaemia and health economic analyses.

Ethics and dissemination

The REACT trial has been approved by the National Health Service Health Research Authority National Research Ethics Service Committee East of England (Cambridge Central); Medical Ethics Review Committee, VU University Medical Centre, Amsterdam, The Netherlands and the Research Ethics Committee, Sant Joan de Déu Research Foundation, Barcelona, Spain. Recruitment began in July 2016 and will continue until mid-2018. The trial has been adopted by the National Institute of Health Research Clinical Research Network portfolio (ID: 18826) and is registered with anInternational Standard Randomised Control Number (ISRCTN registry ID: 12793535). Dissemination plans include presentations at scientific conferences, scientific publications and efforts at stakeholder engagement.

Trial registration number

ISRCTNNCT12793535Pre-results.
Protocol for assessment of sleep quality and duration in the Treatment In Morning versus Evening (TIME) study: a randomised controlled trial using online patient-reported outcome measures
Authors: Rogers Amy , Morrison Ian , Rorie David A , Mackenzie Isla S , MacDonald Thomas M
Published: April 2023

Introduction

We will use the existing online mechanisms of the Treatment in Morning versus Evening (TIME) study to collect patient-reported outcome measures of sleep quality to determine whether nocturnal dosing of antihypertensives affects sleep quality, when compared with morning dosing.

The TIME study aims to determine if morning or evening dosing of antihypertensive medications is more effective in preventing heart attacks and strokes. The cardiovascular end points in TIME are identified by individual-level linkage to routinely collected hospital admissions and mortality data; these data are supplemented with participant-completed follow-up questionnaires, administered online.

This substudy will provide information regarding the relative acceptability of morning and evening dosing of antihypertensives that will be essential should the TIME study results prompt doctors to consider advising particular dosing times to their patients.

Methods and analysis

TIME participants are aged over 18 years and prescribed at least one antihypertensive drug, taken once a day. They are self-enrolled and consented on the secure TIME website (www.timestudy.co.uk) and then randomised to dosing time. Study follow-up is conducted by automated email. Average participant follow-up is expected to be 4 years. Participants in the sleep substudy are asked to complete an online sleep quality questionnaire at baseline, after 3 months and annually. This includes a Pittsburgh Sleep Quality Index (PSQI), a Hospital Anxiety and Depression Scale and an Epworth Sleepiness Scale. The primary outcome of the TIME Sleep substudy is sleep quality as measured by the PSQI. Secondary outcomes include sleep quantity and duration, and an analysis of any association between sleep quality and the main outcome measures of the TIME study (heart attack, stroke and vascular death).

Ethics and dissemination

Ethical approval has been obtained from the Tayside Committee on Medical Research Ethics (MREC reference: 11/AL/0309), and results will be published in a peer-reviewed journal.

Protocol version

9 (approved 19 July 2017).

Trial registration number

UKCRN ID: 17071. ISRCTN:NCT18157641. Pre-results.
Clinical and ultrasonographic predictors for achieving minimal disease activity in patients with psoriatic arthritis: the UPSTREAM (Ultrasound in PSoriatic arthritis TREAtMent) prospective observational study protocol
Authors: Canzoni Marco , Piga Matteo , Zabotti Alen , Scirè Carlo Alberto , Carrara Greta , Olivieri Ignazio , Iagnocco Annamaria
Published: April 2023

Introduction

Psoriatic arthritis (PsA) occurs in 10%–15% of people with psoriasis and accounts for 10%–20% of early arthritis clinics referral. Only a few prognostic factors of therapeutic response in patients with PsA have been identified. In the last years, the role of imaging has grown up and the European League Against Rheumatism recognised that ultrasound (US) has higher sensitivity than clinical examination to detect inflammatory disease activity. The aims of the Ultrasound in PSoriatic arthritis TREAtMent (UPSTREAM) study are to integrate clinic and US in order to inform whether US has provide an added prognostic value in PsA.

Methods and analysis

UPSTREAM is an observational prospective cohort study enrolling patients with PsA having clinically active joint disease and starting a new course of therapy. The primary objective is to evaluate the additional value of US over clinical examination in detecting patients achieving minimal disease activity after 6 months. Data will be obtained at baseline and at standard clinical follow-up visits. Patient’s clinical assessment will be performed according to the core set proposed by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis-Outcome Measures in Rheumatology. Sonographic evaluations will be performed by expert sonographers in 42 joints, 36 tendons, 12 entheses and 2 bursae, according to a score that will be purposely developed for PsA by the US Study Group of the Italian Society for Rheumatology. The UPSTREAM study will identify clinical and US predictors of response to treatment in patients with PsA and active peripheral arthritis starting a new course of therapy.

Ethics and dissemination

Ethic approval for this study has been obtained from the institutional review board (IRB)/independent ethics committee (IEC) Comitato Etico Lazio 1 (Prot. N 198 02-02-2017) and then locally from the IRB/IEC of each participating centre. Results will be published in relevant scientific journals and be disseminated in international conferences. Fully anonymised data will be accessible from authors upon request.

Trial registration number

NCT03330769.
Exploration and characterisation of the phenotypic and genetic profiles of patients with early onset schizophrenia associated with autism spectrum disorder and their first-degree relatives: a French multicentre case series study protocol (GenAuDiss)
Authors: Fernandez Arnaud , Dor Emmanuelle , Maurin Thomas , Laure Gaelle , Menard Marie-Line , Drozd Małgorzata , Poinso Francois , Bardoni Barbara , Askenazy Florence , Thümmler Susanne
Published: April 2023

Introduction

Early-onset schizophrenia (EOS) is a rare and severe condition. A higher rate of neurodevelopmental abnormalities, such as intellectual or communication impairments as well as attention deficit hyperactivity disorder, is observed in EOS compared with adult-onset schizophrenia. Early signs of autism spectrum disorders (ASD) are present in about 30% of patients. Genetic abnormalities, including copy number variations, are frequent in neurodevelopmental disorders and have been associated to ASD physiopathology. Implicated genes encode proteins involved in brain development, synapses morphology and plasticity and neurogenesis. In addition, an increasing number of genetic abnormalities are shared by EOS and ASD, underlying the neurodevelopmental hypothesis of EOS.

The main objective of our study is to identify disease-causing genetic mutations in a cohort of patients affected by both EOS and ASD. Special attention will be paid to genes involved in neurodevelopmental pathways.

Methods and analysis

We describe a multicentric study in a paediatric population. The study started in April 2014. Inclusion criteria are: age 7–22 years, diagnosis of EOS with comorbid ASD and IQ >50; Parents and siblings are also enrolled. We perform psychiatric assessments (Mini International Neuropsychiatric Interview, Kiddie Schedule for Affective Disorders and Schizophrenia -Present and Lifetime Version, Positive and Negative Syndrome Scale and Scale for the Assessment of Negative Symptoms) together with neurocognitive evaluations (IQ, Trail Making Test A/B and verbal fluency). Then, we study variants of the coding part of DNA (exome), using next-generation sequencing process on trio (mother, father and child). Bioinformatics tools (RVIS and PolyPhen-2) are used to prioritise disease-causing mutations in candidate genes. The inclusion period will end in November 2019.

Ethics and dissemination

The study protocol was approved by the Local Ethic Committee and by the French National Agency for Medicines and Health Products Safety. All patients signed informed consent on enrolment in the study. Results of the present study should help to unravel the molecular pathology of EOS, paving the way for an early therapeutic intervention.

Trial registration number

NCT0256552
‘Organisation of delivery of care in operating suite recovery rooms within 48 hours postoperatively and patient outcomes after adult non-cardiac surgery: a systematic review’
Authors: Lloyd Courtney , Ludbrook Guy , Story David , Maddern Guy
Published: April 2023

Context

Postoperative recovery rooms have existed since 1847, however, there is sparse literature investigating interventions undertaken in recovery, and their impact on patients after recovery room discharge.

Objective

This review aimed to investigate the organisation of care delivery in postoperative recovery rooms; and its effect on patient outcomes; including mortality, morbidity, unplanned intensive care unit (ICU) admission and length of hospital stay.

Data sources

NCBI PubMed, EMBASE and Cumulative Index to Nursing and Allied Health Literature.

Study selection

Studies published since 1990, investigating health system initiatives undertaken in postoperative recovery rooms. One author screened titles and abstracts, with two authors completing full-text reviews to determine inclusion based on predetermined criteria. A total of 3288 unique studies were identified, with 14 selected for full-text reviews, and 8 included in the review.

Data extraction

EndNote V.8 (Clarivate Analytics) was used to manage references. One author extracted data from each study using a data extraction form adapted from the Cochrane Data Extraction Template, with all data checked by a second author.

Data synthesis

Narrative synthesis of data was the primary outcome measure, with all data of individual studies also presented in the summary results table.

Results

Four studies investigated the use of the postanaesthesia care unit (PACU) as a non-ICU pathway for postoperative patients. Two investigated the implementation of physiotherapy in PACU, one evaluated the use of a new nursing scoring tool for detecting patient deterioration, and one evaluated the implementation of a two-track clinical pathway in PACU.

Conclusions

Managing selected postoperative patients in a PACU, instead of ICU, does not appear to be associated with worse patient outcomes, however, due to the high risk of bias within studies, the strength of evidence is only moderate. Four of eight studies also examined hospital length of stay; two found the intervention was associated with decreased length of stay and two found no association.

PROSPERO registration number

This protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO) database, registration numberNCT42018106093.
Study to Weigh the Effect of Exercise Training on BONE quality and strength (SWEET BONE) in type 2 diabetes: study protocol for a randomised clinical trial
Authors: Balducci Stefano , Conti Francesco , Sacchetti Massimo , Russo Cosimo R , Argento Giuseppe , Haxhi Jonida , Orlando Giorgio , Rapisarda Gianvito , D'Errico Valeria , Cardelli Patrizia , Pugliese Luca , Laghi Andrea , Vitale Martina , Bollanti Lucilla , Zanuso Silvano , Nicolucci Antonio , Pugliese Giuseppe
Published: April 2023

Introduction

Type 2 diabetes (T2D) is associated with an increased fracture risk despite normal-to-increased bone mineral density, suggesting reduced bone quality. Exercise may be effective in reducing fracture risk by ameliorating muscle dysfunction and reducing risk of fall, though it is unclear whether it can improve bone quality.

Methods and analysis

The ‘Study to Weigh the Effect of Exercise Training on BONE quality and strength (SWEET BONE) in T2D’ is an open-label, assessor-blinded, randomised clinical trial comparing an exercise training programme of 2-year duration, specifically designed for improving bone quality and strength, with standard care in T2D individuals. Two hundred T2D patients aged 65–75 years will be randomised 1:1 to supervised exercise training or standard care, stratified by gender, age ≤ or >70 years and non-insulin or insulin treatment. The intervention consists of two weekly supervised sessions, each starting with 5 min of warm-up, followed by 20 min of aerobic training, 30 min of resistance training and 20 min of core stability, balance and flexibility training. Participants will wear weighted vests during aerobic and resistance training. The primary endpoint is baseline to end-of-study change in trabecular bone score, a parameter of bone quality consistently shown to be reduced in T2D. Secondary endpoints include changes in other potential measures of bone quality, as assessed by quantitative ultrasound and peripheral quantitative CT; bone mass; markers of bone turnover; muscle strength, mass and power; balance and gait. Falls and asymptomatic and symptomatic fractures will be evaluated over 7 years, including a 5-year post-trial follow-up. The superiority of the intervention will be assessed by comparing between-groups baseline to end-of-study changes.

Ethics and dissemination

This study was approved by the institutional ethics committee. Written informed consent will be obtained from all participants. The study results will be submitted for peer-reviewed publication.

Trial registration number

NCT02421393.