bluuebunny/crossref_metadata_2025 huggingface dataset:
Building design for people with dementia: a case study of a UK care home
Authors: Fisher Lee H. , Edwards David John , Pärn Erika Anneli , Aigbavboa Clinton Ohis
Published: March 2018

Purpose

This paper aims to investigate the impact that building design has upon the quality of life for residents of a care home who have dementia. To present a balanced perspective, carers within the care home also participate in the research.

Design/methodology/approach

A case study methodological approach was adopted using one care home, ten residents and five staff as a sample frame. During interviews conducted, participants were asked semi-structured questions on how building design features impact upon the quality of life of residents. Questions posed focussed upon key design principles that emerged from a detailed review of extant literature.

Findings

Building design for people with dementia must consider a complex array of features to provide a safe and habitable living space for residents and family members who visit. This living space must also be suitably utilitarian and provide a workable environment for staff. Hence, an appropriate balance between these two competing requirements must be attained, and often a tailor-made solution is required that fits the individual’s level of dementia. Three prominent areas that study participants expressed a desire for were a safe environment; support for wayfinding, orientation and navigation; and access to nature and the outdoors.

Originality/value

The work reports upon the rarely discussed issue of building design for people with dementia and could be used by policymakers and construction firms to enhance their knowledge capabilities in this area. The research concludes with direction for future research which should seek to provide more evidence-based research vis-a-vis perception enquiry and extend this seminal work to a larger sample of care homes or people with dementia living at home.
A code-compliance framework for fire safety in student housing facilities
Authors: Hassanain Mohammad A. , Garkuwa Jamilu A. , Sanni-Anibire Muizz O.
Published: March 2018

Purpose

The purpose of this paper is to present the development and implementation of a qualitative, code-compliance framework for property managers of student housing facilities.

Design/methodology/approach

The paper identified the fire safety code requirements for student housing facilities and arranged these requirements in the form of a checklist, which was further validated by professional experts. Additionally, the paper presented an IDEF0(Integrated Definition for Function Modeling) framework model that illustrates a stepwise process for the deployment of the checklist. A case study was conducted on three similar student housing facilities in a university campus to demonstrate the application of the framework. Furthermore, the findings from the case study were reported along with recommendations to improve the degree of compliance with the requirements of fire safety codes.

Findings

The developed framework was validated by professional experts and through a case study. Fire safety provisions were mostly found to be adequate in the case study building. The authors proposed several actions to improve the current status of fire safety in the building.

Originality/value

The paper serves to disseminate awareness about the occurrence of fires, their severe consequences and precautionary measures in student housing facilities. It also provides a standardized checklist for ease of use by property managers who may be unable to understand the technical terminologies found in fire safety codes and standards. Thus, the developed framework is of tangible value to property managers, building specialists and student housing administrators.
The incremental informativeness of public subsidiary earnings
Authors: Daly Abbie
Published: March 2018

Purpose

This study aims to investigate how holding public subsidiaries affects the information environment of consolidated entities in Germany.

Design/methodology/approach

The sample consists of German consolidated entities that are traded on major German stock exchanges over the fiscal years 2005-2012 and hold subsidiaries with public common equity. The informativeness of earnings, defined as the association between earnings and returns, is used to investigate how holding public subsidiaries affects the information environment of consolidated entities.

Findings

Findings suggest that public subsidiary earnings are incrementally informative about consolidated entity returns beyond both consolidated and segment earnings reported by consolidated entities in Germany. An investigation into the factors that affect the incremental informativeness of public subsidiary earnings reveals that public subsidiary earnings are more incrementally informative when, compared to the consolidated entity, they are relatively large, have dissimilar growth prospects and are from the same country (i.e. Germany).

Practical implications

These findings suggest that this disclosure is useful to investors and that this type of disclosure could be valuable to adopt in other countries that do not have this disclosure requirement.

Originality/value

These findings contribute to the streams of literature that: investigate ways that regulators can improve the information environment of corporations, compare the informativeness of accounting measures and investigate the informativeness of subsidiary information.
Labor unemployment insurance and firms’ future performance
Authors: Wang Weiwei , Zheng Kenneth
Published: March 2018

Purpose

The purpose of this paper is to investigate the association between unemployment insurance (UI) benefits and firms’ future performance as well as the association between UI benefits and volatility of firms’ future performance.

Design/methodology/approach

Quantitative analyses are used to perform empirical testing, and the variables in this study have been selected from previous literature. Empirical data consists of UI benefits data published from 2003 to 2012 on the US Department of Labor website, accounting data from Compustat, and stock return data from CRSP.

Findings

Unemployment benefits are positively associated with firms’ future earnings and cash flows. Also, unemployment benefits are negatively associated with volatility of firms’ future earnings and cash flows. Finally, the positive association between unemployment benefits and firms’ future performance is more pronounced for firms with larger changes in labor force, and the negative association between unemployment benefits and volatility of firms’ future performance is more pronounced for firms with higher labor force volatility and capital structure volatility.

Research limitations/implications

To the extent that other correlated omitted variables exist, the readers are asked to interpret the findings in this paper with caution.

Originality/value

This study contributes to prior literature on labor economics, finance, and accounting. The findings may be of interest to academic researchers and policy makers.
Board interlocking and firm performance: the role of foreign ownership in Saudi Arabia
Authors: Hamdan Allam
Published: March 2018

Purpose

The purpose of this paper is to investigate what effect, if any, foreign ownership has on the relationship between board interlocking and firm performance.

Design/methodology/approach

Data on 131 firms from various sectors listed in the Saudi Financial Market during the period of 2016 were collected. Board interlocking was measured using two indicators (number of interlocks and number of interlocks per member) and then it was divided into three levels (1-6/7-14/15 or more). As for the performance of firms, it was measured using two indicators: one operational (return on assets and the other financial (return on equity)). Foreign ownership was considered as a moderator variable. In addition to firm and board characteristics, a set of control variables related to ownership structure was used.

Findings

Results provide some support for the “busyness hypothesis” which postulates deterioration in the effectiveness of directors, in terms of their monitoring role, when increasing the number of interlocks per director. Results also manifest a positive effect exerted by foreign ownership in terms of turning around the otherwise negative relationship between board interlocking and firm performance in the second level of interlocking (7-14) Code Article 12’s limit on the number of interlocking per director to a maximum of five directorships. However, there is limited compliance to this code among Saudi firms. The study indicates the need to comply with the governance code in order to enhance governance which undercut performance.

Originality/value

Highlighting the role of foreign ownership in enhancing corporate governance in a conservative business environment characterized by relational networks with gaps in corporate governance.
An empirical analysis of the characteristics of savings and credit cooperatives participating in the reporting excellence awards in Kenya
Authors: Mathuva David Mutua
Published: March 2018

Purpose

In Kenya, an award for reporting excellence is presented annually to the entities in the public and private sector. The purpose of this paper is to examine the characteristics of savings and credit cooperatives (SACCOs) that apply for the annual reporting excellence award in Kenya.

Design/methodology/approach

The study employs correlation and probit regression analyses to establish the factors which explain the decision by SACCOs to participate in the Financial Reporting (FIRE) excellence award. The study utilizes data consisting of 1,272 firm-year observations for 212 SACCOs, over the period 2008-2013.

Findings

Consistent with institutional and legitimacy theories, the results demonstrate that structural and governance variables are significant and positively associated with the decision to participate in the annual FIRE awards by SACCOs in Kenya. Similarly, larger SACCOs and those that have adopted best cooperative governance practices are more likely to participate in the annual FIRE awards. The results also reveal that SACCOs audited by the Big 4 audit firms are more likely to participate in the annual FIRE awards.

Research limitations/implications

The study focuses on the factors explaining the decision to participate in the annual reporting excellence awards by organizations in a specific sector. Further studies can adopt a multi-sectoral approach to investigate the same phenomenon.

Practical implications

The findings highlight the importance of cooperative governance and resources in explaining why SACCOs choose to participate in the FIRE awards.

Originality/value

The study adds onto the dearth of literature on the aspect under focus. Globally, very few studies have examined the drivers of the decision to participate in reporting excellence awards by organizations.
Vedantic applications of augmented reality for strategic social marketing campaigns in India
Authors: Joshi Amrita
Published: March 2018

Purpose

Social outreach campaigns such as mainstream commercial marketing campaigns are drawn to digital communication practices for increased visibility, speed and recall. This paper aims to highlight the usefulness and application of augmented reality (AR) technologies and proposes a change-driven usage of the AR environments for social marketing.

Design/methodology/approach

Paradigmatic structural analysis is used to extract the underlying schematic forms. A multimodal analytic approach is used to propose the conceptual framework.

Findings

AR is defined vis-à-vis conceptualizations of reality and hyper-reality from the Vedantic philosophical texts and treatises. The study examines and demonstrates an earlier version of AR expression in ancient times in the use of spatio-temporal constructs and their degrees of modality. It derives a conceptual schema based on AR resonant applications in narratives from the Vedantic literature. Based on these, the study highlights the persuasive appeal and co-creative potential of these illustrative examples to recommend marketing communication strategies for social outreach campaigns.

Research limitations/implications

The analysis recognizes a conceptual bridge between human extra-sensory/transcendental ability and contemporary technology. This study identifies five propositional structures (PS). It opens up the field of social marketing research to alternative methodologies such as multimodal analysis.

Practical implications

While most of contemporary AR usage is in commercial marketing, this study has derived specific guiding principles/propositional structures. These can be applied to create specific virtual environments that can simulate and demonstrate desirable societal outcomes and behaviours. As newer technologies permit further and more futuristic design interventions, developers could experiment with transitional states to impact behaviours, with implications for experimental layering of information.

Originality/value

This study responds to a call for innovative design interventions in the field of social marketing. Its originality lies in its use of the Vedantic framework which has not been explored in this direction elsewhere.
Measuring customers benefits of click and collect
Authors: Jara Magali , Vyt Dany , Mevel Olivier , Morvan Thierry , Morvan Nelida
Published: March 2018

Purpose

Click and collect (or grocery pickup) represents a growing part of the channel strategy of traditional off-line retailers. The aim of this study is to understand how customers develop their perceptions toward this new channel. In other words, what are the key factors explaining the long-term value creation for each “click and collect” system depending on consumers’ profiles?

Design/methodology/approach

On the basis of a quantitative survey of 479 respondents, this research uses confirmatory analyses based on the partial least square path modeling.

Findings

Based on the structural model, the study finds that the customers’ relations, website and pickup station are the most important factors creating value for customers whatever the internet grocery shopping model. The global conceptual model has been implemented under many variations to test the age effect and the kind of click and collect model. It is made evident that customers’ benefits vary regarding the kind of click and collect model and the age of customers.

Research limitations/implications

This research allows a better understanding of the performance of the click and collect system by looking at the key factors that maximize the customers’ value and those that decrease it. Results precisely show variations of those factors according to the customer’s profile and the click and collect model.

Originality/value

This quantitative paper studies customer behaviors toward their usual retailer and their relationship with them. To do so, segmented approaches of the causal model are retained to provide specific recommendations.
Fake news judgement
Authors: El Rayess Maroun , Chebl Charla , Mhanna Joseph , Hage Re-Mi
Published: March 2018

Purpose

The purpose of this paper is to provide library professionals with insights into students’ fake news judgment and the importance of teaching media and information literacy, not as an option but as a core educational requirement.

Design/methodology/approach

Qualtrics was used to collect the study data. Students completed a set of tasks designed in the form of a survey that entailed verifying whether news, stories, images and news sources were real, fake, dubious or trustworthy. Statistical tests were used to asses whether their responses depended on criteria, such as faculty and gender.

Findings

No significant relationship exists between the students’ responses and variables, such as gender, student category, fact-checking and source of information. The findings reveal that students’ ability to identify the authoritativeness of information is dependent on the faculty in which they are enrolled.

Originality/value

This paper reports the first known attempt in Lebanon to measure students’ ability in distinguishing fake from real news. The results of this paper can be used by library professionals, particularly in Lebanon, to convey the importance of teaching and embedding media and information literacy into their curriculum.
The Relationship Between Walk Distance and Muscle Strength, Muscle Pain in Visually Disabled People
Authors: Akyol Betül
Published: March 2018

The purpose of this study is to examine the relationship between six-minute walk test and muscle pain, muscle strength in visually disabled people. The study includes 50 visually disabled people, aged between 17, 21 ± 5,3. Participants were classified into three categories according to their degree of vision (B1, B2, B3). All participants were administered to six-minute walk test, muscle test and muscle pain threshold test.In B2 and B3 group there is significant moderate correlation between the walk distance and muscles. There were significant differences in pain threshold of quadriceps, pain threshold of hamstring and pain threshold of tibialis anterior among the groups. The data were evaluated using IBM SPSS Statistics 23.0 package software, and the level of significance was taken as p < 0.005.When the visually disabled people were classified according to their visual degree, it was noticed that visual area is important while walking. Muscle power is thought to be effective in walking ability. The muscles of the legs, backs and buttocks act as they walk and allow them to stay in balance. In addition to the muscular strength, people with muscle pain do not want to continue walking because they are feeling pain in their muscles as they walk.As a result, if we want to increase walking distance, which is an important part of daily life activities of visually impaired individuals, an exercise program should be organized to strengthen muscle groups that are effective in walking and to rehabilitate painful muscles.
Projectile Motion Hoop Challenge
Authors: Jordan Connor , Dunn Amy , Armstrong Zachary , Adams Wendy K.
Published: March 2018

Projectile motion is a common phenomenon that is used in introductory physics courses to help students understand motion in two dimensions. Authors have shared a range of ideas for teaching this concept and the associated kinematics in The Physics Teacher; however, the “Hoop Challenge” is a new setup not before described in TPT. In this article an experiment is illustrated to explore projectile motion in a fun and challenging manner that has been used with both high school and university students. With a few simple materials, students have a vested interest in being able to calculate the height of the projectile at a given distance from its launch site. They also have an exciting visual demonstration of projectile motion when the lab is over.
And So Ad Infinitum: The Search for Quark and Lepton Substructure
Authors: Lincoln Don
Published: March 2018

The Victorian era mathematician, Augustus de Morgan wrote, “Great fleas have little fleas upon their backs to bite ‘em,And little fleas have lesser fleas, and so ad infinitum.”
Clash of Harmonics in Stravinsky’sThe Rite of Spring
Authors: Ruiz Michael J.
Published: March 2018

This paper describes a fascinating connection between the physics of music and the famous chord in the dissonant rhythmic section of Stravinsky’s The Rite of Spring (1913). The analysis of Stravinsky’s chord will draw from the physics of harmonics, musical intervals, mathematics, and cognitive psychology. This highly interdisciplinary approach will especially appeal to students typically found in a physics course for non-majors. A video accompanies this paper so that readers and students can hear the construction of Stravinsky’s dissonant chord as well as an orchestra performing an excerpt of The Rite of Spring.
Flawed Applications of Bernoulli’s Principle
Authors: Koumaras Panagiotis , Primerakis Georgios
Published: March 2018

One of the most popular demonstration experiments pertaining to Bernoulli’s principle is the production of a water spray by using a vertical plastic straw immersed in a glass of water and a horizontal straw to blow air towards the top edge of the vertical one. A more general version of this phenomenon, appearing also in school physics problems, is the determination of the rise of the water level h in the straw (see Fig. 1).
Broadband multizone sound rendering by jointly optimizing the sound pressure and particle velocity
Authors: Buerger M. , Hofmann C. , Kellermann W.
Published: March 2018

In this paper, a recently proposed approach to multizone sound field synthesis, referred to as joint pressure and velocity matching (JPVM), is investigated analytically using a spherical harmonics representation of the sound field. The approach is motivated by the Kirchhoff–Helmholtz integral equation and aims at controlling the sound field inside the local listening zones by evoking the sound pressure and particle velocity on surrounding contours. Based on the findings of the modal analysis, an improved version of JPVM is proposed, which provides both better performance and lower complexity. In particular, it is shown analytically that the optimization of the tangential component of the particle velocity vector, as is done in the original JPVM approach, is very susceptible to errors and thus not pursued anymore. Furthermore, the analysis provides fundamental insights as to how the spherical harmonics used to describe three-dimensional sound fields translate into two-dimensional basis functions as observed on the contours surrounding the zones. By means of simulations, it is verified that discarding the tangential component of the particle velocity vector ultimately leads to an improved performance. Finally, the impact of sensor noise on the reproduction performance is assessed.
Impending extinction crisis of the world’s primates: Why primates matter
Authors: Estrada Alejandro , Garber Paul A. , Rylands Anthony B. , Roos Christian , Fernandez-Duque Eduardo , Di Fiore Anthony , Nekaris K. Anne-Isola , Nijman Vincent , Heymann Eckhard W. , Lambert Joanna E. , Rovero Francesco , Barelli Claudia , Setchell Joanna M. , Gillespie Thomas R. , Mittermeier Russell A. , Arregoitia Luis Verde , de Guinea Miguel , Gouveia Sidney , Dobrovolski Ricardo , Shanee Sam , Shanee Noga , Boyle Sarah A. , Fuentes Agustin , MacKinnon Katherine C. , Amato Katherine R. , Meyer Andreas L. S. , Wich Serge , Sussman Robert W. , Pan Ruliang , Kone Inza , Li Baoguo
Published: March 2018

Impending extinction of the world’s primates due to human activities; immediate global attention is needed to reverse the trend.
Direct imaging of electron transfer and its influence on superconducting pairing at FeSe/SrTiO
3
interface
Authors: Zhao Weiwei , Li Mingda , Chang Cui-Zu , Jiang Jue , Wu Lijun , Liu Chaoxing , Moodera Jagadeesh S. , Zhu Yimei , Chan Moses H. W.
Published: March 2018

We demonstrated electron transfer across the FeSe/STO interface and showed its dominant role in
T
c
enhancement in this system.
Comparison of Septic Shock Due to Multidrug-Resistant Acinetobacter baumannii or Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae in Intensive Care Unit Patients
Authors: Russo Alessandro , Giuliano Simone , Ceccarelli Giancarlo , Alessandri Francesco , Giordano Alessandra , Brunetti Grazia , Venditti Mario
Published: March 2018

A significant cause of mortality in the intensive care unit (ICU) is multidrug-resistant (MDR) Gram-negative bacteria, such as MDR
Acinetobacter baumannii
(MDR-AB) and
Klebsiella pneumoniae
carbapenemase-producing
K. pneumoniae
(KPC-Kp). The aim of the present study was to compare the clinical features, therapy, and outcome of patients who developed septic shock due to either MDR-AB or KPC-Kp. We retrospectively analyzed patients admitted to the ICU of a teaching hospital from November 2010 to December 2015 who developed septic shock due to MDR-AB or KPC-Kp infection. Data from 220 patients were analyzed: 128 patients (58.2%) were diagnosed with septic shock due to KPC-Kp, and 92 patients (41.8%) were diagnosed with septic shock due to MDR-AB. The 30-day mortality rate was significantly higher for the MDR-AB group than the KPC-Kp group (84.8% versus 44.5%, respectively;
P
< 0.001). Steroid exposure and pneumonia were associated with MDR-AB infection, whereas hospitalization in the previous 90 days, primary bacteremia, and KPC-Kp colonization were associated with KPC-Kp infection. For patients with KPC-Kp infections, the use of ≥2
in vitro
-active antibiotics as empirical or definitive therapy was associated with higher 30-day survival, while isolation of colistin-resistant strains was linked to mortality. Patients with MDR-AB infections, age >60 years, and a simplified acute physiology score II (SAPS II) of >45 points were associated with increased mortality rates. We concluded that septic shock due to MDR-AB infection is associated with very high mortality rates compared to those with septic shock due to KPC-Kp. Analysis of the clinical features of these critically ill patients might help physicians in choosing appropriate empirical antimicrobial therapy.
The N Terminus of Autographa californica Multiple Nucleopolyhedrovirus DNA Polymerase Is Required for Efficient Viral DNA Replication and Virus and Occlusion Body Production
Authors: Chen Guoqing , Yan Qing , Fang Yang , Wu Lijuan , Krell Peter J. , Feng Guozhong
Published: March 2018

Autographa californica multiple nucleopolyhedrovirus (AcMNPV) DNA polymerase (DNApol) plays a crucial role in viral DNA synthesis, and the N terminus (residues 1 to 186) is highly conserved in the baculovirus DNApol family. However, the functional role of the N terminus of DNApol has not yet been characterized. Here we report a functional analysis of the AcMNPV DNApol N terminus. We truncated the DNApol N terminus to construct truncation mutants Bac-GFP-PolΔ64, Bac-GFP-PolΔ110, and Bac-GFP-PolΔ186, which lack 64, 110, and 186 N-terminal residues, respectively. Although the truncation mutants rescued viral DNA synthesis and infectious virus production, the level of DNA replication decreased, and Bac-GFP-PolΔ64, Bac-GFP-PolΔ110, and Bac-GFP-PolΔ186 showed 10-fold, 89-fold, and 891-fold reductions in infectious viral yield compared to that of the wild-type repair virus, respectively. Production of occlusion bodies was compromised for all truncation mutants. Further bioinformatic analysis showed that the first 64 amino acids (aa) at the extreme N terminus contains a conserved α(-helix)-β(-sheet)-β-β secondary-structure region, and further downstream sequence from aa 67 to 186 is comprised of four conserved sequence motifs. Multiple alanine point substitutions in the α-β-β-β structure region or the four sequence motifs in the N terminus impaired viral DNA replication and resulted in reduction of virus yield and occlusion body production. Together, our results suggested that the secondary structure and four conserved motifs within the N terminus of AcMNPV DNApol are important for viral DNA synthesis, infectious virus yield, and production of occlusion bodies.

IMPORTANCE
DNA polymerase (DNApol) is highly conserved in all baculoviruses and is required for viral DNA replication. The N terminus is one of the highly conserved regions of baculovirus DNApols. Our results showed that the N terminus of baculovirus DNA polymerase plays an important role in efficient viral DNA synthesis and infectious virus yield and production of occlusion bodies. We identified five features, including a highly conserved secondary structure and four conserved amino acid motifs, in the AcMNPV DNApol N terminus, all of which are important for efficient viral DNA synthesis, infectious virus yield, and production of occlusion bodies.
rRNA Mimicry in RNA Regulation of Gene Expression
Authors: Meyer Michelle M.
Published: March 2018

The rRNA is the largest and most abundant RNA in bacterial and archaeal cells. It is also one of the best-characterized RNAs in terms of its structural motifs and sequence variation. Production of ribosome components including >50 ribosomal proteins (r-proteins) consumes significant cellular resources. Thus, RNA
cis
-regulatory structures that interact with r-proteins to repress further r-protein synthesis play an important role in maintaining appropriate stoichiometry between r-proteins and rRNA. Classically, such mRNA structures were thought to directly mimic the rRNA. However, more than 30 years of research has demonstrated that a variety of different recognition and regulatory paradigms are present. This review will demonstrate how structural mimicry between the rRNA and mRNA
cis
-regulatory structures may take many different forms. The collection of mRNA structures that interact with r-proteins to regulate r-protein operons are best characterized in
Escherichia coli
, but are increasingly found within species from nearly all phyla of bacteria and several archaea. Furthermore, they represent a unique opportunity to assess the plasticity of RNA structure in the context of RNA-protein interactions. The binding determinants imposed by r-proteins to allow regulation can be fulfilled in many ways. Some r-protein-interacting mRNAs are immediately obvious as rRNA mimics from primary sequence similarity, others are identifiable only after secondary or tertiary structure determination, and some show no obvious similarity. In addition, across different bacterial species a host of different mechanisms of action have been characterized, showing that there is no simple one-size-fits-all solution.
Periodontitis, edentulism and glycemic control in patients with type 2 diabetes: a cross-sectional study
Authors: Taboza Zuila Albuquerque , Costa Katia Linhares , Silveira Virginia Régia , Furlaneto Flavia Aparecida , Montenegro Jr Renan , Russell Stefanie , Dasanayake Ananda , Rego Rodrigo O
Published: March 2018

Objectives

To compare the glycemic control in non-smoking patients with type 2 diabetes according to their periodontal and dental status.

Research design and methods

This cross-sectional study investigated patients previously diagnosed with type 2 diabetes and under antidiabetic medication. Clinical data and fasting blood glucose (FBG) levels were collected from medical and dental records. Patients were divided into three groups according to dental and periodontal diagnosis: no or mild periodontitis (NO/MILD, n=96), moderate or severe periodontitis (MOD/SEV, n=74) and edentulous (n=141). FBG levels were compared between groups. Logistic regression was also applied to estimate the OR of presenting hyperglycemia.

Results

Edentulous patients had significantly higher FBG levels of 155.7±70.9 (mean±SD mg/dL) than those in the MOD/SEV (136.6±33.8) and the NO/MILD (123.1±36.7) groups. Differences between the latter two groups were also significant. Edentulous patients had adjusted ORs of 4.53, 4.27 and 3.95 of having FBG≥126, ≥150 and ≥180 mg/dL, respectively, in comparison with NO/MILD group. The MOD/SEV group also presented significant odds of having FBG≥126 mg/dL (OR=2.66) and ≥150 mg/dL (OR=2.45) than the NO/MILD group.

Conclusions

Patients in the MOD/SEV group had worse glycemic control than the ones in the NO/MILD group. However, edentulous patients presented higher glycemic levels than both dentate groups, and also presented with higher odds of having hyperglycemia.
Associations between healthcare worker participation in workplace wellness activities and job satisfaction, occupational stress and burnout: a cross-sectional study in Botswana
Authors: Ledikwe Jenny H , Kleinman Nora Joelle , Mpho Maureen , Mothibedi Heather , Mawandia Shreshth , Semo Bazghina-werq , O’Malley Gabrielle
Published: March 2018

Objectives

Healthcare workers (HWs) are prone to high levels of stress and burnout, particularly when caring for people with HIV/AIDS. This study assessed whether participation in Botswana’s Workplace Wellness Programme (WWP) for HWs was associated with job satisfaction, occupational stress, well-being and burnout.

Methods

Using multistage sampling, a paper-based questionnaire was distributed to 1856 randomly selected HWs at 135 public facilities across Botswana. Well-validated scales assessed key outcomes. Analysis of covariance models were built for psychosocial factors associated with WWP participation, controlling for associated demographics.

Results

Response rate was 73% (n=1348). The majority of respondents were female (62%), not married (65%) and had children (84%). Mean age was 40.0 years (SD±9.9). Respondents were roughly split between participation in no WWP activities (29.4%), 1–6 WWP activities (38.9%) and seven or more WWP activities (31.7%) in the past year. High participation was associated with older age, being a doctor or other professional, working at hospitals or District Health Management Teams, working longer in health services or working longer at a facility. In unadjusted analyses, high participation was significantly associated (P<0.05) with higher satisfaction with overall job, work, supervision, promotion, pay and professional efficacy and lower stress, exhaustion and cynicism. All associations remained significant in controlled analyses except cynicism.

Conclusions

Results from this study suggest that participation in workplace wellness activities is associated with higher satisfaction with multiple job facets and lower stress, exhaustion and cynicism. Introduction of these activities may help ameliorate high occupational stress levels among HWs.
Efficacy and moderators of psychological interventions in treating subclinical symptoms of depression and preventing major depressive disorder onsets: protocol for an individual patient data meta-analysis of randomised controlled trials
Authors: Ebert David D , Buntrock Claudia , Reins Jo Annika , Zimmermann Johannes , Cuijpers Pim
Published: March 2018

Introduction

The long-term effectiveness of psychological interventions for the treatment of subthreshold depression and the prevention of depression is unclear and effects vary among subgroups of patients, indicating that not all patients profit from such interventions. Randomised clinical trials are mostly underpowered to examine adequately subgroups and moderator effects. The aim of the present study is, therefore, to examine the short-term and long-term as well as moderator effects of psychological interventions compared with control groups in adults with subthreshold depression on depressive symptom severity, treatment response, remission, symptom deterioration, quality of life, anxiety and the prevention of major depressive disorder (MDD) onsets on individual patient level and study level using an individual patient data meta-analysis approach.

Methods and analysis

Systematic searches in PubMed, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials were conducted. We will use the following types of outcome criteria: (A) onset of major depression; (B) time to major depression onset; (C) observer-reported and self-reported depressive symptom severity; (D) response; (E) remission; (F) symptom deterioration; (G) quality of life, (H) anxiety; and (I) suicidal thoughts and behaviours. Multilevel models with participants nested within studies will be used. Missing data will be handled using a joint modelling approach to multiple imputation. A number of sensitivity analyses will be conducted in order test the robustness of our findings.

Ethics and dissemination

The investigators of the primary trials have obtained ethical approval for the data used in the present study and for sharing the data, if this was necessary, according to local requirements and was not covered from the initial ethic assessment.

This study will summarise the available evidence on the short-term and long-term effectiveness of preventive psychological interventions for the treatment of subthreshold depression and prevention of MDD onset. Identification of subgroups of patients in which those interventions are most effective will guide the development of evidence-based personalised interventions for patients with subthreshold depression.

PROSPERO registration number

CRD42017058585.
Patient confidence regarding secondary lifestyle modification and knowledge of ‘heart attack’ symptoms following percutaneous revascularisation in Japan: a cross-sectional study
Authors: Kitakata Hiroki , Kohno Takashi , Kohsaka Shun , Fujino Junko , Nakano Naomi , Fukuoka Ryoma , Yuasa Shinsuke , Maekawa Yuichiro , Fukuda Keiichi
Published: March 2018

Objective

To assess patient perspectives on secondary lifestyle modification and knowledge of ‘heart attack’ after percutaneous coronary intervention (PCI) for coronary artery disease (CAD).

Design

Observational cross-sectional study.

Setting

A single university-based hospital centre in Japan.

Participants

In total, 236 consecutive patients with CAD who underwent PCI completed a questionnaire (age, 67.4±10.1 years; women, 14.8%; elective PCI, 75.4%). The survey questionnaire included questions related to confidence levels about (1) lifestyle modification at the time of discharge and (2) appropriate recognition of heart attack symptoms and reactions to these symptoms on a four-point Likert scale (1=not confident to 4=completely confident).

Primary outcome measure

The primary outcome assessed was the patients’ confidence level regarding lifestyle modification and the recognition of heart attack symptoms.

Results

Overall, patients had a high level of confidence (confident or completely confident,>75%) about smoking cessation, alcohol restriction and medication adherence. However, they had a relatively low level of confidence (<50%) about the maintenance of blood pressure control, healthy diet, body weight and routine exercise (≥3 times/week). After adjustment, male sex (OR 3.61, 95% CI 1.11 to 11.8) and lower educational level (OR 3.25; 95% CI 1.70 to 6.23) were identified as factors associated with lower confidence levels. In terms of confidence in the recognition of heart attack, almost all respondents answered ‘yes’ to the item ‘I should go to the hospital as soon as possible when I have a heart attack’; however, only 28% of the responders were confident in their ability to distinguish between heart attack symptoms and other conditions.

Conclusions

There were substantial disparities in the confidence levels associated with lifestyle modification and recognition/response to heart attack. These gaps need to be studied further and disseminated to improve cardiovascular care.
Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis
Authors: Vilar-Palop Jorge , Hernandez-Aguado Ildefonso , Pastor-Valero María , Vilar José , González-Alvarez Isabel , Lumbreras Blanca
Published: March 2018

Objectives

To determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated.

Design

Cross-sectional retrospective study.

Setting

Two Spanish public tertiary hospitals.

Participants

2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded.

Primary and secondary outcome measures

Five outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient’s clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category.

Results

Approximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays.

Conclusion

There was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test.
Targeted social care for highly vulnerable pregnant women: protocol of the Mothers of Rotterdam cohort study
Authors: van der Hulst Marije , de Groot Marjolein W , de Graaf Johanna P , Kok Rianne , Prinzie Peter , Burdorf Alex , Bertens Loes C M , Steegers Eric A P
Published: March 2018

Introduction

Social vulnerability is known to be related to ill health. When a pregnant woman is socially vulnerable, the ill health does not only affect herself, but also the health and development of her (unborn) child. To optimise care for highly vulnerable pregnant women, in Rotterdam, a holistic programme was developed in close collaboration between the university hospital, the local government and a non-profit organisation. This programme aims to organise social and medical care from pregnancy until the second birthday of the child, while targeting adult and child issues simultaneously. In 2014, a pilot in the municipality of Rotterdam demonstrated the significance of this holistic approach for highly vulnerable pregnant women. In the ‘Mothers of Rotterdam’ study, we aim to prospectively evaluate the effectiveness of the holistic approach, referred to as targeted social care.

Methods and analysis

The Mothers of Rotterdam study is a pragmatic prospective cohort study planning to include 1200 highly vulnerable pregnant women for the comparison between targeted social care and care as usual. Effectiveness will be compared on the following outcomes: (1) child development (does the child show adaptive development at year 1?) and (2) maternal mental health (is maternal distress reduced at the end of the social care programme?). Propensity scores will be used to correct for baseline differences between both social care programmes.

Ethics and dissemination

The prospective cohort study was approved by the Erasmus Medical Centre Ethics Committee (ref. no. MEC-2016–012) and the first results of the study are expected to be available in the second half of 2019 through publication in peer-reviewed international journals.

Trial registration number

NTR6271; Pre-results.
Awareness of the role of general practitioners in primary care among outpatient populations: evidence from a cross-sectional survey of tertiary hospitals in China
Authors: Liu Xiaojun , Tan Anran , Towne Jr Samuel D , Hou Zhaoxun , Mao Zongfu
Published: March 2018

Objective

General practitioners (GPs) are highly underutilised in China with many patients going directly to hospitals when seeking routine care. Multiple countries around the world have successfully used GPs in routine care, and as such, China may benefit from the use of GPs. This study examines the status of, and factors associated with, knowledge related to GPs among outpatient populations from China’s tertiary hospitals.

Design

This is a cross-sectional survey study.

Study setting and participants

The questionnaires were completed by 565 outpatients from four tertiary hospitals in China during 2016. Convenience sampling on different floors and throughout the outpatient building was carried out.

Primary outcome measures

We used the logistic regression models to identify GP-related knowledge among different populations.

Results

Overall, 50.27% of respondents said they had never heard of GPs. This was also true among females (adjusted OR (AOR)=1.57, 95% CI 1.43 to 2.71), older adults (AOR46–65=1.61, 95% CI 1.39 to 2.98; AOR>65=2.01, 95% CI 1.62 to 3.59), those with lower education level (AORBachelor’s degree=0.61, 95% CI 0.20 to 0.81; AOR≥Master’s degree=0.49, 95% CI 0.23 to 0.76), rural residents (AOR=1.51, 95% CI 1.35 to 2.82) and those with chronic disease (AORwithout chronic disease=0.61, 95% CI 0.22 to 0.71). What is more, less than one-in-ten (9.03%) outpatients were able to accurately describe what a GP was, with less than 30% accurately describing a GP among those receiving GPs’ services.

Conclusions

Outpatients who could have received less costly health services from GPs in primary medical institutions were more likely to choose costlier specialist physicians in tertiary hospitals, which is likely linked to limited knowledge about GPs. Policy makers should invest in outreach efforts to improve public awareness of GPs, while at the same time conducting continued surveillance of these efforts to evaluate progress towards this goal.
Opportunistic screening for heart failure with natriuretic peptides in patients with atrial fibrillation: a meta-analysis of individual participant data of four screening studies
Authors: van Doorn Sander , Geersing Geert-Jan , Kievit Rogier F , van Mourik Yvonne , Bertens Loes C , van Riet Evelien E S , Boonman-de Winter Leandra J , Moons Karel G M , Hoes Arno W , Rutten Frans H
Published: March 2018

Objective

Heart failure (HF) often coexists in atrial fibrillation (AF) but is frequently unrecognised due to overlapping symptomatology. Furthermore, AF can cause elevated natriuretic peptide levels, impairing its diagnostic value for HF detection. We aimed to assess the prevalence of previously unknown HF in community-dwelling patients with AF, and to determine the diagnostic value of the amino-terminal pro B-type natriuretic peptide (NTproBNP) for HF screening in patients with AF.

Methods

Individual participant data from four HF-screening studies in older community-dwelling persons were combined. Presence or absence of HF was in each study established by an expert panel following the criteria of the European Society of Cardiology. We performed a two-stage patient-level meta-analysis to calculate traditional diagnostic indices.

Results

Of the 1941 individuals included in the four studies, 196 (10.1%) had AF at baseline. HF was uncovered in 83 (43%) of these 196 patients with AF, versus 381 (19.7%) in those without AF at baseline. Median NTproBNP levels of patients with AF with and without HF were 744 pg/mL and 211 pg/mL, respectively. At the cut-point of 125 pg/mL, sensitivity was 93%, specificity 35%, and positive and negative predictive values 51% and 86%, respectively. Only 23% of all patients with AF had an NTproBNP level below the 125 pg/mL cut-point, with still a 13% prevalence of HF in this group.

Conclusions

With a prevalence of nearly 50%, unrecognised HF is common among community-dwelling patients with AF. Given the high prior change, natriuretic peptides are diagnostically not helpful, and straightforward echocardiography seems to be the preferred strategy for HF screening in patients with AF.