bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing sustainable food consumption: a case study of localized food supply in Beijing
Authors: Liu Shuo
Published: October 2018

Purpose

China’s rapid economic growth has greatly changed its consumption pattern of agricultural food. Wealthy Chinese consumers demand food of superior quality. However, with the national grain security goal focused primarily on self-sufficiency, China has no choice but to keep increasing the scale of agricultural industrialization and modernization, which inevitably brings in unwanted chemical input that puts food safety at risk. China’s consumers started to adopt an alternative food supply method. This paper aims to examine how Chinese consumers use privatized ways (i.e. their own social capital) to select high-quality local agricultural products as a unique type of inverted quarantine.

Design/methodology/approach

This paper mainly used a qualitative research method, including participant observation and in-depth interviews as the main sources of data. For the fieldwork, two providers of high-quality food in Beijing were selected as the research sites. Data were collected by in-depth interviews with consumers and organizers of the two local food suppliers and participant observation of online and offline interactions between food providers and consumers.

Findings

Instead of seeing development of consumer citizenship, what is witnessed is consumers use their private resources or networks to deal with risks created by institutional failure. In this sense, it is a type of inverted quarantine, but is different from what Szasz described in his book. Instead of purchasing bottled water or organic food sold in the mainstream supermarkets, Chinese middle-class consumers rely more on their personal relations with food suppliers and start to adopt an alternative way of food supply.

Research limitations/implications

Beijing consumers are among the most privileged, in terms of income level and access to alternative trusted sources of food. Therefore, the findings of this paper may not be applicable to other provincial cities in China. A comparative research on healthy food consumption patterns among major cities in China still require further attention. In addition, with the flourish of online shopping platforms, it is highly likely that the current shopping patterns among the affluent middle-class consumers will change accordingly.

Originality/value

This paper reveals the current uncertainty experienced by Chinese middle-class consumers and showed their concerns related to food safety. It may shed some lights on the current discussion about middle-class anxiety in Mainland China. It also developed a typology of inverted quarantine with empirical evidence, and therefore helps further develop the concept of inverted quarantine.
Additive effects of plant chemotype, mutualistic ants and predators on aphid performance and survival
Authors: Senft Matthias , Clancy Mary V. , Weisser Wolfgang W. , Schnitzler Jörg‐Peter , Zytynska Sharon E.
Published: October 2018

Cascading effects in ecological systems acting across three or more trophic levels can be either of a resource‐based (bottom‐up) or natural enemy‐based (top‐down) nature. But, due to their complexity, these effects are often considered separately and their relative strength, acting simultaneously, remains unknown.

In a semi‐natural field experiment using tansy (Tanacetum vulgare L.) and the specialised tansy‐aphid Metopeurum fuscoviride Stroyan as a model system, we compared the effects of four distinct plant chemotypes (i.e., bottom‐up), defined by the bouquet of their volatile terpenoids, on aphid population dynamics by manipulating the presence/absence of mutualistic ants and presence/absence of naturally occurring predators (i.e., top‐down).

Predators reduced aphid abundance and colony survival but did not reduce initial growth rate due to a time‐lag until predators arrived on the plants. Ants directly benefited initial aphid growth rates and abundance, even in the absence of predators, but not the number of days an aphid colony persisted on the plant.

Plant chemotype directly affected aphid growth rate and final abundances across the different plants and indirectly affected the abundances of tending ants and predators through effects on aphids. We found that tending ants were more abundant on one plant chemotype. Although ant abundance did not affect aphid population development, it became clear that ants had a preference towards aphids on certain chemotypes. However, a higher number of predators led to a lower number of aphids.

The results confirm the importance of plant chemical variation, acting through multiple effects on many species in arthropod communities, and support results from field studies. In a natural population, with a diverse selection of host‐plant variants, aphid populations and their interacting species can therefore be structured at the level of an individual plant. Specialist aphids on patchily distributed host plants can exhibit metacommunity dynamics at very local scales. Plant within‐species variation within a local population is often ignored in metacommunity ecology, yet our work shows that this can have strong effects on insect–ant–natural enemy dynamics, and therefore, future research should incorporate this into current theory and experimental studies.

A plain language summary is available for this article.
Is a problem shared a problem halved? Shared services and municipal efficiency
Authors: McQuestin Dana , Drew Joseph
Published: October 2018

It has long been argued that shared services represent an efficacious means of securing efficiencies for municipalities. Indeed, pressures from fiscal austerity, taxation limitations, and the specter of forced amalgamations have resulted in an increasing uptake of shared service arrangements. However, the extant evidence is rather inconclusive and is largely restricted to analyzing the nett efficiency outcomes for the specific service shared. We broaden this evidential base by examining the association between shared service production and the efficiency of entire municipalities. Our analysis, employing a 5‐year panel of data, suggests that shared services are associated with a statistically significant reduction in overall municipal efficiency. We conclude by explicating on the public policy implications arising from ourprima faciesurprising results.
Constructing Cityscapes: Locality, Materiality and Territoriality on the Urban Construction Site in Xinjiang Uyghur Autonomous Region, Northwest China
Authors: Kobi Madlen
Published: October 2018

Urbanization in Xinjiang Uyghur Autonomous Region (Northwest China) has gained momentum in the last three decades. The Chinese government supports infrastructure development in this border region and construction sites have been emerging everywhere. Often framed as a planned nation‐state project of sinicization from above, from an ethnographic perspective infrastructure development involves a much more diverse set of actors and their different motives. The construction sector offers a gateway for global and national architectural designs and manpower to enter the making of local cityscapes. Besides engaging with the political economy of construction activities, this article outlines the meaning of the construction site as a place where social and ethnic senses of locality are negotiated. The data show that many of the economic, material, social and design mobilities on the construction site in Xinjiang extend eastwards to the rest of China rather than to Central Asian countries which are geographically much closer. Power relations and ethnic issues become interwoven into the construction of new cityscapes. In particular, the domination of Han actors in the planning and implementation of construction projects shapes not only the materiality of the built environment but also related senses of locality.
Real world study of the continuation of bevacizumab beyond disease progression after first‐line treatment containing bevacizumab in Chinese patients with advanced non‐small cell lung cancer
Authors: Xing Puyuan , Mu Yuxin , Wang Yan , Hao Xuezhi , Zhu Yixiang , Hu Xingsheng , Wang Hongyu , Liu Peng , Lin Lin , Wang Zhijie , Li Junling
Published: October 2018

Background

Bevacizumab (Bev) plus platinum‐based chemotherapy is a standard first‐line treatment option for advanced non‐squamous non‐small cell lung cancer (NS‐NSCLC). We evaluated the efficacy and safety of continuing Bev in Chinese patients with advanced NS‐NSCLC progression after first‐line treatment containing Bev in a real‐world setting.

Methods

The data of 118 patients with advanced NS‐NSCLC who received Bev between July 2009 and July 2017 were retrospectively collected. The patients were divided into groups: 15 in Bev first‐line, 82 in Bev ≥ second‐line, and 21 in Bev cross‐lines. The primary endpoint was overall survival; secondary objectives were progression‐free survival, objective response rate, disease control rate, and safety.

Results

The overall survival was 21.8, 32.5, and 18.9 months (P = 0.092) in the overall population and 39.3, 25.8, and 15.0 months (P = 0.347) in the wild‐type population in the Bev first‐line, Bev ≥ second‐line, and Bev cross‐lines groups, respectively. There were no significant differences in progression‐free survival of second‐line treatment between the groups in the overall population: 2.6, 3.7, and 3.2 months in the Bev first‐line, Bev ≥ second‐line, and Bev cross‐lines groups, respectively (P = 0.796). No statistically significant improvement in objective response or disease control rates in the Bev cross‐lines group was observed. No unexpected or severe adverse events were recorded.

Conclusion

We found no benefit in continuing Bev treatment beyond progression after first‐line treatment containing Bev for patients with advanced NS‐NSCLC. Further research of validated predictive biomarkers of response to treatment after long‐term antiangiogenic therapy is required.
Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery—2018
Authors: Evered Lis , Silbert Brendan , Knopman David S. , Scott David A. , DeKosky Steven T. , Rasmussen Lars S. , Oh Esther S. , Crosby Greg , Berger Miles , Eckenhoff R. G. ,   The Nomenclature Consensus Working Group
Published: October 2018

Cognitive change affecting patients after anaesthesia and surgery has been recognised for more than 100 yr. Research into cognitive change after anaesthesia and surgery accelerated in the 1980s when multiple studies utilised detailed neuropsychological testing for assessment of cognitive change after cardiac surgery. This body of work consistently documented decline in cognitive function in elderly patients after anaesthesia and surgery, and cognitive changes have been identified up to 7.5 yr afterwards. Importantly, other studies have identified that the incidence of cognitive change is similar after non‐cardiac surgery. Other than the inclusion of non‐surgical control groups to calculate postoperative cognitive dysfunction, research into these cognitive changes in the perioperative period has been undertaken in isolation from cognitive studies in the general population. The aim of this work is to develop similar terminology to that used in cognitive classifications of the general population for use in investigations of cognitive changes after anaesthesia and surgery. A multispecialty working group followed a modified Delphi procedure with no prespecified number of rounds comprised of three face‐to‐face meetings followed by online editing of draft versions.

Two major classification guidelines [Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM‐5) and National Institute for Aging and the Alzheimer Association (NIA‐AA)] are used outside of anaesthesia and surgery, and may be useful for inclusion of biomarkers in research. For clinical purposes, it is recommended to use the DSM‐5 nomenclature. The working group recommends that ‘perioperative neurocognitive disorders’ be used as an overarching term for cognitive impairment identified in the preoperative or postoperative period. This includes cognitive decline diagnosed before operation (described as neurocognitive disorder); any form of acute event (postoperative delirium) and cognitive decline diagnosed up to 30 days after the procedure (delayed neurocognitive recovery) and up to 12 months (postoperative neurocognitive disorder).
Delirium assessment in neuro‐critically ill patients: A validation study
Authors: Larsen Laura Krone , Frøkjær Vibe G. , Nielsen Jette Stub , Skrobik Yoanna , Winkler Yvonne , Møller Kirsten , Petersen Marian , Egerod Ingrid
Published: October 2018

Background

Delirium is underinvestigated in the neuro‐critically ill, although the harmful effect of delirium is well established in patients in medical and surgical intensive care units (ICU).To detect delirium, a valid tool is needed. We hypothesized that delirium screening would be feasible in patients with acute brain injury and we aimed to validate and compare the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist against clinical International Classification of Diseases‐10 criteria as reference.

Methods

Nurses assessed delirium using the Confusion Assessment Method for the ICU and Intensive Care Delirium Screening Checklist in adult patients with acute brain injury admitted to the Neurointensive care unit (Neuro‐ICU), Copenhagen University Hospital, if their Richmond agitation‐sedation scale score was −2 or above. As the reference, a team of psychiatrist assessed patients using the International Classification of Diseases‐10 criteria.

Results

We enrolled 74 patients, of whom 25 (34%) were deemed unable to assess by the psychiatrists, leaving 49 (66%) for final analysis. Sensitivity and specificity for the Confusion Assessment Method for the ICU was 59% (95% CI: 41‐75) and 56% (95% CI: 32‐78), respectively, and 85% (95% CI: 70‐94) and 75% (95% CI: 51‐92), respectively, for the Intensive Care Delirium Screening Checklist.

Conclusions

Our findings suggest that the Intensive Care Delirium Screening Checklist may be a valid tool and the Confusion Assessment Method for the ICU is less suitable for delirium detection for patients in the Neuro‐ICU. In the neuro‐critically ill, delirium screening is challenged by limited feasibility.
Distribution of runs of homozygosity in Chinese and Western pig breeds evaluated by reduced‐representation sequencing data
Authors: Zhang Zhe , Zhang Qianqian , Xiao Qian , Sun Hao , Gao Hongding , Yang Yumei , Chen Jiucheng , Li Zhengcao , Xue Ming , Ma Peipei , Yang Hongjie , Xu Ningying , Wang Qishan , Pan Yuchun
Published: October 2018

Inbreeding, which has several causes including genetic drift, population bottlenecks, mating of close relatives and selection, can leave tracts of runs of homozygosity (ROH) along genomes. Recently, decreasing performance on reproductive traits, which might have resulted from inbreeding, has been observed in Chinese pigs. In this study, 830 individuals from Western and Chinese pig breeds were genotyped using the reduced‐representation sequencing method. After imputation and quality control, 60 850 high‐confidence SNPs were retained for ROH detection. A simulation was performed to explore the reliability of ROH detection with imputed data. Different ROH‐related variables were compared between imputed and non‐missing genotypes used in ROH detection. Furthermore, ROH islands were evaluated and annotated to find genes influenced by inbreeding in these pigs. The simulation results showed that imputed data with 0.7 as the average missing genotype rate and three heterozygotes allowed in a sliding window have comparable ROH detected compared with data with no missing genotypes. Compared with Western pig breeds, Chinese pigs had more autosomes covered by ROH longer than 5 Mb, indicating higher inbreeding in Chinese pigs in recent times. Genes related to reproduction, immunity, meat quality and adaptability in Chinese pigs and several genes related to growth speed and immunity in Western pigs were observed in short ROH islands. The reproduction‐related gene PRM1 was found to be located in the most frequent long ROH island in Chinese pigs, which might explain the decreasing fertility in Chinese pig breeds.
Recent developments and highlights in mechanisms of allergic diseases: Microbiome
Authors: Lunjani Nonhlanhla , Satitsuksanoa Pattraporn , Lukasik Zuzanna , Sokolowska Milena , Eiwegger Thomas , O'Mahony Liam
Published: October 2018

All body surfaces are exposed to a wide variety of microbes, which significantly influence immune reactivity within the host. This review provides an update on some of the critical novel findings that have been published on the influence of the microbiome on atopic dermatitis, food allergy and asthma. Microbial dysbiosis has consistently been observed in the skin, gut and lungs of patients with atopic dermatitis, food allergy and asthma, respectively, and the role of specific microbes in allergic disorders is being intensively investigated. However, many of these discoveries have yet to be translated into routine clinical practice.
Problems in Paradise: Taiwanese Immigrants to Auckland, New Zealand
Authors: Boyer Tania
Published: October 2018

Migration from Asia to New Zealand is now a topic of heated public debate within New Zealand. This study traces the experiences of Taiwanese migrants to Auckland over the past decade and documents their adaption and revised expectations. By the end of June 1995, over 21,000 Taiwanese had been granted permanent residence in New Zealand on the basis of their skills, qualifications and work experience. Although expecting a fall in income as the necessary ‘price’ to pay for an improved quality of life, as well as some language difficulties, few immigrants were prepared for the magnitude of the drop in income, the hardship it would bring and the heavy reliance this would place on their remaining investments in Taiwan. The net result has been unemployment and underemployment of immigrants many of whom are now resigned to net gains through education coming not to them but to their children. As a result of the inability to secure adequate employment, many Taiwanese immigrants have relocated one or all of the family members back to Taiwan. The introduction in October 1995 of stricter English standards and the flatter, less academic basis to point earning qualifications, validation of job offers, recognition of New Zealand work experience together with the spouses’ human capital as well as a clearer commitment to New Zealand should all go some way to addressing many of the difficulties the history of recent Taiwanese immigration has uncovered.
Research Note
Authors: Wong Tai-Chee , Goh Kim Chuan
Published: October 2018

In 1985, the people of the once tin­rich and prosperous Kinta Valley faced a desperate situation when the tin market collapsed. The nightmare was a result of cumulative effects — high cost of production, low yield of mines and extensive use of cheaper alternatives. But the negative effects on tin mining settlements were avoided due largely to Malaysia’s successful economic restructuring and the inflow of international capital in the manufacturing sector which has helped the local economy to recover. With tin mining disappearing from the Malaysian landscape, most of those still living in settlements previously highly dependent on tin have been able to find alternative livelihoods.
(Re)negotiating Gender Hierarchy in the New Order: A South Sumatran Field Study
Authors: Fuller Collins Elizabeth
Published: October 2018

Central to the organisation of gender roles and hierarchical structures in the traditional societies of South Sumatra (and elsewhere in Southeast Asia) is the concept/emotion of malu, which can be translated as shame, embarrassment or shyness. Malu is regarded as providing the foundation for the development of moral consciousness. It supports the hierarchical power structure of society by signalling behaviour that does not demonstrate the respect due to a superior. It also signals behaviour which is gender inappropriate. This paper, based on in­depth interviews with students and faculty at the University of Sriwijaya and the Raden Fateh IAIN, the state­supported Islamic university in Palembang, is aimed at understanding why students in South Sumatra have chosen a form of Islam that emphasises the authority of men over women and greater restraint for women, as compared to men. I argue that the New Order government and the Dakwah movement have mobilised anxiety over social change by defining women’s freedom as dangerous, thereby evoking in women the deeply rooted emotional and ethical response of malu. Thus, women in Indonesia become more important economically, they continue to accept the authority of men over women, and men’s control over the family and society is maintained.
Global Integration and Local Identities: Engendering the Singaporean Chinese
Authors: Doran Christine
Published: October 2018

Forces of global integration and local autonomy have impacted on debates over the definition and redefinition of gendered ethnic identities among the Chinese in Singapore. These discourses are examined in two historical contexts: contemporary government policy­making on gender issues; and the Chinese cultural reform movement at the turn of the century. Linking contemporary and historical discourses are themes of gendered identity formation in response to tense interactions between globalising forces and moves to assert local autonomy. Striking parallels are shown between gender constructions in the two periods in which engendering discourses were central to redefinitions of Chinese ethnic identities.
Modes of Resistance: Gendered Responses to Global Impositions in Coastal Philippines
Authors: Barber Pauline Gardiner
Published: October 2018

This paper considers gender and the conjunction of global and local processes in three different social and spatial configurations; a Philippines locality, a transnational view embracing the Philippines and somewhere else, and globally. Gendered household livelihoods and contradictions in gender ideologies reveal the privileging of men’s work and political potential over women’s. Exporting women’s labour is the most economically viable household strategy; a pattern which creates new transnational social fields embracing the many national contexts where Filipino women work overseas. The conclusion eschews a binary approach to women’s resistance and highlights the paradoxical yet potentially radical political significance of inter/national dependency upon Filipino women’s domestic labour.
Diagonal Likelihood Ratio Test for Equality of Mean Vectors in High-Dimensional Data
Authors: Hu Zongliang , Tong Tiejun , Genton Marc G.
Published: October 2018

We propose a likelihood ratio test framework for testing normal mean vectors in high-dimensional data under two common scenarios: the one-sample test and the two-sample test with equal covariance matrices. We derive the test statistics under the assumption that the covariance matrices follow a diagonal matrix structure. In comparison with the diagonal Hotelling's tests, our proposed test statistics display some interesting characteristics. In particular, they are a summation of the log-transformed squared t-statistics rather than a direct summation of those components. More importantly, to derive the asymptotic normality of our test statistics under the null and local alternative hypotheses, we do not need the requirement that the covariance matrices follow a diagonal matrix structure. As a consequence, our proposed test methods are very flexible and readily applicable in practice. Simulation studies and a real data analysis are also carried out to demonstrate the advantages of our likelihood ratio test methods.
Conservation geopolitics
Authors: Hodgetts Timothy , Burnham Dawn , Dickman Amy , Macdonald Ewan A. , Macdonald David W.
Published: October 2018

We reviewed recent work concerning the impact of geopolitics on wildlife conservation (and vice versa) and identified future priorities in conservation geopolitics research. Geopolitics is understood as both an analytical focus on geopolitical practices (especially concerning the behavior) of countries with respect to territory and national security and a set of theories developed to explain and predict those behaviors. We developed a typology of core geopolitical practices of relevance to conservation: territorial practices of colonization and the management of migrations and borders, and security practices relating to military, economic, and environmental security. We identified research that considers how these practices affect conservation situations and outcomes, noting the recent emergence of conceptual developments such as “environmental geopolitics” and “geopolitical ecology” that draw on multiple fields within the social sciences to theorize the links between geopolitics and environmental management. We defined a "geopolitical perspective" as a focus on geopolitical practices combined with an explicit engagement with geopolitical theory and identified conservation situations where this perspective could contribute to analytical clarity. We suggest the most pressing questions in conservation research to which the geopolitical perspective might contribute are how political and economic differences between countries affect biodiversity outcomes, how geopolitical practices to address those differences facilitate or frustrate conservation efforts, how national borders and human and wildlife movements can be better managed for the benefit of both, and how the most effective conservation strategies can be best selected to suit existing (and future) geopolitical realities.
Novel immune signatures associated with dysplastic naevi and primary cutaneous melanoma in human skin
Authors: Yan Bernice Y. , Garcet Sandra , Gulati Nicholas , Kiecker Felix , Fuentes‐Duculan Judilyn , Gilleaudeau Patricia , Sullivan‐Whalen Mary , Shemer Avner , Mitsui Hiroshi , Krueger James G.
Published: October 2018

Dysplastic naevi (DN) are benign lesions with atypical features intermediate between that of common melanocytic naevi (CMN) and malignant melanoma (MM). Debate remains over whether DN represent progressive lesions from CMN. Through gene expression profiling and analysis of molecular gene signatures, our study revealed progressive increases in immune activation and regulation, along with pathways implicated in melanomagenesis, from CMN to DN to MM. Using criteria of 1.5‐fold change and false discovery rate ≤0.05, we found differential expression of 7186 probes (6370 unique genes) with the largest difference detected between DN and MM from the standpoint of genomic melanoma progression. Despite progressive increases in the T‐helper type 1 (Th1)‐inducing gene (IL‐12), RT‐PCR indicated impaired Th1 or cytotoxic T‐cell response (decreased IFN‐γ) in MM. Concordantly, our results indicated progressive increases in molecular markers associated with regulatory T cells, exhausted T cells and tolerogenic dendritic cells, including detection of increased expression of suppressor of cytokine signalling 3 (SOCS3) in dendritic cells associated with MM. All together, our findings suggest that the increased immunosuppressive microenvironment of melanoma may contribute to unhampered proliferation of neoplastic cells. In addition, the detection of increased markers associated with tolerogenic dendritic cells in MM suggests that targeting these suppressive immune cell types may represent an alternative avenue for future immunotherapy.
Differential expression of VGLUT3 in laboratory mouse strains: Impact on drug‐induced hyperlocomotion and anxiety‐related behaviors
Authors: Sakae Diana Y. , Ramet Lauriane , Henrion Annabelle , Poirel Odile , Jamain Stéphane , El Mestikawy Salah , Daumas Stéphanie
Published: October 2018

The atypical vesicular glutamate transporter VGLUT3 is present in subpopulations of GABAergic interneurons in the cortex and the hippocampus, in subgroups of serotoninergic neurons in raphe nuclei, and in cholinergic interneurons in the striatum. C56BL/6N mice that no longer express VGLUT3 (VGLUT3−/−) display anxiety‐associated phenotype, increased spontaneous and cocaine‐induced locomotor activity and decreased haloperidol‐induced catalepsy. Inbred mouse strains differ markedly in their sensitivity to anxiety and behavioral responses elicited by drugs. The purpose of this study was to investigate strain differences in VGLUT3 expression levels and its potential correlates with anxiety and reward‐guided behaviors. Five inbred mouse lines were chosen according to their contrasted anxiety and drugs sensitivity: C57BL/6N, C3H/HeN, DBA/2J, 129/Sv, and BALB/c. VGLUT3 protein expression was measured in different brain areas involved in reward or mood regulation (such as the striatum, the hippocampus, and raphe nuclei) and genetic variations in Slc17a8, the gene encoding for VGLUT3, have been explored. These five inbred mouse strains express very different levels of VGLUT3, which cannot be attributed to the genetic variation of the Slc17a8 locus. Furthermore, mice behavior in the open field, elevated plus maze, spontaneous‐ and cocaine‐induced locomotor was highly heterogeneous and only partially correlated to VGLUT3 levels. These data highlight the fact that one single gene polymorphism could not account for VGLUT3 expression variations, and that region specific VGLUT3 expression level variations might play a key role in the modulation of discrete behaviors.
Should Ki67 immunohistochemistry be performed on all lesions in multifocal small intestinal neuroendocrine tumours?
Authors: Numbere Numbereye , Huber Aaron R , Shi Chanjuan , Cates Justin M M , Gonzalez Raul S
Published: October 2018

Aims

Well‐differentiated small intestinal neuroendocrine tumours (SI‐NETs) are often multifocal, and this has been suggested to impart worse disease‐free survival. Practice guidelines have not been established for World Health Organisation (WHO) grading of multiple primary lesions.

Methods and results

We identified 68 patients with ileal/jejunal SI‐NET for a combined total of 207 primary lesions. Each case was evaluated for patient age and sex; size of all tumours; presence of lymph node metastases, mesenteric tumour deposits or distant metastases; and disease‐specific outcome. Ki67 staining was performed on all 207 primary lesions. The relationship between multifocality and clinicopathological factors was compared using Fisher's exact test. Outcome was tested using Cox proportional hazard regression. Forty‐two patients had unifocal disease, and 26 had multifocal disease (median five lesions, range = 2–32). Most tumours were WHO grade 1 (201 of 207, 97%). Of the five patients with grades 2/3 tumours, three patients had unifocal disease, one patient had two subcentimetre grade 2 lesions (including the largest) and eight subcentimetre grade 1 lesions, and one patient had one 1.6‐cm grade 3 lesion and one subcentimetre grade 1 lesion. There was a positive correlation between tumour size and Ki67 index (coefficient 0.28; 95% confidence interval 0.05–0.52, P = 0.017). There was no significant association between multifocality and nodal metastases, mesenteric tumour deposits, distant metastases or disease‐specific survival.

Conclusions

In patients with multifocal SI‐NET, unless a particular lesion has a high mitotic rate, only staining the largest lesion for Ki67 should serve to grade almost all cases accurately. Multifocality does not appear to significantly impact patient survival.
Toothbrush wear in relation to toothbrushing effectiveness
Authors: Van Leeuwen Martijn P. C. , Van der Weijden Fridus A. , Slot Dagmar Else , Rosema Martijn A. M.
Published: October 2018

Objective

To investigate to what extent the degree of toothbrush wear of 3‐month‐old manual toothbrushes influence plaque scores.

Material and methods

During a recently published study with a follow‐up of 1 year, all participants performed a similar basic home‐based oral hygiene regimen. Hence, they were instructed to brush for 2 minutes twice daily according to the Bass method technique and using a standard dentifrice containing sodium fluoride. Toothbrushes were turned in every 3‐month, and the degree of wear was scored. The mean plaque score data were additionally analysed and correlated with wear scores of the toothbrushes.

Results

For analysis, for each of 172 individual participants, a set of three identical, 3‐month‐old used toothbrushes were available. Toothbrush wear varied widely between participants. However, per patient, the 3‐month wear status of the three evaluated toothbrushes was strongly correlated (rho = 0.8, P < 0.0001). Participants who returned toothbrushes with extreme wear had significantly higher plaque scores than those who returned toothbrushes with no visible or light wear (P = 0.01).

Conclusion

Toothbrush wear per individual patient is fairly consistent. Toothbrushes with extreme wear were less effective than those with no or light wear. Therefore, bristle splaying appears to be a more appropriate measure of brush replacement time then the commonly used toothbrush age. Splaying of the outer tufts beyond the base of the toothbrush is a condition that indicates it is time to change the brush.
The handover room: a qualitative enquiry into the experience of morning clinical handover for acute medical teams
Authors: Donnelly Sinead , Dinesh Dorothy , Dew Kevin , Stubbe Maria
Published: October 2018

Background

Effective clinical handover has always been integral to delivering safe, high‐quality care in medical wards.

Aim

As handover activity increases in importance we wanted to explore the experience of physicians and trainee doctors. There is little research on internal medicine handover with even less based on direct observational research.

Methods

Data collection over 4 months by two general medicine physicians included participant observation of 37 meetings and 52 audio‐recorded individual interviews. Inductive thematic analysis of the transcribed interviews proceeded iteratively in parallel with data collection.

Results

There was an excellent response rate from 27 of 28 invited trainees and 25 of 26 invited physicians. Overall the experience was positive. Acute medicine handover is a complex human endeavour, occurring daily with an unpredictable workload and areas of tension. Themes were grouped as structural (leadership role, start time, sequence, checklist, handbacks and efficiency) and relational (sensitivity, collegiality, acknowledgement, performance anxiety, tension, responsibility and leadership style). The physician leader needs to be skilled to follow the agreed and evolving process as well as being prepared, authoritative, flexible, equitable, aware and sensitive to the needs of senior colleagues and trainees. There was a tension between efficiency and teaching opportunities.

Conclusion

This paper adds to a contextually sensitive understanding of the social dynamics of handover in acute medicine. Addressing the structural aspects is important to provide the necessary consistency and efficiency in what is an extremely complex and time‐sensitive environment. As we continue to work on the evolution of the handover process in acute internal medicine, we must also attend to the relational aspects which are dynamic and central to its sustainability.
Acute pulmonary embolism: a concise review of diagnosis and management
Authors: Hepburn‐Brown Morgan , Darvall Jai , Hammerschlag Gary
Published: October 2018

An acute pulmonary embolism (aPE) is characterised by occlusion of one or more pulmonary arteries. Physiological disturbance may be minimal, but often cardiac output decreases as the right ventricle attempts to overcome increased afterload. Additionally, ventilation‐perfusion mismatches can develop in affected vascular beds, reducing systemic oxygenation. Incidence is reported at 50–75 per 100 000 in Australia and New Zealand, with 30‐day mortality rates ranging from 0.5% to over 20%. Incidence is likely to increase with the ageing population, increased survival of patients with comorbidities that are considered risk factors and improving sensitivity of imaging techniques. Use of clinical prediction scores, such as the Wells score, has assisted in clinical decision‐making and decreased unnecessary radiological investigations. However, imaging (i.e. computed tomography pulmonary angiography or ventilation‐perfusion scans) is still necessary for objective diagnosis. Anti‐coagulation remains the foundation of PE management. Haemodynamically unstable patients require thrombolysis unless absolutely contraindicated, while stable patients with right ventricular dysfunction or ischaemia should be aggressively anti‐coagulated. Stable patients with no right ventricular dysfunction can be discharged home early with anti‐coagulation and review. However, treatment should be case dependent with full consideration of the patient’s clinical state. Direct oral anti‐coagulants have become an alternative to vitamin K antagonists and are facilitating shorter hospital admissions. Additionally, duration of anti‐coagulation must be decided by considering any provoking factors, bleeding risk and comorbid state. Patients with truly unprovoked or idiopathic PE often require indefinite treatment, while in provoked cases it is typically 3 months with some patients requiring longer periods of 6–12 months.
Stress, health, and job performance: What do we know?
Authors: Jackson Alexander T. , Frame Mark C.
Published: October 2018

This manuscript reviews the literature on and discusses the relationships among stress, health, and job performance in the workplace. All organizations expect employees to perform work‐related tasks and activities that help fulfill the organization's goals. Job performance behaviors often occur in stressful situations and can be a stressor. The links among stress, health, and job performance are reviewed in the context of relevant theories and models. The bidirectional aspects of the relationships among: stress and job performance; performance and stress; health and job performance; and job performance and health are discussed. Job performance and stress are ubiquitous in the workplace and while research into the antecedents and consequences of both has provided some understanding, there is more to be gleaned by future research that includes both physiological and psychological measures which also takes the biopsychosocial context into account.
Identification of Lynch syndrome risk variants in the Romanian population
Authors: Iordache Paul D. , Mates Dana , Gunnarsson Bjarni , Eggertsson Hannes P. , Sulem Patrick , Benonisdottir Stefania , Csiki Irma Eva , Rascu Stefan , Radavoi Daniel , Ursu Radu , Staicu Catalin , Calota Violeta , Voinoiu Angelica , Jinga Mariana , Rosoga Gabriel , Danau Razvan , Sima Sorin Cristian , Badescu Daniel , Suciu Nicoleta , Radoi Viorica , Mates Ioan Nicolae , Dobra Mihai , Nicolae Camelia , Kristjansdottir Sigrun , Jonasson Jon G. , Manolescu Andrei , Arnadottir Gudny , Jensson Brynjar , Jonasdottir Aslaug , Sigurdsson Asgeir , le Roux Louise , Johannsdottir Hrefna , Rafnar Thorunn , Halldorsson Bjarni V. , Jinga Viorel , Stefansson Kari
Published: October 2018

Two familial forms of colorectal cancer (CRC), Lynch syndrome (LS) and familial adenomatous polyposis (FAP), are caused by rare mutations in DNA mismatch repair genes (MLH1, MSH2, MSH6, PMS2) and the genes APC and MUTYH, respectively. No information is available on the presence of high‐risk CRC mutations in the Romanian population. We performed whole‐genome sequencing of 61 Romanian CRC cases with a family history of cancer and/or early onset of disease, focusing the analysis on candidate variants in the LS and FAP genes. The frequencies of all candidate variants were assessed in a cohort of 688 CRC cases and 4567 controls. Immunohistochemical (IHC) staining for MLH1, MSH2, MSH6, and PMS2 was performed on tumour tissue. We identified 11 candidate variants in 11 cases; six variants in MLH1, one in MSH6, one in PMS2, and three in APC. Combining information on the predicted impact of the variants on the proteins, IHC results and previous reports, we found three novel pathogenic variants (MLH1:p.Lys84ThrfsTer4, MLH1:p.Ala586CysfsTer7, PMS2:p.Arg211ThrfsTer38), and two novel variants that are unlikely to be pathogenic. Also, we confirmed three previously published pathogenic LS variants and suggest to reclassify a previously reported variant of uncertain significance to pathogenic (MLH1:c.1559‐1G>C).
In silico and in vitro analyses of the pathological relevance of the R258H mutation of hepatocyte nuclear factor 4α identified in maturity‐onset diabetes of the young type 1
Authors: Sugawara Kenji , Nomura Kazuhiro , Okada Yuko , Sugano Aki , Matsumoto Masaaki , Takarada Toru , Takeuchi Atsuko , Awano Hiroyuki , Hirota Yushi , Nishio Hisahide , Takaoka Yutaka , Ogawa Wataru
Published: October 2018

Mutations of the hepatocyte nuclear factor 4α (HNF4α) gene give rise to maturity‐onset diabetes of the young type 1. Although many such mutations have been identified in affected individuals, part of these mutations has been characterized with regard to their pathological relevance. We here identified a missense mutation (c.773G>A, p.R258H) of HNF4A in a mother and daughter with early‐onset diabetes and impaired insulin secretion. In silico simulation and in vitro luciferase reporter analyses showed that the mutation impairs the stability of self‐dimerization and the transactivation activity of HNF4α. Although arginine‐258 does not appear to participate directly in dimerization, its mutation alters the electrostatic surface potential of the dimer interface. Our results thus suggest that this mutation impairs the function of HNF4α and thereby contributes to the pathogenesis of maturity‐onset diabetes of the young type 1.
Feasibility of an 8‐item questionnaire for early diagnosis of inflammatory bowel disease in primary care
Authors: Chmiel Corinne , Vavricka Stephan R. , Hasler Susann , Rogler Gerhard , Zahnd Nadine , Schiesser Salomé , Tandjung Ryan , Scherz Nathalie , Rosemann Thomas , Senn Oliver
Published: October 2018

Aims

Diagnosis of inflammatory bowel disease (IBD) is often associated with a diagnostic delay. Although faecal calprotectin is a helpful screening tool, the widespread use in primary care (PC) may not be appropriate due to the low prevalence of IBD in this setting. To increase pretest probability for a positive calprotectin test, an 8‐item questionnaire (CalproQuest) was tested for its feasibility and acceptability in PC.

Methods

Population: PC patients with unspecific gastrointestinal complaints for at least 2 weeks. The CalproQuest consists of four major and four minor questions specific for IBD. It is considered positive if greater than or equal to two major or one major and two minor criteria are positive. Primary outcome: feasibility of CalproQuest, secondary outcome: patient's acceptance of stool sampling.

Results

Of 95 patients with a complete CalproQuest 52 (54.7%) were positive, 39 (41.1%) fulfilled two major and 13 (13.7%) one major and greater than or equal to two minor criteria. Twenty‐seven general practitioners completed 83 (87.4%) questionnaires on feasibility which was assessed positive. Eighty‐two patients (86.3%) completed questionnaires on acceptance which was high.

Conclusion

The CalproQuest is a feasible instrument for assessing IBD in PC. Further prospective studies concerning validity and cost effectiveness of a combined use with the calprotectin test in this setting are necessary.
Bonamia in Ostrea angasi: Diagnostic performance, field prevalence and intensity
Authors: Buss Jessica J. , Wiltshire Kathryn H. , Prowse Thomas A. A. , Harris James O. , Deveney Marty R.
Published: October 2018

Bonamia spp. parasites threaten flat oyster (Ostrea spp.) farming worldwide. Understanding test performance is important for designing surveillance and interpreting diagnostic results. Following a pilot survey which found low Bonamia sp. intensity in farmed Ostrea angasi, we tested further oysters (n = 100–150) from each of three farms for Bonamia sp. using heart smear, histology and qPCR. We used a Bayesian Latent Class Model to assess diagnostic sensitivity (DSe) and specificity (DSp) of these tests individually or in combination, and to assess prevalence. Histology was the best individual test (DSe 0.76, DSp 0.93) compared to quantitative polymerase chain reaction (qPCR) (DSe 0.69, DSp 0.93) and heart smear (DSe 0.61, DSp 0.60). Histology combined with qPCR and defining a positive from either test as an infected case maximized test performance (DSe 0.91, DSp 0.88). Prevalence was higher at two farms in a high‐density oyster growing region than at a farm cultivating oysters at lower density. Parasite intensities were lower than in New Zealand and European studies, and this is probably contributed to differences in the performance of test when compared to other studies. Understanding diagnostic test performance in different populations can support the development of improved Bonamia surveillance programs.
Are coronectomy studies being cited? A bibliometric study
Authors: Yeung Andy Wai Kan , Wong Natalie Sui Miu , Leung Yiu Yan
Published: October 2018

Aim

The aim of the present bibliometric study was to analyze the citations received by coronectomy papers and their references.

Methods

Data were extracted from the Web of Science online database. After excluding irrelevant papers, full record and cited references from 79 papers were downloaded and imported into VOSviewer and CRExplorer for bibliometric analyses.

Results

The 79 papers on coronectomy collectively had 9.7 citations per paper. The h‐index of this collection of papers was 17. The top five major contributing countries were the UK (N = 20, 25.3%), the USA (N = 10, 12.7%), Italy (N = 9, 11.4%), China (N = 5, 6.3%), and Turkey (N = 5, 6.3%). The top two major contributing journals, Journal of Oral and Maxillofacial Surgery and British Journal of Oral and Maxillofacial Surgery, together accounted for more than half of the 79 papers (N = 43, 54.4%).

Conclusions

Papers dealing with postoperative morbidity topics had high citation counts in general, such as dry socket (27.4 citations per paper), infection (24.6 citations per paper), and safety (35.5 citations per paper). Citation per paper correlated with publication count at the affiliation level, but not at the author, country, and journal levels.