bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting recovery: challenges for in-home psychiatric support workers
Authors: Shepherd Nicole , Meehan Tom , Humphries Seiji
Published: July 2014

Purpose

– The concept of recovery is well accepted internationally as a guiding vision for mental health services. The purpose of this paper is to highlight the challenges faced by in-home psychiatric support workers in implementing this vision in their work with clients with severe psychiatric disability.

Design/methodology/approach

– The findings reported here are based on interviews with 27 support workers and ten managers of organisations providing support services. These were collected as part of evaluations of two supported housing programmes carried out between 2010 and 2011.

Findings

– Challenges faced by support workers coalesced around two areas: first, balancing the need to provide care with the need to promote autonomy and second, developing an effective working relationship while working mainly within a clients’ home.

Practical implications

– These challenges for support workers highlight tensions within the recovery vision that are not easily resolved. To ensure high quality, recovery-oriented care services are provided, support workers need access to training courses that focus on challenging areas of this work and should be provided with regular professional supervision.

Originality/value

– Existing literature on support workers has generally focused on the nature of the role and support worker interactions with other health workers. In this paper, the authors highlight difficulties faced by support workers in implementing the vision of recovery in their work. The paper provides important information for policy makers and managers who are designing service delivery systems that aim to promote recovery.
GPs’ and patients’ views on recovery from psychosis
Authors: Ryan Seamus , Rogers Anne , Lester Helen
Published: July 2014

Purpose

– Recovery is a key organising principle underlying mental health services, but remains under-researched in primary care. The purpose of this paper is to explore what recovery from psychosis means from multiple perspectives, the role of primary care in fostering recovery, and interventions that might enhance its promotion in primary care.

Design/methodology/approach

– A total of 20 patients who had experienced psychosis and 24 General Practitioners (GPs) with varying expressed interest in mental health participated in semi-structured interviews, and were invited to two subsequent mixed focus groups. Data were analysed using Framework Analysis.

Findings

– Recovery was conceptualised by GPs without a specialist clinical interest in mental health as improvements in symptomatic outcomes, by GPs with a special interest as improvements in social or functional outcomes, and by patients as a process involving a “whole person” approach. Both GPs and patients highlighted benefits of primary care including continuity, accessibility, and the role primary care professionals can play in supporting patients’ families, and helping patients expand social support networks. Despite feeling “fobbed off” at times, patients desired a shift in responsibility for psychosis from secondary to primary care.

Practical implications

– Reflective peer supervision meetings for GPs and patient-led training might improve primary care's ability to provide a more recovery-focused environment.

Originality/value

– This study provided original and valuable findings regarding how GPs viewed their own role in promoting recovery from psychosis. This study also provided original findings regarding how patients viewed the role of primary care in promoting recovery from psychosis.
An empirical study of the career anchors that govern career decisions
Authors: R. Chapman Jared , L. Brown Bruce
Published: July 2014

Purpose

– The purpose of this paper is to examine two of Feldman and Bolino's proposals: career anchor plurality and career anchor relationships.

Design/methodology/approach

– A novel method for examining the relationships between career anchors called “indices of mutual presence” is developed for this study to generate meaningful results from ordinal and ipsative career anchor data.

Findings

– Evidence for some individuals having multiple career anchors was found. Complementary and exclusivity career anchor relationships are identified and a model for representing them is presented. The importance and possible benefit of understanding both an individual's preferred and “unpreferred” anchors is discussed. The non-reflexive nature of career anchors is explored and the idea of “mutually” exclusive career anchors is rejected. Weaknesses in the octagon shaped career anchor relationships diagram presented by Feldman and Bolino are discussed.

Research limitations/implications

– Despite the benefits associated with forced-choice assessments, some have expressed concern because of the nature of this type of evaluation. Each time an item is preferred, another item must be “unpreferred.” Thus, for one item to have a high preference count, some other item must necessarily have lower preference counts. The resulting data is ordinal rather than interval or ratio. It contains information regarding order of preference, but provides little insight into magnitude of preference. This makes it difficult to identify and examine how much more or less one individual prefers an item when compared to another individual.

Originality/value

– The second property of forced-choice data that raises concern is its ipsative nature. As respondents are constrained to unprefer an item each time the prefer one, the total preference counts remain the same for every individual. As a result, the preference scores for every individual will always sum to the same value. When data has this property, it is called ipsative. Ipsative data is not free to vary, and thus statistical methods which analyze variance may yield spurious results. Thus, traditional factorial statistical methods cannot be appropriately used with ipsative data (Baron, 1996; Bartram, 1996; Closs, 1996). It is commonly believed that researchers trade ease of use and accuracy for fewer available statistical tools when using forced-choice methods. However, this paper attempts to use “indices of mutual presence” developed for this study (described below) that do not rely on variance to generate meaningful results from ipsative career anchor data.
Ethics-related selection and reduced ethical conflict as drivers of positive work attitudes
Authors: Valentine Sean , Hollingworth David , Eidsness Bradley
Published: July 2014

Purpose

– There is reason to believe that an ethically minded approach to hiring and the development of an ethical context should be associated with incremental decreases in employees’ perceptions of ethical conflict. It is also likely that the selection of ethical employees, and the reduced ethical conflict that follows, are positively related to employees’ positive work attitudes. The purpose of this paper is to test these relationships.

Design/methodology/approach

– Using a self-report questionnaire, information was collected from 187 employees working for a medium-sized financial services organization with offices located primarily in the Midwestern USA.

Findings

– Results of structural equation modeling indicated that employees’ perceptions of ethics-related selection were negatively related to perceived ethical conflict, and that reduced ethical conflict and enhanced ethics-related selection were associated with an increased positive work attitude, which was comprised of job satisfaction, an intention to stay, and organizational commitment.

Research limitations/implications

– The results cannot prove causal association between the constructs, and the use of one focal firm limits generalizability.

Practical implications

– Organizational leaders and HR professionals should develop ethics-based hiring practices to reduce ethical conflict and strengthen a company's ethical context.

Originality/value

– This investigation is relevant because strong relationships among ethics-related hiring, ethical conflict, and positive work attitudes would suggest that companies must use ethical selection criteria and maintain an ethical culture/climate that meets or exceeds employees’ expectations about ethics. Furthermore, this study adds to the relatively few published works exploring the relationship between ethical conflict and work attitudes.
“Catching them young” – some reflections on the meaning of the age of criminal responsibility in England and Wales
Authors: Bateman Tim
Published: July 2014

Purpose

– The purpose of this paper is to explore the tension between government protestations that youth justice policy is evidence-led and what the evidence implies in the context of the age of criminal responsibility.

Design/methodology/approach

– The paper takes the form of a conceptual analysis of government policy and the evidence base.

Findings

– The paper concludes that the current low age of criminal responsibility in England and Wales can be understood as a manifestation of the influence of underclass theory on successive governments.

Research limitations/implications

– The paper is not based on primary research.

Practical implications

– The arguments adduced help to explain the reluctance of government to countenance any increase in the age of criminal responsibility.

Social implications

– The analysis might help inform approaches adopted by youth justice policy makers, practitioners and academics with an interest in seeking a rise in the age of criminal responsibility.

Originality/value

– The paper offers an original analysis of government intransigence on an important social issue.
Building strategic elements to increase contact lens sales
Authors: Toor Tajinder
Published: July 2014

Purpose

– This paper aims to build important strategic elements to penetrate deeper into the contact lens market and increase sales.

Design/methodology/approach

– The contact lens market is highly competitive and unattractive. Because contact lens market growth has slowed, competitors have become more alike. To survive or make more than normal profits, a contact lens manufacturer has to differentiate and compete on wider dimensions.

Findings

– In a complex, competitive and ever-changing vision care industry environment, a contact lens manufacturer must compete on wider dimensions to gain strategic advantage and increase sales.

Practical implications

– To survive, a contact lens manufacturer’s strategic game plan may not look simple and form wider strategic components.

Originality/value

– Provides a unique look at the contact lens market.
Managerial role in ensuring successful total quality management programme in Ghanaian printing firms
Authors: Kingsley Graham Nicholas , Dissou Arthur Yarhands , Peprah Mensah Duke
Published: July 2014

Purpose

– Most of the total quality management (TQM) programmes implemented in the printing industry fail to produce the intended benefit, because of the view that quality achievement is workers responsibility. The purpose of this paper is to examine the role management plays in the implementation of TQM programme in the Ghanaian printing firms.

Design/methodology/approach

– The study employed mixed method in gathering relevant data. A cross-sectional survey questionnaire was given to 145 managers of registered members of Ghana Printers and Paper Converters Association, Southern Sector to assess the role management plays in TQM programme. Key informant interview was conducted among ten randomly selected production managers of printing firms to complement the survey data.

Findings

– The study finds out that organizational performance (OP) is not significantly influenced by the level of commitment of top management in a printing organization. Rather OP is greatly influenced and determined by leadership styles of management and the quality policy which guides printing operations.

Practical implications

– The Ghanaian printing industry can ensure better OP by considering the kind of leadership style exhibited in the firm and develop quality policy to guides printing operations and activities. No matter the level of commitment of organizational resources, if it is not back by a good leadership style and a quality policy, TQM initiative will not yield the intended result.

Originality/value

– The study presents managerial issues and practices critical for successful TQM programme in the Ghanaian printing industry.
A review of the importance of business process management in achieving sustainable competitive advantage
Authors: Nadarajah Devika , Latifah Syed Abdul Kadir Sharifah
Published: July 2014

Purpose

– In today's height of competition, business process management (BPM) is regarded as best practice management principle that can assist companies in sustaining competitive advantage. The purpose of this paper is to strengthen theory building of BPM in fostering sustainable competitive advantage based on dynamic capability theory.

Design/methodology/approach

– BPM owes its existence to total quality management (TQM) and business process reengineering and has gained importance as an enabler to coordinate the intricacies of the organisations. Past researches on BPM have been largely conceptual using case studies with scarce evidence for theory building.

Findings

– Based on the review of literature, the study of BPM can be studied based on dynamic capability theory.

Originality/value

– The outcome of this paper would add value to theory building for BPM.
Quality management benefits through the “soft” and “hard” aspect of TQM in food companies
Authors: Psomas Evangelos , Vouzas Fotis , Kafetzopoulos Dimitrios
Published: July 2014

Purpose

– The purpose of the paper is to examine the binary character of total quality management (TQM) in food companies and to determine the impact of the two aspects of TQM – the “soft” and “hard” – on the quality management benefits.

Design/methodology/approach

– A research project was carried out in 90 Greek food companies, using the questionnaire method. Two measurement models have been formulated. The first model includes the TQM philosophical elements and quality tools/techniques, while the second model includes the quality management benefits. Exploratory factor analyses are applied to extract the latent factors. The factors that significantly influence the quality management benefits are determined through multiple linear regression analyses.

Findings

– The analysis of the models confirms the binary character of TQM (the “soft” and “hard” TQM elements) in food companies and the existence of internal and external quality management benefits. The “soft” TQM elements have a significant direct impact on quality improvement, employee benefits and customer satisfaction. However, the impact of the “hard” TQM elements on the above quality management benefits is not direct but indirect, through their significant correlation with the “soft” TQM elements. Finally, quality improvement is also a significant factor that directly influences employee benefits, customer satisfaction and business performance.

Research limitations/implications

– The small size of the sample of the responding food companies, the diversity of these companies and the subjective character of the data collected are limitations that suggest future research recommendations.

Practical implications

– Food companies should realize the leading role of the “soft” aspect of TQM and the supporting role of the “hard” aspect in maximizing the quality management benefits and as a consequence in withstanding the current economic downturn.

Originality/value

– Focusing on “quality-oriented” food companies that have ample experience in quality and food safety management systems, the present study reveals a significant direct impact of the “soft” TQM elements and an indirect impact of the “hard” TQM elements on the quality management benefits.
Robust process capability performance
Authors: Besseris George
Published: July 2014

Purpose

– The purpose of this paper is to propose a set of process capability indices (PCIs) which are based on robust and agile statistics such that they may be applicable irrespective of the process status.

Design/methodology/approach

– The four popular PCIs – Cp, Cpk, Cpm and Cpmk – are reconstructed to improve location and dispersion predictions by introducing robust estimators such as the median and the interquartile range. The proposed PCIs are sequentially evaluated in partitioned regions where fluctuations are inspected to be not significant. The runs test playing the role of a detector permits marking those regions between two consecutive appearances of causes that disrupt data randomness. Wilcoxon's one-sample test is utilized to approximate PCI's central tendency and its confidence interval across all formed partitions.

Findings

– The Cpmk depicted the most conservative view of the process status when tracking the magnesium content in a showcased aluminum manufacturing paradigm. Cp and Cpk were benchmarked with controlled random data. It was found that the proposed set of robust PCIs are substantially less prone to false alarm in predicting non-conforming units in comparison to the regular PCIs.

Originality/value

– The recommended method for estimating PCIs is purely distribution-free and thus deployable at any process maturity level. The advantageous approach defends vigorously against the influence of intruding sources of unknown and unknowable variability. Therefore, the predicament here is to protect the monitoring indicators from unforeseen data instability and breakdown, which are conspicuous in wreaking havoc in managerial decisions.
Paths from leadership to upward influence
Authors: Luu Tuan
Published: July 2014

Purpose

– This inquest into consumer goods companies in Vietnam aims to examine if leadership influences corporate social responsibility (CSR) and emotional intelligence (EI), which in turn influences upward influence behavior. The paper aims to discuss these issues.

Design/methodology/approach

– Structural equation modeling approach contributed to the analysis of 406 responses returned from self-administered structured questionnaires sent to 690 middle level managers.

Findings

– From the findings emerged a model of upward influence behavior and its antecedents such as leadership, CSR, and EI. Transformational leadership, ethical CSR, and high level of EI were found to nurture organizationally beneficial upward influence tactics.

Originality/value

– Through the findings of the study, the insight into the leadership-based model of upward influence behavior underscores the role of transformational leadership style, ethical CSR, as well as team EI in the cultivation of organizationally beneficial upward influence tactics in consumer goods companies in Vietnam business context.
Institutional framing and entrepreneurship capital in Uganda
Authors: Mpeera Ntayi Joseph , Mutebi Henry , Byangwa Kenneth , Georgina Kamanyi Susan
Published: July 2014

Purpose

– The purpose of this paper is to provide policy and managerial implications required in solving the daunting problem of the existing low-entrepreneurial capital in Uganda.

Design/methodology/approach

– A large-scale comprehensive survey using a sample of 11,105 small and medium enterprises (SMEs) from 40 high-growth towns was selected and undertaken from five regions of Uganda. The response rate was 40.5 per cent, translating into 4,498 usable questionnaires.

Findings

– Results reveal that institutional framing, entrepreneurship human capital and entrepreneurial moral values predict entrepreneurship capital in Uganda. These results are presented and discussed in detail in this paper.

Research limitations/implications

– The study applied a cross-sectional approach to study behaviour, yet studying behaviour requires time. Therefore, there is need for scholars to undertake a follow up study to test the hypotheses using longitudinal data.

Practical implications

– The paper provides implications for the review and development of supporting institutional frames for entrepreneurship, promoting generalized forms of human capital and entrepreneurial ethics moral values.

Originality/value

– The motivation for the study is derived from the observation that the legal and regulatory framework in Uganda is biased against SMEs. This is manifested in the high-regulatory burden of registering and running enterprises in Uganda. For example, the cost of registering a business in Uganda is high. Legal proceedings in Uganda are inefficient, complex and costly only favouring firms with resources and connections. This may restrict enterprise development and increase the costs of running businesses, distort human capital and entrepreneurial moral values thereby affecting entrepreneurship capital.
Examining the influence of social capital on rural women entrepreneurship
Authors: Nasrolahi Vosta Leila , Reza Jalilvand Mohammad
Published: July 2014

Purpose

– The purpose of this paper is to study the empirical assessment of the influence of social capital on women entrepreneurship in rural regions in Iran.

Design/methodology/approach

– The study involves a questionnaire-based survey of entrepreneurial women from a number of rural regions in the Iran. A total of 265 usable questionnaires were received from rural women who were engaged in entrepreneurial activities from five rural regions. These were subjected to a series of correlational and regression analyses. The measures of the independent (the components of social capital) and dependent (the psychological traits of entrepreneurs) variables are based on literature.

Findings

– The results reveal that social capital has a positive and significant influence on rural women entrepreneurship. With strong statistical significance, three social capital factors – structural, relational, and cognitive – provide an explanation for variations in psychological traits of entrepreneurs including achievement, innovation, personal control, self-esteem, opportunism, autonomy/independence, and risk/uncertainty.

Originality/value

– Although the literature has long pointed out the importance of social capital as a determinant of entrepreneurship activity, entrepreneurship researchers have not focussed on the influence of each dimension of social capital on psychological traits of entrepreneurs. Thus, this study makes a contribution toward filling this gap.
Are Moroccan job seekers different than job creators? An exploratory study of differences in entrepreneurs and non-entrepreneurs
Authors: Hassi Abderrahman , Storti Giovanna
Published: July 2014

Purpose

– The purpose of this paper is to examine differences between Moroccan entrepreneurs and non-entrepreneurs in order to circumvent the nature and origin of their differences.

Design/methodology/approach

– This research was carried out in Morocco with a sample of 20 entrepreneurs identified as individuals who have been operating their own business or who have unsuccessfully started a small business, and a contrast sample of 20 non-entrepreneurs, classified as career professionals working for other organizations such as the public service and/or the private sector who wanted to start their own business but failed in doing so. The study methodology adopted a qualitative approach with semi-structured interviews due to the exploratory nature of the subject. The in-depth interviews were analyzed using the grounded theory approach (Glaser and Strauss, 1999).

Findings

– The findings highlight that there are no differences between entrepreneurs and non-entrepreneurs in terms of personality traits and characteristics. The interviewees emphasize the importance of financial resources, business networks and connections as vital factors in the decision to start a venture.

Research limitations/implications

– In terms of implications of the current research, understanding the determinants of entrepreneurship in Morocco is of considerable theoretical and practical value, especially given that there is no research that looks into this issue in the Moroccan context.

Practical implications

– Concerning practical implications, by identifying reasons why Moroccan young graduates, by large, show a weak entrepreneurial spirit and would rather be job seekers than potential job creators, adequate measures need to be put in place with aspirations that they will encourage the creation of more start-up businesses.

Originality/value

– Studies that compared entrepreneurs and non-entrepreneurs are far from being consistent. Moreover, the current research is the first study that looked into differences between entrepreneurs and non-entrepreneurs in Morocco.
Movement propensity and ability correlate with ecological specialization in European land snails: comparative analysis of a dispersal syndrome
Authors: Dahirel Maxime , Olivier Eric , Guiller Annie , Martin Marie‐Claire , Madec Luc , Ansart Armelle
Published: July 2014

Intra‐ and interspecific differences in movement behaviour play an important role in the ecology and evolution of animals, particularly in fragmented landscapes. As a consequence of rarer and generally more fragmented habitat, and because dispersal tends to disrupt benefits brought by local adaptation, theory predicts that mobility and dispersal should be counter‐selected in specialists.

Using experimental data and phylogenetic comparative tools, we analysed movement propensity and capacity, as well as dispersal‐related phenotypic traits, in controlled conditions in 20 species of European land snails from the Helicoidea superfamily. Costs of movement in terrestrial gastropods are among the highest in animals, which make them a potentially powerful model to test these predictions.

Habitat specialists were indeed less likely to cross a boundary between a familiar and an unfamiliar substrate than generalists. They also had smaller feet, after accounting for size. Furthermore, exploring specialists were slower than generalists and had more tortuous trajectories, leading them to stay closer to the familiar patch. Movement traits were generally evolutionary labile, but some were constrained by body size, a phylogenetically conserved trait.

High specialization and low‐dispersal ability are two traits often considered to increase species vulnerability to fragmentation, climate changes and extinction. This study confirms they should not be considered separately, due to their integration in a dispersal syndrome. Therefore, specialist species face double penalty under habitat loss and other environmental changes, making them more vulnerable to extinction and contributing to the biotic homogenization of communities.
A New Method to Pair‐match Metacarpals Using Bilateral Asymmetry and Shape Analysis
Authors: Garrido‐Varas Claudia , Rathnasinghe Raveen , Thompson Tim , Savriama Yoland
Published: July 2014

Matching pairs of skeletal elements is of fundamental importance when re‐associating skeletons from commingled settings. This study presents a new method that combines the use of traditional anthropometric size measurements and the analysis of shape, through geometric morphometrics, to form pairs from commingled settings. We tested the hypothesis that shape asymmetry among individuals is smaller than between individuals that share similar dimensions. The metacarpals were measured in their maximum length, and absolute means of asymmetry between right and left metacarpals were calculated. To analyze the shape characteristics, two‐dimensional landmarks were recorded from digital images of 111 metacarpals. The specimens were analyzed using generalized Procrustes analysis and multivariate statistics. The accuracy of pair‐matching bones using a combined method was of 100%, showing that the incorporation of geometric morphometrics techniques—in the assessment of shape in physical anthropology—is of particular use when comparing the shape differences/similarities between individuals.
Progression of liver disease in non‐alcoholic fatty liver disease: A prospective clinicopathological follow‐up study
Authors: Chan Wah‐Kheong , Ida Normiha Hilmi , Cheah Phaik‐Leng , Goh Khean‐Lee
Published: July 2014

Objective

To perform a follow‐up study on non‐alcoholic fatty liver disease (NAFLD) patients in our previous study using paired liver biopsy.

Methods

Patients who were included in our previous study on NAFLD and agreed to receive a repeat liver biopsy were included in the study. Their clinical characteristics, laboratory examination results and histological analysis on the repeat liver biopsied specimens were prospectively collected and compared with those in the previous study.

Results

Data from 35 patients (mean age 47.5 ± 10.9 years, male 40.0%) were analyzed. The mean interval between the liver biopsies was 6.4 ± 0.8 years. NAFLD activity score (NAS) worsened in 13, remained unchanged in 9 and ameliorated in 13. Fibrosis worsened in 18 and remained unchanged in 17. Two patients who were confirmed with cirrhosis at baseline developed decompensated cirrhosis. On multivariate analysis, elevated serum aspartate aminotransferase (AST) (odds ratio [OR] 10.74, 95% confidence interval [CI] 1.00–115.86, P = 0.050) and γ‐glutamyl transpeptidase (γ‐GT) (OR 16.10, 95% CI 1.30–198.90, P = 0.030) at follow‐up were associated with worsened NAS. Patients with borderline NASH at baseline were more likely to have worsened NAS at follow‐up than those with definite NASH (OR 12.67, 95% CI 2.29–70.02, P = 0.004). However, both groups had a similar likelihood of having worsened fibrosis at follow‐up. No plausible factors were found to be associated with worsened fibrosis.

Conclusions

NAFLD patients with persistently elevated serum AST and γ‐GT levels during follow‐up should be suspected of having worsened NAS. NASH patients can have significant disease progression over a relatively short period of time and fibrosis might be irreversible without specific interventions.
The use of ultrasound‐guided regional anaesthetic techniques in neonates and young infants
Authors: MARHOFER P. , LÖNNQVIST P.‐A.
Published: July 2014

Optimal pain therapy during the perioperative period or at the neonatal intensive care unit and subsequent reduced use of opioids and various sedative drugs is an important factor for patients care. The use of various regional anaesthetic techniques in experienced hands provides excellent pain relief and has the potency to reduce the requirement for perioperative mechanical ventilation. Most of regional anaesthesia techniques are applicable also in neonates and young infants and can be used in an effective and safe manner. Ultrasound guidance should be used for all regional anaesthetic techniques to increase efficacy and safety. The spectrum of indications for ultrasound‐guided regional anaesthesia in babies and infants are surgery, selective pain therapy and sympathicolysis. This review reflects an expert‐based description of the most recent developments in ultrasound‐guided regional anaesthetic techniques in babies and infants.
miR‐125a‐5p impairs endothelial cell angiogenesis in aging mice via RTEF‐1 downregulation
Authors: Che Peng , Liu Jun , Shan Zhen , Wu Ridong , Yao Chen , Cui Jin , Zhu Xiaonan , Wang Junwei , Burnett Mary Susan , Wang Shenming , Wang JinSong
Published: July 2014

Increasing evidence suggests that microRNAs (miRNAs) play important roles in impaired endothelial cell (EC) angiogenesis during aging. However, their exact roles in the aging process remain unclear. We aimed to determine whether miRNAs cause angiogenesis defects in ECs during aging and to uncover the underlying mechanisms. To study the miRNA‐induced changes in ECs during aging, we performed microarray analyses on arterial ECs collected from young and aging mice. Using qRT–PCR, we showed that microRNA‐125a‐5p (mir‐125a‐5p) expression was approximately 2.9 times higher in old endothelial cells (OECs) compared with samples collected from young animals. Western blot assays showed a lower expression level of an mir‐125a‐5p target known as related transcriptional enhancer factor‐1 (RTEF‐1) in OECs compared with its expression levels in young cells. Overexpression of mir‐125a‐5p in young endothelial cells (YECs) using pre‐mir‐125a‐5p caused the downregulation of RTEF‐1, endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) and resulted in impaired angiogenesis, as evidenced by spheroid sprouting and tube formation assays in vitro. Conversely, repression of mir‐125a‐5p in OECs using anti‐mir‐125a‐5p increased RTEF‐1, eNOS and VEGF expression and improved EC angiogenesis. Importantly, impaired angiogenesis caused by knock‐down of RTEF‐1 was not efficiently rescued by anti‐mir‐125a‐5p. Dual‐luciferase reporter gene analysis showed that RTEF‐1 is a direct target of mir‐125a‐5p, which regulates angiogenesis by repressing RTEF‐1 expression and modulating eNOS and VEGF expression. These findings indicate that mir‐125a‐5p and RTEF‐1 are potential therapeutic targets for improving EC‐mediated angiogenesis in elderly individuals.
Fibroblasts derived from long‐lived insulin receptor substrate 1 null mice are not resistant to multiple forms of stress
Authors: Page Melissa M. , Sinclair Amy , Robb Ellen L. , Stuart Jeffrey A. , Withers Dominic J. , Selman Colin
Published: July 2014

Reduced signalling through the insulin/insulin‐like growth factor‐1 signalling (IIS) pathway is a highly conserved lifespan determinant in model organisms. The precise mechanism underlying the effects of the IIS on lifespan and health is currently unclear, although cellular stress resistance may be important. We have previously demonstrated that mice globally lacking insulin receptor substrate 1 (Irs1−/−) are long‐lived and enjoy a greater period of their life free from age‐related pathology compared with wild‐type (WT) controls. In this study, we show that primary dermal fibroblasts and primary myoblasts derived from Irs1−/− mice are no more resistant to a range of oxidant and nonoxidant chemical stressors than cells derived from WT mice.
Predictors for outcomes after super‐selective mesenteric embolization for lower gastrointestinal tract bleeding
Authors: Chan Dedrick Kok Hong , Soong Junwei , Koh Frederick , Tan Ker Kan , Lieske Bettina
Published: July 2014

Background

The optimal management of bleeding from the lower gastrointestinal tract (LGIB) remains controversial. We aim to evaluate the efficacy of mesenteric embolization for LGIB and to identify predictors for re‐bleeding after the procedure.

Methods

We conducted a retrospective review of all patients who underwent mesenteric embolizations for LGIB in our institution over a 6‐year period (from August 2007 to August 2013). Technical success was defined as the absence of contrast extravasation on post‐embolization angiogram. Clinical success was defined as the absence of overt LGIB (clinical bleeding with >1 g/dL decrease in haemoglobin) within 30 days post‐embolization.

Results

Mesenteric embolization was performed in 26 patients with LGIB. Technical success rate was 100%, with no occurrence of post‐embolization ischaemia. Clinical success rate was 65.4%, with nine patients re‐bleeding within 30 days post‐embolization. Three underwent surgery, one underwent re‐embolization and five were treated conservatively. Mortality rate was 19.3% (five patients), with two bleeding‐associated mortalities. Site and aetiology of LGIB, platelet count and coagulation status prior to embolization, number of packed red blood cells and fresh frozen plasma transfusion were found to be predictors of clinical failure. After Bonferroni's correction (P < 0.005), platelet count of ≤140 × 109/L prior to embolization was the only statistically significant factor associated with re‐bleeding (odds ratio = 17.5, 95% confidence interval: 2.364–129.57; P = 0.004).

Conclusion

Mesenteric embolization was found to be safe and effective in treating LGIB (100% technical success, no post‐embolization ischaemia), with 65.4% of cases not requiring further intervention. Low platelet count prior to embolization appears to be associated with clinical failure.
Reconstruction of perineoscrotal defects in Fournier's gangrene with pedicle anterolateral thigh perforator flap
Authors: Lin Chin‐Ta , Chang Shun‐Cheng , Chen Shyi‐Gen , Tzeng Yuan‐Sheng
Published: July 2014

Background

Fournier's gangrene is an acute and potentially lethal necrotizing fasciitis that involves the scrotum and perineum. This disease can result in the extensive loss of skin and soft tissues of the perineoscrotal area with exposure of the testes. To reconstruct the large defects of scrotal and perineal remains a surgical challenge.

Methods

Between January 2008 and December 2012, 26 patients were admitted with a diagnosis of Fournier's gangrene. The Division of Plastic and Reconstructive Surgery at our hospital was consulted about patients who needed reconstructive procedures after initial debridement was performed in the Division of Colorectal Surgery or the Division of Urology. Of the 26 patients, 10 patients with large perineoscrotal defects who underwent the reconstructive surgery using pedicle anterolateral thigh (ALT) perforator flaps were enrolled in this series.

Results

We carried out the perineoscrotal reconstruction in these 10 patients using the pedicled ALT perforator flaps. They were all male with a mean age of 59.1 years (ranged from 39 to 82 years). The size of the flaps ranged from 72 to 198 cm2. All flaps survived completely but one hematoma was noticed postoperatively. All patients mobilized well with no limitation of motion, and the scrotal contour appeared to be natural.

Conclusion

Early debridement and wound coverage in Fournier's gangrene are mandatory to allow patients to return to normal life. Pedicle ALT perforator flaps provide pliable and reliable soft‐tissue coverage for large perineoscrotal defects with adequate contour that result in satisfactory function and cosmesis.
Perimortem cesarean section for maternal and fetal salvage: concise review and protocol
Authors: Drukker Lior , Hants Yael , Sharon Einav , Sela Hen Y. , Grisaru‐Granovsky Sorina
Published: July 2014

Cardiopulmonary arrest is a rare event during pregnancy and labor. Perimortem cesarean section has been resorted to as a rare event since ancient times; however, greater awareness regarding this procedure within the medical community has only emerged in the past few decades. Current recommendations for maternal resuscitation include performance of the procedure after five minutes of unsuccessful cardiopulmonary resuscitation. If accomplished in a timely manner, perimortem cesarean section can result in fetal salvage and is also critical for maternal resuscitation. Nevertheless, deficits in knowledge about this procedure are common. We have reviewed publications on perimortem cesarean section and present the most recent evidence on this topic, as well as recommending our “easy‐to‐access protocol” adapted for resuscitation following maternal collapse.
Is there an association between sonographically determined occipito‐transverse position in the second stage of labor and operative delivery?
Authors: Phipps Hala , Hyett Jon A. , Graham Kathy , Carseldine Wendy J. , Tooher Jane , de Vries Bradley
Published: July 2014

Objective

To evaluate if ultrasound‐determined occipito‐transverse position early in the second stage of labor is associated with operative delivery.

Design

Retrospective review of two prospective cohort studies.

Setting

An Australian tertiary referral hospital.

Population

Women with term, cephalic singleton pregnancies.

Methods

Retrospective analysis of data from two prospective studies. Logistic regression was undertaken to assess the independent contribution of the occipito‐transverse position to operative delivery.

Main outcome measure

Operative delivery (cesarean section, forceps or vacuum extraction).

Results

Among 422 women included, the occipito‐transverse position was present in 80, occipito‐anterior in 303 and the occipito‐posterior in 39. Compared with occipito‐anterior, the adjusted odds ratio for operative delivery was 2.1 (95% confidence interval 1.2–3.8, p = 0.02) for the occipito‐transverse position, and 7.4 (95% confidence interval 3.2–17) for the occipito‐posterior position. Factors that independently predicted operative delivery were nulliparity, abnormal second stage cardiotocography, maternal place of birth and epidural analgesia. The length of second stage of labor was longer for the occipito‐transverse group than for the occipito‐anterior group (median 2 h 7 min vs. 1 h 36 min, p = 0.003).

Conclusion

The occipito‐transverse position early in the second stage of labor was associated with an increased operative delivery rate.
Contrast sensitivity measured by two different test methods in healthy, young adults with normal visual acuity
Authors: Koefoed Vilhelm F. , Baste Valborg , Roumes Corinne , Høvding Gunnar
Published: July 2014

Purpose

This study reports contrast sensitivity (CS) reference values obtained by two different test methods in a strictly selected population of healthy, young adults with normal uncorrected visual acuity. Based on these results, the index of contrast sensitivity (ICS) is calculated, aiming to establish ICS reference values for this population and to evaluate the possible usefulness of ICS as a tool to compare the degree of agreement between different CS test methods.

Methods

Military recruits with best eye uncorrected visual acuity 0.00 LogMAR or better, normal colour vision and age 18–25 years were included in a study to record contrast sensitivity using Optec 6500 (FACT) at spatial frequencies of 1.5, 3, 6, 12 and 18 cpd in photopic and mesopic light and CSV‐1000E at spatial frequencies of 3, 6, 12 and 18 cpd in photopic light. Index of contrast sensitivity was calculated based on data from the three tests, and the Bland–Altman technique was used to analyse the agreement between ICS obtained by the different test methods.

Results

A total of 180 recruits were included. Contrast sensitivity frequency data for all tests were highly skewed with a marked ceiling effect for the photopic tests. The median ICS for Optec 6500 at 85 cd/m2 was −0.15 (95% percentile 0.45), compared with −0.00 (95% percentile 1.62) for Optec at 3 cd/m2 and 0.30 (95% percentile 1.20) FOR CSV‐1000E. The mean difference between ICSFACT85 and ICSCSV was −0.43 (95% CI −0.56 to −0.30, p < 0.00) with limits of agreement (LoA) within −2.10 and 1.22. The regression line on the difference of average was near to zero (R2 = 0.03).

Conclusion

The results provide reference CS and ICS values in a young, adult population with normal visual acuity. The agreement between the photopic tests indicated that they may be used interchangeably. There was little agreement between the mesopic and photopic tests. The mesopic test seemed best suited to differentiate between candidates and may therefore possibly be useful for medical selection purposes.
Adverse drug reactions – examples of detection of rare events using databases
Authors: Chan Esther W. , Liu Kirin Q. L. , Chui Celine S. L. , Sing Chor‐Wing , Wong Lisa Y. L. , Wong Ian C. K.
Published: July 2014

It is recognised that randomised controlled trials are not feasible for capturing rare adverse events. There is an increasing trend towards observational research methodologies using large population‐based health databases. These databases offer more scope for adequate sample sizes, allowing for comprehensive patient characterisation and assessment of the associated factors. While direct causality cannot be established and confounders cannot be ignored, databases present an opportunity to explore and quantify rare events. The use of databases for the detection of rare adverse events in the following conditions, sudden death associated with attention deficit hyperactivity disorder (ADHD) treatment, retinal detachment associated with the use of fluoroquinolones and toxic epidermal necrolysis associated with drug exposure, are discussed as examples. In general, rare adverse events tend to have immediate and important clinical implications and may be life‐threatening. An understanding of the causative factors is therefore important, in addition to the research methodologies and database platforms that enable the undertaking of the research.
Verapamil decreases the glucose‐lowering effect of metformin in healthy volunteers
Authors: Cho Sung Kweon , Kim Choon Ok , Park Eun Seok , Chung Jae‐Yong
Published: July 2014

Aim

The organic cation transporter 1 (OCT1) plays a key role in the cellular transport of metformin and its subsequent glucose‐lowering effect. A recent non‐clinical study reported that metformin uptake into hepatocytes is regulated via OCT1, and that uptake was strongly inhibited by verapamil. Therefore, we investigated the effects of verapamil co‐administration on the pharmacokinetics and pharmacodynamics of metformin in humans.

Methods

We evaluated the pharmacokinetics and the anti‐hyperglycaemic effects of metformin using an oral glucose tolerance test (OGTT) in 12 healthy participants, before (day 1) and after metformin treatment (day 2), and again on days 15 and 16 after co‐administration with verapamil.

Results

Verapamil inhibited the ability of metformin to reduce maximum blood glucose concentrations (ΔGmax) by 62.5% (P = 0.008) and decreased the area under the glucose concentration–time curve (ΔAUCgluc) by 238% (P = 0.015). However, verapamil did not significantly alter the Cmax and the AUC of metformin, nor its renal clearance.

Conclusions

Our results suggest that verapamil remarkably decreases the glucose‐lowering effect of metformin, possibly by acting as a competitive inhibitor of OCT1.
The efficacy and tolerability of cariprazine in acute mania associated with bipolar I disorder: a phase II trial
Authors: Durgam Suresh , Starace Anju , Li Dayong , Migliore Raffaele , Ruth Adam , Németh György , Laszlovszky István
Published: July 2014

Objectives

Cariprazine, an orally active and potent dopamine D3 and D2 receptor partial agonist with preferential binding to D3 receptors, is being developed for the treatment of schizophrenia and bipolar mania. This Phase II trial evaluated the efficacy, safety, and tolerability of cariprazine versus placebo in the treatment of acute manic or mixed episodes associated with bipolar I disorder.

Methods

This was a multinational, randomized, double‐blind, placebo‐controlled, flexible‐dose study of cariprazine 3–12 mg/day in patients with acute manic or mixed episodes associated with bipolar I disorder. Following washout, patients received three weeks of double‐blind treatment. The primary and secondary efficacy parameters were change from baseline to Week 3 in Young Mania Rating Scale (YMRS) and Clinical Global Impressions–Severity (CGI‐S) scores, respectively. Post‐hoc analysis evaluated changes on YMRS single items.

Results

In each group, 118 patients received double‐blind treatment; 61.9% of placebo and 63.6% of cariprazine patients completed the study. The overall mean daily dose of cariprazine was 8.8 mg/day. At Week 3, cariprazine significantly reduced YMRS and CGI‐S scores versus placebo, with least square mean differences of −6.1 (p < 0.001) and −0.6 (p < 0.001), respectively. On each YMRS item, change from baseline to Week 3 was significantly greater for cariprazine versus placebo (all, p < 0.05). A significantly greater percentage of cariprazine patients than placebo patients met YMRS response (48% versus 25%; p < 0.001) and remission (42% versus 23%; p = 0.002) criteria at Week 3. Adverse events (AEs) led to discontinuation of 12 (10%) placebo and 17 (14%) cariprazine patients. The most common AEs (> 10% for cariprazine) were extrapyramidal disorder, headache, akathisia, constipation, nausea, and dyspepsia. Changes in metabolic parameters were similar between groups, with the exception of fasting glucose; increases in glucose were significantly greater for cariprazine versus placebo (p < 0.05). Based on Barnes Akathisia Rating Scale and Simpson–Angus Scale scores, more cariprazine than placebo patients experienced treatment‐emergent akathisia (cariprazine: 22%; placebo: 6%) or extrapyramidal symptoms (parkinsonism) (cariprazine: 16%; placebo: 1%).

Conclusion

Cariprazine demonstrated superior efficacy versus placebo and was generally well tolerated in patients experiencing acute manic or mixed episodes associated with bipolar I disorder.