bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of seven numerical methods for determining Weibull parameters of wind for sustainable energy in Douala, Cameroon
Authors: Kengne Signe Elie Bertrand , Kanmogne Abraham , Emmanuel Guemene D. , Meva’a Lucien
Published: May 2019

Purpose

The purpose of this paper is contribution to estimate the potential of wind energy in Douala in Cameroon, by modeling and predicting the regime of wind. The paper deals with the analysis and comparison of seven numerical methods for the assessment of effectiveness in determining the parameters for the Weibull distribution, using wind speed data collected at Douala International Airport in Cameroon, in the period from September 2011 to May 2013, obtained by meteorological equipment belonging to the Laboratory of Energy Research of the Institute of Geological and Mining Research.

Design/methodology/approach

By using ANOVA, root mean square error and chi-square tests to compare the proposed methods, this study aims to determine which methods are effective in determining the parameters of the Weibull distribution for the available data, in an attempt to establish acceptable criteria for better usage of wind power in Douala, which is the economic capital and ought to have prominence in the use of renewable sources for electricity generation in Cameroon.

Findings

The study helps to determine that moment, empirical and energy pattern factor methods used to determine the shape parameter k and the scale parameter c of the Weibull distribution present a better curve fit with the histogram of the wind speed. This fact is clearly validated by means of the statistical tests. But, all the seven methods gave excellent performance. Then, k reaching levels ranging from 3.5 to 5.5 and c range from 1.7 to 2.4.

Originality/value

Then as far as we are concerned, for a significant contribution, it could be more effective to have a model for prediction of wind characteristics using wind data collected per hour, one at least three years. A comparison of results obtained from lots of other methods (seven in this case) is necessary before an efficient discussion. Standard deviations and errors between measured and predicted data must also be presented.
Improving pediatric experience of pain during vaccinations: a quality improvement project
Authors: MacDougall Terri , Cunningham Shawna , Whitney Leeann , Sawhney Monakshi
Published: May 2019

Purpose

The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC).

Design/methodology/approach

The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project.

Findings

Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form.

Research limitations/implications

This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide.

Practical implications

Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice.

Originality/value

This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.
In-work poverty: reversing a trend through business commitment
Authors: Panagiotakopoulos Antonios
Published: May 2019

Purpose

This study aims to explore whether employer action may contribute towards reducing in-work poverty. Essentially, the study examines the extent to which small firm owners accept as being among their core responsibilities the support of the working poor both from an ethical and financial perspective. It further explores the impact of employee-friendly policies to support the working poor on the organizational performance of small enterprises.

Design/methodology/approach

A qualitative approach was adopted consisting of 60 responses from 30 small firm owners and 30 employees. More specifically, the study draws on the empirical data collected through face-to-face semi-structured interviews with the firm owners of 30 low-paying enterprises operating in Greece and 30 employees working in those firms.

Findings

The findings reveal that employer measures to reduce in-work poverty such as systematic training, travel allowance, provision of free meals and retail vouchers, bonus schemes and other indirect financial rewards do enhance overall employee well-being, which, in turn, makes employees more engaged with their work and motivate them to “go the extra mile” for their employer. As a result, organizations appear to enjoy several benefits including less absenteeism and staff turnover, reduced errors in production and increased productivity.

Practical implications

The present analysis argues that a narrow focus by policymakers on both direct and indirect governmental measures (e.g. an increase of the minimum wage, childcare and housing support) to reduce in work-poverty could be problematic as there are employer instruments that could also have a direct and indirect impact on employee income that could be useful when thinking about how in-work poverty can best be addressed. The empirical work showed that the above-mentioned measures have the potential to bring various organizational benefits including increased staff loyalty, less absenteeism, improved customer service and increased productivity. Such findings indicate that there is a strong business case for employers to combat in-work poverty and provide “better” jobs to individuals.

Originality/value

The emphasis of research around in-work poverty has been placed predominantly on welfare state measures to support the working poor, whereas the contribution of employers has been ignored. The present study fills this knowledge gap by leading to a better understanding of whether there is a business case for employers to fight in-work poverty.
Dialectical logic for mythical and mystical superstructural systems (ii)
Authors: Usó Doménech José Luis , Nescolarde-Selva Josué Antonio , Gash Hugh , Segura-Abad Lorena
Published: May 2019

Purpose

The distinction between essence and existence cannot be a distinction in God: in the actual infinite, essence and existence coincide and are one. In it, maximum and minimum coincide. Coincidentia oppositorum is a Latin phrase meaning coincidence of opposites. It is a neo-Platonic term, attributed to the fifteenth-century German scholar Nicholas of Cusa in his essay, Docta Ignorantia. God (coincidentia oppositorum) is the synthesis of opposites in a unique and absolutely infinite being. God transcends all distinctions and oppositions that are found in creatures. The purpose of this paper is to study Cusanus’s thought in respect to infinity (actual and potential), Spinoza’s relationship with Cusanus, and present a mathematical theory of coincidentia oppositorum based on complex numbers.

Design/methodology/approach

Mathematical development of a dialectical logic is carried out with truth values in a complex field.

Findings

The conclusion is the same as has been made by thinkers and mystics throughout time: the inability to know and understand the idea of God.

Originality/value

The history of the Infinite thus reveals in both mathematics and philosophy a development of increasingly subtle thought in the form of a dialectical dance around the ineffable and incomprehensible Infinite. First, the authors step toward it, reaching with their intuition beyond the limits of rationality and thought into the realm of the paradoxical. Then, they step back, struggling to express their insight within the limited scope of reason. But the Absolute Infinite remains, at the border of comprehensibility, inviting them with its paradoxes, to once again step forward and transcend the apparent division between finite and Infinite.
Balancing centralization and decentralization management at University of Bahrain
Authors: Alhamad Bassam Mohamed , Aladwan Rama
Published: May 2019

Purpose

There is no such thing as a truly centralized or decentralized management system. With regard to universities, most of the key areas in universities are centralized, e.g. finance, personnel, curriculum, management and quality. These key areas will exhibit a higher impact on learning and research by maintaining the appropriate balance between centralization and decentralization approaches. The purpose of this paper is to study the key features of balanced management implemented within the internal quality assurance system at the University of Bahrain. Areas of such balance will be explained while showing theprosandconsof each management approach.

Design/methodology/approach

In this paper, both quantitative and qualitative surveys were used to study this balanced approach.

Findings

The centralization approach at the university maintained systematic compliance through the development of policies and procedures, quality structure and a clear framework for quality enhancement. Centralization ensured consistency in quality, programmes and activities. It also maintained diffusion of innovation, for example, sharing and transferring the knowledge of international accreditation practices to other colleges. The balance of the centralized with the decentralized management approach provided additional advantages. For example, the management shared the vision of decentralization to raise the level of responsibility and accountability. The management provided an acceptable level of authority to take on spot decisions; hence, building expertise at the decentralized levels. However, this would require support and capacity building to ensure directly responsible persons, who can take on spot decisions. The ownership of the self-improvement cycles was implemented at the level of the departments and colleges.

Practical implications

This study showed that this balanced management had a great influence to maximize the benefits of the internal quality assurance (IQA) system, as it showed that 71.4 and 67.3 per cent of the academic and administrative staff, respectively, found that the IQA system was effective.

Originality/value

This balanced approach would guide the universities to enhance its quality system by organizing its structure, processes and systems in a harmonized nature.
Attitude of Russian teachers towards the new standards
Authors: Khanolainen Daria
Published: May 2019

Purpose

In 2010, the Russian Federation began introducing the new educational standards as a national reform designed to improve education quality. This study aims to identify how teachers feel about the reform to evaluate its intermediate effects.

Design/methodology/approach

The study took place in Tatarstan, one of the regions of Russia. The mixed-methods sequential explanatory design was used: the first phase involved a survey for 123 teachers and at the second phase 10 teachers participated in semi-structured face-to-face interviews.

Findings

The findings of the study reveal that most teachers are still adapting to the new standards and feel only partly prepared to work within the new system. Teachers acknowledge that the reform is necessary, but there are some confusion and disagreement about what the new standards imply and how they should be implemented.

Practical implications

The study argues that teachers have to both feel positive about reforms and perceive themselves to be prepared to address them before they can feel motivated to support them. The results might have been affected by social desirability bias as the number of those viewing the new standard positively is overwhelmingly high. At the same time, teachers report low levels of motivation.

Originality/value

There is a clear dearth in scholarly literature dealing with the Russian educational context and available in English. In addition, there is hardly any research on Russian teachers’ motivation and attitude towards the new educational standards.
Expo 2020 and sustainability: luxury hotel properties challenges and future outlook
Authors: Giardina Giuliana
Published: May 2019

Purpose

The purpose of this study is to know about the recent environmental changes that have impacted society worldwide have led to increased interest in and attention to the topic of sustainability. A good example of this new trend is provided by the Expo 2020, which is focussing on sustainability as one of the key sub-themes of the event.

Design/methodology/approach

This study explores guests’ and employees’ perspectives on the deployment of sustainable practices in hotels. Particular attention is placed on the identification of challenges and drivers of sustainable practices in luxury hotel properties in Dubai.

Findings

The discoveries made during the study hold meaningful implications for industry professionals and provide insightful recommendations for the upcoming Expo 2020, which can be leveraged as a tool to increase awareness and drive education on effective sustainable practices.

Originality/value

With 35 different nationalities contributing to the data collection, the present study provides a diverse sample, enabling the researcher to shed light on the previously identified literature contradictions.
Conclusions: Expo 2020 and its impact on Dubai
Authors: Nadkarni Sanjay
Published: May 2019

Purpose

This concluding paper aims to review the contribution made by this theme issue to the body of knowledge on Dubai as a host city for Expo 2020 and the impact of such mega events overall on the host destinations.

Design/methodology/approach

A content analysis of the contributing articles selected for this theme issue was undertaken.

Findings

The summary paper highlights the key takeaways relating to Expo 2020 Dubai that will help inform policy making and decision-making for stakeholders in Dubai’s economy.

Research limitations/implications

Retaining and nurturing the vibrancy of Dubai’s cosmopolitan and diverse socio-economic landscape in the run-up to and after the Expo are as much an opportunity as they are a challenge. The outcomes and recommendations emanating from the papers provide stakeholders with the tools to consider and mitigate risks.

Originality/value

This theme issue makes a significant scholarly contribution towards understanding the dynamics of Dubai as a destination on the verge of hosting a mega event and captures the zeitgeist of the pre-event planning and post-event strategies in “connecting minds, creating the future”, which is the theme of Expo 2020.
The employment of people with special needs within hotels in Dubai
Authors: Al Fardan Alia , Morris Stephanie
Published: May 2019

Purpose

The purpose of this paper is to identify the challenges and benefits of hiring individuals with special needs in the hospitality industry in Dubai; understand management, colleague and customer perspectives concerning the integration of individuals with special needs in the workforce; emphasize the need for awareness, communication and training when introducing special needs employees to hotel properties in Dubai; recognize laws and policies in respect to introducing the special needs workforce in hotels in Dubai; and classify the requirements needed to facilitate accessibility and integration of special needs employees in the workforce.

Design/methodology/approach

Qualitative research was conducted to better comprehend the benefits, challenges, policies/legalities and perceptions developed when considering employment practices of individuals with disabilities. Interviews with HR directors/managers in hotels in Dubai were conducted using a snowball sampling approach.

Findings

This study suggests that hotels in Dubai must increase their efforts to accommodate the special needs market through the provision of accessible areas, changes in perceptions and enactment of coherent laws and policies to prepare for the inflow of disabled tourists during Expo 2020. Further, that these efforts can be better accomplished by employment of individuals with special needs.

Originality/value

High turnover costs and shortages of labor in the hospitality industry have led to the need for the non-traditional labor force to fill the demand created by the upcoming Expo 2020. As the UAE won the bid for Expo 2020, there has been early construction of hotels to adapt to the increased demand in jobs by and influx of tourists including individuals with disabilities.
Interaction engineering: Non‐trophic effects modify interactions in an insect galler community
Authors: Barbosa Milton , Fernandes G. Wilson , Morris Rebecca J.
Published: May 2019

Theory suggests that non‐trophic interactions can be a major mechanism behind community stability and persistence, but community‐level empirical data are scarce, particularly for effects on species interactions mediated through changes in the physical environment.

Here, we explored how ecosystem engineering effects can feed back to the engineer, not only modulating the engineer’s population density (node modulation) but also affecting its interactions with other species (link modulation).

Gall induction can be viewed as ecosystem engineering since galls serve as habitat for other species. In a community‐level field experiment, we generated treatments with reduced or elevated ecosystem engineering by removing or adding post‐emergence galls to different plots of their host plant in the Brazilian Cerrado. We tested the effect of post‐emergence galls on the galler, as well as on the galler–parasitoid and galler—aphid interactions.

The manipulation of post‐emergence galls had little effect on the galler—abundance and survivorship were not affected, and gall volume changed only slightly—but modified interactions involving the galler, parasitoid wasps and inquiline aphids. Aphid inquilines negatively affected density‐dependent parasitism rates (interaction modification) likely by killing parasitised galling larvae. Post‐emergence galls interfered with aphid inquilinism—likely by the provision of alternative habitat for aphids—and thus interfered with the negative effect of aphids on parasitism (modification of an interaction modification).

This work is one of the few studies to demonstrate experimentally the role played by environment‐mediated interaction modification at a community level in the field. Moreover, by manipulating a species’ ecosystem engineering effect (post‐emergence galls) instead of the species itself, we demonstrate the novel result that populations can be regulated by non‐trophic effects initiated by their own activities that alter their interaction with other species. This reveals that indirect interactions mediated via the environment offer new pathways of feedback loops for population regulation. Our results indicate that interaction modification has the potential to be a key regulatory mechanism underlying interaction variation in nature, and play a major role in community structure, dynamics and stability.
Deep and intermediate complex morphophysiological dormancy in seeds of Ferula gummosa (Apiaceae)
Authors: Zardari Sanaz , Ghaderi‐Far Farshid , Sadeghipour Hamid R. , Zeinali Ebrahim , Soltani Elias , Baskin Carol C.
Published: May 2019

We tested the hypothesis that seeds of the monocarpic perennial Ferula gummosa from the Mediterranean area and central Asia have deep complex morphophysiological dormancy. We determined the water permeability of seeds, embryo morphology, temperature requirements for embryo growth and seed germination and responses of seeds to warm and cold stratification and to different concentrations of GA3. The embryo has differentiated organs, but it is small (underdeveloped) and must grow inside the seed, reaching a critical embryo length, seed length ratio of 0.65–0.7, before the seed can germinate. Seeds required 9 weeks of cold stratification at <10°C for embryo growth, dormancy break and germination to occur. Thus, seeds have morphophysiological dormancy (MPD). Furthermore, GA3 improved the germination percentage and rate at 5°C and promoted 20 and 5% germination of seeds incubated at 15 and 20°C, respectively. Thus, about 20% of the seeds had intermediate complex MPD. For the other seeds in the seed lot, cold stratification (5°C) was the only requirement for dormancy break and germination and GA3 could not substitute for cold stratification. Thus, about 80% of the seeds had deep complex MPD.
Development of Novel Shortenings Structured by Ethylcellulose Oleogels
Authors: Ye Xiuyun , Li Peixu , Lo Y. Martin , Fu Hong , Cao Yanping
Published: May 2019

A novel shortening was developed based on oleogels structured by ethylcellulose (EC) polymers. The texture and oil retention ability of EC oleogels were characterized against the level of viscosity of different grades of EC, as well as the rheological properties in relation to the polymer structure in the gel network. EC100, which has an average viscosity of 100 cP, was selected as the most suitable organogelator at 4% (w/w) in combination with base oil (30% degree of saturation by mixing palm stearin and soybean oil) to form the shortening. Triglyceryl monostearate (TMS) was found to be the most effective emulsifier as evidenced by its ability to strengthen air‐incorporation ability of the shortening while creating evenly distributed fine crystals in the system. The EC100 shortening was able to create breads with excellent specific volume, indicating its ability to incorporate air bubbles during dough development and to serve as an antifirming agent to create bread with stable soft texture.

Practical Application

In the present study, we attempted to create a novel shortening by employing oleogels structured by ethylcellulose (EC), the most promising gelation agent to develop gel network capable of replacing solid fat without health concerns. EC oleogels in shortening with detailed characterization of the shortening microstructure in relation to its functional properties was elucidated. The optimal formulation in relation to preservation of gel structure and consistency with enhanced moisture and air retention were also identified.
Physicochemical Characterization of Yellow Cake Prepared with Structured Lipid Oleogels
Authors: Willett Sarah A. , Akoh Casimir C.
Published: May 2019

Oleogels were produced using a phytosterol blend of β‐sitosterol/γ‐oryzanol or a blend of sucrose stearate/ascorbyl palmitate (SSAP) as oleogelators. Four lipid phases were compared in oleogel formation for each oleogelator blend: menhaden oil, structured lipid (SL) of menhaden oil and 30 mol% caprylic acid (SL‐C), SL of menhaden oil and 20 mol% stearic acid (SL‐S), and SL of menhaden oil and 14 mol% each of caprylic and stearic acid (SL‐CS). All SLs were produced enzymatically using a recombinant lipase from Candida antarctica as the biocatalyst. Menhaden oil, SL, phytosterol, or SSAP oleogels were evaluated as alternatives to shortening in the preparation of yellow cake in terms of batter and cake physicochemical properties. The shortening, phytosterol, and SSAP oleogel batters exhibited statistically similar specific gravities (0.85). The shortening, and menhaden oil phytosterol and SSAP oleogel batters, exhibited similar Power‐Law values (n: 0.78, k: 31 Pa sn), while all SL (and respective oleogels) batters typically had lower flow index values (n: 0.68 to 0.72), and higher consistency index values (k: 45 to 79 Pa sn). All SL (and respective oleogels) cakes exhibited lower hardness (5 to 8 N) and chewiness (4 to 6 N) than the shortening cake (12 N, 9 N). Menhaden oil and SL‐S phytosterol oleogel cakes, and SL‐CS SSAP oleogel cake, showed similar textural properties to the shortening cake. Both phytosterol and SSAP oleogels were acceptable as zero trans‐fat substitutes for shortening in yellow cake.

Practical Application

The oleogels in this study may be a suitable replacement for shortening in yellow cake. These oleogels, which contain health beneficial omega‐3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have the potential to lower consumer consumption of total saturated fat when used in foods.
Long‐term microbial community dynamics at two full‐scale biotrickling filters treating pig house exhaust air
Authors: Van der Heyden Caroline , De Mulder Thijs , Volcke Eveline I. P. , Demeyer Peter , Heyndrickx Marc , Rasschaert Geertui
Published: May 2019

In this study, the microbial community structure of two full‐scale biotrickling filters treating exhaust air from a pig housing facility were evaluated using 16S metabarcoding. The effect of inoculation with activated sludge of a nearby domestic waste water treatment plant was investigated, which is a cheap procedure and easy to apply in practice. The study was performed at a three‐stage and a two‐stage full‐scale biotrickling filter; of which, only the latter was inoculated. Both biotrickling filters evolved towards a rather similar community over time, which differed from the one in the activated sludge used for inoculation. However, the bacterial population at both biotrickling filters showed small differences on the family level. A large population of heterotrophic bacteria, including denitrifying bacteria, was present in both biotrickling filters. In the non‐inoculated biotrickling filter, nitrite‐oxidizing bacteria (NOB) could not be detected, which corresponded with the incomplete nitrification leading to high nitrite accumulation observed in this system. Inoculation with the wide spectrum inoculum activated sludge had in this study a positive effect on the biotrickling filter performance (higher ammonia removal and lower nitrous oxide production). It could thus be beneficial to inoculate biotrickling filters in order to enrich NOB at the start‐up, making it easier to keep the free nitrous acid concentration low enough to not be inhibited by it.
Asset Disposal as a Method of Real Earnings Management: Evidence from the UK
Authors: Campa Domenico , Cao Tongyu , Donnelly Ray
Published: May 2019

We examine asset sales as a method of real earnings management around the benchmarks of loss avoidance and last year's earnings. Evidence is reported of asset sales to boost or reduce earnings near the benchmark of last year's earnings. For the zero earnings benchmark our results are moderated by the opening balance of accruals: only firms with high levels of accruals use asset sales to boost earnings to avoid a loss and only firms with low levels of accruals use asset sales as part of a big bath. We suggest that firms with high accrual balances find it difficult to use additional income‐increasing accruals but find it more convenient to write off accruals rather than sell assets to artificially reduce earnings. International Financial Reporting Standards (IFRS) are associated with reduced use of asset sales for gains and especially with reduced asset sales for losses. We ascribe this to IFRS introducing additional judgement and estimation in relation to the valuation of both long‐lived and current assets on a recurring basis.
Effectiveness of switching to very low nicotine content cigarettes plus nicotine patch versus reducing daily cigarette consumption plus nicotine patch to decrease dependence: an exploratory randomized trial
Authors: Klemperer Elias M. , Hughes John R. , Callas Peter W. , Benner Joy A. , Morley Nicholas E.
Published: May 2019

Background and Aims

The United States Food and Drug Administration has proposed regulation to require that cigarettes contain very low nicotine content (VLNC). In contrast, reducing the number of cigarettes per day (CPD) is the most common current method to reduce nicotine. This trial aims to explore whether gradually transitioning to VLNC cigarettes plus nicotine patch or reducing CPD plus nicotine patch is more effective at decreasing nicotine dependence.

Design

A two‐arm, individually randomized open‐label trial.

Setting

Community setting, Vermont, USA.

Participants

Sixty‐eight adult daily smokers (40% female) of ≥ 10 cigarettes/day who were not planning to quit in the next 30 days.

Interventions

All participants smoked study cigarettes with a nicotine yield similar to most commercial cigarettes ad libitum for 1 week (baseline). Participants then gradually reduced to 70, 35, 15 and 3% of baseline nicotine over 4 weeks by either (a) transitioning to lower nicotine content cigarettes (n = 36) or (b) reducing the number of full nicotine cigarettes (n = 32). All participants received nicotine patches.

Measurements

The primary outcome was change in nicotine dependence assessed at baseline and weekly during the intervention with the Nicotine Dependence Syndrome Scale.

Findings

Dependence declined over time for both VLNC and CPD participants, but declined more for VLNC (mean decrease in Z‐score of 1.0) than CPD (mean decrease in Z‐score of 0.5) participants over time (interaction P = 0.018).

Conclusions

Transitioning to very low nicotine content cigarettes reduced nicotine dependence over a 4‐week period to a greater extent than reducing cigarettes per day when both conditions were aided by nicotine patch.
Prescription opioid use patterns, use disorder diagnoses and addiction treatment receipt after the 2014 Medicaid expansion in Oregon
Authors: Springer Rachel , Marino Miguel , Bailey Steffani R. , Angier Heather , O'Malley Jean P. , Hoopes Megan , Lindner Stephan , DeVoe Jennifer E. , Huguet Nathalie
Published: May 2019

Background/Aims

Evidence suggests that Medicaid beneficiaries in the United States are prescribed opioids more frequently than are people who are privately insured, but little is known about opioid prescribing patterns among Medicaid enrollees who gained coverage via the Affordable Care Act Medicaid expansions. This study compared the prevalence of receipt of opioid prescriptions and opioid use disorder (OUD), along with time from OUD diagnosis to medication‐assisted treatment (MAT) receipt between Oregon residents who had been continuously insured by Medicaid, were newly insured after Medicaid expansion in 2014 or returned to Medicaid coverage after expansion.

Design

Cross‐sectional study using inverse‐propensity weights to adjust for differences among insurance groups.

Setting

Oregon.

Participants

A total of 225 295 Oregon Medicaid adult beneficiaries insured during 2014–15 and either: (1) newly enrolled, (2) returning in 2014 after a > 12‐month gap or (3) continuously insured between 2013 and 2015. We excluded patients in hospice care or with cancer diagnoses.

Measurements

Any opioid‐dispensed, chronic (> 90‐days) and high‐dose (> 90 daily morphine milligram equivalence) opioid use, documented OUD diagnosis and MAT receipt.

Findings

Compared with the continuously insured, newly and returning insured enrollees were less likely to be dispensed opioids [newly: 42.3%, 95% confidence interval (CI) = 42.0–42.7%; returning: 49.3%, 95% CI = 48.8–49.7%; continuously: 52.5%, 95% CI = 52.0–53.0%], use opioids chronically (newly: 12.8%, 95% CI = 12.4–13.1%; returning: 11.9%, 95% CI = 11.5–12.3%, continuously: 15.8%, 95% CI = 15.4–16.2%), have OUD diagnoses (newly: 3.6%, 95% CI = 3.4–3.7%; returning: 3.9%, 95% CI = 3.8–4.1%, continuously: 4.7%, 95% CI = 4.5–4.9%) and receive MAT after OUD diagnosis [hazard ratio newly: 0.57, 95% CI = 0.53–0.61; hazard ratio returning: 0.60, 95% CI = 0.56–0.65 (ref: continuously)].

Conclusions

Residents of Oregon, United States who enrolled or re‐enrolled in Medicaid health insurance after expansion of coverage in 2014 as a result of the Affordable Care Act were less likely than those already covered to receive opioids, use them chronically or receive medication‐assisted treatment for opioid use disorder.
Morphological assessment of cat kidneys using computed tomography
Authors: Darawiroj Damri , Choisunirachon Nan
Published: May 2019

There are numerous publications about feline renal imaging information; however, none have established reference values for kidney size using computed tomography (CT). This study aimed to determine renal size and shape as well as the morphology of renal‐related structures in clinically normal cats (Felis catus) that underwent CT. Twenty‐seven healthy cats underwent pre‐ and post‐iodinated contrast‐enhanced CT. Most cat (59%) kidneys were located at the same level. The average pre‐contrast dimensions of the left kidney included a width of 2.46 ± 0.28 cm, a length of 3.52 ± 0.44 cm and a height 2.19 ± 0.31 cm, whereas those of the right kidneys were 2.45 ± 0.27 cm, 3.54 ± 0.46 cm and 2.05 ± 0.23 cm, respectively. After contrast enhancement, kidneys were slightly enlarged though not significantly. Additionally, renal length (LK or RK) was compared with second lumbar vertebra (L2) length and abdominal aorta diameter (AO). AO was significantly larger in male cats whereas L2 length appeared longer in male cats, but was not statistically different from the female cats. The LK/L2 and RK/L2 ratios were 2.29 ± 0.23 and 2.36 ± 0.20, respectively, and the LK/AO and RK/AO were 11.72 ± 1.37 and 12.05 ± 1.47, respectively. Renal vessels were examined. The renal vein was obviously larger than the renal artery, and paired renal veins were observed periodically. This study provides CT information about the feline kidney, which may help to establish reference values and information regarding renal structure prior to surgery in practice.
Cultural difference in maladaptive functions of perfectionistic self‐presentation
Authors: Wang Yiheng , Li Liman Man Wai , Xie Fuzhe
Published: May 2019

Perfectionistic self‐presentation (PSP), which describes an expressive aspect of perfectionism in the interpersonal domain, is a defensive form of perfectionism that has been relatively understudied. Although existing evidence obtained from Western societies has consistently shown maladaptive functions of PSP, the question of whether these patterns are universal remains unanswered. The current research explored the potential moderating effect of culture by evaluating whether the negative influence of PSP is weaker in Asian societies that encourage the use of defensive interpersonal strategies than in Western societies. Two studies recruiting Chinese and North American participants were conducted. In Study 1 (n = 302), the results showed that the relation between PSP and personal mastery was positive among Chinese participants and was negative among North American participants. In contrast, a positive relation between PSP and perceived constraints was observed in both cultures. Study 2 (n = 295) replicated the findings obtained in Study 1. In addition, the findings showed that the relation between PSP and self‐esteem, but not that between PSP and depression, was moderated by participants’ cultural backgrounds. Taken together, these results indicate both universal and culturally specific patterns regarding the influence of PSP, suggesting that PSP is a complex construct.
Duodenal eosinophilia is associated with functional dyspepsia and new onset gastro‐oesophageal reflux disease
Authors: Ronkainen Jukka , Aro Pertti , Walker Marjorie M. , Agréus Lars , Johansson Sven‐Erik , Jones Mike , Talley Nicholas J.
Published: May 2019

Background

It is unexplained why functional dyspepsia and gastro‐oesophageal reflux disease (GERD) overlap more often than expected by chance. Post‐prandial distress syndrome has been linked to impaired gastric fundic accommodation which may induce increased transient lower oesophageal sphincter relaxations and consequent GERD. Duodenal eosinophilia has been linked to functional dyspepsia and post‐prandial distress syndrome.

Aim

To identify if there is an association between duodenal eosinophilia in functional dyspepsia and symptoms of GERD and whether post‐prandial distress syndrome or epigastric pain syndrome are associated with new onset GERD.

Methods

Participants (n = 1000) were randomly selected from the national Swedish population register and surveyed by questionnaires and oesophagogastroduodenoscopy in 1999‐2001. All eligible subjects (n = 887) were invited to a follow‐up study in 2010 (response rate 79%). In a case‐control study of 213 subjects (functional dyspepsia vs healthy controls), histology from the duodenum was evaluated at baseline and the possible association of eosinophilia to new onset GERD symptoms was analysed.

Results

Functional dyspepsia (OR 7.6; 95% CI 2.93‐19.4, P < 0.001) and post‐prandial distress syndrome at baseline (OR 9.0, 95% CI 3.36‐24.0, P < 0.001) were associated with an increased risk of GERD at follow‐up. Eosinophilia in the second part of duodenum only was independently associated with an increased risk of GERD amongst those with functional dyspepsia (OR 4.2; 95% CI 1.2‐4.77, P = 0.024) and post‐prandial distress syndrome at baseline (OR 6.0; 95% CI 1.50‐23.6, P = 0.011), respectively.

Conclusions

Duodenal eosinophilia is associated with increased risk of GERD at 10‐year follow‐up in those with functional dyspepsia and post‐prandial distress syndrome at baseline. Duodenal eosinophilia may explain the link between GERD and functional dyspepsia, suggesting subsets of functional dyspepsia and GERD may be part of the same disease spectrum.
Why the embryo rescue case is a bad argument against embryonic personhood
Authors: Hendricks Perry
Published: May 2019

The embryo rescue case (ERC) is a thought experiment that is used to argue against the view that embryos have a right to life (i.e., are persons). I will argue that cognitive science undermines the intuition elicited by the ERC. I will show that whether or not embryos have a right to life, our mental tools will make it very difficult to believe that they do have the said right. This suggests that the intuition elicited by the ERC is not truth‐indicative. The upshot of this is that we have an undercutting defeater for our intuition that embryos do not have a right to life. Thus, the ERC is a bad argument against embryonic personhood.
A four‐group urine risk classifier for predicting outcomes in patients with prostate cancer
Authors: Connell Shea P. , Yazbek‐Hanna Marcelino , McCarthy Frank , Hurst Rachel , Webb Martyn , Curley Helen , Walker Helen , Mills Rob , Ball Richard Y. , Sanda Martin G. , Pellegrini Kathryn L. , Patil Dattatraya , Perry Antoinette S. , Schalken Jack , Pandha Hardev , Whitaker Hayley , Dennis Nening , Stuttle Christine , Mills Ian G. , Guldvik Ingrid ,   Movember GAP1 Urine Biomarker Consortium, Parker Chris , Brewer Daniel S. , Cooper Colin S. , Clark Jeremy
Published: May 2019

Objectives

To develop a risk classifier using urine‐derived extracellular vesicle (EV)‐RNAcapable of providing diagnostic information on disease status prior to biopsy, and prognostic information for men on active surveillance (AS).

Patients and Methods

Post‐digital rectal examination urine‐derivedEV‐RNAexpression profiles (n= 535, multiple centres) were interrogated with a curated NanoString panel. ALASSO‐based continuation ratio model was built to generate four prostate urine risk (PUR) signatures for predicting the probability of normal tissue (PUR‐1), D'Amico low‐risk (PUR‐2), intermediate‐risk (PUR‐3), and high‐risk (PUR‐4) prostate cancer. This model was applied to a test cohort (n= 177) for diagnostic evaluation, and to anASsub‐cohort (n= 87) for prognostic evaluation.

Results

EachPURsignature was significantly associated with its corresponding clinical category (P< 0.001).PUR‐4 status predicted the presence of clinically significant intermediate‐ or high‐risk disease (area under the curve = 0.77, 95% confidence interval [CI] 0.70–0.84). Application ofPURprovided a net benefit over current clinical practice. In anASsub‐cohort (n= 87), groups defined byPURstatus and proportion ofPUR‐4 had a significant association with time to progression (interquartile range hazard ratio [HR] 2.86, 95%CI1.83–4.47;P< 0.001).PUR‐4, when used continuously, dichotomized patient groups with differential progression rates of 10% and 60% 5 years after urine collection (HR8.23, 95%CI3.26–20.81;P< 0.001).

Conclusion

Urine‐derived EV‐RNAcan provide diagnostic information on aggressive prostate cancer prior to biopsy, and prognostic information for men onAS.PURrepresents a new and versatile biomarker that could result in substantial alterations to current treatment of patients with prostate cancer.
A retrospective statistical review of deaths owing to migration through the southeasternmost land borders of the European Union, Greece 2000–14
Authors: Pavlidis Pavlos , Karakasi Maria‐Valeria
Published: May 2019

The land borders of Evros, Greece, have been a common entry point for undocumented migrants on their way to Europe through Turkey. Adverse conditions, however, have resulted in many human casualties over the years. On the Greek side, 334 cadavers were retrieved between 2000 and 2014. This study provides a detailed forensic account of the humanitarian disaster in Evros to create an official scientific record of the situation. It showcases the gravity of the global issue of migration relating to health and mortality, and encourages communication and continual improvement of the approach and patterns of practices surrounding the subject. A retrospective statistical research review was conducted of border‐related fatalities between 2000 and 2014, assessing the age and gender of victims, the cause of death, the location of bodies, identification rates, and country of origin. Age ranged generally from 24 to 29 years, but infants and children were among the deceased.
Maternal glycaemic control and risk of neonatal hypoglycaemia in Type 1 diabetes pregnancy: a secondary analysis of the CONCEPTT trial
Authors: Yamamoto J. M. , Corcoy R. , Donovan L. E. , Stewart Z. A. , Tomlinson G. , Beardsall K. , Feig D. S. , Murphy H. R. ,   the CONCEPTT Collaborative Group*
Published: May 2019

Aims

To examine the relationship between maternal glycaemic control and risk of neonatal hypoglycaemia using conventional and continuous glucose monitoring metrics in the Continuous Glucose Monitoring in Type 1 Diabetes Pregnancy Trial (CONCEPTT) participants.

Methods

A secondary analysis of CONCEPTT involving 225 pregnant women and their liveborn infants. Antenatal glycaemia was assessed at 12, 24 and 34 weeks gestation. Intrapartum glycaemia was assessed by continuous glucose monitoring measures 24 hours prior to delivery. The primary outcome was neonatal hypoglycaemia defined as glucose concentration < 2.6 mmol/l and requiring intravenous dextrose.

Results

Neonatal hypoglycaemia occurred in 57/225 (25.3%) infants, 21 (15%) term and 36 (40%) preterm neonates. During the second and third trimesters, mothers of infants with neonatal hypoglycaemia had higher HbA1c [48 ± 7 (6.6 ± 0.6) vs. 45 ± 7 (6.2 ± 0.6); P = 0.0009 and 50 ± 7 (6.7 ± 0.6) vs. 46 ± 7 (6.3 ± 0.6); P = 0.0001] and lower continuous glucose monitoring time‐in‐range (46% vs. 53%; P = 0.004 and 60% vs. 66%; P = 0.03). Neonates with hypoglycaemia had higher cord blood C‐peptide concentrations [1416 (834, 2757) vs. 662 (417, 1086) pmol/l; P < 0.00001], birthweight > 97.7th centile (63% vs. 34%; P < 0.0001) and skinfold thickness (P ≤ 0.02). Intrapartum continuous glucose monitoring was available for 33 participants, with no differences between mothers of neonates with and without hypoglycaemia.

Conclusions

Modest increments in continuous glucose monitoring time‐in‐target (5–7% increase) during the second and third trimesters are associated with reduced risk for neonatal hypoglycaemia. While more intrapartum continuous glucose monitoring data are needed, the higher birthweight and skinfold measures associated with neonatal hypoglycaemia suggest that risk is related to fetal hyperinsulinemia preceding the immediate intrapartum period.
Instruments to measure the ability to self‐reflect: A systematic review of evidence from workplace and educational settings including health care
Authors: Williams Julie C. , Ireland Tony , Warman Sheena , Cake Martin A. , Dymock David , Fowler Ellayne , Baillie Sarah
Published: May 2019

Introduction

Self‐reflection has become recognised as a core skill in dental education, although the ability to self‐reflect is valued and measured within several professions. This review appraises the evidence for instruments available to measure the self‐reflective ability of adults studying or working within any setting, not just health care.

Materials and Methods

A systematic review was conducted of 20 electronic databases (including Medline, ERIC, CINAHL and Business Source Complete) from 1975 to 2017, supplemented by citation searches. Data were extracted from each study and the studies graded against quality indicators by at least two independent reviewers, using a coding sheet. Reviewers completed a utility analysis of the assessment instruments described within included studies, appraising their reported reliability, validity, educational impact, acceptability and cost.

Results

A total of 131 studies met the inclusion criteria. Eighteen were judged to provide higher quality evidence for the review and three broad types of instrument were identified, namely: rubrics (or scoring guides), self‐reported scales and observed behaviour.

Conclusions

Three types of instrument were identified to assess the ability to self‐reflect. It was not possible to recommend a single most effective instrument due to under reporting of the criteria necessary for a full utility analysis of each. The use of more than one instrument may therefore be appropriate dependent on the acceptability to the faculty, assessor, student and cost. Future research should report on the utility of assessment instruments and provide guidance on what constitutes thresholds of acceptable or unacceptable ability to self‐reflect, and how this should be managed.