bluuebunny/crossref_metadata_2025 huggingface dataset:
Small and medium enterprises' collaborations with universities for new product development
Authors: Buganza Tommaso , Colombo Gabriele , Landoni Paolo
Published: March 2014

Purpose

– The aim of this paper is to investigate how small and medium-sized enterprises (SMEs) can engage in collaborations with universities in different phases of the new product development process, taking into account the peculiarities of SMEs.

Design/methodology/approach

– This paper combines a qualitative methodology (five SME case studies) with a quantitative one (a survey of 28 SMEs). The quantitative data are used to support the preliminary results obtained through the qualitative analysis.

Findings

– SMEs engage in collaborations with universities following a progressive model; from the easiest collaborations during the testing phase to more complex collaborations during the research phase. In this way, SMEs establish a trust-based relationship with universities. Furthermore, technology management capabilities and project management capabilities are crucial prerequisites for managing complex forms of collaboration with universities.

Practical implications

– SME managers should be aware of the difficulties associated with complex collaborations. They can overcome such problems by adopting a progressive collaboration model as well by as developing project management and technology management capabilities.

Originality/value

– The paper offers new insights on how to deepen the important topic of how SMEs can manage and develop their relationships with universities.
Critical success factors of quality management practices among SMEs in the food processing industry in Malaysia
Authors: Habibah Abdul Talib Hayati , Anuar Mohd Ali Khairul , Idris Fazli
Published: March 2014

Purpose

– The purpose of this research is to identify and validate a measurement model for assessing the quality management practices among small and medium-sized enterprises, specifically for the food processing industry in developing countries such as Malaysia.

Design/methodology/approach

– A survey was initially conducted among SMEs using a questionnaire mailed to the managing director of companies selected from the SMECorp directory. A total of 207 respondents from SMEs were used for further analysis. Two steps of analysis were undertaken to validate the measurement model of critical success factors: principal component analysis and confirmatory analysis.

Findings

– Eight critical success factors of quality management practices are proposed for assessing quality management practices among SMEs in the food processing industry in Malaysia. A measurement model was then developed. PCA with Varimax rotation revealed 13 components, eight of which were retained for further analysis. First- and second-order CFAs identified the CSF measurement model along with the goodness-of-fit index. Thus, the findings also reveal the status of quality management practices among food processing SMEs in Malaysia.

Research limitations/implications

– This paper is to evaluate only the CSFs; therefore, further work is needed to evaluate the relationship between CSFs and organisational performance of SMEs in the food processing industry in Malaysia.

Originality/value

– There are various papers regarding the assessment of quality management, especially on TQM practices in various industries. However, few assessments of the critical success factors of quality management practices of SMEs in the food processing industry, especially in developing countries like Malaysia, have been found to date. The findings of this paper will help the industry to identify its current quality management practice to focus on improving its performance.
Understanding the differences of public and private self-service technology
Authors: E. Collier Joel , L. Sherrell Daniel , Babakus Emin , Blakeney Horky Alisha
Published: March 2014

Purpose

– The purpose of this paper is to explore the potential differences between types of self-service technology. Specifically, the paper explores how the dynamics of public and private self-service technology influence customers' decision to use the technology.

Design/methodology/approach

– Existing customers of private and public self-service technology were surveyed from the same industry. Using structural equation modeling, the authors examine how relevant self-service constructs influence evaluations and attitudes of customers across both settings.

Findings

– The analysis reveals that customers' control and convenience perceptions differ across public and private self-service technology. Additionally, customers placed a heavier emphasis on the hedonic or utilitarian evaluation of a service experience based on the type of self-service technology.

Practical implications

– For managers of self-service applications, understanding the unique differences of public and private self-service technology can aid in the implementation and adoption of the technology. By properly understanding the differences of the self-service types, managers can provide a beneficial experience to the customer.

Originality/value

– By identifying and describing two distinct categories of SSTs, this study allows managers and researchers to better understand how and why individuals choose to utilize individual self-service technologies. Through understanding the unique dynamics of a public and a private SST experience, retailers can determine the appropriate strategy for customer adoption based on the utilitarian or hedonic functions of the technology.
The experience economy approach to festival marketing: vivid memory and attendee loyalty
Authors: Manthiou Aikaterini , (Ally) Lee Seonjeong , (Rebecca) Tang Liang , Chiang Lanlung
Published: March 2014

Purpose

– A desirable experiential environment is an essential source of competitive advantage in the festival industry. Understanding festival attendees' experience is imperative for festival organizers because attendees' experience is a predictor of their future behavior. With the experience economy concept of Pine and Gilmore (1998), the study identified four underlying dimensions of festival attendees' experience (education, entertainment, esthetics, and escapism) and examined the impacts of these experience dimensions on festival attendees' vividity of memory and loyalty.

Design/methodology/approach

– Data were collected from online surveys completed by 338 attendees of VEISHEA festival. This study employed confirmatory factor analysis, regression analysis, and structural equation modeling to achieve its goals.

Findings

– Experience has a positive effect on vivid memory, which consequently influences loyalty. Each dimension of experience economy significantly influences vividity of memory. However loyalty is affected only by the entertainment and esthetics dimensions.

Practical implications

– Festival marketers are advised to design activities that provide memorable experiential products and services for attendees based on the four dimensions of the experience economy.

Originality/value

– The study is a pioneer in the evaluation of vividity of memory to the festival context.
Shifting protected areas: scheduling spatial priorities under climate change
Authors: Alagador Diogo , Cerdeira Jorge Orestes , Araújo Miguel Bastos
Published: March 2014

Conservation planning decisions are constrained by three important factors: budgets are limited, important areas for biodiversity compete for space with other uses, and climate‐ and land‐use changes are affecting the distribution of life thus compounding existing threats to biodiversity. Decisions about locating and allocating resources for conservation in such complex and dynamic world are far from trivial, with apparently optimal decisions in the present being potential suboptimal in the future.

We propose a methodological framework for the dynamic spatial prioritization of conservation areas that optimizes long‐term conservation goals under climate change. This approach involves a sequential scheduling of conservation areas designation, followed by the release of some areas when they stop contributing to the specified long‐term conservation goals. The usefulness of the proposed approach is demonstrated with a case study involving ten species in the Iberian Peninsula under severe scenarios of climate change, but the framework could be applied more broadly.

Species persistence under climate change is enhanced by the dynamic spatial prioritization strategy that assumes area release. With such strategy, the long‐term persistence of species is consistently higher than expected with no release of redundant areas, particularly when the budgets to acquire and manage conservation areas are small. When budgets are small, long‐term persistence of species might only be achieved when the release of previously selected areas is considered alongside the selection of new areas.

Synthesis and applications. Given that conservation budgets are typically small, conservation strategies involving the release of some underperforming areas might be required to achieve long‐term persistence of species. This should be the case when climate change forces species to move out of current protected areas with other areas becoming important to meet conservation objectives. Implementing such dynamic prioritization approach would require a paradigm shift in conservation planning because conservation areas, once selected, are rarely released. Dynamic selection of areas also involves risks that should be considered in a case‐by‐case situation.
Social Media and Internet‐Based Data in Global Systems for Public Health Surveillance: A Systematic Review
Authors: VELASCO EDWARD , AGHENEZA TUMACHA , DENECKE KERSTIN , KIRCHNER GÖRAN , ECKMANNS TIM
Published: March 2014

Context

The exchange of health information on the Internet has been heralded as an opportunity to improve public health surveillance. In a field that has traditionally relied on an established system of mandatory and voluntary reporting of known infectious diseases by doctors and laboratories to governmental agencies, innovations in social media and so‐called user‐generated information could lead to faster recognition of cases of infectious disease. More direct access to such data could enable surveillance epidemiologists to detect potential public health threats such as rare, new diseases or early‐level warnings for epidemics. But how useful are data from social media and the Internet, and what is the potential to enhance surveillance? The challenges of using these emerging surveillance systems for infectious disease epidemiology, including the specific resources needed, technical requirements, and acceptability to public health practitioners and policymakers, have wide‐reaching implications for public health surveillance in the 21st century.

Methods

This article divides public health surveillance into indicator‐based surveillance and event‐based surveillance and provides an overview of each. We did an exhaustive review of published articles indexed in the databases PubMed, Scopus, and Scirus between 1990 and 2011 covering contemporary event‐based systems for infectious disease surveillance.

Findings

Our literature review uncovered no event‐based surveillance systems currently used in national surveillance programs. While much has been done to develop event‐based surveillance, the existing systems have limitations. Accordingly, there is a need for further development of automated technologies that monitor health‐related information on the Internet, especially to handle large amounts of data and to prevent information overload. The dissemination to health authorities of new information about health events is not always efficient and could be improved. No comprehensive evaluations show whether event‐based surveillance systems have been integrated into actual epidemiological work during real‐time health events.

Conclusions

The acceptability of data from the Internet and social media as a regular part of public health surveillance programs varies and is related to a circular challenge: the willingness to integrate is rooted in a lack of effectiveness studies, yet such effectiveness can be proved only through a structured evaluation of integrated systems. Issues related to changing technical and social paradigms in both individual perceptions of and interactions with personal health data, as well as social media and other data from the Internet, must be further addressed before such information can be integrated into official surveillance systems.
How Might the Affordable Care Act's Coverage Expansion Provisions Influence Demand for Medical Care?
Authors: ABRAHAM JEAN MARIE
Published: March 2014

Context

The Affordable Care Act (ACA) is predicted to expand health insurance to 25 million individuals. Since insurance reduces the price of medical care, the quantity of services demanded by these newly covered individuals is expected to rise. In this article I provide a comprehensive picture of the demographics, health status, and medical care utilization of the population targeted for the ACA's expansion of coverage, contrasted with that of other nonelderly, insured populations. In addition, I synthesize the current evidence regarding the causal impact of insurance on medical care demand, drawing heavily on recent evidence from Massachusetts and Oregon.

Methods

Using the 2008 to 2010 Medical Expenditure Panel Survey, I conducted bivariate and multivariate analyses to examine differences between the ACA target population and other insured groups. I used the results from the descriptive analysis and quasi‐experimental literature to generate “back of the envelope” estimates of the potential impact of the coverage expansion on total medical care utilization by the noninstitutionalized US population.

Findings

Comparisons of the potential ACA target population with the privately and publicly insured reveal that the former is younger and more likely to be male. The ACA target population, and particularly the uninsured with incomes under 200% of the federal poverty line, reports lower rates of several medical conditions relative to those of the privately and publicly insured. Future changes in rates of inpatient hospitalization and ED use among the newly insured could vary widely, based on descriptive findings and inferences from the quasi‐experimental literature. Results also suggest moderate increases in ambulatory care. Total increases in overall demand for medical care by the newly insured comprise a modest proportion of the aggregate utilization.

Conclusions

With the expected increases in utilization resulting from the coverage expansion, stakeholders will need to monitor local health care delivery system capacity and respond where needed with policy‐ and/or market‐based innovations.
Trends in Health Care Financial Burdens, 2001 to 2009
Authors: BLUMBERG LINDA J. , WAIDMANN TIMOTHY A. , BLAVIN FREDRIC , ROTH JEREMY
Published: March 2014

Context

Over the past decade, health care spending increased faster than GDP and income, and decreasing affordability is cited as contributing to personal bankruptcies and as a reason that some of the nonelderly population is uninsured. We examined the trends in health care affordability over the past decade, measuring the financial burdens associated with health insurance premiums and out‐of‐pocket costs and highlighting implications of the Affordable Care Act for the future financial burdens of particular populations.

Methods

We used cross sections of the Medical Expenditure Panel Survey Household Component (MEPS‐HC) from 2001 to 2009. We defined financial burden at the health insurance unit (HIU) level and calculated it as the ratio of expenditures on health care—employer‐sponsored insurance coverage (ESI) and private nongroup premiums and out‐of‐pocket payments—to modified adjusted gross income.

Findings

The median health care financial burden grew on average by 2.7% annually and by 21.9% over the period. Using a range of definitions, the fraction of households facing high financial burdens increased significantly. For example, the share of HIUs with health care expenses exceeding 10% of income increased from 35.9% to 44.8%, a 24.8% relative increase. The share of the population in HIUs with health care financial burdens between 2% and 10% fell, and the share with burdens between 10% and 44% rose.

Conclusions

We found a clear trend over the past decade toward an increasing share of household income devoted to health care. The ACA will affect health care spending for subgroups of the population differently. Several groups’ burdens will likely decrease, including those becoming eligible for Medicaid or subsidized private insurance and those with expensive medical conditions. Those newly obtaining coverage might increase their health spending relative to income, but they will gain access to care and the ability to spread their expenditures over time, both of which have demonstrable economic value.
Employee resilience: an emerging challenge for HRM
Authors: Bardoel E Anne , Pettit Trisha Michelle , De Cieri Helen , McMillan Lindsay
Published: March 2014

Given turbulent economic times, the concept of employee resilience is receiving increasing attention in many organisations. This paper brings the discussion of employee resilience into the field of human resource management (HRM). We explore the foundations of resilience in theories of positive psychology and the conservation of resources (COR); we discuss its relevance for HRM and develop a set of testable hypotheses to guide future research. The first key finding of this paper is that the concept of resilience can be developed from strong theoretical foundations. Second, a coherent set of resilience‐enhancing HR practices have the potential to contribute to employees’ psychological capital, attitudes and behaviour, and to organisational performance not only in turbulent circumstances but also during periods of relative calm. Given the theoretical framing, formal resilience training should be viewed as a single component of a broader, coherent set of resilience‐enhancing HR practices.
Fast‐track surgery combined with laparoscopy could improve postoperative recovery of low‐risk rectal cancer patients: A randomized controlled clinical trial
Authors: Feng Fan , Li Xiao Hua , Shi Hai , Wu Guo Sheng , Zhang Hong Wei , Liu Xiao Nan , Zhao Qing Chuan
Published: March 2014

Objective

In this study we aimed to assess the feasibility and safety of fast‐track surgery (FTS) combined with laparoscopy for treating patients with rectal cancer and compare the results with those of the conventional perioperative intervention group.

Methods

A total of 120 patients with rectal cancer were prospectively randomly assigned to the FTS combined with laparoscopy group and the conventional perioperative intervention plus laparoscopy group from November 2011 to November 2012. All patients received radical anterior resection with total mesorectal excision. Their baseline characteristics and the perioperative outcomes were recorded for analyses.

Results

Compared with the conventional perioperative intervention group, the fast‐track protocol combined with laparoscopy could shorten the time to the first flatus (53.44 ± 23.64 h vs 67.85 ± 20.12 h, P = 0.001) and first defecation (65.23 ± 22.24 h vs 86.98 ± 24.85 h, P = 0.000) after operation, accelerate the decrease of white blood cell count (P < 0.05), inhibit body temperature augmentation (P < 0.05) and reduce postoperative complication rate (16.9% vs 3.5%, P = 0.030). In addition, the length of postoperative stay was also shortened (5.05 ± 1.38 days vs 6.98 ± 2.26 days, P = 0.000). The medical cost of hospitalization was also reduced in the FTS group.

Conclusion

FTS in combination with laparoscopy may accelerate the clinical recovery of patients with rectal cancer after surgery.
Adjuvant systemic chemotherapy with or without bevacizumab in patients with resected pulmonary metastases from colorectal cancer
Authors: Turan Nedim , Benekli Mustafa , Dane Faysal , Unal Olcun Umit , Kara Hasan Volkan , Koca Dogan , Balvan Ozlem , Eren Tulay , Tastekin Didem , Helvaci Kaan , Berk Veli , Demirci Umut , Ozturk Selcuk Cemil , Dogan Erkan , Cetin Bulent , Kucukoner Mehmet , Tonyali Onder , Tufan Gulnihal , Oztop Ilhan , Gumus Mahmut , Coskun Ugur , Uner Aytug , Ozet Ahmet , Buyukberber Suleyman ,   for the Anatolian Society of Medical Oncology (ASMO)
Published: March 2014

Introduction

We investigated the impact of modern chemotherapy regimens and bevacizumab following pulmonary metastasectomy (PM) from metastatic colorectal cancer (CRC).

Methods

A total of 122 consecutive patients who were curatively resected for pulmonary metastases of CRC in twelve oncology centers were retrospectively analysed between January 2000 and April 2012.

Results

Of 122 patients, 14 did not receive any treatment following PM. The remaining 108 patients received fluoropyrimidine‐based (n = 12), irinotecan‐based (n = 56) and oxaliplatin‐based (n = 40) chemotherapy combinations. Among these, 52 patients received bevacizumab (BEV) while 56 did not (NoBEV). Median recurrence‐free survival (RFS) was 17 months and median overall survival (OS) has not been reached at a median follow‐up of 25 months after PM. Three and five‐year OS rates were 66% and 53%, respectively. RFS and OS were similar, irrespective of the chemotherapy regimen or BEV use. Positive pulmonary margin, KRAS mutation status, and previous liver metastasectomy were negative independent prognostic factors for RFS, while pathologically confirmed thoracic lymph node involvement was the only negative independent prognostic for OS in multivariate analysis.

Conclusions

No significant RFS or OS difference was observed in respect to chemotherapy regimens with or without BEV in patients with pulmonary metastases of CRC following curative resection.
Peroneal artery perforator‐based flaps for reconstruction of middle and lower third post‐traumatic defects of the leg
Authors: John Jerry R. , Tripathy Satyaswarup , Sharma Ramesh Kumar , Balan Jyoshid R. , Jadhav Chandan , Bhattacharya Saptarshi
Published: March 2014

Background

Grade IIIb open tibial fractures require local or free flaps for cover of the fracture site. Perforator flap surgery is an innovative method for wound cover in this setting. The anatomy of perforating vessels of the peroneal artery is well described.

Methods

All patients who underwent peroneal artery perforator‐based flap cover for acute Grade IIIb fracture tibia between December 2011 and March 2013 were prospectively studied. The wounds were located either in middle or in lower third of the tibia. Flaps were performed under loupe magnification after identifying perforators preoperatively with handheld Doppler. All flaps were of a hockey stick or J design, incorporating the peroneal skin territory and completely islanded. Patients were followed up until all wounds were epithelialized.

Results

Eleven patients were identified. Eleven flaps were performed, out of which 10 survived entirely and served the purpose of stable wound cover. One patient sustained partial flap necrosis, which was debrided, and another local flap was performed. More than one perforator could be identified and retained in six of these 11 patients.

Conclusion

The peroneal artery perforator‐based flap is reliable and reproducible in an acute post‐traumatic setting. It should be considered as a suitable alternative for reconstruction for limited defects with exposed fractured tibia over the middle and lower third of the leg.
Anti‐vascular endothelial growth factor therapies in ophthalmology: current use, controversies and the future
Authors: Kwong Tsong Qiang , Mohamed Moin
Published: March 2014

Use of anti‐vascular endothelial growth factor (VEGF) therapies was introduced for the treatment of ocular disorders in 2005. In the UK, the current licensed and NICE approved indications are for the treatment of neovascular age‐related macular degeneration (nAMD), diabetic macular oedema (DMO), macular oedema secondary to a retinal vein occlusion (RVO) and choroidal neovascularization in pathological myopia. These diagnoses alone account for two‐thirds of the main causes of legally registrable visual impairment and blindness. Ranibizumab (Lucentis®; Genentech/Novartis), a drug specifically designed for intraocular use, is the primary licensed medication. Controversially however, clinicians have been using an unlicensed cheaper drug, bevacizumab (Avastin®; Genentech/Roche), originally designed for systemic administration, with a similar mode of action and shown to have a similar efficacy. However, there are fears of greater side effects with bevacizumab though studies have not been sufficiently powered to show statistical difference. In the current global economic climate, anti‐VEGF treatment places huge financial and logistical pressure on already strained health care systems. Bevacizumab is considerably more cost effective than ranibizumab, and thus using bevacizumab would widen access to treatment particularly in developing countries. This licensing issue also places clinicians in a difficult medico‐legal position especially in Europe, where doctors are duty bound to use a licensed drug for a particular indication if this is available. As the indications of anti‐VEGF therapies expand and the cost of health care provision becomes more expensive, the controversies surrounding their use will inevitably become more important.
UniPR129 is a competitive small molecule Eph‐ephrin antagonist blocking in vitro angiogenesis at low micromolar concentrations
Authors: Hassan‐Mohamed I , Giorgio C , Incerti M , Russo S , Pala D , Pasquale E B , Zanotti I , Vicini P , Barocelli E , Rivara S , Mor M , Lodola A , Tognolini M
Published: March 2014

Background and Purpose

The Eph receptor tyrosine kinases and their ephrin ligands are key players in tumorigenesis and many reports have correlated changes in their expression with a poor clinical prognosis in many solid tumours. Agents targeting the Eph‐ephrin system might emerge as new tools useful for the inhibition of different components of cancer progression. Even if different classes of small molecules targeting Eph‐ephrin interactions have been reported, their use is hampered by poor chemical stability and low potency. Stable and potent ligands are crucial to achieve robust pharmacological performance.

Experimental Approach

UniPR129 (the L‐homo‐Trp conjugate of lithocholic acid) was designed by means of computational methods, synthetized and tested for its ability to inhibit the interaction between the EphA2 receptor and the ephrin‐A1 ligand in an elisa binding study. The ability of UniPR129 to disrupt EphA2‐ephrin‐A1 interaction was functionally evaluated in a prostate adenocarcinoma cell line and its anti‐angiogenic effect was tested in vitro using cultures of HUVECs.

Key Results

UniPR129 disrupted EphA2‐ephrin‐A1 interaction with Ki = 370 nM in an elisa binding assay and with low micromolar potency in cellular functional assays, including inhibition of EphA2 activation, inhibition of PC3 cell rounding and disruption of in vitro angiogenesis, without cytotoxic effects.

Conclusions and Implications

The discovery of UniPR129 represents not only a major advance in potency compared with the existing Eph‐ephrin antagonists but also an improvement in terms of cytotoxicity, making this molecule a useful pharmacological tool and a promising lead compound.
Beyond Stimulus Deprivation: Iron Deficiency and Cognitive Deficits in Postinstitutionalized Children
Authors: Doom Jenalee R. , Gunnar Megan R. , Georgieff Michael K. , Kroupina Maria G. , Frenn Kristin , Fuglestad Anita J. , Carlson Stephanie M.
Published: March 2014

Children adopted from institutions have been studied as models of the impact of stimulus deprivation on cognitive development (Nelson, Bos, Gunnar, & Sonuga‐Barke, 2011), but these children may also suffer from micronutrient deficiencies (Fuglestad et al., 2008). The contributions of iron deficiency (ID) and duration of deprivation on cognitive functioning in children adopted from institutions between 17 and 36 months of age were examined. ID was assessed in 55 children soon after adoption, and cognitive functioning was evaluated 11–14.6 months postadoption when the children averaged 37.4 months old (SD = 4.9). ID at adoption and longer duration of institutional care independently predicted lower IQ scores and executive function (EF) performance. IQ did not mediate the association between ID and EF.
Heterogeneity of molecular sensitization profiles in grass pollen allergy – implications for immunotherapy?
Authors: Darsow U. , Brockow K. , Pfab F. , Jakob T. , Petersson C. J. , Borres M. P. , Ring J. , Behrendt H. , Huss‐Marp J.
Published: March 2014

Background

Data on molecular allergy diagnostics in adults with grass pollen allergy with regard to conjunctival and nasal provocation test outcome and specific immunotherapy are lacking to date.

Objective

To assess whether molecular allergy diagnostics for grass pollen allergens could help with predicting provocation test outcomes and serve as a basis for future component‐resolved specific immunotherapy.

Methods

Sera of 101 adults with grass pollen allergy was analysed for IgE against timothy grass pollen (Phleum pratense), rPhl p 1, rPhl p 2, nPhl p 4, rPhl p 5b, rPhl p 6, rPhl p 7, rPhl p 11 and rPhl p12 and correlated with the individuals' outcome in the nasal and conjunctival provocation tests and investigated in regard to a potential component‐resolved specific immunotherapy.

Results

An increasing number of sensitizations to timothy grass allergens was correlated to a positive reaction in the conjunctival (4.9 vs. 3.6, P = 0.003) and nasal provocation tests (4.5 vs. 2.2, P = 0.0175). In molecular sensitization profiles, a substantial heterogeneity was detected, with none of the patients exactly matching the allergen composition of a previously published component‐resolved specific immunotherapy containing Phl p 1, Phl p 2, Phl p 5a/b and Phl p 6. The results indicate that in 95% of the patients, a proportion of 50% of timothy‐IgE would be targeted with such a specific immunotherapy, while in 50% and 10% of patients, 80% and 90% of timothy‐IgE would be targeted, respectively.

Conclusion and Clinical Relevance

Molecular allergy diagnostics is a prerequisite for future component‐resolved specific immunotherapy due to the high heterogeneity of sensitization profiles. However, of current clinical relevance is the observed correlation between the number of sensitizations and provocation test outcome.
Effects of delayed hypothermia on time‐dependent microglial production of inflammatory and anti‐inflammatory factors
Authors: Matsui Tomohiro , Miyazaki Shun‐ichiro , Motoki Yukari
Published: March 2014

Objective

Therapeutic hypothermia protects neurons after severe brain damage. We have previously shown that immediate hypothermic culture reduces the temporal microglial production of inflammatory and anti‐inflammatory factors. To better understand the therapeutic time window of this therapy for reducing these potential neurotoxic factors, we investigated the effects of delayed hypothermia on the temporal production of tumor necrosis factor (TNF)‐α, interleukin (IL)‐1β, IL‐10 and nitric oxide (NO) by toll‐like receptor (TLR)‐activated microglia.

Methods

Rat microglia were activated by TLR2 or TLR4 agonists under normothermic (37°C) conditions (time zero). Subsequently, the cells were divided into normothermic or hypothermic (33°C) groups. The hypothermic group was subdivided into two groups with the induction of hypothermia that was started either 1 or 2 h after the activation of microglia. TNF‐α and IL‐1β, and IL‐10 and NO production in the culture supernatant were measured at 3–6 h and 24–48 h, respectively, after time zero.

Results

Compared with normothermia, 1‐h and 2‐h delayed hypothermia decreased TNF‐α and IL‐1β (after TLR2 activation) production at 3–6 h and 6 h, respectively. Both IL‐10 (after TLR2 activation) and NO (after TLR4 activation) production were decreased at 24–48 h by hypothermia that was started within 2 h.

Conclusions

Delayed (1–2 h) hypothermic culture decreased the production of early‐phase TNF‐α and IL‐1β, and late‐phase IL‐10 and NO by TLR‐activated microglia, as has been observed with immediate hypothermic culture, suggesting that therapeutic hypothermia that is started within 1–2 h is sufficient to elicit neuroprotective effects by reducing microglial production of these factors.
An unforgettable event: a qualitative study of the 1997–98 El Niño in northern Peru
Authors: Bayer Angela M. , Danysh Heather E. , Garvich Mijail , Gonzálvez Guillermo , Checkley William , Álvarez María , Gilman Robert H.
Published: March 2014

During the 1997–98 El Niño, Tumbes, Peru received 16 times the annual average rainfall. This study explores how Tumbes residents perceived the impact of the El Niño event on basic necessities, transport, health care, jobs and migration. Forty‐five individuals from five rural communities, some of which were isolated from the rest of Tumbes during the event, participated in five focus groups; six of these individuals constructed nutrition diaries. When asked about events in the past 20 years, participants identified the 1997–98 El Niño as a major negative event. The El Niño disaster situation induced a decrease in access to transport and health care and the rise in infectious diseases was swiftly contained. Residents needed more time to rebuild housing; recover agriculture, livestock and income stability; and return to eating sufficient animal protein. Although large‐scale assistance minimized effects of the disaster, residents needed more support. Residents' perspectives on their risk of flooding should be considered in generating effective assistance policies and programmes.
Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi
Authors: Fares Saleh , Femino Meg , Sayah Assaad , Weiner Debra L. , Yim Eugene Sun , Douthwright Sheila , Molloy Michael Sean , Irfan Furqan B. , Karkoukli Mohamed Ali , Lipton Robert , Burstein Jonathan L. , Mazrouei Mariam Al , Ciottone Gregory
Published: March 2014

Hazard vulnerability analysis (HVA) is used to risk‐stratify potential threats, measure the probability of those threats, and guide disaster preparedness. The primary objective of this project was to analyse the level of disaster preparedness in public hospitals in the Emirate of Abu Dhabi, utilising the HVA tool in collaboration with the Disaster Medicine Section at Harvard Medical School. The secondary objective was to review each facility's disaster plan and make recommendations based on the HVA findings. Based on the review, this article makes eight observations, including on the need for more accurate data; better hazard assessment capabilities; enhanced decontamination capacities; and the development of hospital‐specific emergency management programmes, a hospital incident command system, and a centralised, dedicated regional disaster coordination centre. With this project, HVAs were conducted successfully for the first time in health care facilities in Abu Dhabi. This study thus serves as another successful example of multidisciplinary emergency preparedness processes.
Interrupting the balance: reconsidering the complexities of conflict in South Sudan
Authors: Pendle Naomi
Published: March 2014

By the start of 2014, violent conflict had erupted across much of South Sudan following initial violence in Juba on 15 December 2013. The speed with which the fighting has spread raises questions regarding the impact of national‐level politics on violence at the local level. This article develops a framework in which violent conflict can be comprehended as a response to the interruption of the negotiation of the balance of power between groups; the negotiation is interrupted when that balance tips in favour of one group, such as through changes in the national political market or government reforms. The article provides two cases studies of attempts to strengthen the state that inadvertently interrupted local power relations between groups. In response, the groups engaged in violent conflict to reinstate a balance of power. Both examples involve conflict among Dinka groups from 2005 to 2008.
Knowledge of sports participants about dental emergency procedures and the use of mouthguards
Authors: Sepet Elif , Aren Gamze , Dogan Onur Ozen , Pinar Erdem Arzu , Kuru Sinem , Tolgay Ceren Guney , Unal Sinasi
Published: March 2014

Aim

The aim of this study was to evaluate the knowledge of sports participants regarding emergency management of dental trauma and the awareness about mouthguards.

Methods

A specific questionnaire regarding knowledge, experiences and behaviours after dental trauma and the use of mouthguard was distributed to 359 sports participants up to 18 years of age. The sports involved were basketball, swimming, volleyball, soccer, tennis, badminton, handball, athleticism, golf, gymnastics, water polo and karate. The questions were focused on personal experience, awareness of first aid and dental emergency procedures and knowledge about mouthguards.

Results

The results showed that 10.9% had experienced a kind of dental trauma, and 12.5% would look for a dentist for treatment in emergency. 34.5% would re‐implant the avulsed tooth, 33.4% would maintain the avulsed tooth in handkerchief and 25.3% would maintain it in saline solution. 41.1% were aware of the possibility of oral injuries during sports practice, and 55.4% knew about mouthguards, but only 11.2% of the participants reported to use them. There was a statistically significant difference between the experienced participants (>5 years) and less‐experienced group (<5 years) in knowledge about dental emergency procedures and mouthguards. Reasons given for not wearing mouthguards include ‘lack of aesthetic’ was significantly high in experienced participants. The less‐experienced participants significantly stated that they had never heard about mouthguards before.

Conclusion

Our results showed a lack of knowledge of sports participants about management and prevention of traumatic dental injuries. Educational programs should be organized to give information about emergency treatment and promote the use of mouthguards to sport participants.
Collective Obligations: Their Existence, Their Explanatory Power, and Their Supervenience on the Obligations of Individuals
Authors: Wringe Bill
Published: March 2014

In this paper I discuss a number of different relationships between two kinds of (moral) obligation: those which have individuals as their subject, and those which have groups of individuals as their subject. I use the name collective obligations to refer to obligations of the second sort. I argue that there are collective obligations, in this sense; that such obligations can give rise to and explain obligations which fall on individuals; that because of these facts collective obligations are not simply reducible to individual obligations; and that collective obligations supervene on individual obligations, without being reducible to them. The sort of supervenience I have in mind here is what is sometimes called ‘global supervenience’. In other words, there cannot be two worlds which differ in respect of the collective obligations which exist in them without also differing in respect of the individual obligations which exist in them.
Hidden responses to environmental variation: maternal effects reveal species niche dimensions
Authors: Germain Rachel M. , Gilbert Benjamin
Published: March 2014

Species responses to fluctuating environments structure population and community dynamics in variable ecosystems. Although offspring number is commonly used to measure these responses, maternal effects on offspring quality may be an important but largely unrecognised determinant of long‐term population growth. We selected 29 species across a Mediterranean annual plant phylogeny, and grew populations of each species in wet and dry conditions to determine responses in seed number and maternal effects (seed size, seed dormancy, and seedling growth). Maternal effects were evident in over 40% of species, but only 24% responded through seed number. Despite a strong trade‐off between seed size and seed number among species, there was no consistent trade‐off within species; we observed correlations that ranged from positive to negative. Overall, species in this plant guild show a complex range of responses to environmental variation that may be underestimated when only seed number responses are considered.
Increased risk of ischaemic stroke amongst patients with chronic osteomyelitis: a population‐based cohort study in Taiwan
Authors: Tseng C.‐H. , Chen J.‐H. , Muo C.‐H. , Chang Y.‐J. , Sung F.‐C. , Hsu C. Y.
Published: March 2014

Background and purpose

Inflammatory processes, which kindle endothelial dysfunction and atherosclerosis, may facilitate the development of cardiovascular disease, including ischaemic stroke. Evident stroke risk factors may not be identified in up to 40% of stroke patients, especially in the younger population. Inflammation remains to be established as a stroke risk factor. In this study, it was assessed whether chronic osteomyelitis (COM), an infectious disease with chronic inflammation, increases stroke risk.

Methods

A national insurance claim data set of 22 million enrollees in Taiwan was used to identify 18 509 patients with COM and 74 034 randomly selected age‐ and gender‐matched controls for a follow‐up period of 11 years starting 1 January 2000 and ending 31 December 2010. Stroke risk was analyzed using the Cox proportional hazards regression model.

Results

Comorbidities known to increase stroke risk, including hypertension, diabetes, hyperlipidemia, coronary heart disease and peripheral arterial disease, were more frequently noted in the COM group who had significantly greater stroke risk than the control cohort. Comparing only those without comorbidities, COM carried greater stroke risk than the control group [hazard ratio (HR) = 1.40, 95% confidence interval (CI) 1.22–1.62, P < 0.001]. The younger population carried even greater risk (age < 45, HR = 2.73, 95% CI 1.71–4.35; age > 65, HR = 1.16, 95% CI 1.02–1.31).

Conclusions

This is the first report linking COM to an increased risk of developing stroke. Results suggest that COM is a significant stroke risk factor and call for closer attention to this group of patients for more rigorous stroke prevention, especially in the younger age group.
Transcranial sonography and [18F]fluorodeoxyglucose positron emission tomography for the differential diagnosis of parkinsonism: a head‐to‐head comparison
Authors: Hellwig S. , Reinhard M. , Amtage F. , Guschlbauer B. , Buchert R. , Tüscher O. , Weiller C. , Niesen W. D. , Meyer P. T.
Published: March 2014

Background and purpose

Brain imaging with positron emission tomography using [18F]fluorodeoxyglucose (FDG‐PET) and transcranial B‐mode sonography (TCS) improves the differential diagnosis of parkinsonism. The diagnostic merits of these approaches in identifying and differentiating atypical parkinsonian syndromes (APS) are compared.

Methods

Data were included from 36 patients with clinically suspected APS who underwent PET and TCS. FDG‐PET scans were analyzed by visual assessment (including voxel‐based statistical maps) of a priori defined disease‐specific metabolic patterns. Sonographers achieved diagnoses according to pre‐defined criteria for echogenicities of the substantia nigra and lenticular nucleus, and third ventricle diameter. Patients with APS were identified and allocated to the subgroups multiple system atrophy (MSA), progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD).

Results

After a median follow‐up period of 9 months, the final clinical diagnoses (reference standard) were Parkinson's disease, n = 15; MSA, n = 9; PSP, n = 7; and CBD, n = 5 (n = 21 APS in total). Six patients (4 APS) showed an insufficient bone window for TCS. In the remaining 30 patients, sensitivity/specificity for diagnosing APS were 82%/100% and 82%/85% for FDG‐PET and TCS, respectively. Diagnostic accuracies did not differ between FDG‐PET (90%) and TCS (83%; P = 0.69). Likewise, overall accuracy of subgroup classification (non‐APS, MSA, PSP and CBD) did not differ between modalities (FDG‐PET 87% and TCS 83%; P = 1.00).

Conclusions

FDG‐PET and TCS show comparable accuracies for differential diagnosis of neurodegenerative parkinsonism. This preliminary study supports the use of TCS and warrants further prospective validation.
Thyroid antibodies are associated with stenotic lesions in the terminal portion of the internal carotid artery
Authors: Tanaka M. , Sakaguchi M. , Yagita Y. , Gon Y. , Yoshikawa K. , Takahashi T. , Fukunaga R. , Mochizuki H. , Kitagawa K.
Published: March 2014

Background and purpose

Several studies have reported moyamoya syndrome associated with thyroid disease, and the mechanism involved in this relationship is unknown. This study aimed to clarify the involvement of thyroid antibodies and thyroid function in intracranial arterial stenosis.

Methods

The study included 30 patients <65 years of age with intracranial arterial steno‐occlusion. Patients with definitive moyamoya disease were excluded. Thyroid function and thyroid antibody levels were evaluated. The steno‐occlusive site and the presence of moyamoya vessels were evaluated using digital subtraction angiography. The characteristics of intracranial arterial lesions were compared between patients with and without elevated thyroid antibody levels, and between patients with increased thyroid function and those with normal thyroid function.

Results

Five patients had increased thyroid function and seven had elevated thyroid antibody levels. Four were diagnosed with Graves' disease, 13 with atherosclerotic intracranial stenosis, two with intracranial arterial dissection, one with vasculitis syndrome and 10 with intracranial stenosis of unknown cause. All patients with Graves' disease and patients with elevated antithyroid peroxidase antibody levels had steno‐occlusion in the terminal portion of the internal carotid arteries, whereas most of the patients with normal thyroid function or without elevated thyroid antibody levels had stenosis in the middle cerebral arteries.

Conclusions

In young and middle‐aged patients, a lesion in the terminal portion of the internal carotid artery was associated with elevated thyroid antibody levels and increased thyroid function. Stenoses found in the terminal portion of the internal carotid artery and immune‐mediated thyroid diseases may share a common background.