bluuebunny/crossref_metadata_2025 huggingface dataset:
Intergenerational hybrid products in periods of discontinuous change
Authors: Gatti Junior Wilian , Camargo Junior Alceu Salles , Varella Paul
Published: February 2021

Purpose

This study examines the role of hybrid products employed in companies' innovation strategy within three American industrial sectors: tires, typewriters and photography cameras.

Design/methodology/approach

The authors selected historical cases that enabled us to present the role of hybrid products in periods of discontinuous change. Different sources are employed in this study: papers, books, cases, working papers, videos, manuals and product catalogues, companies' annual reports, company websites, advertising, collectors' websites and museums, in addition to press and other media reports.

Findings

The authors’ historical case analysis points to two forms of hybrid products. (1) Exploitation-hybrid, which incorporates significant elements from the existing dominant design and aims at extending the revenue-generating opportunities of the existing products. (2) Exploration-hybrid, which works as an offensive strategy, as the firm uses the exploration-hybrid to promote a gradual and controlled adoption of new technology by reducing risks and the cost of change for the customer.

Research limitations/implications

The authors’ proposed definitions strengthen the idea that hybrids are not only a reflection of organizational inertia (exploitation-hybrid). Hybrids can also mean a more proactive stance in the strategy of developing and adopting new technology (exploration-hybrid).

Originality/value

This study acknowledged hybrid products as a learning instrument that materialized the organizational ambidexterity, favoring at the same time exploitation, generally attributed to organizational inertia, and the exploration of new segments of customers or the use of new technologies.
Transitional foresight: MLP as the theoretical underpinning of CLA: the case of the water sector of Iran
Authors: Miremadi Tahereh
Published: February 2021

Purpose

The paper aims to complement the six pillars analysis with the multi-level perspective to make it more systematic and policy relevant.

Design/methodology/approach

Take the innovation system foresight as the exemplar; the paper asks if the other systemic approaches to innovation can function as the middle range theory and underpin critical future studies. To answer, the paper combines the six-pillar approach (SPA) with the multilevel perspective (MLP) and builds “transitional foresight”. Then it takes the fourth pillar; transitional causal layered analysis and applies it to a case study: water stress in Iran. The paper concludes noting that in transitional foresight, the borderlines, the players and the orientations of the foresight are clearer than the six-pillar analysis.

Findings

The SPA and MLP-integrated framework make a powerful research instrument for transitional foresight.

Research limitations/implications

The paper applied the integrated framework to a case “water system in Iran”. But the framework should be applied in different cases in different countries to test its applicability.

Practical implications

The suggested framework can be used as a heuristics for the students and researchers who want to engage with the emancipatory perspective of the six-pillar approach and need to have an academic methodology with rigor and granularity.

Originality/value

The six-pillar approach of Sohail Inayatullah and the multilevel perspective of Geels can combine to make a powerful heuristic for transitional foresight.
A novel integrated computational TRIFMRG approach with grey relational analysis toward parametric evaluation of weld bead geometry of ms-grade: IS 2062
Authors: Guo Xiaohui , Sahu Atul kumar , Sahu Nitin Kumar , Sahu Anoop Kumar
Published: February 2021

Purpose

In the presented research work, the authors fabricated the multiple MS plate (Grade: IS 2062) specimens and applied a novel integrated computational TRIFMRG approach with grey relational analysis (GRA) toward solving weld bead optimization problem in MIG welding procedure. The objective of research is to determine the optimum setting between MIG welding input process parameters, e.g. welding current, open circuit voltage and thickness of plate in attaining high tensile strength with weld bead geometry quality characteristics, e.g. bead width, reinforcement, penetration and dilution in investigating define MS specimens.

Design/methodology/approach

The Taguchi's L9 orthogonal array (OA) design is respected to conduct the experiments on MS plate specimens to attain output objectives. Later, the evaluated multiple output objectives are transformed into single response by applying a novel integrated computational TRIFMRG approach with GRA. Thereafter, the outset of signal-to-noise ratio (S/N ratio) accompanied by ANOVA (Analysis of variance) is explored to optimize objective function.

Findings

The computed results are confirmed by conducting the experiments on same identical specimens. The outcome of the confirmation tests yielded an improvement of 0.24454, 0.372486, 0.686635 and 0.4106846 in grey relational grade (GRG), overall ratio index, reference grade and full multiplicative index, respectively, after validating the results.

Originality/value

In the presented work, the authors constructed a novel integrated computational TRIFMRG approach via clustering GRA, overall ratio index (ORI), full multiplicative index (FMI) with GRA-reference grade (RG) and tested as well as applied with Taguchi concept to attain objective of the research work.
Robotic system design and development for automated dismantling of PCB waste
Authors: Doroftei Ioan , Chirita Daniel , Stamate Ciprian , Cazan Stelian , Pascal Carlos , Burlacu Adrian
Published: February 2021

Purpose

The mass electronics sector is one of the most critical sources of waste, in terms of volume and content with dangerous effects on the environment. The purpose of this study is to provide an automated and accurate dismantling system that can improve the outcome of recycling.

Design/methodology/approach

Following a short introduction, the paper details the implementation layout and highlights the advantages of using a custom architecture for the automated dismantling of printed circuit board waste.

Findings

Currently, the amount of electronic waste is impressive while manual dismantling is a very common and non-efficient approach. Designing an automatic procedure that can be replicated, is one of the tasks for efficient electronic waste recovery. This paper proposes an automated dismantling system for the advanced recovery of particular waste materials from computer and telecommunications equipment. The automated dismantling architecture is built using a robotic system, a custom device and an eye-to-hand configuration for a stereo vision system.

Originality/value

The proposed approach is innovative because of its custom device design. The custom device is built using a programmable screwdriver combined with an innovative rotary dismantling tool. The dismantling torque can be tuned empirically.
Teacher readiness for online teaching-learning during COVID − 19 outbreak: a study of Indian institutions of higher education
Authors: Paliwal Manisha , Singh Archana
Published: February 2021

Purpose

Coronavirus (COVID-19) outbreak has utterly disrupted the worldwide education system and compelled an emergency immersion of unplanned and rapid online teaching-learning. The online teaching readiness would highly depend on the competencies of teachers and skills to adapt the pedagogy and new roles by the teachers. In this context, this study aims to assess higher education institutions (HEIs) teachers’ readiness to handle online education based on the online teaching readiness competencies model.

Design/methodology/approach

A structured questionnaire has been adopted to survey and collect data from 296 teachers of HEIs across India. The questionnaire consisted of 29 constructs. The constructs in this section were measured using a five-point Likert scale ranging. In the first step first-order confirmatory factor analysis (CFA) is carried out, by using the software IBM AMOS-26. The initial model is generated for five constructs and outcomes are used to analyze the model’s goodness of fit and construct validity. In the second step structural equation modeling (SEM) is carried out to do the path analysis of the proposed model.

Findings

The findings connote that the level of course design competencies, communication competencies, time management competencies are not sufficient among the teachers of HEI of India, whereas the technical competencies possessed by the teachers meet the requirements for readiness to handle online education. The research is an attempt to provide possible explanations for establishing relationships between the constructs and discusses the usage of information, which can be further used to enhance the online teaching readiness competencies for the teachers of HEIs of India.

Practical implications

The research is an attempt to provide possible explanations for establishing relationships between the constructs and discusses the usage of information, which can be further used to enhance the online teaching readiness competencies for the teachers of HEIs of India.

Originality/value

Teachers’ competencies are a vital part of teaching online which has become the need of the hour in this COVID-19 outbreak. Because of the need for emergency response and strategies to minimize learning disruption at higher education, the study identifies the online teaching readiness competencies possessed by the online teaching communities and provides guidelines to enhance their capacity to build up the longer-term resilience of education systems. The study will be a ready reckoner for online training competencies which can be used as training need analysis to make each teacher highly competent to impart knowledge using online teaching platforms.
Linking supportive leadership to satisfaction with care: proposing and testing a service-profit chain inspired model in the context of elderly care
Authors: Kazemi Ali , Elfstrand Corlin Tinna
Published: February 2021

Purpose

As marketization has gained ground in elderly care, satisfaction with care has come to play a crucial role in designing for high-quality care. Inspired by the service-profit chain (SPC) model, the authors aimed to gain a deeper understanding of the intricate interplay between supportive leadership practices, organizational climate, job satisfaction and service quality in predicting satisfaction with care.

Design/methodology/approach

A Swedish sample of frontline elderly care staff (n = 1,342) participated in a cross-sectional questionnaire study. Mediation analyses were conducted to test the proposed model.

Findings

As predicted, engaging in supportive leadership practices was directly and positively associated with satisfaction with care. In addition, as predicted, this relationship was partially mediated by organizational climate and job satisfaction. Moreover, job satisfaction predicted satisfaction with care with service quality explaining a statistically significant part of this relationship.

Practical implications

Managers in elderly care services may improve satisfaction with care in multiple ways but primarily by showing that they care about the staff and ensuring that they are satisfied with their working conditions. Employee job satisfaction seems to be particularly crucial for satisfaction with care, beyond what can be accounted for by care service quality.

Originality/value

The authors proposed a novel service-outcome model. Adding to the original SPC model, the model in this study suggested previously unexplored relationships including a direct path between leadership practices and satisfaction with service and a multiple-mediator model explaining this relationship. Also, new measures of organizational climate and supportive leadership were developed for which satisfactory reliability estimates were obtained.
Linking performance pressure to employee work engagement: the moderating role of emotional stability
Authors: Kundi Yasir Mansoor , Sardar Shakir , Badar Kamal
Published: February 2021

Purpose

The purpose of this paper is to investigate the mediating role of threat and challenge appraisals in the relationship between performance pressure and employees' work engagement, as well as the buffering role of emotional stability, as a personal characteristic, in this process.

Design/methodology/approach

Data were collected using a three-wave research design. Hypotheses were examined with a sample of 247 white-collar employees from French organizations.

Findings

Performance pressure is appraised as either threat or challenge. Challenge appraisal positively mediated the performance pressure and work engagement relationship, whereas threat appraisal negatively mediated the performance pressure and work engagement relationship. Emotional stability moderated these effects, suggesting performance pressure was appraised as a challenge rather than a threat, which then enhanced employee work engagement.

Practical implications

This study has shown that employees with high emotional stability who perceived performance pressure as a challenge achieved stronger employee work engagement.

Originality/value

Building on Lazare's theory of stress and Mitchellet al.'s theorization, this research demonstrates mediating and moderating mechanisms driving the role of performance pressure on employee work engagement relationships.
Biomass partitioning in response to intraspecific competition depends on nutrients and species characteristics: A study of 43 plant species
Authors: Rehling Finn , Sandner Tobias M. , Matthies Diethart
Published: February 2021

Competition simultaneously limits the availability of above‐ and below‐ground resources for plants. How plants respond to density with changes in patterns of biomass allocation is poorly understood. Previous studies had inconsistent results, but emphasised increased biomass allocation to stems in response to density. However, the response of plants to density may depend on environmental conditions and on characteristics of the species.

We grew 43 herbaceous plant species at three densities (1, 8 and 64 individuals per pot) and two nutrient levels in a common garden and measured biomass allocation to roots (RMF), leaves (LMF) and stems (SMF), and specific root (SRL) and stem length (SSL). The species differed in functional group (grasses, forbs and legumes), life span and realised niche with respect to nutrients (Ellenberg's nutrient indicator value).

Intraspecific competition and self‐thinning increased with nutrient supply. Overall, plants increased their RMF with density independent of nutrient level, indicating that competition was mainly for below‐ground resources. However, characteristics of the species influenced their responses to density and nutrients in terms of biomass allocation, SRL and SSL. At high densities, legumes were more productive than the other functional groups and hardly changed their allocation patterns, suggesting that they were less nutrient limited due to their mutualism with nitrogen‐fixing rhizobia. The SRL of perennials was lower, and their RMF was higher and increased more strongly in response to density than that of annuals, which could be interpreted as mechanisms to increase survival. The realised niche of species with respect to nutrients influenced the response to density and nutrients in terms of SMF, LMF, SRL and SSL in line with adaptations to both nutrient availability and competition for light in the typical habitats.

Synthesis. We found that intraspecific competition was mainly for below‐ground resources, which may be typical for many species growing in moderately nutrient‐rich but high‐light habitats. Our results show that growth conditions, species characteristics and their interactions influence patterns of biomass allocation and plant morphology.
Do remittances moderate financial development–informality nexus in North Africa?
Authors: Akçay Selçuk , Karabulutoğlu Emre
Published: February 2021

The prevalent informality and sheer size of international remittances characterize the North African countries. This study primarily aims at investigating how remittances moderate the effects of financial development on the informal economy in North African countries. Employing pool mean group (PMG)/panel ARDL approach and a balanced panel data set over the period 1980–2015, we find that remittances moderate the negative relationship between financial development and informal economy. This finding suggests that remittances bolster financial development, which, in turn, decreases the informal economy. Based on this result, we recommend that tailored policies and interventions are needed to promote financial development and international remittances in the North African region.
Is the presence of a threatened arboreal mammal in residential areas related to remnant habitats?
Authors: Busschots Marie B. , Close Paul G. , Van Helden Bronte E. , Speldewinde Peter C.
Published: February 2021

Remnant natural habitat is assumed critical for supporting threatened animals within urban landscapes because these species generally have specific habitat requirements and typically respond poorly to anthropogenic disturbances. However, evidence that demonstrates some threatened species can occur, persist and even prosper in highly modified areas with seemingly little dependence on remnant vegetation challenges the role remnant vegetation is perceived to play in sustaining threatened species in urban landscapes. In this study, we tested the assumption that the presence of a threatened species in modified areas of an urban environment was dependent on remnant vegetation using the Critically Endangered western ringtail possum (Pseudocheirus occidentalis) as a case study. We predicted that the presence of possums in highly modified habitats would be positively correlated with proximity to remnant vegetation. Using spotlight surveys of 195 transects to determine species occurrence on residential streets, we found that the presence of the western ringtail possum was not related to remnant vegetation within the immediate surrounds, nor the distance from remnant habitats (neither large nor small). Our results promote the suggestion that highly modified habitats in urban landscapes can contribute conservation outcomes and that their potential role in wildlife conservation warrants serious consideration.
Turnover, richness difference and nestedness of rodent assemblages along the southern Andes elevation gradient
Authors: Novillo Agustina , Ojeda Ricardo
Published: February 2021

Beta diversity in ecological communities can reflect adaptations of species to differences in climate, environmental characteristics and site history, as well as local ecological dynamics. These dissimilarities among communities may reflect different processes as species replacement and richness difference or nestedness, which can be generated by different factors. Assemblages in mountain regions are expected to exhibit high beta diversity due to sharp environmental variation and historical events promoting isolation. Diversity patterns of small mammals along elevation gradients in the southern dry Andes exhibit high richness among high elevations and a humped shape pattern for abundances. However, it is not clear how beta diversity changes along this gradient, or the processes involved in this variation. Here we aim to evaluate small mammal beta diversity patterns along the elevation gradient. Therefore, we decomposed beta diversity into spatial turnover, richness differences and richness differences as a result of nestedness. Assemblage structure variation was assessed qualitatively and quantitatively. Also, we evaluate the local contribution of beta diversity (LCBD) and species contribution to beta diversity, to identify priority conservation sites and species. Our results show contrasting patterns among qualitative and quantitative beta diversity components. The former was mainly explained by species turnover, while the latter showed a higher contribution of richness difference than species turnover. Most components of beta diversity decreased with elevation, except for abundance turnover that showed an opposite trend. Furthermore, LCBD was higher at lower and mid‐elevation sites and exhibited a negative relationship with species richness and abundance.
Structural resistance and functional resilience of the Chaco forest to wildland fires: an approach with MODIS time series
Authors: Landi Marcos A. , Di Bella Carlos M. , Bravo Sandra J. , Bellis Laura M.
Published: February 2021

Forests have resistance that allows them to resist fires without changing to another state, and resilience that allows them to recover after disturbance. These properties are determined by many structural and functional determinants that interact between them. Despite the importance of structural resistance and functional resilience to wildland fires, few studies have evaluated the combined effect that structural and functional determinants have on them. Our goal was to assess the structural resistance and functional resilience to fire using remote sensing information. We specifically assessed the combined effect of pre‐fire vegetation characteristics, burn severity, and post‐fire precipitation on forest structural resistance and functional resilience to fire. Eighty‐five forest plots of 250 m × 250 m were selected in areas that burned in 2003. For each burned plot, a paired unburned control plot of 250 m × 250 m was selected outside the burned areas. We measured burn severity and post‐fire precipitations (2004–2011). We analysed MODIS time series in order to calculate the following pre‐ (2002) and post‐fire (2011) phenological parameters: minimum level of photosynthetic activity per year; maximum level of photosynthetic activity per year; length of growing season per year; integral of annual photosynthetic activity; relative seasonality of photosynthetic activity. Also we detected plots that changed into a shrubland eight years after the fire. Fifty three per cent of burned plots changed from forest into a shrubland state. Results show that the forest structural resistance to fire depends on the balance between the level of severity and the parameters related to pre‐fire aboveground net primary production. The impact of pre‐fire vegetation characteristics on functional resilience ability was driven by burn severity and it’s interactions with pre‐fire productivity and seasonality. Results suggest that changes in forest species composition and aboveground net primary production reduced forest structural resistance and functional resilience to fire.
Current estimates and vegetation preferences of an endangered population of the vulnerable greater glider at Seven Mile Beach National Park
Authors: Vinson Simon G. , Johnson Aidan P. , Mikac Katarina M.
Published: February 2021

This study aimed to provide accurate and current distribution and density estimates of the greater glider population size at Seven Mile Beach National Park, New South Wales Australia from extensive spotlight surveys. Distribution mapping of greater gliders and ArcGIS modelling allowed effective visual representation of the population’s distribution and provided preliminary evidence of a vegetation preference for the species within the study area. Spotlight surveys revealed the population ranged from 0 to 1.13 (±0.34) greater gliders per hectare; with an average of 0.41 greater gliders per hectare across Seven Mile National Park. An estimated total of 335 greater gliders could reside in the area. Vegetation surveys confirmed there was a higher encounter rate of greater gliders within Eucalyptus pilularis, blackbutt dominated forest. As expected, the number of suitable hollows was also an important factor affecting greater glider distribution. These findings have site‐specific implications for a number of suitable management options (e.g. nest boxes, road crossing structures and glider poles).
Effectiveness of bat boxes for bat conservation and insect suppression in a Western Australian urban riverine reserve
Authors: Burgar Joanna M. , Hitchen Yvette , Prince Jim
Published: February 2021

Urban wetlands are important habitat for wildlife, particularly insectivorous bats which provide a key ecosystem service in suppressing insects. While claims are often made that bats consume high numbers of mosquitoes in a given night, the evidence for this claim is scant at best. The Canning River Regional Park (CRRP), an urban riverine reserve in Western Australia, has fauna conservation as a primary goal and mosquito control as a top priority. We took advantage of occupied bat boxes within the CRRP to determine the roosting bat species and their diet using non‐invasive DNA metabarcoding of bat faecal samples. The widespread and urban‐adapted Chalinolobus gouldii was the only bat species detected roosting in the bat boxes. This opportunistic forager consumed over 700 unique prey (operational taxonomic units; OTUs); only 14% of OTUs were assigned to either species or genus, representing seven insect orders. Mosquitoes were detected in 11% of the 90 faecal samples, over multiple years and in both the maternity and non‐maternity seasons. Assigned prey was predominantly Lepidoptera with 40% of the 49 Lepidoptera species negatively impacting humans. Urban riverine reserves are critical habitat for bats, which in turn, are crucial in providing the ecosystem service of insect suppression.
The role of tayra (Eira barbara) as predator of medium and large‐sized mammals
Authors: Grotta‐Neto Francisco , Mello Michel C. H. , Mello Raphael C. , Bernardi Itiberê P. , Carrano Eduardo , Passos Fernando C.
Published: February 2021

Interactions between predators and prey affect their distributions and abundances, and these effects are of central importance in ecology. However, these interactions are difficult to observe in some free‐ranging species due to their elusive behaviour. We describe the video‐recorded observation of predation of a grey brocket deer (Mazama gouazoubira) by a tayra (Eira barbara), which is the largest prey reported for this mustelid. Additionally, we report three other wild species (Dasypus sp., Sylvilagus brasiliensis and Leontopithecus chrysopygus) predated by tayra and we present a review of tayra attacks on, and predation of, small primates and other medium and large‐sized mammal prey. Surprisingly, this mustelid is capable of predating a high diversity of species, both arboreal and terrestrial. At least 20 species were seen to be predated or attacked by tayras, which are capable of predating species with up to twice its own body weight, information which may be unknown due to its elusive behaviour. Additionally, we discuss the role of tayra in a community structure and raised the question of its potential key role as a predator species. This makes this mustelid a predator with greater prey diversity than previously thought and elucidate aspects of the natural history of trophic ecology of tayra, grey brocket deer and others elusive forest species.
Stereotactic body radiotherapy prolongs the progression‐free survival and delays the change of systemic therapy regimen in patients with lung oligoprogressive metastatic colorectal cancer
Authors: Li Shuai , Dong Dezuo , Geng Jianhao , Zhu Xianggao , Shi Chen , Zhang Yangzi , Wang Hongzhi , Zhou Shun , Wu Hao , Cai Yong , Li Yongheng , Wang Weihu
Published: February 2021

Purpose

To analyze the effect of stereotactic body radiotherapy (SBRT) on colorectal cancer (CRC) patients with lung oligoprogression (OP).

Method

Patients with lung OP from CRC treated by SBRT at our center were included in this retrospective analysis. The progression‐free survival (PFS), change of systemic therapy (CST), local control (LC), and overall survival (OS) were analyzed. Cumulative incidence was used to report CST, and the Kaplan‐Meier method was used to evaluate PFS and LC.

Results

A total of 17 patients with 38 lung OP lesions treated by SBRT from October 2012 to December 2018 were involved. All patients had undergone radical resection for primary CRC and administered with standard systemic therapy regimens (seven for the first line and 10 for the second line). Among them, nine (52.9%) had received targeted therapy before SBRT, 14 (82.4%) patients underwent chemotherapy, and 12 received targeted therapy after SBRT. Six patients (35.3%) underwent CST after a median time of 5.2 months (range: 1.7‐27.5 months). The median follow‐up was 9.9 months, and the 1‐year OS rate for all patients was 73.5%. Progression was observed in of 14 of 17 patients (82.4%), and the 6‐month PFS for all patients was 25.9%. Univariate analysis indicated that only targeted therapy before SBRT was a beneficial prognostic indicator for 6‐month PFS (P = .026) and N‐PFS (P = .013). The 1‐year LC for all 38 lesions was 77.8%, and during and after SBRT, no grade 3 or higher toxicities were observed.

Conclusion

SBRT combined with systemic therapy made partial CRC patients with lung OP avoid the progress within 6 months and delayed the need for CST to 5.2 months, and targeted therapy before SBRT was a positive indicator of PFS.
Towards more effective health workforce governance: The case of overseas‐trained doctors
Authors: Marcus Kanchan , Purwaningrum Farah , Short Stephanie
Published: February 2021

Objective

The over‐reliance on overseas‐trained doctors remains a pressing problem in a handful of countries. This study aimed to explore the experience of rural and remote overseas‐trained doctors as regards to their migration, recruitment and ongoing support in Australia as the basis for more effective health workforce governance.

Design

Qualitative interviews were undertaken with overseas‐trained doctors in rural and remote Australia. Interview questions focused on the experiences of overseas‐trained doctors.

Setting

Migrant doctors working in general practice in rural and remote Australia.

Participants

Overseas‐trained doctors who met inclusion criteria participated in interviews (n=14), which were digitally recorded and transcribed. Thematic coding and analysis were conducted with input from the study's Expert Policy Stakeholder Group.

Results

Overseas‐trained doctors enjoyed the relative autonomy of working in rural or remote general practice and were grateful to be in Australia. Specialised rural and remote skills such as cultural competence in matters of Indigenous health and specialised emergency rural skills was a key finding as was the deskilling or lack of career development opportunities. Our analysis pointed to the mismatch in expectations and experiences between overseas‐trained doctors, policy‐makers and employers, as some doctors experienced obstacles with registration, or the location was not ideal, or there was a lack of awareness of Indigenous‐related health and cultural challenges.

Conclusions

In the context of Australia's continuing reliance on overseas‐trained doctors, this study revealed the need for improved communication and coordination between overseas‐trained doctors, policy‐makers (education, health, employment and immigration) and employers, as a basis for more effective health workforce governance.
Management of LDL‐cholesterol levels in patients with Diabetes Mellitus in Cardiology Practice: Real‐life evidence of Under‐treatment from the EPHESUS registry
Authors: Mert Kadir Uğur , Başaran Özcan , Mert Gurbet Özge , Doğan Volkan , Rencüzoğulları İbrahim , Özlek Bülent , Cinier Göksel , Şenol Utku , Çelik Oğuzhan , Özlek Eda , Özdemir İbrahim Halil , Karadeniz Fatma Özpamuk , Bekar Lütfü , Aktaş Müjdat , Resulzade Mübariz Murat , Kalçık Macit , Aksan Gökhan , Akay Kadriye , Pekel Nihat , Biteker Murat , Kayıkçıoğlu Meral
Published: February 2021

Background and aims

Effective treatment of high low‐density lipoprotein cholesterol (LDL‐C) levels has been shown to improve cardiovascular outcomes of patients with diabetes mellitus (DM). Herein, we aimed to provide insight to the real‐life management of patients with DM in terms of LDL‐C goal attainment and adherence to lipid management recommendations. Our objective was also to reveal the reasons of poor LDL‐C goal attainment by assessing the perceptions of both physicians and patients.

Methods

We compared the diabetic and non‐diabetic patients from the database of a nationwide registry conducted in cardiology outpatient clinics with regard to the demographic characteristics, educational status, comorbidities, medications, laboratory parameters and LDL‐C goal attainment. Also, both the patients and attending physicians were surveyed to analyse perceptions and awareness of hypercholesterolemia.

Results

Of the 1868 consecutively enrolled patients, 873 (47%) had DM. Proportion of patients on statins was significantly lower in patients with DM (67.8% vs 55.3%; P < .001). The proportion of patients who attained LDL‐C targets were lower among the diabetic patients (17.8% vs 15%; P = .06). The most common causes of the discontinuation of statin therapy were negative media coverage about statins (32.1%), and recommendations of physicians to stop the lipid lowering therapy (29.6%). Analysis of the physician survey revealed that the physicians could determine the off‐target patients accurately (negative predictive value 98.4%) while the positive predictive value (48.8%) was low. The reasons for not attaining the LDL‐C goals in diabetic patients were not prescription of statins (38%) and inadequate (eg low‐dose, non‐adherent) statin (28.3%) dosages.

Conclusions

In real‐life clinical cardiology practice, diabetic patients are far below the recommended LDL‐C treatment goals. High‐intensity statin treatment in diabetic population is still avoided because of the concerns about polypharmacy and drug interactions. Also, the inertia of physicians and even cardiologists is probably a major cause of refraining of prescription of optimal statin dosages.
The effect of intracranial stenosis on cognitive decline in a memory clinic cohort
Authors: Lim Mervyn Jun Rui , Tan Chuen Seng , Gyanwali Bibek , Chen Christopher , Hilal Saima
Published: February 2021

Background and purpose

Intracranial stenosis (ICS) is a risk factor for cognitive impairment and dementia in cross‐sectional studies. However, data examining the effect of ICS on cognitive decline are limited. We investigated the effect of ICS on cognition over a period of 3 years in a memory clinic cohort.

Methods

Patients were recruited from the National University Hospital in Singapore. Data were collected using a standardised questionnaire, physical examination, and 3‐T magnetic resonance imaging (MRI) at baseline. ICS was defined as arterial narrowing that exceeded 50% of the luminal diameter in any intracranial vessel. Cognition was measured at baseline and annually for 3 years using the Mini‐Mental State Examination, the Montreal Cognitive Assessment, and a detailed neuropsychological test battery. The association between ICS and cognitive decline was analysed using generalised estimating equations.

Results

A total of 364 patients were included in the analysis. The mean (±SD) age was 71.9 (±8.0) years, and 164 (45.1%) patients were male. A total of 66 (18.1%) patients had ICS. ICS was associated with worse executive function (β = −0.37, 95% confidence interval = −0.68 to −0.05, p = 0.022) and modified the effect of follow‐up time on memory (p = 0.005) and visuomotor speed (p = 0.047). These results remained significant after controlling for demographics, overall diagnosis, cardiovascular risk factors, and MRI markers of cerebrovascular disease.

Conclusions

Intracranial stenosis was independently associated with worse executive function across all time points, and cognitive decline in memory and visuomotor speed over 3 years of follow‐up. This suggests that ICS may be a useful indicator of vascular brain damage leading to cognitive decline and may warrant consideration of antiatherosclerotic treatment in clinical trials.
The efficacy of a rubber bristles interdental cleaner on parameters of oral soft tissue health‐a systematic review‐
Authors: van der Weijden Fridus , Slot Dagmar Else , van der Sluijs Eveline , Hennequin‐Hoenderdos Nienke Lisette
Published: February 2021

Aim

This study aimed to establish the efficacy of a rubber bristles interdental cleaner (RBIC) as an adjunct to toothbrushing (TB) compared to that of the adjuvant use of other interdental cleaning devices and TB alone on plaque and gingivitis parameters. Additionally, the safety aspects and panellists’ appreciation were evaluated.

Materials and Methods

Databases were searched for randomized controlled clinical trials (RCTs) evaluating plaque (PI), bleeding (BS), and gingival index (GI) scores, safety assessments, and participants’ appreciation. Extracted data were summarized in a descriptive and, if possible, a meta‐analysis.

Results

The search retrieved 142 unique papers; six studies with 10 comparisons were included in a descriptive analysis. Five RCTs compared RBICs with interdental brushes (IDBs), four with dental floss (DF) and one with manual TB only. No comparisons to wood sticks were retrieved. Using an RBIC resulted in no difference in plaque scores compared to DF and IDBs. For overall bleeding scores, no difference was found. Two studies analysing the accessible sites separately found RBICs to be more favourable than DF and IDBs. Conversely, one study evaluating the efficacy of RBICs compared to IDBs, according to the GI scores, showed that IDBs achieved significantly greater reduction. Moreover, RBICs caused fewer gingival abrasions and were preferred by the study participants.

Conclusion

Based on a descriptive and a meta‐analysis of the available literature, it is synthesized that in gingivitis patients, a weak to very weak certainty exists that a RBIC is indicated for gingivitis and plaque reduction. The evidence supports user safety and participants’ preferences.
Effectiveness of self‐management programmes for adolescents with a chronic illness: A systematic review
Authors: Gauci Jaunna , Bloomfield Jacqueline , Lawn Sharon , Towns Susan , Steinbeck Katharine
Published: February 2021

Aim

To assess what is known about the effectiveness of face‐to‐face self‐management programmes designed specifically for adolescents (10–19 years) with a chronic illness.

Design

A systematic review and synthesis without meta‐analysis (SWiM).

Data sources

Six international web‐based reference libraries were searched with a date range of 1946 to July 2020.

Review method

The PRISMA statement and SWiM guideline were used for reporting the methods and results. The PICO format was used to develop a focused clinical question and the eligibility criteria of our review. Quality assessment of the included studies was performed using the Cochrane Effective Practice Organisation of Care criteria.

Results

Eight studies (four randomized controlled trials and four descriptive designs) met the inclusion criteria and were published between 2003 and 2017. Results of the review: Three studies demonstrated measures of illness control which showed initial improvements in adherence as a result of the interventions but failed to demonstrate sustained adherence over time. Booster sessions were identified as an effective strategy to improve adherence, but were often omitted.

Conclusions

There is a limited body of evidence on the effectiveness of self‐management programmes specifically developed for adolescents with a chronic illness, an important but under researched area. Future research lies in the development of more rigorous studies that focus on quantitative outcome measures for evaluating the effectiveness of self‐management programmes to guide the development of future programmes.

Impact

It is crucial for adolescents with a chronic illness to develop independence and the self‐management skills required to effectively manage their chronic condition as they transition to adulthood. On current evidence, in planning future self‐management interventions should include booster sessions. Nurses with additional training and experience have a key role in supporting adolescents with a chronic illness to develop self‐management skills as they assume responsibility for their own healthcare.
Dielectric imaging for electrophysiology procedures: The technology, current state, and future potential
Authors: Abeln Bob G.S. , van den Broek Johannes L.P.M. , van Dijk Vincent F. , Balt Jippe C. , Wijffels Maurits C.E.F. , Dekker Lukas R.C. , Boersma Lucas V.A.
Published: February 2021

Electroanatomic mapping systems have become an essential tool to guide the identification and ablation of arrhythmic substrate. Recently, a novel guiding system for electrophysiology procedures was introduced that uses dielectric sensing to perform high resolution anatomical imaging. Dielectric imaging systems use electrical fields to differentiate anatomic structures based on their conductivity and permittivity. This technique enables non‐fluoroscopic, noncontact mapping of anatomic structures, assessment of pulmonary vein occlusion state during cryoballoon ablation, and has the potential to assess for additional tissue characterization including tissue thickness and tissue type. This article elaborates on the functioning and potential of dielectric imaging systems and provides two cases to illustrate the clinical impact for electrophysiology procedures.
Commentary: Social Immune Processes as Pathways to Psychopathology: a commentary on Robles (2020)
Authors: Manczak Erika M.
Published: February 2021

In this Annual Research Review, Robles (2020) discusses and synthesizes a growing literature on immune correlates of social relationships during childhood and adolescence. As he notes, the capacity for our social experiences to shape innate immune processes holds tremendous medical and psychiatric import. Childhood social experiences are associated with peripheral inflammation later in life, with related and possibly intermediate markers (like stimulated cytokine production or the expression of NF‐κβ genes), and with circulating inflammatory markers in childhood (at least in high‐risk groups), supporting the interpretation that youth social experiences are important contributors to health trajectories across the life span. Somewhat less explored, however, are what such associations mean for psychopathology.
Proactive primary care model for frail older people in New Zealand delays aged‐residential care: A quasi‐experiment
Authors: Robinson Thomas E. , Boyd Michal L. , North Diana , Wignall Jean , Dawe Martin , McQueen Jean , Frey Rosemary A. , Raphael Deborah L. , Kerse Ngaire
Published: February 2021

Background/Objectives

To determine the effect of a proactive primary care program on acute hospitalization and aged‐residential care placement for frail older people.

Design

Controlled before and after, and controlled after only quasi‐experimental studies, with a comparison group created via propensity score matching. One‐year follow‐up.

Setting

Nine general practices in Auckland, New Zealand.

Participants

Community‐dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks.

Intervention

Primary healthcare based, registered nurse‐led, comprehensive geriatric assessment, goal‐setting, care planning, and regular follow‐up. Patients were also provided self‐management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists.

Measurements

Outcomes from routinely collected administrative data. Primary: aged‐residential care placement. Secondary outcomes: acute hospitalization, mortality, and other health service utilization.

Results

Aged‐residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48‐0.91) and mortality (OR 0.66, 95% CI = 0.49–0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = −0.01–0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased.

Conclusion

The Kare participants had lower aged‐residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results.
Intimate Sovereignty: Mennonite Self‐Government in “Green Hell” and the Politics of Belonging in Paraguay's Chaco
Authors: Canova Paola
Published: February 2021

During the mid‐1920s, Mennonite settlers to the Paraguayan Chaco established a system of self‐governance in a frontier region constructed and imagined at “the edge” of the state. Despite the fast‐paced economic development that has rapidly transformed the region, the Mennonites have managed to remain socially and geographically isolated from the rest of the population until recently. What sustains their contemporary model of self‐governance in a context that is rapidly changing? An examination of the key role of intimacy, explored through the strategic deployment of sexuality and the establishment of socioeconomic institutions, reveals how they have established a racialized project of sovereignty in the region, coconstructed in interdependence with the Paraguayan state. The article discusses the implications of such a model in a region inhabited mostly by indigenous peoples, and offers some theoretical reflections on the intimate role of race and sexuality in shaping nonstate projects of sovereignty.
Histological and immunohistochemical changes in facial skin treated with combined ablative and non‐ablative laser therapy
Authors: Shanina Natalia A. , Patrushev Alexander V. , Zorman Anže
Published: February 2021

Background

Facial skin rejuvenation is a highly sought after procedure. Different materials, energy‐based devices and techniques have been shown to offer good results in facial rejuvenation.

Aims

The aim of this study was to evaluate the macroscopic and histological and immunohistochemical changes in facial skin treated with a combined laser therapy.

Patients/Methods

Fourteen patients aged from 38 to 59 years were included in the study. Two different wavelengths (2940 and 1064 nm) were used in this four‐step procedure.

Results

Significant improvement according to classification for age‐related changes in all areas of the face was achieved. There were also significant structural changes in the epidermis and dermis, confirmed with histology and immunohistochemistry.

Conclusion

The dual‐wavelength protocol has been found to provide excellent results for facial rejuvenation.