bluuebunny/crossref_metadata_2025 huggingface dataset:
How do you change the world? The role of working condition in quest for excellence in quality education: evidence from Bangladesh
Authors: Ashraf Mohammad Ali
Published: October 2020

Purpose

The purpose of this paper is to examine the relationships between quality education and human resource management practices of faculty supervisor’s support, job autonomy and working condition in the private universities. Specifically, how does the working atmosphere in the private universities in Bangladesh play a mediating role in the links between faculty supervisory support and job autonomy toward excelling quality education?

Design/methodology/approach

To answer this question, a theoretical framework using the strategic contingency theory as its basis was established. Data (n= 515) were analyzed using structural equation modeling.

Findings

The findings of the study indicate that faculty supervisor’s support and working condition have significant positive relations with quality education and the working condition has an important mediating role in the links between supervisor’s support, job autonomy and quality education in the private universities in Bangladesh.

Research limitations/implications

First, the study used faculty as respondents from only 19 private universities in Bangladesh where more than 100 universities are in active operation at present. Second, the study included only top-ranking private universities and ignored other low-grade local private universities ranked by the university grant commission and they should be included in the study. Third, this study did not include public universities in the survey. Fourth, only two antecedents to the working environment toward quality education were included. Finally, this study collected data only from the faculty of the school of business and economics for examining their opinion.

Practical implications

From an academic and practical perspective, as a cumulative body of study on the relationship between different HRM practices and quality education, this paper will be better able to advise concerned authorities of higher education intuitions on the elements they need to address to ensure quality teaching and learning in their institutes.

Social implications

Several factors that directly and indirectly influence quality education through pleasant working environments appear to the surface. Thus, to create a vital working condition in private universities, academic leaders or authorities should be aware to make some improvements.

Originality/value

The study reveals a paramount finding that can help academicians and authorities of private higher education institutes.
How types of organizational culture and technological capabilities contribute to organizational learning
Authors: Al Dari Taghreed , Jabeen Fauzia , Hussain Matloub , Al Khawaja Dana
Published: October 2020

Purpose

This study aims to develop a theoretical framework of the impact of clan and hierarchy cultures and knowledge technological capabilities on organizational learning.

Design/methodology/approach

A questionnaire survey was used to collect data from 693 employees working in knowledge management centers in various law and enforcement units in the United Arab Emirates (UAE). Structural equation modeling was used to test the relationships between the variables.

Findings

The findings show that the clan culture had a significant negative effect on organizational learning. However, hierarchy culture and knowledge technological capabilities had a significant positive impact in predicting organizational learning behavior.

Research limitations/implications

The study focuses on a specific type of public organization only, which somewhat limits the generalizability of the research results. Second, as the study was cross-sectional, the causal relationships could not be inferred directly. The study results will help policymakers create a learning organization by examining the impact of organizational culture and knowledge of technological capabilities.

Originality/value

This paper has added knowledge about the relationship between culture types, knowledge technological capabilities and organizational learning, particularly in the UAE. This study helps to bridge the gap in research on culture and knowledge technological capabilities and organizational learning.
Analysis of post-processing influence on the geometrical and dimensional accuracy of selective laser melting parts
Authors: Cuesta Eduardo , Alvarez Braulio J. , Zapico Pablo , Giganto Sara
Published: October 2020

Purpose

This study aims to analyze the effect of the different common post-processes on the geometrical and dimensional accuracy of selective laser melting (SLM) parts.

Design/methodology/approach

An artefact has been designed including cubic features formed by planar surfaces orientated according to the machine axes, covering all the X-Y area of the working space. The artefact has been analyzed both geometrically (flatness, parallelism) and dimensionally (sizes, distances) from coordinate measuring machine measurement results at three stages, namely, as-built, after sand-blasting and after stress-relieving heat treatment.

Findings

Results from the SLM machine used in this study lead to smaller parts than the nominal ones. This effect depends on the direction of the evaluated dimension of the parts, i.e. X, Y or Z direction and is differently affected by the sandblasting post-process (average erosion ratio of 68, 54 and 9 µm, respectively), being practically unaltered by the HT applied after.

Originality/value

This paper shows the influence, from a geometric and dimensional point of view, of two of the most common post-processes used after producing SLM parts, such as sand-blasting and stress-relieving heat treatment, that have not been considered in previous research.
Investigation into effects of cooling rate on properties of polyamide 12 parts in the multi jet fusion process
Authors: Mele Mattia , Campana Giampaolo , Pisaneschi Gregorio , Monti Gian Luca
Published: October 2020

Purpose

Multi jet fusion is an industrial additive manufacturing technology characterised by high building speed and considerable properties of the parts. The cooling phase represents a crucial step to determine productivity, since it can take up to 4.5 times the building time. The purpose of this paper is to investigate into effects of cooling rate on parts manufactured by multi jet fusion. Crystallinity, density, distortions and mechanical properties of specimens produced through an HP multi jet fusion 4200 are examined.

Design/methodology/approach

An experimental activity is carried out on specimens cooled down at three different rates. Properties of the parts are analysed by means of differential scanning calorimetry, optical microscopy, three-dimensional scanning and tensile testing.

Originality/value

The present work makes a contribution to the body of knowledge providing correlations between the cooling phase of multi jet fusion and part properties. These results can be used to choose the right balance between production time and product quality.
No child is an island: from attachment narratives towards a sense of belonging
Authors: Vermeire Sabine
Published: October 2020

Children and young people who have experienced violence, abuse or neglect run the risk of becoming insulated from their family, carers and the broader communities they belong to. They often present problematic behaviour and may get diagnosed with reactive attachment disorder or are seen as insecurely attached. Despite all the efforts made by the people involved, feelings of alienation can increase. Drawing upon the rich literature on attachment, we therapeutically elaborate ideas that run counter to such isolating tendencies. A systemic approach to theoretical concepts of attachment such as ‘a sense of personal and relational agency’, ‘a sense of coherence’ and ‘a sense of belonging’ opens up therapeutic possibilities. A thoughtful use of playfulness and narrative methods in work with children, their families, their carers and wider networks facilitates new ways of relating: we talk and do attachment in ever widening circles. This is illustrated by a case study.

Practitioner points

A systemic take on difficult attachment behaviour opens up new therapeutic possibilities, especially when using narrative ideas and playfulness

Creating a safe place allows children and their carers to co‐research difficulties and start to talk and ‘do’ attachment, in ever widening circles

By continually involving different actors, professional as well as nonprofessional, teams of solidarity and care are created
Internal Control over Financial Reporting and Resource Extraction: Evidence from China*
Authors: Ge Weili , Li Zining , Liu Qiliang , McVay Sarah
Published: October 2020

We examine whether the strength of internal control over financial reporting (internal control) reduces the expropriation of resources from the firm by managers and controlling shareholders. Although we have ample evidence from prior literature that internal controls reduce errors in financial reports, it is less clear that they can curb resource extraction, because management may fail to enforce these controls. Exploiting the setting of China, where we have a rich internal control data set and established measures of resource extraction, we provide evidence consistent with internal controls curbing resource extraction on average. In particular, we document a negative association between internal control strength and resource extraction. We also find that the association between internal control strength and resource extraction is weaker in settings where we expect management to have fewer incentives to enforce these controls: within state‐owned firms and within non‐state‐owned firms that have a powerful controlling shareholder. We interpret these results as suggesting that internal controls must both exist and be enforced by management for the controls to safeguard assets. Although the analyses are conducted using Chinese data, we expect the spirit of our findings to generalize to other settings—management can “window dress” internal control procedures while still engaging in undesirable behavior.
Controlling Shareholders' Tax Incentives and Classification Shifting*
Authors: Chung Heesun , Choi Sunhwa , Jung Woon‐Oh
Published: October 2020

Although prior studies provide evidence on the financial reporting incentives to inflate core earnings through classification shifting (e.g., shifting core expenses to income‐decreasing noncore items), few examine the tax‐related incentive to report lower core earnings through classification shifting. We examine the effect of controlling shareholders' tax incentives on firms' classification shifting using the introduction of a tax law in Korea that imposes a gift tax on controlling shareholders based on firms' reported core earnings. This tax law creates incentives for managers to report lower core earnings through classification shifting, even though doing so would incur significant financial reporting costs. Using a difference‐in‐differences research design, we find that firms with controlling shareholders subject to the gift tax exhibit a significant decline in classification shifting in the post‐tax period, while those not subject to the tax do not. We also predict and find that the extent to which managers reduce classification shifting decreases with financial reporting costs and increases with the tax benefits. Overall, our results indicate that firms forgo financial reporting benefits associated with reporting higher core earnings for the tax savings of their controlling shareholders.
Revealing Oz: Institutional Work Shaping Auditors' National Office Consultations*
Authors: Aghazadeh Sanaz , Dodgson Mary Kate , Kang Yoon Ju , Peytcheva Marietta
Published: October 2020

National office consultations (NOCs) are a mechanism intended to enhance audit quality, consistent with the logic of professionalism inherent in the audit profession. Yet research indicates that the competing logic of commercialism has become institutionalized in audit firms. We examine how the coexisting and conflicting logics of professionalism and commercialism manifest themselves in the current NOC dynamic. Specifically, we interview 22 highly experienced Big 4 audit firm partners to investigate how key actors engage in institutional work that creates, maintains, and disrupts the influence of professionalism and commercialism in NOC practices. We observe a swing of the pendulum: in the wake of SOX, audit firms adopted professionalism‐based practices which involved creating a more authoritative, “Oz”‐like national office identity, while in recent years key actors' institutional work reconfigured NOC practices and placed a renewed focus on commercialism. Our findings bring to light a number of implications that offer opportunities for future research. Although the new client‐inclusive culture aims to improve audit outcomes by encouraging consultations and fostering open dialogue with clients, it also exposes the national office to relationship‐management pressures and client‐service demands. Thus, practices developed to uphold professionalism also created a channel for commercialism‐focused practices, leading to unintended second‐order effects.
Serum level of interleukin‐35 as a potential prognostic factor for gastric cancer
Authors: Gu Jin‐Hua , Wang Xiao‐Ge , Wang Li‐Qiang , Zhou Li‐Na , Tang Min , Li Ping , Wu Xiao‐Yang , Chen Min‐Bin , Zhang Yan
Published: October 2020

Aims

Interleukin‐35 (IL‐35), a novel anti‐inflammatory cytokine, has recently been implicated in tumor development, progression, and survival. However, the relationship between serum IL‐35 levels and gastric cancer (GC) is inconclusive. Here, we performed this study to clarify the role of serum level of IL‐35 in GC patients.

Methods

We enrolled 180 GC patients and 170 healthy controls and used enzyme‐linked immunosorbent assay to detect serum IL‐35 levels. The clinical relevance between IL‐35 and clinical pathology parameters was assessed. Univariate and multivariate logistic regressions were used to determine the feasibility of IL‐35 as a clinical biomarker.

Results

We observed that serum IL‐35 levels were significantly higher in GC patients (17.559 ± 13.266 pg/mL) than in healthy controls (8.077 ± 3.801 pg/mL, P < .001). High serum IL‐35 levels were significantly associated with clinical stage (P = .048) and Helicobacter pylori (HP) infection (P < .001). The Kaplan‐Meier survival analysis indicated that patients in the high‐IL‐35 group had poor overall survival (OS) and progression‐free survival (PFS) (median OS: 26.0 vs 36.0 months, P < .001; median PFS: 18.0 vs.26.0 months, P = .044). Multivariate analyses demonstrated that serum IL‐35 was an independent prognostic factor for GC (OS: hazard ratio [HR] = 1.031 [95% CI, 1.017‐1.045], P < .001; PFS: HR = 1.029 [95% CI, 1.015‐1.043], P < .001).

Conclusions

High serum IL‐35 levels are associated with poor disease prognosis in GC patients, and it may be become a new and promising biomarker for prognosis of gastric cancer.
Helping Couples Connect during the COVID‐19 Pandemic: A Pilot Randomised Controlled Trial of an Awareness, Courage, and Love Intervention
Authors: Tsai Mavis , Hardebeck Emerson , Ramos Fabiana Pinheiro , Turlove Hannah , Nordal‐Jonsson Kaisa , Vongdala Akoly , Zhang Wen , Kohlenberg Robert J.
Published: October 2020

Background

A second pandemic of mental health problems due to COVID‐19 is predicted, suggesting a demand for interventions to mitigate its impacts. This study evaluated the effectiveness of an online psychological intervention based on the Awareness, Courage, and Love (ACL) model from Functional Analytic Psychotherapy to promote closeness between couples during the pandemic.

Method

Thirty‐one couples were randomised into either the intervention or control group for a 2‐hour online group session. The intervention was designed to increase closeness between couples, whereas control group members watched a movie. In both groups, participants responded to two instruments that assessed the couple's relationship. Generalised linear mixed modeling was used to compare the change scores over time between the groups, with random effects used to control for the correlation within a couple and the correlation within the individual.

Results

The intervention group’s closeness increased by 23 per cent while the control group’s closeness increased only 2 per cent. A week later, a significant difference between the two groups emerged on closeness.

Conclusion

Online ACL protocols requiring minimal training offer a promising intervention to quickly buffer against stress for large numbers of individuals during pandemic times.
Genetic associations between reproductive traits for first calving and growth curve characteristics of Japanese Black cattle
Authors: Inoue Keiichi , Hosono Masahiko , Oyama Hidemi , Hirooka Hiroyuki
Published: October 2020

The objective of this study was to estimate genetic parameters for first calving reproductive traits and growth curve characteristics in Japanese Black cattle. The Gompertz growth function was fitted to body weight–age data to obtain the mature weight (MWT) and rate of maturing (ROM) of cows. Data of reproductive traits including the first service conception rate (CR) for heifers, age at the first calving (AFC), and gestation length for the first calving were collected. Records of 3,204 animals were used for analysis. Genetic parameters were estimated using a linear uni‐ and bivariate animal model. The heritability estimates were moderate (0.29 for ROM) and high (0.57 for MWT) for growth curve parameters and low (0.03–0.11) for reproductive traits. There was a negative genetic correlation between MWT and ROM (−0.26), suggesting that an animal with a faster ROM would show a lower MWT. CR was negatively correlated with MWT (−0.42) but significantly and positively correlated with ROM (0.91). There was a negative genetic correlation between AFC and MWT (−0.49). These results suggest that a heifer with a faster ROM and lower MWT would show a higher CR. Meanwhile, a heifer with a lower MWT would show a higher AFC.
Comparative morphology and histochemistry of the uropygial gland of the endangered and endemic Hooded Grebe (Podiceps gallardoi, Podicipediformes)
Authors: Chiale María Cecilia , Carril Julieta , Montalti Diego , Barbeito Claudio Gustavo
Published: October 2020

The Hooded Grebe is an endangered and endemic species of Podicipediformes of Argentina. Many aspects of this bird's biology are still unknown including the uropygial gland. This is the first morphological and histochemical description of the uropygial gland for this species in a comparative context. The uropygial gland of these birds had parallel arranged lobes with a kidney‐like shape, a conical papilla and a feather tuft in a sub‐terminal position. The lobes were composed of tubular adenomers with a straight course that lead to secondary chambers. The capsule and connective tissue around the adenomers had elastic fibres. It showed a positive reaction to AlcianBlue/Periodic Acid Schiff and several lectins indicating the presence of glycoconjugates. The uropygial gland of the Hooded Grebe shares morphological characteristics with other aquatic species (e.g. secondary chambers) and the presence of glycoconjugates might suggest protective functions against microbes as previously proposed. The sub‐terminal position of the feather tuft is a unique characteristic of this species indicating that this position leaves the tuft in a dorsal location and could be involved in parent‐chick recognition mediated by odour transmission. Further studies are needed to increase our knowledge on some behavioural aspects of this species related to the biochemical composition of the uropygial secretion.
Nonparametric variable importance assessment using machine learning techniques
Authors: Williamson Brian D. , Gilbert Peter B. , Carone Marco , Simon Noah
Published: October 2020

In a regression setting, it is often of interest to quantify the importance of various features in predicting the response. Commonly, the variable importance measure used is determined by the regression technique employed. For this reason, practitioners often only resort to one of a few regression techniques for which a variable importance measure is naturally defined. Unfortunately, these regression techniques are often suboptimal for predicting the response. Additionally, because the variable importance measures native to different regression techniques generally have a different interpretation, comparisons across techniques can be difficult. In this work, we study a variable importance measure that can be used with any regression technique, and whose interpretation is agnostic to the technique used. This measure is a property of the true data‐generating mechanism. Specifically, we discuss a generalization of the analysis of variance variable importance measure and discuss how it facilitates the use of machine learning techniques to flexibly estimate the variable importance of a single feature or group of features. The importance of each feature or group of features in the data can then be described individually, using this measure. We describe how to construct an efficient estimator of this measure as well as a valid confidence interval. Through simulations, we show that our proposal has good practical operating characteristics, and we illustrate its use with data from a study of risk factors for cardiovascular disease in South Africa.
Therapists’ perceptions of barriers and facilitators to uptake and engagement with therapy in long‐term conditions
Authors: Carroll Susan , Moss‐Morris Rona , Hulme Katrin , Hudson Joanna
Published: October 2020

Objective

Improving Access to Psychological Therapies (IAPT) services in England have established a long‐term condition (LTC) pathway in recent years, meaning that LTC therapies are now delivered via varied modes and by professionals with varied experiences. To gain insight into how this new pathway is functioning in practice, this study aimed to explore therapists’ perceptions of barriers and facilitators to uptake and engagement with therapy in LTCs.

Design

A qualitative design was employed using semi‐structured interviews.

Methods

Fifteen therapists were recruited from IAPT and physical health care settings. Interviews were first analysed using inductive thematic analysis. A deductive approach was then taken to map themes onto Normalisation Process Theory constructs (coherence, cognitive participation, collective action, reflective monitoring) to guide steps towards improving implementation.

Results

Four key themes highlighted patient, therapist, and service‐level factors related to uptake and engagement: Working flexibly with barriers within the National Health Service context; Acceptability of ‘embedded’ versus ‘separate’ psychological care; Confidence in working with people with LTCs; and Navigating implementation of online therapies. Therapists recognized the need for tailored LTC therapies, though opinions about online therapies varied. Therapists expressed commitment to flexibly adapting their practice to suit patient needs, but felt their flexibility was limited by system and service constraints.

Conclusion

Barriers to uptake and engagement need to be addressed to optimize LTC pathways. Findings demonstrated the importance of offering flexible, tailored therapy to people with LTCs, and equipping staff and services with adequate training and resources to improve functioning of LTC pathways in practice.
Sustainable harvesting and conservation of Laelia furfuracea, a rare epiphytic orchid from Oaxaca, Mexico
Authors: Orozco‐Ibarrola Octavio , Solano Rodolfo , Valverde Teresa
Published: October 2020

Many epiphytic orchids are harvested in Mexico for different purposes. Laelia furfuracea is one of the most intensively traded species. Its inflorescences are used as ornaments during the December festivities. We investigated the effect of severing the flowering pseudobulb. This is the traditional technique frequently used by collectors at the study area. We wished to investigate its effects on the production of new pseudobulbs, as well as on their size and flowering probability. Also, we examined the survival probability and growth of individuals that had fallen on the ground to evaluate their potential as trading resources. Inflorescence collection did not affect the production of new pseudobulbs the following season. However, it affected the size of these pseudobulbs, as well as their flowering probability. Yet, the direction of this effect was not consistent between years. Nearly six percent of all L. furfuracea plants at the study site were found on the ground. Over 80 percent of them survived for at least two years, although most of them showed pseudobulb loss over that period of time. We conclude that harvesting of flowering pseudobulbs may be sustainable in terms of its effects on plant performance, at least in the short term. The active management of plants that have fallen on the ground may reduce the harvesting pressure on natural populations. Harvesting of flowering pseudobulbs may diminish some aspects of plant performance, but its effects need to be evaluated with complete life cycle data and take into account interannual variation in vital rates.

Abstract in Spanish is available with online material
Small subset of Wnt‐activated cells is an initiator of regrowth in colorectal cancer organoids after irradiation
Authors: Endo Hiroko , Kondo Jumpei , Onuma Kunishige , Ohue Masayuki , Inoue Masahiro
Published: October 2020

Most colorectal cancers (CRCs) are differentiated adenocarcinomas, which maintain expression of both stemness and differentiation markers. This observation suggests that CRC cells could retain a regeneration system of normal cells upon injury. However, the role of stemness in cancer cell regeneration after irradiation is poorly understood. Here, we examined the effect of radiation on growth, stemness, and differentiation in organoids derived from differentiated adenocarcinomas. Following a sublethal dose of irradiation, proliferation and stemness markers, including Wnt target genes, were drastically reduced, but differentiation markers remained. After a static growth phase after high dose of radiation, regrowth foci appeared; these consisted of highly proliferating cells that expressed stem cell markers. Radiosensitivity and the ability to form foci differed among the cancer tissue‐originated spheroid (CTOS) lines examined and showed good correlation with in vivo radiation sensitivity. Pre‐treating organoids with histone deacetylase inhibitors increased radiation sensitivity; this increase was accompanied by the suppression of Wnt signal‐related gene expression. Accordingly, Wnt inhibitors increased organoid radiosensitivity. These results suggested that only a small subset of, but not all, cancer cells with high Wnt activity at the time of irradiation could give rise to foci formation. In conclusion, we established a radiation sensitivity assay using CRC organoids that could provide a novel platform for evaluating the effects of radiosensitizers on differentiated adenocarcinomas in CRC.
Changes in income‐related inequalities in oral health status in Ontario, Canada
Authors: Fang Cheng , Aldossri Musfer , Farmer Julie , Gomaa Noha , Quiñonez Carlos , Ravaghi Vahid
Published: October 2020

Objectives

Oral health inequalities impose a substantial burden on society and the healthcare system across Canadian provinces. Monitoring these inequalities is crucial for informing public health policy and action towards reducing inequalities; however, trends within Canada have not been explored. The objectives of this study are as follows: (a) to assess trends in income‐related inequalities in oral health in Ontario, Canada's most populous province, from 2003 to 2014, and (b) to determine whether the magnitude of such inequalities differ by age and sex.

Methods

Data representative of the Ontario population aged 12 years and older were sourced from the Canadian Community Health Survey (CCHS) cycles 2003 (n = 36,182), 2007/08 (n = 36,430) and 2013/14 (n = 41,258). Income‐related inequalities in poor self‐reported oral health (SROH) were measured using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) and compared across surveys. All analyses were sample‐weighted and performed with STATA 15.

Results

The prevalence of poor SROH was stable across the CCHS cycles, ranging from 14.1% (2003 cycle) to 14.8% (2013/14 cycle). SII estimates did not change (18.7‐19.0), while variation in RII estimates was observed over time (2003 = 3.85; 2007/08 = 4.47; 2013/14 = 4.02); differences were not statistically significant. SII and RII were lowest among 12‐ to 19‐year‐olds and gradually higher among 20‐ to 64‐year‐olds. RII was slightly higher among females in all survey years.

Conclusion

Absolute and relative income‐related inequalities in SROH have persisted in Ontario over time and are more severe among middle‐aged adults. Therefore, oral health inequalities in Ontario require attention from key stakeholders, including governments, regulators and health professionals.
Safeguarding freshwater life beyond 2020: Recommendations for the new global biodiversity framework from the European experience
Authors: van Rees Charles B. , Waylen Kerry A. , Schmidt‐Kloiber Astrid , Thackeray Stephen J. , Kalinkat Gregor , Martens Koen , Domisch Sami , Lillebø Ana I. , Hermoso Virgilio , Grossart Hans‐Peter , Schinegger Rafaela , Decleer Kris , Adriaens Tim , Denys Luc , Jarić Ivan , Janse Jan H. , Monaghan Michael T. , De Wever Aaike , Geijzendorffer Ilse , Adamescu Mihai C. , Jähnig Sonja C.
Published: October 2020

Plans are currently being drafted for the next decade of action on biodiversity—both the post‐2020 Global Biodiversity Framework of the Convention on Biological Diversity (CBD) and Biodiversity Strategy of the European Union (EU). Freshwater biodiversity is disproportionately threatened and underprioritized relative to the marine and terrestrial biota, despite supporting a richness of species and ecosystems with their own intrinsic value and providing multiple essential ecosystem services. Future policies and strategies must have a greater focus on the unique ecology of freshwater life and its multiple threats, and now is a critical time to reflect on how this may be achieved. We identify priority topics including environmental flows, water quality, invasive species, integrated water resources management, strategic conservation planning, and emerging technologies for freshwater ecosystem monitoring. We synthesize these topics with decades of first‐hand experience and recent literature into 14 special recommendations for global freshwater biodiversity conservation based on the successes and setbacks of European policy, management, and research. Applying and following these recommendations will inform and enhance the ability of global and European post‐2020 biodiversity agreements to halt and reverse the rapid global decline of freshwater biodiversity.
Population Pharmacokinetics of Remimazolam in Procedural Sedation With Nonhomogeneously Mixed Arterial and Venous Concentrations
Authors: Zhou Jie , Curd Laura , Lohmer Lauren L. , Ossig Joachim , Schippers Frank , Stoehr Thomas , Schmith Virginia
Published: October 2020

Remimazolam is an ultra‐short acting benzodiazepine under development for procedural sedation and general anesthesia. Population pharmacokinetic analysis (PopPK) was conducted for remimazolam with arterial and venous samples previously, but results were limited by arterial‐venous concentration differences and inaccurate central volume of distribution (V1) estimates. A new model was developed to describe covariate effects after accounting for arterial‐venous differences. Arterial and venous plasma concentration‐time data from 11 clinical trials were pooled for PopPK. Data from two constant‐rate infusion studies were used to account for venous‐to‐arterial (VtoA) ratio within residual error and to accurately estimate V1. V1 and VtoA ratio from the pilot model were applied to the full dataset, where the optimal fixed/random effects and covariates were assessed. VtoA ratio was described using a maximum effect (Emax) model during infusion and as a constant postdose. V1 was estimated as 4.83 L for a 70 kg subject and interindividual variability (IIV) on V1 could only be estimated in studies with early concentrations. IIV on clearance was low (22.9%). Covariates included effects of sex on clearance (women 10% > men), and race on clearance and steady‐state volume of distribution (African Americans 16% < other races). Arterial‐venous concentration differences were best described using an Emax model during infusion with a constant ratio after infusion, resulting in low residual error (20.7%). There are no clinically relevant dose adjustments needed for any covariates based on pharmacokinetic differences.
Short fully covered self‐expandable metal stent for treatment of proximal anastomotic benign biliary stricture after living‐donor liver transplantation
Authors: Jang Sung Ill , Chung Tae Ryong , Cho Jae Hee , Lee Kwang‐Hun , Joo Seung‐Moon , Choi Jung Hye , Kim Sae In , Lee Dong Ki
Published: October 2020

Objectives

Non‐surgical methods have high success rates for treating benign biliary strictures (BBSs), but treatment of proximal strictures is difficult. Recent studies have reported that fully covered self‐expandable metal stents (FCSEMSs) are useful for treating refractory BBSs. We investigated the efficacy of a short and removable FCSEMS with an anti‐migration design for treatment of proximal BBSs.

Methods

Fully covered self‐expandable metal stents were inserted endoscopically in patients with BBSs after living donor liver transplantation (LDLT). Each FCSEMS was initially maintained for 3 months and subsequently exchanged every 3 months until the stricture resolved. Adverse events and stricture recurrence after FCSEMS removal were assessed during follow‐up.

Results

A total of 63 patients with a median age of 57 years were enrolled in this study; 50 were male. The most common underlying disease was hepatocellular carcinoma and the previous operation was LDLT. The mean duration from surgery to diagnosis of stricture was 8.5 months, and the mean stent indwelling time was 4.2 months. The technical success and stricture resolution rate were 100%. The recurrence rate was 23.8% and the adverse event rate was 12.7%. All stents were removable, and asymptomatic stent migration was observed in four patients (6.4%).

Conclusions

The newly designed FCSEMS is effective in the treatment of proximal BBSs after LDLT.
Efficacy and safety of exenatide as add‐on therapy for patients with type 2 diabetes with an intensive insulin regimen: A randomized double‐blind trial
Authors: Joubert Michael , Opigez Victoria , Pavlikova Barbora , Peyro Saint Paul Laure , Jeandidier Nathalie , Briant Anaïs R. , Parienti Jean‐Jacques , Reznik Yves
Published: October 2020

Aim

To assess the safety and efficacy of the short‐acting glucagon‐like peptide‐1 receptor agonist exenatide on a population of patients with type 2 diabetes (T2D) mostly treated with continuous subcutaneous insulin injection (CSII).

Materials and Methods

A phase 2/3, multicentre, randomized, parallel‐group, double‐blind, placebo‐controlled, 6‐month trial was conducted. Patients were randomized to receive subcutaneous (SC) injections of exenatide (10 μg BID) or matched placebo.

Results

A total of 46 patients with T2D and elevated HbA1c were randomized (42% of the planned sample size): exenatide (n = 28) and placebo (n = 18). CSII treatment was used by 75% and 89% of patients of the exenatide and placebo groups, respectively. At 6 months, the change in HbA1c was −0.62% ± 0.94% and 0.08% ± 0.81% in the exenatide and placebo groups, respectively (difference, −0.70%; 95% CI [−1.24%; −0.15%], P = .014); body weight and body mass index decreased in the exenatide group (−2.55 ± 3.25 kg and −1.00 ± 1.31 kg/m2) and increased in the placebo group (1.29 ± 2.82 kg and 0.46 ± 1.16 kg/m2) (observed difference, −3.85 and −1.45, respectively, both P < .001); the postdinner capillary blood glucose value was lower in the exenatide group compared with the placebo group (162.4 ± 80.5 vs. 259.1 ± 94.4 mg/dL, respectively; observed difference, −96.7, P < .01). Hypoglycaemic risk, quality of life and overall safety were not different between the groups, apart from the expected occurrence of digestive effects in the exenatide group.

Conclusions

Although we failed to reach our planned sample size, the addition of exenatide treatment 10 μg BID SC in T2D patients with uncontrolled HbA1c despite an intensified insulin regimen, resulted in a significant reduction of HbA1c and body weight with a good overall safety profile and acceptance.
The benefits of intraguild predation for a top predator spider
Authors: Michalko Radek , Uhrinec Martin , Khum Warbota , Sentenská Lenka
Published: October 2020

1. Intraguild predation (IGP) among generalist predators significantly affects the food web dynamics but the benefits of IGP for top predators are still unclear.

2. We offered diets consisting of aphids, of spiders, and their sequential mix (i.e. polytypic diet) to the spider Philodromus cespitum and measured its survival, weight, development, and fecundity. To avoid a species‐specific effect, the aphid and spider prey consisted of several similarly sized species.

3. The spider diet prolonged survival in comparison to starvation while the aphid and polytypic diets enabled the highest survival of juveniles. The spider diet resulted in low weight gain and slow development in juveniles at the population level. However, the weight change was highly variable among individuals, and a substantial portion of the individuals engaging in IGP gained the most weight compared to other diets. The aphid and polytypic diets resulted in the largest weight increase and fastest development in juveniles at the population level, and there was little variability in the amount of weight gained among individuals. Diet did not affect survival of adult females, but females on the spider and polytypic diets had higher fecundity than those on the aphid diet.

4. While both the aphids and the spiders had energetic and nutritional value for Philodromus cespitum, a polytypic diet consisting of a mix of them improved overall fitness. IGP therefore seems to be an adaptive strategy of Philodromus cespitum, and IGP on small spiders may increase its performance in ecosystems where aphids are highly dominant pests.
Association of anticoagulation dose and survival in hospitalized COVID‐19 patients: A retrospective propensity score‐weighted analysis
Authors: Ionescu Filip , Jaiyesimi Ishmael , Petrescu Ioana , Lawler Patrick R , Castillo Edward , Munoz‐Maldonado Yolanda , Imam Zaid , Narasimhan Mangala , Abbas Amr E. , Konde Anish , Nair Girish B.
Published: October 2020

Background

Hypercoagulability may contribute to COVID‐19 pathogenicity. The role of anticoagulation (AC) at therapeutic (tAC) or prophylactic doses (pAC) is unclear.

Objectives

We evaluated the impact on survival of different AC doses in COVID‐19 patients.

Methods

Retrospective, multi‐center cohort study of consecutive COVID‐19 patients hospitalized between March 13 and May 5, 2020.

Results

A total of 3480 patients were included (mean age, 64.5 years [17.0]; 51.5% female; 52.1% black and 40.6% white). 18.5% (n = 642) required intensive care unit (ICU) stay. 60.9% received pAC (n = 2121), 28.7% received ≥3 days of tAC (n = 998), and 10.4% (n = 361) received no AC. Propensity score (PS) weighted Kaplan‐Meier plot demonstrated different 25‐day survival probability in the tAC and pAC groups (57.5% vs 50.7%). In a PS–weighted multivariate proportional hazards model, AC was associated with reduced risk of death at prophylactic (hazard ratio [HR] 0.35 [95% confidence interval {CI} 0.22‐0.54]) and therapeutic doses (HR 0.14 [95% CI 0.05‐0.23]) compared to no AC. Major bleeding occurred more frequently in tAC patients (81 [8.1%]) compared to no AC (20 [5.5%]) or pAC (46 [2.2%]) subjects.

Conclusions

Higher doses of AC were associated with lower mortality in hospitalized COVID‐19 patients. Prospective evaluation of efficacy and risk of AC in COVID‐19 is warranted.
Benefit of first‐pass complete reperfusion in thrombectomy is mediated by limited infarct growth
Authors: Ben Hassen W. , Tordjman M. , Boulouis G. , Bretzner M. , Bricout N. , Legrand L. , Benzakoun J. , Edjlali M. , Seners P. , Cordonnier C. , Oppenheim C. , Turc G. , Henon H. , Naggara O.
Published: October 2020

Background and Purpose

The number of clot retrieval attempts required to achieve complete reperfusion by mechanical thrombectomy impacts functional outcome in acute ischaemic stroke (AIS). Complete reperfusion [expanded Treatment In Cerebral Infarction (eTICI) score = 3] at first pass (FP), is associated with the highest rates of favorable outcome compared to complete reperfusion by multiple passes. The aim of the present study was to investigate the relationship between FP complete reperfusion and infarct growth (IG).

Methods

Anterior AIS patients with baseline and 24‐h diffusion‐weighted magnetic resonance imaging were included from two prospective registries. IG was measured by voxel‐based segmentation of initial and 24‐h diffusion‐weighted imaging lesions. IG and favorable 3‐month modified Rankin Scale (mRS) score (≤ 2) were compared between patients in whom complete reperfusion (eTICI 3) was achieved with a single pass (FP group) and those for whom multiple passes were required (MP group), after matching for confounding factors. Mediation analysis was performed to examine the association between FP and 3‐month mRS score, with IG as mediating variable.

Results

A total of 200 patients were included, of whom 118 (28.9%) had FP complete reperfusion. In case–control analysis, the FP group had lower IG than the MP group [8.7 (5.4–12.9) ml vs. 15.2 (11–22.6) ml, respectively; P = 0.03). Favorable outcome was higher in the FP population compared to a matched MP population (70.9% vs. 53.2%, respectively; P = 0.04). FP compete reperfusion (eTICI 3) was independently associated with favorable outcome in multivariable regression analysis [odds ratio 1.86, 95% confidence interval (CI) 1.01–4.39; P = 0.04]. The effect of complete reperfusion at FP on functional outcome was explained by limited IG in mediation analysis [indirect effect: −0.32 (95% CI −0.47 to −0.09)].

Conclusion

Complete reperfusion at FP is independently associated with significant decrease in IG compared to complete reperfusion by multiple attempts, explaining better functional outcomes.
COVID‐19 pandemic and mental distress in multiple sclerosis: Implications for clinical management
Authors: Costabile Teresa , Carotenuto Antonio , Lavorgna Luigi , Borriello Giovanna , Moiola Lucia , Inglese Matilde , Petruzzo Martina , Trojsi Francesca , Ianniello Antonio , Nozzolillo Agostino , Cellerino Maria , Boffa Giacomo , Rosa Laura , Servillo Giuseppe , Moccia Marcello , Bonavita Simona , Filippi Massimo , Lanzillo Roberta , Brescia Morra Vincenzo , Petracca Maria
Published: October 2020

Background and Purpose

In multiple sclerosis (MS), disease‐related factors and dysfunctional coping might favor the development of mental distress induced by COVID‐19 containment measures. Aim of this study was exploring the relationship between disability, coping strategies, daily life reorganization and neuropsychiatric symptoms in an Italian MS population during the COVID‐19 lockdown, in order to identify potentially modifiable factors that could inform clinical management of mental distress in people with MS.

Methods

We explored the relationship between mental distress, disability and coping strategies in the Italian MS population under lockdown. Structural equation modeling was applied to information collected via web survey to identify modifiable factors that could account for mental distress.

Results

A total of 845 participants (497 with MS and 348 controls) were included in the study. The MS group had higher scores than the control group for depression (p = 0.005), but not for anxiety, emotional dyscontrol or sleep disturbances. The structural equation modeling explained 74% of the variance observed in depression score. Within the model, three latent factors were characterized from measured variables: motor disability and cognitive dysfunction contributed to disability (β = 0.509 and β = 0.836; p < 0.001); positive attitude and exercise contributed to active attitude (β = 0.386 and β = 0.297; p < 0.001); and avoidance, social support and watching television contributed to passive attitude (β = 0.301, β = 0.243 and β = 0.212; p < 0.001). With regard to the relationship between latent factors and their influence on depression, disability contributed to passive attitude (β = 0.855; p < 0.001), while both passive and active attitude significantly influenced depression (β = 0.729 and β = −0.456; p < 0.001).

Conclusion

As a practical implication of our model, favoring exercise would enhance active attitude and its positive impact on mental well‐being while, at the same time, reducing the negative impact of disability on depression, representing a valuable tool in facing COVID‐19‐related mental distress.
Value of treatment by comprehensive stroke services for the reduction of critical gaps in acute stroke care in Europe
Authors: Webb A. J. S. , Fonseca A. C. , Berge E. , Randall G. , Fazekas F. , Norrving B. , Nivelle E. , Thijs V. , Vanhooren G. ,   for the Stroke Working Group of the European Brain Council Value of Treatment initiative
Published: October 2020

Stroke is the second leading cause of death and dependency in Europe and costs the European Union more than €30bn, yet significant gaps in the patient pathway remain and the cost‐effectiveness of comprehensive stroke care to meet these needs is unknown. The European Brain Council Value of Treatment Initiative combined patient representatives, stroke experts, neurological societies and literature review to identify unmet needs in the patient pathway according to Rotterdam methodology. The cost‐effectiveness of comprehensive stroke services was determined by a Markov model, using UK cost data as an exemplar and efficacy data for prevention of death and dependency from published systematic reviews and trials, expressing effectiveness as quality‐adjusted life‐years (QALYs). Model outcomes included total costs, total QALYs, incremental costs, incremental QALYs and the incremental cost‐effectiveness ratio (ICER). Key unmet needs in the stroke patient pathway included inadequate treatment of atrial fibrillation (AF), access to neurorehabilitation and implementation of comprehensive stroke services. In the Markov model, full implementation of comprehensive stroke services was associated with a 9.8% absolute reduction in risk of death of dependency, at an intervention cost of £9566 versus £6640 for standard care, and long‐term care costs of £35 169 per 5.1251 QALYS vs. £32 347.40 per 4.5853 QALYs, resulting in an ICER of £5227.89. Results were robust in one‐way and probabilistic sensitivity analyses. Implementation of comprehensive stroke services is a cost‐effective approach to meet unmet needs in the stroke patient pathway, to improve acute stroke care and support better treatment of AF and access to neurorehabilitation.