bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring challenges to ICT utilisation in construction site management
Authors: Ozumba Aghaegbuna Obinna U. , Shakantu Winston
Published: April 2018

Purpose

The purpose of this paper is to explore the nature and occurrence, and peculiarities and dynamics, if any, of perceived challenges to the adoption of information and communication technologies (ICT) in construction site management; using South Africa as context for empirical study.

Design/methodology/approach

Literature on the constraints to technology transfer and ICT adoption in construction is used as basis for the study. A national survey of registered persons in South Africa was used to collect qualitative data. A robust multi-stepped analytical approach was used to derive results.

Findings

Findings suggest appreciable similarity between literature and primary data, in types of individual challenges and their categories. Lack of technology and management support, and knowledge and information related issues, are relatively more prevalent in site management. There is a fair level of commonality in perception of technical barriers among the various categories of respondents who are active in site management. However, project managers seem to be more sensitive to some inhibiting factors, more than other respondent groups.

Research limitations/implications

Inherent limitations of survey strategy were experienced, but highly qualitative data were collected at a national level. The study highlights the range of barriers to ICT in site management, and compounding effects of technology-, knowledge- and management-related constraints.

Practical implications

The possibility of knowledge-based factors remotely manifesting in other categories was highlighted. There is need to consider all challenges in planning for ICT in projects, and prioritise technology-, knowledge- and management-related challenges. A classification for exploring challenges to ICT in the site management process is also proposed.

Social implications

Appreciable paucity remains in research focused on ICT in the site management process, as opposed to the popular operations/application focus of IT/ICT studies. Furthermore, there is still scarcity of ICT research in Africa, with regard to the built environment and specifically site management.

Originality/value

This study contributes to research in ICT innovation adoption in the construction industry, by developing a better understanding of the dynamics of perceived challenges to ICT adoption in the site management process; according to types and classifications of challenges, and roles and age groups of stakeholders. The study further sets a baseline for future studies in this area by proposing a frame of categorisation that is focused on site management.
Using geostatistical techniques to map adaptive capacities of resource-poor communities to climate change
Authors: Chari Martin Munashe , Hamandawana Hamisai , Zhou Leocadia
Published: April 2018

Purpose

This paper aims to present a case study-based approach to identify resource-poor communities with limited abilities to cope with the adverse effects of climate change. The study area is the Nkonkobe Local Municipality, in the Eastern Cape which is one of South Africa’s provinces ranked as being extremely vulnerable to the adverse effects of climate change because of high incidences of poverty and limited access to public services such as water and education. Although adaptive capacity and vulnerability assessments help to guide policy formulation and implementation by identifying communities with low coping capacities, policy implementers often find it difficult to fully exploit the utility of these assessments because of difficulties in identifying vulnerable communities. The paper attempts to bridge this gap by providing a user-friendly, replicable, practically implementable and adaptable methodology that can be used to cost-effectively and timeously identify vulnerable communities with low coping capacities.

Design/methodology/approach

A geostatistical approach was used to assess and evaluate adaptive capacities of resource-poor communities in the Nkonkobe Local Municipality. The geospatial component of this approach consisted of a multi-step Geographical Information Systems (GIS) based technique that was improvised to map adaptive capacities of different communities. The statistical component used demographic indicators comprising literacy levels, income levels, population age profiles and access to water to run automated summation and ranking of indicator scores in ArcGIS 10.2 to produce maps that show spatial locations of communities with varying levels of adaptive capacities on a scale ranging from low, medium to high.

Findings

The analysis identified 14 villages with low adaptive capacities from a total of 180 villages in the Nkonkobe Local Municipality. This finding is important because it suggests that our methodology can be effectively used to objectively identify communities that are vulnerable to climate change.

Social implications

The paper presents a tool that could be used for targeting assistance to climate change vulnerable communities. The methodology proposed is of general applicability in guiding public policy interventions aimed at reaching, protecting and uplifting socio-economically disadvantaged populations in both rural and urban settings.

Originality/value

The approach’s ability to identify vulnerable communities is useful because it aids the identification of resource-poor communities that deserve priority consideration when planning adaptation action plans to deliver support and assistance to those least capable of effectively coping with the adverse effects of climate change induced vulnerabilities.
Competences management for improving performance in health organizations
Authors: Fanelli Simone , Lanza Gianluca , Zangrandi Antonello
Published: April 2018

Purpose

The purpose of this paper is to describe the design and construction of a privilege mapping system (clinical and organizational competences) of the medical staff of the Niguarda Hospital in Milan, Italy. The second aim is to measure and assess the impact of implementing an evaluation process of clinical competences at the same hospital.

Design/methodology/approach

The paper retraces the development and implementation of the evaluation of the privilege system, highlighting the subjects involved, the phases and outputs. Moreover, a questionnaire was distributed to 50 heads of unit involved in the planning, building and implementation of competences mapping. Five areas were investigated: competences evaluation for professional development; the impact on work organization and professional roles; professional collaboration; its impact according to context (hospital or unit) and time scale (short or long term); and ability to evaluate clinical outcome.

Findings

Results reveal success factors for the development and implementation of a privilege mapping system. Furthermore, the survey revealed that clinical leaders are aware of the importance of competences evaluation. In particular, they consider it as a management tool useful for professional development, for identifying excellence and planning operational activities.

Originality/value

Literature and practical evidence recognize the need to assess the clinical and organizational competences in order to assign tasks and responsibilities. However, there are no studies that describe the construction of systems of evaluation of privileges, as it has never been investigated as professionals perceive these tools.
A study of deficiencies in teamwork skills among Jordan caregivers
Authors: Al-Araidah Omar , Al Theeb Nader , Bader Mariam , Mandahawi Nabeel
Published: April 2018

Purpose

The purpose of this paper is to present the deficiencies in teamwork skills at Jordan hospitals as seen by team members. The study aims to identify training needs to improve teamwork-related soft skills of caregivers to enhance staff satisfaction and improve quality of care. Moreover, the paper provides a methodology to identify the training needs in any healthcare workplace by repeating the same questionnaire.

Design/methodology/approach

A self-administrated questionnaire was designed to study deficiencies in teamwork and team leadership at Jordan hospitals as seen by team members. Surveyed care providers included physicians, nursing and anesthesiologists operating in emergency departments, surgical operating rooms and intensive care units from various hospitals.

Findings

With a response rate of 78.8 percent, statistical analysis of collected data of opposing staff members revealed low levels of satisfaction (40.7-48 percent opposing), lack of awareness on the impact of teamwork on quality of care (15.6-22.1 percent opposing), low levels of involvement of top management (27.1-57.3 percent opposing), lack of training (52.5-69.8 percent opposing), lack of leadership skills (29.8-60 percent opposing), lack of communication (22.3-62.1 percent opposing), lack of employee involvement (37.6-50.8 percent opposing) and lack of collaboration among team members (28.6-50 percent opposing). Among the many, results illustrate the need for improving leadership skills of team leaders, improving communication and involving team members in decision making.

Originality/value

Several studies investigated relationships between teamwork skills and quality of care in many countries. To the authors’ knowledge, no local study investigated the deficiencies of teamwork skills among Jordan caregivers and its impact on quality of care. The study provides the ground for management at Jordan hospitals and to healthcare academic departments to tailor training courses to improve teamwork skills of caregivers. Data of this study are collected from the society who is working in the field of healthcare. As the results of this are produced from a real data, it is expected that applying the recommendations will impact the society positively by enhancing the patients’ satisfaction.
On the success of megaprojects
Authors: Turner John Rodney , Xue Yan
Published: April 2018

Purpose

The purpose of this paper is to develop a new model for the success of megaprojects. Megaprojects are often said to fail because they finish late and/or overspent. As megaprojects are usually complex, so small changes in input can lead to disproportionate changes in output. So the time and cost targets at the start can have little validity. They are useful targets, not values which can be used to judge success or failure. The authors suggest that a megaproject is a success if it produces a worthwhile result at a time and cost that makes it valuable.

Design/methodology/approach

The authors develop a new model for the success of megaprojects, and asses its applicability against a number of case studies from well-known sources.

Findings

The authors identify four dimensions of megaproject success: they produce an output at a time and cost that makes it valuable; they achieve the desired outcome and benefit at a time and cost that makes them valuable; they deliver positive net present value; and they deliver a business or public need at a time and cost which makes it valuable.

Research limitations/implications

The authors propose a new model for megaproject success that moves away from the so-called iron triangle or triple constraint, which are meaningless in the context of complex projects. Time and cost to completion cannot be predicted on complex projects. However, targets are required because a megaproject must produce a valuable outcome at a time and cost that makes it valuable.

Practical implications

The paper produces a new way of assessing the success of megaprojects which will lead to a larger number of megaprojects being assessed to be successful. It indicates what is truly important, that the megaproject should produce and outcome of value at a time and cost that makes it valuable.

Social implications

Megaprojects often produce benefits to society over and above the financial benefits. Often an economic benefit cannot be paced on these social benefits, which makes it problematic to assess the value of the project. In one of the cases economic value was placed on the social benefits, and the benefit:cost ratio was increased from 0.85 to 2.5.

Originality/value

The authors propose a new model for the success of megaprojects.
Transitions in workplace information practices and culture
Authors: Nordsteien Anita , Byström Katriina
Published: April 2018

Purpose

The purpose of this paper is to empirically investigate how new healthcare professionals engage with information practices and information culture in their workplace, and the resulting influences on development and change.

Design/methodology/approach

A longitudinal study was conducted on a hospital training programme. Three series of focus groups provided data from 18 recently qualified nurses, supported by observations. Data were thematically analysed applying a framework consisting of six approaches to information use.

Findings

Newcomers take a proactive approach to seek, use and share scientific information, which is negotiated within existing information practices and organisational information culture. Their competencies, such as research skills, values, motivation and sense of integrity to use and share scientific information, often differ from those existing workplace practices. For this reason, they drive towards renewal and change.

Practical implications

Examination of organisational approaches to information use indicates clearly the necessity for improvements to meet the needs of information proactiveness and thus be able to face challenges and changes in an organisation.

Originality/value

This work sheds new light on newcomers’ information use, as they integrate into a workplace and interact with information practices and organisational approaches to information use. A significant contribution is the identification of the dynamics and interdependencies between newcomers’ individual agency in their way of seeking, using and sharing information, and the established community’s social agency promoting existing information practices and the organisational agency represented by information culture.
Simulation-based analysis of a forced distribution performance appraisal system
Authors: Evans Lee , Bae Ki-Hwan
Published: April 2018

Purpose

The paper aims to estimates the limitations of a forced distribution performance appraisal system in identifying the highest performing individuals within an organization. Traditionally, manpower modeling allows organizations to develop plans that meet future human resource requirements by modeling the flow of personnel within an organization. The aim is to quantify the limitations of a performance appraisal system in identifying the best-qualified individuals to fill future requirements.

Design/methodology/approach

This paper describes an exploratory study using discrete event simulation based on the assignment, evaluation and promotion history of over 2,500 officers in the US Army. The obtained data provide a basis for estimating simulation inputs that include system structure, system dynamics, human behavior and policy constraints. The simulation approach facilitates modeling officers who receive evaluations as they move throughout the system over time.

Findings

The paper provides insights into the effect of system structure and system dynamics on the evaluation outcome of employees. It suggests that decreasing the number of a rater’s subordinates has a significant effect on the accuracy of performance appraisals. However, increasing the amount of time individuals spend on each assignment has little effect on system accuracy.

Practical implications

This research allows an organization’s leadership to evaluate the possible consequences associated with evaluation policy prior to policy implementation.

Originality/value

This work advances a framework in assessing the effect of system dynamics and structure, and the extent to which they limit or enhance the accuracy of an organization’s forced distribution performance appraisal system.
Understanding how nurses ration care
Authors: Harvey Clare Lynette , Thompson Shona , Willis Eileen , Meyer Alannah , Pearson Maria
Published: April 2018

Purpose

The purpose of this paper is to explore how nurses make decisions to ration care or leave it undone within a clinical environment that is controlled by systems level cost containment. The authors wanted to find out what professional, personal and organisational factors contribute to that decision-making process. This work follows previous international research that explored missed nursing care using Kalisch and Williams’ MISSCARE survey.

Design/methodology/approach

The authors drew on the care elements used by Kalisch and Williams, asking nurses to tell us how they decided what care to leave out, the conduits for which could include delaying care during a shift, delegating care to another health professional on the same shift, handing care over to staff on the next shift or leaving care undone.

Findings

The findings suggest that nurses do not readily consider their accountability when deciding what care to leave or delay, instead their priorities focus on the patient and the organisation, the outcomes for which are frequently achieved by completing work after a shift.

Originality/value

The actions of nurses implicitly rationing care is largely hidden from view, the consequences for which potentially have far reaching effects to the nurses and the patients. This paper raised awareness to hidden issues facing nurses within a cycle of implicitly rationing care, caught between wanting to provide care to their patients, meeting the organisation’s directives and ensuring professional safety. Rethinking how care is measured to reflect its unpredictable nature is essential.
Variables affecting hospital length of stay: a scoping review
Authors: Buttigieg Sandra C. , Abela Lorraine , Pace Adriana
Published: April 2018

Purpose

Tertiary hospitals have registered an incremental rise in expenditure mostly because of the increasing demands by ageing populations. Reducing the length of stay (LOS) of patients within tertiary hospitals is one of the strategies, which has been used in the last decades to ensure health care systems’ sustainability. Furthermore, LOS is one of the key performance indicators, which is widely used to assess hospital efficiency. Hence, it is crucial that policy makers use evidence-based practices in health care to aim for optimal LOS. The purpose of this paper is to identify and summarize empirical research that brings together studies on the various variables that directly or indirectly impact on LOS within tertiary hospitals so as to develop a LOS causal systems model.

Design/methodology/approach

This scoping review was guided by the following research question: “What is affecting the LOS of patients within tertiary-level health care?” and by the guidelines specified by Arksey and O’Malley (2005), and by Armstronget al.(2011). Relevant current literature was retrieved by searching various electronic databases. The PRISMA model provided the process guidelines to identify and select eligible studies.

Findings

An extensive literature search yielded a total of 30,350 references of which 46 were included in the final analysis. These articles yielded variables, which directly/indirectly are linked to LOS. These were then organized according to the Donabedian model – structure, processes and outcomes. The resultant LOS causal model reflects its complexity and confirms the consideration by scholars in the field that hospitals are complex adaptive systems, and that hospital managers must respond to LOS challenges holistically.

Originality/value

This paper illustrates a complex LOS causal model that emerged from the scoping review and may be of value for future research. It also highlighted the complexity of the construct under study.
Innovation and research skill for knowledge-based economy of Myanmar
Authors: Sinha G.R.
Published: April 2018

Purpose

This study aims to assess current status of innovation and research skill in Myanmar that could contribute to the knowledge-based economy.

Design/methodology/approach

This paper suggests a critical review-based methodology that studies the knowledge-based economy of Myanmar, a beautiful country with all potential of practicing innovation and research skill. Employability skills among students and professionals make them professionally competent, thereby contributing the country as a knowledge-based economy (KBE). The KBE can ensure that a country becomes the biggest and sustainable economy in the world. Innovation and research-based skills play the most significant roles in novel contributions and consistent growth in all sectors of economy. Thus, it has been studied and concluded that Myanmar has been doing great to encourage, rather practice, the modern research and innovation skills in making it a KBE country. There are few important challenges that create gaps between skill development and KBE nation, which are identified, and the recommendations have been made to overcome the challenges envisaging Myanmar as a KBE. Quality indicators and a set of skills and viable ways of their development are identified.

Findings

The innovation and research-based skills need great attention in this country. However, the sincere efforts have been already initiated by the Government of Myanmar through few important activities.

Originality/value

The critical analysis of the study of status of innovation and research skill is based on an honest and extensive study of important documents and recommendations of various reputed organizations and universities. Thus, the reflections of the current status and recommendations are thoroughly novel.
Price and in-store promotions in an emerging market
Authors: Guissoni Leandro Angotti , Sanchez Juan Machado , Rodrigues Jonny Mateus
Published: April 2018

Purpose

The purpose of this paper is to evaluate the influence of price and products on the promotion (through in-store temporary displays) on consumer sales in an emerging market context (i.e. Brazil) in different regions with contrasts in the market and store formats analyzed.

Design/methodology/approach

The data originate from retail market audits conducted over three years and are broken down by a region and a channel for a product category that has experienced increased competition and growth and is highly distributed throughout the analyzed regions and channel formats (i.e. the ready-to-drink juice category). This study uses a panel vector autoregression framework and an impulse-response function to determine the effects on sales over time.

Findings

The results suggest that price sensitivity and the effects of promotions on sales vary with the type of store format rather than through structural differences between regions with lower vs higher levels of economic development in an emerging market.

Practical implications

Managers should consider differences in store format more than the heterogeneity among regions when making price and promotion decisions. Additionally, this paper highlights the importance of in-store product visibility through temporary displays of promoted products, especially in smaller stores in an emerging market.

Originality/value

By considering the challenges of managing a consumer brand for which market heterogeneity is key, this paper extends the current research by contrasting consumer price and in-store promotion decisions across two heterogeneous regions and store formats within an emerging market.
Impact of the antecedents of eWOM on CBBE
Authors: Sijoria Charu , Mukherjee Srabanti , Datta Biplab
Published: April 2018

Purpose

The purpose of this paper is to consolidate the antecedents of electronic word of mouth (eWOM). Thereafter, it examines the impact of eWOM and its antecedents on consumer-based brand equity (CBBE).

Design/methodology/approach

A total of 93 research articles on eWOM and CBBE were critically reviewed using the systematic literature review method.

Findings

This study has consolidated the antecedents of eWOM from the extant literature. It has identified eight antecedents of eWOM including information or argument quality, loyalty, social relationship, source quality, satisfaction, subjective norms, and information quantity. This study has come out with a conceptual framework, followed by 16 hypotheses addressing the possible relationships between eWOM, its antecedents, and CBBE.

Originality/value

This study pioneers to examine the impact of the antecedents of eWOM on CBBE through an exhaustive review of contemporary literature. It has also explored the possibility of eWOM acting as a mediator between the antecedents of eWOM and CBBE. Therefore, this study unravels a wide array of directions for researchers to examine the relationships between the constructs mentioned above and CBBE.
Business advice by accountants to SMEs: relationships and trust
Authors: Blackburn Robert , Carey Peter , Tanewski George
Published: April 2018

Purpose

The purpose of this paper is to test a conceptual framework explaining the role of relationships and trust in enabling the purchase of business advice by small business owner–managers from their external accountants.

Design/methodology/approach

The study uses a semi-structured interview approach with 20 small- and medium-sized enterprise (SME) owners and accountants in London and Melbourne.

Findings

The interview data support the conceptual framework’s central proposition that relationships and trust, rather than being antecedents of demand for advice, are necessary conditions for enabling latent demand. SMEs with greater propensity to trust are more open to buying business advice but not necessarily from their accountant.

Research limitations/implications

A limitation of the fieldwork is that it is based on a non-random and limited sample of accountants and SMEs.

Practical implications

Accountants in public practice can no longer assume that the already established relationships with their clients, developed while providing compliance services, will automatically lead SME clients to purchase business advice.

Originality/value

The paper contributes to the accounting literature by developing a conceptual model of relationships and trust that will assist the profession in better understanding the complex dynamics of the accountant–client relationship. The conceptual model distinguishes, for the first time, the antecedent factors of demand for business advice from the enabling roles of relationships and trust. Fieldwork interviews also yielded new insights into how SMEs’ decisions to purchase business advice are influenced by specific personality traits of SME owner–managers and additional antecedent demand factors not identified in the extant literature – economic conditions, environmental turbulence and business life-cycle.
Methodology for digital preservation of the cultural and patrimonial heritage: generation of a 3D model of the Church St. Peter and Paul (Calw, Germany) by using laser scanning and digital photogrammetry
Authors: Owda Abdalmenem , Balsa-Barreiro José , Fritsch Dieter
Published: April 2018

Purpose

Representative cultural heritage sites and monuments around the world have been lost or damaged by natural disasters, human conflicts and daily erosion and deterioration. Documentation and digital preservation by using three-dimensional (3D) modeling techniques enables to ensure the knowledge and access for future generations. Efficient working methods and techniques should be proposed for this purpose.

Design/methodology/approach

In this paper, a methodology for the generation of 3D photorealistic models of representative historical buildings is introduced, for using data are obtained using terrestrial laser scanning systems and photogrammetry.

Findings

In this paper, an approach to reconstruct 3D photorealistic models by using laser scanning and photogrammetric data is shown. Combination of data from both sources offers an improved solution for 3D reconstruction of historical buildings, sites and places. Integration of 3D models into virtual globes and/or software applications can ensure digital preservation and knowledge for next generations.

Research limitations/implications

Results obtained in a concrete building are shown. However, each building or studied area can show some other different drawbacks.

Practical implications

The study enables to generate 3D and four-dimensional models of most valuable buildings and contribute to the preservation and documentation of the cultural heritage.

Social implications

The study enables digital documentation and preservation of cultural heritage.

Originality/value

A proper solution at field (in a real and complicated case) is explained, in addition to the results, which are shown.
Study on the transmission path and timing scheduling for WSNs with heterogeneous nodes
Authors: Zhao Huiyuan , Mao Yuxing , Cheng Tao
Published: April 2018

Purpose

Application environments of wireless sensor networks (WSNs) include heterogeneous nodes with different packet sizes, transmission abilities and tolerable delay times. This study aims to design a reasonable network topology and transmission timing for these heterogeneous nodes to improve the quality of service (QoS) of networks.

Design/methodology/approach

In this paper, the authors treat node urgency and data packets as the basis of network clustering and to extend the network lifetime. The flow, energy consumption and residual energy of a node are included in the cluster head election. We also propose a delay evaluation function.

Findings

All the nodes in the network are guaranteed to transmit to the sink nodes efficiently by planning the transmission order in each cluster.

Originality/value

The simulation results show that the proposed method can balance node urgency and data packets path planning, which not only extends the lifetime of the network but also decreases network delay and improves the overall efficiency.
Synergistic selection regimens drive the evolution of display complexity in birds of paradise
Authors: Miles Meredith C. , Fuxjager Matthew J.
Published: April 2018

Integrated visual displays that combine gesture with colour are nearly ubiquitous in the animal world, where they are shaped by sexual selection for their role in courtship and competition. However, few studies assess how multiple selection regimens operate on different components of these complex phenotypes on a macroevolutionary scale.

Here, we study this issue by assessing how both sexual and ecological selection work together to influence visual display complexity in the birds of paradise.

We first find that sexual dichromatism is highest in lekking species, which undergo more intense sexual selection by female choice, than non‐lekking species. At the same time, species in which males directly compete with one another at communal display courts have more carotenoid‐based ornaments and fewer melanin ornaments.

Meanwhile, display habitat influences gestural complexity. Species that dance in the cluttered understorey have more complex dances than canopy‐displaying species.

Taken together, our results illustrate how distinct selection regimens each operate on individual elements comprising a complex display. This supports a modular model of display evolution, wherein the ultimate integrated display is the product of synergy between multiple factors that select for different types of phenotypic complexity.
Descriptive profile of the academic integrity of Australian occupational therapy students
Authors: Brown Ted , Isbel Stephen , Bourke‐Taylor Helen , Gustafsson Louise , McKinstry Carol , Logan Alexandra
Published: April 2018

Background

Academic integrity is the moral code of academia. Students who demonstrate trustworthiness in an academic setting are more likely to be dependable in a clinical setting. It is, therefore, important for occupational therapy academic and fieldwork educators to know the academic integrity profile of their students and to address any areas of academic dishonesty in curriculum design and delivery. To date, there has been no baseline description of the academic honesty profile of Australian occupational therapy students.

Aim

To establish a baseline of academic integrity and academic dishonesty among occupational therapy undergraduate and graduate‐entry masters students in a cohort of Australian students.

Methods

Seven hundred and one students from five Australian universities completed a self‐report questionnaire comprising demographic questions and six standardised scales measuring academic integrity.

Results

Overall, occupational therapy students reported high levels of academic and fieldwork integrity; however, some areas of concerns exist. Students report copying material without citations at least once during their studies (55%), obtaining test questions at least once during their studies (42.6%) or padding out a bibliography (39.5%).

Conclusion

Occupational therapy education needs to continue to emphasise the importance of academic and fieldwork integrity. Students need to be explicitly taught what academic honesty and dishonesty is and be provided with the resources and time to complete academic work to reduce the risk of academic dishonesty.
The glucagon‐like peptide‐1 receptor agonist Exendin‐4, ameliorates contrast‐induced nephropathy through suppression of oxidative stress, vascular dysfunction and apoptosis independent of glycaemia
Authors: Hussien Noha I , Sorour Safwa M , El‐kerdasy Hanan I , Abdelrahman Bakr A
Published: April 2018

Contrast‐induced nephropathy (CIN) is a leading cause of hospital‐acquired acute kidney injury, particularly in diabetic patients. Previous studies have shown renoprotective effects of glucagon‐like peptide‐1 (GLP‐1) signalling; however, its role in CIN remains unexplored. This study investigates the prophylactic effect of exendin‐4, a GLP‐1R agonist, against CIN in a rat model mimicking both healthy and diabetic conditions. Animals were randomly divided into 7 groups: a control sham group (n = 8), and 2 identical sets of 3 disease groups, one received exendin‐4 before exposure to contrast medium (CM), while the other served as untreated control. The 3 disease groups represented diabetes (n = 8), CIN (n = 8), or diabetes and CIN combined (n = 8). Untreated groups showed deteriorating renal function as indicated by significantly higher levels of serum creatinine and blood urea nitrogen, malondialdehyde, and endothelin‐1 and caspase‐3 expression compared to the sham control group. This was accompanied by a significant decrease in tissue reserves of reduced glutathione, superoxide dismutase, nitrate and endothelin nitric oxide synthase as well as deteriorating renal histology. The CM‐induced changes in diabetic rats indicate impaired renal function, oxidative stress, vascular dysfunction, and apoptosis, and were significance higher in intensity compared to non‐diabetic rats. Pretreatment with exendin‐4 ameliorated all the aforementioned CM‐induced nephropathic effects independent of the glycemic state. To our knowledge, this is the first study describing the prophylactic renoprotective effects of exendin‐4 against CIN. With the current pharmaceutical use of exendin‐4 as a hypoglycaemic agent, the GLP‐1R agonist becomes an interesting candidate for human clinical trials on CIN prevention.
The Health Risks of Belgian Illicit Indoor Cannabis Plantations
Authors: Vanhove Wouter , Cuypers Eva , Bonneure Arne‐Jan , Gotink Joachim , Stassen Mirna , Tytgat Jan , Van Damme Patrick
Published: April 2018

We assessed the prevalence of potential health hazards to intervention staff and cannabis growers in Belgian indoor cannabis plantations. Surface mold swab samples were taken at 16 Belgian indoor plantations contained mostly Penicillium sp. and Aspergillus sp. However, their precise health impact on intervention staff and illicit growers is unclear as no molds spore concentrations were measured. Atmospheric gas monitoring in the studied cannabis plantations did not reveal dangerous toxic substances. Health symptoms were reported by 60% of 221 surveyed police, but could not be linked to specific plantation characteristics. We conclude that Belgian indoor cannabis plantations pose a potential health threat to growers and intervention staff. AS there are currently no clear safety guidelines for seizure and dismantling of Belgian indoor cannabis plantations, we recommend first responders to follow strict safety rules when entering the growth rooms, which include wearing appropriate personal protective equipment.
A Fatal Case of Gas Intoxication in Silage Pit
Authors: Handlos Petr , Gebauerová Vladimíra , Tomková Jana , Zielinski Petr , Marecová Klára
Published: April 2018

Fatalities due to gas intoxication are rare in routine forensic casework. The most common gas is carbon monoxide, with other gases (ammonia, methane, propane and butane, carbon dioxide, hydrogen sulfide) encountered only very rarely. In this report, we describe the accidental death of two maintenance workers who were found in the silage pit at a biogas plant. The autopsy revealed signs of asphyxia in both the deceased. Analysis of the gaseous mixtures in the tank using an infrared gas analyzer showed slightly elevated concentrations of carbon dioxide. Toxicological examination of the blood of both the deceased using gas chromatography with a flame ionization detector, spectrophotometry and liquid chromatography‐mass spectrometry did not detect any toxicologically significant substance that would explain the sudden collapse. Both the autopsy and the toxicology analyses suggest CO2 intoxication as the most likely cause for the collapse of the two men, which then led to sudden asphyxia.
Pharmacological treatments for alleviating agitation in dementia: a systematic review and network meta‐analysis
Authors: Kongpakwattana Khachen , Sawangjit Ratree , Tawankanjanachot Itthipol , Bell J. Simon , Hilmer Sarah N. , Chaiyakunapruk Nathorn
Published: April 2018

Aims

To determine the most efficacious and acceptable treatments of agitation in dementia.

Methods

MEDLINE, EMBASE, PsycINFO, CENTRAL and clinicaltrials.gov were searched up to 7 February 2017. Two independent reviewers selected randomized controlled trials (RCTs) of treatments to alleviate agitation in people with all‐types dementia. Data were extracted using standardized forms and study quality was assessed using the revised Cochrane Risk of Bias Tool for RCTs. Data were pooled using meta‐analysis. The primary outcome, efficacy, was 8‐week response rates defined as a 50% reduction in baseline agitation score. The secondary outcome was treatment acceptability defined as treatment continuation for 8 weeks.

Results

Thirty‐six RCTs comprising 5585 participants (30.9% male; mean ± standard deviation age, 81.8 ± 4.9 years) were included. Dextromethorphan/quinidine [odds ratio (OR) 3.04; 95% confidence interval (CI), 1.63–5.66], risperidone (OR 1.96; 95% CI, 1.49–2.59) and selective serotonin reuptake inhibitors as a class (OR 1.61; 95% CI, 1.02–2.53) were found to be significantly more efficacious than placebo. Haloperidol appeared less efficacious than nearly all comparators. Most treatments had noninferior treatment continuation compared to placebo, except oxcarbazepine, which was inferior. Findings were supported by subgroup and sensitivity analyses.

Conclusions

Risperidone, serotonin reuptake inhibitors as a class and dextromethorphan/quinidine demonstrated evidence of efficacy for agitation in dementia, although findings for dextromethorphan/quinidine were based on a single RCT. Our findings do not support prescribing haloperidol due to lack of efficacy, or oxcarbazepine due to lack of acceptability. The decision to prescribe should be based on comprehensive consideration of the benefits and risks, including those not evaluated in this meta‐analysis.
Population pharmacokinetics of tacrolimus in children with nephrotic syndrome
Authors: Hao Guo‐Xiang , Huang Xin , Zhang Dong‐Feng , Zheng Yi , Shi Hai‐Yan , Li Yan , Jacqz‐Aigrain Evelyne , Zhao Wei
Published: April 2018

Aims

Nephrotic syndrome (NS) is the most common clinical manifestation of glomerular disease in children. Currently, tacrolimus (TAC) is widely used in children with NS. However, pharmacokinetic data in children with nephrotic syndrome is limited. This study was intended to evaluate the population pharmacokinetics (PPK) of TAC in paediatric NS and to optimize dosing regimen.

Methods

Blood samples from NS children treated with TAC were collected and the blood concentrations of TAC were detected using HPLC‐MS/MS. A PPK model was developed using NONMEM software. Pharmacogenetic analysis was carried out in the CYP3A5 gene.

Results

The data from 28 children were used for PPK analysis. A one‐compartment model and first‐order elimination were accorded with the TAC data in paediatric NS. A covariate analysis showed that body weight and CYP3A5 genotype significantly affected TAC pharmacokinetics. Monte Carlo simulation indicated that NS children with CYP3A5*3/*3 receiving 0.10 mg kg−1 dose−1 twice daily and NS children with CYP3A5*1 receiving 0.25 mg kg−1 dose−1 twice daily TAC could achieve the target concentrations of 5–10 ng ml−1.

Conclusion

The PPK of TAC was estimated in children with NS and a CYP3A5 genotype‐based dosing regimen was set up based on simulations.
The World Health Organization 1973 classification system for grade is an important prognosticator in T1 non‐muscle‐invasive bladder cancer
Authors: van de Putte Elisabeth E. Fransen , Bosschieter Judith , van der Kwast Theo H. , Bertz Simone , Denzinger Stefan , Manach Quentin , Compérat Eva M. , Boormans Joost L. , Jewett Michael A.S. , Stoehr Robert , van Leenders Geert J.L.H. , Nieuwenhuijzen Jakko A. , Zlotta Alexandre R. , Hendricksen Kees , Rouprêt Morgan , Otto Wolfgang , Burger Maximilian , Hartmann Arndt , van Rhijn Bas W.G.
Published: April 2018

Objectives

To compare the prognostic value of the World Health Organization (WHO) 1973 and 2004 classification systems for grade in T1 bladder cancer (T1‐BC), as both are currently recommended in international guidelines.

Patients and Methods

Three uro‐pathologists re‐revised slides of 601 primary (first diagnosis) T1‐BCs, initially managed conservatively (bacille Calmette–Guérin) in four hospitals. Grade was defined according to WHO1973 (Grade 1–3) and WHO2004 (low‐grade [LG] and high‐grade [HG]). This resulted in a lack of Grade 1 tumours, 188 (31%) Grade 2, and 413 (69%) Grade 3 tumours. There were 47 LG (8%) vs 554 (92%) HG tumours. We determined the prognostic value for progression‐free survival (PFS) and cancer‐specific survival (CSS) in Cox‐regression models and corrected for age, sex, multiplicity, size and concomitant carcinoma in situ.

Results

At a median follow‐up of 5.9 years, 148 patients showed progression and 94 died from BC. The WHO1973 Grade 3 was negatively associated with PFS (hazard ratio [HR] 2.1) and CSS (HR 3.4), whilst WHO2004 grade was not prognostic. On multivariable analysis, WHO1973 grade was the only prognostic factor for progression (HR 2.0). Grade 3 tumours (HR 3.0), older age (HR 1.03) and tumour size >3 cm (HR 1.8) were all independently associated with worse CSS.

Conclusion

The WHO1973 classification system for grade has strong prognostic value in T1‐BC, compared to the WHO2004 system. Our present results suggest that WHO1973 grade cannot be replaced by the WHO2004 classification in non‐muscle‐invasive BC guidelines.
Non‐abusing mothers' support needs after child sexual abuse disclosure: A narrative review
Authors: Serin Hanife
Published: April 2018

The role of maternal support has been perceived as vital throughout the recovery process of sexually abused children. However, it is important to look at the concept “support” from the perspective of non‐abusing mothers' personal needs. This narrative review of the literature aimed to find out how non‐abusing mothers' need for support in their responses to disclosure of child sexual abuse has been recognized. A comprehensive search on Jyväskylä University Library interface yielded 12 academic articles based on empirical research. These articles were selected from those considered to have sufficiently investigated support for non‐abusing mothers and included a mixture of qualitative, quantitative, and mixed‐method research. The data consisted of peer‐reviewed online articles published in English between 2000 and 2017. Four themes emerged from the thematic analysis: improving the quality of the whole social support network for non‐abusing mothers; being blamed, maternal guilt, and shame; anger; and coping strategies. The findings show that the support needs of non‐abusing mothers are usually explained based on their interaction with sexually abused children. However, it is necessary to listen to women's needs independently of their mothering role. If these mothers are better understood, not only they, but also their children, could be empowered.
Quantitative chest CT for subtyping chronic lung allograft dysfunction and its association with survival
Authors: Horie Miho , Salazar Pascal , Saito Tomohito , Binnie Matthew , Brock Kristy , Yasufuku Kazuhiro , Azad Sassan , Keshavjee Shaf , Martinu Tereza , Paul Narinder
Published: April 2018

Chronic lung allograft dysfunction (CLAD) is a major cause of mortality in lung transplant recipients. CLAD can be sub‐divided into at least 2 subtypes with distinct mortality risk characteristics: restrictive allograft syndrome (RAS), which demonstrates increased overall computed tomography (CT) lung density in contrast with bronchiolitis obliterans syndrome (BOS), which demonstrates reduced overall CT lung density. This study aimed to evaluate a reader‐independent quantitative density metric (QDM) derived from CT histograms to associate with CLAD survival. A retrospective study evaluated CT scans corresponding to CLAD onset using pulmonary function tests in 74 patients (23 RAS, 51 BOS). Two different QDM values (QDM1 and QDM2) were calculated using CT lung density histograms. Calculation of QDM1 includes the extreme edges of the histogram. Calculation of QDM2 includes the central region of the histogram. Kaplan‐Meier analysis and Cox regression analysis were used for CLAD prognosis. Higher QDM values were significantly associated with decreased survival. The hazard ratio for death was 3.2 times higher at the 75th percentile compared to the 25th percentile using QDM1 in a univariate model. QDM may associate with CLAD patient prognosis.
A long‐term experience with expansion of Milan criteria for liver transplant recipients
Authors: Commander Sarah Jane , Shaw Brian , Washburn Laura , Yoeli Dor , Rana Abbas , Goss John A.
Published: April 2018

The Milan criteria (MC) have historically determined eligibility for transplantation for hepatocellular carcinoma (HCC). The United Network for Organ Sharing (UNOS) Region 4 expanded the criteria for transplantation in HCC to include a single tumor ≤6 cm or up to 3 tumors with the largest diameter ≤5 cm and total additive diameter ≤9 cm (R4C). The aim of this study was to report the 10‐year outcomes of this expanded criteria compared to MC. Transplants performed for HCC in Region 4 between October 2007 and December 2016 were reviewed using the UNOS database. Recipients were categorized based on imaging findings at initial evaluation. A total of 2068 patients were included in the study. There was no significant difference in 10‐year patient survival between the groups (53% MC vs 48% R4C, P = .23). There was also no significant difference in recurrence‐free survival (54% MC vs 47% R4C, P = .15) or allograft survival (53% MC vs 48% R4C, P = .16). Finally, there was no significant difference in outcomes between the MC and R4C groups when stratifying patients by locoregional therapy. This study demonstrates promising data that the criteria for liver transplantation in HCC can be safely expanded to the R4C without compromising outcomes.