bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of soft and hard TQM on quality performance and patient satisfaction in health care: investigating direct and indirect effects
Authors: Alkhaldi Rasha Zuhair , Abdallah Ayman Bahjat
Published: October 2021

Purpose

The present study conceptualizes total quality management (TQM) in terms of soft and hard aspects and examines their effects on quality performance and patient satisfaction. The indirect effects of soft and hard TQM on patient satisfaction through quality performance are also investigated.

Design/methodology/approach

A multi-item questionnaire was prepared to gather primary data from a sample of 312 medical employees in private hospitals in Jordan. The measurement model was evaluated for validity and reliability and determined to be acceptable. Structural equation modeling (SEM) was applied to test the research hypotheses.

Findings

The results revealed that soft TQM has a strong positive effect on quality performance and patient satisfaction. Hard TQM was found to positively affect quality performance but to a lesser extent compared to soft TQM. The effect of hard TQM on patient satisfaction, meanwhile, was not significant. Quality performance positively mediated the relationship between TQM – both soft and hard – and patient satisfaction.

Originality/value

This study is one of the first to conceptualize TQM in terms of soft and hard aspects in a health care context. It offers valuable insights for managers of private hospitals looking to enhance quality performance and patient satisfaction. The results reveal that soft TQM is the primary driver of quality performance and patient satisfaction in the health care context, which is in stark contrast to the manufacturing sector.
Survival advantage of worker buyouts over newly created worker-owned firms
Authors: Mirabel Thibault
Published: October 2021

Purpose

Various theories predict that firm buyouts survive longer than newly created firms. The study aims to know whether it is the case for worker-owned firms (WOFs), i.e. firms owned and controlled mostly by their workers.

Design/methodology/approach

The author conducted a comparative survival analysis of French WOFs distinguished by their entry mode (i.e. newly created, worker buyouts (WBOs) of sound conventional firms, WBOs of conventional firms in difficulty or WBOs of non-profit organizations).

Findings

The hazard of exit is 32% lower for WBOs of sound conventional firms than newly created WOFs, 18% for WBOs of conventional firms in difficulty and 64% for WBOs of non-profit organizations. The current study confirms that WBOs, even of conventional firms in difficulty, have on average a survival advantage over newly created WOFs. Surprisingly, the author also shows that this survival advantage is similar across sectors with different knowledge intensity but is lower in high capital-intensive sectors than in low capital-intensive ones.

Research limitations/implications

Endogeneity issues limit the scope of the results and should be tackled in future research. Overall, these findings show that WOFs are composed of groups with different survival likelihoods that are obscured if one only looks at the aggregate population.

Practical implications

With caution, support agencies could foster WBOs of firms in difficulty and of non-profit organizations as viable forms of entrepreneurship.

Originality/value

The current study offers the first survival analysis distinguishing four modes of entry among WOFs.
Social media users and cybersecurity awareness: predicting self-disclosure using a hybrid artificial intelligence approach
Authors: Khan Naurin Farooq , Ikram Naveed , Murtaza Hajra , Asadi Muhammad Aslam
Published: October 2021

Purpose

This study aims to investigate the cybersecurity awareness manifested as protective behavior to explain self-disclosure in social networking sites. The disclosure of information about oneself is associated with benefits as well as privacy risks. The individuals self-disclose to gain social capital and display protective behaviors to evade privacy risks by careful cost-benefit calculation of disclosing information.

Design/methodology/approach

This study explores the role of cyber protection behavior in predicting self-disclosure along with demographics (age and gender) and digital divide (frequency of Internet access) variables by conducting a face-to-face survey. Data were collected from 284 participants. The model is validated by using multiple hierarchal regression along with the artificial intelligence approach.

Findings

The results revealed that cyber protection behavior significantly explains the variance in self-disclosure behavior. The complementary use of five machine learning (ML) algorithms further validated the model. The ML algorithms predicted self-disclosure with an area under the curve of 0.74 and an F1 measure of 0.70.

Practical implications

The findings suggest that costs associated with self-disclosure can be mitigated by educating the individuals to heighten their cybersecurity awareness through cybersecurity training programs.

Originality/value

This study uses a hybrid approach to assess the influence of cyber protection behavior on self-disclosure using expectant valence theory (EVT).
The dark side of the quarantine: night eating, sleep quality and the health locus of control in women
Authors: Yılmaz Sine , Sanlier Nevin , Göbel Pınar , Açıkalın Büşra , Kocabas Sule , Dundar Akif
Published: October 2021

Purpose

Staying at home for a prolonged period, the stress during COVID-19 quarantine may affect sleep quality, night eating behaviours of individuals. This paper aims to identify the relationship between night eating behaviour, sleep quality, perceptions of health locus of control in women during the pandemic.

Design/methodology/approach

An anonymous, Web based, cross-sectional study was conducted for the duration of a month (April-May, 2020). The study evaluated the nutritional habits of the participants. Anthropometric measurements were noted. Night Eating Syndrome Questionnaire (NESQ), Pittsburgh Sleep Quality Index (PSQI), Multi-dimensional Health Locus of Control-A were used for data collection.

Findings

With a mean age of 33 ± 8 years, 529 women participated in the study. The mean NESQ score was 14.4 ± 4.7, PSQI score was 6.4 ± 2.9. Higher night eating scores were observed in participants with chance locus of control (CLC) perception when compared to participants with internal health locus of control (IHLC) perception (p< 0.05). Lower sleep quality was observed in obese participants compared to normal/overweight participants (p< 0.05). It was also found that night eating behaviours significantly predicted sleep quality (R= 0.36,R2= 0.13;p< 0.01), explaining about 13.3% of total variance of sleep quality.

Research limitations/implications

Only internet users and women participated in the study, and the questionnaire form was applied online; the information was obtained in the form of the participants' own statements.

Practical implications

It was found that night eating behaviour significantly predicted sleep quality during the pandemic. It was also determined that the individuals with high chance locus of control perception had higher NES scores than the individuals with high internal locus of control perception.

Originality/value

The night eating behaviours significantly predict sleep quality, individuals with a high perception of CLC had a higher night eating score than individuals with high perception of IHLC during the pandemic.
Effects of Sn-Ag-x leveling layers on the microstructure and mechanical properties of SnBi low-temperature solder joints
Authors: Liu Yang , Xue Yuxiong , Zhou Min , Cao Rongxing , Zeng Xianghua , Li Hongxia , Zheng Shu , Zhang Shuang
Published: October 2021

Purpose

The purpose of this paper is to investigate the effects of Sn-Ag-x leveling layers on the mechanical properties of SnBi solder joints. Four Sn-Ag-x (Sn-3.0Ag-0.5Cu, Sn-0.3Ag-0.7Cu, Sn-0.3Ag-0.7Cu-0.5 Bi-0.05Ni and Sn-3.0Ag-3.0 Bi-3.0In) leveling layers were coated on Cu pads to prepare SnBi/Sn-Ag-x/Cu solder joints. The microstructure, hardness, shear strength and fracture morphology of solder joints before and after aging were studied.

Design/methodology/approach

The interfacial brittleness of the SnBi low-temperature solder joint is a key problem affecting its reliability. The purpose of this study is to improve the mechanical properties of the SnBi solder joint.

Findings

Owing to the addition of the leveling layers, the grain size of the ß-Sn phase in the SnBi/Sn-Ag-x/Cu solder joint is significantly larger than that in the SnBi/Cu eutectic solder joint. Meanwhile, the hardness of the solder bulk in the SnBi/Cu solder joint shows a decrease trend because of the addition of the leveling layers. The SnBi/Cu solder joint shows obvious strength drop and interfacial brittle fracture after aging. Through the addition of the Sn-Ag-x layers, the brittle failure caused by aging is effectively suppressed. In addition, the Sn-Ag-x leveling layers improve the shear strength of the SnBi/Cu solder joint after aging. Among them, the SnBi/SACBN/Cu solder joint shows the highest shear strength.

Originality/value

This work suppresses the interfacial brittleness of the SnBi/Cu solder joint after isothermal aging by adding Sn-Ag-x leveling layers on the Cu pads. It provides a way to improve the mechanical performances of the SnBi solder joint.
Teaching and learning with morning meeting in elementary social studies methods courses
Authors: Cornett Ariel , Quinn Alexa M.
Published: October 2021

Purpose

Using morning meeting, an evidence-based practice that is part of the responsive classroom (RC) approach, the authors (two teacher educators [TEs]) created opportunities for teacher candidates (TCs) to experience representations, decompositions and approximations of practice in multiple iterations of an elementary social studies methods course.

Design/methodology/approach

The authors detail how TEs can expose TCs to social studies content (e.g. the National Council for the Social Studies themes) that can be incorporated into structured, daily classroom routines, such as morning meeting.

Findings

The authors include TE-created morning meeting facilitation guides with components such as a morning message, greeting, share, group activity and theme justification. Furthermore, the authors outline TCs' reflections on planning and implementing a morning meeting with a partner in addition to their own reflections on the TCs' feedback.

Originality/value

This work has implications related to TEs and TCs in elementary social studies methods courses as well as current and future students in elementary classrooms.
The relationship between different types of leadership, client's identity, and self-confidence and auditors' impartiality
Authors: Salehi Mahdi , Ghaderi Alireza , Hashemisima Habibe , Zahedi Zohreh
Published: October 2021

Purpose

This paper aims to assess the effect of different leadership types, the client's identity and auditors' self-confidence on auditors' impartiality.

Design/methodology/approach

This paper is a descriptive-survey type, and the collected data are based on a predesigned questionnaire distributed in January 2020. The PLS software is used for data analysis, and the statistical population of this paper includes employed auditors in enlisted audit firms on the Official Association of Auditors. When the parameters were insignificant, the obtained probability from the model fitting was used for hypothesis testing, and the appropriateness of the model was assessed via the structural equations.

Findings

The results show a significant relationship between charismatic, transformational, participatory, delegating and bureaucratic leadership and auditors' impartiality. There is also an association between the client's identity and the auditor's impartiality. The client's identity mediates the relationship between transformational leadership and the auditor's impartiality. Moreover, there is a significant relationship between self-confidence and auditor's impartiality.

Originality/value

This paper enjoys an innovative method in the field of behavioural auditing. The effect of transformational leadership on auditor's impartiality with the mediatory role of the client's identity shows the in-depth client–auditor relationship has been taken for granted and not examined previously, so the results of this paper can lend a helping hand to audit firms to enhance the organisational performance.
Alopecia areata: Current understanding of the pathophysiology and update on therapeutic approaches, featuring the Japanese Dermatological Association guidelines
Authors: Fukuyama Masahiro , Ito Taisuke , Ohyama Manabu
Published: October 2021

Alopecia areata (AA) is a relatively common nonscarring hairloss disease characterized by an autoimmune response to anagen hair follicles (HFs). Accumulated evidence suggests that collapse of the HF immune privilege subsequent to triggering events, represented by viral infection, leads to autoimmune response in which autoreactive cytotoxic CD8+NKG2D+ T cells mainly target exposed HF autoantigens. AA had been recognized as type 1 inflammatory disease, but recent investigations have suggested some roles of type 2‐ and Th17‐associated mediators in AA pathogenesis. The significance of psychological stress in AA pathogenesis is less emphasized nowadays, but psychological comorbidities, such as depression and anxiety, attract greater interest in AA management. In this regard, the disease severity may not solely be evaluated by the extent of hair loss. Use of trichoscopy markedly improved the resolution of the diagnosis and evaluation of the phase of AA, which is indispensable for the optimization of treatment. For the standardization of AA management, the establishment of guidelines/expert consensus is pivotal. Indeed, the Japanese Dermatological Association (JDA) and other societies and expert groups have published guidelines/expert consensus reports, which mostly recommend intralesional/topical corticosteroid administration and contact immunotherapy as first‐line treatments, depending on the age, disease severity, and activity of AA. The uniqueness of the JDA guidelines can be found in their descriptions of intravenous corticosteroid pulse therapy, antihistamines, and other miscellaneous domestically conducted treatments. Considering the relatively high incidence of spontaneous regression in mild AA and its intractability in severe subsets, the importance of course observation is also noted. Evidenced‐based medicine for AA is currently limited, however, novel therapeutic approaches, represented by JAK inhibitors, are on their way for clinical application. In this review, the latest understanding of the etiopathogenesis and pathophysiology, and update on therapeutic approaches with future perspectives are summarized for AA, following the current version of the JDA AA management guidelines.
Schools as social spaces: Towards an Arendtian consideration of multicultural education
Authors: Azada-Palacios Rowena
Published: October 2021

Hannah Arendt has been criticised for the sharp distinction she drew between the social and political realms, and her application of this distinction to schools. In this paper, I demonstrate that this distinction can be interpreted as a heuristic that Arendt developed to address a tension that she had encountered in her attempt to understand childhood. She understood schools to be spaces that could prepare children for citizenship. However, she also recognised that attempts to prepare children for citizenship threatened two characteristics of childhood: their vulnerability and their natality. Arendt's heuristic can be fruitful for addressing dilemmas in citizenship education in ethnoculturally plural contexts.
Obstetric anal sphincter injury by maternal origin and length of residence: a nationwide cohort study
Authors: Sørbye IK , Bains S , Vangen S , Sundby J , Lindskog B , Owe KM
Published: October 2021

Objective

To estimate the association between maternal origin and obstetric anal sphincter injury (OASI), and assess if associations differed by length of residence.

Design

Population‐based cohort study.

Setting

The Medical Birth Registry of Norway.

Population

Primiparous women with vaginal livebirth of a singleton cephalic fetus between 2008 and 2017 (n = 188 658).

Methods

Multivariable logistic regression models estimated adjusted odds ratios (aORs) for OASI with 95% CI by maternal region of origin and birthplace. We stratified models on length of residence and paternal birthplace.

Main outcome measures

OASI.

Results

Overall, 6373 cases of OASI were identified (3.4% of total cohort). Women from South Asia were most likely to experience OASI (6.2%; aOR 2.24, 95% CI 1.87–2.69), followed by those from Southeast Asia, East Asia & the Pacific (5.7%; 1.59, 1.37–1.83) and Sub‐Saharan Africa (5.2%; 1.85, 1.55–2.20), compared with women originating from Norway. Among women born in the same region, those with short length of residence in Norway (0–4 years), showed the highest odds of OASI. Migrant women across most regions of origin had the lowest risk of OASI if they had a Norwegian partner.

Conclusions

Primiparous women from Asian regions and Sub‐Saharan Africa had up to two‐fold risk of OASI, compared with women originating from Norway. Migrants with short residence and those with a foreign‐born partner had higher risk of OASI, implying that some of the risk differential is due to sociocultural factors. Some migrants, especially new arrivals, may benefit from special attention during labour to reduce morbidity and achieve equitable outcomes.

Tweetable abstract

Anal sphincter injury during birth is more common among Asian and Sub‐Saharan migrants and particularly among recent arrivals.
Stress Distribution and Fracture Resistance of repairing Cracked Tooth with Fiber‐reinforced Composites and Onlay
Authors: Shi Rui , Meng Xingwang , Feng Rui , Hong Shanshan , Hu Chen , Yang Min , Jiang Yuegui
Published: October 2021

The purpose of this study was to explore the effects of fibre‐reinforced composites and onlay restorations on the fracture resistance of the cracked teeth. The experiments were grouped as follows: intact teeth, cracked teeth, crown; onlay; annular ribbond + onlay, laminated ribbond + onlay and fibre post + onlay; annular ribbond + crown, laminated ribbond + crown and fibre post + crown. The maximal Von Mises stress of dentin, the maximal Von Mises stress at the crack, the fracture resistance and fracture pattern under static loading were analysed by single‐factor analysis of variance (ANOVA) and post‐test by LSD. The annular ribbond + crown had a significant difference in fracture resistance than the crown (P < 0.05). The annular ribbond + onlay had more favourable fractures than crown in fracture pattern, and there were significant differences (P < 0.05). Compared with crown restoration, fibre‐reinforced composites and onlay can improve the fracture resistance of the cracked teeth.
Drug‐eluting bead transarterial chemoembolization with medium‐sized versus small‐sized CalliSpheres microspheres in unresectable primary liver cancer
Authors: Zhang Jiao , Feng Guo‐an , Li Yuliang , Wang Wujie
Published: October 2021

Purpose

The optimal microparticle size for drug‐eluting beads transarterial chemoembolization (DEB‐TACE) remains unknown. This retrospective cohort study analyzed the efficacy and safety of CalliSpheres microsphere embolization in the treatment of unresectable hepatocellular carcinoma (HCC) to determine the influence of particle size on the results.

Patients and methods

Forty‐two patients with unresectable HCC were enrolled in this retrospective study from January 2018 to January 2020. Patients received DEB‐TACE with CalliSpheres of 100–300 μm (small‐size, n = 15) or 300–500 μm (medium‐size, n = 27). The tumor response was evaluated via enhanced CT or MRI at 1 month, 3 months, and 6 months after treatment, based on the Modified Response Evaluation Criteria in Solid Tumors. Adverse events after DEB‐TACE were recorded.

Results

Complete response, partial response, stable disease, and progressive disease were recorded in 20%, 20%, 33.3%, 26.7%, respectively, of patients in the small‐size group and 3.7%, 25.9%, 44.4%, 25.9% of patients in the medium‐size group, respectively. No significant difference was found between the two groups (p = 0.516). Major adverse events, including grade three liver toxicity (n = 4) and liver abscess (n = 3), occurred significantly more in the small‐size group, while none were reported in the medium size group (p < 0.05).

Conclusion

DEB‐TACE with medium‐size (300–500 μm) CalliSpheres microspheres had similar efficacy and a better safety profile than DEB‐TACE with small‐size (100–300 μm) CalliSpheres, indicating that medium‐size microspheres may be a better choice for unresectable primary liver cancer.
Case report of paroxysmal atrioventricular block and ventricular arrest in a young pregnant woman: What is the mechanism?
Authors: Wei Jiaohua , Peng Huiru , Li Haisha
Published: October 2021

A 30‐year‐old female patient with 12 weeks of gestation was admitted to our hospital due to dizziness and amaurosis fugax. Moreover, 24 h Holter monitoring showed paroxysmal atrioventricular block (P‐AVB) and ventricular arrest. The heart block in the patient was likely a vagally mediated heart block based on the "vagal score." She was not given a pacemaker, and the symptoms and AV nodal conduction were improved following the delivery.
β2‐adrenergic stimulation potentiates spontaneous calcium release by increasing signal mass and co‐activation of ryanodine receptor clusters
Authors: Nolla‐Colomer Carme , Casabella‐Ramon Sergi , Jimenez‐Sabado Veronica , Vallmitjana Alexander , Tarifa Carmen , Herraiz‐Martínez Adela , Llach Anna , Tauron Manel , Montiel Jose , Cinca Juan , Chen S. R. Wayne , Benitez Raul , Hove‐Madsen Leif
Published: October 2021

Aims

It is unknown how β‐adrenergic stimulation affects calcium dynamics in individual RyR2 clusters and leads to the induction of spontaneous calcium waves. To address this, we analysed spontaneous calcium release events in green fluorescent protein (GFP)‐tagged RyR2 clusters.

Methods

Cardiomyocytes from mice with GFP‐tagged RyR2 or human right atrial tissue were subjected to immunofluorescent labelling or confocal calcium imaging.

Results

Spontaneous calcium release from single RyR2 clusters induced 91.4% ± 2.0% of all calcium sparks while 8.0% ± 1.6% were caused by release from two neighbouring clusters. Sparks with two RyR2 clusters had 40% bigger amplitude, were 26% wider, and lasted 35% longer at half maximum. Consequently, the spark mass was larger in two‐ than one‐cluster sparks with a median and interquartile range for the cumulative distribution of 15.7 ± 20.1 vs 7.6 ± 5.7 a.u. (P < .01). β2‐adrenergic stimulation increased RyR2 phosphorylation at s2809 and s2815, tripled the fraction of two‐ and three‐cluster sparks, and significantly increased the spark mass. Interestingly, the amplitude and mass of the calcium released from a RyR2 cluster were proportional to the SR calcium load, but the firing rate was not. The spark mass was also higher in 33 patients with atrial fibrillation than in 36 without (22.9 ± 23.4 a.u. vs 10.7 ± 10.9; P = .015).

Conclusions

Most sparks are caused by activation of a single RyR2 cluster at baseline while β‐adrenergic stimulation doubles the mass and the number of clusters per spark. This mimics the shift in the cumulative spark mass distribution observed in myocytes from patients with atrial fibrillation.
In vitro ruminal fermentation characteristics of gum arabic under concentrate and forage substrate conditions
Authors: Han Hongyan , Yamanaka Sayaka , Tsukahara Takamitsu , Hotta Yoshio , Takagi Tokuji , Kumagai Hajime
Published: October 2021

Gum arabic (GA) has potential rumen modifier functions. This is the first study to investigate the in vitro ruminal fermentation characteristics of GA. Rumen fluid was collected from ruminal fistulated wethers; rolled barley and ryegrass straw were used as substrates for concentrate and forage conditions, respectively. Besides incubating with the substrates alone (control), GA or potato starch (PS) was added at 0.2%, 1.0%, and 2.0% along with substrates. Under the concentrate substrate condition, GA treatments showed higher total gas production in 24‐h incubation, but lower methane production in 24‐ and 48‐h incubation compared with PS treatments (p < 0.05). The 1.0% and 2.0% GA and 0.2% and 1.0% PS treatments showed higher dry matter and neutral detergent fiber digestibility and lower NH3‐N, and higher short chain fatty acid concentrations compared with the control at 24‐h incubation (p < 0.05). The GA treatments also showed a lower acetate/propionate ratio than PS treatments at 48‐h incubation (p < 0.01). Under the forage substrate condition, the treatment effects were not significant, except for a higher proportion of propionate with GA than with PS at 24 and 48 h of incubations. We thus concluded that GA supplement may exert potential rumen modifier effects particularly under concentrate feeding condition.
The ecology of sleep in non‐avian reptiles
Authors: Mohanty Nitya P. , Wagener Carla , Herrel Anthony , Thaker Maria
Published: October 2021

Sleep is ubiquitous in the animal kingdom and yet displays considerable variation in its extent and form in the wild. Ecological factors, such as predation, competition, and microclimate, therefore are likely to play a strong role in shaping characteristics of sleep. Despite the potential for ecological factors to influence various aspects of sleep, the ecological context of sleep in non‐avian reptiles remains understudied and without systematic direction. In this review, we examine multiple aspects of reptilian sleep, including (i) habitat selection (sleep sites and their spatio‐temporal distribution), (ii) individual‐level traits, such as behaviour (sleep postures), morphology (limb morphometrics and body colour), and physiology (sleep architecture), as well as (iii) inter‐individual interactions (intra‐ and inter‐specific). Throughout, we discuss the evidence of predation, competition, and thermoregulation in influencing sleep traits and the possible evolutionary consequences of these sleep traits for reptile sociality, morphological specialisation, and habitat partitioning. We also review the ways in which sleep ecology interacts with urbanisation, biological invasions, and climate change. Overall, we not only provide a systematic evaluation of the conceptual and taxonomic biases in the existing literature on reptilian sleep, but also use this opportunity to organise the various ecological hypotheses for sleep characteristics. By highlighting the gaps and providing a prospectus of research directions, our review sets the stage for understanding sleep ecology in the natural world.
Predictive model for recurrence of renal cell carcinoma by comparing pre‐ and postoperative urinary metabolite concentrations
Authors: Morozumi Kento , Kawasaki Yoshihide , Maekawa Masamitsu , Takasaki Shinya , Sato Tomonori , Shimada Shuichi , Kawamorita Naoki , Yamashita Shinichi , Mitsuzuka Koji , Mano Nariyasu , Ito Akihiro
Published: October 2021

To improve treatment outcomes in real practice, useful biomarkers are desired when predicting postoperative recurrence for renal cell carcinoma (RCC). We collected data from patients who underwent definitive surgery for RCC and for benign urological tumor at our department between November 2016 and December 2019. We evaluated the differences in pre‐ and postoperative urinary metabolites with our precise quantitative method and identified predictive factors for RCC recurrence. Additionally, to clarify the significance of metabolites, we measured the intracellular metabolite concentration of three RCC cell lines. Among the 56 patients with RCC, nine had a recurrence (16.0%). When comparing 27 patients with T1a RCC and 10 with benign tumor, a significant difference was observed between pre‐ and postoperative concentrations among 10 urinary metabolites. In these 10 metabolites, multiple logistic regression analysis identified five metabolites (lactic acid, glycine, 2‐hydroxyglutarate, succinic acid, and kynurenic acid) as factors to build our recurrence prediction model. The values of area under the receiver operating characteristic curve, sensitivity, and specificity in this predictive model were 0.894%, 88.9%, and 88.0%, respectively. When stratified into low and high risk groups of recurrence based on this model, we found a significant drop of recurrence‐free survival rates among the high risk group. In in vitro studies, intracellular metabolite concentrations of metastatic tumor cell lines were much higher than those of primary tumor cell lines. By using our quantitative evaluation of urinary metabolites, we could predict postoperative recurrence with high sensitivity and specificity. Urinary metabolites could be noninvasive biomarkers to improve patient outcome.
Evaluation of the abuse potential of difelikefalin, a selective kappa‐opioid receptor agonist, in recreational polydrug users
Authors: Shram Megan J. , Spencer Robert H. , Qian Jenny , Munera Catherine L. , Lewis Michael E. , Henningfield Jack E. , Webster Lynn , Menzaghi Frédérique
Published: October 2021

Difelikefalin, a selective kappa‐opioid receptor agonist with limited central nervous system penetration, is being developed for the treatment of chronic pruritic conditions. This randomized, double‐blind, active‐ and placebo‐controlled, four‐way crossover study was designed to evaluate the abuse potential of difelikefalin in healthy recreational polydrug users. Using a 4 × 4 Williams design, nondependent adult users of opioids and hallucinogens (N = 44) were randomized to receive single intravenous (i.v.) injections of difelikefalin at supratherapeutic doses (5 and 15 mcg/kg); pentazocine (0.5 mg/kg), a schedule IV mu‐opioid partial agonist and kappa‐opioid receptor agonist; and placebo. The abuse potential of difelikefalin was compared with pentazocine and placebo using the maximal score (maximum effect [Emax]) of the Drug Liking visual analog scale (VAS; primary end point), along with multiple secondary end points of subject‐rated measures and pupillometry. Difelikefalin produced significantly lower Drug Liking VAS Emax, and lower peak positive, sedative, and perceptual effects compared with pentazocine. These effects of difelikefalin were small, brief, and not dose‐dependent, although marginally greater than those observed with placebo. Neither dose of difelikefalin elicited significant negative or hallucinogenic effects. On end‐of‐session measures of overall drug liking and willingness to take the drug again, difelikefalin did not differ from placebo, indicating subjects neither liked nor disliked the effects overall and did not feel motivated to take the drug again. Consistent with its lack of mu agonist activity, difelikefalin did not induce miosis compared with pentazocine. All treatments were generally well‐tolerated. This study indicates that difelikefalin presents a low potential for abuse.
Insulin Centennial: Milestones influencing the development of insulin preparations since 1922
Authors: Owens David R. , Monnier Louis , Ceriello Antonio , Bolli Geremia B.
Published: October 2021

During 1921 to 1922, a team effort by Banting, Macleod, Collip and Best isolated and purified insulin and demonstrated its life‐giving properties, giving rise to the birth of insulin therapy. In the early years (1922‐1950), priorities revolved around the manufacture of insulin to meet demand, improving purity to avoid allergic reactions, establishing insulin standards and increasing its duration of action to avoid multiple daily injections. Shortly after the emergence of insulin, Joslin and Allen advocated the need to achieve and maintain good glycaemic control to realize its full potential. Although this view was opposed by some during a dark period in the history of insulin, it was subsequently endorsed some 60 years later endorsed by the Diabetes Control and Complications Trial and United Kingdom Prospective Diabetes Study. Major scientific advances by the Nobel Laureates Sanger, Hodgkin, Yalow and Gilbert and also by Steiner have revolutionized the understanding of diabetes and facilitated major advances in insulin therapy. The more recent advent of recombinant technology over the last 40 years has provided the potential for unlimited source of insulin, and the ability to generate various insulin ‘analogues’,in an attempt to better replicate normal insulin secretory patterns. The emerging biosimilars now provide the opportunity to improve availability at a lower cost.
Disrupted education trajectories: Exploring the effects of Covid‐19 on adolescent learning and priorities for “building back better” education systems in Ethiopia
Authors: Jones Nicola , Devonald Megan , Dutton Rebecca , Baird Sarah , Yadete Workneh , Gezahegne Kiya
Published: October 2021

Motivation

The Covid‐19 pandemic delivered an unprecedented shock to education systems globally, with school closures affecting 1.6 billion children. Education systems in low‐ and middle‐income countries (LMICs) are facing significant budget cuts further constraining capacities to adapt to Covid‐19 impacts. The need for evidence to inform policy dialogues about how best to mitigate impacts and support education systems to “build back better” is pressing.

Purpose

In Ethiopia, schools reopened in October 2020 after a seven‐month pandemic‐related closure. Employing an adapted resilience systems analysis framework, this article focuses on the extent to which Ethiopia’s education system—which has in recent decades seen rapid progress in enrolment rates—has adapted to the impacts of the pandemic on adolescents’ education and learning, and has achieved this equitably.

Methods and approach

The article draws on mixed‐methods data from Ethiopia collected virtually with a pre‐existing cohort of 3,066 adolescents (1,683 girls and 1,383 boys) during the immediate onset of the pandemic (April–June 2020) and following the reopening of schools (November 2020–February 2021). Adolescent perspectives are complemented by 27 key informant interviews at community and district levels.

Findings

Rural adolescents, girls, and adolescents with disabilities were less likely to access distance education during school closures due to connectivity challenges and discriminatory norms, and to subsequently re‐enrol. Implementation of adaptive measures, including hygiene guidance, smaller class sizes, and catch‐up classes, has been highly uneven, and outreach to support re‐enrolment of socially marginalized adolescents has been very limited.

Policy implications

For LMICs like Ethiopia to build back better post‐pandemic and stay on track to achieve Sustainable Development Goal 4’s commitment to inclusive and equitable quality education for all, scaled‐up investments in blended learning approaches, addressing the digital divide, and ensuring targeted outreach and social protection to support re‐enrolment of socially marginalized adolescents are critical.
COVID‐19 induced telogen effluvium
Authors: Aksoy Hasan , Yıldırım Umut Mert , Ergen Pınar , Gürel Mehmet Salih
Published: October 2021

COVID‐19 is a febrile, infectious illness that has previously been associated with telogen effluvium (TE). However, to date, no study has been conducted to determine the incidence of TE in those who have had COVID‐19. To assess the frequency of TE in post‐COVID‐19 patients and the correlation between the development of TE and the severity of COVID‐19, to understand whether emotional stress or medications are responsible for the development of TE. Totally 204 patients with a history of SARS‐CoV‐2 infection in the last 3 months were included in the study. The diagnosis of TE was made by history of excessive hair shedding, hair pull test, diffuse or bitemporal thinning, and absence of anisotrichosis in trichoscopy. Patients who did not have any TE cause other than COVID‐19 and whose hair loss started after COVID‐19 were considered as “COVID‐19 associated TE (CATE).” We found TE in 75 (36.7%) cases and androgenetic alopecia (AGA) in 85 (41.7%) cases. CATE was present in 27.9% of cases and developed on average 53.76 (± 23.772) days after COVID‐19 real‐time reverse transcription polymerase chain reaction (RT‐PCR) positivity. The proportion of patients with CATE was numerically higher in hospitalized patients compared to outpatients (31.7% vs. 24.3%; p = 0.238); and significantly higher in women compared to men (42.3% vs. 6.2%; p < 0.001), in patients with hypertension compared to those without hypertension (40.4% vs. 23.1%; p = 0.014), and in patients who had respiratory symptoms compared to those who had not (31.7% vs. 14.0%; p = 0.021). The patients with and without CATE were similar in terms of stress level and usage of COVID‐19 medications. Patients with AGA had a higher rate of hospitalization (69.4% vs. 35.3%; p < 0.001) and a higher incidence of fever (69.4% vs. 54.6%; p = 0.033) during COVID‐19, compared to those without. TE developed in approximately one‐quarter of people who have had COVID‐19, and our study is the first to detect it. The time to onset of CATE, which was 7–8 weeks after the SARS‐CoV‐2 RT‐PCR positivity, was not much different from post‐infectious TE. Patients with severe COVID‐19 seem to be more prone to develop TE. The presence of AGA is associated with a more severe COVID‐19. During the pandemic, clinicians should consider a previous SARS‐CoV‐2 infection in patients presenting with hair loss.
SME investment and financing under asymmetric information
Authors: Wang Yao , Zhang Hai , Zhao Zhiming
Published: October 2021

We investigate the investment timing and financing decisions of financially constrained small and medium‐sized enterprises (SMEs) in a real‐option setting with asymmetric information. ‘Bad’ firms can sell over‐priced securities by mimicking in a pooling equilibrium. However, ‘good’ firms can separate from bad firms by imposing an adverse selection cost for mimicry only when the benefit of being recognized as the ‘good’ type outweighs the investment distortion costs. Further, asymmetric information induces good firms to accelerate investment, leading to investment distortion and higher guarantee costs. Equity‐for‐guarantee swap not only mitigates SMEs' financing constraints but also reduces the investment and finance distortions.
Computed tomography image and mechanism of spiral neuron T‐type calcification channel of elderly patient with senile sudden deafness under embedded system combined with artificial intelligence algorithm
Authors: Dai Qiong , Ai Wei , Yuan Kun , Jia Min , Sun Jingwu
Published: October 2021

To analyse the computed tomography (CT) images of spiral neuron T‐type calcification channels and the mechanism of action in patients with sudden deafness in the elderly, the artificial intelligence (edge algorithm) algorithm was applied to the embedded system to analyse the CT images of the sudden deafness of the elderly, and then the mechanism of the spiral neuron T‐calcification channel was studied. The results showed that among the 48 patients with labyrinthitis, 26 were acute labyrinthitis, 14 were chronic labyrinthitis, and 8 were sclerosing labyrinthitis. α1G, α1H, and α1I were expressed on the cochlea and spiral neurons in the 66–68‐year‐old population, but the expression levels were significantly different. The expression of the three receptors on spiral neurons was slightly higher than that of the cochlea. α1H was most expressed on spiral neurons compared with the other two calcium channel receptors (p < 0.05). In addition, the minimum intensity projection method, multi‐layer reconstruction method, and surface reconstruction method can fully display the bony labyrinth, cochlea, cochlear duct (2.5 weeks), and shape and edge damage. In summary, the adoption of artificial intelligence algorithms based on embedded systems to analyse CT images can comprehensively and accurately reflect the three‐dimensional structure of the inner surface of the inner ear labyrinth. It can also fully display the scope, shape, density, and edge of the lesion. T‐type calcium channel receptors were expressed on the cochlea and spiral neurons of the C57BL/6J elderly, and decreased with age.
The life evaluation by linear cumulative damage rule for cold dwell fatigue of Ti‐6Al‐4V alloy
Authors: Ota Yutaro , Kubushiro Keiji , Yamazaki Yasuhiro
Published: October 2021

Low cycle fatigue (LCF) life at ambient temperature of Ti alloys is well known to decrease with stress dwell. This phenomenon, called cold dwell fatigue (CDF), is influenced by the peak stress, dwell time, and microstructure. For this study, the CDF life was evaluated by the linear cumulative damage rule. The influence of test conditions and microstructure on the linear cumulative damage rule was also verified. By the linear cumulative damage rule, when creep damage is calculated using the time exhaustion rule, theCDF damage was evaluated by the inequality of DTotal = (DF, DC) ≤ (0.01, 10−6). However, the CDF damage can be evaluated in the range of DTotal = 0.6–1.2 when creep damage was calculated using the ductile exhaustion rule. Results indicate that the evaluation was almost independent of the dwell time, peak stress, and microstructure, so it is also a versatile method for evaluating CDF responses.
Indigenous and gendered persons and peoples in business ethics education: Intersections of Indigenous wisdoms and de Beauvoirian existentialism
Authors: Price Shelley T. , Hartt Christopher M. , Mills Albert J. , MacFarlane Nia F.
Published: October 2021

The purpose of this paper is to explore how business ethics textbooks include Indigenous and gendered persons and peoples and whether they acknowledge Indigenous philosophies and theories. We explore 363 cases from eighteen (18) business ethics textbooks. A form and theme based content analysis was employed to help us better understand the inclusion, obfuscation and omission of Indigenous and gendered persons. A purpose of business ethics education is to disrupt injustice and oppressive practices in business. We find that business ethics education can provide more inclusive and respectful cases as it relates to Indigenous and gendered characters. There are cases that marginalize, obfuscate and omit Indigenous peoples, females, and gender diverse persons. This study contributes to diversity scholarship by identifying ways in which Indigenous and gendered persons and peoples can be included in management and business ethics education.
Molecular study of a large cohort of 109 haemophilia patients from Cuba using a gene panel with next generation sequencing‐based technology
Authors: Borràs Nina , Castillo‐González Dunia , Comes Natalia , Martin‐Fernandez Laura , Rivero‐Jiménez René Antonio , Chang‐Monteagudo Arturo , Ruiz‐Moleón Vera , Garrote‐Santana Heidys , Vidal Francisco , Macías‐Abraham Consuelo
Published: October 2021

Introduction

In several countries, molecular diagnosis of haemophilia A (HA) and B (HB) is hampered by a lack of resources for DNA analysis. The advent of next‐generation sequencing (NGS) has enabled gene analysis at a reasonable cost.

Aim

Describe a collaboration between Cuban and Spanish researchers to identify candidate variants and investigate the molecular epidemiology of 106 Cuban haemophilia patients using NGS.

Patients/methods

The molecular analysis protocol included well‐established LR‐PCR procedures to detect F8 inversions, NGS with a 30‐gene panel to sequence F8 and F9, and multiplex ligation‐dependent probe amplification to identify large structural variants.

Results

One‐hundred and thirty‐one candidate variants were identified along F8, F9, and VWF; 72 were unique and 28 (39%) had not been previously recorded. Putative variants were identified in 105/106 patients. Molecular characterization enabled confirmation and reclassification of: 90 HA (85%), 15 HB (14%), and one type 2N VWD (1%). Null variants leading to non‐production of FVIII or FIX were common in severe HA (64%), moderate HA (74%), and severe HB (60%), whereas missense variants were frequent in mild HA (57%) and moderate or mild HB (83%). Additional variants in VWF were identified in 16 patients.

Conclusion

This is the first description of the molecular epidemiology of HA and HB in Cuba. Variants identified in index cases will be of value for local implementation of familial studies and prenatal diagnosis using the molecular approaches available in Cuba. The results of this protocolled genetic study improved the accuracy of the clinical diagnosis and will facilitate management of these patients.
miR‐378‐3p alleviates contusion spinal cord injury by negatively regulating ATG12
Authors: Zhang Haocong , Yu Hailong , Yang Huifeng , Zhan Yang , Liu Xinwei
Published: October 2021

MicroRNAs (miRNAs or miRs) serve essential roles in the pathogenic process of spinal cord injury (SCI). The present study investigated the role of miR‐378‐3p and autophagy‐related 12 (ATG12) in SCI. RT‐qPCR was used to detect the mRNA expression levels of miR‐378‐3p and ATG12. Cell viability and membrane integrity were evaluated using CCK‐8 and LDH assays. For the analysis of the interaction between miR‐378‐3p and ATG12, a dual‐luciferase reporter assay was conducted. The hindlimb function of rats was detected with the Basso, Beattie and Bresnahan score, and the motor deficit index score was used to evaluate nerve function. Using these approaches, it was identified that miR‐378‐3p expression was downregulated, while that of ATG12 was upregulated in SCI tissues and in cells exposed to hypoxia. Hypoxia repressed the expression of miR‐378‐3p via hypoxia‐inducible factor 1‐α. The overexpression of miR‐378‐3p exerted anti‐apoptotic effects on nerve cells by directly repressing ATG12. The infusion of miR‐378‐3p improved hindlimb motor function and the neurological functions of rats with contusion SCI, which contributed to amelioration of functional deficits and the relief of contusion SCI. Therefore, it was concluded that upregulated expression of miR‐378‐3p in PC12 or N2A cells repressed the apoptosis of nerve cells, and the administration of miR‐378‐3p in model rats with contusion SCI improved neurological and motor functions.
EXCESS CAPACITY AND EFFECTIVENESS OF POLICY INTERVENTIONS: EVIDENCE FROM THE CEMENT INDUSTRY
Authors: Okazaki Tetsuji , Onishi Ken , Wakamori Naoki
Published: October 2021

Strategic interaction among firms may hinder the reduction of excess capacity in a declining industry. Policy interventions that attempt to reduce excess capacity may increase efficiency by accelerating the capital adjustment but may decrease efficiency by increasing the market power of firms and/or by distorting firms' divestment decisions. We study capacity coordination policies—forcing firms to reduce their capacity simultaneously—applied to the Japanese cement industry. Estimation results suggest that these interventions did not increase market power because reduction in capacity resulted in higher utilization of the remaining plants, and did not distort firms' scrappage decisions.