bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing service sabotage and improving employee commitment to service quality
Authors: Schwepker, Jr Charles H. , Dimitriou Christina K. , McClure Todd
Published: September 2019

Purpose

The purpose of this paper is to investigate the impact of formal [ethics training (ET)] and informal [psychological ethical climate (EC)] controls in reducing service sabotage (SS) and increasing employee commitment to service quality.

Design/methodology/approach

Data were electronically collected from a national survey of hotel/motel customer contact employees leading to a usable sample of 316 employees. Structural equation modeling was used to analyze the data.

Findings

The findings indicate that ET can be used to positively influence the EC of customer contact service employees, which, in turn, reduces their SS behavior and increases their commitment to service quality.

Practical implications

Management should incorporate both formal (ET) and informal (EC) controls to bring about less SS and greater commitment to service quality among customer contact employees in service settings.

Originality/value

This research furthers the understanding of SS by finding an important variable, EC that may be used to reduce its incidence in service settings. Further, it shows that EC is an important contributor to improving ECSQ. As such, this research gives important direction for companies wishing to improve the customer service experience.
Role of customer attributes on absolute price thresholds
Authors: Vastani Saloni Firasta , Monroe Kent Bourdon
Published: September 2019

Purpose

This paper aims to examine how customer heterogeneity influences absolute price thresholds in a service industry.

Design/methodology/approach

Customer purchase behavior is studied in the context of a firm’s and competitor’s price changes. Customer purchase behavior is further examined in the context of specific customer attributes such as loyalty, motivation, online purchase channel, gender and frequency of purchase. The study uses a longitudinal data set spanning over 44 months and tracks over 13,000 of a firm’s customers, totaling over 200,000 transactions from a parking services provider.

Findings

Results show that absolute price thresholds affect purchasing decisions. Customers are willing to pay a range of prices for a considered purchase, and when a price is within customers’ acceptable price range, it does not induce a change in their purchase behavior. However, specific identifiable customer attributes influence the propensity to continue buying and influence the acceptable price range.

Practical implications

Knowledge from this study can be applied to developing a deeper understanding of customers and their price thresholds to improve customer retention and firm performance after a price change.

Originality/value

For a better understanding of the consumer choice process, it is essential to understand what factors affect price thresholds. Additionally, very few studies are using transaction-level data to empirically validate concepts from behavioral price research in the service industry, and none that do it at an individual customer level over three years.
The transaction-relationship paradox
Authors: Arvidsson Niklas , Jonsson Sara , Snickare Lotta Karin
Published: September 2019

Purpose

The purpose of this paper is to apply a capability perspective to investigate the shift from relationship lending to transaction lending in a bank’s corporate segment. The authors investigate the impact of three operational capabilities: assisting corporate clients in funding and business operations, management of customer relationships and internal cooperation on performance in relationship and transaction lending.

Design/methodology/approach

The primarily empirical material comprises longitudinal survey data, collected on three occasions during the period 1998 throughout 2001 from one of Sweden’s largest banks. Data are analyzed using factor analysis and OLS regression.

Findings

Results show that the effects of the three capabilities are contingent on the type of lending strategy: In relationship lending, assisting corporate clients has no significant direct effect on performance; however, it has an indirect effect on performance via the management of customer relationships. In transaction lending, assisting corporate clients has a direct effect on performance, and this effect becomes stronger as the transaction strategy is further implemented. The results also show that the direct effect of the management of customer relationships and cooperation on performance is significant in both strategies; however, the relation is stronger in relationship lending compared with transaction lending.

Originality/value

The findings indicate that the choice of lending strategy is more complex than a choice between a strict relationship strategy and a strict transaction strategy and that a strategy that leads to competitive advantage includes elements of both strategies.
Identification of two Chinese oculocutaneous albinism type 6 patients and mutation updates of the SLC24A5 gene
Authors: Zhang Yunlan , Zhang Yingzi , Liu Teng , Bai Dayong , Yang Xiumin , Li Wei , Wei Aihua
Published: September 2019

Oculocutaneous albinism (OCA) is a rare and heterogeneous disorder characterized by hypopigmentation of the skin, hair and eyes. Thirty OCA type 6 (OCA6) patients with 24 mutations in SLC24A5 have been reported across various populations; however, only one patient has been identified in a Chinese population. This study identifies two novel SLC24A5 frame‐shift variants in two unrelated Chinese patients and both are predicted to be pathogenic by American College of Medical Genetics guidelines. The genotypes and phenotypes of all three Chinese OCA6 patients are unique compared with those identified in other populations. All of the mutations identified to date in Chinese OCA6 patients are predicted to be non‐functional, a finding that is useful in guiding genetic diagnosis and counseling for OCA6 in China.
Resource acquisition strategies facilitate Gilbertiodendron dewevrei monodominance in African lowland forests
Authors: Hall Jefferson S. , Harris David J. , Saltonstall Kristin , Medjibe Vincent de Paul , Ashton Mark S. , Turner Benjamin L.
Published: September 2019

Tropical forests are hyperdiverse, yet extensive areas of monodominant forest occur in the tropics worldwide. Most long‐lived and persistent monodominant tree species form ectomycorrhizal fungi symbioses, allowing them to obtain nutrients directly from soil organic matter. This might promote monodominance by reducing nutrient availability to co‐occurring species, the majority of which form associations with arbuscular mycorrhizal fungi.

Gilbertiodendron dewevrei forest is the most widespread monodominant forest in tropical Africa. Its distribution appears determined in part by moisture availability, but its monodominance is not thought to be driven by its fungal partner or soil fertility.

Here, we compare soil fertility of 20 G. dewevrei stands to mixed forest from three sites across an 8,400 km2 region of the Central African Republic and the Republic of Congo. In contrast to previous studies, we find monodominant G. dewevrei stands associated with infertile soils, as base cations (calcium, magnesium, total exchangeable bases) and extractable manganese are extremely low, and significantly lower in soils under G. dewevrei forest compared to mixed forest. Further, and consistent with ectomycorrhizal forests globally, soil carbon to nitrogen and carbon to phosphorus ratios are significantly higher in G. dewevrei stands than in mixed forest stands, providing evidence in support of direct acquisition of nitrogen and phosphorus from soil organic matter by ectomycorrhizal fungi.

Gilbertiodendron dewevrei recruits from the seedling bank, with its large seedlings surviving in high densities for over a decade. We tested whether light plasticity could facilitate monodominance by growing seedlings of G. dewevrei under controlled light conditions. We found that its seedlings grow well under a wide range of irradiance levels and conclude that this plasticity affords a competitive advantage.

Synthesis. We reframe the discussion of factors contributing to monodominance of Gilbertiodendron dewevrei into one of resource acquisition and use efficiency. In particular, G. dewevrei is associated with moist and infertile soils and competes well under a variety of light conditions. Our data are consistent with a model where root associations with ectomycorrhizal fungi drive monodominance through the direct acquisition of nutrients from soil organic matter, promoting nutrient limitation of co‐occurring species.
Harmonized data on early stage litter decomposition using tea material across Japan
Authors: Suzuki Satoshi N. , Ataka Mioko , Djukic Ika , Enoki Tsutomu , Fukuzawa Karibu , Hirota Mitsuru , Hishi Takuo , Hiura Tsutom , Hoshizaki Kazuhiko , Ida Hideyuki , Iguchi Akira , Iimura Yasuo , Ise Takeshi , Kenta Tanaka , Kina Yoshifumi , Kobayashi Hajime , Kominami Yuji , Kurokawa Hiroko , Makoto Kobayashi , Matsushita Michinari , Miyata Rie , Muraoka Hiroyuki , Nakaji Tatsuro , Nakamura Masahiro , Niwa Shigeru , Noh Nam J. , Sato Takanori , Seino Tatsuyuki , Shibata Hideaki , Suzuki Ryo O. , Takahashi Koichi , Tsunoda Tomonori , Ustumi Tasuhiro , Watanabe Kenta
Published: September 2019

Litter and soil organic matter decomposition represents one of the major drivers of carbon and nutrient cycling in a given ecosystem; however, it also contributes to a significant production of relevant greenhouse gasses. The Japanese archipelago spans several biomes (boreal‐temperate‐subtropical) and covers a large range of elevations and ecosystem types. Hence, the comprehension of this fundamental biogeochemical process in diverse ecosystems is crucial to maintain their ecosystem services. In this article, we have provided data on plant leaf decomposition from 33 research sites across Japan. At each site, standard litter material with different decomposition rates, rooibos tea and green tea were incubated for 90 days between 2012 and 2016 and the remaining mass was recorded. In total, 1904 bags were used. In addition, supplementary measurements of environmental variables essential for the interpretation of the collected data, such as soil and vegetation, were recorded. Plot‐level averages of the remaining mass rates of bag contents after incubation ranged 0.17–0.51 for green tea and 0.54–0.82 for rooibos tea. Continued monitoring will also provide important insights into the temporal dynamics of litter decomposition.
Science versus art in obstetrics and gynaecology
Authors: Chien Patrick
Published: September 2019

Deputy Editor‐in‐Chief, Dr Patrick Chien, discusses the latest thinking in women's health and highlights articles from this issue in an audio podcast available at: https://soundcloud.com/bjog/october-editorial-2019
Ultra‐thin sectioning and grinding of epoxy plastinated tissue
Authors: Sora Mircea Constantin , von Horst Christoph , López-Albors Octavio , Latorre Rafael
Published: September 2019

With classical sheet plastination techniques such as E12, the level and thickness of the freeze‐cut sections decide on what is visible in the final sheet plastinated sections. However, there are other plastination techniques available where we can look for specific anatomical structures through the thickness of the tissue. These techniques include sectioning and grinding of plastinated tissue blocks or thick slices. The ultra‐thin E12 technique, unlike the classic E12 technique, starts with the plastination of a large tissue block. High temperatures (30–60°C) facilitate the vacuum‐forced impregnation by decreasing the viscosity of the E12 and increasing the vapour pressure of the intermediary solvent. By sectioning the cured tissue block with a diamond band saw plastinated sections with a thickness of <300 μm can be obtained. The thickness of plastinated sections can be further reduced by grinding. Resulting sections of <100 µm are suitable for histological staining and microscopic studies. Anatomical structures of interest in thick plastinate slices can be followed by variable manual grinding in a method referred to as Tissue Tracing Technique (TTT). In addition, the tissue thickness can be adapted to the transparency or darkness of tissue types in different regions of the same plastinated section. The aim of this study was to evaluate the advantages of techniques based on sectioning and grinding of plastinated tissue (E12 ultra‐thin and TTT) compared to conventional sheet‐forming techniques (E12).
Impact of Asian ethnicity on outcome in metastatic EGFR‐mutant non–small cell lung cancer
Authors: Gibson Amanda J. W. , D'Silva Adrijana , Elegbede Anifat A. , Tudor Roxana A. , Dean Michelle L. , Bebb Dafydd Gwyn , Hao Desiree
Published: September 2019

Aim

To determine factors associated with survival in de novo stage IV, non–small cell lung cancer (NSCLC) patients possessing epidermal growth factor receptor mutations (EGFRmut+) receiving tyrosine kinase inhibitors (TKI) in the first‐line setting.

Methods

The Glans‐Look Lung Cancer Database was used to retrospectively review stage IV EGFRmut+ NSCLC patients diagnosed 2010–2016 receiving first‐line TKI. Patients with overall survival times in the upper quartile (≥34 months) were designated “long‐term survivors” (LTS), the remaining deemed “average‐term survivors” and characteristics between these groups were compared in univariate analysis, and multivariable models constructed to determine predictors of outcome.

Results

Of 170 eligible patients, median overall survival was 21 months. LTS were significantly more likely to be of Asian ethnicity, be never‐smokers and not possess brain or bone metastases at diagnosis. Asian and non‐Asian patients were comparable, save for an increased propensity of Asian patients to be never smokers and have normal‐range BMI. Multivariable analysis revealed Asian ethnicity [hazard ratio (HR) = 0.65; P = 0.016] and never‐smoking history (HR = 0.65; P = 0.034) as indicators of improved outcome, and presence of brain metastasis at diagnosis an indicator of poor outcome (HR = 2.21; P < 0.001).

Conclusions

Analysis of this population‐based cohort identifies never‐smoking history and absence of brain metastasis along with Asian ethnicity as an independent prognosticators of favorable outcome, and reveals Asian patients to be clinicopathologically similar to non‐Asian patients. These findings suggest Asian patients represent a unique subpopulation within EGFRmut+ NSCLC who may possess different biological underpinnings of NSCLC.
Epidural use in labour is not associated with an increased risk of maternal or neonatal morbidity when the second stage is prolonged
Authors: Turner Jessica , Flatley Christopher , Kumar Sailesh
Published: September 2019

Background

Epidural analgesia increases length of labour and risk of operative delivery (caesarean or instrumental).

Aim

This study aimed to assess the impact of epidural anaesthesia on maternal and neonatal adverse outcomes when the second stage of labour was prolonged.

Methods

A retrospective cohort study of women delivering at term at the Mater Mother's Hospital, Brisbane between 2008 and 2017. Intrapartum, maternal and neonatal outcomes were assessed and dichotomised according to the presence of prolonged second stage of labour and further by epidural use. Prolonged second stage of labour was defined as: nulliparous women ≥3 h (with epidural) and ≥2 h (without); multiparous women ≥2 h (with epidural) and ≥1 h (without).

Results

There were 48 352 women who met the inclusion criteria – 43 676 without and 4676 with prolonged second stage of labour. The overall epidural rate was 35.9%. Women with epidural had significantly lower odds of achieving a spontaneous vaginal birth and higher odds of an operative birth regardless of length of second stage. While rates of several adverse maternal and neonatal outcomes were higher when the second stage was prolonged, after adjusting for clinically relevant confounders, epidural use was not associated with increased odds of the majority of these adverse outcomes. Indeed, epidural use was associated with a significant reduction in the odds of obstetric anal sphincter injuries and reduced odds of neonatal acidosis in women with prolonged second stage.

Conclusion

While epidural increases the risk of operative birth, this is not associated with an increase in adverse maternal or neonatal outcomes.
In vitro antimicrobial activity of a new ophthalmic solution containing povidone‐iodine 0.6% (IODIM®)
Authors: Pinna Antonio , Donadu Matthew Gavino , Usai Donatella , Dore Stefano , D'Amico‐Ricci Giuseppe , Boscia Francesco , Zanetti Stefania
Published: September 2019

Purpose

To assess the in vitro antimicrobial activity of a new commercial ophthalmic solution containing povidone‐iodine 0.6% (IODIM®).

Methods

Staphylococcus aureus ATCC 43300, Pseudomonas aeruginosa ATCC 27853, three ocular bacterial isolates (1 S. epidermidis, 1 S. aureus, 1 P. aeruginosa) and five Candida species were used. The bacterial and fungal isolates were cultured on Columbia blood agar base plates and Sabouraud‐dextrose agar plates, respectively and incubated overnight at 37°C. Bacterial and fungal suspensions in sterile saline solution were prepared to an optical density equal to 0.5 McFarland standard (approximately 108 CFU/ml). Suspensions of the isolates were made in IODIM® solution to obtain a final concentration of 106 CFU/ml. The suspensions were then distributed in conical tubes in a final volume of 1 ml and incubated at 37°C. At different time‐points (1, 5, 10, 15, 20, 25, 30 min and 24 hr), 10 μl of each suspension was removed, seeded on Columbia blood agar base and Sabouraud‐dextrose agar plates and then incubated for 24 hr at 37°C. Positive and negative controls were included in all experiments.

Results

After 5‐min incubation, there was no bacterial growth on any plate. Conversely, IODIM® failed to kill the Candida isolates after 30 min’ exposure and needed 24 hr to eradicate the organisms.

Conclusion

IODIM® ophthalmic solution showed in vitro antimicrobial activity against S. epidermidis, S. aureus, P. aeruginosa and Candida species. Results suggest that it may be a potential candidate for the treatment of ocular surface infections and antimicrobial prophylaxis before intravitreal injections.
Kaempferol alleviates the reduction of developmental competence during aging of porcine oocytes
Authors: Yao Xuerui , Jiang Hao , Li Ying‐Hua , Gao Qingshan , Xu Yong Nan , Kim Nam‐Hyung
Published: September 2019

Kaempferol (KAE) is a natural flavonoid present in different plant species and exhibits anti‐inflammatory, antioxidant, and anticancer therapeutic properties. In the present study, we investigated the influence and underlying mechanisms of KAE supplementation on porcine oocytes during in vitro aging. The results show that KAE treatment can alleviate the aging‐related reduction of developmental competence. We observed that the blastocyst production rate in aged oocytes treated with 0.1 μM KAE was significantly higher than in untreated aging oocytes (36.78 ± 0.86% vs. 27.55 ± 2.60%, respectively, p < .05). The KAE‐treated aging oocytes had significantly reduced levels of reactive oxygen species (p < .05). Furthermore, the mRNA levels of the embryonic pluripotency‐related genes Oct4, NANOG, and ITGA5 were significantly increased in blastocysts derived from KAE‐treated oocytes (p < .05). During excessive oocyte culture, KAE treatment maintained the mitochondrial membrane potential and reduced apoptosis; however, this was not observed in untreated aging oocytes. In conclusion, our results suggest that KAE treatment can alleviate the aging of porcine oocytes by reducing oxidative stress and improving mitochondrial function.
The safety of amoxicillin and clavulanic acid use during the first trimester of pregnancy
Authors: Daniel Sharon , Doron Maya , Fishman Boris , Koren Gideon , Lunenfeld Eitan , Levy Amalia
Published: September 2019

Aims

The goal of the current study was to assess the risk for major congenital malformations following first‐trimester exposure to amoxicillin, or amoxicillin and clavulanic acid (ACA).

Methods

A population‐based retrospective cohort study was conducted, by linking 4 computerized databases: maternal and infant hospitalization records, drug dispensing database of Clalit Health Services in Israel and data concerning pregnancy terminations. Multivariate negative‐binomial regression was used to assess the risk for major malformations following first‐trimester exposure, adjusted for mother's age, ethnicity (Bedouin vs Jewish), parity, diabetes mellitus, lack of perinatal care, and the year of birth.

Results

The study included 101 615 pregnancies, of which 6919 (6.8%) were exposed to amoxicillin: 1045 (1.0%) to amoxicillin only and 6041 (5.9%) to ACA. No significant association was found, in the univariate and multivariate analyses, between first‐trimester exposure to amoxicillin or ACA and major malformations in general (crude relative risk, 1.05 95% confidence interval 0.95–1.16; adjusted relative risk 1.09, 95% confidence interval 0.98–1.20), or for major malformations according to organ systems. No dose–response relationship was found between exposure in terms of the defined daily dose and major malformations.

Conclusion

Exposure to amoxicillin and ACA during the first trimester of pregnancy was not associated with an increased risk of major congenital malformations.
Physiologically based pharmacokinetic evaluation of cefuroxime in perioperative antibiotic prophylaxis
Authors: Rimmler Christer , Lanckohr Christian , Akamp Ceren , Horn Dagmar , Fobker Manfred , Wiebe Karsten , Redwan Bassam , Ellger Bjoern , Koeck Robin , Hempel Georg
Published: September 2019

Aims

Adequate plasma concentrations of antibiotics during surgery are essential for the prevention of surgical site infections. We examined the pharmacokinetics of 1.5 g cefuroxime administered during induction of anaesthesia with follow‐up doses every 2.5 hours until the end of surgery. We built a physiologically based pharmacokinetic model with the aim to ensure adequate antibiotic plasma concentrations in a heterogeneous population.

Methods

A physiologically based pharmacokinetic model (PK‐Sim®/MoBi®) was developed to investigate unbound plasma concentrations of cefuroxime. Blood samples from 25 thoracic surgical patients were analysed with high‐performance liquid chromatography. To evaluate optimized dosing regimens, physiologically based pharmacokinetic model simulations were conducted.

Results

Dosing simulations revealed that a standard dosing regimen of 1.5 g every 2.5 hours reached the pharmacokinetic/pharmacodynamic target for Staphylococcus aureus. However, for Escherichia coli, >50% of the study participants did not reach predefined targets. Effectiveness of cefuroxime against E. coli can be improved by administering a 1.5 g bolus immediately followed by a continuous infusion of 3 g cefuroxime over 3 hours.

Conclusion

The use of cefuroxime for perioperative antibiotic prophylaxis to prevent staphylococcal surgical site infections appears to be effective with standard dosing of 1.5 g preoperatively and follow‐up doses every 2.5 hours. In contrast, if E. coli is relevant in surgeries, this dosing regimen appears insufficient. With our derived dose recommendations, we provide a solution for this issue.
A contemporary, nationwide analysis of surgery and radiotherapy treatment for prostate cancer
Authors: Roberts Matthew J. , Papa Nathan , Perera Marlon , Scott Susan , Teloken Patrick E. , Joshi Andre , Vela Ian , Pryor David , Martin Jarad , Woo Henry
Published: September 2019

Objective

To characterize national clinical practice trends in the treatment of prostate cancer (PCa) in Australia.

Patients and Methods

Population‐level data were extracted from existing Medicare Benefits Schedule data for radical prostatectomy (RP) and brachytherapy (2002–2016), as well as external beam radiotherapy (EBRT; 2012–2016). Treatment rates were calculated relative to whole and PCa populations among privately treated patients. Overall age‐related and geographical trends were analysed.

Results

The use of RP and low‐dose‐rate (LDR) brachytherapy increased between 2002 and 2009, but subsequently decreased to 124 and 6.9 per 100 000 men, respectively, in 2016. More dramatic decreases were observed for men aged <65 years. From 2012, rates of RP (15% drop) and LDR brachytherapy (58% drop) decreased, while the use of EBRT remained steady, falling by 5% to 42 per 100 000 men in 2016. Overall treatment increased in the age group 75–84 years, with the rate of RP increasing by 108%.

Conclusion

National claims data indicate there has been a reduction in PCa treatment since 2009, which is mostly attributable to a reduction in the treatment of younger patients and reduced use of brachytherapy. RP is most commonly used and its use is rising in men aged >65 years.
Reduced uterine volume after induction of puberty in women with hypogonadism
Authors: Burt Elizabeth , Davies Melanie C. , Yasmin Ephia , Cameron‐Pimblett Antoinette , Mavrelos Dimitri , Talaulikar Vikram , Conway Gerard S.
Published: September 2019

Objective

Adequate uterine growth is an essential component of pubertal induction with exogenous oestradiol in those with hypogonadism. Poor uterine development will render the individual vulnerable in the context of fertility. We assessed uterine size using ultrasound in those who had undergone pubertal induction treatment compared with a reference group who had experienced spontaneous puberty.

Design

This is a single‐centre, retrospective, cross‐sectional study of women who underwent pubertal induction compared with a reference group.

Patients

Ninety‐five women with hypogonadism who had previously undergone pubertal induction and were receiving maintenance oestrogen replacement as adults were recruited: 48 women with Turner syndrome, 32 with premature ovarian insufficiency and 15 with gonadotrophin deficiency. The reference group consisted of 35 nulliparous women attending with male factor subfertility with a normal pelvis on ultrasonography.

Measurements

Pelvic ultrasound was performed by a single observer. Uterine dimensions (total length, anterior–posterior (AP), transverse, uterine volume and fundal cervical AP ratio (FCR) measurements) were recorded. Clinical details were also recorded.

Results

Those with hypogonadism had significantly reduced uterine dimensions compared with the reference group (uterine length 64 mm vs 71 mm P = <.05, uterine volume 28.9 mL vs 43.9 mL P = <.05). All women in the reference group attained a mature uterine configuration with a FCR >1, compared with 84% of those with hypogonadism (P = .01). A total of 24% and 48% of the diagnostic group had total uterine length and uterine volume measurements less than the 5th percentile of the reference group, respectively. In a subgroup of 22 women in whom serum oestradiol concentrations could be analysed, there was a positive correlation between this parameter and uterine volume.

Conclusion

Despite standard oestrogen therapy, uterine growth is often compromised in those with hypogonadism. Uterine health has historically been overlooked in pubertal induction protocols; however, with increasing options for fertility treatment, adequate uterine development is crucial. Given the variation in uterine size witnessed, a more tailored approach to treatment with regular monitoring of uterine dimensions should be advocated.
Are dual and single exposures differently associated with clinical levels of trauma symptoms? Examining physical abuse and witnessing intimate partner violence among young children
Authors: Showalter Kathryn , Yoon Susan , Maguire‐Jack Kathryn , Wolf Kathryn G. , Letson Megan
Published: September 2019

A significant portion of children living in the United States have experienced trauma. Informed by the developmental traumatology model, we explored the effects of physical abuse and witnessing intimate partner violence (IPV) on childhood trauma symptoms. This study utilizes a convenience sample of 580 high‐risk children between 3 and 12 years who received services from one‐child advocacy centre during a 12‐month period. We performed a series of binary logistic regression analyses to examine if physical abuse, exposure to IPV, and dual exposure (i.e., both physical abuse and IPV) are distinctly associated with six trauma symptoms, including anxiety, depression, posttraumatic stress (PTS), dissociation, anger, and sexual concerns. The results indicated that dual exposure was predictive of all trauma symptoms, except for dissociation. Additionally, physical abuse was associated with PTS, anger, and sexual concerns, whereas exposure to IPV was associated with depression, PTS, and sexual concerns. Research and implications for practitioners working with young children are discussed.
Whole‐exome sequencing identifies rare pathogenic and candidate variants in sporadic Chinese Han deaf patients
Authors: Zou Songfeng , Mei Xueshuang , Yang Weiqiang , Zhu Rvfei , Yang Tao , Hu Hongyi
Published: September 2019

Genetic causes of hearing loss are highly heterogeneous and often ethnically specific. In recent years, a variety of next‐generation sequencing (NGS) panels have been developed to target deafness‐causative genes. Whole‐exome sequencing (WES), on the other hand, was rarely used for genetic testing for deafness. In this study, we performed WES in 38 sporadic Chinese Han deaf patients who have been pre‐excluded for mutations in common deafness genes GJB2, SLC26A4 and MT‐RNR1. Non‐synonymous variants have been filtered based on their minor allele frequencies in public databases and ethnically matched controls. Bi‐allelic pathogenic mutations in eight deafness genes, OTOF, TRIOBP, ESPN, HARS2, CDH23, MYO7A, USH1C and TJP2, were identified in 10 patients, with 17 mutations identified in this study not being associated with deafness previously. For the rest 28 patients, possibly bi‐allelic rare non‐synonymous variants in an averaged 4.7 genes per patient were identified as candidate pathogenic causes for future analysis. Our study showed that WES may provide a unified platform for genetic testing of deafness and enables retro‐analyzing when new causative genes are revealed.
Diagnosis of peripheral pulmonary lesions using endobronchial ultrasonography with a guide sheath and computed tomography guided transthoracic needle aspiration
Authors: Zhu Jun , Gu Ye
Published: September 2019

Introduction

Peripheral pulmonary lesions (PPL) are difficult to diagnose. We analysed the diagnostic values and risks of endobronchial ultrasonography with a guide sheath (EBUS‐GS) and computed tomography‐guided transthoracic needle aspiration (CT‐TTNA) in diagnosing PPL.

Methods

We collected 250 cases received EBUS‐GS examination, and 279 cases received CT‐TTNA examination. We analysed the diagnosis results and the complications of each operation and determined the relevant indications.

Results

Biopsy was successful in 239 cases (95.6%) using EBUS‐GS and in 279 cases (100%) using CT‐TTNA. Lesions were smaller than or equal to 30 mm for biopsy using EBUS‐GS in 60.7% of the cases. The distances of lesions from the chest wall were greater than 80 mm for EBUS‐GS examination in 89.1% of the cases. The diagnostic rate of EBUS‐GS was 78.2%, including 41.8% (100 cases) malignant diseases. EBUS‐GS is a highly safe method. The distances of lesions from the chest wall were no greater than 80 mm for CT‐TTNA examination in 90.0% of the cases. The diagnosis rate using CT‐TTNA was 94.6%, including 90.0% (251 cases) malignant diseases. For CT‐TTNA, there is a high chance of complications such as pneumothorax and intrapulmonary hemorrhage.

Conclusion

EBUS‐GS and CT‐TTNA each have their own limitations. EBUS‐GS has a slightly lower diagnostic rate but higher safety, while CT‐TTNA has a higher diagnostic rate but requires attention to complications. For lesions 80 mm more from the chest wall, we recommend EBUS‐GS. For lesions 80 mm from or closer to the chest wall, we recommend CT‐TTNA.
Development and validation of a questionnaire to measure empowerment in adult patients with atopic dermatitis. The DATEMP questionnaire
Authors: Pereyra‐Rodriguez José Juan , Dominguez‐Cruz Javier Jesús , Hernandez‐Montoya Carlos , Galan‐Gutiérrez Manuel , Carrasco Pablo Martín , Luna Sara Alcántara , Navarro‐Triviño Francisco José , del Pozo Jesús , Ruiz‐Villaverde Ricardo
Published: September 2019

Background and objectives

In recent years, the hypothesis that increasing the empowerment of patients can help to improve health outcomes and rationalize the use of health services has become relevant, especially for chronic diseases. Developing validated measurement tools is necessary to achieve this goal. In the field of dermatology, there are few studies related to empowerment of the patient.

The aim of the present research is to develop and validate a self‐administered questionnaire for adult patients diagnosed with atopic dermatitis (AD) in order to measure their level of empowerment.

Methods

After a literature review and the establishment of consulting groups of patients and dermatologists, a large battery of 35 items was generated, based on the dimensions included in previous empowerment descriptions. A multidisciplinary group selected the 20 most suitable items to include in the questionnaire. A cross‐sectional study was carried out with the items included in the questionnaire as well as demographic and clinical characteristics. To reduce the number of items and measure the construct validity, an exploratory factorial analysis (EFA) of the primary components and varimax rotation were used. Cronbach's α was used to measure the reliability of the individual scales and the global questionnaire.

Results

242 valid questionnaires were included. After completion of the EFA, the final Dermatitis Atópica EMPoderamiento (DATEMP) questionnaire was composed of 17 items that converged on four factors. The four scales had adequate reliability: “Knowledge” (Cronbach's alpha = 0.808), “Abilities” (Cronbach's alpha = 0.744), “Intention to change” (Cronbach's alpha = 0.798) and “Coping skills” (Cronbach's alpha = 0.772). The overall Cronbach's α of the questionnaire was 0.764.

Conclusions

The DATEMP questionnaire is the first specific empowerment measurement instrument developed for patients with AD that has demonstrated adequate levels of reliability and construct validity. It is a self‐administered questionnaire that is simple and quick to answer.
Favourable effect of the sodium‐glucose co‐transporter‐2 inhibitor canagliflozin plus the dipeptidyl peptidase‐4 inhibitor teneligliptin in combination on glycaemic fluctuation: An open‐label, prospective, randomized, parallel‐group comparison trial (the CALMER study)
Authors: Cho Kyu Yong , Nomoto Hiroshi , Nakamura Akinobu , Kawata Shinichiro , Sugawara Hajime , Takeuchi Jun , Nagai So , Tsuchida Kazuhisa , Omori Kazuno , Yokoyama Hiroki , Manda Naoki , Kurihara Yoshio , Aoki Shin , Atsumi Tatsuya , Miyoshi Hideaki
Published: September 2019

This multicentre, prospective, randomized, open‐label, blinded‐endpoint, parallel‐group, short‐term (4–5 weeks) controlled trial was conducted to investigate the superiority of the effect of reducing mean amplitude of glycaemic excursions (MAGE) during meal tolerance tests (MTTs) for the combination of dipeptidyl peptidase‐4 (DPP‐4) inhibitor and sodium‐glucose co‐transporter‐2 (SGLT2) inhibitor compared with SGLT2 inhibitor monotherapy. Ninety‐nine patients with type 2 diabetes who were taking teneligliptin (20 mg/d) were randomized to one of the following two groups: those who switched to 100 mg/d of canagliflozin (SWITCH group) or those who added 100 mg/d of canagliflozin (COMB group). MAGE in the COMB group was significantly decreased compared with that in the SWITCH group (COMB 117.5 ± 39.8 to 92.2 ± 28.0 mg/dL vs SWITCH 110.7 ± 29.8 to 104.2 ± 27.6 mg/dL; P<0.01). Mean blood glucose decreased significantly during MTTs in both groups, although the extent of the reduction was significantly greater in the COMB group (COMB 142.3 ± 28.7 to 119.5 ± 25.1 mg/dL vs SWITCH 146.4 ± 25.5 to 135.5 ± 22.4 mg/dL; P < 0.01). SGLT2 inhibitor combined with DPP‐4 inhibitor therapy strongly reduced glycaemic fluctuation compared with SGLT2 inhibitor monotherapy.
Absence of the fetal right pulmonary artery complicated with coarctation of the aorta: Prenatal and postnatal diagnosis
Authors: Wang Yu , Zhang Jiaqi , Feng Wei , Wu You , Yang Li , Yin Jiabao
Published: September 2019

Unilateral absence of the pulmonary artery (UAPA) is a rare congenital cardiovascular malformation that can present as an isolated lesion or may be associated with other congenital heart malformations. Several studies have reported UAPA after birth. To our knowledge, the absence of the right pulmonary artery in the fetus has not been reported. Here, we report a rare case of fetal right pulmonary artery absence with aortic coarctation, which was confirmed by postpartum ultrasound and computed tomography angiography (CTA). Our case demonstrates that fetal echocardiography, especially the three‐vessel view, is beneficial for the prenatal diagnosis of pulmonary artery malformations.
“The Starry Sky.” A new intraprocedural three‐dimensional echocardiographic technique
Authors: Vairo Alessandro , Marro Matteo , Speziali Giovanni , Rinaldi Mauro , Salizzoni Stefano
Published: September 2019

The NeoChord procedure is a micro‐invasive, trans‐ventricular, beating‐heart chordal replacement technique for patients with severe degenerative mitral valve regurgitation resulting from prolapsed or flail leaflets. Three dimensional transoesophageal echocardiographic guidance is crucial to assist the operator during the procedure. Equidistant placement of neochordae along the free edge of the prolapsing leaflet segment is important to ensure uniform stress distribution and to avoid damaging any of the previously placed neochordae. Lowering the image gain associated with the three‐dimensional surgical view of the mitral valve allows for signal attenuation of the native structures delineating the precise placement location of the neochordae.
Effects of Alzheimer's disease and Lewy body disease on subcortical atrophy
Authors: Yoo H. S. , Lee E. C. , Chung S. J. , Lee Y. H. , Lee S. G. , Yun M. , Lee P. H. , Sohn Y. H. , Seong J.‐K. , Ye B. S.
Published: September 2019

Background and purpose

Subcortical structures are affected by neurodegeneration in Alzheimer's disease (AD) and Lewy body disease (LBD). Although the co‐occurrence of AD and LBD pathologies and their possible interaction have been reported, the effect of AD and LBD on subcortical structures remains unknown. The effects of AD and LBD on subcortical atrophy and their relationship with cognitive dysfunction were investigated.

Methods

The cross‐sectional study recruited 42 patients with pure AD related cognitive impairment (ADCI), 30 patients with pure LBD related cognitive impairment (LBCI), 58 patients with mixed ADCI and LBCI, and 29 normal subjects. A general linear model was used to compare subcortical volume and shape amongst the groups, to investigate the independent and interaction effects of ADCI and LBCI on subcortical shape and volume, and to analyze the relationship between subcortical volume and cognitive dysfunction in each group.

Results

Alzheimer's disease related cognitive impairment and LBCI were independently associated with subcortical atrophies in the hippocampus and amygdala and in the hippocampus and putamen respectively, but their interaction effect was not significant. Compared to the control group, the pure LBCI group exhibited additional local atrophies in the amygdala, caudate and thalamus. Subcortical atrophies correlated differently with cognitive dysfunction according to the underlying causes of cognitive dysfunction.

Conclusions

The patterns of subcortical atrophies and their correlation with cognitive dysfunction differ according to the underlying AD, LBD or concomitant AD and LBD.
Do hotspots fall within protected areas? A Geographic Approach to Planning analysis of regional freshwater biodiversity
Authors: Walters Ashley D. , Brown Madelyn A. , Cerbie Gina M. , Williams Marsha G. , Banta Joshua A. , Williams Lance R. , Ford Neil B. , Berg David J.
Published: September 2019

Identification of biodiversity hot spots is necessary for developing conservation strategies. The south‐eastern U.S.A. harbours high aquatic biodiversity; however, this diversity is threatened as a result of anthropogenic activities. We report patterns of fish and mussel biodiversity, locate hotspots of diversity and endemism, and identify gaps in protection of these hotspots.

Maxent was used to generate species distribution models for native fish and mussel species in river basins throughout east Texas. Stacked species distribution models were used to assess spatial patterns of biodiversity and examine the concordance between fish and mussel hotspots. A Geographic Approach to Planning analysis was used to identify areas of high conservation concern.

Predicted geographical variation in species richness of mussels corresponds to patterns shown in fish; however, there was discordance among endemicity hotspots between the two taxa. Because overall endemicity was low in both groups, species richness is likely to be the more informative measure of biodiversity at these regional scales.

While hotspots represent a small percentage of the study area, almost all richness and endemicity hotspots (>95%) in east Texas occur outside of protected areas. The results of this study suggest that protected areas designated based on terrestrial habitat may fail to protect aquatic biodiversity. Studies such as this provide a baseline for development of conservation and management strategies for protection of regional freshwater biodiversity, while also suggesting that designating conservation lands should include consideration of both terrestrial and aquatic biodiversity.
The impact of drought spells on forests depends on site conditions: The case of 2017 summer heat wave in southern Europe
Authors: Rita Angelo , Camarero Jesus Julio , Nolè Angelo , Borghetti Marco , Brunetti Michele , Pergola Nicola , Serio Carmine , Vicente‐Serrano Sergio M. , Tramutoli Valerio , Ripullone Francesco
Published: September 2019

A major component of climate change is an increase in temperature and precipitation variability. Over the last few decades, an increase in the frequency of extremely warm temperatures and drought severity has been observed across Europe. These warmer and drier conditions may reduce productivity and trigger compositional shifts in forest communities. However, we still lack a robust, biogeographical characterization of the negative impacts of climate extremes, such as droughts on forests. In this context, we investigated the impact of the 2017 summer drought on European forests. The normalized difference vegetation index (NDVI) was used as a proxy of forest productivity and was related to the standardized precipitation evapotranspiration index, which accounts for the temperature effects of the climate water balance. The spatial pattern of NDVI reduction in 2017 was largely driven by the extremely warm summer for parts of the central and eastern Mediterranean Basin (Italian and Balkan Peninsulas). The vulnerability to the 2017 summer drought was heterogeneously distributed over Europe, and topographic factors buffered some of the negative impacts. Mediterranean forests dominated by oak species were the most negatively impacted, whereasPinus pinasterwas the most resilient species. The impact of drought on the NDVI decreased at high elevations and mainly on east and north‐east facing slopes. We illustrate how an adequate characterization of the coupling between climate conditions and forest productivity (NDVI) allows the determination of the most vulnerable areas to drought. This approach could be widely used for other extreme climate events and when considering other spatially resolved proxies of forest growth and health.
Assessing hypoglycemia frequency using flash glucose monitoring in older Japanese patients with type 2 diabetes receiving oral hypoglycemic agents
Authors: Abe Hironori , Shikuma Junpei , Suwanai Hirotsugu , Sano Koji , Okumura Takako , Kan Kenshi , Takahashi Tomono , Miwa Takashi , Suzuki Ryo , Odawara Masato
Published: September 2019

Aim

It is important to consider hypoglycemia for glycemic control in elderly patients with type 2 diabetes. Continuous blood glucose monitoring system is an effective method to investigate blood glucose fluctuation. This study examined hypoglycemia frequency using continuous blood glucose monitoring system in older patients with type 2 diabetes.

Methods

A total of 70 patients with type 2 diabetes aged >65 years, receiving oral treatment only and having a glycated hemoglobin (HbA1c) level of <8% were enrolled. Flash glucose monitoring system was used for the device. Patients were classified into three groups according to the type of medicine administered, in addition to other oral hypoglycemics, and were compared: (i) those taking sulfonylureas (SU); (ii) those taking glinides; and (iii) those who did not take either SU or glinides.

Results

There was a significant positive correlation between the coefficient of variation and hypoglycemic frequency in all the patients, and a significant negative correlation between HbA1c and hypoglycemia in those receiving SU. When hypoglycemia was defined as glucose levels <54 mg/dL and <70 mg/dL, the cut‐off HbA1c values for developing hypoglycemia were 6.3% and 6.7%, sensitivity was 75.0% and 76.2%, and specificity was 90.9% and 77.6%, respectively.

Conclusions

In older patients with type 2 diabetes receiving SU, hypoglycemic frequency increases with decreases in HbA1c level. In particular, in patients with HbA1c levels of <6.3% receiving SU, it is necessary to consider medication modification. Geriatr Gerontol Int 2019; 19: 1030–1035.
Forty‐five years on home hemodialysis, a case of exceptional longevity
Authors: Abdul Salim Sohail , Cheungpasitporn Wisit , Echols Vonda , Monga Divya , Davidson Jamie , Juncos Luis A. , Fülöp Tibor
Published: September 2019

End‐stage renal disease is associated with dismal long‐term survival in general. Home hemodialysis (HHD) has been advocated as a modality affirming better quality of life and longer survival. We report a 62‐year‐old Caucasian female with end‐stage renal disease who has been exclusively on HHD for a total of 45 years, utilizing various platforms over the years. She has been one of the first home dialysis patients of the founding father of renal dialysis in the state of Mississippi, John D. Bower and cared by him throughout his career. Throughout this period, her life bore witness to the evolving technology of dialysis accesses, platforms, and evolution of HHD in its entirety. After review of the literature, we find that the longest vintage time on HHD documented to date was around 35 years. This extraordinary longevity bears testimony to the extraordinary self‐motivation of the patient, the dedication of her providers and the true potential of HHD in motivated subjects.