bluuebunny/crossref_metadata_2025 huggingface dataset:
Social networking sites and customers’ attitude towards advertisements
Authors: Mukherjee Kaustav , Banerjee Neelotpaul
Published: October 2019

Purpose

The study aims to demonstrate the impact of social media users’ positive attitude towards the social networking sites (SNS) on the generation of a positive attitude towards social networking advertisements (SNA). A favourable attitude towards the SNA thus generated can positively influence brand attitude and purchase intention.

Design/methodology/approach

An online survey was conducted to collect relevant data using a structured questionnaire. Structural equation modelling was conducted using the statistical software AMOS 18.

Findings

Empirical analysis revealed the importance of brand advertisements on the social networks in inciting a positive attitude as well as a purchase intention for the brand in the SNS users’ minds.

Research limitations/implications

The study has been conducted in the Indian context using Facebook as a model social networking site.

Practical implications

Social media being one of the most popular and user-friendly platforms for regular communications, marketers are suggested to allocate a sizeable share of the advertising budget for social media advertisements and customer engagement so as to help build a positive attitude towards the advertised brand in the SNS users’ minds.

Originality/value

To the best of the authors’ knowledge, the impact of users’ positive evaluation of SNS as an effective communication medium, on the generation of a positive attitude towards the SNA, has been dealt for the first time here.
Factors for improving performance in ISO 9001 certified small- and medium-sized service enterprises
Authors: Chiarini Andrea , Castellani Paola , Rossato Chiara
Published: October 2019

Purpose

The purpose of this paper is to investigate the factors that are important for improving the performance of ISO 9001 certified small- and medium-sized service enterprises (SMSEs).

Design/methodology/approach

Preliminary research questions were set on the basis of a literature review and then submitted to a Delphi panel of experts. The results from the Delphi panel were transformed into hypotheses in the form of a survey. A sample comprising 115 Italian SMSEs answered the survey, which also included specific fields for qualitative notes. The hypothesis tests used 95% confidence intervals, and notes and suggestions from the respondents were also collected.

Findings

The findings relate to the role and responsibilities of the quality manager, as well the entrepreneur and partners, the quality of the enterprise culture, training, awareness concerning process key performance indicators, visual management and modern digitised documentation and communication. Furthermore, criticisms emerged regarding the ISO 9001 standard in terms of cost of quality measurement, day-to-day improvement and problem-solving.

Research limitations/implications

This research is limited to SMSEs. The limitations of this research open avenues for further research. In particular, many suggestions from the respondents seem generalisable to other industries and also to large manufacturing firms.

Practical implications

The findings of this research could be used as a guideline for implementing ISO 9001 in the SMSE sector. Moreover, some of the criticisms could be taken into account for the next revision of the ISO 9001 standard.

Originality/value

This is one of the first papers to discuss important factors for improving the performance of ISO 9001 in the SMSE sector.
The UNTOLD story
Authors: Moisescu Ovidiu Ioan , Gică Oana Adriana , Coroș Monica Maria , Yallop Anca C.
Published: October 2019

Purpose

This paper aims to examine the negative effects of events on residents’ quality of life. Particularly, the paper analyses the specific negative effects generated via “overtourism” for the duration of large-scale music festivals.

Design/methodology/approach

The paper uses a case study method approach to examine the negative effects that UNTOLD, the largest music festival in Romania, has on residents’ quality of life. The case is analysed via a comprehensive desk research of secondary data from industry and academic sources.

Findings

Despite its success and the positive economic impact UNTOLD festival had on the host city, several issues have a negative impact on residents’ quality of life and well-being. The negative impacts are noise pollution, vandalism and crime, traffic and parking issues, waste and damages to the natural environment, pressure on and over usage of local services and infrastructure and the increased cost of living.

Social implications

Whilst organisers, local businesses and local authorities are the main parties benefiting from events, residents mainly feel the negative impact. Organisers, local authorities and businesses need to minimise the negative effects residents’ experience during the event by building sustainable partnerships and taking a more hands-on approach to sustainable and socially responsible practices. Current and potential initiatives are discussed in the paper.

Originality/value

This paper examines the negative impacts events may have on residents’ quality of life and discusses the case of a large-scale music festival, an under-researched context. The analysis and discussion may assist scholars and industry experts alike in generating new debates in sustainable event management practices, as well as festival organisers and public authorities in developing strategies for avoiding, containing or minimising the negative effects of events.
Perceptions of tourism-related non-governmental organization (NGO) managers in Antalya
Authors: Akbulut Onur , Ekin Yakin
Published: October 2019

Purpose

The purpose of this paper is to investigate the perceptions of tourism-related non-governmental organization (NGO) managers on overtourism trends in Antalya, Turkey.

Design/methodology/approach

Focus group study was implemented and three focus group interviews were undertaken with 34 NGO managers in total as a sample. The population of the research consisted of 65 tourism-related NGO managers in Antalya.

Findings

The results of the research reveal that Antalya was perceived as neither in a tourism development stage nor afflicted by overtourism by NGO managers. NGOs are one of the major stakeholders in the tourism industry, and hence their perceptions of overtourism would probably be the stimulating force for further sustainable development in the destination.

Research limitations/implications

The limitation is that the research was realized voluntarily by 34 NGOs in Antalya. It would have been better to have more volunteer respondents.

Practical implications

The viewpoints of stakeholders about their perceptions of tourism development in Antalya would be a helpful next step to refer back to practitioners so as to develop further strategic plans from their perspectives.

Social implications

As social exchange theory states, communities benefiting from tourism development will support further improvement in tourism. Hence, in their role as spokespersons for the community, the perceptions of NGOs will influence decision-makers to draw implications from the study for wider consideration.

Originality/value

As a consequence, a model was proposed according to the results of the research. The findings of the research paper highlight the evolution of high-flow tourism in the destination.
Overtourism: a result of the Janus-faced character of the tourism industry
Authors: Avond Guillaume , Bacari Chaarani , Limea Isabelle , Seraphin Hugues , Gowreesunkar Vanessa , Mhanna Rami
Published: October 2019

Purpose

This paper aims to evaluate the “Janus-faced” character and causes of overtourism to propose recommendations to tackle such a phenomenon.

Design/methodology/approach

A case study analysis approach is adopted for this study. Studies of practitioners are presented and reflected upon with reference to academic literature on overtourism.

Findings

The study presents practical examples from Haiti, Nicaragua and Zanzibar. Tourism practitioners’ studies on overtourism are presented and general recommendations on tackling overtourism are proposed.

Research limitations/implications

This study will be of interest to tourism practitioners and Destination Marketing Organisations (DMOs) worldwide who seek understanding of the overtourism phenomenon and the associated negative impacts. The study provides useful recommendations that can be used in similar situations of overtourism.

Originality/value

The paper extends understanding of overtourism causes and consequences. While overtourism is generally looked at from impact studies, this paper argues the urgent need for solutions to tackle the phenomenon.
Spreading tourists around host countries of mega sport events
Authors: Mhanna Rami , Blake Adam , Jones Ian
Published: October 2019

Purpose

This study aims to recommend initiatives that can be adopted to overcome overtourism in host destinations of mega sport events.

Design/methodology/approach

This study adopts a qualitative research design that involves 20 semi-structured interviews with key informant stakeholders of the London 2012 Olympic Games. An exploratory case study approach was used to investigate strategies used to leverage tourism benefits in host destinations, and the authors used thematic analysis to present strategies to overcome overtourism in host cities.

Findings

This study emphasises the need for spreading tourists beyond the host city as a main strategy. To do so, three initiatives are recommended: spreading domestic tourism outside the host city, showcasing destination beyond the host city and promoting regional collaboration.

Practical implications

This research provides tourism practitioners and destination management organisations in host destinations of mega sport events with an advanced strategic insights to capitalise on mega sport events. The authors suggest considering the events as athemethrough an event planning process to overcome potential overtourism in unique host cities.

Originality/value

As overtourism has an impact on visited destinations, this study argues that overtourism can be generated by mega sport events. This paper offers an extended insight into overcoming overtourism by implementing strategic event tourism, leveraging initiatives that can be extended in use to reach geographic areas beyond host cities of mega sport events.
Introduction
Authors: Gowreesunkar Vanessa , Seraphin Hugues
Published: October 2019

Purpose

This paper aims to provide an overview of the significance of this theme issue. To develop a better understanding of the context, the phenomenon of overtourism is introduced. The paper also sheds light on perverse impacts of overtourism on key stakeholders and seeks to provide justification for the need for smart and sustainable strategies.

Design/methodology/approach

The research design follows a mixed approach and draws from a combination of case studies, online sources, literature reviews and an industry paper. This combination of primary, secondary and tertiary data enables more meaningful analysis of overtourism from destinations with different specificities and characteristics.

Findings

The paper provides valuable insight on the causes and consequences of overtourism on the destination and its people, which arguably include both tourists, residents and other stakeholders. Based on empirical evidence, the paper presents common strategies that are used to tackle overtourism and seeks to draw insights from those case studies to propose smarter and more sustainable strategies.

Originality/value

The value of this theme issue is that it presents a variety of case studies that might be used as examples to mitigate the consequences of overtourism. Destinations showing similar symptoms may draw from the paper to manage the strain of overtourism. As one size does not fit all, the variety of strategies proposed within those papers might help practitioners and destination managers to select and adapt them to their respective contexts. Further, the research findings may be applicable to other geographic regions with similar contexts.
Reflections on the theme issue outcomes
Authors: Gowreesunkar Vanessa , Seraphin Hugues , Teare Richard
Published: October 2019

Purpose

The purpose of this paper is to summarise the main outcomes of the collection of studies in this theme issue and to offer some key reflections based on the experiences of the theme editors and contributors.

Design/methodology/approach

This study uses structured questions to enable the theme editors to reflect on the rationale for the theme issue question, the starting point, the selection of the contributors and material and the editorial process.

Findings

This paper provides insights and practical suggestions in response to the theme issue question from different academic and professional backgrounds, namely, the hotel industry, the events industry, the technology sector, non-governmental organisations, government sectors, and the local community.

Practical implications

The theme issue outcomes provide lines of enquiry for others to explore and reinforce the value of worldwide hospitality and tourism theme’s approach to collaborative working and writing.

Originality/value

The collaborative study reported in this theme issue offers a unified but contrarian response to the theme’s strategic question. Taken together, the papers provide a range of options for destination marketing organisations in response to the issues highlighted.
Morphine stimulates angiogenesis through Akt/mTOR/eIF4E activation under serum deprivation or H2O2‐induced oxidative stress condition
Authors: Zhang Kun , Huang Wei , Chen Wei , Zhou Qian , Zhang Qiongxia , Wu Xiaoqin , Xu Yong , Li Dezhan , Xie Tao , Liu Jie
Published: October 2019

Morphine is an opioid analgesic drug routinely used to treat pain in several medical conditions including cancer. Increasing evidence has shown that morphine can directly modulate cancer growth via regulating angiogenesis. In this work, we investigated the effect of morphine on angiogenesis under pathological conditions. We showed that morphine, in a concentration typical of that observed in patient's blood, stimulates tumour angiogenesis under serum deprivation and H2O2‐induced oxidative stress conditions. We found that morphine protected human lung tumour associated‐endothelial cell (HLT‐EC) against serum deprivation or H2O2‐induced inhibition of capillary network formation. Furthermore, morphine stimulated other biological functions of HLT‐EC under serum deprivation and H2O2‐induced pathological conditions, such as growth, migration and survival, without affecting HLT‐EC adhesion. Interestingly, morphine at the same concentration did not affect lung tumour cell growth and survival, suggesting the specific protective role of morphine at low micromolar concentrations on tumour angiogenesis. Using in vivo Matrigel angiogenesis assay, it was found that morphine stimulated in vivo angiogenesis under H2O2‐induced pathological condition. The opioid receptor antagonist, naloxone, did not inhibit the protective activity of morphine in in vivo angiogenesis, indicating that the effect was less likely to be mediated by the typical opioid receptors. Mechanism analysis indicated that morphine alleviated serum deprivation and H2O2‐induced angiogenesis inhibition via reducing oxidative stress and damage, and activating Akt/mTOR/eIF4E signalling. We demonstrate the protective role of morphine on tumour angiogenesis under pathological conditions. Our work suggests that clinical use of morphine may be harmful in patients with angiogenesis‐dependent cancers.
A New Chapter in the Normalisation of Closed Material Procedures
Authors: Lock Daniella
Published: October 2019

This note provides an analysis of the Supreme Court decision in Haralambous, which authorised the use of closed material procedures (CMPs) in proceedings surrounding search and seizure warrants issued under the Police and Criminal Evidence Act 1984 (PACE). After presenting the facts of the case and the reasoning of the Court, the note examines the decision as an instance of CMP normalisation consistent with the model of normalisation argued for by Eva Nanopoulos in a previous MLR article. The notes goes on to make the case that Haralambous may be distinguished from previous instances of CMP normalisation on account of the Supreme Court's more open acceptance of CMPs in the decision, which signals a new chapter in CMP normalisation in the UK.
Enzymatic Production, Bioactivity, and Bitterness of Chickpea (Cicer arietinum) Peptides
Authors: Real Hernandez Luis M. , Gonzalez de Mejia Elvira
Published: October 2019

Chickpeas are inexpensive, protein rich (approximately 20% dry mass) pulses available worldwide whose consumption has been correlated with positive health outcomes. Dietary peptides are important molecules derived from dietary proteins, but a comprehensive analysis of the peptides that can be produced from chickpea proteins is missing in the literature. This review provides information from the past 20 years on the enzymatic production of peptides from chickpea proteins, the reported bioactivities of chickpea protein hydrolysates and peptides, and the potential bitterness of chickpea peptides in food products. Chickpea peptides have been enzymatically produced with pepsin, trypsin, chymotrypsin, alcalase, flavorzyme, and papain either alone or in combination, but the sequences of many of the peptides in chickpea protein hydrolysates remain unknown. In addition, a theoretical hydrolysis of chickpea legumin by stem bromelain and ficin was performed by the authors to highlight the potential use of these enzymes to produce bioactive chickpea peptides. Antioxidant activity, hypocholesterolemic, and angiotensin 1‐converting enzyme inhibition are the most studied bioactivities of chickpea protein hydrolysates and peptides, but anticarcinogenic, antimicrobial, and anti‐inflammatory effects have also been reported for chickpea protein hydrolysates and peptides. Chickpea bioactive peptides are not currently commercialized, but their bitterness could be a major impediment to their incorporation in food products. Use of flavorzyme in the production of chickpea protein hydrolysates has been proposed to decrease their bitterness. Future research should focus on the optimization of chickpea bioactive peptide enzymatic production, studying the bioactivity of chickpea peptides in humans, and systematically analyzing chickpea peptide bitterness.
Diversity and dynamics of microbial communities in brown planthopper at different developmental stages revealed by high‐throughput amplicon sequencing
Authors: Wang Zheng‐Liang , Wang Tian‐Zhao , Zhu Hang‐Feng , Pan Hai‐Bo , Yu Xiao‐Ping
Published: October 2019

The microbiome associated with brown planthopper (BPH) plays an important role in mediating host health and fitness. Characterization of the microbial community and its structure is prerequisite for understanding the intricate symbiotic relationships between microbes and host insect. Here, we investigated the bacterial and fungal communities of BPH at different developmental stages using high‐throughput amplicon sequencing. Our results revealed that both the bacterial and fungal communities were diverse and dynamic during BPH development. The bacterial communities were generally richer than fungi in each developmental stage. At 97% similarly, 19 phyla and 278 genera of bacteria were annotated, while five fungal phyla comprising 80 genera were assigned. The highest species richness for the bacterial communities was detected in the nymphal stage. The taxonomic diversity of the fungal communities in female adults was generally at a relatively higher level when compared to other developmental stages. The most dominant phylum of bacteria and fungi at each developmental stage all belonged to Proteobacteria and Ascomycota, respectively. A significantly lower abundance of bacterial genus Acinetobacter was recorded in the egg stage when compared to other developmental stages, while the dominant fungal genus Wallemia was more abundant in the nymph and adult stages than in the egg stage. Additionally, the microbial composition differed between male and female adults, suggesting that the microbial communities in BPH were gender‐dependent. Overall, our study enriches our knowledge on the microbial communities associated with BPH and will provide clues to develop potential biocontrol techniques against this rice pest.
5α‐Reductase type 2 deficiency in families from an isolated Andean population in Venezuela
Authors: Avendaño Andrea , González‐Coira Mercedes , Paradisi Irene , Rojas Ascanio , Da Silva Gloria , Gómez‐Pérez Roald , Ceballos Jesús Osuna
Published: October 2019

5α‐Reductase type 2 deficiency causes a 46,XY disorder of sex development (DSD) characterized by ambiguous external genitalia, rudimentary prostate, and normal internal genitalia. The disease prevalence worldwide is low, but in a small and isolated village of the Venezuelan Andes, a higher incidence has been found. DNA analysis of the SRD5A2 gene was performed in three inbred affected individuals clinically diagnosed with DSD. The entire coding regions, the p.L89V polymorphism (rs523349) and five intragenic SNPs (rs2300702, rs2268797, rs2268796, rs4952220, rs12470196) used to construct haplotypes were analyzed by Sanger sequencing. To assess the probable ethnic origin of the mutation in this geographic isolate, a population structure analysis was performed. Homozygosis for the p.N193S mutation was found in all patients, with a mutation carrier frequency of 1:80 chromosomes (0.0125) in the geographic focus, suggesting a founder phenomenon. The results of the population structure analysis suggested a mutation origin closer to the Spanish populations, according to the clusters grouping. The genotype–phenotype correlation in the patients was not absolute, being hypospadias and cryptorchidism the main traits that differentiate affected individuals.
Higher frequency of the CTLA‐4+LAG‐3+ T‐cell subset in patients with newly diagnosed acute myeloid leukemia
Authors: Chen Youchun , Tan Jiaxiong , Huang Shuxin , Huang Xin , Huang Jingying , Chen Jie , Yu Zhi , Lu Yuhong , Weng Jianyu , Du Xin , Li Yangqiu , Zha Xianfeng , Chen Shaohua
Published: October 2019

Aim

Immune suppression based on alternative regulation of immune checkpoint proteins, for example, programmed cell death receptor‐1 (PD‐1) and cytotoxic T lymphocyte–associated molecule‐4 (CTLA‐4), which results in T‐cell exhaustion, contributes to cancer development and progression. In this study, we sought to characterize the distribution of CTLA‐4 and T‐cell lymphocyte activation gene‐3 (LAG‐3) expression on exhausted T cells in different T‐cell subsets from patients with acute myeloid leukemia (AML).

Methods

The coexpression of CTLA‐4 and LAG‐3 on exhausted CD244+ and CD57+ T cells from the CD3+, CD4+, and CD8+ T‐cell subsets in peripheral blood from 12 patients with newly diagnosed AML was analyzed by multicolor flow cytometry assay.

Results

A significantly higher percentage of CTLA‐4+CD3+, CD4+ and CD8+ T cells was found in patients with AML. In addition, higher numbers of both CTLA‐4+CD244+ and CTLA‐4+CD57+CD3+ T cells were detected. Interestingly, the increased CTLA‐4+CD244+ T cells were predominantly CD4+ T cells. In contrast, the increased CTLA‐4+CD57+ T cells primarily consisted of the CD8+ T‐cell subset. A high proportion of LAG‐3+ T cells was found in only a few cases with AML; however, a significantly higher proportion of coexpression of CTLA‐4 and LAG‐3 in the CD3+ and CD8+ T‐cell subsets was detected.

Conclusion

We for the first time observed higher CTLA‐4+CD244+CD4+, CTLA‐4+CD57+CD8+, CTLA‐4+LAG‐3+CD3+ and CTLA‐4+LAG‐3+CD8+ T cells in patients with AML, whereas the upregulated expression of LAG‐3 on T cells was only found in a subset of the cases. These data may provide further information by complementing the heterogeneity of immune checkpoints expression in AML.
Faecal microbiota transplant decreases mortality in severe and fulminant Clostridioides difficile infection in critically ill patients
Authors: Tixier Emily N. , Verheyen Elijah , Ungaro Ryan C. , Grinspan Ari M.
Published: October 2019

Background

Severe and fulminant Clostridioides difficile infection is associated with high mortality rates. While faecal microbiota transplant has been shown to be effective for recurrent C difficile infection, there is little data on the utility of faecal microbiota transplant in severe or fulminant C difficile infection.

Aim

To compare the outcomes of antibiotics and faecal microbiota transplantation vs antibiotics alone (standard of care) in critically ill patients with severe or fulminant C difficile infection.

Methods

This was a retrospective, matched cohort study in one urban tertiary academic care centre including 48 patients hospitalised with severe or fulminant C difficile infection who required care in intensive care unit.

Results

Patients who received faecal microbiota transplantation (n = 16) had a 77% decrease in odds for mortality (OR 0.23, 95% CI 0.06‐0.97) with a number needed to treat of 3 to prevent one death.

Conclusions

Faecal microbiota transplantation provides mortality benefit over standard of care for severe and fulminant C difficile infection and should be considered in critically ill patients.
Induction of labor versus expectant management after successful external cephalic version
Authors: Barbash‐Hazan Shiri , Nattiv Noga , Salzer‐Sheelo Liat , Bergel Riki , Hadar Eran , Osovsky Micky , Shmueli Anat
Published: October 2019

Background

External cephalic version (ECV) is a common procedure for women carrying a breech‐presenting fetus, in an effort to avoid a cesarean birth. The benefit of immediate labor induction after ECV vs. expectant management is undetermined. We aimed to evaluate whether induction of labor immediately after a successful ECV improves the chances of a vaginal delivery compared with expectant management.

Methods

Retrospective analysis of 296 women who underwent successful ECV performed in term singleton gestations (2007‐2018) in the Rabin Medical Center. Mode of delivery and other obstetrical and neonatal outcomes were compared between women undergoing immediate labor induction after ECV and those managed expectantly.

Results

Of 296 women after successful ECVs, 54 (18.2%) underwent immediate labor induction and 242 (81.8%) were managed expectantly. Immediate induction was associated with higher parity (2.4 vs 1.7, P = .03) and lower mean birthweight (3128 vs 3346 g, P < .01). Mode of delivery was similar between groups, and no other significant differences in obstetrical and neonatal adverse outcomes were noted.

Discussion

In our cohort, immediate labor induction after successful ECV apparently had no benefits in terms of obstetrical or neonatal complications, and did not reduce the risk of cesarean birth. Therefore, expectant management seems reasonable and safe.
Ultra‐hypofractionated radiation therapy for unfavourable intermediate‐risk and high‐risk prostate cancer is safe and effective: 5‐year outcomes of a phase II trial
Authors: Macias Victor A. , Barrera‐Mellado Inmaculada
Published: October 2019

Objectives

To report toxicity (primary endpoint) and biochemical disease‐free survival (BDFS) outcomes of a phase II trial evaluating ultra‐hypofractionated radiation therapy (UHRT), focusing on patients with unfavourable intermediate‐risk and high‐risk prostate cancer (PCa).

Patients and Methods

From 2012 to 2017, 154 patients (92 with unfavourable intermediate‐risk or high‐risk PCa) were treated with helical TomoTherapy delivering 43.8–45.2 Gy in eight fractions over 3 weeks. Of these, 73% received hormonotherapy (51% neoadjuvant).

Results

The median (range) follow‐up was 48 (19–84) months. For the whole series, crude BDFS and 5‐year BDFS rates were 97.4% and 94.3%, respectively. The corresponding figures for unfavourable intermediate‐risk and high‐risk PCa were 96.7% and 90%, respectively. The crude metastasis‐free survival rate was 98% for the unfavourable intermediate‐risk and high‐risk group. For the whole series, the 5‐year cumulative urinary/intestinal grade 2+ late toxicity was 17.8/7.4%. No grade 4–5 toxicity was observed. One patient experienced late grade 3 toxicity (urinary).

Conclusion

This eight‐fraction UHRT regimen can be safely delivered to patients with unfavourable intermediate‐risk/high‐risk PCa. Its relapse rates are similar to those reported for the combination of external beam radiotherapy plus brachytherapy, however, the observed toxicity profile is milder. The disease survival rates compare favourably with historical controls in some other forms of radiotherapy, with similar side effects. Since the low rate of biochemical/metastasis relapse is encouraging, further research to confirm these results is justified.
Editorial: The job of an editor—one year on
Authors: Ougrin Dennis
Published: October 2019

Incredible as it still sounds to me, it has now been a year since I took over as the editor‐in‐chief of Child and Adolescent Mental Health. It is time to both look back and look forward. Over the past year, my approach remained unchanged: CAMH should grow to become a leading source of the most clinically relevant knowledge worldwide in our field. I would like you, our readers, to think of CAMH whenever you need clinical advice, a research update, or an innovative service development idea.
Clinician perspectives on the use of National Institute for Health and Care Excellence guidelines for the process of transition in Attention Deficit Hyperactivity Disorder
Authors: Eke Helen , Janssens Astrid , Newlove‐Delgado Tamsin , Paul Moli , Price Anna , Young Susan , Ford Tamsin
Published: October 2019

Background

The UK National Institute for Health and Care Excellence (NICE) clinical guidelines recommends the following steps in the transition from child to adult services for young people with attention deficit hyperactivity disorder (ADHD): reassessment before and after transition, transition planning, formal meeting between services, and involvement from young person and carer, completed by age 18.

Methods

A UK surveillance study asked clinicians to report young people on their caseloads with ADHD in need of transition to adult services in 2016 to support their continued access to medication need. Clinicians reported young people as they aged to within 6 months of the transition boundary, a prospective questionnaire prior to transition asked about intended transition and the use of local transition protocols. A retrospective questionnaire sent 9 months later established which steps recommended by NICE were followed during transition. Clinicians (38) working in child or adult services were interviewed about their experiences of transition and the use of NICE guidelines during transition and were analysed using a framework approach.

Results

Information was shared between services in 85% of the 315 identified transition cases. A joint meeting was planned in 16% of cases; joint working before transfer occurred in 10% of cases. Clinicians were aware of NICE guidelines; they had mixed views on whether (local) guidelines or protocols were helpful. The main reason for not following guidelines was workload and resources: “NICE recommends stuff that is miles above what we will ever be able to provide”.

Conclusions

Clinicians involved in the transition process of young people with ADHD judged NICE guidelines to be unrealistic given the current limited resources and service organization. More open dialogue is needed for recommendations on service models to bridge the gap between guideline recommendations and what is viewed as feasible and how implementation of guidance is funded, monitored, and prioritized. This may lead to valuable changes in the consultation process, for example, consideration of a layered (gold, standard, and minimal) system for some NICE guidelines.
Fracture rate in women with oestrogen deficiency – Comparison of Turner syndrome and premature ovarian insufficiency
Authors: Cardona Attard Carol , Cameron‐Pimblett Antoinette , Puri Davina , Elliot Jessica , Wilson Jack C. , Talaulikar Vikram S. , Davies Melanie C. , Conway Gerard S.
Published: October 2019

Objective

Women with early‐onset oestrogen deficiency are at risk of reduced bone mineral density (BMD). We sought to assess fracture history and BMD in women with Turner syndrome (TS) and premature ovarian insufficiency (POI).

Design

A cross‐sectional observational study.

Patients

Two hundred and sixty seven women with TS (median age 34.3 years) and 67 women with POI (median age 28.1 years).

Measurements

A questionnaire was used to collect data on fracture history, co‐morbidities and drug history including age at first oestrogen exposure. Clinical data included height, weight, serum vitamin D and hip and spine T‐scores, which were adjusted for height and age. Fractures were subdivided into major osteoporotic fractures (MOF) and ‘other’ fracture types.

Results

Overall fracture rate was similar in women with TS and POI (82 [30.5%] vs 22 [32.8%] respectively, P = .74). Compared to women with POI, those with TS had more fractures at MOF sites (30.2% vs 52.7%, P = .012) and fewer phalangeal fractures (27.9% vs 9.8%, P = .005). There was no difference in BMD between women who sustained a fracture compared to those who did not. Women with TS who fractured were more likely to suffer from hearing impairment compared to those with no fracture (62.2% vs 48.1%, P = .045).

Conclusions

TS is not associated with an overall excess risk of bone fracture. The higher rate of fractures at MOF sites in women with TS may be secondary to hearing impairment, thin cortical bone and abnormal bone remodelling.
“We Made a Contribution to the Revolution”: Shifting Scales of Politics and Unity in Ukraine
Authors: Channell‐Justice Emily S.
Published: October 2019

Based on ethnographic and interview data from the 2013‐2014 Euromaidan mobilizations in Ukraine, I use the example of the “secondary city” of Cherkasy to show that protest participants used shifting scales to participate in the protests in Cherkasy and in the capital city of Kyiv. This participation showed national unity across Ukraine at the same time that it refocused Cherkasy residents’ attention to local political issues. These processes call into question protesters’ definitions of Europe, democracy, and national identity, all contested across Ukraine during Euromaidan. This article argues for greater attention to secondary cities in the context of mass mobilization, as local instances of protest participation redefined notions of community at multiple scales.
TLE1 expression fails to distinguish between synovial sarcoma, atypical fibroxanthoma, and dermatofibrosarcoma protuberans
Authors: Pukhalskaya Tatsiana , Smoller Bruce R.
Published: October 2019

Transducin‐like enhancer of split 1 (TLE1) belongs to the Groucho/TLE/Grg family. It functions as a transcriptional corepressor and is widely used as a biomarker of synovial sarcoma (SS). Within the skin, atypical fibroxanthoma (AFX) and dermatofibrosarcoma protuberans (DFSP) often enter the histopathologic differential diagnosis. TLE1 expression has not been evaluated in these neoplasms. We examined archived tissues sections from the surgical pathology files from 10 adult patients diagnosed with AFX and 10 adult patients diagnosed with DFSP. We found nuclear staining in 10 of 10 AFX and 2 of 10 DFSP. We also noticed three patterns of staining in AFX: predominantly spindle component, predominantly epithelioid component, or mixed pattern of both epithelioid and spindle components. The group with the predominantly spindle pattern expressed the strongest nuclear TLE1 staining. In the DFSP group, one lesion demonstrated staining of epithelioid cells, with strong, diffuse nuclear TLE 1 expression, and the second lesion stained only the spindled cells, with weak nuclear TLE1 marking. In conclusion, TLE1, while a sensitive marker for SS, is not specific. A wide range of cutaneous spindle cell neoplasms also express TLE1. AFX and DFSP should be added to this list. TLE1 might be added to a diagnostic panel in this differential diagnosis.
Habitat type drives the distribution of non‐indigenous species in fouling communities regardless of associated maritime traffic
Authors: Leclerc Jean‐Charles , Viard Frédérique , González Sepúlveda Elizabeth , Díaz Christian , Neira Hinojosa José , Pérez Araneda Karla , Silva Francisco , Brante Antonio
Published: October 2019

Aim

Biological invasions and changes in land and sea use are among the five major causes of global biodiversity decline. Shipping and ocean sprawl (multiplication of artificial structures at the expense of natural habitats) are considered as the major forces responsible for marine invasions and biotic homogenization. And yet, there is little evidence of their interplay at multiple spatial scales. Here, we aimed to examine this interaction and the extent to which the type of artificial habitat alters the distribution of native and non‐indigenous biodiversity.

Location

Southeast Pacific—Central Chilean coastline.

Methods

Settlement plates were deployed upon two types of artificial habitats (floating and non‐floating hard substrates) at a total of ten study sites, exposed to either international or local traffic. After colonization periods of 3 and 13 months, plates were retrieved to determine their associated fouling sessile assemblages at an early and late stage of development, respectively. Putative confounding factors (temperature, metal concentrations) were taken into account.

Results

While traffic type had no detectable effect, there were strong differences in community structure between habitats, consistent across the study region. These differences were driven by non‐indigenous species which contributed to 58% and 40% of the community structure in floating habitats after 3 and 13 months, respectively—roughly 10 times greater than in their non‐floating counterparts. Assemblages on floating structures also displayed a lower decline in similarity with increasing distance between sampling units, being thus more homogenous than non‐floating habitats at the regional scale.

Main conclusions

With the absence of international traffic effect, the colonization success by non‐indigenous species appears to be mainly habitat‐dependent and driven by local propagules. Floating structures not only provide specific niches but characteristics shared with major introduction and dispersal vectors (notably hulls), and in turn constitute important corridors to invasions and drivers of biotic homogenization at multiple scales.
Novel model‐based clustering reveals ecologically differentiated bacterial genomes across a large climate gradient
Authors: Simonsen Anna K. , Barrett Luke G. , Thrall Peter H. , Prober Suzanne M.
Published: October 2019

A pervasive challenge in microbial ecology is understanding the genetic level where ecological units can be differentiated. Ecological differentiation often occurs at fine genomic levels, yet it is unclear how to utilise ecological information to define ecotypes given the breadth of environmental variation among microbial taxa. Here, we present an analytical framework that infers clusters along genome‐based microbial phylogenies according to shared environmental responses. The advantage of our approach is the ability to identify genomic clusters that best fit complex environmental information whilst characterising cluster niches through model predictions. We apply our method to determine climate‐associated ecotypes in populations of nitrogen‐fixing symbionts using whole genomes, explicitly sampled to detect climate differentiation across a heterogeneous landscape. Although soil and plant host characteristics strongly influence distribution patterns of inferred ecotypes, our flexible statistical method enabled us to identify climate‐associated genomic clusters using environmental data, providing solid support for ecological specialisation in soil symbionts.
Extremely divergent host plant acceptance with gene flow between sympatric host races of the phytophagous ladybird beetle Henosepilachna diekei
Authors: Matsubayashi Kei W. , Kahono Sih , Hartini Sri , Katakura Haruo
Published: October 2019

Ecological divergence alone can prevent the majority of gene flow in the absence of other forms of reproductive isolation. Although the importance of ecological divergence in promoting reproductive isolation has been broadly recognized, its net impact on speciation has rarely been estimated in the wild. The phytophagous ladybird beetle Henosepilachna diekei Jadwiszczak & Wegrzynowicz includes two sympatric host races that are reproductively isolated solely by extreme specialization to either of the host plants Mikania micrantha Kunth (Asteraceae) or Leucas lavandulifolia Sm. (Lamiaceae) in West Java, Indonesia. To investigate the impact of differential host use as an isolating barrier, we carried out adult host acceptance tests and molecular population genetic analyses based on mitochondrial ND2 and nucleic ITS2 gene sequences using 13 wild populations of the host races, including four sympatric population pairs. Almost all individuals of these host races persistently accepted only the original host plant. We detected restricted but a degree of gene flow between these host races. A migration event occurred only in very recent time compared to their divergence time, indicating recent secondary contact of these host races in the surveyed area. These results reveal the remarkably large impact of host‐plant shift over almost the entire process of speciation and illustrate that ecological divergence has been maintained even under the presence of a certain degree of gene flow.
Generalized quasiperiodic epileptiform activity in sleep is associated with cognitive impairment in children with drug‐resistant focal lesional epilepsy
Authors: Novak Vilem , Maulisova Alice , Jezdik Petr , Benova Barbora , Belohlavkova Anezka , Liby Petr , Tichy Michal , Krsek Pavel
Published: October 2019

Objective

To evaluate the impact of generalized quasiperiodic epileptiform discharges (“hurdles”) observed in non–rapid eye movement (NREM) sleep on cognitive function in children with intractable focal epilepsy. “Hurdles” pattern does not meet the criteria of the electrical status epilepticus in slow‐wave sleep (ESES).

Methods

In a retrospective analysis, 24 patients with “hurdles” and their 24 peers matched for demographic and epilepsy‐related variables were compared in terms of neuropsychological domains and electroencephalography (EEG)–derived quantifiers. Both “hurdles” and controls were children between 2 and 19 years of age who had intractable focal epilepsy evaluated as candidates of resective epilepsy surgery.

Results

Full‐scale intelligence quotient/developmental quotient (FSIQ/DQ) (P = .002) and visuoconstructional skills (P = .004) were significantly lower in children with “hurdles” compared to controls. Patients with “hurdles” presented with higher interictal spike indexes in sleep (P < .001, median difference −0.9, 95% confidence interval [CI] −1.4, −0.6) and wakefulness (P < .001, median difference −0.3, 95% CI −0.5, −1). Relative time of sleep spindles in NREM sleep was significantly reduced (P < .001, median difference 0.1, 95% CI 0.0, 0.1) in the “hurdles” group. The time proportion of sleep spindles represented a significant positive (P = .008) and spike index of generalized spikes in sleep a significant negative explanatory variable (P = .004) of FSIQ/DQ scores. The proportion of seizure‐free patients 2 years after epilepsy surgery did not differ significantly between the two groups (P = .19).

Significance

Although the “hurdles” pattern does not fulfill the criteria of ESES, it is associated with a pronounced cognitive dysfunction. Disturbed sleep structure marked by reduced sleep spindles and generalized spiking in sleep is associated with worse cognitive performance. Despite having a generalized nature, we did not find a lower probability of postsurgical seizure freedom in patients with “hurdles” pattern.
A score to map the lateral nonprimary motor area: Multispectrum intrinsic brain activity versus cortical stimulation
Authors: Neshige Shuichiro , Kobayashi Katsuya , Matsuhashi Masao , Togo Masaya , Sakamoto Mitsuhiro , Shimotake Akihiro , Hitomi Takefumi , Kikuchi Takayuki , Yoshida Kazumichi , Kunieda Takeharu , Matsumoto Riki , Maruyama Hirofumi , Takahashi Ryosuke , Miyamoto Susumu , Ikeda Akio
Published: October 2019

Objective

Multispectrum electrocorticographic components are critical for mapping the nonprimary motor area (NPMA). The objective of this study was to derive and validate a reliable scoring system for electrocorticography‐based NPMA mapping (NPMA score) to replace electrical cortical stimulation (ECS) during brain surgery.

Methods

We analyzed 14 consecutive epilepsy patients with subdural electrodes implanted in the frontal lobe at Kyoto University Hospital. The NPMA score was retrospectively derived from multivariate analysis in the derivation group (patients = 7, electrodes = 713, during 2010‐2013) and validated in the validation group (patients = 7, electrodes = 772, during 2014‐2017). We assessed the accuracy and reliability of the score relative to ECS in determining the NPMA and predicting postoperative functional outcomes.

Results

Multivariate analysis in the derivation group led to an 8‐point score for predicting ECS‐based NPMA (1 point for anatomical localization of the electrode and 1 or 2 points for movement‐related electrocorticographic components regardless of somatotopy in very slow cortical potential shifts [<0.5 Hz], 40‐80–Hz band power increase, and 8‐24–Hz band power decrease), which was validated in the validation group. The area under the receiver operating characteristic curve (AUC) was 0.89 in the derivation group. Good prediction (specificity = 94%, sensitivity = 100%) and discrimination (AUC = 0.87) were reproduced in the validation group. Overall, higher NPMA scores identified 2 patients with postoperative deficits after frontal lobe resection.

Significance

The NPMA score is reliable for NPMA mapping, potentially replacing ECS. It is a potential prognostic marker for postoperative functional deficits.
Sex differences in disease avoidance behavior vary across modes of pathogen exposure
Authors: Keiser Carl N. , Rudolf Volker H.W. , Luksik Matthew C. , Saltz Julia B.
Published: October 2019

Sex differences in disease susceptibility are widespread, and these disparities are often compounded in cases where sexual dimorphism increases exposure risk to parasites for one sex more than the other. Studies rarely link sex differences in disease susceptibility to sex differences in infection avoidance behavior. Yet, understanding the intersection of hosts’ susceptibility to infection and infection avoidance behavior is essential to predicting infection risk variation. Here, we use the fruit fly Drosophila melanogaster and a generalist entomopathogenic fungus, Metarhizium robertsii, which can be transmitted directly, indirectly, and post‐mortem as a model host–pathogen system. We test whether the relationship between susceptibility to infection and pathogen avoidance behavior covaries with host sex. We first measured differences in resistance between male and female flies after three different types of exposure—direct, sexual, and environmental—to infectious fungal conidiospores. Then, we tested whether male and female flies differed in the likelihood of mating with infected partners and their avoidance of food patches with increased infection risk. Females were more susceptible to infection under all three exposure techniques. When confronted with an infectious partner, females mated sooner than males. However, when given a choice between an exposed partner and an unexposed partner, females take longer to begin copulating compared with males, though neither sex was more likely to choose the unexposed partner than expected by chance. Neither male nor females flies avoided food patches containing infectious conidiospores, though only females show an aversion to food sites containing an infectious fly corpse. These experiments suggest that sex differences in disease susceptibility may be counteracted via differential pathogen avoidance behavior, though the strength of avoidance behavior appears to vary across different contexts of infection risk.