bluuebunny/crossref_metadata_2025 huggingface dataset:
Posterior parietal cortex represents sensory history and mediates its effects on behavior
Authors: Akrami Athena , Kopec Charles D. , Diamond Mathew E. , Brody Carlos
Published: August 2017

Many models of cognition and of neural computations posit the use and estimation of prior stimulus statistics1–4: it has long been known that working memory and perception are strongly impacted by previous sensory experience, even when that sensory history is irrelevant for the current task at hand. Nevertheless, the neural mechanisms and brain regions necessary for computing and using such priors are unknown. Here we report that the posterior parietal cortex (PPC) is a critical locus for the representation and use of prior stimulus information. We trained rats in an auditory Parametric Working Memory (PWM) task, and found that rats displayed substantial and readily quantifiable behavioral effects of sensory stimulus history, similar to those observed in humans5,6and monkeys7. Earlier proposals that PPC supports working memory8,9predict that optogenetic silencing of this region would impair behavior in our working memory task. Contrary to this prediction, silencing PPC significantly improved performance. Quantitative analyses of behavior revealed that this improvement was due to the selective reduction of the effects of prior sensory stimuli. Electrophysiological recordings showed that PPC neurons carried far more information about sensory stimuli of previous trials than about stimuli of the current trial. Furthermore, the more information about previous trial sensory history in the neural firing rates of a given rat’s PPC, the greater the behavioral effect of sensory history in that rat, suggesting a tight link between behavior and PPC representations of stimulus history. Our results indicate that the PPC is a central component in the processing of sensory stimulus history, and open a window for neurobiological investigation of long-standing questions regarding how perception and working memory are affected by prior sensory information.
Drug discovery to counteract antinociceptive tolerance with mu-opioid receptor endocytosis
Authors: Chao Po-Kuan , Ke Yi-Yu , Chang Hsiao-Fu , Huang Yi-Han , Ou Li-Chin , Chuang Jian-Ying , Lin Yen-Chang , Lee Pin-Tse , Chang Wan-Ting , Chen Shu-Chun , Ueng Shau-Hua , Hsu John Tsu-An , Tao Pao-Luh , Law Ping-Yee , Loh Horace H. , Shih Chuan , Yeh Shiu-Hwa
Published: August 2017

Morphine antinociceptive tolerance is highly correlated with its poor ability to promote mu-opioid– receptor (MOR) endocytosis. Our objective was to discover a novel positive allosteric modulator of MOR to enhance morphine-induced MOR endocytosis. We used high-throughput screening to identify several cardiotonic steroids as positive allosteric modulators of morphine-induced MOR endocytosis having high potency and efficacy, independently of Na+/K+-ATPase inhibition. Convallatoxin was found to enhance morphine-induced MOR endocytosis through an adaptor protein 2/clathrin-dependent mechanism without regulating G protein- orβ-arrestin-mediated pathways. Both F243 and I292 residues of MOR were essential to the effect of convallatoxin on MOR endocytosis. Co-treatment with chronic morphine and convallatoxin reduced morphine tolerance in animal models of acute thermal pain and chronic inflammatory pain. Acute convallatoxin administration reversed morphine tolerance in morphine-tolerant mice. These findings suggest that cardiotonic steroids are potentially therapeutic for morphine side effects and open a new avenue for the study of MOR trafficking.
The cultural dividend: a hidden source of economic growth in emerging countries
Authors: Li Shaomin , Park Seung Ho , Selover David Duden
Published: August 2017

Purpose

The purpose of this paper is to develop the theoretical linkage between culture and economic growth and empirically test the relationship by measuring culture and how it affects labor productivity.

Design/methodology/approach

This study uses a cross-section study of developing countries and regresses economic productivity growth on a set of control variables and cultural factors.

Findings

It is found that three cultural factors, economic attitudes, political attitudes, and attitudes towards the family, affect economic productivity growth.

Originality/value

Many economists ignore culture as a factor in economic growth, either because they discount the value of culture or because they have no simple way to quantify culture, resulting in the role of culture being under-researched. The study is the first to extensively examine the role of culture in productivity growth using large-scale data sources. The authors show that culture plays an important role in productivity gains across countries, contributing to the study of the effects of culture on economic development, and that culture can be empirically measured and linked to an activity that directly affects the economic growth – labor productivity.
Modeling and control of an unbalanced magnetic rotor-bearing system as a bearingless motor
Authors: Chen Shyh-Leh , Lee Pei-Hua , Toh Chow-Shing
Published: August 2017

Purpose

This paper is concerned with the design and analysis of a bearingless motor.

Design/methodology/approach

The bearingless motor is obtained by a regular three-pole active magnetic bearing with an intentionally attached unbalanced mass on the rotor. It is the unbalanced mass that will generate the rotational torque for the motor function. Modeling and control of the unbalanced mass-type bearingless motor have been considered.

Findings

It is found through simulations that both functions of motor and magnetic bearing can indeed be achieved in this system.

Originality/value

This novel bearingless motor requires no additional windings and permanent magnets. Thus, it can greatly reduce the cost and design of the bearingless motor.
Smart cities
Authors: Öberg Christina , Graham Gary , Hennelly Patrick
Published: August 2017

Purpose

The smart city idea refers to new ways of organising city functions and urban life, which are believed to move production and consumption from global to local, manufacturing from competitive to collaborative, and business from a shareholder to a multiple-stakeholder point of view. Most previous research has focussed on the societal level of smart cities, while less seems to be known about the management of business as part of smart cities. The purpose of this paper is to present a literature review on the state of the art of management research on smart cities. The following research question is addressed: How has previous research captured the management of organisations in smart cities?

Design/methodology/approach

A literature review using the search term “smart city/cities” in research on business, management, and operational management was conducted for the purpose of capturing previous research. Findings were coded based on main ideas, central concepts, and theories, thematic content of the articles related to the main ideas underpinning smart cities (digitalization, urbanisation, and sustainability as antecedents, and local, collaborative and multiple-stakeholder manufacturing as indicators), and units of analysis.

Findings

The paper points to how most studies on the management of organisations as part of smart cities focus on sustainability and how digitalisation enables new businesses. Collaborative efforts are emphasised and the theoretical framing is fragmented. Issues related to the organising of business is also not problematised and the business network approach could, as discussed in the paper, provide valuable insights related to the collaborative efforts of organisations and the multiple-stakeholder perspective.

Originality/value

The paper is the first to capture and present an overview of previous research on the management of business as part of smart cities. Research on smart cities has focussed on the policy and societal levels, and so far there is a lack of problematisation on how organisations may act, and potentially change their way of acting, should smart cities become a reality.
Business models in business networks – how do they emerge?
Authors: La Rocca Antonella , Snehota Ivan
Published: August 2017

Purpose

The expanding body of research on business models generally assumes that firms operate in a “transactional” context. Several recent studies suggest that the concept of business models in contexts where relationships matter, such as business markets, involves issues that the transactional microeconomic perspective is ill suited to capture. In the expanding literature on business models, the role of context in how business models emerge and evolve is a topic that appears under researched. The purpose of this paper is to review the findings of these studies and explore how “relational context” affects the emergence and evolution of business models.

Design/methodology/approach

The authors review the literature on business models in business markets where high-involvement relationships with customers and suppliers are common, and report a case to illustrate the critical issues involved.

Findings

The authors find that context where high-involvement relationships are common implies that business models are relationship specific and tend to be different across key relationships of a business; the involvement of others limits the autonomy of a single business in developing its business model; business models are continuously emergent and transient.

Originality/value

This study is among the few that examine the emergence and evolution of business model in business network in a longitudinal perspective. The value of the study also lies in the implications of the relationship-centric business model for management practice and research.
Public procurement reform in the EU: start of a new era?
Authors: Torvatn Tim , de Boer Luitzen
Published: August 2017

Purpose

The purpose of this paper is to study the reform of public purchasing directives initiated by the European Union (EU) and discuss them in light of the criticism against existing public purchasing directives.

Design/methodology/approach

A literature review of empirical articles is critical to existing public purchasing directives to summarize the main directions and categories of their criticism, and a thorough reading of the proposed reform of the public purchasing directives is carried out to see if the changes will answer some or all of the criticism directed toward the public purchasing directives.

Findings

The reforms seem to be a step in the right direction, particularly with respect to public organizations possibility to support innovation and new product and service development, but little change in the possibilities for development of strategic, long-term relationships.

Research limitations/implications

The reform has just been introduced, and so the analysis of the possible effects of the reform is not based on empirical data (since such data do not exist yet), but mostly on the authors experience in the field and through a comparison with selected literature.

Originality/value

An early assessment of the possible effects of the reform regarding public procurement directives in the EU area is introduced.
Shifting the balance of care…and making the money add up
Authors: Wilderspin John
Published: August 2017

Purpose

A critical commentary on policy and practice over time in English health and social care. The paper aims to discuss these issues.

Design/methodology/approach

Personal reflections based on prior experience as a senior leader in the English health and care system, combined with insights and relevant evidence from other senior leaders and health and care “think-tanks”.

Findings

Shifting the balance of care from a hospital to a community setting can potentially be cost-effective as well as improving quality for service users. However, it will require a change in the approach to planning and implementation, by focussing on service users and communities, rather than on statutory organisations. It will also require a greater level of integration between primary care, community health services, social care and the voluntary sector, and greater levels of “co-production” with service users and the public.

Research limitations/implications

Front-line health and care leaders are generally unaware of the evidence base in this field. Emergent findings in this field need to be rapidly evaluated and then communicated to front-line leaders and practitioners.

Originality/value

Incorporates direct experience of senior leaders in the field together with the existing and emerging evidence base.
Professionals’ views on integrated care
Authors: Jolanki Outi , Tynkkynen Liina-Kaisa , Sinervo Timo
Published: August 2017

Purpose

Integrated care policies have been at the heart of recent health reforms in many European countries. The purpose of this paper is to study the integration from the perspective of health care personnel working in primary health care clinics.

Design/methodology/approach

The study employs data from interviews collected in a research project examining patient choice and integrated care in primary health care clinics in Finland. The interviews were conducted in five cities in Southern Finland in 17 primary health care clinics in Autumn 2014. Among the interviewees there were both doctors (n=32) and nurses (n=31).

Findings

The typical problems hindering integration were, according to the workers, poor communication and insufficient information exchange between professionals, unclear definition of responsibilities between professionals, and lacking contacts and information exchange between health and social care professionals. To secure availability and continuity of care, doctors and nurses did extra work and exceeded their duties or invented ad hoc solutions to solve the problem at hand. According to professionals, patients were forced to take an active role as coordinator of their own care when responsibilities were not clearly defined between professionals.

Originality/value

This paper highlights that successful integration requires taking into account the requirements of the day-to-day work of health care clinics, and clarifying what facilitates and what hinders practical collaboration between different actors in health care and between health care and other service providers.
Neonicotinoid insecticides differently modulate acetycholine‐induced currents on mammalian α7 nicotinic acetylcholine receptors
Authors: Cartereau Alison , Martin Carine , Thany Steeve H
Published: August 2017

Background and Purpose

Neonicotinoid insecticides are described as poor agonists of mammalian nicotinic ACh receptors. In this paper, we show that their effects on mammalian nicotinic receptors differ between compounds.

Experimental Approach

Two‐electrode voltage‐clamp electrophysiology was used to characterize the pharmacology of three neonicotinoid insecticides on nicotinic α7 receptors expressed in Xenopus oocytes. Single and combined application of clothianidin, acetamiprid and thiamethoxam were tested.

Results

Two neonicotinoid insecticides, clothianidin and acetamiprid, were partial agonists of mammalian neuronal α7 nicotinic receptors, whereas another neonicotinoid insecticide, thiamethoxam, which is converted to clothianidin in insect and plant tissues, had no effect. Pretreatment with clothianidin and acetamiprid (10 μM) ACh significantly enhanced the subsequent currents evoked by ACh (100 μM ) whereas pretreatment with thiamethoxam (10 μM) reduced ACh‐induced current amplitudes.A combination of the three neonicotinoids decreased the ACh‐evoked currents.

Conclusions and Implications

The present findings suggest that neonicotinoid insecticides differ markedly in their direct effects on mammalian α7 nicotinic ACh receptors and can also modulate ACh‐induced currents. Furthermore, our data indicate a previously unknown modulation of mammalian α7 nicotinic receptors by a combination of clothianidin, acetamiprid and thiamethoxam.

Linked Articles

This article is part of a themed section on Nicotinic Acetylcholine Receptors. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.11/issuetoc
Transcrestal sinus floor augmentation with immediate implant placement applied in three types of fresh extraction sockets: A clinical prospective study with 1‐year follow‐up
Authors: Chen Yaqian , Yuan Shanshan , Zhou Nan , Man Yi
Published: August 2017

Background

Immediate implant insertion and transcrestal sinus augmentation both can provide a lot of advantages for patients and clinicians.

Objective

This prospective study aims to verify the use of a modified technique for immediate implant insertion simultaneously with sinus augmentation in different types of sockets.

Materials and methods

Thirty‐seven patients were recruited for the clinical study and were divided into 3 groups according to the relationship of their maxillary molar roots and sinus floor: group 1 with none of the teeth roots contacts sinus floor; group 2 as at least 1 teeth root contacting sinus floor, but no root is observed penetrating into sinus cavity; group 3 with at least 1 teeth root penetrating into sinus cavity. Implants were inserted after transcrestal sinus floor augmentation and immediately after tooth extraction. The change of mucosa thickness, diagnosis of rhinosinusitis, marginal bone loss (MBL), pocket depth (PD), and sulcus bleeding index were examined through radiographic measurement or clinical monitoring.

Result

During the study period, no implants failed. The relationship of the root of maxillary molars and sinus floor may have an effect on the bone height of the interradicular crest. Sinus mucosa was observed thicker after surgery. After healing period, sinus mucosa returned as thin as presurgery. At the time of 1‐year follow‐up, MBL was measured on X‐ray (group 1: mesial: 0.63 ± 0.20 mm, distal: 0.70 ± 0.14 mm; group 2: mesial: 0.67 ± 0.21, distal: 0.65 ± 0.22 mm; group 3: mesial: 0.70 ± 0.15 mm, distal: 0.73 ± 0.19 mm). No statistical difference was found in MBL and PD as well as bleeding index among 3 groups.

Conclusion

In consideration of the advantages of sinus floor augmentation and immediate implant placement, our clinical result confirms that it is promising to combine the 2 techniques for replacing maxillary molars especially when using residual roots as implant orientation and taking full advantage of the interradicular crest bone.
Effects of animal species and diet composition on long‐chain alcohol faecal recoveries and accuracy of subsequent diet composition estimates
Authors: Ferreira L. M. M. , López López C. , Celaya R. , Osoro K. , Rodrigues M. A. M.
Published: August 2017

Long‐chain alcohols (LCOH) were evaluated as markers to estimate diet composition of ruminant species fed with two distinct diets composed of herbage and “heather” (Ericaceae species). Diet composition was estimated using LCOH, combined or not with n‐alkanes and/or long‐chain fatty acids (LCFA), by least‐squares procedures, using faecal concentrations corrected or not for their incomplete recovery. The effect of grouping plant species with similar marker profiles and the impact of feeding selectivity (FS) within the dietary group on the accuracy of diet composition estimates were also evaluated. Results showed the usefulness of LCOH as diet composition markers. The LCOH were incompletely recovered in the faeces of all animal species and tended to increase with carbon‐chain length in a curvilinear manner in cattle and sheep, whereas in goats this association was better described by a linear function. Accuracy of estimates was higher when LCOH and n‐alkane markers were combined. For all marker types, results indicated that a correction of marker faecal concentrations to incomplete faecal recovery is needed to obtain accurate diet composition estimates. Grouping plant species with similar marker profiles improved the accuracy of estimates, whereas combination of marker types minimized the FS effect within the dietary group.
Measuring Smart Land Use in Urban–Rural Regions of China: A Case Study of Pukou, Nanjing City
Authors: Wei Cao , Shenglu Zhou , Shaohua Wu
Published: August 2017

This article expands the study of smart growth from urban space to urban–rural regions based on land use. It analyses smart land use in urban–rural regions. The study sets up an integrated measure indicator system of smart land use in urban–rural regions, which consisted of three subsystems: land amount controls, land form compactness, and land use efficiency. As a case study, the system was used to measure the smart land use in the Pukou District of Nanjing City, an area with intensive urbanization in the Yangtze River Delta of China. The results show that smart land use in the investigated area is increasing year by year, but it remains to be further improved. The integrated measure indicator system of smart land use in urban–rural regions is effective for measuring the level and status of regional smart land use.
Jaw sensorimotor control in healthy adults and effects of ageing
Authors: Avivi‐Arber L. , Sessle B. J.
Published: August 2017

The oro‐facial sensorimotor system is a unique system significantly distinguished from the spinal sensorimotor system. The jaw muscles are involved in mastication, swallowing and articulatory speech movements and their integration with respiration. These sensorimotor functions are vital for sustaining life and necessitate complex neuromuscular processing to provide for exquisite sensorimotor control of numerous oro‐facial muscles. The function of the jaw muscles in relation to sensorimotor control of these movements may be subject to ageing‐related declines. This review will focus on peripheral, brainstem and higher brain centre mechanisms involved in reflex regulation and sensorimotor coordination and control of jaw muscles in healthy adults. It will outline the limited literature bearing on age‐related declines in jaw sensorimotor functions and control including reduced biting forces and increased risk of impaired chewing, speaking and swallowing. The mechanisms underlying these alterations include age‐related degenerative changes within the peripheral neuromuscular system and in brain regions involved in the generation and control of jaw movements. In the light of the vital role of jaw sensorimotor functions in sustaining life, normal ageing involves compensatory mechanisms that utilise the neuroplastic capacity of the brain and the recruitment of additional brain regions involved in sensorimotor performance and closely associated functions (e.g. cognition and memory). However, these regions are themselves susceptible to detrimental age‐related changes. Thus, better understanding of the peripheral and central mechanisms underlying age‐related sensorimotor impairment is crucial for developing improved treatment approaches to prevent or cure impaired jaw sensorimotor functions and to thereby improve health and quality of life.
FRICTION STIR WELDING OF NYLON -6: EFFECT OF PROCESS PARAMETERS ON MECHANICAL AND MICROSTRUCTURAL PROPERTIES
Authors: Ethiraj N. , Sivabalan T. , Vijaya Raghavan C. , Mourya Shubham
Published: August 2017

Friction stir welding (FSW) is solid state joining process with more advantages than that of fusion welding. Nylon -6 is one of the engineering plastics used widely in various industrial applications. The main aim of this research work is to investigate the effect of tool rotational speed and tool traversing speed on the mechanical and microstructural properties of the nylon-6 butt welded joints made by FSW. The FSW process was performed in a computer numerically controlled (CNC) vertical milling machine using a cylindrical tool with threaded pin made of heat treated high carbon high chromium (HCHCr) steel. The tensile testing and microscopic examinations were carried out to study the mechanical and microstructural properties of the welded joints. In visual inspection, it is observed that the excessive flashes are observed on either sides of the weld line in all cases. From the results, it is observed that the maximum tensile properties are achieved in a joint made which is approximately 18% and 26% of the parent material’s ultimate tensile strength (UTS) and yield strength (YS) respectively with the tool rotational speed 1200 rpm and the tool traversing speed of 30 mm/min within the experimented process parameters. Overall, the tensile properties of the welded joints made using the experimented process parameters are very much lower than the parent material.
DOUBLE BOOTSTRAP CONTROL CHART FOR MONITORING SUKUK VOLATILITY AT BURSA MALAYSIA
Authors: Lola Muhamad Safiih , Zainuddin Nurul Hila , Ramlee Mohd Noor Afiq , Sofyan Hizir
Published: August 2017

The bootstrap approach on control limit has provided a solution in solving uncertainty estimation problem in control chart performance. However, the limitation of this standard chart has shown to be less efficient and invalidation at certain magnitude shift, especially the monitored sample data is assumed from skewed family distribution. Thus, in this study, a double bootstrap base-model and its control limit is developed in order to improve the efficiency and decrease the invalidation chart performance. In order to test the performance of proposed model, a simulation study using Average Run Length (ARL) and Type II Error rate were implemented. The result has shown that the proposed chart is sensitive and effective in detecting the shift process for small and medium size of skewed sample data. Also, it has found that the proposed chart shown to has better performance on large magnitude shift. The performance of the proposed model was investigated further using sukuk volatility data at Bursa Malaysia. The result revealed that the double bootstrap control chart is sensitive to small shifts process when it can detect changes in the volatility faster. In other words, it is efficient in monitoring the shifts process. Thus, the proposed model could help the traders in making a new decision, for example, either save/hold for a certain period, sell or buy the sukuk certificate.
LIGHTWEIGHT ENCRYPTION FOR HIGH EFFICIENCY VIDEO CODING (HEVC)
Authors: A. Saleh Mohammed , Md. Tahir Nooritawati , Hashim Habibah
Published: August 2017

Video data are being compressed and distributed using one of several coding standards, among which the most recent and popular is the High Efficiency Video Coding (HEVC) standard. The threatening growth of security attacks, on the other hand, has brought security and privacy concerns to the attention of governments and people as well. In the absence of a reliable security system, shared multimedia data used on the public networks such as the internet will continue to be exposed to different types of attacks, making end-to-end encryption for video data a necessity to protect their sensitive information. Therefore, providing a reliable video security technique that complies to and fulfills the requirements of HEVC is pertinent. In this paper, a fast selective encryption approach is developed to provide protection for video bitstreams of HEVC, which can be used in real-time video applications, with low computational overhead and maintaining the standard’s video bit rate. This approach employs the popular Advance Encryption Standard (AES) algorithm to encrypt selected elements in the horizontal intra prediction modes. Experimental evaluations confirm the provision of adequate security level of video information, with no bitrate increase, no increase in computational delay and no additional impact on the compression performance when compared to non-secure techniques, while also achieving a satisfactory trade-off between the encryption reliability, flexibility, and computational complexity. The security level of this method was found to be strongly secure against plaintext and brute force attacks.
ENHANCED ANTI-FOULING BEHAVIOR AND PERFORMANCES OF NANO HYBRID PES-SIO2 AND PES-ZNO MEMBRANES FOR PRODUCED WATER TREATMENT
Authors: Kusworo Tutuk Djoko , Ismail Ahmad Fauzi , Aryanti Nita , Widayat Widayat , Qudratun Qudratun , Utomo Dani Puji
Published: August 2017

This research is implemented primarily to obtain the enhanced performance in terms of permeability, solute rejection and anti-fouling behavior of PES membrane towards produced water treatment by incorporating nano-SiO2 and nano-ZnO as nano inorganic filler. The fabricated membrane was modified through UV irradiation and immersion in Acetone-Ethanol mixture. The effect of several modification treatments is investigated in this study. Nano hybrid PES-SiO2 and PES-ZnO membrane were prepared using Loeb-Sourirajan methods (NIPS phase inversion). The casted membrane was exposed under UV lights for 2 min and followed by immersion in Acetone-Ethanol mixture for 24 h. The result of SEM and FTIR analysis confirmed that the nano particles incorporation change the membrane surface structure, while UV treatment and Ac-Et immersion significantly enhanced the hydrophilicity of membrane material. Nano hybrid membrane displayed high efficiency of oil removal up to >99%, the immersion in the Ac-Et increased the water permeability about 20% and caused slightly decrease in solute rejection. The modified nano hybrid membrane performed an anti-fouling behavior in produced water filtration process.
THE EVOLUTION OF CHANNEL SYSTEM IN THE NORTHEAST MALAY BASIN, TERENGGANU OFFSHORE
Authors: Sulaiman Noorzamzarina , Hamzah Umar , Samsudin Abd Rahim
Published: August 2017

This study aims to evaluate the evolution of the channel system in the Pleistocene-Recent succession in the northeast Malay Basin based on channel morphologies. The variable types of channel morphologies were determined from seven seismic time slices of study area. The fluvial channel became wider and low-sinuous when the sea-level rise. Meanwhile, the fluvial channel became narrower and high-sinuous when sea levels decreased. The point bars are seen in the meandering curve of the high-sinuosity channel. This occurred because of the sea-level decrease and more sediment being deposited in the study area. The point bars morphology do not appear in the transgressive event. An oxbow lake appeared in the 525 ms seismic time slice and is labelled as the oldest channel system. The channel morphologies then changed, and the oxbow lake does not appear in the younger system channel (Recent). The channel morphology changes have been proven to be affected by global sea-level changes.
Decreased severity of Shiga toxin-producingEscherichia colihaemolytic uraemic syndrome (STEC-HUS) in a child with type 1 von Willebrand disease
Authors: Geramita Matthew A , Hofer Johannes , Cooper James , Moritz Michael L
Published: August 2017

Shiga toxin-producingEscherichia coli-associated haemolytic uraemic syndrome (STEC-HUS) is characterised by haemolytic anaemia, thrombocytopenia and acute kidney injury. Von Willebrand Factor (vWF) is an important mediator of normal thrombi formation and indirect evidence suggests that vWF may play an important role in Shiga toxin-induced thrombi formation. Clinical evidence supporting the role of vWF in STEC-HUS is lacking. A 10-year-old girl with type 1 von Willebrand Disease (vWD) had a mild case of STEC-HUS, with nadir haemoglobin 7.3 g/dL and platelet count 105×109 cells/L and peak serum creatinine 0.56 mg/L and lactate dehydrogenase 741 U/L. This is the first report of STEC-HUS in a patient with vWD. We speculate that the quantitative deficiency of vWF associated with type 1 vWD may have attenuated the course of disease by reducing platelet aggregation, complement activation and thrombi formation. This case adds to a growing literature supporting a link between vWF and STEC-HUS.
What role does performance information play in securing improvement in healthcare? a conceptual framework for levers of change
Authors: Levesque Jean-Frederic , Sutherland Kim
Published: August 2017

Objective

Across healthcare systems, there is consensus on the need for independent and impartial assessment of performance. There is less agreement about how measurement and reporting performance improves healthcare. This paper draws on academic theories to develop a conceptual framework—one that classifies in an integrated manner the ways in which change can be leveraged by healthcare performance information.

Methods

A synthesis of published frameworks.

Results

The framework identifies eight levers for change enabled by performance information, spanning internal and external drivers, and emergent and planned processes: (1) cognitive levers provide awareness and understanding; (2) mimetic levers inform about the performance of others to encourage emulation; (3) supportive levers provide facilitation, implementation tools or models of care to actively support change; (4) formative levers develop capabilities and skills through teaching, mentoring and feedback; (5) normative levers set performance against guidelines, standards, certification and accreditation processes; (6) coercive levers use policies, regulations incentives and disincentives to force change; (7) structural levers modify the physical environment or professional cultures and routines; (8) competitive levers attract patients or funders.

Conclusion

This framework highlights how performance measurement and reporting can contribute to eight different levers for change. It provides guidance into how to align performance measurement and reporting into quality improvement programme.
Determining the sample size required to establish whether a medical device is non-inferior to an external benchmark
Authors: Sayers Adrian , Crowther Michael J , Judge Andrew , Whitehouse Michael R , Blom Ashley W
Published: August 2017

Objectives

The use of benchmarks to assess the performance of implants such as those used in arthroplasty surgery is a widespread practice. It provides surgeons, patients and regulatory authorities with the reassurance that implants used are safe and effective. However, it is not currently clear how or how many implants should be statistically compared with a benchmark to assess whether or not that implant is superior, equivalent, non-inferior or inferior to the performance benchmark of interest.

We aim to describe the methods and sample size required to conduct a one-sample non-inferiority study of a medical device for the purposes of benchmarking.

Design

Simulation study.

Setting

Simulation study of a national register of medical devices.

Methods

We simulated data, with and without a non-informative competing risk, to represent an arthroplasty population and describe three methods of analysis (z-test, 1−Kaplan-Meier and competing risks) commonly used in surgical research.

Primary outcome

We evaluate the performance of each method using power, bias, root-mean-square error, coverage and CI width.

Results

1−Kaplan-Meier provides an unbiased estimate of implant net failure, which can be used to assess if a surgical device is non-inferior to an external benchmark. Small non-inferiority margins require significantly more individuals to be at risk compared with current benchmarking standards.

Conclusion

A non-inferiority testing paradigm provides a useful framework for determining if an implant meets the required performance defined by an external benchmark. Current contemporary benchmarking standards have limited power to detect non-inferiority, and substantially larger samples sizes, in excess of 3200 procedures, are required to achieve a power greater than 60%. It is clear when benchmarking implant performance, net failure estimated using 1−KM is preferential to crude failure estimated by competing risk models.
Does ‘Time Together’ increase quality of interaction and decrease stress? A study protocol of a multisite nursing intervention in psychiatric inpatient care, using a mixed method approach
Authors: Molin Jenny , Lindgren Britt-Marie , Graneheim Ulla Hällgren , Ringnér Anders
Published: August 2017

Introduction

Despite the long-known significance of the nurse–patient relationship, research in psychiatric inpatient care still reports unfulfilled expectations of, and difficulties in, interactions and relationships between patients and staff. Interventions that create structures to allow quality interactions between patients and staff are needed to solve these problems. The aim of this project is to test effects of the nursing intervention Time Together and to evaluate the intervention process.

Methods and analysis

This is a multisite study with a single-system experimental design using frequent measures. The primary outcomes are quality interactions for patients and perceived stress for staff. Secondary outcomes are levels of symptoms of anxiety and depression for patients and stress of conscience for staff. A process evaluation is performed to describe contextual factors and experiences. Data are collected using questionnaires, participant observations and semistructured interviews. For analysis of quantitative data, both visual and statistical methods will be used. Qualitative data will be analysed using qualitative content analysis.

Ethics and dissemination

Ethical approval was granted by the Ethical Review Board in the region (Dnr 2016/339-31). The findings will contribute to the development of nursing interventions in general, but more specifically to the development of the intervention. This is relevant both nationally and internationally as similar interventions are needed but sparse. The findings will be disseminated through conference presentations and peer-reviewed publications.

Trial registration number

NCT02981563
Gender and psychosocial factors associated with healthy lifestyle in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort: a cross-sectional study
Authors: Patrão Ana Luísa , Almeida Maria da Conceição , Matos Sheila Maria Alvim , Chor Dora , Aquino Estela M. L.
Published: August 2017

Objectives

It has been estimated that over 50% of the premature deaths occurring in Western countries can be attributed to causes rooted in lifestyle. In turn, leading a healthy lifestyle has also been associated with a wide range of psychosocial factors. Today, it is known that these differ among men and women. The present article aimed to identify, from a gender-based perspective, the psychosocial factors associated with healthy lifestyles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort, the largest study concerning adult health conducted in Latin America to date.

Design

This cross-sectional study was conducted using ELSA-Brasil baseline data, collected between 2008 and 2010.

Setting

Six Brazilian public higher education and research institutions.

Participants

The ELSA-Brasil cohort consists of approximately 15 000 employees (8218 women and 6887 men), both currently working and retired.

Main outcome measures

The lifestyle indicator was constructed by summing the scores attributed to four different behaviours.

Results

The women of the ELSA-Brasil cohort have healthier lifestyles than men. In women, strong associations were found between a healthy lifestyle and age 60 years or older, Asian race and university level of education or higher. In men, being 60 years or older, of Asian or Caucasian race, having a high-school equivalent level of education or higher, being retired, having a housekeeper, having a good or very good self-perception of health and being satisfied with body image were the psychosocial factors associated with leading a healthy lifestyle.

Conclusions

The factors that influenced healthy lifestyles were found to differ among men and women, a fact that must be addressed when developing programmes designed to promote health.
Mortality and risk of cardiac complications among immediate survivors of accidental electric shock: a Danish nationwide cohort study
Authors: Hansen Steen Møller , Riahi Sam , Hjortshøj Søren , Mortensen Rikke , Køber Lars , Søgaard Peter , Torp-Pedersen Christian
Published: August 2017

Objective

Exposure to electric shock has been associated with an increased risk of developing delayed cardiac arrhythmias and cardiac diseases. We examined whether electric shock patients have an increased risk of developing cardiac disease, cardiac arrhythmias or death compared with the general Danish population.

Design

Matched cohort study.

Setting

A nationwide study in Denmark from 1994 to 2011.

Participants

We identified 11 462 Danish patients who visited an emergency ward or were admitted to a hospital due to electric shock from 1994 to 2011. Each patient was matched for age and sex with five random controls from the Danish population.

Main outcome measures

Mortality, cardiac procedures and cardiac diseases following electric shock.

Results

A total of 7390 electric shock patients were seen at an emergency ward and 4072 electric shock patients were admitted to a hospital. The median patient age was 28.6 years (Q1–Q3, 21.3–37.7) for the emergency ward patients and 26.4 years (Q1–Q3, 18.3–37.4) for admitted patients. In both groups, most patients were male (74.0% and 76.8%). Few of the electric shock patients had a record of cardiovascular disease at baseline (364/11 462, 3.2%). The 5-year cumulative incidence of death was 0.47% (95% CI 0.29% to 0.65%) for emergency ward patients and 1.04% (95% CI 0.71% to 1.37%) for admitted patients. No difference in 5-year survival was observed compared with matched controls (emergency ward, p=0.10; admitted patients, p=0.80). Fewer than four patients received a pacemaker within 30 days.

Conclusions

This nationwide study did not demonstrate an increase in mortality among patients seen at hospitals after accidental electric shock compared with a background population. Cardiac procedures and diseases following electric shock were very rare. We suggest that nearly all patients can be discharged safely from the emergency room after electric shock without further observation.
Validation of two case definitions to identify pressure ulcers using hospital administrative data
Authors: Ho Chester , Jiang Jason , Eastwood Cathy A , Wong Holly , Weaver Brittany , Quan Hude
Published: August 2017

Objective

Pressure ulcer development is a quality of care indicator, as pressure ulcers are potentially preventable. Yet pressure ulcer is a leading cause of morbidity, discomfort and additional healthcare costs for inpatients. Methods are lacking for accurate surveillance of pressure ulcer in hospitals to track occurrences and evaluate care improvement strategies. The main study aim was to validate hospital discharge abstract database (DAD) in recording pressure ulcers against nursing consult reports, and to calculate prevalence of pressure ulcers in Alberta, Canada in DAD. We hypothesised that a more inclusive case definition for pressure ulcers would enhance validity of cases identified in administrative data for research and quality improvement purposes.

Setting

A cohort of patients with pressure ulcers were identified from enterostomal (ET) nursing consult documents at a large university hospital in 2011.

Participants

There were 1217 patients with pressure ulcers in ET nursing documentation that were linked to a corresponding record in DAD to validate DAD for correct and accurate identification of pressure ulcer occurrence, using two case definitions for pressure ulcer.

Results

Using pressure ulcer definition 1 (7 codes), prevalence was 1.4%, and using definition 2 (29 codes), prevalence was 4.2% after adjusting for misclassifications. The results were lower than expected. Definition 1 sensitivity was 27.7% and specificity was 98.8%, while definition 2 sensitivity was 32.8% and specificity was 95.9%. Pressure ulcer in both DAD and ET consultation increased with age, number of comorbidities and length of stay.

Conclusion

DAD underestimate pressure ulcer prevalence. Since various codes are used to record pressure ulcers in DAD, the case definition with more codes captures more pressure ulcer cases, and may be useful for monitoring facility trends. However, low sensitivity suggests that this data source may not be accurate for determining overall prevalence, and should be cautiously compared with other prevalence studies.
Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients
Authors: van Lieshout Eline C C , Visser-Meily Johanna M A , Neggers Sebastiaan F W , van der Worp H Bart , Dijkhuizen Rick M
Published: August 2017

Introduction

Many patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.

Methods and analysis

In a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.

Ethics and dissemination

The study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.

Trial registration number

NTR6133