bluuebunny/crossref_metadata_2025 huggingface dataset:
From east to west and back again: the effects of reverse culture shock on female Saudi Arabian university students studying abroad
Authors: Winkel Carmen , Strachan Laura , Aamir Siddiqua
Published: November 2021

Purpose

The purpose of this study is to explore the experiences of Saudi Arabian university students returning home after having spent time away studying internationally. The investigation focused exclusively on female students who for diverse reasons were unable to complete their studies abroad.

Design/methodology/approach

A thematic analysis was applied to analyze the seven in-depth interviews conducted by the authors. By using an open coding method analytic patterns across the entire data set were identified and then analyzed.

Findings

The findings suggest that the students experienced reverse culture shock reintegrating and assimilating into their former lives in the Kingdom of Saudi Arabia and its conservative culture. This was especially surprising considering not one of the participants experienced culture shock when they first traveled to their host country – the USA, Canada or England.

Research limitations/implications

The study is limited to a small group of seven female undergraduates who are comparatively well educated and come from a middle and upper socioeconomic demographic. As a result, without additional research, the findings cannot be extended to groups outside of this demographic.

Practical implications

Students who have studied abroad need improved academic and social support networks when they return home, according to the findings. The authors want to raise awareness about the difficulties that students face upon their return. Teachers, counselors, and advisors need to be on the lookout for the symptomatology associated with these types of problems.

Social implications

Female Saudi students returning home after an extended period of study abroad face a variety of problems. They must fit into a restrictive, partriarchal culture in which they are not legally equal to men.

Originality/value

To date, there are no studies that shed light on reverse culture shock for students who returned to Saudi Arabia without a degree. Due to the large number of Saudi scholarship holders who study in English-speaking countries with government support, the study is the first attempt in this direction.
The management discourse: collective or strategic performance drive?
Authors: Verhoef Grietjie
Published: November 2021

Purpose

The purpose of this paper is to engage with the discourse on the assumed existence of an distinct “African management” model. It critically deconstructs the concepts and submits an alternative strategy to address the need to understand what is happening in management of business in Africa.

Design/methodology/approach

Qualitative critical text analysis is used to understand the discourse on the nature of “African management” from the extant literature. The identity theory informs the understanding of the references to “African” as fundamental to identify a distinct management model. This analysis is supplemented by empirical case study research into successful African business.

Findings

Scholars failed to conceptualise what is “African”, and subsequently also what constitutes “African management”. This conceptual void undermines the critical reconstruction of a single African management model. Empirical research into actual management practices emerge as fundamental to systematic progress in this discourse. This research points to diverse management traditions converging into pragmatic practices.

Research limitations/implications

Only a limited number of case studies were conducted into management history in Africa. This paper argues for an extended research programme, but this is future work.

Practical implications

It suggests a research strategy for scholars in African business studies, business history and management history to collaborate towards making a solid contribution to the economic development of our continent.

Social implications

This research has the potential of forging collaboration in business among all of the people in Africa.

Originality/value

A critical text analysis is used to expose the conceptual lacunae that undermines progress in the discourse. This paper contributes to the literature on “African management” by systematically deconstructing the concept of “African identity” as a prerequisite to the management discourse. By signalling ethnic nostalgia, the critical reconceptualisation of Africanness offers an intellectually creative strategy out of the stalled discourse.
Servant leadership and its association with an environment of empathic care: an empirical analysis of the perspectives of mid-level practitioners
Authors: Silver Reginald , Martin Mark
Published: November 2021

Purpose

At the nexus of servant leadership and empathic care, this paper aims to explore the perceptions that mid-level practitioners express regarding the role that servant leadership plays in fostering an environment of empathic care.

Design/methodology/approach

The authors surveyed mid-level practitioners across a large integrated health system (n= 167). Through exploratory factor analysis, we identify factors that serve as antecedents to an environment of empathic care. The factor analysis was complimented with partial least squares structural equation modeling to test a theoretical model of empathic care.

Findings

The model explains approximately 37% of the variance observed in an empathic care environment (R2= 0.372). The authors identify key constructs within servant leadership that health-care leaders can focus their efforts on to promote an environment of empathic care.

Originality/value

This study answers multiple calls for more empirical research into servant leadership and is one of the few studies that explores servant leadership within an exogeneous context. This research focuses on the perceptions of mid-level providers, whereas most extant servant leadership and empathy research focuses on the perceptions of patients. The authors extend servant leadership theory in a health-care context and support prior findings that servant leadership is a multidimensional construct. The authors outline a sound methodological approach for investigating the linkage between specific principles of servant leadership that can serve as predictors for the creation of an environment of empathic care.
Anti‐polymyositis/Scl antibody‐positive overlap syndrome of diffuse cutaneous systemic sclerosis, dermatomyositis, systemic lupus erythematosus, and antiphospholipid syndrome
Authors: Saito Shintaro , Endo Yukie , Nishio Mayu , Uchiyama Akihiko , Uehara Akihito , Toki Sayaka , Yasuda Masahito , Ishikawa Osamu , Muro Yoshinao , Motegi Sei‐ichiro
Published: November 2021

A 37‐year‐old Japanese man with a 3‐year history of diffuse cutaneous systemic sclerosis was admitted to our hospital with high fever, arthralgia, myalgia, and muscle weakness. A physical examination revealed facial erythema, Gottron’s sign, and mechanic’s hands in addition to skin sclerosis. Laboratory data revealed significantly elevated levels of creatine kinase and decreased complement. Anti‐RNP, anti‐Smith, anti‐DNA, anti‐β2‐glycoprotein 1, anti‐polymyositis (PM)/Scl75, and anti‐PM/Scl100 antibodies were detected. He also had urinary protein, interstitial lung disease, pericarditis, multifocal cerebral infarctions, and leukoencephalopathy. Thus, a diagnosis of overlap syndrome of diffuse cutaneous systemic sclerosis, dermatomyositis, and systemic lupus erythematosus with antiphospholipid syndrome was made. Because of the intractable course, he was treated with multiple immunosuppressive and immunomodulatory drugs, including three rounds of 1000 mg methylprednisolone pulse therapy. This is the first case report of anti‐PM/Scl antibody‐positive overlap syndrome of three major connective tissue diseases.
Aptasensors for mycotoxins in foods: Recent advances and future trends
Authors: Hou Yujiao , Jia Boyu , Sheng Ping , Liao Xiaofang , Shi Linchun , Fang Ling , Zhou Lidong , Kong Weijun
Published: November 2021

Mycotoxin contamination in foods has posed serious threat to public health and raised worldwide concern. The development of simple, rapid, facile, and cost‐effective methods for mycotoxin detection is of urgent need. Aptamer‐based sensors, abbreviated as aptasensors, with excellent recognition capacity to a wide variety of mycotoxins have attracted ever‐increasing interest of researchers because of their simple fabrication, rapid response, high sensitivity, low cost, and easy adaptability for in situ measurement. The past few decades have witnessed the rapid advances of aptasensors for mycotoxin detection in foods. Therefore, this review first summarizes the reported aptamer sequences specific for mycotoxins. Then, the recent 5‐year advancements in various newly developed aptasensors, which, according to the signal output mode, are divided into electrochemical, optical and photoelectrochemical categories, for mycotoxin detection are comprehensively discussed. A special attention is taken on their strengths and limitations in real‐world application. Finally, the current challenges and future perspectives for developing novel highly reliable aptasensors for mycotoxin detection are highlighted, which is expected to provide powerful references for their thorough research and extended applications. Owing to their unique advantages, aptasensors display a fascinating prospect in food field for safety inspection and risk assessment.
Third molar development in a London population of White British and Black British or other Black ethnicity
Authors: Andrews Sally E. , Roberts Graham , Set Pat , Warburton Fiona , Gilbert Fiona J.
Published: November 2021

Population differences in dental development between Black and White ethnic groups have been debated but not previously studied in the UK. Using inappropriate data for dental age estimation (DAE) could lead to erroneous results and injustice. Data were collected from dental panoramic radiographs of 5590 subjects aged 6–24 years in a teaching hospital archive. Demirjian stages were determined for left‐sided teeth and third molars and data collected regarding hypodontia and third molar agenesis. Third molar development in self‐assigned Black British, including other self‐assigned Black ethnicity, was compared with that of self‐assigned White British subjects. Data were compared for males and females in the two ethnic groups using T‐tests for Demirjian Stages A–G of third molar development and Mann‐Whitney tests for Stage H once a cut‐off age at the maximum age for Stage G had been imposed. Third molar development occurred earlier in subjects of Black ancestry compared to those of White ancestry. While both ethnic groups showed large age ranges for every third molar stage, in female subjects these generally occurred at least 1.5 years earlier, and in males at least one year earlier. Hypodontia and third molar agenesis were more prevalent in White British, but the ethnic difference in third molar development persisted in subjects with complete dentitions. This is a large study that confirms ethnic differences in a London population, emphasises the difficulties of establishing the 18‐year‐old threshold using DAE, and confirms the risk of overestimating the age of individuals of Black ethnicity using White ethnic reference data.
Influence of fat content and water activity on the heating pattern of model systems submitted to microwave heating
Authors: Pérez‐Reyes M.E. , Gómez‐Salazar J.A. , López‐Malo A. , Sosa‐Morales Maria Elena
Published: November 2021

This research analyzed the influence of fat content (1%, 3%, 5%, and 10%, w.b.) and of water activity (0.85, 0.90, 0.95, and 0.99) on the effectiveness of microwave heating within model systems (agar gel). Findings indicate that an increased fat content promotes more uniform heating in the model systems and results in longer heating times to reach the target temperature of 50°C. In the model systems with different aw values, the warming of the central model zone was slower while in the corners, heating was accelerated. Additionally, in these models, heating times increased as the aw was decreased.

Practical Application

The study of model systems allows for a detailed assessment of food when subjected to microwaves; and how heating is influenced by food properties such as aw and fat content. Findings indicate that changes in product formulation could improve the heating of ready‐to‐eat foods, either by increasing the fat content (better uniformity) or having high aw (shorter heating time).
A high‐throughput turbidimetric method for quantitative preparation of Plasmodiophora brassicae inoculum for bioassays
Authors: Yang Xinyu , Wang Siqi , Hong Yingzhe , Zhang Xinyu , Pang Wenxing , Piao Zhongyun , Feng Jie , Liang Yue
Published: November 2021

Clubroot caused by Plasmodiophora brassicae is one of the major diseases on cruciferous crops. This disease has been a problem all over the world and led to serious economic losses in cruciferous crop production. The improvement of clubroot management is dependent on the effectiveness of bioassays on pathogenicity or plant resistance. P. brassicae resting spore inoculum prepared from clubroot tissues was widely used in bioassays. Traditionally, resting spore concentration was measured by visual counting with a haemocytometer; however, this method is time‐consuming, labour intensive and with poor repeatability due to the tiny size of resting spores. In this study, we established a turbidimetric method to measure P. brassicae resting spore concentration of the inoculum. A regression curve was generated by plotting optical density of gradiently diluted resting spore suspension against the corresponding resting spore concentrations, which resulted in a logarithmic regression equation. This method was validated and proved to be robust and effective in determining resting spore concentration of different samples, and was further confirmed by bioassay of infection and clubroot development. In conclusion, we established a standard protocol to prepare P. brassicae inoculum and provided an effective method for resting spore concentration determination. The results of this study can be widely used in research activities on clubroot sustainable management when an effective assessment of P. brassicae biomass is needed.
Associations of common mental disorder with alcohol use in the adult general population: a systematic review and meta‐analysis
Authors: Puddephatt Jo‐Anne , Irizar Patricia , Jones Andrew , Gage Suzanne H. , Goodwin Laura
Published: November 2021

Background and Aims

Research has shown that alcohol use and common mental disorders (CMDs) co‐occur; however, little is known about how the global prevalence of alcohol use compares across different CMDs. We aimed to (i) report global associations of alcohol use (alcohol use disorder (AUD), binge drinking and consumption) comparing those with and without a CMD, (ii) examine how this differed among those with and without specific types of CMDs and (iii) examine how results may differ by study characteristics.

Methods

We used a systematic review and meta‐analysis. Cross‐sectional, cohort, prospective, longitudinal and case–control studies reporting the prevalence of alcohol use among those with and without a CMD in the general population were identified using PsycINFO, MEDLINE, PsyARTICLES, PubMed, Scopus and Web of Science until March 2020. Depression, anxiety and phobia were included as a CMD. Studies were included if they used a standardized measure of alcohol use. A random‐effects meta‐analysis was conducted to generate pooled prevalence and associations of AUD with CMD with 95% confidence intervals (CI). A narrative review is provided for binge drinking and alcohol consumption

Results

A total of 512 full‐texts were reviewed, 51 included in our final review and 17 in our meta‐analyses (n = 382 201). Individuals with a CMD had a twofold increase in the odds of reporting an AUD [odds ratio (OR) = 2.02, 95% CI = 1.72–2.36]. The odds of having an AUD were similar when stratified by the type of CMD (mood disorder: OR = 2.00, 95% CI = 1.62–2.47; anxiety/phobic disorder: OR = 1.94, 95% CI = 1.35–2.78). An analysis of study characteristics did not reveal any clear explanations for between‐study heterogeneity (I2 > 80%). There were no clear patterns for associations between having a CMD and binge drinking or alcohol consumption, respectively.

Conclusions

People with common mental disorders (depression, anxiety, phobia) are twice as likely to report an alcohol use disorder than people without common mental disorders.
Curvature and competitiveness: Carbon taxes in cattle markets
Authors: Schaufele Brandon
Published: November 2021

Environmental regulation can interact with agricultural markets to produce underappreciated competitiveness and leakage effects. This paper measures effective carbon tax stringency by structurally recovering the domestic supply schedule for a trade‐exposed beef cattle industry such that elasticities and carbon tax rates change with product prices (i.e., due to the curvature of the supply function). Two basic propositions from the economics of taxation—that excess burdens increase in elasticities and tax rates—are shown to cause the stringency of uniform carbon policy to vary nonlinearly with output prices. Based on the domestic supply function, the relationship between marginal excess burden, a measure of policy stringency from the industry's perspective, and product prices is estimated. Several policy‐relevant counterfactual scenarios are explored. Results show that with moderately high output prices, supply elasticities are small and the efficiency cost of a $40/tCO2e carbon tax (gross of environmental benefits) is less than $0.01 per dollar tax revenue. As prices decline, supply curves become increasingly elastic and marginal excess burdens grow rapidly.
Reference Points and Democratic Backsliding
Authors: Grillo Edoardo , Prato Carlo
Published: November 2021

We propose a theory of democratic backsliding where citizens' retrospective assessment of an incumbent politician depends on expectations that are endogenous to the incumbent's behaviour. We show that democratic backsliding can occur even when most citizens and most politicians intrinsically value democracy. By challenging norms of democracy, an incumbent can lower citizens' expectations; by not doubling down on this challenge, he can then beat this lowered standard. As a result, gradual backsliding can actually enhance an incumbent's popular support not despite but because of citizens' opposition to backsliding. This mechanism can only arise when citizens are uncertain enough about incumbents' preferences (e.g. owing to programmatically weak parties). Mass polarization, instead, can reduce the occurrence of backsliding while simultaneously increasing its severity.
Are adaptable employees more likely to stay? Boundaryless careers and career ecosystem perspectives on career adaptability and turnover
Authors: Wang Fuxi , Xu Ying , Zhou Xinyi , Fu Anguo , Guan Yanjun , She Zhuolin , Wang Zhimei , Bi Yanzhao
Published: November 2021

Employees with higher career adaptability (CA) have been shown in previous research to be more likely to build high‐quality social exchange relations with current employers, thereby displaying a lower intention to leave. Based on boundaryless careers and career ecosystem perspectives, this study aimed to challenge and enrich the extant understanding of this important question by examining the mixed effects of CA on turnover behavior. Results from a three‐wave survey study with 179 Chinese employees show that after controlling the baseline turnover intention (Time 1), CA (Time 1) predicted both affective commitment and relative deprivation at Time 2 (6 months after Time 1), which in turn produced opposite effects on voluntary turnover behavior at Time 3 (12 months after Time 1). Moreover, the boundaryless career mindset positively moderated the relationship between CA and relative deprivation and strengthened the indirect positive effect of CA on turnover behavior via relative deprivation. These results offer a more comprehensive and balanced view of the mixed role of CA in employees' turnover behavior and carry important implications for human resource management.
Leading in times of crisis: How perceived COVID‐19‐related work intensification links to daily e‐mail demands and leader outcomes
Authors: Venz Laura , Boettcher Katrin
Published: November 2021

The COVID‐19 crisis brought numerous challenges to work life. One of the most notable may be the acceleration of digital transformation, accompanied by an intensification of e‐mail usage and related demands such as high e‐mail workload. While research quickly started to examine the implications of these changes for employees, another important group of stakeholders has been overlooked: leaders. We focus on leaders during the COVID‐19 crisis and examine how COVID‐19‐related work intensification links to leaders' e‐mail overload appraisal and finally exhaustion and transformational leadership, a leader behaviour especially needed in times of crisis. In a 5‐day diary study in September 2020, 84 leaders responded to daily surveys on 343 days. Results of multilevel analysis showed that perceived COVID‐19‐related work intensification was positively linked to worktime spent dealing with e‐mail and appraised e‐mail overload. E‐mail overload appraisal was positively related to leaders' exhaustion, but unrelated to their transformational behaviour. Day‐specific time spent dealing with e‐mail, however, was negatively related to transformational leadership. E‐mail overload appraisal mediated the relationship between COVID‐19‐related work intensification and exhaustion. Turning the focus on leaders during the COVID‐19 crisis, our study has important implications for the design of work of leaders in times of crisis and beyond.
Prospective validation of the provisional entity of refractory cytopenia of childhood, proposed by the World Health Organization
Authors: Hama Asahito , Hasegawa Daisuke , Manabe Atsushi , Nozawa Kazue , Narita Atsushi , Muramatsu Hideki , Kosaka Yoshiyuki , Kobayashi Masao , Koh Katsuyoshi , Takahashi Yoshiyuki , Watanabe Kenichiro , Ohara Akira , Ito Masafumi , Kojima Seiji
Published: November 2021

In 2008, the World Health Organization proposed a new entity of childhood myelodysplastic syndrome (MDS), which was referred to as refractory cytopenia of childhood (RCC). However, whether this morphological classification reflects clinical outcomes remains unclear. We performed a prospective evaluation of bone marrow morphology in 252 children with acquired bone marrow failure between 2009 and 2013. Of 252 patients, 63 were diagnosed with aplastic anaemia (AA), 131 with RCC without multilineage dysplasia (RCC‐w/o‐MLD) and 58 with RCC with MLD (RCC‐MLD). One patient with AA, three with RCC‐w/o‐MLD and nine with RCC‐MLD presented with chromosomal abnormalities at diagnosis (P = 0·001). The response rates to immunosuppressive therapy (IST) at 6 months and the cumulative incidence of clonal evolution at 5 years did not significantly differ among the three groups. A multivariate analysis revealed that the morphological classification of RCC‐MLD was a significant risk factor for secondary graft failure after haematopoietic cell transplantation (HCT) (P = 0·003). In view of these findings, RCC could be divided into two categories, RCC‐w/o‐MLD and RCC‐MLD, because children with this condition exhibited a distinct morphology, frequent chromosomal abnormalities at diagnosis and a high frequency of secondary graft failure after HCT.
The diamond ratio: A visual indicator of the extent of heterogeneity in meta‐analysis
Authors: Cairns Maxwell , Cumming Geoff , Calin‐Jageman Robert , Prendergast Luke A.
Published: November 2021

The result of a meta‐analysis is conventionally pictured in the forest plot as a diamond, whose length is the 95% confidence interval (CI) for the summary measure of interest. The Diamond Ratio (DR) is the ratio of the length of the diamond given by a random effects meta‐analysis to that given by a fixed effect meta‐analysis. The DR is a simple visual indicator of the amount of change caused by moving from a fixed‐effect to a random‐effects meta‐analysis. Increasing values of DR greater than 1.0 indicate increasing heterogeneity relative to the effect variances. We investigate the properties of the DR, and its relationship to four conventional but more complex measures of heterogeneity. We propose for the first time a CI on the DR, and show that it performs well in terms of coverage. We provide example code to calculate the DR and its CI, and to show these in a forest plot. We conclude that the DR is a useful indicator that can assist students and researchers to understand heterogeneity, and to appreciate its extent in particular cases.
Quality forecasts: Predicting when and how much markets value higher‐protein wheat
Authors: Bekkerman Anton
Published: November 2021

Wheat markets stand out among other major crop commodity markets because pricing at the first point of exchange—typically a grain handling facility—is differentiated on specific quality characteristics. Moreover, the premiums and discounts that elevators offer to obtain grain of specific quality can be significant. The relative importance of quality premiums and discounts to farm‐level production and marketing decisions demonstrate a need to quantitatively measure and explain factors that affect elevators' wheat‐quality pricing decisions. This study develops an informed expectation model of elevators' quality‐based pricing strategies and empirically estimates the model from a lengthy dataset of weekly price observations. I find empirical evidence that elevators use linear pricing schedules, but more aggressively discount wheat with protein levels lower than a baseline than reward higher‐protein wheat. The results also indicate that weather characteristics, futures contract price indicators, and USDA Crop Progress reports are contributors to predicting the new crop protein premiums and discounts, and that out‐of‐sample accuracy for predicting how grain elevators will value wheat protein ranges between 70% and 80%.
A nerve conduit filled with Wnt5a‐loaded fibrin hydrogels promotes peripheral nerve regeneration
Authors: Liu Yi‐jun , Chen Xiao‐feng , Zhou Li‐ping , Rao Feng , Zhang Dian‐ying , Wang Yan‐hua
Published: November 2021

Aims

Peripheral nerve injury is a significant clinical problem with a substantial impact on quality of life, for which no optimal treatment has been found. This study aimed to analyze the effect and mechanism of Wnt5a‐loaded fibrin hydrogel on a 10‐mm rat sciatic nerve defect.

Methods

The Wnt5a‐loaded fibrin hydrogel was synthesized by mixing a Wnt5a solution with thrombin and fibrinogen solutions. The loading capacity and release profile of Wnt5a‐loaded fibrin hydrogel and the effect of Wnt5a on Schwann cells were evaluated in vitro. We also assessed the in vivo repair status via histological analysis of the regenerative nerve and gastrocnemius muscle, electrophysiological examination, gait analysis, and muscle wet weight.

Results

We developed a nerve conduit filled with Wnt5a‐loaded fibrin hydrogel (Fn) as a sustained‐release system to repair a 10‐mm rat sciatic nerve defect. In vitro, Wnt5a could promote SC proliferation and the gene expression of vascular endothelial growth factor (VEGF), nerve growth factor (NGF), and cholinergic neurotrophic factor (CNTF), as well as the protein secretion of VEGF and NGF. In vivo, the Wnt5a/Fn group was superior to the hollow, fibrin hydrogel, and Wnt5a groups in terms of axonal growth, myelination, electrophysiological recovery, target organ innervation, and motor function recovery 12 weeks after the operation.

Conclusion

The Wnt5a/Fn nerve conduit can promote peripheral nerve defect regeneration, with potential clinical applications. The mechanism for this may be the facilitation of multiple neurotrophin secretion, combining vascularization and neurotrophic growth cues.
Nodal metastases in small rectal neuroendocrine tumours
Authors: O’Neill Sarah , Haji Amyn , Ryan Suzanne , Clement Dominique , Sarras Konstantinos , Hayee Bu , Mulholland Nicola , Ramage John K. , Srirajaskanthan Rajaventhan
Published: November 2021

Aim

Rectal neuroendocrine tumours (NETs) are the most common type of gastrointestinal NET. European Neuroendocrine Tumour Society guidelines suggest that rectal NETs measuring ≤10 mm are indolent with low risk of spread. In practice, many patients with lesions ≤1 cm do not undergo complete tumour staging. However, the size of the lesion may not be the only risk factor for nodal involvement/metastases. The aim of this study was to determine if MRI ± nuclear medicine imaging alters tumour stage in patients with rectal NETs ≤10 mm.

Methods

Patients referred to a tertiary NET centre between 2005 and 2020 who met the inclusion criteria of a rectal NET ≤10 mm, full cross‐sectional imaging, primarily an MRI scan and, if abnormal findings were identified, a subsequent 68Ga‐DOTATATE positron emission tomography scan were included. All patients were followed up at our institution.

Results

In all, 32 patients with rectal NETs 10 mm or less were included in the study: 16 women; median age 58 years (range 33–71); 47% (n = 15) were referred from bowel cancer screening procedures. The median size of the lesions was 5 mm (range 2–10 mm). 81% (n = 26) were World Health Organization Grade 1 tumours with Ki67 <3%. Radiological staging confirmed nodal involvement in 25% (8/32); two cases had distant metastatic disease. Lymphovascular invasion was present in 3% (1/32) of patients but none demonstrated peri‐neural invasion.

Conclusion

This study demonstrates that small rectal NETs can develop nodal metastases; therefore it is important to stage these tumours accurately with MRI at baseline and, if there are concerns regarding potential lymph node metastases, to consider 68Ga‐DOTATATE positron emission tomography imaging.
Effectiveness and safety of empagliflozin in routine care patients: Results from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study
Authors: Patorno Elisabetta , Pawar Ajinkya , Wexler Deborah J. , Glynn Robert J. , Bessette Lily G. , Paik Julie M. , Najafzadeh Mehdi , Brodovicz Kimberly G. , Déruaz‐Luyet Anouk , Schneeweiss Sebastian
Published: November 2021

Aim

To investigate effectiveness and safety outcomes among patients with type 2 diabetes (T2D) initiating empagliflozin versus dipeptidyl peptidase‐4 (DPP‐4) inhibitor treatment across the broad spectrum of cardiovascular risk.

Methods

In a population‐based cohort study we identified 39 072 pairs of 1:1 propensity score‐matched adult patients with T2D initiating empagliflozin or DPP‐4 inhibitors, using data from 2 US commercial insurance databases and Medicare between August 2014 and September 2017. The primary outcomes were a composite of myocardial infarction (MI)/stroke, and hospitalization for heart failure (HHF). Safety outcomes were bone fractures, lower‐limb amputations (LLAs), diabetic ketoacidosis (DKA), and acute kidney injury (AKI). We estimated pooled hazard ratios (HRs) and 95% confidence intervals (CIs) adjusting for more than 140 baseline covariates.

Results

Study participants had a mean age of 60 years and only 28% had established cardiovascular disease. Compared to DPP‐4 inhibitors, empagliflozin was associated with similar risk of MI/stroke (HR 0.99 [95% CI 0.81‐1.21]), and lower risk of HHF (HR 0.48 [95% CI 0.35‐0.67] and 0.63 [95% CI 0.54‐0.74], based on a primary and any heart failure discharge diagnosis, respectively). The HR was 0.52 (95% CI 0.38‐0.72) for all‐cause mortality (ACM) and 0.83 (95% CI 0.70‐0.98) for a composite of MI/stroke/ACM. Empagliflozin was associated with a similar risk of LLA and fractures, an increased risk of DKA (HR 1.71 [95% CI 1.08‐2.71]) and a decreased risk of AKI (HR 0.60 [95% CI 0.43‐0.85]).

Conclusions

In clinical practice, the initiation of empagliflozin versus a DPP‐4 inhibitor was associated with a lower risk of HHF, ACM and MI/stroke/ACM, a similar risk of MI/stroke, and a safety profile consistent with documented information.
Transgastric imaging—The key to successful periprocedural TEE guiding for edge‐to‐edge repair of the tricuspid valve
Authors: da Rocha e Silva Jaqueline G. , Ruf Tobias F. , Hell Michaela M. , Tamm Alexander , Geyer Martin , Munzel Thomas , von Bardeleben Ralph Stephan , Kreidel Felix
Published: November 2021

Intraprocedural transesophageal echocardiography (TEE) guidance plays an essential role in transcatheter repair therapy of the tricuspid valve (TV). So far, several different imaging concepts are in use. We propose an imaging protocol that fully addresses the morphological complexity of the TV and further offers efficacious workarounds for the frequently occurring restrictions of TV imaging in edge‐to‐edge repair of the TV. As a tertiary referral center with a large experience of more than 250 cases of transcatheter edge‐to‐edge repair (TEER) of the TV performed at the Heart Valve Center in Mainz/Germany, we have constantly adapted our peri‐interventional echocardiographic approach to accomplish both. As a key measure for success, we intensely rely on the transgastric acoustic windows that not only deliver high‐resolution information on the morphology of the TV and all relevant procedural steps but also help to avoid the frequent shadowing artifacts experienced in transesophageal imaging.
How many macropods?A manager’s guide to small‐scale population surveys of kangaroos and wallabies
Authors: Coulson Graeme , Snape Melissa A. , Cripps Jemma K.
Published: November 2021

Every macropod population is unique in terms of the combination of species, site and management goals, so there is no universal ‘best’ method for surveying populations. We distinguish between different measures of abundance and the confidence a manager can place in them. We examine the separate components of survey methods: the survey platform, mode of detection and form of sampling. We also review the range of current methods available and highlight new developments, including their assumptions and limitations. To guide managers in choosing a method for their management context, we provide a decision matrix based on the behavioural ecology of the target species, the structure of habitat at the site and the porosity of the site boundary. To promote current best practice, we describe in detail four standard counting methods: direct count, sweep count, faecal accumulation rate and distance sampling.
Kangaroos in peri‐urban areas: A fool’s paradise?
Authors: Herbert Catherine A. , Snape Melissa A. , Wimpenny Claire E. , Coulson Graeme
Published: November 2021

Peri‐urban Eastern Grey Kangaroo (Macropus giganteus) populations can reach very high densities in areas with remnant native vegetation and adequate pasture. This review summarizes the scientific evidence for the impacts of these high‐density peri‐urban populations, which predominantly involve threats to human life and livelihood (kangaroo–vehicle collisions), impacts on threatened species and ecosystems and declines in the health of individual kangaroos. The latter two impacts result from an imbalance between the kangaroo population and their food resources. We argue that urban infrastructure is a fundamental driver of many of these inter‐related impacts through population fragmentation, isolation and direct mortality of kangaroos on roads. Roads may also act as barriers to movement, isolating populations and promoting this localized overabundance. However, not all peri‐urban kangaroo populations attain high densities. Combined with the impacts of climate change on resource availability, peri‐urban development has the capacity to push local populations towards extinction in actively urbanizing areas via the impacts of habitat loss and/or fragmentation and road mortality. The successful coexistence of people and kangaroos in these peri‐urban environments therefore requires a better understanding of the impacts of urban infrastructure on kangaroo population dynamics, and a better policy framework to promote ecologically sensitive development.
Pilot study of focused ultrasound for drug‐resistant epilepsy
Authors: Lee Cheng‐Chia , Chou Chien‐Chen , Hsiao Fu‐Jung , Chen Yi‐Hsiu , Lin Chun‐Fu , Chen Ching‐Jen , Peng Syu‐Jyun , Liu Hao‐Li , Yu Hsiang‐Yu
Published: November 2021

Objective

The neuromodulatory effects of focused ultrasound (FUS) have been demonstrated in animal epilepsy models; however, the safety and efficacy of FUS in humans with epilepsy have not been well established. Patients with drug‐resistant epilepsy (DRE) undergoing stereo‐electroencephalography (SEEG) provide an opportunity to investigate the neuromodulatory effects of FUS in humans.

Methods

Patients with DRE undergoing SEEG for localization of the seizure onset zone (SOZ) were prospectively enrolled. FUS was delivered to the SOZ using a neuronavigation‐guided FUS system (ceiling spatial‐peak temporal‐average intensity level = 2.8 W/cm2, duty cycle = 30%, modulating duration = 10 min). Simultaneous SEEG recordings were obtained during sonication and for 3 days after treatment. Seizures, interictal epileptiform discharges, and adverse events after FUS were monitored.

Results

Six patients met the eligibility criteria and completed FUS treatment. A decrease in seizure frequency was observed in two patients within the 3‐day follow‐up; however, one patient presented an increase in the frequency of subclinical seizures. Posttreatment magnetic resonance imaging revealed neither lesion nor brain edema. Significant changes in spectral power of SEEG were noted at the targeted electrodes during FUS treatment. One patient reported subjective scalp heating during FUS, and one patient developed transient naming and memory impairment that resolved within 3 weeks after FUS.

Significance

FUS can be safely delivered to the SOZ of patients with DRE, resulting in significant changes in spectral power of SEEG. A larger sample cohort and pursuing optimal sonication parameters will be required to elucidate the neuromodulatory effects of FUS when used for seizure control.
The effect of friction welding on the mechanical properties and corrosion fatigue resistance of titanium alloy drill pipe
Authors: Mou Yisheng , Lian Zhanghua , Li Wei , Zhong Xiankang , Li Jiuyi , He Yuantai , Cao Jinchao , Eliaz Noam
Published: November 2021

Titanium alloys are the best candidates to replace steels for drill pipes in horizontal wells. However, friction welding (FW) may significantly change the properties of titanium alloy drill pipes. In this work, the microstructure, tensile and impact mechanical properties, and corrosion fatigue performance of the FW zone were compared with those of the base alloy. The results show that the base material is mainly composed of equiaxed globular α (hcp)‐Ti, while the acicular α + β (bcc)‐Ti is dominant in the FW zone. Due to these differences in microstructure, the FW zone has higher strength but lower stiffness and toughness than the base alloy. In addition, the fatigue performance and corrosion resistance of the material decrease in drilling fluid. These results indicate that FW zones in titanium alloy drill pipes might be the weakest region where crack, fracture, and corrosion are more likely to occur.
Hydration and microhardness of mineral trioxide aggregate depending on ratio between di‐ and tricalcium silicates
Authors: Kim Yurian , Lee Se Woong , Rho Hyung Tay , Kim Sang‐il
Published: November 2021

Tricalcium silicate (C3S) and dicalcium silicate (C2S) are the main components related with the hydration process of mineral trioxide aggregates (MTAs) for endodontic materials. In this study, we investigate the influence of different ratios of C3S and C2S in a series of MTA samples with (100‐x)C3S‐xC2S‐18ZrO2 (x = 0, 10, 15, 34, and 100) on their physical and chemical characteristics, hydration process, and microhardness properties. The chemical compositional properties of different samples are measured using X‐ray diffraction, X‐ray photoelectron spectrometry, and scanning electron microscopy. The physical and microhardness properties are also investigated after the standard hydration process (ISO 6876:2021). Generally, the sample with higher C3S ratio induces the faster hydration, which results in decreased fluidity as well as shorter working and setting times. The microhardness generally decreases with larger C3S ratio.
Patient satisfaction with medication consultations and medicines information provided by nurses working autonomously in sexual health services: A questionnaire study
Authors: Black Adam , Gage Heather , Norton Christine , Franklin Bryony Dean , Murrells Trevor , Courtenay Molly
Published: November 2021

Aim

To compare the satisfaction of patients managed by independent nurse prescribers with that of patients managed by nurses using PGDs with respect to experience of the consultation and information received about the medication.

Design

Survey.

Methods

Patients receiving medications from nurses in five urban sexual health services in the United Kingdom completed validated questionnaires immediately after the consultation, September 2015–August 2016. Scores of independent nurse prescribers and nurses using patient group directions were compared about consultation experience (5 items) Satisfaction with Information about Medicines (SIMS 16 items scale).

Results

Of 808 patients receiving medications, 393 (48.6%) received questionnaires and 380 were returned (independent nurse prescribers 180 of 198, 90.9%; patient group directions 173 of 195, 88.7%). Patients in both groups reported high levels of satisfaction. About the consultation experience, patients found nurses friendly/ approachable (>99%), instilling confidence and trust (>99%) and explaining reasons for medications clearly (97%). Satisfaction with medication information: Of 348 (92%) respondents completing SIMS, the overall mean score was 13.4 of maximum 16 (no difference between groups, t‐test, p = .63).

Conclusions

Patients were highly satisfied with nurse consultations and information around medications regardless of whether they were managed by independent nurse prescribers or nurses using patient group directions.

Impact

Findings provide evidence in support of autonomous provision of medications by nurses in sexual health clinics.
Lysergic acid diethylamide induces increased signalling entropy in rats’ prefrontal cortex
Authors: Savino Aurora , Nichols Charles D.
Published: November 2021

Psychedelic drugs are gaining attention from the scientific community as potential new compounds for the treatment of psychiatric diseases such as mood and substance use disorders. The 5‐HT2A receptor has been identified as the main molecular target, and early studies pointed to an effect on the expression of neuroplasticity genes. Analysing RNA‐seq data from the prefrontal cortex of rats chronically treated with lysergic acid diethylamide (LSD), we describe the psychedelic‐induced rewiring of gene co‐expression networks, which become less centralised but more complex, with an overall increase in signalling entropy typical of highly plastic systems. Intriguingly, signalling entropy mirrors, at the molecular level, the increased brain entropy reported through neuroimaging studies in human, suggesting the underlying mechanisms of higher‐order phenomena. Moreover, from the analysis of network topology, we identify potential transcriptional regulators and propose the involvement of different cell types in psychedelics’ activity.

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Value of peripheral perfusion index to predict acute limb ischaemia in newborns after peripheral artery cannulation
Authors: Liu Xiaoshu , Nie Jiao , Pan Junhui , Fu Fang
Published: November 2021

Aims and objectives

To investigate the feasibility of using peripheral perfusion index (PPI) to monitor acute limb ischaemia (ALI) in newborns after catheterisations.

Background

ALI is common complication of neonatal peripheral artery cannulation. It is important to address as soon as the early signs of ALI. PPI could aid in noninvasive evaluation of distal extremity perfusion in an effort to notify risk of potential ischaemic injury from catheterisations.

Design

A nested case–control study.

Methods

Clinical information of newborns who had been admitted to the Neonatal Intensive Care Unit of Jiangxi Provincial Children's Hospital and had received peripheral artery cannulation from January 2018 to January 2020 was prospectively collected. Transcutaneous blood oxygen saturation (TcSO2), PPI and delta‐PPI (ΔPPI1; the difference in PPI values of the two arms. ΔPPI2; difference in the PPI values before and after cannulation) were recorded. We used STROBE checklist as an EQUATOR in this study.

Results

A total of 25 newborns with ALI were included in the study. These were then paired with 100 newborns without ALI. The PPI and TcSO2 of the cannulated limb were significantly lower in the ALI group than in the non‐ALI (NALI) group (p < .05). The area under the receiver‐operating characteristic curve was significant for ΔPPI1. The ΔPPI1 had a sensitivity and specificity of 92% and 87%, respectively, for diagnosing ALI. ΔPPI1 greater than 0.315 suggested that the infant was at risk of ALI.

Conclusions

Monitoring the change in the PPI in newborns after catheterisations helped in the early assessment of ALI.

Relevance to clinical practice

Drops in the PPI and TcSO2 of the cannulated limbs might, to some extent, reflect the possibility of ALI in newborns. ΔPPI1 (the difference in PPI values of the two arms) proved to be a simple, objective parameter to predict the presence of ALI.
Association between fetal vascular malperfusion and gestational diabetes
Authors: Goto Tomoko , Sato Yuichiro , Kodama Yuki , Tomimori Kayo , Sameshima Hiroshi , Aman Murasaki , Maekawa Kazunari , Yamashita Atsushi , Asada Yujiro
Published: November 2021

Aim

Diabetes mellitus (DM) is a major complication in pregnancy. Placental lesions with DM remain unclear and controversial. Recently, the terms of placental pathological findings, such as maternal and fetal vascular malperfusions (MVM and FVM, respectively) were introduced by the Amsterdam Placental Workshop Group Consensus Statement (APWGCS). FVM cases were classified as the partial obstruction type (global FVM) and the complete obstruction type (segmental FVM). The aim of this study was to clarify the pathological characteristics of the placenta with pregestational DM/gestational DM; GDM according to APWGCS.

Methods

We studied the placentas of 182 DM women (27 pregestational DM and 155 GDM) and control placentas of 460 women without DM during 2011–2018. We excluded cases of intrauterine fetal death or multiple pregnancies. We reviewed microscopical findings including, MVM, FVM, chorioamnionitis with the slides according to the APWGCS.

Results

Microscopically, the incidence of FVM was significantly higher in GDM patients than control (17% vs. 10%, p = 0.0138), but not significant in pregestational DM (11%, p = 0.7410). Segmental FVM (complete obstruction) was significantly more observed in GDM than control group (5% vs. 0.4%, p = 0.0013). Segmental FVM in GDM showed high incidence of light‐for‐dates infant (three of seven cases, 43%, p = 0.0288). In addition, several segmental FVM findings (villous stromal‐vascular karyorrhexis and stem vessel occlusion) were frequently noted in 2 or 3 points positive of 75 g oral glucose tolerance test than 1 point positive GDM.

Conclusion

Our placental findings suggest disorder of carbohydrate metabolism might affect the fetal vascular damage, especially complete fetal vascular obstruction.