bluuebunny/crossref_metadata_2025 huggingface dataset:
Verifying alternative measures of healthcare service quality
Authors: Shafei Ingy , Walburg Jan , Taher Ahmed
Published: February 2019

Purpose

The purpose of this paper is to determine the best measure among several alternatives (SERVQUAL, weighted SERVQUAL, SERVPERF, weighted SERVPERF) and develop a scale which healthcare providers can use for measurement of healthcare service quality.

Design/methodology/approach

The study involved two phases. The first phase was through a series of in-depth interviews with experts and patients followed by a pilot study. Subsequently, the second phase involved a quantitative phase through surveys with 384 patients. Alternative measures were analyzed using coefficient (Cronbach) α, composite reliability, factor analysis and logistic regression analysis.

Findings

Findings confirmed “Weighted SERVPERF” using an interactive methodology as the most appropriate for measurement of healthcare service quality.

Originality/value

Using the model and scale developed, healthcare providers will be able to measure healthcare service quality and identify areas of shortfall and act accordingly to improve delivery through allocating resources in service areas that would generate the greatest returns in customer satisfaction. Enhancing satisfaction will ultimately generate patient loyalty and positive recommendation behavior.
TORS for OSA: a practice, pitfalls and literature review
Authors: Hassaan Amro , Trinidade Aaron , Kotecha Bhik , Tolley Neil
Published: February 2019

Purpose

Trans-oral robotic surgery (TORS) is increasingly employed in obstructive sleep apnoea (OSA) management. Objective outcomes are generally assessed through polysomnography. Pre-operative magnetic resonance imaging (MRI) can be a useful adjunct in objective upper airway assessment, in particular the tongue base, providing useful information for surgical planning and outcome assessment, though care must be taken in patient positioning during surgery. The purpose of this paper is to identify pitfalls in this process and suggest a protocol for pre-operative MRI scanning in OSA.

Design/methodology/approach

This study is a four-patient prospective case-series and literature review. Outcome measures include pre- and post-operative volumetric changes in the pharynx as measured on MRI and apnoea–hypopnea indices (AHI), with cure being OSA resolution or a 50 per cent reduction in AHI.

Findings

All patients achieved AHI reduction and/or OSA cure following TORS, despite a decrease in pharyngeal volume measurements at the tongue base level. This study and others lacked standardisation in the MRI scanning protocol, which resulted in an inability to effectively compare pre- and post-operative scans. Pitfalls were related to variation in head/tongue position, soft-tissue marker usage and assessed area boundary limits.

Practical implications

TORS appears to be effective in OSA management. A new protocol for patient positioning and anatomical landmarks is suggested.

Originality/value

The findings could provide directly comparable data between scans and may allow correlation between tongue base volumetric changes and AHI through subsequent and historical study meta-analysis.
Applying the ESD approach in textile and apparel education
Authors: Abner Melissa , Baytar Fatma , Kreiner David
Published: February 2019

Purpose

The purpose of this study was to provide more information about the effectiveness of the Education for Sustainable Development (ESD) approach in textiles and apparel by applying it to a semester-long sustainability course.

Design/methodology/approach

A University-level course was re-designed using the ESD concepts. The course was taught from a consumer viewpoint using the product lifecycle as a focus, so the information was applicable to students’ lives and multiple consumer products. Quantitative results of a pre- and post-test taken by students measured changes in knowledge, attitudes and behavior related to sustainability. Qualitative data from open-ended questions collected student feedback on instructional strategies.

Findings

A significant change in knowledge and attitudes were observed on the post-test. Students perceived assignments that required critical thinking, research and related to their lives as the most beneficial.

Practical implications

The ESD approach changed student knowledge and attitudes to be more sustainable. Assignments that included real world examples had the most impact on pro-environmental attitudes and support the use of a student-centered pedagogy.

Originality/value

This study is based on a semester-long sustainability course designed with ESD, while many existing studies are based on a single intervention or lesson. The results of this study add to the body of ESD literature in the textile and apparel area and are applicable to other disciplines.
The superstitious scholar
Authors: Andrews Robin A.F. , Tyson Philip
Published: February 2019

Purpose

The development and application of critical thinking skills are an important component of success at University. Such skills permit students to evaluate the strengths and weaknesses of evidence, argument and theory. However research suggests that many students believe in paranormal phenomena (e.g. telekinesis). Such beliefs defy the basic principles of science and do not stand up to critical scrutiny. The paper aims to discuss these issues.

Design/methodology/approach

This study aimed to investigate paranormal beliefs within a student population: differences among gender, academic discipline and academic performance were explored.

Findings

Findings indicated that females expressed higher levels of paranormal belief than males, “hard” science students (e.g. Biology) and “soft” science students (e.g. Sociology) expressed lower levels of belief than arts students, and a significant negative correlation indicated that high achievers were less likely to endorse paranormal beliefs.

Originality/value

In light of these results the authors suggest that paranormal phenomena may be a useful tool for teaching critical thinking skills at university.
Brand engagement without brand ownership: a case of non-brand owner community members
Authors: Kumar Jitender , Nayak Jogendra Kumar
Published: February 2019

Purpose

Considering brand ownership as a cause of concern, this paper aims to propose a conceptual model portraying brand engagement as a function of members’ brand psychological ownership (BPO) and value-congruity and to investigate the effect of brand engagement on brand attachment and brand purchase intentions.

Design/methodology/approach

Data were collected from 275 brand community members who do not own the brand. Six different brand communities were shortlisted and offline events were targeted. For testing the hypothesised relationships, the authors used structural equation modelling.

Findings

The results indicate that BPO and value-congruity positively influence the brand engagement of the members, which further influences the brand attachment and brand purchase intentions. It is also observed that brand attachment mediates the effect of brand engagement on brand purchase intentions.

Research limitations/implications

The primary limitation of this paper is the research context, which needs to be further replicated. The specific customer-segment approach of the study adds a new direction to the scope of brand engagement in the brand management domain.

Practical implications

The study shows that brand managers need to expand their focus from existing brand customers to non-customers as brand engagement subjects because the non-brand owners can also experience brand attachment and develop intentions to purchase the brand, if engaged.

Originality/value

The study endorses the role of psychological ownership theory in brand engagement research; explores the feasibility of brand engagement among “non-owner community members”; highlights the role of their engagement in enhancing attachment towards the brands and purchase intentions; and sheds light on the blurred boundaries between brand engagement and brand attachment.
Counterfeiting: conceptual issues and implications for branding
Authors: Evans Bradley P. , Starr Richard G. , Brodie Roderick J.
Published: February 2019

Purpose

This paper aims to apply a broader perspective of branding to foster new insights and develop strategies to address product counterfeiting.

Design/methodology/approach

A review of the counterfeiting and branding literature leads to the development of a new conceptual framework that incorporates proactive, collaborative processes, in addition to the traditional product branding approach.

Findings

The integrative framework provides a basis to develop innovative, proactive strategies that complement traditional branding approaches to address product counterfeiting. The complexity of an integrative framework (or network) offers more opportunities for the firm to co-create robust meaning with multiple stakeholders. Identity elements are readily copied, whereas meanings are not. These strategies help to control counterfeiting by developing deep and inimitable relationships between managers and other stakeholders in a marketing network.

Research limitations/implications

A research agenda is proposed to structure future studies on counterfeiting.

Practical implications

The framework outlines how to leverage collaboration between managers and brand stakeholders to complement conventional approaches to control counterfeiting based on traditional product branding.

Originality/value

This paper contributes to the growing body of counterfeiting and brand protection literature by adapting and applying contemporary integrative branding concepts, leading to novel strategies to address the issue.
Application of quality function deployment for the prioritization of National Board of Accreditation quality parameters
Authors: Singh Ajit Kumar , Rawani A.M.
Published: February 2019

Purpose

Owing to high competition in education sector, quality in education has become utmost important criteria to deliver better education service. For this purpose, it is required to monitor the quality of education. This paper aims to prioritize National Board of Accreditation (NBA) quality parameters in engineering education as per student’s needs using quality function deployment (QFD).

Design/methodology/approach

This study is conducted among students of an institute of National importance in three stages. Stage 1 involves conducting interview with 23 students to find the student’s requirement from an institute. Further Stage 2 involves importance rating collection through questionnaire survey method. In this stage, 228 students have given a rating of each student’s requirement. Finally, Stage 3 involves establishing correlation between student’s requirement and NBA quality parameters that has been done by 20 academic experts and finally making a QFD matrix for ranking of each NBA quality parameter.

Findings

The result of the study first indicates that among all students’ requirements, job-oriented requirement is the most important need, and ergonomics-based requirement is the least important need of students. Further, to fulfill their needs, an institute has to focus on each NBA quality parameter. But among all NBA quality parameters, student’s performance is highly desirable quality parameter.

Practical implications

This study will help top management of engineering institutions in making better policies and strategies for preparing their quality framework. These strategies will indirectly fulfill the customer needs that help in attracting more number of students toward those institutes.

Originality/value

In India, NBA is one of the leading bodies that monitor the quality of education. On the other hand, the institution has to satisfy the need of customer of education sector; therefore, prioritization of NBA quality parameter as per student’s need is one of the important needs that will help engineering institution to focus on a certain parameter to get a good quality certificate and also attract a number of meritorious students.
Daddy Diary for the daughter of the future: a sound-based archive
Authors: Prescott-Steed David
Published: February 2019

Purpose

The purpose of this paper is to explore a range of questions and problems pertaining to a sound-based project that the author began half-way through 2011. Called Daddy Diary, this archive-in-progress takes the form of a series of free-association audio monologues, produced by a first-time father, that are addressed to his adult-daughter of the future and that reflect upon their evolving familial relationship.

Design/methodology/approach

As is often the case with creative projects that are embedded in a plurality of ideological, material and temporal conditions, Daddy Diary requires an eclectic and para-humanities approach to its theorisation. By drawing from ethical, sociological, historical and pedagogical assemblages, this paper shows how Daddy Diary activates a non-hegemonic truth space wherein familial knowledge (tacit knowledge captured in the raw material of the voice recordings) participates in the sustainable and counter-institutional negotiation of self-concept.

Findings

Sound recording technologies have made accessible new ways of documenting human life-narratives, thus augmenting how notions of the self can be written, reviewed and shared with a creative learning community. Just as photography has been used in creative practice reinforce parental worth, playing into the experience of holding and letting go, so too does an audio diary provide the apparatus through which a parent may reflexively navigate death anxiety and the possibility of loss. Thus, this paper contains insight that may prove useful for other first-time fathers. It’s insight may also be of benefit to practice-led researchers wishing to understand how to translate non-institutional activity into a creative learning experience.

Originality/value

Just as the foregrounding of sound poses a challenge to the so-called dominance of visual cultural communication, so too can “listening” engage an alternative sensory perspective from which we “see” ourselves.
Efficacy of combined radiotherapy and anti‐programmed death 1 therapy in acral and mucosal melanoma
Authors: Kato Junji , Hida Tokimasa , Someya Masanori , Sato Sayuri , Sawada Masahide , Horimoto Kohei , Fujioka Mao , Minowa Tomoyuki , Matsui Yoshiyuki , Tsuchiya Takaaki , Kitagawa Mio , Nakata Kensei , Sakata Koh‐ichi , Torigoe Toshihiko , Uhara Hisashi
Published: February 2019

Some studies showed that clinical response to immune check point inhibitors is lower in acral and mucosal melanoma than in cutaneous melanoma. Although the synergistic effect of radiotherapy (RT) and ipilimumab has been reported in patients with brain metastasis, the efficacy of combined RT and anti‐programmed death 1 (PD‐1) therapy for acral and mucosal melanoma is unclear. The present study aimed to evaluate the efficacy of combined RT and anti‐PD‐1 therapy for acral and mucosal melanoma. We retrospectively analyzed patients with acral or mucosal melanoma who were treated with anti‐PD‐1 and RT at Sapporo Medical University Hospital. In 10 patients (acral, 3; mucosal, 7), the response rate (RR) and the disease control rate (DCR) were 40% and 60%, respectively. As regards mucosal melanoma, four of the seven patients had achieved complete response + partial response, and three had progressive disease (RR = 57.1%). Meanwhile, two of the three patients with acral melanoma had stable disease and one had progressive disease (RR and DCR were 0% and 66.6%, respectively). Except for the patients treated with palliative RT for bone metastasis in the present study, the RR was 50% (4/8 patients), and the DCR was 75% (6/8 patients). Vitiligo developed after RT in five (50%) patients at a median duration of 2 months after RT. The clinical response and the high occurrence of vitiligo suggest that the combination of RT and anti‐PD‐1 therapy could be effective in some patients with mucosal melanoma.
Failed predator attacks have detrimental effects on antipredatory capabilities through developmental plasticity in Pelobates cultripes toads
Authors: Zamora‐Camacho Francisco Javier , Aragón Pedro
Published: February 2019

How predation events experienced by preys can shape phenotypic traits through the ontogenetic development of the interacting species should be a key issue in Evolutionary and Conservation Biology.

Locomotor performance plays a fundamental role on the fitness of many animals, mainly because it enhances ability to fleeing from predators. Predators represent indeed a capital selective force on prey, mainly because they end prey life. However, predators may also damage prey by other means, such as injuries caused by failed attacks. This damage can severely affect locomotion, among several other aspects of prey fitness. In the case of anuran tadpoles, failed predator attacks often result in injured tails, which reduces swimming performance. However, little is known about lasting effects of those failed attacks on fleeing capabilities after metamorphosis.

In this work, we clipped 55% tail length of pre‐tail‐resorption stage anaesthetized larval Pelobates cultripes toads, and compared metamorph hindlimb length and jump distance with metamorphs resulting from anaesthetized and non‐anaesthetized non‐clipped controls. Previous findings showed that this treatment produced metamorphs with reduced body condition.

Results herein suggest that partial tail loss in tadpoles diminishes jumping performance of resultant metamorphs. This effect is likely a consequence of tail‐clipped tadpoles developing shorter hindlimbs as metamorphs, which is parallel to their reduced body condition.

Therefore, predator attacks in the tail may be less potentially mortal than those in the head and body, but have costs in terms of an efficient antipredatory response that persist in post‐metamorphic stage. This effect might compromise metamorph ability to survive subsequent predator attacks.
Increased algicidal activity of Aeromonas veronii in response to Microcystis aeruginosa: interspecies crosstalk and secondary metabolites synergism
Authors: Weiss Gad , Kovalerchick Dimitry , Lieman‐Hurwitz Judy , Murik Omer , De Philippis Roberto , Carmeli Shmuel , Sukenik Assaf , Kaplan Aaron
Published: February 2019

Toxic Microcystis spp. blooms constitute a serious threat to water quality worldwide. Aeromonas veronii was isolated from Microcystis sp. colonies collected in Lake Kinneret. Spent Aeromonas media inhibits the growth of Microcystis aeruginosa MGK isolated from Lake Kinneret. The inhibition was much stronger when Aeromonas growth medium contained spent media from MGK suggesting that Aeromonas recognized its presence and produced secondary metabolites that inhibit Microcystis growth. Fractionations of the crude extract and analyses of the active fractions identified several secondary metabolites including lumichrome in Aeromonas media. Application of lumichrome at concentrations as low as 4 nM severely inhibited Microcystis growth. Inactivation of aviH in the lumichrome biosynthetic pathway altered the lumichrome level in Aeromonas and the extent of MGK growth inhibition. Conversely, the initial lag in Aeromonas growth was significantly longer when provided with Microcystis spent media but Aeromonas was able to resume normal growth. The longer was pre‐exposure to Microcystis spent media the shorter was the lag phase in Aeromonas growth indicating the presence of, and acclimation to, secondary MGK metabolite(s) the nature of which was not revealed. Our study may help to control toxic Microcystis blooms taking advantage of chemical languages used in the interspecies communication.
Success and Failure in Professional Projects: The Nature, Contours and Limits of Consulting Professionalism
Authors: Collins David , Butler Nick
Published: February 2019

This paper offers an analysis of the professional project that was pursued by the Institute of Management Consultants (IMC) on behalf of its members. The paper builds on Sturdy's (2011) call to develop empirically grounded accounts of the ways and means of consulting. In addition, it responds to the analysis of the Association of Project Management (APM) developed by Hodgson, Paton and Muzio (2015), which invited further comparative study of professional projects. Drawing on archive data, this paper develops a comparative analysis that considers four key themes: (1) the professionalization strategies developed by the IMC and the APM; (2) jurisdictional issues and shifts in the fields of consulting and project management; (3) the structure of credentials developed for practitioners in both arenas; and (4) the attitudes and actions of key stakeholders shaping policy in the APM and the IMC. The paper examines the contrasting fortunes of the APM and the IMC, yet observes similarities in working practices across these apparently distinct settings. Reflecting on this comparison, the authors consider the nature, contours and limits of consulting professionalism and conclude with the suggestion that, within the analysis of professional projects, conventional conceptualizations of ‘success’ and ‘failure’ should be considered as ‘impostors’.
Assessment of Knowledge and Behavior Change of a High School Positive Deviance Food Safety Curriculum
Authors: Feng Yaohua , Bruhn Christine M. , Elder Gary , Boyden Dawn
Published: February 2019

High school students are a critical audience for food safety. Students may enter the foodservice industry or become primary meal preparers for their families. The positive deviance food safety curriculum was developed based on the messages from the Fight BAC! Campaign. The curriculum is designed for high school students to overcome barriers to safe food handling practices. This study evaluated the effectiveness of the positive deviance approach to change food safety knowledge and behaviors among high school students. Students (n = 218) from two high schools participated in this study. The positive deviance method uses group discussions lead by the teacher who reinforces and praises behaviors, which reflect recommended food handling practices. Measurements included pre‐ and postsurveys, preobservations and postobservation cooking classes, take‐home tasks, and in‐class activities. Results indicated that the curriculum significantly increased students’ food safety knowledge. Specifically, the percentage of students believing that color was a good indicator of meat doneness dropped from 52% to 17% after exposure to the curriculum. When observed, the students’ compliance with recommended behaviors increased. Prior to instruction, most ground beef burgers students cooked did not reach 160°F, while after the intervention, almost all of the burgers reached 160°F or higher. The curriculum will benefit from a revision that emphasizes areas such as how to use, calibrate, and to clean food thermometers.
Gridlock, Innovation and Resilience in Global Health Governance
Authors: Held David , Kickbusch Ilona , McNally Kyle , Piselli Dario , Told Michaela
Published: February 2019

Global health governance is in many ways proving more innovative and resilient than other sectors in global governance. In order to understand the mechanisms that have made these developments possible, this article draws on the concept of gridlock, as well as on the additional theoretical strands of metagovernance and adaptive governance, to conceptualize how global health governance has been able to adapt despite increasingly difficult conditions in the multilateral order. The remarkable degree of innovation that characterizes global health governance is the result of two interrelated conditions. First, developments that are normally associated with gridlock in multilateral cooperation, such as institutional fragmentation and growing multipolarity, have transformed, rather than gridlocked, global health governance. Second, global health actors have often been able to harness the opportunities offered by three important pathways of change, namely: (1) a significant degree of organizational learning and active feedback loops between epistemic and practice communities; (2) a highly polycentric system of governance; and (3) the increased role of political leadership as a catalyst for governance innovation. These trends are discussed in the context of three case studies of significant political, social and health relevance, namely HIV/AIDS, the 2014 Ebola outbreak and antimicrobial resistance.
Uniportal video‐assisted thoracoscopic left S4 anatomical segmentectomy
Authors: Song Nan , Duan Liang , Fang Zhiyong , Jiang Gening
Published: February 2019

Uniportal video‐assisted thoracic surgery (VATS) segmentectomy is a demanding technique but is safe and feasible in selected patients and confers favorable efficacy. It presents an acceptable alternative to conventional VATS. Lingulectomy is usually performed with left S4 + S5 segmentectomy. This report describes a case of uniportal VATS of left S4 anatomical segmentectomy alone.
Post‐extubation continuous positive airway pressure improves oxygenation after pediatric laparoscopic surgery: A randomized controlled trial
Authors: Abdel‐Ghaffar Hala S. , Youseff Hamdy A. , Abdelal Fatma A. , Osman Mohamed A. , Sayed Jehan A. , Riad Mohamed Amir Fathy , Abdel‐Rady Marwa M.
Published: February 2019

Background

Effects of intraoperative recruitment maneuvers (RMs) on oxygenation and pulmonary compliance are lost during recovery if high inspired oxygen and airway suctioning are used. We investigated the effect of post‐extubation noninvasive CPAP mask application on the alveolar arterial oxygen difference [(A–a) DO2] after pediatric laparoscopic surgery.

Methods

Sixty patients (1‐6 years) were randomly allocated to three groups of 20 patients, to receive zero end‐expiratory pressure (ZEEP group), RM with decremental PEEP titration only (RM group), or followed with post‐extubation CPAP for 5 minutes (RM‐CPAP group). Primary outcome was [(A–a) DO2] at 1 hour postoperatively. Secondary outcomes were respiratory mechanics, arterial blood gas analysis, hemodynamics, and adverse events.

Results

At 1 hour postoperatively, mean [(A–a) DO2] (mm Hg) was lower in the RM‐CPAP group (41.5 ± 13.2, [95% CI 37.6‐45.8]) compared to (80.2 ± 13.7 [72.6‐87.5],P < 0.0001] and (59.2 ± 14.6, [54.8‐62.6],P < 0.001) in the ZEEP and RM groups. The mean PaO2(mm Hg) at 1 hour postoperatively was higher in the RM‐CPAP group (156.2 ± 18.3 [95% CI 147.6‐164.7]) compared with the ZEEP (95.9 ± 15.9 [88.5‐103.3],P < 0.0001) and RM groups (129.1 ± 15.9 [121.6‐136.5],P < 0.0001). At 12 hours postoperatively, mean [(A–a) DO2] and PaO2were (9.6 ± 2.1 [8.4‐10.8]) and (91.9 ± 9.4 [87.5‐96.3]) in the RM‐CPAP group compared to (25.8 ± 5.5 [23.6‐27.6]) and (69.9 ± 5.5 [67.4‐72.5],P < 0.0001) in the ZEEP group and (34.3 ± 13.2, [28.4‐40.2],P < 0.0001) and (74.03 ± 9.8 [69.5‐78.6],P < 0.0001) in the RM group. No significant differences of perioperative adverse effects were found between groups.

Conclusions

An RM done after pneumoperitoneum inflation followed by decremental PEEP titration improved oxygenation at 1 hour postoperatively. The addition of an early post‐extubation noninvasive CPAP mask ventilation improved oxygenation at 12 hours postoperatively.
Association of hormone replacement therapy with increased risk of meningioma in women: A hospital‐based multicenter study with propensity score matching
Authors: Shu Xiaochen , Jiang Yun , Wen Tao , Lu Shun , Yao Lu , Meng Fang
Published: February 2019

Aim

There is no consensus regarding the association between hormone replacement therapy (HRT) and risk of meningioma so far. We conducted the first study among Chinese female patients to investigate the influence of HRT use on the risk of meningioma.

Methods

We retrospectively collected records of diagnosis of meningioma for women aged 50 years and above during 2011–2016 and dispense of HRT prior to meningioma diagnosis in three tertiary hospitals in China. Meningioma cases were matched with controls at a ratio of 1:2 by using nearest neighbor propensity scores matching in order to balance the baseline characteristics between groups, which generated a total of 629 cases with 1258 controls.

Results

We observed prior use of HRT associated with increased risk of meningioma (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.0–1.4) and the association was more prominent among women having multiple HRT dispenses and longer term exposure (OR, 1.3; 95% CI, 1.1–1.6), among those with combination therapy of estrogens and progestogens (OR, 1.3; 95% CI, 1.1–1.7) than monotherapy, and among progestogen users than estrogen users as for monotherapy. Furthermore, vaginal, subcutaneous implant seems to be associated with a higher risk of meningioma compared with oral administration although no significance had been reached.

Conclusion

This case–control study provides evidence that hormone use for an HRT purpose might constitute the development and growth of meningioma as an independent risk factor, especially for combination therapy and/or long‐term users, which supports that meningioma might be a hormone‐sensitive tumor.
Elective egg freezing without medical indications
Authors: Alteri Alessandra , Pisaturo Valerio , Nogueira Daniela , D'Angelo Arianna
Published: February 2019

The aim of this review is to provide current knowledge on fertility preservation for non‐medical reasons in women willing to postpone childbearing. The topic is highly debatable, starting from disagreement about its terminology, the number of eggs necessary to predict chances of success, and the safety and socio/ethical point of view. Cost analysis and discrepancies among countries’ recommendations and regulations are described to confirm the controversies and unsolved issues around this very interesting topic. Finally, an overview on the returning rate of women among “egg bankers” and reasons behind their decisions are illustrated.
A prospective study of the incidence of drug‐induced liver injury by the modern volatile anaesthetics sevoflurane and desflurane
Authors: Bishop Bridget , Hannah Nicholas , Doyle Adam , Amico Francesco , Hockey Brad , Moore David , Sood Siddharth , Gorelik Alexandra , Liew Danny , Njoku Dolores , Nicoll Amanda
Published: February 2019

Background

Volatile anaesthetics are known to cause drug‐induced liver injury, a hepatotoxic reaction characterised by antibodies to trifluoroacetylated lipid and protein adducts and cytochrome p450 2E1. The incidence of volatile anaesthetic drug‐induced liver injury from older agents has been described, but modern agents have not been prospectively studied.

Aim

To determine prospectively the incidence of volatile anaesthetic drug‐induced liver injury from sevoflurane and desflurane.

Methods

Adult surgical patients with a predicted post‐operative stay of at least 4 days were recruited. If volatile anaesthetic was administered, liver biochemistry was performed regularly. Medications, observations and other investigations were documented. Patients with abnormal liver biochemistry were classified as likely volatile anaesthetic drug‐induced liver injury or not based on clinical assessment, Roussel Uclaf Causality Assessment Method score, and the absence of other likely pathology. Some patients were also tested for antibodies to both trifluoroacetylated lipid and protein adducts, and cytochrome p450 2E1.

Results

A total of 209 patients were recruited, of which 121 were included for analysis. Post‐operative liver biochemistry was abnormal in 62 patients (51.2%); further classified as not volatile anaesthetic drug‐induced liver injury in 47 cases (38.8%), and likely volatile anaesthetic‐drug induced liver injury in 15 cases (12.4%). Of the likely volatile anaesthetic drug‐induced liver injury patients, only one had severe disease with alanine transaminase greater than five times the upper limit of normal, while four cases had moderate disease with alanine transaminase greater than three times the upper limit of normal. Thus, the incidence of clinically significant volatile anaesthetic drug‐induced liver injury was 4.1%. No risk factors were identified.

Conclusions

Volatile anaesthetic drug‐induced liver injury from modern agents seems to be as common (4.1%) as previously reported with older agents (3%), and may identify patients at risk of severe acute liver injury with subsequent re‐exposure.
β‐Adrenoceptor activation affects galectin‐3 as a biomarker and therapeutic target in heart disease
Authors: Du Xiao‐Jun , Zhao Wei‐Bo , Nguyen My‐Nhan , Lu Qun , Kiriazis Helen
Published: February 2019

Myocardial fibrosis is a key histopathological component that drives the progression of heart disease leading to heart failure and constitutes a therapeutic target. Recent preclinical and clinical studies have implicated galectin‐3 (Gal‐3) as a pro‐fibrotic molecule and a biomarker of heart disease and fibrosis. However, our knowledge is poor on the mechanism(s) that determine the blood level or regulate cardiac expression of Gal‐3. Recent studies have demonstrated that enhanced β‐adrenoceptor activity is a determinant of both circulating concentration and cardiac expression of Gal‐3. Pharmacological or transgenic activation of β‐adrenoceptors leads to increased blood levels of Gal‐3 and up‐regulated cardiac Gal‐3 expression, effect that can be reversed with the use of β‐adrenoceptor antagonists. Conversely, Gal‐3 gene deletion confers protection against isoprenaline‐induced cardiotoxicity and fibrogenesis. At the transcription level, β‐adrenoceptor stimulation activates cardiac mammalian sterile‐20‐like kinase 1, a pivotal kinase of the Hippo signalling pathway, which is associated with Gal‐3 up‐regulation. Recent studies have suggested a role for the β‐adrenoceptor‐Hippo signalling pathway in the regulation of cardiac Gal‐3 expression thereby contributing to the onset and progression of heart disease. This implies a therapeutic potential of the suppression of Gal‐3 expression. In this review, we discuss the effects of β‐adrenoceptor activity on Gal‐3 as a biomarker and causative mediator in the setting of heart disease and point out pivotal knowledge gaps.

Linked Articles

This article is part of a themed section on Adrenoceptors—New Roles for Old Players. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.14/issuetoc
Small‐molecule inhibition of prostaglandin E receptor 2 impairs cyclooxygenase‐associated malignant glioma growth
Authors: Qiu Jiange , Li Qianqian , Bell Katherine A. , Yao Xue , Du Yifeng , Zhang Erik , Yu Jane J. , Yu Ying , Shi Zhi , Jiang Jianxiong
Published: February 2019

Background and Purpose

An up‐regulation of COX‐2 in malignant gliomas causes excessive synthesis of PGE2, which is thought to facilitate brain tumour growth and invasion. However, which downstream PGE2 receptor subtype (i.e., EP1–EP4) directly contributes to COX activity‐promoted glioma growth remains largely unknown.

Experimental Approach

Using a publicly available database from The Cancer Genome Atlas research network, we compared the expression of PGE2 signalling‐associated genes in human lower grade glioma and glioblastoma multiforme (GBM) samples. The Kaplan–Meier analysis was performed to determine the relationship between their expression and survival probability. A time‐resolved FRET method was used to identify the EP subtype that mediates COX‐2/PGE2‐initiated cAMP signalling in human GBM cells. Taking advantage of a recently identified novel selective bioavailable brain‐permeable small‐molecule antagonist, we studied the effect of pharmacological inhibition of the EP2 receptor on glioma cell growth in vitro and in vivo.

Key Results

The EP2 receptor is a key Gαs‐coupled receptor that mediates COX‐2/PGE2‐initiated cAMP signalling pathways in human malignant glioma cells. Inhibition of EP2 receptors reduced COX‐2 activity‐driven GBM cell proliferation, invasion, and migration and caused cell cycle arrest at G0–G1 and apoptosis of GBM cells. Glioma cell growth in vivo was also substantially decreased by post‐treatment with an EP2 antagonist in both subcutaneous and intracranial tumour models.

Conclusion and Implications

Taken together, our results suggest that PGE2 signalling via the EP2 receptor increases the malignant potential of human glioma cells and might represent a novel therapeutic target for GBM.
Die Wirksamkeit der Radiofrequenztherapie mit isolierten Mikronadeln zur Reduktion von hervortretenden infraorbitalen Fettpolstern
Authors: Shin Jung‐Won , Park Jung‐Tae , Chae Je‐Byeong , Choi Ji‐Young , Na Jung‐Im , Park Kyoung‐Chan , Huh Chang‐Hun
Published: February 2019

Hintergrund und Zielsetzungen

Die konventionellen Therapieoptionen zur Reduktion von infraorbitalen Fett depots (gemeinhin auch als Tränensäcke bezeichnet) sind im Allgemeinen auf chirurgische Verfahren beschränkt. In letzter Zeit wurden jedoch zahlreiche Versuche unternommen, um diesem Schönheitsfehler mit nichtchirurgischen Interventionen zu begegnen. Ziel dieser Studie war es, die Wirksamkeit und Sicherheit eines Radiofrequenzsystems mit isolierten Mikronadeln zur Behandlung von infraorbitalen Fett depots zu untersuchen.

Methoden

Dies ist eine monozentrische Studie mit Vorher‐Nachher‐Vergleich. Zweiundzwanzig Probanden mit infraorbitalen Fettansammlungen wurden mit einem micro‐insulated needle radiofrequency system zweimal in einem Abstand von vier Wochen behandelt. Bei jeder Sitzung wurden nacheinander zwei Nadelaufsätze mit teilisolierten Nadeln unterschiedlicher Länge eingesetzt. Mit einem dreidimensionalen Photogrammetrie‐System wurden die Veränderungen der infraorbitalen Fettpolster objektiv vermessen. Das Ergebnis wurde darüber hinaus vom Untersucher mit Hilfe des Investigator Global Assessment (IGA) Scores beurteilt.

Ergebnisse

Das durchschnittliche Ausmaß der Fettpolster hatte sich nach zwölf Wochen signifikant verringert und dieser Zustand blieb bis Woche 24 erhalten. Der IGA‐Score veringerte sich nach vier Wochen signifikant, nahm bis zur Woche 12 weiter ab und blieb anschließend bis zur Woche 24 erhalten. Bis auf Schwellungen und Blutergüsse am Unterlid, die nach etwa einer Woche abgeheilt waren, gab es keine Nebenwirkungen.

Fazit

Die Radiofrequenztherapie mit isolierten Mikronadeln ist eine effektive und nebenwirkungsarme Therapieoption, um infraorbitale Fettdepots zu behandeln.
Hand eczema among Dutch beekeepers – a cross‐sectional study
Authors: Oosterhaven Jart A. F. , Verbist Julia , Schuttelaar Marie‐Louise A.
Published: February 2019

Background and objectives

Studies of beekeepers have mostly focused on contact allergy to propolis. The overall prevalence of hand eczema (HE) in beekeepers has not been studied. Our objectives were to gain insight into the prevalence of HE in the Dutch beekeeper population; to define the impact of beekeeping activities on HE and vice versa; and to determine associated factors.

Patients and methods

We used a cross‐sectional online survey. Dutch beekeepers answered questions on beekeeping activities, the prevalence and characteristics of HE, including severity, and the impact of the disease on beekeeping.

Results

We analyzed 833 surveys (12 % of Dutch beekeepers). The one‐year prevalence of HE was 13.2 %, and the lifetime prevalence was 20.5 %. In 28 patch‐tested beekeepers with hand eczema, eight (28.6 %) were allergic to propolis. Atopic dermatitis was the only variable associated with HE: the odds ratio was 4.53 (95 % confidence interval 2.78–7.38). One in three beekeepers reported that HE was caused or worsened by beekeeping, although only 3.8 % reported working less at beekeeping because of HE, and the impact of HE on beekeeping activities (as perceived by beekeepers) is low.

Conclusions

In this sample of Dutch beekeepers, hand eczema was more prevalent than in the general population, but seems to have had little impact on the beekeeping activities of the majority of beekeepers.
Importance of assessing the intermanual asymmetry of mirror movements in paediatric hemiparesis
Authors: Tallet Jessica
Published: February 2019

This commentary is on the original article by Riddell et al. on pages 943–949 of this issue.
Uric acid and the cardio‐renal effects of SGLT2 inhibitors
Authors: Bailey Clifford J.
Published: February 2019

Sodium/glucose co‐transporter‐2 (SGLT2) inhibitors, which lower blood glucose by increasing renal glucose elimination, have been shown to reduce the risk of adverse cardiovascular (CV) and renal events in type 2 diabetes. This has been ascribed, in part, to haemodynamic changes, body weight reduction and several possible effects on myocardial, endothelial and tubulo‐glomerular functions, as well as to reduced glucotoxicity. This review evaluates evidence that an effect of SGLT2 inhibitors to lower uric acid may also contribute to reduced cardio‐renal risk.

Chronically elevated circulating uric acid concentrations are associated with increased risk of hypertension, CV disease and chronic kidney disease (CKD). The extent to which uric acid contributes to these conditions, either as a cause or an aggravating factor, remains unclear, but interventions that reduce urate production or increase urate excretion in hyperuricaemic patients have consistently improved cardio‐renal prognoses. Uric acid concentrations are often elevated in type 2 diabetes, contributing to the “metabolic syndrome” of CV risk. Treating type 2 diabetes with an SGLT2 inhibitor increases uric acid excretion, reduces circulating uric acid and improves parameters of CV and renal function. This raises the possibility that the lowering of uric acid by SGLT2 inhibition may assist in reducing adverse CV events and slowing progression of CKD in type 2 diabetes. SGLT2 inhibition might also be useful in the treatment of gout and gouty arthritis, especially when co‐existent with diabetes.
sRNA‐pathway genes regulating myxobacterial development exhibit clade‐specific evolution
Authors: Chen I‐Chen Kimberly , Satinsky Brandon M. , Velicer Gregory J. , Yu Yuen‐Tsu Nicco
Published: February 2019

Small non‐coding RNAs (sRNAs) control bacterial gene expression involved in a wide range of important cellular processes. In the highly social bacterium Myxococcus xanthus, the sRNA Pxr prevents multicellular fruiting‐body development when nutrients are abundant. Pxr was discovered from the evolution of a developmentally defective strain (OC) into a developmentally proficient strain (PX). In OC, Pxr is constitutively expressed and blocks development even during starvation. In PX, one mutation deactivates Pxr allowing development to proceed. We screened for transposon mutants that suppress the OC defect and thus potentially reveal new Pxr‐pathway components. Insertions significantly restoring development were found in four genes—rnd, rnhA, stkA and Mxan_5793—not previously associated with an sRNA activity. Phylogenetic analysis suggests that the Pxr pathway was constructed within the Cystobacterineae suborder both by co‐option of genes predating the Myxococcales order and incorporation of a novel gene (Mxan_5793). Further, the sequence similarity of rnd, rnhA and stkA homologs relative to M. xanthus alleles was found to decrease greatly among species beyond the Cystobacterineae suborder compared to the housekeeping genes examined. Finally, ecological context differentially affected the developmental phenotypes of distinct mutants, with implications for the evolution of development in variable environments.
Primary immune thrombocytopenia (ITP) treated with romiplostim in routine clinical practice: retrospective study from the United Kingdom ITP Registry
Authors: Doobaree Indraraj Umesh , Newland Adrian , McDonald Vickie , Nandigam Raghava , Mensah Lesley , Leroy Sandrine , Seesaghur Anouchka , Patel Hitan , Wetten Sally , Provan Drew
Published: February 2019

Background

Romiplostim is a thrombopoietin‐mimetic peptibody for adult refractory chronic immune thrombocytopenia (ITP). We aimed to describe ITP patients receiving romiplostim, platelet counts and romiplostim usage in UK clinical practice.

Methods

This was a retrospective cohort study of patients in the UKITP Registry who received romiplostim between October 2009 and January 2015, including data up to 6 months before romiplostim initiation through follow‐up.

Results

Of 1440 patients in the UKITP Registry, 118 adults with primary ITP were eligible. Before romiplostim, 22% had splenectomy, 12% received platelet transfusion, 97% received ≥ 1 different ITP medication and 77% received ≥ 3. Most patients (73%) initiated romiplostim ≥ 1 year after ITP diagnosis (chronic phase). The mean duration of romiplostim treatment was 5.7 (SE 0.9) months, and the median was 1.4 months (IQR: 0.2, 6.5). Mean platelet count before romiplostim was 38 × 109/L, rising to 103 × 109/L within 1 month, and remaining 50‐150 × 109/L through up to 3 years of follow‐up. After romiplostim, 4% of patients had splenectomy, 6% received platelet transfusion, and 57% received just one ITP medication other than romiplostim.

Conclusion

The study provides valuable insights into the real‐world use of romiplostim in primary ITP in routine practice and highlighted the timing of romiplostim initiation at different ITP disease phases.
Sensitivity analysis of C and N modules in biogeochemical crop and grassland models following manure addition to soil
Authors: Cavalli Daniele , Bellocchi Gianni , Corti Martina , Marino Gallina Pietro , Bechini Luca
Published: February 2019

Process‐based crop and grassland models estimating carbon (C) and nitrogen (N) dynamics are widely used to investigate best management practices in agriculture. They integrate several processes in a complex structure, but studies where modules corresponding to specific processes extracted from the whole model structure are assessed independently are uncommon. With the support of documented aerobic incubation trials in manure‐amended soils, a sensitivity analysis was performed on the C–N cycling processes of four modules (MOD1–4), corresponding to the models APSIM, EPIC, FASSET and STICS. The results showed that the parameter ‘substrate use efficiency’ had the most effect on the predicted values of net CO2 emissions and net N mineralization, together with the C/N ratio of the soil microbial biomass. They explained 74–75% on average of both output variances, whereas parameters determining manure C and N partitioning and first‐order decomposition constants of manure pools explained, on average, an additional 17–19%. Efforts should be focused on calibrating these parameters for more accurate simulations. The greater sensitivity of both outputs to parameters related to manure pools in more complex modules (MOD2–4) facilitates their adaptation to specific contexts, whereas MOD1 probably requires that parameters related to soil pools are also adapted to specific applications. Parameter interactions were limited, becoming noticeable only in situations of N‐limited soil organic matter decomposition. Models MOD1 and MOD3 allowed the C/N ratio of the soil microbial biomass to vary temporarily; therefore, they were less sensitive to mineral N availability and more easily adapted to a wide range of situations. This study provides essential information to support the development of state‐of‐the‐art biogeochemical models.

Highlights

We compared four C–N modules embedded in process‐based biogeochemical models.

We used sensitivity analysis to assess the simulation of manure decomposition in soil.

We identified a few parameters that influenced CO2 emissions and N mineralization.

We found that substrate use efficiency explained most of the output variance for all models.