bluuebunny/crossref_metadata_2025 huggingface dataset:
The tinnitus patient information pack: usefulness in intrusive tinnitus
Authors: Hassaan Amro , Trinidade Aaron
Published: February 2019

Purpose

The purpose of this paper is to determine a tinnitus patient information pack’s (TPIP) usefulness in patients suffering with tinnitus with respect to their need for further tinnitus retraining therapy (TRT) and in reducing TRT cancellations and non-attenders.

Design/methodology/approach

The paper consists of prospective case series in a district general hospital ENT out-patient department.

Findings

Patients with tinnitus-related symptoms constitute around 2 per cent of the ENT OPD workload at the West Middlesex Hospital, Chelsea & Westminster NHS Trust, London, i.e., 365 patients with intrusive tinnitus were referred by the ENT surgeon for TRT; 56/365 patients (15.3 per cent) failed to attend and 60 (16.4 per cent) cancelled their appointments. The following year, a TPIP was administered to all tinnitus sufferers, despite the affliction’s intrusiveness, and told to contact the audiology department if they felt that TRT was required, which resulted in 43/233 patients (18.5 per cent) over a one-year period self-referring for TRT; 2/233 (0.9 per cent) did not attend, and 1/233 (0.4 per cent) were cancelled appointments.

Practical implications

The patient-focussed TPIP acts as an initial therapy for the tinnitus sufferer by providing reassurance and self-therapy. This results in patients who are less likely to seek TRT, leading to more efficient clinical resource usage (p<0.01).

Originality/value

The data suggest that all tinnitus sufferers presenting to ENT clinics could be handed a TPIP and empowered with the decision whether they require further intervention.
Adherence to surgical antimicrobial prophylaxis: “checking-the-box” is not enough
Authors: Karamchandani Kunal , Barden Kyle , Prozesky Jansie
Published: February 2019

Purpose

The purpose of this paper is to review surgical antimicrobial prophylaxis administration practices in a small cohort and assess compliance with national guidelines.

Design/methodology/approach

Patients that developed surgical site infections (SSI) in a tertiary care academic medical center over a two-year period were identified. Their electronic medical records were reviewed for compliance with national guidelines with respect to surgical antibiotic prophylaxis.

Findings

Over a two-year period, 283 SSI patients were identified. An appropriate antibiotic was chosen in 80 percent, an appropriate dose was administered in 45 percent and timing complied in 89 percent. The antibiotics were appropriately re-dosed in only 9.2 percent in whom the requirement was met. The prescribing guidelines were adhered to in entirety in only 54 patients (23.8 percent).

Practical implications

Timely and appropriate antibiotic administration prior to surgery is essential to prevent SSI. Proper diligence is required to accomplish this task effectively.

Originality/value

Based on the findings, it appears that merely, “checking a box” for antibiotic administration during surgery is not enough, and a multidisciplinary approach should be followed to ensure “appropriate” antibiotic administration.
Discrete event simulation and pharmacy process re-engineering
Authors: Al Badi Khalid
Published: February 2019

Purpose

The purpose of this paper is to describe a case study undertaken at Al Buraimi Hospital in Oman, which used computer simulation and the Delphi approach to improve efficiency by reducing prescription dispensing waiting times.

Design/methodology/approach

This study’s framework was based on a discrete event simulation (DES) to identify the as-is pharmacy process and to create a to-be (future situation) to achieve an improvement in pharmacy workflow and service quality. Owing to healthcare environment complexity, and to gain a deeper understanding about Al Buraimi Hospital pharmacy problems, a Delphi technique was also used.

Findings

Based on Delphi, and according to the expert panel suggestions, two alternative scenarios were proposed to improve Al Buraimi Hospital pharmacy efficiency: fast-track and direct-dispensing, which should help to reduce the prescription dispensing waiting time process by 7.3 and 9.8 min, respectively.

Research limitations/implications

The main limitation is the pharmacists’ shortage, which may affect the prescription dispensing process’s quality as insufficient manpower to check the prescriptions may increase the medication errors’ risk.

Originality/value

Based on this case study’s real-world data, findings can be used to improve public healthcare sector pharmacy efficiency. The DES can be used in healthcare services to describe and test actual and proposed situations.
Housing features and rent: estimating the microstructures of rental housing
Authors: Nishi Hayato , Asami Yasushi , Shimizu Chihiro
Published: February 2019

Purpose

While consumers did not previously have information on detailed housing features via traditional media, such as magazines, nowadays, due to the progress in information technology, they can access detailed information on various housing features via housing information websites. Therefore, detailed housing features may affect current rents to some extent. This paper aims to identify the effects of detailed housing features on rent and on omitted variable bias in Tokyo, Japan.

Design/methodology/approach

This paper applies the hedonic approach. To identify the effects of features which are not observed previously, we use a unique data set that contains various housing features and over 200,000 housing units. This data set enables to simulate the situations when the researcher cannot get some variables, and this simulation shows which variables cause omitted variable bias.

Findings

The analysis shows that housing features significantly influence housing rent. If significant housing feature variables are not included in the hedonic model, the estimated coefficients show omitted variable bias. Additionally, unit-specific features such auto-locking door can cause omitted variable bias on location-specific features such accessibility to downtown.

Originality/values

This paper shows empirical evidence that detailed housing features can cause omitted variable bias on other features including variables which are often used in previous searches. The result from our unique data set can be a guide for variable selection to reduce omitted variable bias.
Public policy and its effects on Mexico’s housing industry
Authors: Rodríguez-Reyes Luis Raúl , Trejo-Pech Carlos Omar , Pasillas-Torres Mireya
Published: February 2019

Purpose

The Mexican housing industry was hindered by a shrinking market and tighter financial conditions related to the Great Recession. Moreover, in 2013, a major change in public policy further modified this industry’s environment. Mexico’s new urban development policy supported inner-city new housing, in contrast to the previous policy that incentivized sprawling. Three out of eight publicly traded housing companies filed for bankruptcy protection in 2013-2014, arguably because of the effects of the Great Recession and the new housing policy. The purpose of this study is to identify firm-level factors that caused some firms to file for bankruptcy protection.

Design/methodology/approach

Three approaches were used to analyze the housing industry in Mexico from 2006 to 2015. First, a policy analysis focused on the new housing policy and its consequences for housebuilding companies. Second, a financial analysis of the two economic shocks was performed in search for the transmission mechanisms in the companies’ financial metrics. Third, a retrospective analysis using the Fisher’s exact test was used to identify variables statistically associated with companies filing for bankruptcy protection.

Findings

There are two features significantly associated with bankruptcy protection: increasing market share while being vertically integrated, as a response to the Great Recession, and the relative magnitude of the loss on firms’ inventory value due to the new public policy. Neither Altman’s Z-score values nor firm size or degree of integration are significantly related to bankruptcy.

Research limitations/implications

The small sample size presented a challenge, as most statistical methodologies require large samples; however, this was overcome by using the Fisher’s exact test.

Originality/value

The main contribution of this paper is the statistical identification of the possible causes for bankruptcy protection in Mexico amongst homebuilding firms in 2013 and 2014, which have not previously been reported in the literature.
Study of maintenance project manpower dynamics in Indian software outsourcing industry
Authors: Mishra Debasisha , Mahanty Biswajit
Published: February 2019

Purpose

The paper aims to study manpower dynamics at offshore and onsite location for maintenance project, which are transferred to offshore location in a phase-wise manner. The purpose of the paper is to find good values of onsite–offshore team strength, the number of hours of communication between onsite and offshore teams for smooth transfer of software maintenance project to offshore location.

Design/methodology/approach

This study uses system dynamics simulation approach to study manpower allocation at onsite and offshore locations to transfer the maintenance work to offshore location in a gradual manner. The authors consulted 13 experts from Indian software outsourcing industry during the model construction and validation.

Findings

The simulation results show that the complexity of maintenance project has an insignificant effect on offshore migration. The maintenance work transfer should start with initial onsite team strength higher than that of required for ticket solving and project. The initial offshore team strength should be based on training capacity available at the onsite location. The higher attrition rate at an offshore is detrimental for offshore migration.

Research limitations/implications

The implication of the study is in the development of a broad framework of software maintenance work transfer to offshore locations for Indian software outsourcing projects. As the study is based on expert opinion in the context of India, it cannot be generalized for outsourcing scenarios elsewhere.

Practical implications

The software project manager can use the findings to get more insight into maintenance project offshore migration and divide the software team between onsite and offshore location.

Originality/value

The study is novel as there is little attempt at finding the manpower composition at onsite and offshore locations for software maintenance project during the migration phase.
A theoretical framework for the social pillar of lean
Authors: McMackin John , Flood Patrick
Published: February 2019

Purpose

The purpose of this paper is to propose a theoretical framework for the social pillar of lean (SPL), which is a neglected topic in the lean management literature.

Design/methodology/approach

The authors first identify shortcomings in research on the SPL that are attributable to neglect of relevant perspectives in organisational research. The authors then present a theoretical case outlining the factors that should be considered in SPL research, how they relate to one another and how they should be integrated in future studies of lean change implementation.

Findings

The theoretical framework for the SPL proposes a categorisation of factors and their relationships across levels of analysis that are relevant to the SPL. The inclusion of previously neglected perspectives, such as the relational coordination theory, within this framework offers new insights and directions for research.

Practical implications

By emphasising relationships, the SPL framework sheds light on the scale and complexity of the management challenges involved in lean implementation.

Originality/value

The proposed framework promises to enhance the efficacy of lean research by focussing on factors, such as relationships, that are most relevant to lean implementation.
The impact of occupational stereotypes in human-centered service systems
Authors: Huetten Antje Sarah Julia , Antons David , F. Breidbach Christoph , Piening Erk P. , Salge Torsten Oliver
Published: February 2019

Purpose

The purpose of this paper is to explore the impact that occupational stereotypes held by customers have on value co-creation processes in human-centered service systems (HCSSs) like hospitals. Specifically, by exploring if and how customers’ (i.e. patients’) stereotypes toward frontline employees (e.g. nurses) affect their satisfaction as co-creators of value, this study responds to current service research priorities attempting to understand value co-creation in collaborative contexts like healthcare, and addresses calls to investigate the changing role of health care customers therein.

Design/methodology/approach

A field study was conducted in the context of German hospitals, which provides unique empirical evidence into the relationship between patients’ stereotypes toward healthcare professionals and their satisfaction with health services as well as the mediating mechanisms through which such stereotypes affect patient satisfaction.

Findings

Negative (positive) stereotypes patients hold toward healthcare occupations decrease (increase) their satisfaction and are associated with perceptions of reduced (improved) patient orientation and patient participation in co-creation. However, only perceived patient orientation partially mediates the link between occupational stereotypes and patient satisfaction.

Originality/value

This study develops and tests new hypotheses related to occupational stereotyping in complex HCSSs, and extends previous research on stereotypes in service by exploring the previously unknown mediating mechanisms through which these impact value co-creation processes overall. It furthermore provides important guidance for future research about stereotyping in general, and its impact on value co-creation and HCSS, in particular.
How much is “too much” for a brand to use an advergame with children?
Authors: Agante Luisa , Pascoal Ana
Published: February 2019

Purpose

The purpose of this study is to understand the magnitude of the impact advergames have on children’s preferences and choices for unhealthy products and brands, in terms of time of exposure (immediate vs delayed) and number of exposures (single vs repeated exposure). Past literature has focused essentially on the immediate effects of single exposures to advergames. Few studies explored the delayed or repetition effects and found wear-out effects of multiple exposure and also no delayed effects of single exposure. Therefore, this study will reduce the existent gap in the literature by studying simultaneously both effects.

Design/methodology/approach

A sample of 104 children aged 6-9 years old was used, divided into three groups (no exposure/single exposure/repeated exposure) in an experimental between-subjects design setting.

Findings

The results confirm the existence of all the expected effects: exposure to advergames has immediate and longer effects on a child’s preferences and choices of the brand depicted in the advergame and in that product category. Repeated exposure to the advergame enhances all the effects on the brand, but not on the product category.

Originality/value

Although earlier literature has already analyzed time and repetition effects on traditional media, or sought to analyze effects of advergames but with an adult sample, this article highlights the extent of these effects with children, and based on these results, reflects on the ethicality of using advergames with children on products high in fat, salt and/or sugar.
Modeling of tourists, local population, natural and cultural resources toward ecotourism product (case study in Seagrass Trikora Conservation Area)
Authors: Mulyadi Aras
Published: February 2019

Purpose

The purpose of this study is to investigate the relationship between local population, natural and cultural resources on tourist quality an ecotourism product in Seagrass Trikora Conservation Area, Bintan Regency and Riau Island.

Design/methodology/approach

The research model portrayed in this case consists of three variables (tourists, local population and resources); these variables try to describe how ecotourism in Riau Island can be developed. This study is based on a survey conducted in June 2015 of 200 Indonesian citizens and residents. List contains 900 potential participants that were filtered from numerous public sources and from the researchers’ professional and social contacts. The interviewers were contacted to alert them to participate in the survey. A total of 200 completed responses were received within 10 weeks of survey, and 200 responses were successfully collected. These responses are analyzed and presented in this research.

Findings

This study found that higher quality of the local population, natural resources and cultural resources would have an impact on improving ecotourism quality. On the other hand, higher ecotourism quality would be able to improve the performance of ecotourism. The implications of this research contributed to the development of ecotourism in the Riau Island: improving the quality of the surrounding population, i.e. in the improvement of non-formal education of the population capable of supporting ecotourism; improvement of material and non-material quality of the ecotourism area; and maintenance of the natural resources of the ecotourism area.

Originality/value

This research tried to sort natural and cultural resources into two different things: natural resources were measured by specific activities, biodiversity protection, ecology maintenance and travel involvement in natural landscape and cultural resources were measured by ensuring cultural integrity, ensuring the social coherence of communities and maintaining cultural possibilities. Thus, the originality of this research lied in the use of two separate variables of natural resources and cultural resources in the performance of ecotourism. Separation of variables of ecotourism quality and performance of ecotourism became the second originality in this study. This study aimed to examine the effects of quality of local population (X1), natural resources (X2) and cultural resources (X3) on ecotourism quality (Y1), and its impact on Performance of Ecotourism (Y2), comprehensively.
Comparing results of ranking conjoint analyses, best–worst scaling and discrete choice experiments in a nonhypothetical context
Authors: Yangui Ahmed , Akaichi Faical , Costa‐Font Montserrat , Gil José Maria
Published: February 2019

This study assesses the comparability of discrete choice experiment (DCE), ranking conjoint analysis (RCA) and multiprofile best–worst scaling (BWS) in a nonhypothetical context in terms of estimated partworths, willingness to pay (WTP), response consistency and external validity. Overall, the results suggest that: (i) the conjoint analysis formats that were used in this study provide similar estimated WTP, but different estimated partworths and computed external validity; (ii) the inclusion of the full ranking information in the estimation of the parameters of interest affects the estimated partworths, but not the estimated WTP; and (iii) it is more appropriate to use multiprofile BWS over DCE and RCA because it has better predictive power of consumers’ preferences and provides estimated WTP comparable to those obtained in the others conjoint analysis formats. The BWS’ cognitive process could be considered clearness for participants implying significant increment of its predictive power.
Omeprazole treatment elicits contrasting responses to salt stress in two basil genotypes
Authors: Cirillo Valerio , Van Oosten Michael J. , Izzo Miriam , Maggio Albino
Published: February 2019

Omeprazole (OP) has been shown to act as a plant growth regulator and enhances tolerance to salt stress. In this study, two Ocimum basilicum genotypes were tested for their responses to OP under salt stress. The two genotypes, Napoletano (NAP) a salt sensitive genotype, and Genovese (GEN) a salt tolerant genotype, had contrasting responses to OP treatment. NAP demonstrated increases in terms of growth (+36%) and salt tolerance (+19%) upon treatment while GEN had a growth increase (+35%) and OP enhanced sensitivity to salt stress (−13%). OP treatment also had an effect on the post‐harvest behaviour of these two genotypes by increasing NAP shelf life while decreasing GEN shelf life. The contrasting responses to OP in these two genotypes has provided insight into the role of this molecule in mediating growth and adaptation to stress and, more importantly, into the complexity of the mechanisms mediating these processes.
Ultrahigh‐resolution anterior segment optical coherence tomography for analysis of corneal microarchitecture during wound healing
Authors: Pantalon Anca , Pfister Martin , Aranha dos Santos Valentin , Sapeta Sabina , Unterhuber Angelika , Pircher Niklas , Schmidinger Gerald , Garhöfer Gerhard , Schmidl Doreen , Schmetterer Leopold , Werkmeister René M.
Published: February 2019

Purpose

To employ ultrahigh‐resolution (UHR) optical coherence tomography (OCT) for investigation of the early wound healing process in corneal epithelium.

Methods

A custom‐built UHR‐OCT system assessed epithelial healing in human keratoconic cornea after epi‐off crosslinking (CXL) procedure and a wound healing model in rabbits with iatrogenic corneal injury. 3D OCT data sets enhanced obtaining epithelial thickness maps and evaluation of reepithelization stage. Accompanying changes in deeper corneal microarchitecture were analysed.

Results

The mean central corneal thickness in 40 eyes with keratoconus at baseline was 482.7 ± 38.2 μm, while mean central epithelial thickness (CET) was 43.8 ± 6.4 μm. At the final visit 20 ± 5 days post‐CXL procedure, CET was 35.0 ± 5.8 μm, significantly thinner after reepithelization (p < 0.001). Surgical success was assessed at the final visit through the demarcation line (DL), identified at 43.7 ± 13.5% stromal depth. In rabbits, the mean CET in 20 eyes at baseline was 35.9 ± 2.6 μm. In rabbits that revealed complete wound closure (10/20 eyes) at the last study day at 72 hr, CET was significantly thinner compared to baseline (30.4 ± 2.8 μm versus 35.4 ± 2.9 μm, p = 0.005). An intra‐stromal landmark indicating early keratocyte apoptosis was measured at 30.0 ± 5.1% stromal depth. Epithelial thickness maps showed the time–course of corneal healing.

Conclusion

Ultrahigh‐resolution (UHR)‐OCT provided precise assessment of epithelial wound and its healing by 3D‐mapping. In addition, microarchitectural changes in the cornea in early phases of epithelial healing were revealed.
Machine learning model to predict recurrent ulcer bleeding in patients with history of idiopathic gastroduodenal ulcer bleeding
Authors: Wong Grace Lai‐Hung , Ma Andy Jinhua , Deng Huiqi , Ching Jessica Yuet‐Ling , Wong Vincent Wai‐Sun , Tse Yee‐Kit , Yip Terry Cheuk‐Fung , Lau Louis Ho‐Shing , Liu Henry Hin‐Wai , Leung Chi‐Man , Tsang Steven Woon‐Choy , Chan Chun‐Wing , Lau James Yun‐Wong , Yuen Pong‐Chi , Chan Francis Ka‐Leung
Published: February 2019

Background

Patients with a history of Helicobacter pylori–negative idiopathic bleeding ulcers have an increased risk of recurring ulcer complications.

Aim

To build a machine learning model to identify patients at high risk for recurrent ulcer bleeding.

Methods

Data from a retrospective cohort of 22 854 patients (training cohort) diagnosed with peptic ulcer disease in 2007‐2016 were analysed to build a model (IPU‐ML) to predict recurrent ulcer bleeding. We tested the IPU‐ML in all patients with a diagnosis of gastrointestinal bleeding (n = 1265) in 2008‐2015 from a different catchment population (independent validation cohort). Any co‐morbid conditions which had occurred in >1% of study population were eligible as predictors.

Results

Recurrent ulcer bleeding developed in 4772 patients (19.5%) in the training cohort, during a median follow‐up period of 2.7 years. IPU‐ML model built on six parameters (age, baseline haemoglobin, and presence of gastric ulcer, gastrointestinal diseases, malignancies, and infections) identified patients with bleeding recurrence within 1 year with an area under the receiver operating characteristic curve (AUROC) of 0.648. When we set the IPU‐ML cutoff value at 0.20, 27.5% of patients were classified as high risk for rebleeding with a sensitivity of 41.4%, specificity of 74.6%, and a negative predictive value of 91.1%. In the validation cohort, the IPU‐ML identified patients with a recurrence ulcer bleeding within 1 year with an AUROC of 0.775, and 84.3% of overall accuracy.

Conclusion

We developed a machine‐learning model to identify those patients with a history of idiopathic gastroduodenal ulcer bleeding who are not at high risk for recurrent ulcer bleeding.
Ballistic Study Tackles Kinetic Energy Values of Palaeolithic Weaponry
Authors: Coppe J. , Lepers C. , Clarenne V. , Delaunois E. , Pirlot M. , Rots V.
Published: February 2019

The appearance of new projectile propulsion modes is viewed as an important element for understanding human behaviour during the Palaeolithic. Because the organic components of hunting weapons (the bow, spear‐thrower and arrow, and spear shaft) are only rarely preserved archaeologically, some effort has been invested in experiments to explore how the projecting modes could be identified through the analysis of stone points. The kinetic energy developed by each mode of propulsion has been considered a key variable in these experiments. However, the data used in these studies generally come from a few ballistic studies, with varied results. We present the results of a systematic study conducted with a ballistic pendulum and combined with a classic ballistic analysis. We quantified and compared the kinetic energy developed by the four standard modes of propulsion known for the Palaeolithic. The kinetic energy values that we attained, especially those measured for thrusting spears, clearly differ from what has been assumed up to now, and thus challenge current models on the evolution of hunting technology.
Development of genetic evaluation for milk production traits of Holsteins in Japan
Authors: Hagiya Koichi
Published: February 2019

The procedure used for the genetic evaluation of dairy cattle in Japan has developed from a lactation sire–MGS model to a multiple‐lactation random regression test‐day animal model. Genetic evaluation of Holstein bulls in Japan began in 1989 with the use of field‐style progeny testing; dairy herd improvement program data from all over Japan were used, along with a sire and maternal grandsire model. In 1993, an animal model was introduced to estimate breeding values for yield and type traits. A random regression test‐day model was first applied in 2010. In the business of breeding dairy cattle, it is very important to users that estimated breeding values are reliable and stable among subsequent routine evaluations. With experience in the genetic evaluation of dairy cattle in Japan, Japanese researchers have found ways to improve the stability of estimated breeding values. These modifications involve changes in data editing, development of evaluation models, changes to the structures of unknown‐parent groups, awareness of the problems of predicting lactation yield from partial test‐day records, and adjustment for heterogeneity within herd variances. Here, I introduce developments in, and our experiences with, the genetic evaluation of yield traits of Holstein cattle in Japan.
Say‐On‐Pay Voting: A Five‐Year Retrospective
Authors: Hemphill Thomas A.
Published: February 2019

The Dodd‐Frank Wall Street Reform and Consumer Protection Act, signed into law by President Obama in July 2010, included two significant corporate governance mandates: “say‐on‐pay” shareholder voting and the frequency of such votes among all publicly traded companies. The say‐on‐pay rule requires publicly traded companies subject to proxy rules to offer their shareholders an advisory, or nonbinding, vote at least once every three years on the compensation packages of the most highly compensated executives. The actual data for the first five years of say‐on‐pay voting indicates one intractable conclusion: that shareholder say‐on‐pay voting has not verified what many shareholder activists originally believed, i.e., that the majority of shareholders held similar opinions about business executives being significantly overpaid for their managerial performances. During its first five years in effect, the results of say‐on‐pay voting indicate that shareholders are overwhelmingly satisfied with executive compensation packages, as a 92 percent average shareholder say‐on‐pay approval result (i.e., exceeding 70 percent) among companies listed in the Russell 3000 Index attests.
Rising rates of cesarean delivery in Ecuador: Socioeconomic and institutional determinants over two decades
Authors: Jahnke Johanna R. , Houck Kelly M. , Bentley Margaret E. , Thompson Amanda L.
Published: February 2019

Background

Ecuador’s cesarean delivery rate far exceeds that recommended by the Pan American Health Organization (PAHO) and the World Health Organization (WHO). Using data from three iterations of Ecuador’s nationally representative, population‐based survey Encuesta Nacional de Salud y Nutrición (ENSANUT/ENDEMAIN), spanning 23 years, this study examines women’s mode of delivery outcomes by sociodemographic characteristics and hospital type (private, public, social security) in light of Ecuador’s major health care reform over the past two decades.

Methods

Using data from the 1994, 2004, and 2012 iterations of the data set, we analyzed trends in cesarean delivery based on province, year, and institution of care. Logistic regression was used to test the odds of cesarean delivery based on hospital type, sociodemographics, and birth complications for the full sample and primiparous women. Predicted probabilities were derived from this model.

Results

Ecuador’s cesarean rate increased from 22% in 1989 to 41% in 2012. From 2008 to 2012, the probability of cesarean delivery in private centers was significantly higher than in public centers, and from 2009 to 2012, the probability of cesarean delivery in social security centers was significantly higher than in public centers. Higher maternal age, income, education, and parity, earlier prenatal care initiation, and more prenatal visits were associated with risk for cesarean delivery.

Conclusions

To decrease the adverse effects of cesarean delivery for women and their babies, cesarean delivery should be reduced. Future research should investigate how incentive structures are used and how medical indication is defined within health institutions in Ecuador.
The Commons: Separating Tragedy and Triumph at a City Park
Authors: Cataldi John
Published: February 2019

Littering in a city park is often considered a capricious act of neglect associated with simple carelessness. Using Ostrom's model, Governing the Commons, this research finds that littering is correlated with specific park activities. This article advances our understanding of the Commons and littering by considering the concept of “pollution,” as well as understanding patterns of litter for a communal city. I argue that among the variety of park activities, there are “nonlitter” activities that require little more than the husbandry of local communal governance and there are “litter” activities that require the additional husbandry of the state. However, additional empirical evidence was also discovered that there are instances where the abuse of common resources is socially structured and that there is, on occasion, a normative structure to norm–violating behavior.
The DILI‐sim Initiative: Insights into Hepatotoxicity Mechanisms and Biomarker Interpretation
Authors: Watkins Paul B.
Published: February 2019

The drug‐induced liver injury (DILI)‐sim Initiative is a public‐private partnership involving scientists from industry, academia, and the US Food and Drug Administration (FDA). The Initiative uses quantitative systems toxicology (QST) to build and refine a model (DILIsym) capable of understanding and predicting liver safety liabilities in new drug candidates and to optimize interpretation of liver safety biomarkers used in clinical studies. Insights gained to date include the observation that most dose‐dependent hepatotoxicity can be accounted for by combinations of just three mechanisms (oxidative stress, interference with mitochondrial respiration, and alterations in bile acid homeostasis) and the importance of noncompetitive inhibition of bile acid transporters. The effort has also provided novel insight into species and interpatient differences in susceptibility, structure‐activity relationships, and the role of nonimmune mechanisms in delayed idiosyncratic hepatotoxicity. The model is increasingly used to evaluate new drug candidates and several clinical trials are underway that will test the model's ability to prospectively predict liver safety. With more refinement, in the future, it may be possible to use the DILIsym predictions to justify reduction in the size of some clinical trials. The mature model could also potentially assist physicians in managing the liver safety of their patients as well as aid in the diagnosis of DILI.
Reliability and responsiveness of the Jebsen‐Taylor Test of Hand Function and the Box and Block Test for children with cerebral palsy
Authors: Araneda Rodrigo , Ebner‐Karestinos Daniela , Paradis Julie , Saussez Geoffroy , Friel Kathleen M , Gordon Andrew M , Bleyenheuft Yannick
Published: February 2019

Aim

To assess the reliability and to evaluate the responsiveness of both the Jebsen‐Taylor Test of Hand Function (JTTHF) and the Box and Block Test (BBT) in children with cerebral palsy (CP).

Method

In this retrospective study, the reliability analyses were conducted with paired t‐tests considering a short (mean 14d) and a long (mean 120d) time in between two assessment periods. In addition, an intraclass correlation coefficient (ICC) was used to assess the level of congruency. The responsiveness to therapy was conducted with a paired t‐test in the whole sample regarding the age, the manual ability level as classified with the Manual Ability Classification System (MACS), and the topography.

Results

Our main results confirmed the tests’ reliability in a short time period for the JTTHF in both hands and for the BBT on the less affected hand. These results were consistent with the ICC. The responsiveness was confirmed, except on the less affected hand for the JTTHF, with similar results for age, MACS, and topography approach.

Interpretation

This study supports the use of the JTTHF and the BBT to examine changes after short‐term interventions for children with CP. These results should be interpreted with association to normative values or with a control group when used over long assessment periods.

What this paper adds

The Box and Block Test (BBT) is reliable in a brief period of assessment in children with cerebral palsy (CP).

The Jebsen‐Taylor Test of Hand Function (JTTHF) is reliable in a brief period of assessment in children with CP.

The JTTHF and BBT are responsive to changes in a brief period of intensive therapy in children with CP.

The reliability and responsiveness of the JTTHF and BBT are weak over long assessment periods.
Quantifying motor learning strategies can translate to physiotherapy dose for children with cerebral palsy
Authors: Dumas Helene M
Published: February 2019

This commentary is on the original article by Ryan et al. on pages 1061–1066 of this issue.
The independent role of neonatal seizures in epilepsy and other long‐term neurological outcomes
Authors: Spagnoli Carlotta , Pisani Francesco
Published: February 2019

This commentary is on the original article by Oh et al. on pages 661–666 of this issue.
Association between uric acid, renal haemodynamics and arterial stiffness over the natural history of type 1 diabetes
Authors: Lytvyn Yuliya , Bjornstad Petter , Lovshin Julie A. , Singh Sunita K. , Boulet Genevieve , Farooqi Mohammed A. , Lai Vesta , Tse Josephine , Cham Leslie , Lovblom Leif E. , Weisman Alanna , Keenan Hillary A. , Brent Michael H. , Paul Narinder , Bril Vera , Advani Andrew , Sochett Etienne , Perkins Bruce A. , Cherney David Z. I.
Published: February 2019

Aims

To examine the relationship between normal plasma uric acid (PUA) levels, renal haemodynamic function, arterial stiffness and plasma renin and aldosterone over a wide range of type 1 diabetes (T1D) durations in adolescents, young adults and older adults.

Materials and methods

PUA, glomerular filtration rate (GFR), effective renal plasma flow (ERPF), vascular stiffness parameters (aortic augmentation index [AIx], carotid AIx, carotid femoral pulse wave velocity [cfPWV]), and plasma renin and aldosterone were measured during a euglycaemic clamp in people with T1D: 27 adolescents (mean ± SD age 16.8 ± 1.9 years), 52 young adults (mean ± SD age 25.6 ± 5.5 years) and 66 older adults (mean ± SD age 65.7 ± 7.5 years).

Results

PUA was highest in patients with the longest T1D duration: 197 ± 44 μmol/L in adolescents versus 264 ± 82 μmol/L in older adults (P < 0.001). Higher PUA correlated with lower GFR only in older adults, even after correcting for age, glycated haemoglobin and sex (β = −2.12 ± 0.56; P = 0.0003), but not in adolescents or young adults. Higher PUA correlated with lower carotid AIx (β = −1.90, P = 0.02) in adolescents. In contrast, PUA correlated with higher cfPWV (P = 0.02) and higher plasma renin (P = 0.01) in older adults with T1D.

Conclusions

The relationship between higher PUA with lower GFR, increased arterial stiffness and renin angiotensin aldosterone system (RAAS) activation was observed only in older adults with longstanding T1D. T1D duration may modify the association between PUA, renal haemodynamic function and RAAS activation, leading to renal vasoconstriction and ischaemia. Further work must determine whether pharmacological PUA‐lowering prevents or reverses injurious haemodynamic and neurohormonal sequelae of longstanding T1D, thereby improving clinical outcomes.
Effect of cilostazol, a phosphodiesterase‐3 inhibitor, on coronary artery stenosis and plaque characteristics in patients with type 2 diabetes: ESCAPE study
Authors: Lee Dong‐Hwa , Chun Eun Ju , Oh Tae Jung , Kim Kyoung Min , Moon Jae Hoon , Choi Sung Hee , Park Kyong Soo , Jang Hak Chul , Lim Soo
Published: February 2019

Aim

To perform a prospective study to evaluate the effect of cilostazol (CTZ) compared with aspirin (acetylsalicylic acid; ASA) in Korean people with diabetes and subclinical coronary atherosclerosis.

Materials and methods

A total of 100 people with diabetes who had mild to moderate coronary atherosclerosis, assessed by coronary computed tomographic angiography (CCTA), were randomly assigned to either 200 mg/d CTZ or 100 mg/d ASA (n = 50 each group). The primary outcome was change in coronary artery stenosis assessed by CCTA after 12 months of treatment. Secondary outcomes included changes in plaque composition, coronary artery calcium score and cardiac markers.

Results

The mean age, body mass index and glycated haemoglobin concentration were 61.5 years, 25.0 kg/m2 and 56.8 mmol/mol, respectively, and were well matched between the two groups. Coronary artery stenosis decreased in the CTZ group (from 44.0 ± 2.1% to 40.4 ± 2.5%) but remained unchanged in the ASA group (from 38.9 ± 2.1% to 40.6 ± 2.1%). In the CTZ group, the non‐calcified portion of plaques decreased significantly (from 20.6 ± 3.0 to 17.3 ± 3.0 mm3), whereas it did not change significantly in the ASA group (15.2 ± 2.8 vs 16.6 ± 2.9 mm3). Increases in HDL cholesterol, decreases in triglycerides, liver enzyme and high‐sensitivity C‐reactive protein levels, and reductions in abdominal visceral fat area and insulin resistance were observed only in the CTZ group.

Conclusion

CTZ treatment for 12 months decreased coronary artery stenosis and the non‐calcified plaque component. These results suggest that CTZ treatment may be an option for preventing the progression of coronary atherosclerosis in people with diabetes.
Axonal water fraction as marker of white matter injury in primary‐progressive multiple sclerosis: a longitudinal study
Authors: Margoni M. , Petracca M. , Schiavi S. , Fabian M. , Miller A. , Lublin F. D. , Inglese M.
Published: February 2019

Background and purpose

Diffuse white matter (WM) injury is prominent in primary‐progressive multiple sclerosis (PP‐MS) pathology and is a potential biomarker of disease progression. Diffusion kurtosis imaging allows the quantification of non‐Gaussian water diffusion, providing metrics with high WM pathological specificity. The aim of this study was to characterize the pathological changes occurring in the normal‐appearing WM of patients with PP‐MS at baseline and at 1‐year follow‐up and to assess their impact on disability and short‐term disease progression.

Methods

A total of 26 patients with PP‐MS and 20 healthy controls were prospectively enrolled. Diffusion kurtosis imaging single‐shot echo‐planar imaging (EPI) was acquired on a 3‐T scanner (Philips Achieva, Best, The Netherlands) (voxel size, 2 × 2 × 2 mm3, 30 directions for each b‐value = 1000, 2000 s/mm2 and one b = 0 s/mm2). A two‐compartment biophysical model of WM tract integrity was used to derive spatial maps of axonal water fraction (AWF), intra‐axonal diffusivity, extra‐axonal axial and radial diffusivities (De,axial, De,radial) and tortuosity from the following WM tracts: corpus callosum (CC), corticospinal tract (CST) and posterior thalamic radiation (PTR).

Results

At baseline, patients with PP‐MS showed a widespread decrease of AWF, tortuosity and De,axial and an increase of De,radial in CC, CST and PTR (P ranging from 0.001 to 0.036). At 1‐year follow‐up, a significant AWF decrease was detected in the body of CC (P = 0.048), PTR (P = 0.008) and CST (P = 0.044). Baseline AWF values in CST significantly discriminated progressed from non‐progressed patients (P = 0.021; area under the curve, 0.854).

Conclusion

Based on its change over time and its relationship with disease progression, among the analyzed metrics, AWF seems the most sensitive metric of WM tissue damage in PP‐MS and therefore it could be considered as a marker for monitoring disease progression.
Structural insights into the unique polylactate‐degrading mechanism of Thermobifida alba cutinase
Authors: Kitadokoro Kengo , Kakara Mizuki , Matsui Shingo , Osokoshi Ryouhei , Thumarat Uschara , Kawai Fusako , Kamitani Shigeki
Published: February 2019

Cutinases are enzymes known to degrade polyester‐type plastics. Est119, a plastic‐degrading type of cutinase from Thermobifida alba AHK119 (herein called Ta_cut), shows a broad substrate specificity toward polyesters, and can degrade substrates including polylactic acid (PLA). However, the PLA‐degrading mechanism of cutinases is still poorly understood. Here, we report the structure complexes of cutinase with ethyl lactate (EL), the constitutional unit. From this complex structure, the electron density maps clearly showed one lactate (LAC) and one EL occupying different positions in the active site cleft. The binding mode of EL is assumed to show a figure prior to reaction and LAC is an after‐reaction product. These complex structures demonstrate the role of active site residues in the esterase reaction and substrate recognition. The complex structures were compared with other documented complex structures of cutinases and with the structure of PETase from Ideonella sakaiensis. The amino acid residues involved in substrate interaction are highly conserved among these enzymes. Thus, mapping the precise interactions in the Ta_cut and EL complex will pave the way for understanding the plastic‐degrading mechanism of cutinases and suggest ways of creating more potent enzymes by structural protein engineering.
Contested governance: The new repertoire of the Eurozone crisis
Authors: Jabko Nicolas
Published: February 2019

The austerity policies that EU policymakers adopted in response to the Eurozone crisis are often criticized as the product of institutionalized neoliberal ideas. This critique has merits, but tends to overlook institutional changes that do not neatly conform to well demarcated neoliberal ideas considered as “switchmen,” “paradigms,” or “blueprints.” This article offers an alternative reading of the Eurozone's institutional evolution that bridges pragmatist scholarship with cognitive and social psychology. The Eurozone crisis saw the emergence of a new and contested repertoire of governance. Policymakers agreed that “stronger governance” was necessary, but they struggled over how to perform that repertoire. This contest ultimately produced institutional changes that typically mixed austerity and unconventional policies. The advantage of thinking about ideas in terms of repertoires that actors perform is to afford a more granular view of institutions as sites of individual cognition, collective innovation, and political contestation.
Ageing profiles of Caucasian and Chinese cohorts – focus on hands skin
Authors: Messaraa C. , Doyle L. , Mansfield A. , O'Connor C. , Mavon A.
Published: February 2019

Objective

In spite of hand care being a dynamic segment of skin care, hands skin physiology has been receiving little attention in comparison to facial skin. In the present study, we aimed at gathering a comprehensive set of skin data from the dorsal part of the hand to study age related‐changes in two ethnic groups (Caucasian and Chinese).

Methods

Skin topographic, skin colour/colour heterogeneities, skin chromophores and skin biophysical measurements of 116 Caucasian and Chinese female volunteers aged 30–65 years old were collected in Ireland and in China as part of a cross‐sectional study.

Results

Topographic alterations happened at both micro and macro scales with a noticeable delay in the onset of 10 years for the Chinese cohort. Similar evolution of skin colour with ageing was observed between the two cohorts and strong dissimilarities were seen when it came to colour heterogeneities and melanin hyper concentration, with a 20‐year delay in severity for the Chinese cohort. A similar sharp drop of skin hydration occurred when reaching the 60's regardless of the group and substantial differences were recorded for skin biomechanical properties of the skin.

Conclusion

These results provide additional insights about hand skin physiology in relation to ageing and ethnic differences, especially when put into perspective with what is currently known about facial ageing. This research yield additional material for hand cream product rationale and strategies for mitigating the appearance of ageing hands.