bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of IV to Enteral Benzodiazepine Conversion Calculations in a Pediatric Intensive Care Setting
Authors: Warrington Susan E. , Collier Hailey K. , Himebauch Adam S. , Wolfe Heather A.
Published: August 2018

Objectives:

To evaluate if institutionally established calculations for transitioning continuous IV midazolam to enteral benzodiazepines maintain Withdrawal Assessment Tool—Version 1 scores equal to or less than preconversion values.

Design:

Retrospective cohort study evaluating the effectiveness and safety of benzodiazepine conversion calculations embedded within an institution-specific clinical pathway for sedation and weaning of mechanically ventilated pediatric patients.

Setting:

A 55-bed, mixed-medical, noncardiac surgical PICU in a tertiary care children’s hospital.

Patients:

All patients age 6 months to 18 years who received continuous midazolam for 5 days or longer while mechanically ventilated for 5–21 days and were then converted to either enteral diazepam or lorazepam following extubation (or return to baseline ventilator settings in tracheostomy-dependent patients) between January 1, 2015, and June 30, 2016.

Interventions:

Benzodiazepine conversion calculations were applied according to institutional clinical pathway guidance.

Measurements and Main Results:

Withdrawal Assessment Tool—Version 1 scores were compared pre and post benzodiazepine conversion. Patient demographics, benzodiazepine dose escalations, as needed benzodiazepine requirements, and severe adverse events within 48 hours of conversion were assessed. Seventy-one patient encounters were analyzed (median age, 2.5 yr; interquartile range, 1.2–5.3). The median Withdrawal Assessment Tool—Version 1 scores pre conversion and post conversion were not significantly different (1 [interquartile range, 0.75–2] and 1 [interquartile range, 0.25–2], respectively, p = 0.1). As needed benzodiazepine doses were administered in 38% of encounters post conversion, but escalation of a scheduled enteral benzodiazepine regimen was only required in 2.8% of encounters. Post conversion, one patient (1.4%) had increased seizure activity, and four patients (5.6%) required fluid boluses secondary to tachycardia or dehydration, but not hypotension.

Conclusions:

These findings suggest that standardized benzodiazepine conversions successfully achieved consistent Withdrawal Assessment Tool—Version 1 scores compared with preconversion values. Severe adverse events associated with oversedation and/or withdrawal were minimal and confounded by underlying disease states.
Pediatric Massive Transfusion
Authors: Maw Graeme , Furyk Claire
Published: August 2018

Introduction

Balanced resuscitation of plasma, platelets, and red blood cells is now recognized as improving outcomes in traumatic bleeding in adults. The correct approach in children has yet to be determined.

Methods

We performed a systematic review of the literature into transfusion protocols in traumatic hemorrhage in children by conducting an article search of significant databases to identify relevant articles. Studies of interest included interventional trials with comparisons relating to the transfusion of blood including blood component therapy. The search identified 422 articles of interest, the abstracts of which were independently reviewed by 2 authors for inclusion in the trial. This revealed 35 articles, the full texts of which were reviewed. There were no randomized controlled trials and 4 nonrandomized trials with a further 21 articles that were deemed relevant. The data were insufficient for meta-analysis, and so a descriptive analysis was performed.

Results

There were 4 main trials. Two trials were small (approximately 100 patients) nonrandomized trials into pediatric hemorrhage managed as per a massive transfusion protocol or at physician discretion. One was a retrospective analysis of pediatric trauma patients who received red blood cell transfusion with differing platelet ratios, and one was a trauma database review of component ratios in hemorrhaging children. All 4 trials found increased ratios had no effect on mortality.

Discussion

As well as blood component therapy, adjunctive therapies used in the management of bleeding children are discussed. These include tranexamic acid, viscoelastic hemostatic assays, factor VIIa, and fibrinogen use.

Conclusions

There is little evidence for improved outcomes using component-based transfusion in a rigid 1:1:1 strategy in children. A goal-directed approach using viscoelastic hemostatic assay–guided treatment with early institution of tranexamic acid and fibrinogen replacement is considered the way forward.
An Unusual Cause for Intermittent Stridor and Dysphagia in an Infant
Authors: Ryan Sydney E. , Beyerlein Larissa , Lee Justin H. , Fenton Stephen J. , Hewes Hilary A.
Published: August 2018

Stridor is a common presenting symptom in young children and is produced by turbulent flow through the upper airway or trachea. In children under 12 months of age, stridor is commonly caused by laryngomalacia, tracheomalacia, croup, airway foreign body, and/or retropharyngeal abscess. In atypical presentations of stridor, soft tissue neck radiographs can be helpful to determine the underlying etiology. Occasionally, children will require bronchoscopy to determine the etiology and treatment.
Staged Raising of a Coronal Flap for Fronto-Orbital Advancement and Remodeling in Saethre–Chotzen Syndrome Complicated by Sinus Pericranii
Authors: Shaw Abigail V. , Jayamohan Jayaratnam , Sheerin Fintan , Johnson David
Published: August 2018

This article reports the surgical management of a 3-month-old girl with Saethre–Chotzen syndrome, who presented with bicoronal synostosis and a large midline sinus pericranii with abnormal cerebral venous drainage via scalp veins. Raised intracranial pressure was demonstrated on monitoring, indicating the need for calvarial expansion necessitating a coronal access incision. A 2-staged delayed raising of the coronal flap was performed to reduce the potential risk of cerebral venous infarction. Monitoring for clinical sequelae and a computerised tomography venogram followed each of these procedures, demonstrating successful redirection of the venous drainage of the brain posteriorly. Finally, a successful fronto-orbital advancement and remodeling procedure was performed with no complications.
Surgical Techniques and Long-term Outcomes of Living-donor Liver Transplantation With Inferior Vena Cava Replacement Using Atriocaval Synthetic Interposition Graft for Budd-Chiari Syndrome
Authors: Yoon Young-In , Lee Sung-Gyu , Moon Deok-Bog , Ahn Chul-Soo , Hwang Shin , Kim Ki-Hun , Ha Tae-Yong , Song Gi-Won , Jung Dong-Hwan , Park Gil-Chun , Kim Dong-Sik , Choo Suk-Jung
Published: August 2018

Objective:

We aimed to describe our living-donor liver transplantation (LDLT) surgical technique and its long-term patency for patients with Budd-Chiari syndrome (BCS) and retrohepatic inferior vena cava (IVC) obstruction that extends up to the atrium.

Background:

From a technical perspective, LDLT for BCS with an IVC obstruction up to the right atrium is one of the most challenging surgical procedures. Consequently, the optimal surgical technique for patients with BCS has not yet been elucidated.

Methods:

A durable LDLT technique without piggy-back hepatectomy was designed using a large-caliber synthetic interposition vascular graft between the right atrium and the infrahepatic IVC for reconstructing the hepatic outflow tract in patients with BCS.

Results:

Between May 2006 and May 2017, 5 of 17 BCS patients who underwent LDLT required the described technique. All patients with a median follow-up of 10.5 years (range, 9.2–11.5 years) demonstrated the patent IVC grafts and no recurrence of BCS.

Conclusions:

Our refined technique does not require unnecessary and dangerous dissection of the diseased IVC, and eliminates the residual suprahepatic vena cava with the possibility of BCS recurrence by connecting the graft to the healthy atrium.
Circulating Tumor Cells Dynamics in Pancreatic Adenocarcinoma Correlate With Disease Status
Authors: Gemenetzis Georgios , Groot Vincent P. , Yu Jun , Ding Ding , Teinor Jonathan A. , Javed Ammar A. , Wood Laura D. , Burkhart Richard A. , Cameron John L. , Makary Martin A. , Weiss Matthew J. , He Jin , Wolfgang Christopher L.
Published: August 2018

Objectives:

Previous retrospective studies demonstrated that circulating tumor cells (CTCs) subtypes correlate with overall survival in patients with pancreatic ductal adenocarcinoma (PDAC). Herein, we report results of a prospective observational study on CTCs dynamics to assess their clinical significance.

Methods:

The CLUSTER study is a prospective longitudinal study on PDAC CTCs dynamics (NCT02974764). Multiple peripheral blood samples were collected from 200 consecutively enrolled patients with presumed PDAC diagnosis. CTCs were isolated and characterized by immunofluorescence.

Results:

Two major CTCs subtypes were identified in PDAC patients: epithelial CTCs (eCTCs) and epithelial/mesenchymal CTCs (mCTCs). Patients who received neoadjuvant chemotherapy had significantly lower total CTCs (tCTCs, P = 0.007), eCTCs (P = 0.007), and mCTCs (P = 0.034), compared with untreated patients eligible for upfront resection. Surgical resection of the primary tumor resulted in significant reduction, but not disappearance, of CTCs burden across all cell subtypes (P < 0.001). In multivariable logistic regression analysis, preoperative numbers of all CTCs subpopulations were the only predictors of early recurrence within 12 months from surgery in both chemo-naive and post-neoadjuvant patients (odds ratio 5.9 to 11.0). Alterations in CTCs were also observed longitudinally, before disease recurrence. A risk assessment score based on the difference of tCTCs increase accurately identified disease recurrence within the next 2 months, with an accuracy of 75% and 84% for chemo-naive and post-neoadjuvant patients, respectively.

Conclusion:

We report novel findings regarding CTCs from a large prospective cohort of PDAC patients. CTCs dynamics reflect progression of disease and response to treatment, providing important information on clinical outcomes, not available by current tumor markers and imaging.
A Comparison of the Learning Curves of Laparoscopic Liver Surgeons in Differing Stages of the IDEAL Paradigm of Surgical Innovation
Authors: Halls Mark Christopher , Alseidi Adnan , Berardi Giammauro , Cipriani Federica , Van der Poel Marcel , Davila Diego , Ciria Ruben , Besselink Marc , D’Hondt Mathieu , Dagher Ibrahim , Alrdrighetti Luca , Troisi Roberto Ivan , Abu Hilal Mohammad
Published: August 2018

Objective:

To compare the learning curves of the self-taught “pioneers” of laparoscopic liver surgery (LLS) with those of the trained “early adopters” in terms of short- and medium-term patient outcomes to establish if the learning curve can be reduced with specific training.

Summary of Background Data:

It is expected that a wider adoption of a laparoscopic approach to liver surgery will be seen in the next few years. Current guidelines stress the need for an incremental, stepwise progression through the learning curve in order to minimize harm to patients. Previous studies have examined the learning curve in Stage 2 of the IDEAL paradigm of surgical innovation; however, LLS is now in stage 3 with specific training being provided to surgeons.

Methods:

Using risk-adjusted cumulative sum analysis, the learning curves and short- and medium-term outcomes of 4 “pioneering” surgeons from stage 2 were compared with 4 “early adapting” surgeons from stage 3 who had received specific training for LLS.

Results:

After 46 procedures, the short- and medium-term outcomes of the “early adopters” were comparable to those achieved by the “pioneers” following 150 procedures in similar cases.

Conclusions:

With specific training, “early adapting” laparoscopic liver surgeons are able to overcome the learning curve for minor and major liver resections faster than the “pioneers” who were self-taught in LLS. The findings of this study are applicable to all surgical specialties and highlight the importance of specific training in the safe expansion of novel surgical practice.
Lipid associated polygenic enrichment in Alzheimer’s disease
Authors: Broce Iris J. , Tan Chin Hong , Fan Chun Chieh , Witoelar Aree , Wen Natalie , Jansen Iris , Hess Christopher P. , Dillon William P. , Glastonbury Christine M. , Glymour Maria , Yokoyama Jennifer S. , Elahi Fanny M. , Rabinovici Gil D. , Miller Bruce L. , Mormino Elizabeth C. , Sperling Reisa A. , Bennett David A , McEvoy Linda K. , Brewer James B. , Feldman Howard A. , Posthuma Danielle , Hyman Bradley T. , Schellenberg Gerard S. , Yaffe Kristine , Andreassen Ole A. , Dale Anders M. , Sugrue Leo P. , Karch Celeste M. , Desikan Rahul S.
Published: August 2018

Cardiovascular (CV) and lifestyle associated risk factors (RFs) are increasingly recognized as important for Alzheimer’s disease (AD) pathogenesis. Beyond the ∊4 allele of apolipoprotein E (APOE), comparatively little is known about whether CV associated genes also increase risk for AD (genetic pleiotropy). Using large genome-wide association studies (GWASs) (total n > 500,000 cases and controls) and validated tools to quantify genetic pleiotropy, we systematically identified single nucleotide polymorphisms (SNPs) jointly associated with AD and one or more CV RFs, namely body mass index (BMI), type 2 diabetes (T2D), coronary artery disease (CAD), waist hip ratio (WHR), total cholesterol (TC), low-density (LDL) and high-density lipoprotein (HDL). In fold enrichment plots, we observed robust genetic enrichment in AD as a function of plasma lipids (TC, LDL, and HDL); we found minimal AD genetic enrichment conditional on BMI, T2D, CAD, and WHR. Beyond APOE, at conjunction FDR < 0.05 we identified 57 SNPs on 19 different chromosomes that were jointly associated with AD and CV outcomes including APOA4, ABCA1, ABCG5, LIPG, and MTCH2/SPI1. We found that common genetic variants influencing AD are associated with multiple CV RFs, at times with a different directionality of effect. Expression of these AD/CV pleiotropic genes was enriched for lipid metabolism processes, over-represented within astrocytes and vascular structures, highly co-expressed, and differentially altered within AD brains. Beyond APOE, we show that the polygenic component of AD is enriched for lipid associated RFs. Rather than a single causal link between genetic loci, RF and the outcome, we found that common genetic variants influencing AD are associated with multiple CV RFs. Our collective findings suggest that a network of genes involved in lipid biology also influence Alzheimer’s risk.
Ankyrin domain encoding genes resulting from an ancient horizontal transfer are functionally integrated into developmental gene regulatory networks in the waspNasonia
Authors: Pers Daniel , Lynch Jeremy A.
Published: August 2018

Background

How and why regulatory networks incorporate additional components, and how novel genes are maintained and functionally integrated into developmental processes are two important and intertwined questions whose answers have major implications for the evolution of development. We recently described a set of novel genes with robust and unique expression patterns along the dorsal-ventral axis of the embryo of the waspNasonia.Given the unique evolutionary history of these genes, and their apparent integration in to the dorsal-ventral (DV) patterning network, they are collectively an excellent model to study the evolution of regulatory networks, and the fates of novel genes.

Results

We have found that the novel DV genes are part of a large family of rapidly duplicating and diverging ankyrin domain encoding genes that originated most likely by horizontal transfer fromWolbachiain a common ancestor of the wasp superfamilly Chalcidoidea. We tested the function of those ankyrin encoding genes expressed along the DV axis and found that they participate in early embryonic DV patterning. We also developed a new wasp model system(Melittobia)and found that some functional integration of ankyrin genes have been preserved for over 90 million years, while others are lineage specific.

Conclusions

Our results indicate that regulatory networks can incorporate novel genes that then become necessary for stable and repeatable outputs. Even modest role in developmental networks may be enough to allow novel or duplicate genes to be maintained in the genome and become fully integrated network components.
Fine-mapping cis-regulatory variants in diverse human populations
Authors: Tehranchi Ashley K. , Hie Brian , Dacre Michael , Kaplow Irene M. , Pettie Kade P , Combs Peter A. , Fraser Hunter B.
Published: August 2018

Genome-wide association studies (GWAS) are a powerful approach for connecting genotype to phenotype. Most GWAS hits are located in cis-regulatory regions, but the underlying causal variants and their molecular mechanisms remain unknown. To better understand human cis-regulatory variation, we mapped quantitative trait loci for chromatin accessibility (caQTLs)—a key step in cis-regulation—in 1000 individuals from 10 diverse populations. Most caQTLs were shared across populations, allowing us to leverage the genetic diversity to fine-map candidate causal regulatory variants, several thousand of which have been previously implicated in GWAS. In addition, many caQTLs that affect the expression of distal genes also alter the landscape of long-range chromosomal interactions, suggesting a mechanism for long-range expression QTLs. In sum, our results show that molecular QTL mapping integrated across diverse populations provides a high-resolution view of how worldwide human genetic variation affects chromatin accessibility, gene expression, and phenotype.
Structural capture of an intermediate transport state of a CLC CI-/H+ antiporter
Authors: Park Kunwoong , Lim Hyun-Ho
Published: August 2018

The CLC family proteins are involved in a variety of cellular processes, where chloride homeostasis needs to be controlled. Two distinct classes of CLC proteins, Cl- channels and Cl-/H+ antiporters, have been functionally and structurally investigated over the last several decades. Recent studies have revealed that the conformational heterogeneity of the critical glutamate residue, Gluex could explain the transport cycle of CLC-type Cl-/H+ antiporters. However, the presence of multiple conformations of the Gluex has been suggested from combined structural snapshots of two different CLC antiporters. Thus, we aimed to investigate the presence of these three intermediate conformations in CLC-ec1, the most deeply studied CLC at both functional and structural levels. By comparing crystal structures of E148D, E148A mutant and wildtype CLC-ec1 with varying anion concentrations, we suggest that the Gluex indeed take at least three distinct conformational states in a single CLC antiporter, CLC-ec1.
The limiting DNA replication initiation factors Sld2 and Sld3 influence origin efficiency independent of origin firing time
Authors: Lynch Kelsey L. , Kwan Elizabeth X. , Alvino Gina M. , Brewer Bonita J. , Raghuraman M.K.
Published: August 2018

Chromosome replication inSaccharomyces cerevisiaeis initiated from roughly 300 origins that are regulated both by DNA sequence and by the limited abundance of fourtrans-actinginitiation proteins (Sld2, Sld3, Dpb11 and Dbf4, collectively called “SSDD”). We set out to determine how the association of Sld2 or Sld3 at origins contributes to time of origin activation and/or origin efficiency using auxin-induced protein degradation to further decrease their abundance. Depleting cells of either factor slows growth rate, increases S-phase duration, and causes viability defects, without activating the S phase checkpoint. Chr XII is uniquely unstable with breakage occurring specifically within the rDNA locus. The efficiency of the rDNA origin is decreased while the onset of replication initiation is unchanged. We found that origin efficiency is reduced uniformly across the unique portions of the yeast genome. We conclude that the abundance of Sld2 and Sld3 contribute primarily to origin efficiency.
Differences in audit pricing between voluntary and mandatory audits
Authors: Gandía Juan L. , Huguet David
Published: August 2018

Purpose

Despite the extensive research on the determinants of audit pricing in both public and private settings, there is a lack of research about the differences in audit fees between voluntary audits and mandatory audits. The purpose of this paper is to address this gap.

Design/methodology/approach

First, a theoretical framework is developed to justify differences in audit pricing between voluntary and mandatory audits. Next, using a sample of Spanish private small and medium enterprises (SMEs) running from 2009 to 2014, the authors empirically test whether the fees charged for voluntary audits differ from those charged for mandatory ones. The authors also examine whether the premium observed among large auditors is persistent in the SME setting, and whether this premium differs depending on whether the audits are voluntary or mandatory.

Findings

Although a preliminary analysis does not report significant differences in pricing between voluntary and mandatory audits, additional analyses using samples restricted by company size show that voluntary audits are charged with a premium. The authors observe a premium related to large auditors, and find no significant differences in the audit pricing of Big 4 auditors depending on the mandatory/voluntary nature of the audit, but the premium associated with Middle-Tier auditors disappears in the voluntary setting.

Originality/value

This paper contributes to the previous literature by introducing the examination of differences in audit pricing between voluntary and mandatory audits. As far as the authors know, this is the first study to examine the differences in audit pricing between voluntary and mandatory audits. It also elaborates on studies on audit pricing in SMEs.
Lost in translation? Cross-language thematic analysis in tourism and hospitality research
Authors: Esfehani Minoo H. , Walters Trudie
Published: August 2018

Purpose

Tourism and hospitality research is frequently cross language in nature; yet, English is the most used language to disseminate research findings. The use of thematic analysis is increasing; yet, critical discussions of the implications of the timing of translation when applying this method are rare. The purpose of this study is to present a model for bilingual researchers undertaking qualitative studies in their mother language who are reliant on their own language skills to translate and overcome language differences, and who are using thematic analysis.

Design/methodology/approach

Thematic analysis is a six-phase iterative analysis process during which the main themes are identified and a network of related themes is constructed to facilitate the interpretation of the material. The model is illustrated through reference to a research project carried out by the first author on the role and manifestation of intangible cultural heritage in tourism in protected areas in Iran.

Findings

The model introduces translation as an internal procedure within thematic analysis, situating it between the second and third phases when the codes are being consolidated into basic themes. Translation is viewed as a part of the iterative process of thematic analysis.

Originality/value

This model is the first to provide bilingual cross-language researchers with a practical and epistemologically, methodologically and ethically sound rationale for the timing of translation when using thematic analysis. While it was developed on a tourism case study, the authors believe it is applicable to research in other disciplines where cross-language qualitative analysis is used.
Medical education governance based on strategic planning
Authors: Nurakynova Sabina
Published: August 2018

Purpose

The purpose of this paper is to analyze the medical education strategic planning to align with international best practices in university governance.

Design/methodology/approach

Research methods used: content analysis, analysis of modern concepts of strategic planning in universities. The study used two main methodological approaches: analysis of medical education governance and analysis of strategic planning in universities.

Findings

Applied models of educational governance at most universities are not always effective in achieving their goals. A strategy is a complex and potentially powerful tool, with the help of which a modern university can withstand the constantly changing environment. By using such a tool, the university can gain prestige, leading positions and recognition in international scientific and educational spheres. Therefore, strategy and strategic planning deserve close attention as a higher education governance tool, suitable not only for a medical college but also for a wide range of other types of social organizations.

Originality/value

Education is a policy priority of any state determining the state’s level of modern socio-economic development and building a productive workforce. The quality of human resources primarily depends on the system of higher education, which is carried out by universities. Foreign countries’ experience shows that prosperity of the state and society is impossible without a healthy nation. Improving the quality of people’s lives depends, in particular, on health education, so “medical education governance” is how we prepare personnel, which must be properly trained and qualified to provide high-quality health care services. Kazakhstan medical universities are increasingly becoming players in the medical education market, but the governance systems of universities are lagging behind. The success of universities largely depends on the results of their strategic planning, which is why special attention should be given to strategic planning analysis. Despite the importance of analyzing medical education governance, there has been insufficient research in this area in Kazakhstan.
A study on performance of slot entry hybrid journal bearing considering effect of surface irregularities
Authors: Sahu Krishnkant , Sharma Satish C.
Published: August 2018

Purpose

This study aims to deal with the performance of symmetric/asymmetric slot entry hybrid journal bearing system considering the effect of three dimensional irregularities in the analysis.

Design/methodology/approach

The asperity profile of three-dimensional irregularities has been modeled in both circumferential and axial directions. To compute the bearing performance characteristics parameter, finite element formulation of governing Reynolds equation has been derived using Galerkin’s technique.

Findings

Based on the numerically simulated results, it has been observed that the three-dimensional irregularities enhance the value of minimum fluid film thickness (h̄min), lubricant flow (Q̄) and fluid film damping coefficients (C̄11,C̄22) approximately by order of magnitude of 24-26, 43-51 and 18-66 per cent, respectively, for the case of asymmetric slot entry configuration. Whereas, the values of fluid film stiffness coefficients (S̄11,S̄22) and threshold speed (ω̄th) reduces approximately by order of 1-6 and 0-3 per cent, respectively, for the case of symmetric slot entry configuration.

Originality/value

The present paper describes that the influence of three-dimensional irregularities on bearing surface on the performance of slot entry hybrid journal bearing is original in literature gaps. The numerically simulated results presented in this study are expected to be quite useful to the bearing designers.
Designing web-scale discovery systems using the VuFind open source software
Authors: Roy Bijan Kumar , Biswas Subal Chandra , Mukhopadhyay Parthasarathi
Published: August 2018

Purpose

This paper aims to provide an overview of the emergence of resource discovery systems and services along with their advantages and best practices including current landscapes. It reports the development of a resource discovery system by using the “VuFind” software and describes other technological tools, software, standards and protocols required for the development of the prototype.

Design/methodology/approach

This paper describes the process of integrating VuFind (resource discovery tool) with Koha (integrated library system), DSpace (repository software) and Apache Tika (as full-text extractor for full-text searching), etc.

Findings

The proposed model performs like other existing commercial and open source Web-scale resource discovery systems and is capable of harvesting resources from different subscribed or external sources replacing a library’s OPAC.

Originality/value

This discovery system is an important add-on to designing a one-stop access in place of the existing retrieval silos in libraries. This system is capable of indexing a variety of content within and beyond library collections. This work may help library professionals and administrators in designing their discovery system, as well as vendors to improve their products, to provide different library-friendly services.
A practitioner’s guide to the design of strategy map frameworks
Authors: Islam Syrus
Published: August 2018

Purpose

The purpose of this study is to synthesise the prior literature on strategy maps to develop a practitioner’s guide to the design of strategy map frameworks. Robert Kaplan and David Norton introduced the strategy map in their 2000 Harvard Business review article. A strategy map visually represents how the critical elements of an organisation’s strategies are linked together. In an organisation’s strategy execution process, a strategy map complements a performance measurement framework such as the balanced scorecard.

Design/methodology/approach

This is a technical paper, which primarily builds on the prior literature on the strategy map design. In particular, this study reviews 41 publications on strategy maps in the period 2000-2015, including observation of 333 strategy map frameworks.

Findings

This study develops 14 design principles across seven features of a strategy map framework. This study also identifies a significant lack of empirical research on strategy map design features and principles.

Research limitations/implications

Future research could examine whether and why various design features and principles could exert different or same effects (e.g. decision-relevance).

Practical implications

The developed design features and principles can be used by practitioners as guidance for developing customised strategy maps for their organisations.

Originality/value

This paper contributes to the literature by serving as a “one-stop shop” for both practitioners and researchers seeking a comprehensive understanding of the current state of the strategy map design features and principles.
Social studies and beyond: attending to informal citizenship education in schools
Authors: Kissling Mark T.
Published: August 2018

Purpose

Although social studies teachers are charged with explicitly teaching about citizenship, all teachers in a school implicitly teach about citizenship. That is, in their daily interactions with students, whether specific to subject area content or not, teachers impart lessons to their students about what citizenship is and what it means to be a citizen. The paper aims to discuss these issues.

Design/methodology/approach

Examining the “powerful” stories of three teachers, only one of whom teaches social studies, this paper focuses on “informal citizenship education” across schools.

Findings

It concludes with implications for workers in and beyond the field of social studies education.

Originality/value

Ultimately, it suggests that as notions of citizenship education expand to include informal citizenship education, teachers will better teach students to be effective citizens.
The elephant in the classroom: a comparative study of civics end-of-course assessment
Authors: Furgione Brian , Evans Kelsey , Walker Irenea , Russell III William B.
Published: August 2018

Purpose

Over the last 40 years, K-12 education has seen a continuous and significant increase in the amount of mandated standardized testing. This rise in standardized testing has led many in the field to question the extent to which these tests are affecting students, teachers and schools. The purpose of this paper is to explore the results of a social studies standardized test, specifically, the Florida Civics End-of-Course assessment.

Design/methodology/approach

Researchers used population data for seventh grade students and aggregated countywide proficiency rates from 2013–2016 for comparative statistical measures. Descriptive statistics and regression analyses were utilized to identify emerging trends using mean proficiency percentages when accounting for race, gender and socioeconomic status.

Findings

Initial findings indicated disparity within each subgroup (R2=0.511 (2013–2014), 0.500 (2014–2015) and 0.456 (2015–2016)). Following an analysis of the results, the conclusion and implications discuss the influence of standardized testing in social studies education.

Originality/value

This is a large-scale project that has never been done.
Kermanshahi roghan and yoghurt: Comparison of fatty acid profiles and lipid qualities
Authors: Chalabi Maryam , Bahrami Gholamreza , Mostafaie Ali
Published: August 2018

The aim of the study was to compare the fatty acid composition and lipid quality of roghan with that of yoghurt in order to obtain information about their fat nutritional quality. Our findings showed that, after fermentation, roghan short‐chain fatty acid levels increased compared with milk and yoghurt. Saturated fatty acid levels in roghan and yoghurt decreased, while unsaturated fatty acids in both products increased compared with milk. The atherogenic and thrombogenic indices of both products were lower than those for milk. The roghan omega‐6/omega‐3 and monounsaturated fatty acid to polyunsaturated fatty acid ratios were lower than those of yoghurt. There was no difference between the polyunsaturated to saturated fatty acid ratios of the two products. Collectively, our study suggests that roghan is a product with an appropriate lipid quality index.
Safety and efficacy of zotarolimus‐eluting stents in the treatment of diabetic coronary lesions in Chinese patients: The RESOLUTE‐DIABETES CHINA Study
Authors: Zhu Zhengbin , Wu Yongjian , Shen Zhujun , Xu Yawei , Li Yigang , Wang Yan , Su Xi , Li Bao , Jiang Tiemin , Jiang Jinfa , Wang Lefeng , He Shenghu , Li Xueqi , Li Hongwei , Liu Yin , Zhou Yujie , Tang Qiang , Chen Yundai , Fang Weiyi , Jiang Li , Lu Chengzhi , Guo Jincheng , Zhang Jianjun , Chen Shaoliang , Xia Yong , Zheng Hongchao , Wang Bin , Zhang Daifu , Feng Liuliu , Tang Lijiang , Xu Peng , Liu Xuebo , Zhang Ruiyan ,   on behalf of the RESOLUTE‐DIABETES CHINA Investigators
Published: August 2018

Background

The RESOLUTE‐DIABETES CHINA study was specifically designed to investigate the safety and efficacy of Resolute zotarolimus‐eluting stents (ZES; Medtronic, Santa Rosa, CA, USA) in the treatment of diabetic coronary lesions in the Chinese population.

Methods

In all, 945 patients with de novo native coronary lesions and type 2 diabetes mellitus were recruited at 32 cardiac centers across the Chinese mainland and were implanted with Resolute ZES. The primary endpoint was target vessel failure (TVF); secondary endpoints were clinical outcomes, namely all‐cause death, stroke, bleeding, target lesion revascularization (TLR), target vessel revascularization (TVR), non‐TVR, and stent thrombosis (ST). The follow‐up period for all endpoints was 12 months after the procedure.

Results

In all, 933 patients (98.73%) had clinical follow‐up at 12 months. The rate of TVF was 11.60%, whereas the rate of occurrence of secondary endpoints was 5.47%, with four patients (0.43%) having subacute or late ST. There were no significant differences in TVF rates comparing patients with different HbA1c levels or receiving different glucose control treatments (all P > 0.05). Patients with multivessel lesions had higher TVF rates (95% confidence intervals) than those with single‐vessel lesions (16.76% [12.10%–22.97%) vs 9.72% [7.79%–12.11%], respectively; P = 0.006). There were no significant differences in TVF rates in patients with or without small vessels, bifurcated lesions, or chronic total occlusions (all P > 0.05). [Correction added on 17 January 2019, after first online publication: in the second sentence of Results section, “TLF” was changed to “TVF”.].

Conclusions

Resolute ZES may perform well in the Chinese diabetic population, especially in those with poor glucose control, complex lesions, and certain unfavorable clinical features. Further studies are needed to determine why ZES perform well in this population.
Computed tomographic features of inflammatory myofibroblastic tumour of the stomach in adult patients: An analysis of five multicentre cases with literature review
Authors: Lee Ji Eun , Choi Seo‐Youn , Lee Hae Kyung , Yi Boem Ha , Lee Min Hee , Lee Sunyoung , Lee So Jung , Lee Jisun , Jeong Woo Kyoung
Published: August 2018

Introduction

The aim of this study was to describe the clinical and computed tomography (CT) features of gastric inflammatory myofibroblastic tumour (IMT) in adult patients and provide a review of the literature.

Methods

Five adult patients with surgically resected and pathologically confirmed gastric IMT were included in the study from four tertiary referral centres. Clinical history was assessed for determination of patient demographics and symptoms at presentation. All patients underwent contrast‐enhanced abdominal CT, and two radiologists assessed the CT features by consensus. Also, abdominal CT findings from previous case reports of nine adult patients with gastric IMT were reviewed and summarised.

Results

Of five gastric IMTs, four (80%) appeared as a well‐defined subepithelial mass and only one (20%) appeared as an irregular wall thickening. All of five gastric IMTs showed strong enhancement. When we analysed the CT features of nine cases from previously published literatures combined with our five cases, predominant imaging feature of gastric IMT was a well‐defined subepithelial mass with strong enhancement. Perigastric infiltration or direct invasion of the neighbouring organs was rarely seen.

Conclusion

Gastric IMT in adult patients appeared either as a well‐defined subepithelial mass or irregular wall thickening, with mostly strong enhancement. Although rare, these imaging feature may be helpful for diagnosis of gastric IMT.
Prolonged vasopressor support during hip‐fracture surgery is a risk factor for enhanced mortality
Authors: Kristiansson Johan , Olsen Fredrik , Hagberg Eva , Dutkiewicz Robert , Nellgård Bengt
Published: August 2018

Background

Hip fracture is a common injury in the elderly population and is associated with high morbidity and mortality. Intraoperative hypotension is commonly noted, and is often treated with vasopressors (VP), however, to what extent is unknown. We set out to examine retrospectively how many hip fracture‐patients received VP perioperatively and further to investigate if VP treatment is connected to increased mortality.

Method

Data on VP treatment were captured from medical and anaesthesia journals, and if so, data were investigated to find potential confounders. Patients were divided into (a) no VP, (b) VP by injection, (c) VP by infusion <3 hours, and (d) VP by infusion ≥3 hours to achieve stratification.

Results

Nine hundred and ninety‐seven patients were included. About 80.4% received VP treatment. The 30‐day mortality rates in subgroups were 3.6%, 5.4%, 6.4% and 19.1% respectively. The 90‐day mortality rates were 6.7%, 10.3%, 11.6% and 30.3% respectively. Finally, the same patient groups had 365‐day mortality rates of 12.8%, 20.0%, 23.3% and 44.9% respectively. We found a significant increase in mortality (30‐90‐365 days) in patients receiving VP infusion ≥3 hours, after adjusting for confounding factors. There was no increased mortality in patients treated by injection and by infusion <3 hours after adjustment for confounding factors vs untreated patients.

Conclusion

Vasopressor treatment is common during hip fracture surgery. Patients treated with VP infusion ≥3 hours have increased mortality, while patients treated with injections or infusion <3 hours have not. We suggest that the prolonged use of VP treatment is linked to increased mortality.
Professional firefighter and trained volunteer first‐responding units in emergency medical service
Authors: Tamminen Joonas I. , Hoppu Sanna E. , Kämäräinen Antti J. J.
Published: August 2018

Background

Although widely dispatched to out‐of‐hospital cardiac arrests, the performance of prehospital first‐responding units in other medical emergencies is unknown.

Methods

In this retrospective, descriptive study, the general performance of 44 first‐responding units in Pirkanmaa County, Finland, were examined. A subgroup analysis compared the first‐responding units made up of professional firefighters and trained volunteers.

Results

First‐responding units were dispatched to patients during 1622 missions between 1 January 2013 and 31 December 2013. The median time to reach the scene was 9 minutes in any mission. Overall, first responders evaluated 1015 patients and provided treatment or assisted ambulance personnel in 793 (78%) cases. The most common treatment modalities were assistance, such as carrying (22%) and the administration of supplemental oxygen (19%). There were 83 resuscitation attempts during the time period. In 42 of these, first‐responding units initiated basic life support a median of 4 minutes prior to the arrival of ambulance personnel. Return of spontaneous circulation was achieved in 20% of cases. The subgroup analysis showed that trained volunteers administered oxygen more liberally than professional firefighters in stroke and chest pain mission (stroke: professional 9/236 cases [4%] vs layperson 26/181 cases [14%], P < 0.001; chest pain: professional 16/78 cases [21%] vs layperson 77/159 cases [48%], P < 0.001).

Conclusion

First‐responding units provided initial treatment or assistance to ambulance personnel in approximately half of the missions. Implementation of professional‐ and layperson‐staffed first‐responding units in emergency medical service system seems to be feasible.
Genetic variants in fat‐ and short‐tailed sheep from high‐throughput RNA‐sequencing data
Authors: Ma L. , Li Z. , Cai Y. , Xu H. , Yang R. , Lan X.
Published: August 2018

The identification of genetic variations underlying desired phenotypes is one of the main challenges of current livestock genetic research. High‐throughput transcriptome sequencing has been recognized as an efficient way to unravel the rich genetic variants across various species. The Lanzhou Fat‐Tail sheep is an endangered sheep breed in China with a notable feature of an exaggerated fat tail that also independently occurs in other sheep breeds. However, the genetic mechanism underlying this particular trait has not been fully elucidated yet. In this study, we used RNA‐seq on tissue samples (longissimus dorsi muscle, perinephric fat and tail fat) from three sheep breeds with either fat or thin tails and characterized the genetic variation in Lanzhou Fat‐Tail sheep with the ultimate goal of identifying the causal genes and genetic networks responsible for the fat tail in this rare sheep breed. In total, 7 122 920 SNPs and 901 518 indels were detected in the nine individual sheep investigated, of which 606 952 SNPs (8.5%) and 77 633 indels (8.6%) overlapped with QTL associated with fat traits in sheep. Furthermore, we detected 26 613 specific SNPs in Lanzhou Fat‐Tail sheep and 44 SNPs located in the same genomic position reported in another sheep breed with fat tails. Interestingly, 33 SNPs are selectively distributed on a chromosome 3 region (39.58–40.91 Mb) that was reported as a strong candidate genomic region for fat deposition in tails of sheep. Our research has also suggested that three genes (CREB1, WDR92 and ETAA1) may be associated with fat tail development. In summary, the resultant genetic variants data in this study provide a valuable resource for marker‐assisted selection of the trait in Lanzhou Fat‐Tail sheep populations.
Management of feeding decisions in hospitalised adults with severe oropharyngeal dysphagia
Authors: McHutchison Louise , Miles Anna , Spriggs David , Jayathissa Sisira
Published: August 2018

Objective

For patients with dysphagia, decisions must be made for provision of nutrition and hydration. This retrospective audit explored feeding decisions for patients with severe oropharyngeal dysphagia.

Methods

Fifty adult inpatients were identified across a 15‐month period as requiring a feeding decision due to severe persisting oropharyngeal dysphagia. For each patient, all admissions (previous and subsequent admissions up to and including six months postrecruitment) where dysphagia or dysphagia‐related complications were reported in the discharge summary were audited.

Results

A total of 103 admissions were identified with palliation in 22%. Enteral tube feeding (ETF) was initiated in 19% of admissions; and 63% of enteral tube placements failed. Nil‐by‐mouth with ETF was the final feeding decision in only 8% of admissions, while 43% of admissions led to documented oral feeding despite risk. Dysphagia was documented in only 44% of discharge summaries, with a feeding decision documented in only 34%.

Conclusion

Variation in management and poor documentation in this cohort suggest the need for a Risk Feeding Clinical Guideline.
Development of a pelvic exenteration service at a tertiary referral centre
Authors: Dickfos Marilla , Tan Stephanie B. M. , Stevenson Andrew R. L. , Harris Craig A. , Esler Rachel , Peters Matthew , Taylor David G.
Published: August 2018

Background

Over one‐third of primary rectal cancers are locally advanced at diagnosis, and local recurrence of rectal cancer occurs at a rate of 3–10% following primary curative resection. Extended resectional surgery, including pelvic exenteration, is the only proven therapy with curative potential in the treatment of these cancers along with many other pelvic malignancies. A microscopically clear resection margin (R0 resection) is the predominant prognostic factor affecting overall and disease‐free survival. The extent and complexity of surgery required to achieve an R0 resection is associated with significant risk of morbidity and mortality. The aim of this paper is to show that pelvic exenterations can be performed with acceptable oncological and safe perioperative results in an appropriately resourced specialist centre.

Methods

Data was collected retrospectively for 61 consecutive patients treated between June 2012 and February 2017. This included patient demographics, tumour characteristics, operative, clinical and histological data, length of hospital stay, morbidity and mortality data.

Results

A total of 61 patients underwent surgery. Median age was 57 years (range 27–78 years). Median length of stay was 41 days (range 6–288 days). Median operative time was 624 min (range 239–1035 min); 30‐day mortality was 3.3% (n = 2). Resection rates were 91.5% – R0, 6.8% – R1 and 1.7% – R2 resections. Histologically, 86.9% – adenocarcinomas, 3.3% – squamous cell carcinomas and 9.8% – represented by leiomyosarcoma, melanoma, myxoid chondrosarcoma, non‐neoplastic processes and undifferentiated carcinoma.

Conclusion

Our experience confirms that radical resectional pelvic surgery can be safely performed with acceptable results during the establishment phase of a dedicated tertiary service.