bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of intermediaries in food export: case evidence from Finland
Authors: Lehtinen Ulla E.E. , Ahokangas Petri , Lu Jinghui
Published: April 2016

Purpose

This paper examines the role of export intermediaries in the internationalization of small and medium sized companies in Finland. The empirical study focuses on small Finnish food companies that export to German and Chinese markets.

Design/methodology/approach

The research method of this study is qualitative. Data is collected through semi-structured interviews with six respondents presenting exporting companies and export consultants.

Findings

The paper provides an empirical contribution to the food internationalization debate. First, the paper discusses the definitions of export intermediaries and their role in export based on the literature. Second, by examining how Finnish food companies experience the role of export intermediaries, the paper contributes to the current discussion on internationalization modes. The empirical results highlight that export companies need transaction-creating services from intermediaries especially when entering physically and culturally distant markets like China.

Research limitations/implications

Limitations of the research generally relate to the use of a small case sample.

Practical implications

The paper holds a number of relevant insights for food companies seeking to enter to German and Chinese markets. Identifying the export services needed by small food companies might help export intermediaries and public policy agencies to better focus their supporting initiatives.

Originality/value

The findings add to the current body of knowledge on the key influence on internationalization modes within the food sector.
Better at Home, Abroad, Or Both?
How Chinese Firms use Ambidextrous Internationalization Strategies to Drive Innovation
Authors: Prange Christiane , Bruyaka Olga
Published: April 2016

Purpose

Existing research emphasized that Chinese firms gain experience and improve innovation capability through interaction with competitors at home (i.e., inside-out internationalization) and abroad (i.e., outside-in internationalization). However, how Chinese firms transform these experiences into different types of innovation (product vs. process) is largely unknown. The present study (1) analyzes how different internationalization trajectories lead to different types of innovation, (2) establishes how Chinese firms use ambidextrous strategies to combine inside-out and outside-in internationalization, and 3) provides empirical evidence of how ambidextrous strategies might influence performance.

Design/methodology/approach

This study uses (1) a case research method to refine the classification of firms’ internationalization strategy types, (2) a qualitative textual analysis of firms’ annual reports to differentiate between product and process innovation and to estimate these firms’ international performance, and (3) an inductive approach to derive testable propositions from the literature review and empirical cases.

Findings

This study provides evidence that many Chinese firms follow an inside-out approach to internationalization and primarily focus on process innovation. At the same time, those firms that implement ambidextrous internationalization strategies develop both product and process innovations and appear to exhibit higher performance.

Research limitations/implications

This study’s focus on understanding what drives different types of innovation of Chinese firms is important as these firms often struggle to accomplish the dual tasks of competing both at home and abroad with innovation-driven domestic and foreign rivals. Applying an ambidexterity perspective to the context of internationalization strategy makes it possible to reconcile the need to simultaneously implement both outside-in and inside-out strategies and to achieve higher performance results. Further empirical research is required to confirm and generalize this study’s findings.

Practical implications

Managers are advised to assess which internationalization path would be optimal under a given set of conditions. Further, they should balance their internationalization strategies with respect to innovation types. Foreign multinationals may learn from Chinese firms how to develop ambidextrous internationalization strategies.

Originality/value

This study applies the ambidexterity lens and differentiates between product and process innovation to explore how different types of internationalization strategies affect product vs. process innovation, as well as firm performance. The empirical evidence provided in this paper is based on original data from 30 Chinese companies and two in-depth case studies. This study provides novel insights into how different trajectories could be combined through ambidextrous strategies.
Presenteeism as a global phenomenon: unraveling the psychosocial mechanisms from the perspective of social cognitive theory
Authors: Cooper Cary L , Lu Luo
Published: April 2016

Purpose

Presenteeism occurs when people are physically present in the workplace but are functionally absent (Cooper, 1996). With evidence from the developed West, researchers have argued that being excessively present may be even costlier than absenteeism to employers (Burton, Chen, Conti, Schultz, & Edington, 2006; Hemp, 2004). However, research on presenteeism in the East is almost non-existent. With the strong Confucius cultural imperative for hard work, the prevailing pressure for working long hours, compounded with the lack of labor welfare protection at the national level and lack of resources at the organizational level in SMEs, the problem of presenteeism in the developing Asian societies may be exacerbated (c.f., Bockerman & Laukkanen, 2010), making it a worthy subject for cross-cultural research and subsequent intervention. Thus one purpose of this article is to situate this problem in a global context, using the Chinese tradition as a cultural exemplar.

Design/methodology/approach

Furthermore, most of the existing studies on presenteeism have overlooked the underlying psychological process of such an act: why do people decide to work while sick? Thus, our second goal in this article is to outline a conceptual framework that attempts to explain central, dynamic processes and mechanisms through which people ascribe meanings to the situation, make decisions to come to work when ill, and attempt to achieve performance outcomes.

Findings

In formulating this scheme, we drew primarily from Bandura’s (1986) social cognitive theory (SCT) and tried to adapt, elaborate, and extend those aspects of the general theory that seemed most relevant to the basic personal experiences of presenteeism.

Originality/value

We have outlined a social cognitive conceptual framework, to facilitate theory integration in the field of presenteeism research. To systematically examine key mechanisms delineated in the overarching theoretical framework that accounts for the intricate relationships among self-regulation, presenteeism, and performance, we were able to bridge social cognitive psychological processes with organizational research on the global phenomenon of presenteeism. The thrust of using theoretical development to lead empirical investigation in this emerging field may also enable better managerial interventions to promote occupational health and employee development.
What makes employees engaged with their work? The role of self-efficacy and employee’s perceptions of social context over time
Authors: Consiglio Chiara , Borgogni Laura , Di Tecco Cristina , Schaufeli Wilmar B.
Published: April 2016

Purpose

– Work engagement represents an important aspect of employee well-being and performance and has been related to both job and personal resources. The purpose of this paper, based on Social Cognitive Theory, is to emphasize the proactive role of self-efficacy which is hypothesized to predict work engagement, not only directly, but also indirectly through positive changes in employee’s perceptions of social context (PoSC); namely, perceptions of one’s immediate supervisor, colleagues and top management.

Design/methodology/approach

– A sample of 741 employees of a communication service company completed two questionnaires, with a time interval of three years. Structural equation modeling was performed in order to test the hypothesized model.

Findings

– Results revealed that, as expected: first, initial self-efficacy predicts work engagement three years later; and second, positive changes in employee’s perceptions of the social work context across the three year period, mediates the relationship between self-efficacy and work engagement.

Research limitations/implications

– Results relied only upon self-report data. Moreover, each variable was only measured at the time in which it was hypothesized by the conceptual model.

Practical implications

– The significant role of self-efficacy as a direct and indirect predictor of work engagement suggests the development of training programs centered on the main sources of self-efficacy, specifically focussed on the social work domain.

Originality/value

– This research provides evidence of the substantial contribution of self-efficacy to work engagement over time. Moreover, the results also support the beneficial effects of self-efficacy through its influence on the improvements in the individuals’ perceptions of their social context.
Mindfulness at work: resource accumulation, well-being, and attitudes
Authors: Zivnuska Suzanne , Kacmar K. Michele , Ferguson Merideth , Carlson Dawn S.
Published: April 2016

Purpose

– Mindfulness is a well-studied phenomenon in many disciplines. Little is known about its impacts on employees at work. The purpose of this paper is to focus on mindfulness at work, defined as a psychological state in which employees intentionally pay full attention to the present moment while executing job tasks. The research model, grounded in conservation of resources theory, depicts how mindfulness at work may help employees develop resources (work-family balance and job engagement) which may be associated with greater well-being (less psychological distress and more job satisfaction) and organizational attitudes (intent to turnover and affective commitment).

Design/methodology/approach

– Using a sample of 503 full time employees, the authors test the model with structural equation modeling.

Findings

– Results supported the full research model, suggesting that mindfulness at work is an important antecedent to resource accrual, well-being, and organizational attitudes. Mindfulness at work exerted direct and indirect effects on turnover intentions and affective commitment.

Research limitations/implications

– The inclusion of job engagement as a mediator provides an interesting counterpoint and extension of prior studies suggesting that job engagement negates the effects of mindfulness on turnover intentions (Dane, 2014).

Practical implications

– The research suggests that mindfulness at work is highly trainable and may enhance a variety of career outcomes.

Originality/value

– This study extends emerging literature on mindfulness at work by offering a new scale grounded in established theory and the practice of mindfulness.
Collaboration between the library and Office of Student Disability Services
Authors: Arzola Rebecca
Published: April 2016

Purpose

The paper aims to discuss the relationship between interdepartmental stakeholders in higher education and the information identified as a result of collaborations. It proposes that collaborations can help clarify issues to then advocate for them.

Design/methodology/approach

The paper opted for a naturalistic case study design, gathering direct and participant observation of interdepartmental collaborations including 1 Student Share, 12 one-hour collaborative sessions and 1 Accessibility Conference.

Findings

The paper provides observed insight about student needs to have documents that are accessible for assistive technologies to recognize and read how change is brought about during internal brand building. It suggests that successful accessibility implementation in higher education calls for collaboration with stakeholders.

Originality/value

This paper shows how a collaboration between the library and Student Disability Services can work to understand document accessibility issues. It also reveals that students with disabilities are adept with current mobile trends and technology, and need to be, for productivity in college. It will be valuable to librarians, faculty, staff and other technology stakeholders that work with students with disabilities.
Leadership for knowledge organizations
Authors: Amar A D , Hlupic Vlatka
Published: April 2016

Purpose

– The purpose of this paper is to give some theoretical foundation to leadership function and style for managing knowledge workers whose work, by definition, is non-routine, thrives on innovation, and places a special demand on autonomy for its execution.

Design/methodology/approach

– Extant search of literature to look for evidence supporting successful leadership theories and practices that are shown to improve performance of knowledge workers. Synthesis of findings to structure a framework in the form of major propositions for their testing by future research.

Findings

– The authors begin with establishing the first finding that states that leadership of knowledge organizations is different from the leadership of traditional organizations. Then the authors build six additional findings for shaping a successful leadership process for knowledge organizations.

Research limitations/implications

– Since it is a theoretical paper built on a search of literature in the field of leadership, there is a need to empirically test the findings to give them their final shape. Each of the seven propositions in this paper would result into many hypotheses that should initiate several empirical studies.

Practical implications

– The authors consider individual and organizational/group contexts of the leadership proposed here, and also provide recommendations for carrying out this research further. While the paper is written more specifically with regard to the leadership of knowledge organizations where its findings should be fully implantable, however, to some extent, they would apply to all organizations.

Social implications

– Leadership is a ubiquitous social phenomenon. It affects not only organizations, but also every aspect of human activity. This paper is an attempt to alter the fundamental thinking of leaders, suggesting to not to use authority, and instead, to allow everyone connected with the task the opportunity to lead. This shift in leadership paradigm will have an impact on the behavior of all involved, and steadily, will bring a change in the norms of social behavior.

Originality/value

– This paper is a move toward giving the knowledge organization leadership some theoretical framework, as it is still in a state of flux in spite of attracting a lot of research.
Does bribery have a negative impact on firm performance? A firm-level analysis across 132 developing countries
Authors: Williams Colin C , Martinez-Perez Alvaro , Kedir Abbi
Published: April 2016

Purpose

– Reflecting the moral theorisation of bribery as a negative phenomenon, bribery has been widely shown to have a deleterious impact at the national level on economic development and growth. The purpose of this paper is to evaluate whether it is also the case at the firm level that bribery has negative impacts on firm performance. Until now, the few studies conducted in individual nations and regions have produced mixed results. Here, therefore, a more comprehensive evaluation of the relationship between bribery and firm performance is undertaken across the developing world.

Design/methodology/approach

– To do so, World Bank Enterprise Survey data on 106,805 enterprises across 132 developing countries is used to provide a firm-level analysis of the relationship between bribery and firm performance.

Findings

– The finding is that bribery enhances firm performance. Firms asserting that it is necessary for enterprises like theirs to give gifts or payments to public officials in order to get things done have 13.9 per cent higher average annual sales growth rates and 48 per cent higher annual productivity growth rates, after controlling for other determinants of firm performance.

Practical implications

– Given that engaging in bribery at the firm level results in higher firm performance, despite bribery having an overall detrimental negative impact at the country level, public authorities will need to develop measures to alter not only the cost-benefit ratio confronting individual enterprises but also the institutional deficiencies that result in the prevalence of bribery.

Originality/value

– This is the first firm-level evaluation of the relationship between bribery and firm performance across the developing world.
Entrepreneurial orientation and performance – are sexes equal?
Authors: Fellnhofer Katharina , Puumalainen Kaisu , Sjögrén Helena
Published: April 2016

Purpose

– The purpose of this paper is to shed light on the different perceptions of entrepreneurial orientation (EO) of females compared to those of their male counterparts. EO and its links to performance are examined at the level of both the individual and the firm.

Design/methodology/approach

– Multiple linear regression analyses of a data set with 301 employees in different industries reveal significant differences between genders.

Findings

– EO has a positive impact on performance at both individual and firm levels of analysis. Females tend to perceive their individual EO as lower than males, but their self-evaluated work performance is higher than that of males. The firm’s EO is also perceived differently by men and by women, but the perceptions of firm’s performance are similar.

Research limitations/implications

– The results draw attention to the differences between individuals when they evaluate firm-level constructs like EO. While the sample is based on a small number of firms, the findings suggest that EO is neither pervasive throughout the firm nor gender-neutral.

Practical implications

– The different gender-related perceptions should be kept in mind when promoting entrepreneurially oriented behaviour within organizations. A strong focus on EO in entrepreneurship policy or education may discourage women.

Originality/value

– So far, multi-level organizational interrelationships have been substantially neglected with respect to the gender dimension.
Mixed policies give more options in multifunctional tropical forest landscapes
Authors: Law Elizabeth A. , Bryan Brett A. , Meijaard Erik , Mallawaarachchi Thilak , Struebig Matthew J. , Watts Matthew E. , Wilson Kerrie A.
Published: April 2016

Tropical forest landscapes face competing demands for conserving biodiversity, sustaining ecosystem services and accommodating production systems such as forestry and agriculture. Land‐sparing and land‐sharing have emerged as contrasting strategies to manage trade‐offs between production and biodiversity conservation. Both strategies are evident in land‐management policies at local‐to‐international scales. However, studies rarely report the impacts of these strategies, assessed for multiple stakeholders and multiple ecosystem services, particularly in real landscapes.

Using a case study from a high‐priority region for forest protection, restoration and rural development in Central Kalimantan, Indonesia, we analysed the potential outcomes under 10 alternative policy scenarios, including land‐sharing, land‐sparing and mixed strategies. We used a novel optimization process integrating integer programming with conservation‐planning software (Marxan with Zones) to identify production possibility frontiers (PPFs), highlighting the trade‐off between smallholder agriculture and oil palm, subject to achievement of a set of carbon, timber and biodiversity conservation targets.

All policy scenarios modelled proved to be capable of achieving all targets simultaneously. Most strategies resulted in an expansion of the PPF from the baseline, increasing the flexibility of land allocation to achieve all targets. Mixed strategies gave the greatest flexibility to achieve targets, followed closely by land‐sparing. Land‐sharing only performed better than the baseline when no yield penalties were incurred, and resulted in PPF contraction otherwise. Strategies assessed required a minimum of 29–37% to be placed in conservation zones, notably protecting the majority of remaining forest, but requiring little reforestation.

Policy implications. Production possibility frontiers (PPFs) can evaluate a broad spectrum of land‐use policy options. When using targets sought by multiple stakeholders within an ecosystem services framework, PPFs can characterize biophysical, socio‐economic and institutional dimensions of policy trade‐offs in heterogeneous landscapes. All 10 policy strategies assessed in our case study are biophysically capable of achieving all stakeholder objectives, provided at least 29–37% of the landscape is conserved for biodiversity. This novel methodological approach provides practical options for systematic analysis in complex, multifunctional landscapes, and could, when integrated within a larger planning and implementation process, inform the design of land‐use policies that maximize stakeholder satisfaction and minimize conflict.
Perception of Coexistence Measures by Farmers in Five European Union Member States
Authors: Tillie Pascal , Dillen Koen , Rodríguez‐Cerezo Emilio
Published: April 2016

Farm‐level coexistence measures between GM and non‐GM crops are essential to ensure the freedom of choice of both farmers and consumers that is the cornerstone of European policy in this matter. However, it is important that coexistence measures do not tip the balance against GM crops, and distort farmers’ decisions on whether or not to grow these. Based on a farm survey conducted in 2012, this article analyses the perceptions of the burden of coexistence measures by farmers. A total of 1,403 farmers were interviewed in five Member States of the EU. Results illustrate that farmers perceive coexistence measures that imply a restriction of their freedom of choice as the most burdensome, while they are less affected by practical coexistence measures in the fields or by administrative rules. Liability for damage to non‐GM farmers is also considered extremely burdensome due to the unpredictable outcome of potential litigation. However, according to the survey, few conflicts have arisen because of coexistence issues with neighbouring farmers. The burden of practical, farm‐level coexistence measures also varies across countries, depending on agro‐ecological conditions. This calls for the design of flexible, context‐specific coexistence measures, possibly complemented by non‐production constraining administrative rules.
Asynchronous Flowering or Buffer Zones: Technical Solutions for Small‐scale Farming
Authors: Nadal Anna , Pla Maria , Messeguer Joaquima , Melé Enric , Piferrer Xavier , Serra Joan , Capellades Gemma
Published: April 2016

To ensure consumers' and farmers' freedom of choice, many countries have regulated the labelling of products derived from genetically modified (GM) crops and coexistence of conventional and GM fields. On the basis of published research results a guide for Good Agricultural Practices (GAP) was compiled to facilitate maize coexistence in farming zones with temperate climate. In the frame of the PRICE EU‐funded research project we validated these recommended measures in real agricultural fields representing the worst case scenario, i.e. small‐scale farming in a region with around 75 per cent commercial GM maize. The two alternative strategies proposed in the GAP, buffer zones and flowering asynchrony, successfully guaranteed coexistence in the frame of the present EU regulation. These measures do not lead to unnecessary costs, are simple to apply and are compatible with small deviations resulting from common agricultural practices. The results are applicable for temperate zones such as Southern Europe and cannot easily be transferred to other parts of Europe due to differences in climatic conditions which limit the use of different flowering times as a coexistence strategy.
CMS Maize: A Tool to Reduce the Distance between GM and non‐GM Maize
Authors: Bückmann Heidrun , Thiele Katja , Schiemann Joachim
Published: April 2016

To limit admixture of genetically modified (GM) with non‐GM crops in the early stages of production, codes of good agricultural practice for GM crops have been developed. In addition to general measures, crop‐specific measures including the establishment of ‘isolation distances’ are required. The use of biological means like cytoplasmic male sterility (CMS) in maize provide more flexible isolation distances particularly in cases where GM maize requires higher levels of containment/confinement to ensure coexistence with agricultural production systems that do not cultivate GM plants. This article discusses the role of CMS where plants develop no or no vital pollen but the female fertility is not affected, as a biological means of reducing isolation requirements. Results of the PRICE project and other EU‐funded projects provide evidence that current isolation distances set by EU Member States are disproportionate for achieving admixture levels below the 0.9 per cent GM admixture threshold for labelling and may lead to unnecessary costs for farmers. Distances might be reduced or replaced by the use of GM CMS maize as it provides an efficient biological confinement tool and increases the flexibility for ‘good agricultural practices of GM crop cultivation’.
Issues in GM and Non‐GM Coexistence: A United States Perspective
Authors: Huffman Wallace
Published: April 2016

The US food system is embedded as a supply chain within a diverse, ever‐changing, and broad economic, biophysical, and socio‐political context. A variety of actors with diverse goals are interested in increasing agricultural productivity, protecting the environment, improving food quality, and/or improving specific aspects of health, and their decisions shape the food system. US regulatory policy on GMOs is based on the principle of substantial equivalence – GMO and non‐GMO foods contain comparable amounts of basic components – which is favourable to new technologies. Anti‐GMO activists seem to be less concerned about using mandatory labelling to increase consumer choice and more interested in using a GMO label to stigmatise food products so as to eliminate GMOs from store shelves. However, federal legislation is being considered to create a new voluntary ‘free of GMOs’ food label that would require costly verification and special handling. It would also pre‐empt States from enacting mandatory GM labelling policies. The US is a society where the majority of consumers are indifferent to or favour GMO foods and only a minority, but a growing one, is opposed. A national mandatory GM labelling policy is not expected to gain wide political support but a voluntary ‘free of GMOs’ label might.
Intraoperative cholangiogram during laparoscopic cholecystectomy: A clinical trial in rural setting
Authors: Verma Shreya , Wichmann Matthias W. , Gunning Thomas , Beukes Eben , Maddern Guy
Published: April 2016

Objective

The routine use of intraoperative cholangiogram (IOC) in laparoscopic cholecystectomy (LC) remains a contentious issue. IOC helps to delineate biliary tree anatomy, prevent bile duct injury and image stones in the common bile duct (CBD). It may prove to be a valuable alternative to ERCP or MRCP, especially in the rural setting with limited resources.

Design/Setting/Participants/Interventions/Main outcome measures

All patients undergoing laparoscopic cholecystectomy during a 12‐month period were audited. For the first 6 months, patients were recruited for routine IOC and for the second 6 months, routine IOC was not performed. Cases were analysed with regard to patient demographics, operative details and clinical outcomes.

Results

A total of 75 patients were analysed within the 12‐month period. The majority were women aged 41–50. Ultrasound suggested common bile duct stones in 6.7% of cases. IOC was attempted in 50.7% of cases. Of these, 29 (76.3%) were successful. IOC added an average of 28 min to total theatre time. A total of 75% (n = 22) of IOCs showed normal flow of contrast into the intra‐ and extra‐hepatic biliary systems. In 17% (n = 5) of patients, stones within the CBD were suspected, and these were referred for further management. ERCP/MRCP confirmed CBD stones in 60% (n = 3) of these patients. There was poor correlation between pre‐operative suspicion and confirmed CBD stones (two patients only with pre‐operative suspected CBD stone confirmed on IOC and ERCP). There were no operative complications related to IOC. There were no post‐operative complications in cases where no IOC was done.

Conclusion

The majority of patients treated in our centre were women, middle‐aged patients booked for elective laparoscopic cholecystectomy. Although only 6.7% cases were suspicious for CBD stones pre‐operatively, a total of 17% of patients with routine IOC suggested CBD stones. IOC was found to be safe, taking only an additional 28 min of total theatre time. Routine rather than selective use of IOC could be considered to improve patient safety and long‐term results.
Extracorporeal Respiratory Support With a Miniature Integrated Pediatric Pump‐Lung Device in an Acute Ovine Respiratory Failure Model
Authors: Wei Xufeng , Sanchez Pablo G. , Liu Yang , Claire Watkins A. , Li Tieluo , Griffith Bartley P. , Wu Zhongjun J.
Published: April 2016

Respiratory failure is one of the major causes of mortality and morbidity all over the world. Therapeutic options to treat respiratory failure remain limited. The objective of this study was to evaluate the gas transfer performance of a newly developed miniature portable integrated pediatric pump‐lung device (PediPL) with small membrane surface for respiratory support in an acute ovine respiratory failure model.

The respiratory failure was created in six adult sheep using intravenous anesthesia and reduced mechanical ventilation at 2 breaths/min. The PediPL device was surgically implanted and evaluated for respiratory support in a venovenous configuration between the right atrium and pulmonary artery. The hemodynamics and respiratory status of the animals during support with the device gas transfer performance of the PediPL were studied for 4 h.

The animals exhibited respiratory failure 30 min after mechanical ventilation was reduced to 2 breaths/min, indicated by low oxygen partial pressure, low oxygen saturation, and elevated carbon dioxide in arterial blood. The failure was reversed by establishing respiratory support with the PediPL after 30 min. The rates of O2 transfer and CO2 removal of the PediPL were 86.8 and 139.1 mL/min, respectively.

The results demonstrated that the PediPL (miniature integrated pump‐oxygenator) has the potential to provide respiratory support as a novel treatment for both hypoxia and hypercarbia. The compact size of the PediPL could allow portability and potentially be used in many emergency settings to rescue patients suffering acute lung injury.
Symptomatic and quality‐of‐life outcomes after treatment for clinically localised prostate cancer: a systematic review
Authors: Whiting Penny F. , Moore Theresa H.M. , Jameson Catherine M. , Davies Philippa , Rowlands Mari‐Anne , Burke Margaret , Beynon Rebecca , Savovic Jelena , Donovan Jenny L.
Published: April 2016

To conduct a systematic review of the risks of short‐term outcomes after major treatments for clinically localised prostate cancer. MEDLINE, EMBASE and the Cochrane Library were searched from 2004 to January 2013. Study arms that included ≥100 men with localised prostate cancer in receipt of surgery, radiotherapy or active surveillance and reported symptomatic and quality‐of‐life (QoL) data from 6 to 60 months after treatment were eligible. Data were extracted by one reviewer and checked by another. In all, 64 studies (80 treatment cohorts) were included. Most were single treatment cohorts from the USA or Europe. Radiotherapy was the most common treatment (40 cohorts, including 31 brachytherapy cohorts) followed by prostatectomy (39 cohorts), with only one active surveillance cohort. Most frequently measured symptoms were urinary, followed by sexual, and bowel; QoL was assessed in only 17 cohorts. Most studies used validated measures, although poor data reporting and differences between studies meant that it was not possible to pool data. Data on the precise impact of short‐term symptomatic and QoL outcomes after treatment for localised prostate cancer are of insufficient quality for clear guidance to men about the risks to these aspects of their lives. It is important that future studies focus on collecting core outcomes through validated measures and comply with reporting guidelines, so that clear and accurate information can be derived for men considering screening or treatment for prostate cancer.
The Common Assessment Framework form 9 years on: a creative process
Authors: Nethercott Kathryn
Published: April 2016

Legislation within England states that local authorities should provide services for all those families in need. However, research has identified that regardless of the introduction of strategies to identify need and enhance family support, ongoing barriers to services adhere.

Taking a social constructionist approach, this study explored professionals' experiences of the use of the Common Assessment Framework form. Data were collected in four different local authorities in two phases. Forty‐one professionals from a variety of agencies took part in semi‐structured interviews. Data were analyzed thematically.

Findings demonstrate that the professionals experienced difficulties in working through the Common Assessment Framework process, for example, in completing the form and engaging families. This situation led to the more experienced and knowledgeable professionals utilising creative ways to successfully navigate the ‘referral process’. Such creative working practices included the terminology used to complete the form and how the process was ‘sold’ to parents, so that they could be in a better position to engage parents and complete the Common Assessment Framework form. Because of this, more experienced professionals seem to be able to accelerate the referral process in order to access much needed support services for children and young people.
Autoimmune dermatologic toxicities from immune checkpoint blockade with anti‐PD‐1 antibody therapy: a report on bullous skin eruptions
Authors: Jour George , Glitza Isabella C. , Ellis Rachel M. , Torres‐Cabala Carlos A. , Tetzlaff Michael T. , Li Janet Y. , Nagarajan Priyadharsini , Huen Auris , Aung Phyu P. , Ivan Doina , Drucker Carol R. , Prieto Victor G. , Rapini Ronald P. , Patel Anisha , Curry Jonathan L.
Published: April 2016

Monoclonal antibodies against the immune checkpoint programmed cell death receptor 1 (PD‐1) improve the hosts' antitumor immune response and have showed tremendous promise in the treatment of advanced solid tumors and hematologic malignancies. Reports of serious autoimmune dermatologic toxicities from immune checkpoint blockade therapy, however, are emerging. We report our experience with five patients who presented with pruritic vesicles and blisters on the skin while treated with anti‐PD‐1 antibody immunotherapy with either nivolumab or pembrolizumab. Four of the patients' skin biopsies revealed subepidermal bullae with immunohistochemical study for type IV collagen labeling the floor of the blister cavity and direct immunofluorescence studies (in three of the four patients tested) decorated linear IgG and C3 immune deposits on the blister roof, diagnostic of bullous pemphigoid. One patient developed bullous erythema multiforme. All patients had partial or complete resolution of skin lesions following treatment with systemic corticosteroid and cessation of checkpoint blockade. Recognition and treatment of rare immune‐related bullous dermatologic toxicities will become increasingly important as more patients are treated with effective and newer immune checkpoint blockade therapy.
Proliferative lesion of anogenital mammary‐like glands in the setting of Cowden syndrome: case report and review of the literature
Authors: Hedayat Amin A. , Pettus Jason R. , Marotti Jonathan D. , Tafe Laura J. , Holubar Stefan D. , Lisovsky Mikhail
Published: April 2016

Mammary‐like glands are normal appendages of anogenital skin and can give rise to epithelial and stromal tumors that closely resemble breast tumors. Cowden syndrome is an autosomal‐dominant cancer‐predisposition syndrome that is associated with increased risk of various benign and malignant tumors including breast cancers. Here, we report the first case of a proliferative lesion of mammary‐like glands in the setting of Cowden syndrome. A 27‐year‐old female with Cowden syndrome (R130Q‐PTEN mutation) presented with a 1‐cm tender, polypoid perianal lesion. An excisional biopsy revealed a circumscribed, lobulated lesion with fibromyxoid stroma and epithelial hyperplasia with apocrine and columnar cell changes that was arranged in papillary, micropapillary and focal cribriform architecture. The features strikingly resembled proliferative changes commonly seen in the breast. Interestingly, the patient subsequently developed an atypical complex sclerosing lesion of the breast. Given the increased risk of breast neoplasia in Cowden syndrome, and the morphologic relationship between breast glands and mammary‐like glands, this case raises the possibility of an increased risk of neoplasia arising in mammary‐like glands in the setting of Cowden syndrome.
Impact of a multifaceted strategy to improve perioperative diabetes care
Authors: Hommel I. , Wollersheim H. , Tack C. J. , Mulder J. , van Gurp P. J. , Hulscher M. E. J. L.
Published: April 2016

Aims

To assess the impact of a multifaceted strategy to improve perioperative diabetes care throughout the hospital care pathway.

Methods

We conducted a controlled before‐and‐after study in six hospitals. The purpose of the strategy was to target four predominant barriers that obstruct optimal care delivery. We provided feedback on baseline indicator performance, developed a multidisciplinary protocol and patient information, and provided professional education. After a 6‐month intervention, we determined the performance changes against three outcome indicators and nine process indicators using data on 811 patients with diabetes who underwent major surgery. The progress of the interventions was monitored closely.

Results

Two process indicators improved significantly in the intervention hospitals: the proportion of patients for whom glycaemic control had been evaluated preoperatively increased by 9% (P < 0.002) and the proportion of patients with blood glucose measurements within 1 h after surgery increased by 29% (P < 0.0001). Four other process indicators and all three outcome indicators improved more in the intervention hospitals than in the control hospitals, but the differences were not statistically significant. These included the proportion of patients with all glucose values at 6–10 mmol/l (+3%) and the proportion of patients with hyperglycaemia (−8%). The implementation of the multidisciplinary protocol was still ongoing after the 6‐month intervention period.

Conclusions

The multifaceted improvement strategy had a limited impact on the quality of perioperative diabetes care. This study demonstrates the complexity of improving perioperative diabetes care throughout the multiprofessional hospital care pathway.
Sitagliptin plus pantoprazole can restore but not maintain insulin independence after clinical islet transplantation: results of a pilot study
Authors: Senior P. A. , Koh A. , Yau J. , Imes S. , Dinyari P. , Malcolm A. J. , Light P. , Shapiro A. M. J.
Published: April 2016

Aims

Resuming insulin use due to waning function is common after islet transplantation. Animal studies suggest that gastrointestinal hormones, including gastrin and incretins may increase β–cell mass. We tested the hypothesis that pantoprazole plus sitagliptin, would restore insulin independence in islet transplant recipients with early graft insufficiency and determined whether this would persist after a 3–month washout.

Methods

Single‐centre, uncontrolled, open label study of sitagliptin 100 mg daily plus pantoprazole 40 mg twice daily for 6 months.

Results

After 6 months of treatment, two of eight participants (25%) achieved the primary endpoint, defined as HbA1C < 42 mmol/mol (6%), fasting plasma glucose < 7.0 mmol, C–peptide > 0.5 nmol and no insulin use. There was a significant reduction in mean insulin dose, but no change in HbA1C or weight. There were no changes in the acute insulin response to arginine, the mixed meal tolerance test or blinded continuous glucose monitoring. After the washout, no participants met the primary endpoint and HbA1C increased from 45 ± 8 mmol/mol (6.3 ± 0.7%) to 51 ± 6 mmol/mol (6.8 ± 0.6%) (P < 0.05). Two participants had mild–moderate transient gastrointestinal side effects. There were no episodes of hypoglycaemia.

Conclusions

Sitagliptin plus pantoprazole is well tolerated and safe and may restore insulin independence in some islet transplant recipients with early graft insufficiency, but this was not sustained when treatment was withdrawn. A larger, controlled trial is required to confirm the effectiveness of this combination to achieve insulin independence and to confidently exclude any persistent benefit for graft function. (Clinical Trials Registry No.: NCT00768651)
Aspirin for primary prevention of cardiovascular and all‐cause mortality events in diabetes: updated meta‐analysis of randomized controlled trials
Authors: Kunutsor S. K. , Seidu S. , Khunti K.
Published: April 2016

Aims

To evaluate the benefits and harms of aspirin for the primary prevention of cardiovascular disease and all‐cause mortality events in people with diabetes by conducting a systematic review and meta‐analysis.

Methods

Randomized controlled trials of aspirin compared with placebo (or no treatment) in people with diabetes with no history of cardiovascular disease were identified from MEDLINE, EMBASE, Web of Science, the Cochrane Library and a manual search of bibliographies to November 2015. Study‐specific relative risks with 95% CIs were aggregated using random effects models.

Results

A total of 10 randomized trials were included in the review. There was a significant reduction in risk of major adverse cardiovascular events: relative risk of 0.90 (95% CI 0.81–0.99) in groups taking aspirin compared with placebo or no treatment. Limited subgroup analyses suggested that the effect of aspirin on major adverse cardiovascular events differed by baseline cardiovascular disease risk, medication compliance and sex (P for interaction for all > 0.05).There was no significant reduction in the risk of myocardial infarction, coronary heart disease, stroke, cardiovascular mortality or all‐cause mortality. Aspirin significantly reduced the risk of myocardial infarction for a treatment duration of ≤ 5 years. There were differences in the effect of aspirin by dosage and treatment duration on overall stroke outcomes (P for interaction for all < 0.05). There was an increase in risk of major or gastrointestinal bleeding events, but estimates were imprecise and not significant.

Conclusions

The emerging data do not clearly support guidelines that encourage the use of aspirin for the primary prevention of cardiovascular disease in adults with diabetes who are at increased cardiovascular disease risk.
Real Rigidities and Nominal Price Changes
Authors: Klenow Peter J. , Willis Jonathan L.
Published: April 2016

Real rigidities can help to generate persistent effects of monetary policy shocks. We analyse an industry equilibrium model with two types of real rigidities: a ‘micro’ real rigidity from a kinked demand curve, and a ‘macro’ real rigidity due to sticky intermediate prices. We estimate key model parameters using micro data from the US CPI, which features big movements in relative prices within and across sectors. The micro real rigidity necessitates large idiosyncratic shocks to productivity. The macro real rigidity does not entail such large idiosyncratic shocks, and is consistent with the volatility of sectoral TFP growth.
Casein glycomacropeptide for active distal ulcerative colitis: a randomized pilot study
Authors: Hvas Christian L. , Dige Anders , Bendix Mia , Wernlund Pernille G. , Christensen Lisbet A. , Dahlerup Jens F. , Agnholt Jørgen
Published: April 2016

Background

In ulcerative colitis (UC), dietary supplements may have anti‐inflammatory properties and improve disease course. We investigated the effects of casein glycomacropeptide (CGMP), a fraction of bovine whey protein, in active UC.

Materials and methods

In a randomized open‐label intervention study, 24 patients with active UC involving 10–40 cm of the distal colon were randomized in a 2 : 1 ratio into two groups. The first group was administered their usual treatment plus a daily supplement of CGMP 30 g, and the second group was administered a dose escalation to 4800 mg oral mesalamine daily (standard treatment) for 4 weeks. Clinical, endoscopic, mucosal and circulating disease activity markers were monitored. Acceptance of and adherence to CGMP up to 8 weeks were documented.

Results

After 4 weeks of treatment, 10 of 16 (63%) patients who received CGMP had an unchanged or decreased Simple Clinical Colitis Activity Index (SCCAI), which was similar to the four of eight (50%) (P = 0·67) patients on the standard treatment. The number of patients in which SCCAI decreased by three or more did not differ between the two groups: nine of 16 (56%) in the CGMP group vs. four of eight (50%) in the standard treatment group (P = 0·77). Changes in disease extent and severity were similar between the two groups. CGMP was well tolerated and accepted by the patients.

Conclusions

The addition of CGMP as a nutritional therapy to standard treatment was safe and accepted by patients with active distal UC. The disease‐modifying effect of CGMP was similar to that of the mesalamine dose escalation.