bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of technology to car parking facilities in Asian smart cities
Authors: Lam Patrick T.I. , Yang Wenjing
Published: March 2019

Purpose

This study aims investigate the status of applying technology in car parking facilities. It also examines the factors affecting the deployment of these technologies as they improve the efficiency and convenience of car parking facilities amidst changing transport needs in Asian smart cities.

Design/methodology/approach

A comprehensive literature review informs the relationships between car park provisions and the traffic congestion problem. A typology covering different technological solutions is then formulated. The factors affecting the use of two such common technologies (i.e. mechanical car parks and intelligent information systems) are examined in two emerging smart cities in Asia with the aid of a desk-top study for Singapore and a survey covering over 600 samples (including users and non-users, as both groups are important to derive influencing factors) in Hong Kong.

Findings

The extent to which mechanical car parks may help relieve the space shortage problem depends on their relative costs and the facility management performance. For real-time vacancy information systems, their wide spread use depends on drivers’ age and past parking experience.

Research limitations/implications

Due to geographical constraints, only two Asian cities (Singapore and Hong Kong), where the use of smart technologies is flourishing, are included in the study. The survey on car parking apps is preliminary due to their relative short deployment in Asia. It is expected that the phenomena will quickly spread in the region as more smart cities are developed.

Originality/value

By expounding on the development of modern parking technologies in smart cities, the important influence of car parks as a strategic facility toward solving traffic congestion and environmental problems is brought to the attention of policy makers, in particular the influencing factors affecting strategies to promote the use of parking apps.
Online outsourcing and the future of work
Authors: Ray Korok , Thomas Tessa A.
Published: March 2019

Purpose

The purpose of this paper is to provide an argument supporting the growth of online outsourcing, which will exponentially increase in the coming years with the spread of internet availability to the less-developed regions of the world. In addition, this paper stresses the role of human decision-making in fostering this growth, rather than promoting inhibitory policies because of nationalism or fear of change.

Design/methodology/approach

First, globalization and the three “waves” of outsourcing are discussed. Next, the economic principles guiding online outsourcing (disintermediation, the rise of global internet connectivity and the benefits of output-based pay over input-based pay) are discussed. After explaining how artificial intelligence will complement rather than replace human laborers, a case study and evidence are provided. Then, suggestions for government policies going forward, including skill development and education are provided. Finally, the debate that will inevitably emerge regarding online worker benefits is introduced.

Findings

Evidence points toward the growth of online outsourcing and the resulting increased efficiency and gains through this type of trade. The increase in freelance workers and their earnings, the investments of Google and Facebook to develop internet capabilities in less-developed regions and the reducing costs of technology (such as laptops) provide support for this argument (Elance, 2013; Forbes, 2014; Pofeldt, 2015). Finally, a case study provides evidence illustrating how individuals may gain from these advances.

Originality/value

This paper contributes to the literature by providing a compelling argument for the upcoming transition to increased efficiency in work through online outsourcing. Technological advances will allow the modern worker to delegate his/her mundane tasks so that he/she is free to focus on more pressing issues. This shift will multiply the domestic and foreign labor markets, creating opportunities that have not been available to this point. As this transition is not inevitable, this paper further outlines suggestions for policymakers to ensure maximized gains in the future.
Financial reporting quality, family ownership, and investment efficiency
Authors: Shahzad Faisal , Rehman Ijaz Ur , Colombage Sisira , Nawaz Faisal
Published: March 2019

Purpose

The purpose of this paper is to empirically investigate the impact of two monitoring mechanisms: family ownership (FO) and financial reporting quality (FRQ) on investment efficiency (IE) over the period of 2007–2014 for listed firms on the Pakistan Stock Exchange.

Design/methodology/approach

The authors employ two-dimensional pooled OLS cluster at the firm and year level, two-stage least square regression and feasible generalized lease square regression regression methods.

Findings

The findings suggest that higher FRQ and FO are associated with higher IE. Further, the authors report that higher FRQ and FO mitigate over- and under-investment. The impact of FRQ on IE is stronger (weaker) for family-controlled businesses. The results for these particular estimates are robust for alternative estimation techniques and measures of FRQ and FO.

Originality/value

The study draws on both agency and behavioral agency theories and therefore contributes to the literature in the following ways. First, the authors examine a relationship between FRQ and IE. Second, the authors test the impact of FO on IE. Third, the authors test the moderating impact of FO on the relationship between FRQ and the IE of family and non-family firms in relatively less regulated emerging market.
Service branding from the perspective of higher education administrators
Authors: Endo Ana Claudia Braun , de Farias Luiz Alberto , Coelho Pedro Simões
Published: March 2019

Purpose

The purpose of this paper is to provide empirical insights about service branding from higher education administrators (HEAs) perspectives and to identify the main factors involved in their strategic thinking in this sector.

Design/methodology/approach

Adopting a qualitative approach, 22 in-depth interviews were performed in Brazilian HEAs to analyze service branding as a strategic institutional process in this context.

Findings

Findings reveal that service branding depends on several factors, e.g., in this case, deep integration between branding and services, leadership involvement, strong value propositions, sharing of strategic guidelines, branding experiences and, finally, credibility and reputation. Excellence of service is considered essential in higher education (HE) and, therefore, service branding faces the challenge of promoting the provision of quality services.

Originality/value

Although there have been many studies relating to HE and branding, few authors have studied service branding in educational sector and which issues must be observed in a competitive marketplace.
The defensive function of a pollinator‐attracting floral volatile
Authors: Kessler Danny , Bing Julia , Haverkamp Alexander , Baldwin Ian T.
Published: March 2019

Benzyl acetone (4‐phenylbutan‐2‐one; BA), the dominant floral fragrance of the wild tobaccoNicotiana attenuata, is known to attract night‐time pollinators, such asManduca sextahawkmoths. For this pollinator, BA is not only essential for the pollen transport between conspecific plants, but also for the moth’s short‐distance handling of flowers at night. The emission of BA from the corolla limb, however, starts up to 4 hr before dusk, peaks at dusk and continues throughout the first half of the night. While the function of the nocturnal part of the emission is well studied, the function of the early part of the peak emission remained unknown.

By using plants silenced in the expression of the biosynthetic gene of BA (Nachal1), we investigated the function of this early peak emission of BA in the plants´ native habitat in Southwestern Utah.

By emitting BA before dusk,N. attenuatais able to prevent the establishment and resulting floral damage by a florivore, the cucumber beetle (Diabrotica undecimpunctata). Plants lacking BA emissions (CHAL) were not only more often colonized by florivores, but also suffered significantly more damage, than control empty vector plants (EV). Choice assays revealed thatD. undecimpunctatafeeding required the absence of BA. While feeding damage to CHAL flowers was higher than to EV flowers in the early night hours, the effect disappeared during the second half of the night, when flowers stop emitting BA. The close proximity of BA‐emitting flowers to non‐emitting CHAL flowers preventedD. undecimpunctatafeeding. In the field, the emission of BA at dusk was sufficient to protect plants for the entire night, as beetles search for new hosts during the early evening hours and remain for the duration of the night, once a host is chosen.

Floral BA emission before dusk may have evolved as a consequence of antagonistic interactions with florivores. A single floral volatile can thus simultaneously function as an important floral attractant for pollinators and as effective feeding deterrent against florivores in the same plant species.

Aplain language summaryis available for this article.
Masters of hybridity: how activists reconstructed Nepali society
Authors: Gellner David N.
Published: March 2019

This article discusses the changes that activists have brought to Nepali society in relation to two key elements of Bruno Latour's actor‐network theory (ANT): (1) its account of modernity and (2) its radical downplaying of human agency. ANT, contrary to the way it tends to be understood, deserves to be seen, at least in Latour's treatment, as a major theory of modernity. As such, it is important and enlightening, even though its attack on human agency – at least when discussing activism – is unhelpful. On this point Ian Hacking's notion of ‘making up people’ provides a better guide. The main example explored is the new kinds of ethnic identity that have achieved state recognition and become politically influential in Nepal over the last thirty years. The case of one ethnic and religious activist, Dr Keshabman Shakya, is used to illustrate the argument. Based on notions of human rights, rather similar processes of ‘making up people’ have also occurred with other minority groups, most strikingly in the case of the ‘third gender’, a context in which Nepal is famously ‘progressive’ compared to other nation‐states in the region.
Impact of Postharvest Operations on Rice Grain Quality: A Review
Authors: Tong Chuan , Gao Haiyan , Luo Shunjing , Liu Lei , Bao Jinsong
Published: March 2019

Postharvest operations, such as drying, storage, and milling, have been used to ameliorate the aging of rice grains and to achieve and maintain desirable rice grain quality, and thus play a key role in determining rice commercial quality and value. This review summarizes publications from the past decade and outlines the evidence supporting attribution of grain quality changes induced by postharvest processes to changes in the physical properties and chemical composition of the rice grain (starch, protein, lipids, and antioxidants). Rice drying mainly affects rice milling quality as rice kernel fissuring that may occur during drying leads to head rice yield reduction. Rice grain aging occurring during storage is inevitable and responsible for the changes in rice appearance, milling, eating, cooking, and nutritional quality. As milling significantly changes the chemical composition of rice by removing protein‐ and lipid‐rich bran layers, milling can alter the aging process of rice and also affect rice appearance, eating, and sensory quality, but mainly affects the nutritional quality. Therefore, drying methods, storage conditions, and milling methods warrant further research to achieve and maintain the desired rice grain quality. This review may contribute to better understanding of the impacts of postharvest processes on rice grain quality, and provide insights into potential improvements in these practices for rice production and utilization in the whole rice industry.
A Critical Overview of Labeling Information of Pomegranate Juice‐Based Drinks: Phytochemicals Content and Health Claims
Authors: Cano‐Lamadrid Marina , Turkiewicz Igor Piotr , Tkacz Karolina , Sánchez‐Rodríguez Lucía , López‐Lluch David , Wojdyło Aneta , Sendra Esther , Carbonell‐Barrachina Angel A.
Published: March 2019

Punicalagin is responsible for over 50% of the antioxidant activity of pomegranate, but ellagic acid (EA) and total polyphenol content (TPC) are also key parameters regarding pomegranate bioactivity. Many juices and other drinks based on pomegranate take advantage from the widespread healthy image of this fruit, whereas their real content of bioactive phytochemicals is low. For that reason, the objective of this study was to compare the labelling information with the real phytochemical contents (TPC, punicalagin [Pn] [isomers α, β], and EA). Titratable acidity (TA), color density (CD), polymeric color (PC), and sensory profiles (trained panel) were assessed. The experimental ranges of TPC and Pn contents were 2.75 to 70.9 mg/g and traces to 3.18 mg/g, respectively. The percentage of pomegranate juice was highly correlated with the intensity of the pomegranate ID attribute (R = 0.85; p < 0.001), Pn content (R = 0.71; p < 0.001), and EA content (R = 0.36; p < 0.001). The experimental results showed a high variability in the content of bioactive compounds and the need to urge food companies to optimize processes and storage conditions. Although no health claim for pomegranate has been authorized so far at the European Union, significant mismatches among labelling and bioactive compounds content are misleading consumers.

Practical Application

Pomegranate juice and nectar producers need to evaluate the real content of bioactive Pn, EA, and TPC in their products to optimize formulation, heat treatment, packaging and storage conditions to guarantee high levels of bioactive compounds during shelf life. Producers’ organizations may benefit from harmonizing Pom products labelling, so they may fulfill consumer expectations and may be ready if health claims are finally authorized for these products. The development of a new sensory quality marker will be an interesting option.
Clinical correlates of HLA‐B*27 and its subtypes in enthesitis‐related arthritis variant of juvenile idiopathic arthritis in south Indian Tamil patients
Authors: Kavadichanda Chengappa G. , Seth Gaurav , Kumar Gunjan , Gulati Reena , Negi Vir Singh
Published: March 2019

Aim

The aim of the study was to assess the distribution of human leukocyte antigen (HLA)‐B*27 subtypes and its correlation with disease phenotypes in children with enthesitis‐related arthritis variant of juvenile idiopathic arthritis (JIA‐ERA).

Method

One hundred and sixty patients (132 males, 28 females) satisfying the International League Against Rheumatism (ILAR) classification criteria for JIA‐ERA were assessed and relevant demographic, clinical and radiographic data were documented. HLA‐B*27 typing was done for all the patients and B*27 positive samples were subjected to high‐resolution gene sequencing. The effect of duration of illness, HLA‐B*27, its subtypes, and gender on the clinical phenotype were analyzed.

Results

The mean age of disease onset was 12.69 ± 2.4 years with a male:female ratio of 4.7:1.0. HLA‐B*27 was positive in 109/160 patients and HLA‐B*27:04 was detected in 63% followed by B*27:05 (30%). Duration of illness was greater in patients with skeletal deformity, hip arthritis, sacroiliitis, cervical spine involvement and acute anterior uveitis (AAU) (P < 0.05). HLA‐B*27 positivity was associated with a prolonged course of disease, higher incidence of AAU (14.7% vs 2%, P = 0.015), family history of spondyloarthritis (21.1% vs 5.9%; P = 0.015) and higher erythrocyte sedimentation rate as compared to HLA‐B*27 negative patients (P < 0.01). The HLA‐B*27:04 and *27:05 positive patients had similar clinical phenotypes.

Conclusion

Presence of HLA‐B*27 and long duration of illness results in skeletal deformity, hip arthritis, sacroiliitis, cervical spine involvement and AAU. HLA‐B*27:04 followed by B*27:05 are the most common HLA‐B*27 subtypes in our study population and both have a similar clinical phenotype.
Re‐biopsy and liquid biopsy for patients with non‐small cell lung cancer after EGFR‐tyrosine kinase inhibitor failure
Authors: Zhou Juan , Zhao Chao , Zhao Jing , Wang Qi , Chu Xiangling , Li Jiayu , Zhou Fei , Ren Shengxiang , Li Xuefei , Su Chunxia , Zhou Caicun
Published: March 2019

Background

Re‐biopsy is important for exploring resistance mechanisms, especially for non‐small cell lung cancer (NSCLC) patients who develop resistance to EGFR‐tyrosine kinase inhibitors (TKIs). Liquid biopsy using circulating tumor DNA has come into use for this purpose. This retrospective study investigated the status of re‐biopsy and liquid biopsy in NSCLC patients with EGFR mutations and evaluated their effect on clinical strategies and prognosis.

Methods

Five hundred fifty‐five NSCLC patients with resistance to EGFR‐TKIs were included and divided into three groups: re‐biopsy, liquid biopsy, and no re‐biopsy. Amplification refractory mutation system (ARMS) PCR or super ARMS PCR was used to detect EGFR mutations.

Results

Three hundred eight (55.5%) patients underwent re‐biopsy; 45.5% (140/308) were positive for T790M. The most common re‐biopsy procedure was computed tomography‐guided percutaneous core needle biopsy (60.1%), followed by effusion drainage (29.5%) and superficial lymph node biopsy (6.5%). One hundred eighteen (21.3%) patients underwent liquid biopsy; the T790M detection rate was 41.5% (49/118.) Of the 308 patients who underwent re‐biopsy, 69 were examined for EGFR mutations with plasma. The concordance rate of T790M detection between tissue and plasma was 66.7%. A statistical difference in further treatment after EGFR‐TKI failure was observed among all groups (P = 0.014). Patients in the biopsy groups were more likely to receive third‐generation EGFR‐TKIs. Multivariate analysis showed that re‐biopsy had a significant impact on overall survival (P < 0.001).

Conclusion

Re‐biopsy plays a pivotal role in the management of patients with NSCLC and resistance to EGFR‐TKIs. Liquid biopsy may be an alternative if difficulties performing re‐biopsy exist.
Factors related to delayed intensive care unit admission from emergency department—A retrospective cohort study
Authors: Aitavaara‐Anttila Mia , Liisanantti Janne H. , Raatiniemi Lasse , Ohtonen Pasi , Ala‐Kokko Tero
Published: March 2019

Background

The delays in transferring patients from emergency department (ED) to intensive care unit (ICU) are known to be linked with several adverse events, including prolonged ICU stay and increased hospital mortality. The factors associated with delayed ICU admission include shortage of ICU beds, organizational factors, ED overcrowding, and patient‐related factors, including sepsis as admission diagnosis. The aim of this study was to examine ED‐related factors associated with prolonged ED stay.

Methods

The study population consisted of adult patients admitted (n = 479) from ED to ICU between 31 May 2016 and 19 March 2017 in Oulu University Hospital. A patient's ED length of stay (LOS) exceeding 180 minutes was considered delayed.

Results

Most of the patients (380, 79.3%) were admitted to the ICU within 3 hours of hospital admission. In a logistic regression analysis, odds ratios (ORs) for ED LOS > 180 minutes were as follows: for Glasgow Coma Scale score > 9, 2.73 (1.39‐5.32); for thrombocytes < 100 × 109/mmol, 6.69 (2.32‐19.26); for absence of pre‐arrival notification, 5.27 (3.04‐9.14); and for radiological examination, 3.95 (1.72‐9.10). Trauma and intoxicated patients had shorter ED LOS while patients with medical conditions had more often prolonged admissions.

Conclusion

The delays in ICU admissions were linked to therapeutic and diagnostic procedures and absence of pre‐arrival notification. Patients were admitted to the ICU on the basis of diagnosis instead of clinical risk. However, the delays were not associated with worsening outcome, which indicates that sufficient care can be provided at the ED while the ICU admission is pending.
Vascular smooth muscle cell‐specific progerin expression in a mouse model of Hutchinson–Gilford progeria syndrome promotes arterial stiffness: Therapeutic effect of dietary nitrite
Authors: del Campo Lara , Sánchez‐López Amanda , Salaices Mercedes , von Kleeck Ryan A. , Expósito Elba , González‐Gómez Cristina , Cussó Lorena , Guzmán‐Martínez Gabriela , Ruiz‐Cabello Jesús , Desco Manuel , Assoian Richard K. , Briones Ana M. , Andrés Vicente
Published: March 2019

Vascular stiffness is a major cause of cardiovascular disease during normal aging and in Hutchinson–Gilford progeria syndrome (HGPS), a rare genetic disorder caused by ubiquitous progerin expression. This mutant form of lamin A causes premature aging associated with cardiovascular alterations that lead to death at an average age of 14.6 years. We investigated the mechanisms underlying vessel stiffness in LmnaG609G/G609G mice with ubiquitous progerin expression, and tested the effect of treatment with nitrites. We also bred LmnaLCS/LCSTie2Cre+/tgand LmnaLCS/LCSSM22αCre+/tg mice, which express progerin specifically in endothelial cells (ECs) and in vascular smooth muscle cells (VSMCs), respectively, to determine the specific contribution of each cell type to vascular pathology. We found vessel stiffness and inward remodeling in arteries of LmnaG609G/G609G and LmnaLCS/LCSSM22αCre+/tg, but not in those from LmnaLCS/LCSTie2Cre+/tgmice. Structural alterations in aortas of progeroid mice were associated with decreased smooth muscle tissue content, increased collagen deposition, and decreased transverse waving of elastin layers in the media. Functional studies identified collagen (unlike elastin and the cytoskeleton) as an underlying cause of aortic stiffness in progeroid mice. Consistent with this, we found increased deposition of collagens III, IV, V, and XII in the media of progeroid aortas. Vessel stiffness and inward remodeling in progeroid mice were prevented by adding sodium nitrite in drinking water. In conclusion, LmnaG609G/G609G arteries exhibit stiffness and inward remodeling, mainly due to progerin‐induced damage to VSMCs, which causes increased deposition of medial collagen and a secondary alteration in elastin structure. Treatment with nitrites prevents vascular stiffness in progeria.
Depression in Emergency Department Patients and Association With Health Care Utilization
Authors: Beiser David G. , Ward Charlotte E. , Vu Milkie , Laiteerapong Neda , Gibbons Robert D.
Published: March 2019

Background

Depression is one of the most common illnesses in the United States, with increased prevalence among people with lower socioeconomic status and chronic mental illness who often seek care in the emergency department (ED). We sought to estimate the rate and severity of major depressive disorder (MDD) in a nonpsychiatric ED population and its association with subsequent ED visits and hospitalizations.

Methods

This prospective cohort study enrolled a convenience sample of English‐speaking adults presenting to an urban academic medical center ED without psychiatric complaints between January 1, 2015, and September 21, 2015. Patients completed a computerized adaptive depression diagnostic screen (CAD‐MDD) and dimensional depression severity measurement test (CAT‐DI) via tablet computer. Primary outcomes included number of ED visits and hospitalizations assessed from index visit until January 1, 2016. Negative binomial regression modeling was performed to assess associations between depression, depression severity, clinical covariates, and utilization outcomes.

Results

Of 999 enrolled patients, 27% screened positive for MDD. The presence of MDD conveyed a 61% increase in the rate of ED visits (incidence rate ratio [IRR] = 1.61, 95% confidence interval [CI] = 1.27 to 2.03) and a 49% increase in the rate of hospitalizations (IRR = 1.49, 95% CI = 1.06–2.09). For each 10% increase in MDD severity, there was a 10% increase in the relative rate of subsequent ED visits (IRR = 1.10, 95% CI = 1.04 to 1.16) and hospitalizations (IRR = 1.10, 95% CI = 1.02 to 1.18). Across the range of the severity scale there was over a 2.5‐fold increase in the rate of ED visits and hospitalization rates.

Conclusions

Rates of depression were high among a convenience sample of English‐speaking adult ED patients presenting with nonpsychiatric complaints and independently associated with increased risk of subsequent ED utilization and hospitalization. Standardized assessment tools that provide rapid, accurate, and precise classification of MDD severity have the potential to play an important role in identifying ED patients in need of urgent psychiatric resource referral.
Community trial of silver fluoride treatment for deciduous dentition caries in remote Indigenous communities
Authors: Roberts‐Thomson KF , Ha DH , Wooley S , Meihubers S , Do LG
Published: March 2019

Background

Silver fluoride 40% followed by 10% stannous fluoride (AgF) has been used in dental practice in some parts of Australia for many years. This study compared the effectiveness of application of AgF with atraumatic restorative technique (ART) in managing cavitated carious primary molars.

Methods

The study was a community effectiveness trial in two remote Aboriginal communities where AgF has been used for some time. Children between 4 and 8 years of age with caries on primary molars were randomized by birth date to receive AgF or ART. There were 210 children who were included in the study with 384 eligible teeth. Children were followed up for periods between 9 months and 4 years. Negative outcomes such as dental pain, extraction, use of antibiotics and more extensive restorative treatment were considered as the primary outcomes of the study.

Results

Those negative outcomes were infrequent in both treatment groups. The prevalence ratio of negative sequelae for children treated with AgF compared with those treated with ART was lower at 0.18.

Conclusions

Silver fluoride was well accepted, easy to use and at least as effective a treatment as ART for dental caries in primary molars in young Aboriginal children in remote areas.
Elevation has contrasting effects on avian and mammalian nest traits in the Andean temperate mountains
Authors: Altamirano Tomás A. , Honorato María Teresa , Ibarra José Tomás , de la Maza Mariano , de Zwaan Devin R. , Bonacic Cristián , Martin Kathy
Published: March 2019

Nest building is a widespread breeding strategy across taxa. Nest composition and structure can play a critical role in the breeding success and/or adult survival of nest‐building vertebrates. Although nest traits are expected to vary adaptively across elevational gradients, few studies address this relationship. We studied the variation in nest traits (composition and structure) across elevation for two taxa with two different functions in the Andean temperate forests of southern Chile: a bird (Aphrastura spinicauda, Furnariidae, 170 breeding nests) and a marsupial mammal (Dromiciops gliroides, Microbiotheriidae, 91 winter torpor nests). ForA. spinicauda, we further assessed how nest traits influenced clutch size and hatching success. Both species used fewer types of nest materials (items) with increasing elevation, and a greater proportion of leaves were used in highland compared to lowland forests.Aphrastura spinicaudaused feathers and hair, andD. gliroidesused bryophytes more frequently in lowland forests. The mass and volume of nests decreased with increasing elevation forA. spinicaudaand increased forD. gliroides. Nest traits had subsequent fitness consequences forA. spinicauda, such that: (i) greater cup volume and depth were associated with larger clutch sizes, (ii) more items used during nest building were linked to improved clutch size at high elevation only, and (iii) nest wall thickness was negatively associated with hatching success. Thus, in temperate mountain ecosystems, elevation may be an important factor influencing nest‐building behaviour for cavity‐using vertebrates. However, the direction of the elevational effects may vary among taxa and nest functions in these ecosystems.
Referral patterns for genetic counselling of women diagnosed with tubo‐ovarian or peritoneal high‐grade serous carcinoma (HGSC) within the Auckland Gynaecological Oncology Centre
Authors: Burling Michael J , Gamet Kimberly , Eva Lois , Tan Ai Ling
Published: March 2019

Background

Germline BRCA1/2 mutations account for approximately 15% of invasive ovarian carcinomas. Referral of all women with non‐mucinous epithelial tubo‐ovarian and peritoneal cancer, especially high‐grade serous carcinoma (HGSC) to genetic services for genetic counselling and subsequent BRCA testing, has become standard of care in many countries. Publicly funded BRCA testing was restricted to women ≤70 years old with HGSC in New Zealand for most of our study period. Referral rates of women with HGSC for BRCA mutation testing in New Zealand have not previously been reported.

Aims

To determine the proportion of eligible patients with tubo‐ovarian or peritoneal HGSC referred to Auckland Gynaecologic Oncology Centre who were referred for genetic counselling. To determine the number of patients who underwent BRCA1/2 genetic testing and the rate of germline BRCA mutations.

Methods

Eligible cases were identified from Auckland Gynaecologic Oncology multidisciplinary meetings database from 1 January 2012 to 31 December 2014. Genetic referrals sent were checked against the genetic services database to ensure that referrals were received. Genetic counselling clinic attendance, uptake and results of genetic testing were also collected.

Results

One hundred and four eligible patients were identified with 58 patients referred. Referral rates increased from 37.5% in 2012 to 64.3% in 2014. Of the 58 patients referred, 53 attended genetic counselling, and 49 underwent BRCA mutation testing, of whom 10 (20.4%) tested positive for a germline BRCA mutation.

Conclusion

Overall, 55.8% of eligible patients were referred for genetic testing; however, referral rates increased with time. This BRCA mutation‐positive rate is comparable with current international data.
Pre‐eclampsia causing severe maternal morbidity – A national retrospective review of preventability and opportunities for improved care
Authors: MacDonald Evelyn Jane , Lepine Sam , Pledger Megan , Geller Stacie E. , Lawton Bev , Stone Peter
Published: March 2019

Introduction

Pre‐eclampsia and related sequelae are a leading cause of severe maternal and neonatal morbidity and mortality. A significant proportion of these poor outcomes may be preventable with improvements along the continuum of maternal and neonatal care.

Aims

The aim of this study was to review cases of pre‐eclampsia resulting in severe maternal morbidity, describing the maternal and neonatal outcomes and the potential preventability of severe maternal morbidity (SMM).

Materials and Methods

This was a retrospective cohort study of cases of SMM associated with severe pre‐eclampsia – a subset of a national SMM review study. Inclusion criteria for this subset were women who were pregnant or within 42 days of delivery with severe pre‐eclampsia as the main reason for admission to an intensive care unit or high dependency unit in New Zealand between 1 August 2013 and 31 January 2015 inclusive. A multidisciplinary expert panel reviewed cases for preventability using a validated preventability tool.

Results

Of the 89 severe morbidities that were reviewed, 10 had eclampsia (11%) and there were four neonatal mortalities (4.3%). Multidisciplinary committees assessed the severe morbidity as potentially preventable in 31% (28) of cases with the majority due to delays in diagnosis and suboptimal treatment.

Conclusion

We found a high level of preventable morbidity in cases of severe pre‐eclampsia with a concerning number of preventable eclampsia. Implementation of evidence‐based guidelines reinforced with education would assist clinicians to improve risk recognition, timely diagnosis and treatment and decrease potentially preventable severe morbidity associated with pre‐eclampsia.
Measuring and Explaining Political Sophistication through Textual Complexity
Authors: Benoit Kenneth , Munger Kevin , Spirling Arthur
Published: March 2019

Political scientists lack domain‐specific measures for the purpose of measuring the sophistication of political communication. We systematically review the shortcomings of existing approaches, before developing a new and better method along with software tools to apply it. We use crowdsourcing to perform thousands of pairwise comparisons of text snippets and incorporate these results into a statistical model of sophistication. This includes previously excluded features such as parts of speech and a measure of word rarity derived from dynamic term frequencies in the Google Books data set. Our technique not only shows which features are appropriate to the political domain and how, but also provides a measure easily applied and rescaled to political texts in a way that facilitates probabilistic comparisons. We reanalyze the State of the Union corpus to demonstrate how conclusions differ when using our improved approach, including the ability to compare complexity as a function of covariates.
Are Biased Media Bad for Democracy?
Authors: Wolton Stephane
Published: March 2019

This article assesses the normative and positive claims regarding the consequences of biased media using a political agency framework that includes a strategic voter, polarized politicians, and news providers. My model predicts that voters are always better informed with unbiased than with biased outlets even when the latter have opposite ideological preferences. However, biased media may improve voter welfare. Contrary to several scholars' fears, partisan news providers are not always bad for democracy. My theoretical findings also have important implications for empirical analyses of the electoral consequences of changes in the media environment. The impact of left‐wing and right‐wing biased outlets depends on the partisan identity of officeholders. Empirical findings may, thus, not be comparable across studies or even over time within a study. Existing empirical works are unlikely to measure the consequences of biased media, as researchers never observe and can rarely approximate the adequate counterfactual: elections with unbiased news outlets.
Mathematical model of the risk of drug error during anaesthesia: the influence of drug choices, injection routes, operation duration and fatigue
Authors: Sivia D. S. , Pandit J. J.
Published: March 2019

The incidence of an anaesthetic drug error can be directly observed in large trials. In an alternative approach, we developed a probabilistic mathematical model in which the anaesthetist is modelled as a ‘fallible entity’ who makes repeated drug administration choices during an operation. This fallibility was factored in the model as an initial ‘intrinsic error rate’. The choices faced included: dose; timing of administration; and the routes available for injection (e.g. venous, arterial, epidural, etc.). Additionally, we modelled the effect of fatigue as a factor that magnifies the cumulative error rate. For an initial intrinsic error rate of 1 in 1000 (which from first principles we consider a reasonable estimate), our model predicted a cumulative probability of error over a ~12 h operation of ~10%; that is, 1 in 10 operations this long results in some drug error. This is similar to the rate reported by large observational trials. Serious errors constitute a small fraction of all errors; our model predicts a Poisson distribution for the uncommon serious errors, also consistent with independent observations. Even modest assumptions for the development of fatigue had a dramatic and adverse impact on the cumulative error rate. The practice implications of our modelling include: exercising caution or avoiding starting work if under par; added vigilance in unfamiliar environments; keeping anaesthetic recipes simple; and recognising that operation durations > 5–6 h constitute a time of exaggerated risk. These implications are testable predictions in observational trials. If validated, our model could serve as a potential research tool to investigate the impact of safety interventions on the rate of intrinsic error using simulation.
Open reduction through a posterior incision in the surgical treatment of shoulder posterior dislocation associated with proximal humeral fractures
Authors: Shen Longxiang , Jiang Chaolai , An Zhiquan
Published: March 2019

Background

We explored the surgical technique of reducing the humeral head and repairing the fractures through a combined approach in the treatment of this complex injury.

Methods

Six patients with posterior shoulder dislocations associated with proximal humerus fractures were enrolled in this study. The posteriorly dislocated head was first reduced through a shoulder posterior incision and the ruptured posterior capsular tissues were repaired simultaneously using a suture anchor. The fractures were then reduced and fixed with a PHILOS through a deltopectoral approach. The affected shoulders were immobilized in a neutral position for 6 weeks postoperatively with a customized orthosis and then permitted active shoulder exercises after removal of the orthosis. At the last visit, union of the fractures was evaluated. Degrees of anterior forward of the affected shoulder were recorded. Outcomes were evaluated according to UCLA and Constant criteria.

Results

Six patients were followed up for an average of 24.5 ± 7.4 (range 13–35) months. At the last visit, the mean degree of anterior forward was 171.7 ± 7.5 (range 160–180) degrees. An average of 32.9 ± 1.2 (range 31–34) points was obtained according to UCLA criteria, demonstrating excellent and good results in two and four cases, respectively. The mean Constant score was 87.3 ± 4.1 (range 83–92) points.

Conclusions

The dislocated humeral head can be reduced through a posterior approach, while fractures can be reduced and fixed through a deltopectoral approach. This technique has the advantages of simplicity and its minimally invasive approach for reducing the dislocation.
Automated pose estimation captures key aspects of General Movements at eight to 17 weeks from conventional videos
Authors: Marchi Viviana , Hakala Anna , Knight Andrew , D'Acunto Federica , Scattoni Maria Luisa , Guzzetta Andrea , Vanhatalo Sampsa
Published: March 2019

Aim

General movement assessment requires substantial expertise for accurate visual interpretation. Our aim was to evaluate an automated pose estimation method, using conventional video records, to see if it could capture infant movements using objective biomarkers.

Methods

We selected archived videos from 21 infants aged eight to 17 weeks who had taken part in studies at the IRCCS Fondazione Stella Maris (Italy), from 2011 to 2017. Of these, 14 presented with typical low‐risk movements, while seven presented with atypical movements and were later diagnosed with cerebral palsy. Skeleton videos were produced using a computational pose estimation model adapted for infants and these were blindly assessed to see whether they contained the information needed for classification by human experts. Movements of skeletal key points were analysed using kinematic metrics to provide a biomarker to distinguish between groups.

Results

The visual assessments of the skeleton videos were very accurate, with Cohen's K of 0.90 when compared with the classification of conventional videos. Quantitative analysis showed that arm movements were more variable in infants with typical movements.

Conclusion

It was possible to extract automated estimation of movement patterns from conventional video records and convert them to skeleton footage. This could allow quantitative analysis of existing footage.
Species abundance distributions should underpin ordinal cover‐abundance transformations
Authors: McNellie Megan J. , Dorrough Josh , Oliver Ian
Published: March 2019

Questions

The cover and abundance of individual plant species have been recorded on ordinal scales for millions of plots world‐wide. Ordinal cover data often need to be transformed to a quantitative form (0%–100%), especially when scrutinising summed cover of multiple species. Traditional approaches to transforming ordinal data often assume that data are symmetrically distributed. However, skewed abundance patterns are ubiquitous in plant community ecology. The questions this paper addresses are (a) how can we estimate transformation values for ordinal data that account for the underlying right‐skewed distribution of plant cover; (b) do different plant groups require different transformations; and (c) how do our transformations compare to other commonly used transformations within the context of exploring the aggregate properties of vegetation?

Location

Global.

Methods

We assigned Braun‐Blanquet cover‐abundance ordinal values to continuous cover observations. We fitted a Bayesian hierarchical beta regression to estimate the predicted mean (PM) cover of each of six plant growth forms within six ordinal classes. We illustrate our method using a case study (2,809 plots containing 95,812 observations), compare the model‐derived estimates to other commonly used transformations and validate our model using an independent dataset (2,227 plots containing 51,497 observations) accessed through the VegBank database.

Results

Our model found that PM estimates differed by growth form and that previous methods overestimated cover, especially of smaller growth forms such as forbs and grasses. Our approach reduced the cumulative compounding of errors and was robust when validated against an independent dataset.

Conclusions

By accounting for the right‐skewed distribution of cover data, our alternate approach for estimating transformation values can be extended to other ordinal scales. A more robust approach to transforming floristic data and aggregating cover estimates can strengthen ecological analyses to support biodiversity conservation and management.
Pharmacokinetics and subjective effects of a novel oral LSD formulation in healthy subjects
Authors: Holze Friederike , Duthaler Urs , Vizeli Patrick , Müller Felix , Borgwardt Stefan , Liechti Matthias E.
Published: March 2019

Aims

The aim of the present study was to characterize the pharmacokinetics and exposure–subjective response relationship of a novel oral solution of lysergic acid diethylamide (LSD) that was developed for clinical use in research and patients.

Method

LSD (100 μg) was administered in 27 healthy subjects using a placebo‐controlled, double‐blind, cross‐over design. Plasma levels of LSD, nor‐LSD, and 2‐oxo‐3‐hydroxy‐LSD (O‐H‐LSD) and subjective drug effects were assessed up to 11.5 hours.

Results

First‐order elimination kinetics were observed for LSD. Geometric mean maximum concentration (Cmax) values (range) of 1.7 (1.0–2.9) ng/mL were reached at a tmax (range) of 1.7 (1.0–3.4) hours after drug administration. The plasma half‐life (t1/2) was 3.6 (2.4–7.3) hours. The AUC∞ was 13 (7.1–28) ng·h/mL. No differences in these pharmacokinetic parameters were found between male and female subjects. Plasma O‐H‐LSD but not nor‐LSD (< 0.01 ng/mL) concentrations could be quantified in all subjects. Geometric mean O‐H‐LSD Cmax values (range) of 0.11 (0.07–0.19) ng/mL were reached at a tmax (range) of 5 (3.2–8) hours. The t1/2 and AUC∞ values of O‐H‐LSD were 5.2 (2.6–21) hours and 1.7 (0.85–4.3) ng·h/mL, respectively. The subjective effects of LSD lasted (mean ± SD) for 8.5 ± 2.0 hours (range: 5.3–12.8 h), and peak effects were reached 2.5 ± 0.6 hours (range 1.6–4.3 h) after drug administration. EC50 values were 1.0 ± 0.5 ng/mL and 1.9 ± 1.0 ng/mL for “good” and “bad” subjective drug effects, respectively.

Conclusion

The present study characterized the pharmacokinetics of LSD and its main metabolite O‐H‐LSD. The subjective effects of LSD were closely associated with changes in plasma concentrations over time.
Conflicting demands on a modern healthcare service: Can Rawlsian justice provide a guiding philosophy for the NHS and other socialized health services?
Authors: Fritz Zoë , Cox Caitríona
Published: March 2019

We explore whether a Rawlsian approach might provide a guiding philosophy for the development of a healthcare system, in particular with regard to resolving tensions between different groups within it. We argue that an approach developed from some of Rawls’ principles – using his ‘veil of ignorance’ and both the ‘difference’ and ‘just savings’ principles which it generates – provides a compelling basis for policy making around certain areas of conflict. We ask what policies might be made if those making them did not know if one was patient, doctor, nurse or manager – in this generation or the next.

We first offer a brief summary of Rawls’ approach and how we intend to extrapolate from it. We examine how this adapted Rawlsian framework could be applied to specific examples of conflict within healthcare; we demonstrate how this framework can be used to develop a healthcare service which is both sustainable (in its training and treatment of staff, and in encouraging research and innovation) and open (to protect the powers and opportunities of those using the health service). We conclude that while Rawls’ approach has previously been rejected as a means to address specific healthcare decisions, an adapted veil of ignorance can be a useful tool for the consideration of how a just health service should be constructed and sustained. Turning the theoretical into the practical (and combining Rawls’ thought experiment with Scanlonian contractarianism), managers, doctors, patients, carers and nurses could come together and debate conflicting issues behind a hypothetical veil.
Research versus practice: The dilemmas of research ethics in the era of learning health‐care systems
Authors: Piasecki Jan , Dranseika Vilius
Published: March 2019

In this article we attempt to answer the question of how the ethical and conceptual framework (ECF) for a learning health‐care system (LHS) affects some of the main controversies in research ethics by addressing five key problems of research ethics: (a) What is the difference between practice and research? (b) What is the relationship between research ethics and clinical ethics? (c) What is the ethical relevance of the principle of clinical equipoise? (d) Does participation in research require a higher standard of informed consent than the practice of medicine? and (e) What ethical principle should take precedence in medicine? These questions allow us to construct two opposite idealized positions on the distinction between research and practice: the integration model and the segregation model of research and practice. We then compare the ECF for an LHS with these two idealized positions. We argue that the ECF for a LHS does not, in fact, solve these problems, but that it is a third, separate position in the relationship between research ethics and clinical ethics. Moreover, we suggest that the ECF for a LHS raises new ethical problems that require additional ethical analysis and justification. Our article contributes to the discussion on the relationship between research ethics and clinical ethics, revealing that although a learning health‐care system may significantly change the landscape of health care, some ethical dilemmas still require resolving on both theoretical and policy‐making levels.