bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of governance in the health expenditure–health outcomes nexus: insights from West Africa
Authors: Ibukun Cleopatra Oluseye
Published: February 2021

Purpose

Despite the global attempt at achieving goal 3 of the Sustainable Development Goals by improving health outcomes, some countries (West African countries inclusive) still do not spend a significant proportion of their income on health and they exhibit health outcomes that are still far below that of developed countries. Besides countries like Nigeria, Chad and Guinea-Bissau are experiencing worsening insecurity and political instability. This study, therefore, examines the effect of health expenditure on three health outcomes in the West African sub-region, while investigating the effect of the quality of governance in this nexus.

Design/methodology/approach

This study conducts an instrumental variable approach (two-stage least squares regression) on a panel of 15 West African countries over the period 2000–2018. This study uses three proxies to measure health outcomes and six measures of the quality of governance were also considered.

Findings

The result of this study shows that all forms of health expenditures significantly influenced health outcomes. That is, there is a negative relationship between health expenditure, infant mortality and under-five mortality, but a positive relationship between health expenditure and life expectancy at birth. Besides, the general effect of the same quantity of public health spending is subject to the quality of governance because countries with a higher quality of governance benefit better from their public health spending.

Originality/value

This study, to the authors' knowledge, is the first empirical attempt to examine the role of governance in the health expenditure-health outcomes nexus in 15 ECOWAS countries, using different measures of health outcomes and governance.
Organizational culture and leadership as antecedents to organizational flexibility: implications for SME competitiveness
Authors: Anning-Dorson Thomas
Published: February 2021

Purpose

This study aims to assess how innovative organizational culture and innovative leadership generate market flexibility for small and medium enterprises (SMEs) in the service sector to enhance their competitiveness. Both organizational culture and leadership are seen as firm-level resources capable of influencing the flexibility of the firm in periods of market turbulence. The study argues that SME service firms must use their internal resources to develop their flexibility capability which is more valuable, rare, inimitable and not substitutable.

Design/methodology/approach

SME service firms from Ghana are used to test the study’s hypotheses through robust standard regression analysis. A sampling frame was developed from an online database of small and medium enterprises operating in the service sector.

Findings

The findings suggest that although organizational culture and leadership may influence a service firm’s competitiveness, it is more viable to use these firm-level resources to create market flexibility capability to amplify the effect. This means, when culture and leadership propel the flexibility drive, the service firm is able to connect, coordinate and synchronize functional units to take advantage of new product and market opportunities. Additionally, market flexibility emanating from organizational culture and leadership wields enough power and resource support to tackle the turbulent market conditions better than firms with less support.

Practical implications

The managerial implication from this study is that firms should use their organizational culture and leadership to create flexible organizations that afford them the opportunity to adapt to the environmental dynamics. If both leadership and culture work together, they are able to create strong market capabilities such as flexibility which determines how well the firm will respond to the competition, customer demand and all other external pressures. It is, therefore, the view of this paper that SMEs should use their organizational culture and leadership to build a market-flexible organization to create a competitive advantage.

Originality/value

This paper shows how internal resources/assets such as culture and leadership generate the needed flexibility to create a competitive advantage for SMEs. This paper explains the two dimensions of Volberda’s flexibility from a firm-level resource perspective and highlights flexibility as a second-order capability whose cultivation and effectiveness are dependent on a firm’s culture and leadership. Evidence of how a firm’s market flexibility is fuelled by organizational leadership and culture is demonstrated. Finally, this paper shows how resource-poor SMEs in emerging African economies can enhance their market competitiveness through internal systems and processes.
Suicide prevention across the UK criminal justice system: an overview of current provision and future directions
Authors: Oliveira Antunes Stefanie , Wainwright Verity , Gredecki Neil
Published: February 2021

Purpose

This paper aims to provide an overview of current suicide prevention across the UK criminal justice system (CJS). It considers shortcomings in current provision and how improvements could be made by drawing on international practice. Recommendations for practice going forward and suggestions for future research are made based on the literature.

Design/methodology/approach

This paper provides an overview of suicide prevention research to date. Relevant literature was identified through a basic journal article search, including terms such as “probation”, “criminal justice system”, “suicide”, “suicide prevention”, “UK” and “suicide theory”.

Findings

This paper highlights opportunities to improve practice based on the current evidence base, making several recommendations and suggestions for practice, including improving multi-agency cooperation through clearer distribution of responsibilities, simplifying data sharing and investing in trauma-focussed suicide training for staff.

Practical implications

This paper considers how research and psychological theory has informed suicide prevention practice in the UK. Limitations and challenges in applying theory to practice are explored, in the context of research with frontline staff who use such policies. This review proposes potential improvements to suicide prevention implementation to reduce suicide across the wider CJS.

Originality/value

This article represents an overview of the existing literature as well as possible future ideas for policy. It is therefore a piece that represents the viewpoint of all involved authors.
Developing business students’ intercultural competence through intercultural virtual collaboration: a task sequence implementation
Authors: Ferreira-Lopes Luana , Elexpuru-Albizuri Iciar , Bezanilla María José
Published: February 2021

Purpose

Allowing for interaction with foreign cultures without the need to travel, intercultural virtual collaboration represents a potential tool to develop business students’ intercultural competence. This study aims to explore students’ perceptions towards the implementation of a research-based task sequence in a project in which undergraduate Business students from Spain collaborated virtually with undergraduate business students from The Netherlands during a semester. More specifically, this paper investigates what intercultural competence indicators were mostly developed by the sequence implemented; how much each task from the sequence in question developed different intercultural competence indicators; and how much students enjoyed participating in each task.

Design/methodology/approach

Data was collected through after-task reflection questionnaires. A quantitative analysis of Likert-type questions was carried out and open-ended responses were used to illustrate findings.

Findings

Results reveal that the task sequence developed different dimensions of students’ intercultural competence and, particularly, fostered a positive attitude towards intercultural relationships, increased students’ cultural knowledge and awareness and equipped students with skills to work in diverse teams. It also showed that as complexity grew along the sequence, the average students’ perception of their intercultural competence development tended to decrease. The majority of students’ very much liked participating in the different tasks.

Originality/value

Designing telecollaborative projects can be very challenging and understanding the learning potential of different pedagogical strategies for virtual collaborative environments can help teachers to take better-informed decisions.
Strategic orientation toward digitalization to improve innovation capability: why knowledge acquisition and exploitation through external embeddedness matter
Authors: Arias-Pérez José , Velez-Ocampo Juan , Cepeda-Cardona Juan
Published: February 2021

Purpose

This study aims to analyze the mediating effect of the open innovation processes of knowledge acquisition and exploitation as external embeddedness strategy on the relationships between strategic orientation toward digitalization and the three dimensions of the innovation capability: client, marketing and technology.

Design/methodology/approach

The research model was tested using a structural equation modeling design based on survey data from a financial and insurance sector multinational enterprise with direct operations in seven emerging countries. This sector is classified as being highly digitalized.

Findings

The results show that strategic orientation toward digitalization has an effect on innovation capability, with a greater impact on the client and technology dimensions than on the marketing dimension. However, the relationships with clients and technology are partially mediated by acquisition, while the one with marketing is mediated by exploitation.

Originality/value

This finding widens the current purpose and theoretical sense of external embeddedness as a type of inter-organizational arrangement key for digitalization in the literature, which is focused on the adaptation of digital technology of the head office to the needs of the subsidiaries and the systems of their local allies. By contrast, the study results show that external embeddedness is key for the multinational to be able, from its global way of creating value through digital technologies, not only to improve operating efficiency, but also to meet costumer experience expectations in each host country and innovate in local commercialization strategies, on account of the knowledge transfer between the multinational and the local players on customer preferences and technology uses in local markets.
Postulation of India-Japan Vedic-Buddhist cross-cultural management cluster: conceptualizing a spiritual philosophy-based explanation for emerging theory
Authors: Ashta Ashok
Published: February 2021

Purpose

Though there is emerging research that induces a postulation for a Vedic–Buddhist (V–B) cultural cluster, good theory development requires not only generalizability but also strong explanation. This paper aims to address the explanation gap to strengthen emerging theory development.

Design/methodology/approach

Religion-derived spiritual philosophy travel is traced from historical origins in India to contemporary Japanese management practice and its underpinning values.

Findings

The enhanced explanation developed in this paper finds a clear trace of spiritual values with roots in India surfacing in contemporary Japanese management as identified in extant cross-cultural management (CCM) literature.

Research limitations/implications

This paper offers important explanation to strengthen emerging theory on the novel idea of a V–B CCM cluster.

Practical implications

The strengthening of explanation for emerging theory adds to the case for modification of the traditional CCM meta-narrative that has positioned India and Japan in separate cultural clusters.

Social implications

Strengthening the postulation of a V–B cultural cluster potentially lubricates foreign investment from Japan to India contributing to achievement of United Nations Sustainable Development Goal no. 17 that pertains to international partnerships. Additionally, the findings raise questions for public policymakers who in modern times occlude religion from the public sphere.

Originality/value

This paper offers novel explanatory perspectives for emerging CCM theory, potentially expanding the spiritual philosophy avenue of management research.
Predicting employee engagement with micro-level corporate social responsibility (CSR) practices in the public accounting firms
Authors: Low Mei Peng , Spong Heath
Published: February 2021

Purpose

This research aims to examines the impact of micro-level corporate social responsibility (CSR) practices on employee engagement within the public accounting firm setting.

Design/methodology/approach

This research uses a quantitative approach with a survey instrument as the data collection tool. A total of 269 complete responses were collected from employees working in the public accounting firms. Micro-level CSR practices were analysed with a hierarchical component model (HCM) in partial least square structural equation modelling (PLS-SEM) to examine the influence of such practices on employee engagement. A predictive performance metric was applied to assess the out-of-sample prediction.

Findings

This study uncovers a positive and significant relationship between micro-level CSR practices and employee engagement. Furthermore, the PLSpredict results indicate that the current model possesses high predictive power with all indicators in the PLS-SEM analysis demonstrating lower root mean squared error (RMSE) values compared to the naïve linear regression model benchmark.

Research limitations/implications

While the methods applied in this analysis are at the frontier of CSR research, the present study has not explored the heterogeneity amongst groups of respondents and size of accounting firms. Sampling weight adjustment for the purposes of representativeness was not used in the current research. These could be the subject of future work in this area.

Practical implications

These research findings shed light on the positive manifestation effect of micro-level CSR practices at firm level as well as individual level. Through micro-level CSR practices, firms can reap the benefits of enhanced employee engagement, which leads to productive workforce while also facilitating increased employees’ intrinsic job satisfaction.

Social implications

Micro-level CSR practices address the needs of the millennium workforce, whereby employees are no longer solely focussed on pay checks as their compensation. Employees are seeking out employers whose CSR practices appeal to their social conscience. Micro-level CSR practices meet the needs of the contemporary workforce yet enable companies to attract and retain skilled employees.

Originality/value

The originality of this research is attributed to the vigorous statistical analysis by the use of HCMs and PLSpredict in PLS-SEM context for the assessment of predictive performance. Also, micro-level CSR practices are conceptualised in HCM for parsimonious purpose.
Spatial patterns of weed dispersal by wintering gulls within and beyond an agricultural landscape
Authors: Martín‐Vélez Víctor , van Leeuwen Casper H. A. , Sánchez Marta I. , Hortas Francisco , Shamoun‐Baranes Judy , Thaxter Chris B. , Lens Luc , Camphuysen Cornelis J. , Green Andy J.
Published: February 2021

Non‐frugivorous waterbirds disperse a wide variety of plants by endozoochory, providing longer‐dispersal distances than other mechanisms. Many waterbirds visit both agricultural and natural landscapes during their daily movements, but potential bird‐mediated dispersal of weed plants within and from agricultural landscapes to other habitats is commonly overlooked. Gulls (Laridae) are expanding in numbers and increasingly exploiting anthropogenic habitats worldwide, with possible growing implications for the spread of weeds. Yet, to date, there are no studies on the spatial distribution of weed dispersal by waterbirds.

We developed a plant dispersal model based on movements of 19 Larus fuscus using ricefields, via GPS telemetry. We combined daily movements with two curves estimating the retention times of plant seeds in their guts: (a) an experimental curve based on retention time in captivity for four weeds with dry fruits known to be dispersed by gulls: Juncus bufonius, Cyperus difformis, Polypogon monspeliensis and the alien Amaranthus retroflexus; (b) a theoretical curve based on the interspecific scaling relationship between body mass and mean retention time.

Median dispersal distances of weed plant seeds by gulls ranged between 690 and 940 m, but maximum distances exceeded 150 km. The theoretical retention time model showed higher median dispersal distances than the experimental retention time model. Spatial patterns of weed deposition were very similar between retention time methods, and most strongly depended on gull movements. Variation between individual gulls had little influence on seed shadows. About 92% of all seeds (>10,000 intact seeds per day) were dispersed within the ricefield area of 370 km2. The remaining 8% of seeds were deposited beyond ricefields into other habitats, 42% of which reached moist environments (other irrigated agriculture, rivers and natural wetlands) presumably suitable for weed establishment.

Synthesis. Gulls can disperse weed plants over long distances across a mosaic of habitats. This implies exchange of weed plant species between human‐dominated and natural areas by waterbirds as dispersal vectors. This spatial study highlights the importance of non‐frugivorous birds for long‐distance plant dispersal, which is generally an overlooked mechanism in studies aiming to predict and manage expansion of weed plants.
Effect of escitalopram on an acetic acid‐induced ulcerative colitis model
Authors: Firouzabadi Negar , Alimoradi Nahid , Najafizadeh Mohammad , Najafizadeh Parvaneh
Published: February 2021

Ulcerative colitis (UC) is a chronic and recurrent gastrointestinal (GI) disorder with an unknown aetiology and pathogenesis. Regarding the effectiveness of antidepressants on UC in animal models of depression and the known anti‐inflammatory effects of escitalopram this study was conducted to evaluate the beneficial effects of escitalopram on an acetic acid‐induced UC model without depression. UC model was induced by intra rectal (i.r.) administration of 4% acetic acid in rats after 24 hours of fasting. Animals were treated with three doses of escitalopram (5, 10 and 20 mg/kg). Prednisolone (4 mg/kg) was used as a reference drug in UC. Histological and oxidative stress markers were measured in all groups. Results showed significant increase in superoxide dismutase (SOD) activity and glutathione (GSH) levels, as well as significant decrease in myeloperoxidase (MPO) activity, malondialdehyde (MDA) levels, macroscopic factors (ulcer surface area, ulcer severity and weight‐to‐colon ratio) and microscopic and histological parameters (severity and extent of inflammation, cryptic destruction and severity of tissue involvement) in escitalopram treated rats (10, 20 mg/kg) compared to the UC group. In conclusion, the results of our study are in support of beneficial anti‐inflammatory and antioxidant effects of escitalopram in UC.
Transient systemic inflammation in adult male mice results in underweight progeny
Authors: Rokade Sushama , Upadhya Manoj , Bhat Dattatray S. , Subhedar Nishikant , Yajnik Chittaranjan S. , Ghose Aurnab , Rath Satyajit , Bal Vineeta
Published: February 2021

Problem

While the testes represent an immune‐privileged organ, there is evidence that systemic inflammation is accompanied by local inflammatory responses. We therefore examined whether transient systemic inflammation caused any inflammatory and functional consequences in murine testes.

Method of Study

Using a single systemic administration of Toll‐like receptor (TLR) agonists [lipopolysaccharide (LPS) or peptidoglycan (PG) or polyinosinic‐polycytidylic acid (polyIC)] in young adult male mice, we assessed testicular immune‐inflammatory landscape and reproductive functionality.

Results

Our findings demonstrated a significant induction of testicular TNF‐α, IL‐1β and IL‐6 transcripts within 24 h of TLR agonist injection. By day 6, these cytokine levels returned to baseline. While there was no change in caudal sperm counts at early time points, eight weeks later, twofold decrease in sperm count and reduced testicular testosterone levels were evident. When these mice were subjected to mating studies, no differences in mating efficiencies or litter sizes were observed compared with controls. Nonetheless, the neonatal weights of progeny from LPS/PG/polyIC‐treated sires were significantly lower than controls. Postnatal weight gain up to three weeks was also slower in the progeny of LPS/polyIC‐treated sires. Placental weights at 17.5 days post‐coitum were significantly lower in females mated to LPS‐ and polyIC‐treated males. Given this likelihood of an epigenetic effect, we found lower testicular levels of histone methyltransferase enzyme, mixed‐lineage leukaemia‐1, in mice given LPS/PG/polyIC 8 weeks earlier.

Conclusion

Exposure to transient systemic inflammation leads to transient local inflammation in the testes, with persistent sperm‐mediated consequences for foetal development.
Skewed inflammation is associated with aberrant interleukin‐37 signaling pathway in atopic dermatitis
Authors: Hou Tianheng , Tsang Miranda Sin‐Man , Chu Ida Miu‐Ting , Kan Lea Ling‐Yu , Hon Kam‐Lun , Leung Ting‐Fan , Lam Christopher Wai‐Kei , Wong Chun‐Kwok
Published: February 2021

Background

Atopic dermatitis (AD) is a severe global burden on physical, physiological, and mental health. The role of IL‐37, a fundamental inhibitor of immunity, in AD was herein explored.

Method

Serum levels of IL‐37 and T helper (Th) 2‐related inflammatory mediators were quantified in subjects with or without AD. The expression of IL‐37 receptors was determined by flow cytometry. Proteomics was employed to explore the serum protein profile and novel biomarkers. In vitro cell model, 3D‐keratinocytes mimicking skin model, and the serum of subjects with or without AD were investigated to verify the proteomic results.

Results

AD patients were found to present with higher levels of total and specific IgE as well as Th2 inflammatory mediators compared with healthy controls (HC). IL‐37 level and its receptor IL18Rɑ expression in AD patients were significantly decreased, together with increased population of eosinophils, indicating that the signaling of IL37/IL18Rɑ was dampened. In addition, proteomic analysis revealed a significantly differential protein profile of AD patients compared with HC. IL‐37 showed the strongest negative correlation with involucrin, a keratinizing epithelia protein. IL‐37 was verified to suppress induced involucrin expression in in vitro skin cell models. AD patients show a significantly higher serum concentration of involucrin compared with HC. Together, our results demonstrated that IL‐37 plays a regulatory role in AD. Its deficiency may lead to the aberrant involucrin expression in AD.

Conclusions

The dysregulation of serum protein and skin disruption in AD is related to the insufficiency of IL‐37 and its attenuated anti‐inflammatory signaling.
Concurrent screen use and cross‐sectional association with lifestyle behaviours and psychosocial health in adolescent females
Authors: Harrington Deirdre M. , Ioannidou Ekaterini , Davies Melanie J. , Edwardson Charlotte L. , Gorely Trish , Rowlands Alex V. , Sherar Lauren B. , Staiano Amanda E.
Published: February 2021

Aim

To describe concurrent screen use and any relationships with lifestyle behaviours and psychosocial health.

Methods

Participants wore an accelerometer for seven days to calculate physical activity sleep and sedentary time. Screen ownership and use and psychosocial variables were self‐reported. Body mass index (BMI) was measured. Relationships were explored using mixed models accounting for school clustering and confounders.

Results

In 816 adolescent females (age: 12.8 SD 0.8 years; 20.4% non‐white European) use of ≥2 screens concurrently was: 59% after school, 65% in evenings, 36% in bed and 68% at weekends. Compared to no screens those using: ≥1 screens at weekends had lower physical activity; ≥2 screens at the weekend or one/two screen at bed had lower weekend moderate‐to‐vigorous physical activity; one screen in the evening had lower moderate‐to‐vigorous physical activity in the after‐school and evening period; ≥1 screens after school had higher BMI; and ≥3 screens at the weekend had higher weekend sedentary time. Compared to no screens those using: 1–3 after‐school screens had shorter weekday sleep; ≥1 screens after‐school had lower time in bed.

Conclusion

Screen use is linked to lower physical activity, higher BMI and less sleep. These results can inform screen use guidelines.
Effects of liraglutide versus sitagliptin on circulating cardiovascular biomarkers, including circulating progenitor cells, in individuals with type 2 diabetes and obesity: Analyses from the LYDIA trial
Authors: Ahmad Ehtasham , Waller Helen L. , Sargeant Jack A. , Webb M'Balu A. , Htike Zin Zin , McCann Gerry P. , Gulsin Gaurav , Khunti Kamlesh , Yates Tom , Henson Joseph , Davies Melanie J. , Webb David R.
Published: February 2021

The mechanisms behind the beneficial cardiovascular effects of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) compared with dipeptidyl peptidase‐4 inhibitors (DPP4is) remain largely unknown, despite both targeting the incretin pathway to improve glycaemic control. In these prespecified secondary analyses of the LYDIA trial, we examined the impact of the GLP‐1RA liraglutide (1.8 mg once‐daily) and the DPP4i sitagliptin (100 mg once‐daily) on circulating cardiovascular biomarkers associated with atherosclerotic risk, including circulating progenitor cells (CPCs). LYDIA was a 26‐week, randomized, active‐comparator trial in 61 adults with type 2 diabetes and obesity (mean ± SD: age 43.8 ± 6.5 years, body mass index 35.3 ± 6.4 kg/m2, HbA1c 7.5% ± 0.83% [58.5 ± 9.1 mmol/mol]). Vascular endothelial growth factor (VEGF) and stromal cell‐derived factor‐1‐alpha (SDF‐1ɑ), both of which are implicated in endothelial function, were higher at 26 weeks with liraglutide therapy compared with sitagliptin (mean between‐group difference [95% CI]: 77.03 [18.29, 135.77] pg/mL, p = .010; and 996.25 [818.85, 1173.64] pg/mL, p < .001, respectively). There were no between‐group differences in CPCs, nitric oxide, C‐reactive protein, interleukin‐6, tumour necrosis factor alpha and advanced glycation end‐products. These analyses suggest a favourable impact of liraglutide on VEGF and SDF‐1ɑ levels compared with sitagliptin. These factors may therefore be implicated in the differential cardiovascular effects observed between these agents in large cardiovascular outcome trials. However, these are secondary analyses from a previous trial and thus hypothesis‐generating. Purposive trials are required to examine these findings further.
Exploratory pilot study of exogenous sustained‐release melatonin on nocturia in Parkinson's disease
Authors: Batla Amit , Simeoni Sara , Uchiyama Tomoyuki , deMin Lorenzo , Baldwin Joanne , Melbourne Charles , Islam Saiful , Bhatia Kailash P. , Pakzad Mahreen , Eriksson Sofia , Panicker Jalesh N.
Published: February 2021

Introduction

Nocturia is one of the commonest non‐motor symptoms in Parkinson's disease (PD). Nocturia has evolved from being understood as a symptom of urological disorders or neurogenic bladder dysfunction to being considered as a form of circadian dysregulation. Exogenous melatonin is known to help circadian function and can be an effective strategy for nocturia in PD.

Methods

In this open‐label, single‐site, exploratory, phase 2 pilot study, adults with PD and nocturia underwent assessments using standardized questionnaires, urodynamics studies and a bladder scan. This was followed by completion of a frequency volume chart (FVC) and 2‐week sleep diary. Sustained‐release melatonin 2 mg was then administered once‐nightly for 6 weeks. A repeat assessment using questionnaires, the FVC and sleep diary was performed whilst on treatment with melatonin. Companion or bed partners filled in sleep questionnaires to assess their sleep during the intervention.

Results

Twenty patients (12 males; mean age 68.2 [SD = 7.8] years; mean PD duration 8.0 [±5.5] years) with PD reporting nocturia were included. Administration of melatonin was associated with a significant reduction in the primary outcome bother related to nocturia measured using the International Consultation on Incontinence Questionnaire Nocturia (ICIQ‐N) (p = 0.01), number of episodes of nocturia per night (p = 0.013) and average urine volume voided at night (p = 0.013). No serious adverse events were reported. No significant improvement was noted in bed partner sleep scores.

Conclusions

In this preliminary open‐label study, administration of sustained‐release melatonin 2 mg was found to be safe for clinical use and was associated with significant improvements in night‐time frequency and nocturnal voided volumes in PD patients.
Crystal structure of the full‐length LysR‐type transcription regulator CbnR in complex with promoter DNA
Authors: Giannopoulou Evdokia‐Anastasia , Senda Miki , Koentjoro Maharani Pertiwi , Adachi Naruhiko , Ogawa Naoto , Senda Toshiya
Published: February 2021

LysR‐type transcription regulators (LTTRs) comprise one of the largest families of transcriptional regulators in bacteria. They are typically homo‐tetrameric proteins and interact with promoter DNA of ~ 50–60 bp. Earlier biochemical studies have suggested that LTTR binding to promoter DNA bends the DNA and, upon inducer binding, the bend angle of the DNA is reduced through a quaternary structure change of the tetrameric LTTR, leading to the activation of transcription. To date, crystal structures of full‐length LTTRs, DNA‐binding domains (DBD) with their target DNAs, and the regulatory domains with and without inducer molecules have been reported. However, these crystal structures have not provided direct evidence of the quaternary structure changes of LTTRs or of the molecular mechanism underlying these changes. Here, we report the first crystal structure of a full‐length LTTR, CbnR, in complex with its promoter DNA. The crystal structure showed that, in the absence of bound inducer molecules, the four DBDs of the tetrameric CbnR interact with the promoter DNA, bending the DNA by ~ 70°. Structural comparison between the DNA‐free and DNA‐bound forms demonstrates that the quaternary structure change of the tetrameric CbnR required for promoter region‐binding arises from relative orientation changes of the three domains in each subunit. The mechanism of the quaternary structure change caused by inducer binding is also discussed based on the present crystal structure, affinity analysis between CbnR and the promoter DNA, and earlier mutational studies on CbnR.

Database

Atomic coordinates and structure factors for the full‐length Cupriavidus necator NH9 CbnR in complex with promoter DNA are available in the Protein Data Bank under the accession code 7D98.
Money, Violence, and the Financialized Self in Michael Haneke's Glaciation Trilogy
Authors: Carter William H.
Published: February 2021

This essay argues that Haneke's Glaciation Trilogy actively engages the mounting financialization of self during the late 1980s and early 1990s. Against the backdrop of Robert Bresson's 1983 film L'argent, which features the relatively new automated teller machine (ATM), the study analyzes the provocative destruction of money scene in Der siebente Kontinent (1989), the pyramid scheme and financial strategy of hedging against risk in Benny's Video (1992), and the violent denouement in a Viennese bank that concludes 71 Fragmente einer Chronologie des Zufalls (1994). While both Bresson and Haneke focus on money, the latter accentuates the increasing financialization of daily life. Drawing on the work of critical finance theorists, this study demonstrates how Haneke explores the ascent of the risk‐managing, financialized self as part of his trenchant critique of violence in the era of financial capitalism.
Expression of lipid transport‐associated genes in lipid‐deprived cancer cells
Authors: Shoaib Naila , Bashir Muniba , Munir Rimsha , Rashid Rida , Zaidi Nousheen
Published: February 2021

Cancer cells are known to significantly alter their lipid profiles in response to changes in extracellular lipid availability. Recent studies have shown that in response to lipid deprivation, cancer cells display significant changes in their cellular lipid homeostasis. These changes have been linked to the modulation of de novo lipid synthesis pathways that are markedly altered under lipid‐deprived growth conditions. However, the effects of such environment on intracellular lipid trafficking—that could also affect cellular lipid homeostasis—have not been widely investigated. The presented work studies the effect of lipid deprivation on expression of genes for lipid transport proteins (LTPs) in cancer cell lines.
Evaluation of thiol/disulphide balance in patients with cutaneous leishmaniasis
Authors: Sebel Yusuf , Aksoy Mustafa , An Isa , Celik Hakim
Published: February 2021

Objective

The aim of this study was to evaluate serum thiol disulphide levels in patients with cutaneous leishmaniasis (CL) compared with a healthy control group and to investigate whether thiol/disulphide balance can be used as a new marker of oxidative stress in CL patients.

Material and Methods

This prospective study included 47 patients diagnosed with CL and 46 healthy individuals without any disease. Native thiol, disulphide and total thiol levels were used in plasma. Disulphide/total thiol, disulphide/native thiol and native thiol/total thiol levels were measured.

Results

Disulphide, native thiol disulphide and total thiol disulphide levels were significantly lower in CL patients compared with the control group. However, there was no statistically significant difference between CL patients and the control group in terms of disulphide/native thiol, disulphide/total thiol and native thiol/total thiol values.

Conclusion

Based on the data in our study, it can be said that the use of thiol/disulphide balance as a new oxidative stress marker in CL patients is not appropriate, but studies with a larger number of patients are needed.
The effect of Clip‐tone® and its smartphone application on optimisation of metered‐dose inhalers inhalation technique
Authors: Wael Waleed , Sanders Mark J. , Hussein Raghda R. S. , Sarhan Rania M. , Ramadan Waleed , Abdelrahim Mohamed E. A.
Published: February 2021

Backgrounds

Although metered‐dose inhalers (pMDI) therapy is convenient and widely prescribed, its use usually results in repetitive inhalation technique errors.

One of the most repetitive errors is inhaling too fast through the pMDI. The present study aimed to evaluate the effect of Clip‐tone® along with smartphone visual feedback application on the subject's inhalation time.

Methods

Two hundred subjects were included in the study. They were randomised into four groups. Group 1 received only verbal counselling; group 2 received verbal counselling with resistance (a modified Clip‐tone® that does not produce whistle attached to their pMDI); group 3 received verbal counselling plus whistle (as audio feedback) from ordinary Clip‐tone® and group 4 received verbal counselling plus audio feedback (whistle) from Clip‐tone® and visual feedback (smartphone application). Inhalation time through the pMDI for each subject was recorded three times and inter and intra‐subjects variations were calculated.

Results

Verbal counselling plus audio feedback and verbal counselling plus audio and visual feedbacks groups had 45/50 (90%) and 37/50 (74%) subjects respectively, having correct inhalation flow (inhaling at between 3 to 7 seconds). Verbal counselling plus audio feedback and verbal counselling plus audio and visual feedbacks groups' inter and intra‐subjects variations were lower than that of verbal counselling and verbal counselling with resistance groups which had 28/50 (52%) and 20/50 (40%) subjects respectively, with inhalation time between 3 and 7 seconds.

Conclusions

Providing audio feedback by the Clip‐tone® along with smartphone visual feedback application maintained the deep and slow inhalation through pMDI much better compared to verbal counselling only. We recommend the patients to take all their inhaled doses using pMDI attached to a training device like Clip‐tone® along with a smartphone visual feedback application for optimisation of the aerosol delivery from the pMDI.
Usefulness of novel Martin/Hopkins and Sampson equations over Friedewald equation in cardiology outpatients: A CVSCORE‐TR substudy
Authors: Dinç Asarcıklı Lale , Kış Mehmet , Güvenç Tolga Sinan , Tosun Veysel , Acar Burak , Avcı Demir Fulya , Naser Abdulrahman , Zoghi Mehdi ,   CVSCORE‐TR investigators
Published: February 2021

Background and aims

The Friedewald equation (LDL‐Cf) is known to produce inaccurate estimations of low‐density lipoprotein cholesterol (LDL‐C) when triglycerides are high (>400 mg/dL) or LDL‐C is low (<70 mg/dL). The Martin/Hopkins (LDL‐Cmh) and Sampson (LDL‐Cs) equations were developed to overcome these limitations, but few data are available to assess whether these equations offer incremental usefulness over LDL‐Cf. Our aim was to understand whether there was any incremental usefulness of novel equations on decisions regarding patient management.

Methods

Four thousand one hundred and ninety‐six cardiology patients who were included in a multicentre registry database were analysed. Each patient was assigned to a cardiovascular risk class using the SCORE (Systematic COronary Risk Evaluation) algorithm, and relevant European guidelines were used to assess LDL‐C targets.

Results

Compared with LDL‐Cmh and LDL‐Cs, LDL‐Cf was able to correctly identify 96.9%‐98.08% of patients as within or outside the LDL‐C target, respectively, and 1.95%‐2.8% of patients were falsely identified as being within the LDL‐C target. Kappa coefficients for agreement between LDL‐Cf vs LDL‐Cmh and LDL‐Cf vs LDL‐Cs were 0.868 and 0.918 (P < .001). For patients not on cholesterol‐lowering drugs, the decision to initiate treatment would be different in 1.2%‐1.8% of cases if LDL‐Cs or LDL‐Cmh were used, respectively. For those already on cholesterol‐lowering drugs, decisions regarding treatment intensification would be different in 1.5%‐2.4% of cases if LDL‐Cs or LDL‐Cmh were used.

Conclusions

In most cardiology outpatients, the Friedewald equation has excellent agreement with the novel Martin/Hopkins and Sampson equations, and treatment decisions should not change in most patients.
A method to screen left ventricular dysfunction through ECG based on convolutional neural network
Authors: Sun Jin‐Yu , Qiu Yue , Guo Hong‐Cheng , Hua Yang , Shao Bo , Qiao Yu‐Cong , Guo Jin , Ding Han‐Lin , Zhang Zhen‐Ye , Miao Ling‐Feng , Wang Ning , Zhang Yu‐Min , Chen Yan , Lu Juan , Dai Min , Zhang Chang‐Ying , Wang Ru‐Xing
Published: February 2021

Objective

This study aims to develop an artificial intelligence‐based method to screen patients with left ventricular ejection fraction (LVEF) of 50% or lesser using electrocardiogram (ECG) data alone.

Methods

Convolutional neural network (CNN) is a class of deep neural networks, which has been widely used in medical image recognition. We collected standard 12‐lead ECG and transthoracic echocardiogram (TTE) data including the LVEF value. Then, we paired the ECG and TTE data from the same individual. For multiple ECG‐TTE pairs from a single individual, only the earliest data pair was included. All the ECG‐TTE pairs were randomly divided into the training, validation, or testing data set in a ratio of 9:1:1 to create or evaluate the CNN model. Finally, we assessed the screening performance by overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value.

Results

We retrospectively enrolled a total of 26 786 ECG‐TTE pairs and randomly divided them into training (n = 21 732), validation (n = 2 530), and testing data set (n = 2 530). In the testing set, the CNN algorithm showed an overall accuracy of 73.9%, sensitivity of 69.2%, specificity of 70.5%, positive predictive value of 70.1%, and negative predictive value of 69.9%.

Conclusion

Our results demonstrate that a well‐trained CNN algorithm may be used as a low‐cost and noninvasive method to identify patients with left ventricular dysfunction.
Multi‐lead cephalic venous access and long‐term performance of high‐voltage leads
Authors: Akhtar Zaki , Harding Idris , Elbatran Ahmed I. , Gonna Hanney , Mannakkara Nilanka N. , Leung Lisa W. M. , Zuberi Zia , Bajpai Abhay , Pearse Simon , Cox Andrew T. , Li Anthony , Jouhra Fadi , Valencia Oswaldo , Chen Zhong , Sohal Manav , Beeton Ian , Gallagher Mark M.
Published: February 2021

Background

Cardiac resynchronization therapy‐defibrillator (CRT‐D) implantation via the cephalic vein is feasible and safe. Recent evidence has suggested a higher implantable cardioverter‐defibrillator (ICD) lead failure in multi‐lead defibrillator therapy via the cephalic route. We evaluated the relationship between CRT‐D implantation via the cephalic and ICD lead failure.

Methods

Data was collected from three CRT‐D implanting centers between October 2008 and September 2017. In total 633 patients were included. Patient and lead characteristics with ICD lead failure were recorded. Comparison of “cephalic” (ICD lead via cephalic) versus “non‐cephalic” (ICD lead via non‐cephalic route) cohorts was performed. Kaplan–Meier survival and a Cox‐regression analysis were applied to assess variables associated with lead failure.

Results

The cephalic and non‐cephalic cohorts were equally male (81.9% vs. 78%; p = .26), similar in age (69.7 ± 11.5 vs. 68.7 ± 11.9; p = .33) and body mass index (BMI) (27.7 ± 5.1 vs. 27.1 ± 5.7; p = .33). Most ICD leads were implanted via the cephalic vein (73.5%) and patients had a mean of 2.9 ± 0.28 leads implanted via this route. The rate of ICD lead failure was low and statistically similar between both groups (0.36%/year vs. 0.13%/year; p = .12). Female gender was more common in the lead failure cohort than non‐failure (55.6% vs. 17.9%, respectively; p = .004) as was hypertension (88.9% vs. 54.2%, respectively, p = .038). On multivariate Cox‐regression, female sex (p = .008; HR, 7.12 [1.7−30.2]), and BMI (p = .047; HR, 1.12 [1.001−1.24]) were significantly associated with ICD lead failure.

Conclusion

CRT‐D implantation via the cephalic route is not significantly associated with premature ICD lead failure. Female gender and BMI are predictors of lead failure.
Competition, Collusion, and Spatial Sales Patterns: Theory and Evidence*
Authors: Hunold Matthias , Hüschelrath Kai , Laitenberger Ulrich , Muthers Johannes
Published: February 2021

This article studies competition in markets with transport costs and capacity constraints. Using a rich micro‐level data set of the cement industry in Germany, we study a cartel breakdown to identify the effect of competition on transport distances. We find that when firms compete, they more often serve more distant customers. Moreover, the transport distance also varies in the ratio of capacity relative to demand, but only if firms compete and not when they coordinate their sales. We provide a theoretical model of spatial competition with capacity constraints that rationalizes the empirical results.
On Multitasking and Job Design in Relational Contracts*
Authors: Ishihara Akifumi
Published: February 2021

We investigate job design problems in relational contracting environments with multitasking and an aggregated and distorted performance measurement. Compared to assigning all the tasks to a single agent, assigning the tasks to multiple agents mitigates misallocation of effort among the tasks but tightens the self‐enforcing constraint. Consequently, task separation is optimal if and only if the discount factor is high. Some tasks may not be assigned to the agents at all under the optimal job design. When the principal provides explicit incentives as well, it may be the case that task bundling is suboptimal for any discount factor.
Intrahospital transport of critically ill patients: A survey of emergency nurses
Authors: Hu Yingli , Shi Donglei , You Lili , Li Wei
Published: February 2021

Background

Despite the frequency of its occurrence, few Chinese studies examined the status of intrahospital transport (IHT) of critically ill emergency room patients.

Aims and objectives

To investigate the current status of IHT of critically ill patients and emergency nurses' perception of IHT across China; explore the perceived associations of written protocols with adverse events during IHT; and compare regional differences in IHT of critically ill patients across China.

Design

A self‐report questionnaire was conducted among the attendees of a large emergency medicine conference in Beijing in May 2015.

Methods

The data, collected through convenience sampling, were analysed using descriptive statistics. Categorical variables were compared using the chi‐squared test.

Results

Of the 528 participants from 142 hospitals whose data were analysed, 19.3% considered all nurses competent enough to perform IHT of critically ill patients without special training, and 7.6% even considered nursing students capable of the task. The absence of written transport protocols was perceived to be significantly associated with the occurrence of adverse events such as oxygen supply depletion and incorrect destination. Hospitals in the western region were less likely to have established written IHT protocols and emergency checklists than those in the eastern region.

Conclusions

Safe IHT of critically ill patients in the emergency department involves enormous challenges. The results of this survey can facilitate a preliminary understanding of the characteristics and current situation of IHT in emergency settings across China.

Relevance to clinical practice

The establishment of standard transport protocols may help reduce the incidence of adverse events.
Case study: An older COVID‐19 patient in a Turkish intensive care unit with prolonged stay
Authors: Kebapcı Ayda , Kütük Kübra , Eker Emine
Published: February 2021

This paper reports the presentation and management of an older female patient who was diagnosed with Coronavirus disease (COVID‐19) and discharged from an intensive care unit (ICU) after prolonged hospitalization. The patient's COVID‐19 test was negative; therefore, she was monitored in the COVID‐19 general clinic with normal levels of oxygen saturation (SpO2). The patient had been taking Plaquenil for rheumatoid arthritis for a long time. Azithromycin was administered first, and then, the treatment continued with favipiravir according to the national treatment protocol in Turkey. On the third day in the COVID‐19 general clinic, she was transferred to the ICU because of decreased saturation levels. Owing to worsening respiratory status and SpO2 <70%, the patient was intubated on the sixth day in the ICU, and every day, she was nursed in a prone position for >16 hours. We believe that the treatment and care activities under qualified and effective nursing care, such as providing appropriate respiratory support at the right time, early initiation and maintenance of anticoagulant therapy, long‐term prone positioning, maintaining sufficient fluid resuscitation, and early commencement of balanced enteral nutrition, contributed to the successful discharge of the patient from the ICU. The patient was finally extubated on the 23rd day. Respiratory support was continued with oxygen administered at 2 lt/min through a nasal canula with SpO2 at 94%. We believe that by combining all these factors, the patient's results improved. She was discharged from the ICU after 25 days without any organ dysfunction. During the 25 days of care in the ICU, infectious disease protection and isolation rules were strictly adhered to, and personal protective equipment was worn.