bluuebunny/crossref_metadata_2025 huggingface dataset:
Licence to operate
Authors: Klemelä Juha
Published: December 2016

Purpose

The Social Return on Investment (SROI) framework has been developed for mapping and measuring social impact. It may be used for legitimating organisations and projects. The framework is often criticised for its overemphasis of the SROI ratio, i.e. the relationship between monetised benefits and costs. This study aims to demonstrate how the SROI method legitimates organisations or projects with multiple other discursive ways besides the SROI ratio. It also discusses the status of these other ways of legitimation in relation to the quantifying and monetising core tendency of SROI.

Design/methodology/approach

The empirical data consist of an SROI guidebook and 12 SROI reports. Their study applies Theo van Leeuwen’s ideas for analysing the discursive legitimation of social practices. The study takes place broadly in the framework of Norman Fairclough’s critical discourse analysis, aided by qualitative content analysis.

Findings

In the analysis, the full spectrum of the van Leeuwenian legitimation means used by SROI – authorisation, rationalisation, moral evaluation and mythopoetical narration – is brought out in the data and the status and social context of the legitimation means are assessed and discussed. It is shown that there is existing potential for broader and more visible use of different legitimation means.

Practical implications

Based on the findings of the study, suggestions for the improvement of SROI reporting by a more balanced explicit use of the multitude of legitimation means are presented.

Originality/value

The study is original both in its subject (the spectrum of legitimation in SROI) and its method (qualitative discursive and contentual analysis of SROI as a legitimating discourse).
User expectancies for green products
Authors: Lin Chen-Ju , Chen Hwang-Yeh
Published: December 2016

Purpose

This study was commissioned by DA-AI Technology Co. Ltd. and used the outcome
expectancy theory from the social cognitive framework and concept of planned behavior to structure an outside-inside user expectancy model. The purpose of this study is to identify the elements that influence internal customers to select green products.

Design/methodology/approach

The model reflected the outside expectancy of users regarding three aspects: perceived benefits, barriers and perceived corresponding value of green products as the stimulus of a user-perceptive process. The trained onsite interviewers collected 438 completed questionnaires focused on the volunteers of Tzu Chi as the main subjects of this study.

Findings

The volunteers emphasized the meaningfulness and superiority of products much more than they emphasized the enterprise image and brand image when they were trying to adopt green products. The volunteers did not express an unwillingness to adopt green products, even if they had to face the complexity of the products and pay an extra learning cost.

Originality/value

The volunteers would decrease the consumption of green products when the price was high and would increase their consumption when their ecological values encouraged them to do so. This consumptive value implies that green product adoption was perceived to enhance the social image, self-assessed value and bodily happiness of the users because their inside expectancies were fulfilled.
Social venture creation and the influence of commercial ventures
Authors: Kachlami Habib
Published: December 2016

Purpose

The purpose of this paper is to understand how social and commercial ventures interact with each other. It investigates how the entry, exit and prevalence of commercial ventures in a given region can influence the creation of social ventures.

Design/methodology/approach

Market failure theory has been used as a framework for analysing the interaction between social and commercial ventures. The results of the theoretical analysis were further empirically examined using a large-scale database covering all 290 municipalities in Sweden from 1990 to 2014 and applying the panel-corrected standard errors method.

Findings

The results of this study, in general, reveal a competition between social and commercial ventures. Its specific results, however, are related to influences that the entry, exit and prevalence of commercial ventures can have on the creation of social ventures. The study’s results reveal that while the entry and prevalence of commercial ventures in a region negatively influence the creation of social ventures, commercial ventures’ exits have a positive influence.

Originality/value

Within social entrepreneurship literature, this is the first study that empirically investigates the influence of commercial ventures’ entry and exit on social venture creation and the second study to investigate the influence of commercial ventures’ prevalence on social venture creation. It is also the first of such studies in the Swedish context. The study is also unique due to the large-scale database it uses.
Trends in hotel pricing
Authors: Castro Conceição , Ferreira Fernanda A. , Ferreira Flávio
Published: December 2016

Purpose

The aim of this paper is to analyze and compare the effect of different hotel characteristics and room attributes on room rates of hotels in the cities of Lisbon and Porto, the capital and second most important city in Portugal.

Design/methodology/approach

Using the hedonic pricing method, hotel characteristics are decomposed and analyzed, giving us the perception of the impact of each hotel attributes on the room rates and the people’s willingness to pay for this. Ordinary least square regression analysis was applied to the hedonic price model to find which variables could explain differences in the hotel room rates in Lisbon and Porto.

Findings

The results suggest that in Lisbon and in Porto, a number of common characteristics have significant effects on consumer willingness to pay for a stay in a hotel as star rating, consumer rating and the room size. In Porto, the existence of a fitness centre and in Lisbon, the distance to the city centre are also attributes that create a premium in room rates.

Practical implications

The knowledge of the most valued characteristics by consumers is an important tool for hotel managers to define a price strategy. Also important is the knowledge of the attributes that provide more added value for consumers as these should be taken into account in new investment decisions.

Originality/value

This study highlights the implications of the way one defines and measures qualitative hotel characteristics in hedonic pricing. Although the hedonic method has been applied in several studies, to our knowledge, in Portugal, there are few studies applied only to hotel room rates, and there are no studies comparing hotel room rates in different Portuguese cities. Moreover, the research highlights the critical role of a proper definition and measurement of the variables in hedonic pricing in general and the hotel star in particular.
What global trends are challenging tourism organizations and destinations today?
Authors: Costa Jorge , Montenegro Mónica , Gomes João
Published: December 2016

Purpose

The main aim of this paper is to introduce the articles of this theme issue and explain the pertinence of the strategic question.

Design/methodology/approach

A brief context for the strategic question is provided, as well as the issue alignment and a content analysis of the articles selected.

Findings

The profile of current and future tourists is changing. Travel consumers now want and expect accurate information to guide their choices, and these are increasingly based on quality, experimentation, willingness to undertake active holidays and to travel to sites with diverse and unique tourism products.

Practical implications

Collectively, the articles in this theme issue provide rich insights on key trends impacting the worldwide tourism industry, as well as suggestions on how to explore the opportunities arising from the highly competitive tourism markets. Proposals on scanning the tourism business environment are also presented and their importance discussed and illustrated.

Originality/value

From various angles of analysis, the final articles for this issue explore the trends and issues affecting the tourism industry, as well as approaches to scan the tourism business environment.
“Everyone was wasted”! Insights from adolescents’ alcohol experience narratives
Authors: Knox Kathy , Schmidtke David James , Dietrich Timo , Rundle-Thiele Sharyn
Published: December 2016

Purpose

This paper aims to examine the socialization of alcohol through a reflective writing task within a social marketing program delivered to adolescents. The aim was to elicit adolescents’ experiences and perceptions of alcohol and investigate cognitions, emotions, attitudes’ and behaviors regarding alcohol.

Design/methodology/approach

This study used a qualitative approach in which 1,214 adolescents aged 14 to 16 years were invited to write a story about an experience that involved alcohol. Data were qualitatively coded, and themes were discerned by an inductive analytic process.

Findings

Adolescents’ perceptions of alcohol were arranged along a continuum from mere description with little analysis to reasoned reflection and cognition. Qualitatively different socializing agents, learning situations, processes and effects of learning were apparent in the narratives. Family roles influenced adolescents’ perceptions and experiences of alcohol.

Research limitations/implications

This study supports the use of narratives and reflective introspection tasks as methods that uncover insights into the socialization of alcohol among adolescents. Findings provide guidance to social marketers and alcohol educators for future program design. By understanding the continuum of developing socializations toward alcohol, social marketers can effectively engage adolescents and design targeted programs involving key social learning variables that shape adolescents’ perceptions and experiences with alcohol.

Originality/value

Narratives provide a research methodology that can bring consumer voice to inform scenarios that can be delivered in future program design.
Like “My Wife and Mother-in-Law”: Mikmak and the need to assign a three-dimensional definition for groups of children-consumers
Authors: Levin David
Published: December 2016

Purpose

This paper aims to set out to demonstrate the need for an integrated model that was titled, after the famous optical illusion (Hill, 1915), “Like My Wife and Mother-in-Law”, addressing three prevalent definitions of consumers’ communities: subculture, neo-tribe and brand community. It shows how it is only the use made of insights gleaned from all three that can faithfully describe the world of local and global meanings found in a computer game-based consumer community of children.

Design/methodology/approach

The analysis relies on a semiotic analysis of this computer game’s contents as well as on information obtained by a way of ethnography performed among group members, 9-11-year-olds. The combination of methods proves appropriate in tackling this model’s complexity, allowing to describe the interaction offered by the game, and the type of conduct attending it, online as well as offline.

Findings

Like the optical illusion where one can see two images in a single picture, this analysis shows that the participant children demonstrate complex, conflictual attitudes to the website’s effort to market subscriptions and products. Despite the game’s high popularity among children, a tension was identified between developers’ intentions and the game’s nature in practice.

Originality/value

Previous works seek to describe the experience of a given consumer community by opting for one of the three definitions. Unlike this approach, the author intends to show how the three-dimensional model offers a richer view of the consumers’ experience. Communicating this view may also prevent marketing misguided approaches when targeting consumer communities, based on a single-dimensional characterization of audiences.
Ecological outsourcing: a pitcher plant benefits from transferring pre‐digestion of prey to a bat mutualist
Authors: Schöner Caroline R. , Schöner Michael G. , Grafe T. Ulmar , Clarke Charles M. , Dombrowski Linda , Tan Moi Chan , Kerth Gerald
Published: December 2016

Mutualisms are interspecific interactions where each of the species involved gains net benefits from the other(s). The exchange of resources and/or services between mutualistic partners often involves tasks that species originally accomplished themselves but which have been taken over by or transferred to the more efficient partner during the evolution of the mutualism. Such ‘ecological outsourcing’ can be seen, for example, in several carnivorous plants that have transferred prey capture and digestion to animal partners. However, the outcome of this transfer and its fitness relevance has rarely been quantified.

Using a digestive mutualism between a carnivorous pitcher plant (Nepenthes hemsleyana) and a bat (Kerivoula hardwickii) as a model, we tested the hypothesis that ecological outsourcing is a profitable strategy for the outsourcing partner. To evaluate the value of this mutualism, we conducted a series of field and glasshouse experiments. We measured the benefits of ecological outsourcing by comparing survival, growth, photosynthesis and nutrient content of N. hemsleyana plants fed with bat faeces to those fed with arthropods. To investigate the costs of such outsourcing processes, we repeated the experiment with the closest relative (Nepenthes rafflesiana) that is not adapted to digest bat faeces.

We found that N. hemsleyana plants fed with faeces had increased survival, growth and photosynthesis compared to plants fed with arthropods only. On average, plants covered 95% of their nitrogen demand from faeces under strong nutrient deprivation. Despite N. rafflesiana's higher arthropod capture rate, faeces covered a large part of this species’ nutrient demand as well, suggesting low costs for outsourcing.

Synthesis. Outsourcing prey capture and digestion to the mutualism partner seems to be a beneficial strategy for N. hemsleyana. It may explain the evolutionary trend of several carnivorous plants to lose their carnivorous traits while increasing their attractiveness to mutualistic partners. On a much broader scale, we propose that ecological outsourcing could be one of the major drivers for the evolution and maintenance of mutualisms.
An ERP Study of Response Inhibition in the Auditory Domain in Children with Fetal Alcohol Spectrum Disorders
Authors: Gerhold Matthew M. , Jacobson Sandra W. , Jacobson Joseph L. , Molteno Christopher D. , Meintjes Ernesta M. , Andrew Colin M.
Published: December 2016

Background

Previous event‐related potential (ERP) studies of response inhibition in children with fetal alcohol spectrum disorder (FASD) have used a visual Go/NoGo task to study the impact of prenatal alcohol exposure on response inhibition. No studies exist using auditory versions of the task; thus, it is unclear how the deficits observed in visual tasks translate into the auditory domain.

Methods

This study examined ERPs using an auditory Go/NoGo paradigm in a sample of 35 school‐age children—18 with heavy prenatal alcohol exposure and 17 normally developing controls.

Results

Alcohol‐exposed children performed as well as controls in terms of inhibiting their responses; however, their reaction times were significantly slower under the Go condition. As in the ERP visual Go/NoGo task previously administered to these children, group differences were seen in early perceptual processing, specifically related to stimulus discrimination, with a decrease in P2 amplitude in the alcohol‐exposed group. The control group exhibited greater N2 amplitude in the NoGo compared to the Go condition while the alcohol‐exposed group did not, suggesting a group difference in the neural substrates underlying conflict monitoring. The alcohol‐exposed group demonstrated longer latency P3 with reduced amplitude, suggesting poorer allocation of attention. The alcohol‐exposed group also exhibited a late positive component (LPC) similar to the one observed in the previous visual ERP study. This LPC may indicate compensatory neurophysiological function related to resetting of attentional control networks in preparation for the next trial. None of the ERP outcomes in this study were related to potential confounders which included cognitive and socioeconomic measures as well as ADHD diagnosis.

Conclusions

The observed ERP group differences point to elements of perceptual and attentional processing likely to be involved in the performance deficits often observed in children with FASD. We also observed changes in ERPs related to conflict monitoring/response inhibition, highlighting fetal alcohol‐related effects on how the brain responds when there is need to identify and respond to environmental cues by switching away from a prepotent motor response to an inhibited state.
Long‐term safety of icatibant treatment of patients with angioedema in real‐world clinical practice
Authors: Zanichelli A. , Maurer M. , Aberer W. , Caballero T. , Longhurst H. J. , Bouillet L. , Fabien V. , Andresen I. ,   the IOS Study Group
Published: December 2016

The Icatibant Outcome Survey (IOS) is an observational study monitoring safety and effectiveness of icatibant in the real‐world setting. We analyzed safety data from 3025 icatibant‐treated attacks in 557 patients (enrolled between July 2009 and February 2015). Icatibant was generally well tolerated. Excluding off‐label use and pregnancy, 438 patients (78.6%) did not report adverse events (AEs). The remaining 119 (21.4%) patients reported 341 AEs, primarily gastrointestinal disorders (19.6%). Of these, 43 AEs in 17 patients (3.1%) were related to icatibant. Serious AEs (SAEs) occurred infrequently. A total of 143 SAEs occurred in 59 (10.6%) patients; only three events (drug inefficacy, gastritis, and reflux esophagitis) in two patients were considered related to icatibant. Notably, no SAEs related to icatibant occurred in patients with cardiovascular disease, nor in those using icatibant at a frequency above label guidelines. Additionally, no major differences were noted in AEs occurring in on‐label vs off‐label icatibant users.
Targeting granulocyte‐macrophage colony‐stimulating factor in epithelial and vascular remodeling in experimental eosinophilic esophagitis
Authors: McNamee E. N. , Biette K. A. , Hammer J. , Harris R. , Miyazawa H. , Lee J. J. , Furuta G. T. , Masterson J. C.
Published: December 2016

Background

Eosinophilic esophagitis (EoE) is a chronic antigen‐mediated clinicopathologic disease of the esophagus characterized by an eosinophil‐predominant inflammatory infiltrate. A clinical hallmark is extensive tissue remodeling including basal zone hyperplasia, fibrosis, and angiogenesis. However, the cellular mechanisms responsible for these processes are not fully defined. We hypothesized that targeting granulocyte‐macrophage colony‐stimulating factor (GM‐CSF; an agonist cytokine linked with eosinophil survival and activation) would be protective in a preclinical model of EoE.

Methods

Eosinophilic esophagitis‐like esophageal inflammation was induced in the L2‐IL5OXA EoE mouse model, and GM‐CSF production was assessed by mRNA and protein analyses. Granulocyte‐macrophage colony‐stimulating factor‐receptor‐alpha expression patterns were examined by flow cytometric and immunofluorescence analysis. L2‐IL5OXA EoE mice were treated with anti‐GM‐CSF neutralizing antibody or isotype control and assessed for histopathological indices of eosinophilia, epithelial hyperplasia, and angiogenesis by immunohistochemistry and RT‐PCR.

Results

Significantly increased levels of esophageal GM‐CSF expression was detected in the L2‐IL5OXA mouse EoE model during active inflammation. Granulocyte‐macrophage colony‐stimulating factor‐receptor‐alpha was predominantly expressed on esophageal eosinophils during EoE, in addition to select cells within the lamina propria. Anti‐GM‐CSF neutralization in L2‐IL5OXA EoE mice resulted in a significant diminution of epithelial eosinophilia in addition to basal cell hyperplasia and vascular remodeling. This treatment response was independent of effects on esophageal eosinophil maturation or activation.

Conclusion

Granulocyte‐macrophage colony‐stimulating factor is a potential therapeutic target to reduce esophageal eosinophilia and remodeling.
Repair of groin hernia under local anaesthesia in secondary health facility
Authors: Olaogun Julius G. , Afolayan Jide M. , Areo Peter O. , Ige Joshua T.
Published: December 2016

Background

Repair of groin hernias is the most commonly performed elective procedure by general surgeons worldwide. The techniques of anaesthesia differ among surgeons and vary from one health facility to another. General anaesthesia is much favoured in spite of the lack of anaesthetists in our setting. We aim to determine the feasibility of groin hernia repair under local anaesthesia (LA) with respect to patients’ morbidity, acceptability and satisfaction.

Method

Ninety‐seven patients with uncomplicated groin hernias treated between July 2012 and June 2015, at the State Specialist Hospital, Ikere‐Ekiti, Nigeria were recruited for the study.

Results

One hundred and five hernias in 97 patients of American Society of Anesthesiologists categories I–III were successfully repaired under LA. Their ages ranged between 16 and 95 years with a median age of 52. There were 91 (93.8%) males and six (6.2%) females, giving a male to female ratio of 15:1. Most hernias were indirect (81.9%) and inguinoscrotal (65.7%) type. Nylon darn and modified Bassini were surgical techniques of repair in 60.9 and 36.2%, respectively. The mean operating time was 51.1 ± 11.2 min. Two patients (1.9%) developed scrotal haematoma while a patient each (1%) developed superficial surgical site infection and scrotal burns. Ninety (92.8%) patients were satisfied with anaesthesia technique. The mean follow‐up was 8.9 ± 4.1 months and there was no recurrence.

Conclusion

Groin hernia repair under LA is safe, feasible with high patient's satisfaction and would be the most ideal technique in our local setting where anaesthetists are not readily available.
Danshen‐Enhanced Cardioprotective Effect of Cardioplegia on Ischemia Reperfusion Injury in a Human‐Induced Pluripotent Stem Cell‐Derived Cardiomyocytes Model
Authors: Wei Wei , Liu Yiwei , Zhang Qiang , Wang Yangming , Zhang Xiaoling , Zhang Hao
Published: December 2016

Myocardial ischemia‐reperfusion (I/R) injury is unavoidable during cardioplegic arrest and open‐heart surgery. Danshen is one of the most popular traditional herbal medicines in China, which has entered the Food and Drug Administration‐approved phase III clinical trial. This study was aimed to develop a human‐induced pluripotent stem cell‐derived cardiomyocytes (hiPSC‐CMs) model to mimic I/R injury and evaluate the cardioprotective effect of regular cardioplegic solution with Danshen. hiPSC‐CMs were cultured with the crystalloid cardioplegic solution (Thomas group) and Thomas solution with 2 or 10 µg/mL Danshen (Thomas plus Danshen groups). The cells under normoxic culture condition served as baseline group. Then, the cells were placed in a modular incubator chamber. After 45 min hypoxia and 3 h reoxygenation, hiPSC‐CMs subjected to hypoxia/reoxygenation resulted in a sharp increase of reactive oxygen species (ROS) content in Thomas group versus baseline group. Compared with the Thomas group, ROS accumulation was significant suppressed in Thomas plus Danshen groups, which might result from elevating the content of glutathione and enhanced activities of superoxide dismutase and glutathione peroxidase. The enhanced L‐type Ca2+ current in hiPSC‐CMs after I/R injury was also significantly decreased by Danshen, and meanwhile intracellular Ca2+ level was reduced and calcium overload was suppressed. Thomas plus Danshen groups also presented less irregular transients and lower apoptosis rates. As a result, Danshen could improve antioxidant and calcium handling in cardiomyocytes during I/R and lead to reduced arrhythmia events and apoptosis rates. hiPSC‐CMs model offered a platform for the future translational study of the cardioplegia.
Assessing Quantile Prediction with Censored Quantile Regression Models
Authors: Li Ruosha , Peng Limin
Published: December 2016

An important goal of censored quantile regression is to provide reliable predictions of survival quantiles, which are often reported in practice to offer robust and comprehensive biomedical summaries. However, formal methods for evaluating and comparing working quantile regression models in terms of their performance in predicting survival quantiles have been lacking, especially when the working models are subject to model mis-specification. In this article, we proposes a sensible and rigorous framework to fill in this gap. We introduce and justify a predictive performance measure defined based on the check loss function. We derive estimators of the proposed predictive performance measure and study their distributional properties and the corresponding inference procedures. More importantly, we develop model comparison procedures that enable thorough evaluations of model predictive performance among nested or non-nested models. Our proposals properly accommodate random censoring to the survival outcome and the realistic complication of model mis-specification, and thus are generally applicable. Extensive simulations and a real data example demonstrate satisfactory performances of the proposed methods in real life settings.
Equal in Poverty, Unequal in Wealth: Ethnic Stratification in Chile, the Mapuche Case
Authors: VALENZUELA MACARENA S. , TORO SERGIO Y. , ROJO‐MENDOZA FÉLIX
Published: December 2016

How does ethnic status affect social stratification in Chile? Despite a rich theoretical debate in the literature on social stratification, there is a shortage of empirical approaches to this phenomenon in Latin America. This research note seeks to bridge the analytical gap by describing the social exclusion of indigenous people in Chile. From a case study in La Araucanía region and using statistical techniques to give equal weightings to indigenous and non‐indigenous groups (specifically Mapuches and non‐Mapuches), we attempt to show that given equal socio‐demographic conditions, the incomes of both groups are similar in the low and middle strata, and differentiated in the higher strata.
Facial dysmorphism is influenced by ethnic background of the patient and of the evaluator
Authors: Lumaka A. , Cosemans N. , Lulebo Mampasi A. , Mubungu G. , Mvuama N. , Lubala T. , Mbuyi‐Musanzayi S. , Breckpot J. , Holvoet M. , de Ravel T. , Van Buggenhout G. , Peeters H. , Donnai D. , Mutesa L. , Verloes A. , Lukusa Tshilobo P. , Devriendt K.
Published: December 2016

The evaluation of facial dysmorphism is a critical step toward reaching a diagnostic. The aim of the present study was to evaluate the ability to interpret facial morphology in African children with intellectual disability (ID). First, 10 experienced clinicians (five from Africa and five from Europe) rated gestalt in 127 African non‐Down Syndrome (non‐DS) patients using either the score 2 for ‘clearly dysmorphic’, 0 for ‘clearly non dysmorphic’ or 1 for ‘uncertain’. The inter‐rater agreement was determined using kappa coefficient. There was only fair agreement between African and European raters (kappa‐coefficient = 0.29). Second, we applied the FDNA Face2Gene solution to assess Down Syndrome (DS) faces. Initially, Face2Gene showed a better recognition rate for DS in Caucasian (80%) compared to African (36.8%). We trained the Face2Gene with a set of African DS and non‐DS photographs. Interestingly, the recognition in African increased to 94.7%. Thus, training improved the sensitivity of Face2Gene. Our data suggest that human based evaluation is influenced by ethnic background of the evaluator. In addition, computer based evaluation indicates that the ethnic of the patient also influences the evaluation and that training may increase the detection specificity for a particular ethnic.
Angiotensin converting enzyme 2 polymorphisms and postexercise hypotension in hypertensive medicated individuals
Authors: Goessler Karla F. , Polito Marcos D. , Mota Gloria de F. , de Oliveira Edilamar M. , Cornelissen Véronique A.
Published: December 2016

The renin‐angiotensin aldosterone system (RAAS) is associated with diverse physiological responses and adaptations to exercise. The angiotensin converting enzyme (ACE) 2 has vasodilatory effects, which might be associated with the blood pressure (BP) responses to acute exercise. The aim of this study was to investigate the role of ACE2 polymorphisms in postexercise hypotension (PEH). Thirty‐four medicated hypertensive (61·3 ± 1·7 years, 76·1 ± 2·7 kg, 160 ± 1·6 cm) men (n = 12) and women (n = 22), participated in a control and a moderate intensity exercise session in a randomized order. After both experimental sessions, they left the laboratory wearing an ambulatory BP device for 24‐h monitoring. ACE2 polymorphisms (Int‐1 and Int‐3) were assessed by polymerase chain reaction. Over the course of 5‐h monitoring, we observed a significant reduction in SBP and DBP following exercise in the AA/AG of the Int‐1 polymorphism (p‐interaction = 0·02 and 0·001, respectively), whereas this could not be found in the individuals homozygous G (p‐interaction = 0·76 and 0·51, respectively). With regard to Int‐3 polymorphism, individuals AA/AG showed a significant reduction in SBP following exercise (p‐interaction <0·0001) but not for DBP (p‐interaction = 0·06) whereas GG individuals showed only a significant reduction in DBP following exercise (p‐interaction = 0·02). Our results suggest that ACE2 polymorphism could affect PEH; however, larger trials are needed to confirm our findings.
Pulmonary hypertension as estimated by Doppler echocardiography in adolescent and adult patients with cystic fibrosis and their relationship with clinical, lung function and sleep findings
Authors: Ziegler Bruna , Perin Christiano , Casarotto Fernanda Cano , Fagondes Simone Chaves , Menna‐Barreto Sérgio Saldanha , Dalcin Paulo de Tarso Roth
Published: December 2016

Background

In cystic fibrosis (CF) patients, end stage of pulmonary disease is characterized by pulmonary hypertension (PH), hypoxemia, decrease in exercise tolerance, and sleep quality.

Objective

To evaluate the association between clinical, lung function, sleep quality, and polysomnographic variables with PH in CF patients aged 16 years or older.

Methods

In a cross‐sectional study, 51 clinically stable CF patients underwent a clinical evaluation, an overnight polysomnography and answered sleep questionnaires (Pittsburgh Sleep Quality Index and Epworth sleepiness scale). Also, CF patients had their pulmonary function, 6‐minute walk test (6MWT) and echocardiography assessed.

Results

Fifty‐one CF patients participated in the study; 47% were female. The mean age was 25.1 ± 8.8 years. Pulmonary artery systolic pressure (PASP) was greater than 35 mm Hg in 11 (27.5%) patients. Variables associated with PASP>35 mm Hg in univariate analysis were Shwachman‐Kulczycki clinical score, forced expiratory volume in 1 second % of predicted, Pseudomonas aeruginosa in sputum culture, at‐rest peripheral capillary oxygen saturation (SpO2), SpO2 at end of 6MWT and time of oxygen desaturation <90% during sleep. These variables were included in the binary logistic regression. The independent variable associated with the PASP > 35 mm Hg was at‐rest SpO2 (OR = 10.8, CI 95% 1.7‐67.3, P = .011). The cuttoff SpO2< 94% had the sensitivity = 7/11 = 64%, specificity = 40/40 = 100%, positive predicted values = 7/7 = 100% and negative predicted values = 40/44 = 91% to the diagnosis of PH.

Conclusion

the present study showed a high rate of PH in adolescent and adult CF patients. At‐rest SpO2 was associated with PH.
Both pharyngeal and esophageal phases of swallowing are associated with recurrent pneumonia in pediatric patients
Authors: Serel Arslan Selen , Demir Numan , Karaduman Aynur Ayşe
Published: December 2016

Introduction

One of the underlying causes of recurrent pneumonia in children is swallowing dysfunction, with aspiration syndrome. Swallowing dysfunction should be considered not only a problem of the oropharyngeal phase but also a problem of the esophageal phase.

Objectives

This study aimed to determine the relationship between findings from a swallowing study and a history of recurrent pneumonia in pediatric patients.

Methods

A videofluroscopic swallowing study of 274 pediatric patients who had swallowing dysfunction was conducted. Information on a history of recurrent pneumonia during a 1‐year period was obtained from hospital files.

Results

The median age of the participants was 33 months (min =10, max = 180), of whom 51.8% were females. In the study, 83.2% of the patients had cerebral palsy, 7.7% had syndromic symptoms, 3.6% had muscular dystrophy, and 5.5% were classified as “other.” During the 1‐year period, 67.9% of the participants had a history of recurrent pneumonia history. Furthermore, 66.4% had oral dysfunction, 32.5% had laryngeal penetration, 46.4% had aspiration, 45.3% had abnormal esophageal body function, and 35.8% had reflux symptoms. There was no correlation between oral dysfunction and recurrent pneumonia (P = .902), but there was a positive correlation between recurrent pneumonia and laryngeal penetration (P < .001, r = .26), aspiration (P < .001, r =.49), abnormal esophageal body function (P = .002, r = .18), and reflux (P < .001, r = .22).

Conclusion

Both pharyngeal swallowing disorders, such as penetration and aspiration, and esophageal disorders and reflux may result in recurrent pneumonia in pediatric patients. Thus, all phases of deglutition should be considered and followed up during swallowing evaluation.
Usefulness of admission red blood cell distribution width as a predictor of severity of acute pulmonary embolism
Authors: Akgedik Recep , Karamanli Harun , Kurt Ali Bekir , Günaydın Zeki Yüksel
Published: December 2016

Background

Previous researches have represented a considerable relation between acute pulmonary embolism (PE) and red blood cell distribution width (RDW). To the authors' knowledge no research has been informed in subjects with PE severity. Pulmonary arterial obstruction index (PAOI) is associated with the severity of acute PE.

Objectives

In our investigation, we purposed to assess the relation between PAOI and RDW and the benefit of these factors in the detection of PE severity.

Methods

We retrospectively investigated the demographic information, probability of clinical scores, laboratory parameters, serum D‐dimer levels, and echocardiographic findings of systolic pulmonary artery pressure (PAP) in Acute PE individuals who were diagnosed by computed tomography of pulmonary arterial angiography. Right ventricular dysfunction (RVD) on CT was assessed by calculating the right ventricular/left ventricular (RV/LV) diameter ratios on transverse (RV/LVtrans).

Results

The information of 131 patients with acute PE and 51 (64.6%) female and 28 (35.4%) male healthy control were evaluated. Acute PE group's RDW values were higher than control subjects (P < .0001). RDW (%) level was remarkable higher in patients with massive PE than in patients with nonmassive PE. There were statistically considerable differences in terms of PAOI and systolic pulmonary arterial pressure (sPAP) between nonmassive and massive PE patients (P < .0001 for all).

Conclusions

PAOI was correlated with PE severity, D‐dimer level, sPAP and clinical probability scores. PAOI was correlated with RDW levels. RDW levels, an inexpensive and easily measurable laboratory factor, were considerable associated with the severity and presence of PE.
Nanograin layer formation at crack initiation region for very‐high‐cycle fatigue of a Ti–6Al–4V alloy
Authors: Su H. , Liu X. , Sun C. , Hong Y.
Published: December 2016

The microstructural features and the fatigue propensities of interior crack initiation region for very‐high‐cycle fatigue (VHCF) of a Ti–6Al–4V alloy were investigated in this paper. Fatigue tests under different stress ratios of R = −1, −0.5, −0.1, 0.1 and 0.5 were conducted by ultrasonic axial cycling. The observations by SEM showed that the crack initiation of VHCF presents a fish‐eye (FiE) morphology containing a rough area (RA), and the FiE and RA are regarded as the characteristic regions for crack initiation of VHCF. Further examinations by TEM revealed that a layer of nanograins exists in the RA for the case of R = −1, while nanograins do not appear in the FiE outside RA for the case of R = −1, and in the RA for the case of R = 0.5, which is explained by the Numerous Cyclic Pressing model. In addition, the estimations of the fatigue propensities for interior crack initiation stage of VHCF indicated that the fatigue life consumed by RA takes a dominant part of the total fatigue life and the related crack propagation rate is rather slow.
Metastatic type A thymoma: morphological and genetic correlation
Authors: Bürger Tobias , Schaefer Inga‐Marie , Küffer Stefan , Bohnenberger Hanibal , Reuter‐Jessen Kirsten , Chan John Kwok‐Cheung , Emmert Alexander , Hinterthaner Marc , Marx Alexander , Ströbel Philipp
Published: December 2016

Aims

The vast majority of type A thymomas are diagnosed in tumour stages 1 or 2, and metastatic cases are exceedingly rare. The histological and genetic features of such metastatic type A thymomas have not been described in detail.

Methods and results

Five metastatic type A thymomas in tumour stage Masaoka IVb that had been reviewed by a panel of expert pathologists were analysed using comparative genomic hybridization (CGH). Cases 1, 2 and 3 showed the prototypical morphology of type A thymomas with mainly solid growth patterns. These cases displayed only very subtle nuclear irregularities and slight nuclear crowding, but no other atypical features. Mitoses were absent. Cases 3 and 4, in contrast, had a distinctly atypical morphology. CGH revealed partially recurrent alterations in four cases (with and without atypical morphology), including gains on chromosome 1q (one case), 17q (two cases), chromosome 19 (three cases) and 22q (one case) and losses on chromosome 17p (two cases) and 22q (one case).

Conclusion

Rare metastatic type A thymomas, both with typical and ‘atypical’ histological features, show partially recurrent genomic alterations that differ from the much more frequent localized and indolent tumours. The fact that these alterations were recurring points to a link between clinical behaviour and molecular features. Our findings may have implications for the management and treatment of such tumours.
NUT midline carcinoma of the larynx: an international series and review of the literature
Authors: Hellquist Henrik , French Christopher A , Bishop Justin A , Coca‐Pelaz Andrés , Propst Evan J , Paiva Correia António , Ngan Bo‐Yee , Grant Ronald , Cipriani Nicole A , Vokes David , Henrique Rui , Pardal Fernando , Vizcaino Jose Ramon , Rinaldo Alessandra , Ferlito Alfio
Published: December 2016

Aims

NUT midline carcinoma (NMC) is a rare undifferentiated and aggressive carcinoma that locates characteristically to the midline of the head and neck, and mediastinum. NMC is characterized by chromosomal rearrangements of the gene NUT, at 15q14. The BRD4 gene on 19q13 is the most common translocation partner forming a fusion oncogene, BRD4–NUT. By the end of 2014, the International NUT Midline Carcinoma Registry had 48 patients treated for NMC. Laryngeal NMC are exceedingly rare, and we report a case series of seven cases.

Methods and results

We searched for cases in files of different hospitals as well as a thorough search of the English language literature. The diagnosis of NMC is made by demonstration of NUT rearrangement either by immunohistochemistry, fluorescence in‐situ hybridization (FISH) or reverse transcription–polymerase chain reaction (RT–PCR). We found three previously published cases, and in this series add four cases of our own.

Conclusions

NMC consists of monomorphic, often discohesive, cells with an epithelioid appearance and distinct nucleoli. The tumours typically show abrupt squamous differentiation. The mean age of the patients was 34 years, hence significantly lower than that for conventional laryngeal carcinoma. All tumours were located in the supraglottis and five patients died of the disease after 3, 7, 8, 9 and 11 months. Laryngeal NMC may be underdiagnosed, and an increased awareness among pathologists is warranted. NMC has characteristic morphological features, and positive immunostaining with the NUT antibody is diagnostic. Its aggressive behaviour demands a very intense treatment strategy and the need for its recognition is emphasized further by new promising treatment strategies.
Tumour budding evaluated in biopsy specimens is a useful predictor of prognosis in patients with cN0 early stage oral squamous cell carcinoma
Authors: Seki Mai , Sano Takaaki , Yokoo Satoshi , Oyama Tetsunari
Published: December 2016

Aims

Oral squamous cell carcinoma (OSCC) prognosis depends upon lymph node metastasis (LNM). We have reported recently that tumour budding is a good predictive factor for LNM in squamous cell carcinoma (SCC) of the tongue and floor of the mouth (FOM). Our aim was to evaluate whether tumour budding is a good prognostic factor in OSCC.

Methods and results

We examined conventional histopathological assessment and a new factor, tumour budding, in 209 cases of OSCC in incisional biopsy specimens. The relationship of tumour budding with LNM and prognosis was studied. The budding score was evaluated using immunostaining for pan‐cytokeratin in all biopsies specimens; the number of budding foci was counted using a ×20 objective lens. Significant factors using univariate analysis (P < 0.05) in association with LNM were the budding score (intermediate or high score ≥3; high score ≥5), tumour grade (2 and 3), tumour depth (≥5 mm), infiltrative pattern (INF), lymphatic invasion and vessel invasion. In multivariate analysis, the budding score, INF and lymphatic invasion were found to be independent risk factors for LNM; in particular, budding score concerning relapse‐free survival was statistically significant among patients with T1/2 stage and cN0 cancer using the Kaplan–Meier method and the log‐rank test.

Conclusions

The assessment of tumour budding is effective in predicting prognosis in cN0 early stage OSCC. In T1/2 stage and cN0 cancer, prophylactic neck dissection to prevent LNM should be considered when the tumour budding score regarding pre‐operative biopsy specimens is intermediate or high.
Inflammation, oxidative stress and apoptosis cascade implications in bisphenol A‐induced liver fibrosis in male rats
Authors: Elswefy Sahar El‐Sayed , Abdallah Fatma Rizk , Atteia Hebatallah Husseini , Wahba Alaa Samir , Hasan Rehab Abdallah
Published: December 2016

Bisphenol A (BPA) is a key monomer in the production of plastics. It has been shown to be hepatotoxic. Inflammation and oxidative stress are closely linked with liver fibrosis, the major contributing factor to hepatic failure. Therefore, the aim of this study was to evaluate the impact of chronic exposure to BPA on the development of hepatic fibrosis in male rats and to determine the cross‐talk between the hepatic cytokine network, oxidative stress and apoptosis. For this purpose, 30 male Wistar albino rats were divided into three equal groups as follows: the first group was given no treatment (normal control group); the second group was given corn oil once daily by oral gavage for 8 weeks (vehicle control group); and the third group received BPA (50 mg/kg body weight/day, p.o.) for 8 weeks. BPA administration induced liver fibrosis as reflected in an increase in serum hepatic enzymes activities, hepatic hydroxyproline content and histopathological changes particularly increased collagen fibre deposition around the portal tract. In addition, there was inflammation (as reflected in increase in interleukin‐1beta ‘IL‐1β’, decrease in interleukin‐10 ‘IL‐10′ serum levels and increase in IL‐1β/IL‐10 ratio), oxidative stress (as reflected in increase in malondialdehyde (MDA) level, reduction in reduced glutathione (GSH) content and inhibition of catalase (CAT) activity) and apoptosis [as reflected in an increase in caspase‐3 level and a decrease in numbers of B‐cell lymphoma 2 (BCL2)‐immunopositive hepatocytes]. Interestingly, BPA had an upregulating effect on an extracellular matrix turnover gene [as reflected in matrix metalloproteinase‐9 (MMP‐9)] and a downregulating effect on its inhibitor gene [as reflected in tissue inhibitor of matrix metalloproteinase‐2 (TIMP‐2)] expression. Thus, the mechanism by which BPA induced liver fibrosis seems to be related to stimulation of the inflammatory response, along with oxidative stress, the apoptotic pathway and activation of extracellular matrix turnover.
Doctors’ use of mobile devices in the clinical setting: a mixed methods study
Authors: Nerminathan Arany , Harrison Amanda , Phelps Megan , Scott Karen M. , Alexander Shirley
Published: December 2016

Background

Mobile device use has become almost ubiquitous in daily life and therefore includes use by doctors in clinical settings. There has been little study as to the patterns of use and impact this has on doctors in the workplace and how negatively or positively it impacts at the point of care.

Aim

To explore how doctors use mobile devices in the clinical setting and understand drivers for use.

Methods

A mixed methods study was used with doctors in a paediatric and adult teaching hospital in 2013. A paper‐based survey examined mobile device usage data by doctors in the clinical setting. Focus groups explored doctors’ reasons for using or refraining from using mobile devices in the clinical setting, and their attitudes about others’ use.

Results

The survey, completed by 109 doctors, showed that 91% owned a smartphone and 88% used their mobile devices frequently in the clinical setting. Trainees were more likely than consultants to use their mobile devices for learning and accessing information related to patient care, as well as for personal communication unrelated to work. Focus group data highlighted a range of factors that influenced doctors to use personal mobile devices in the clinical setting, including convenience for medical photography, and factors that limited use. Distraction in the clinical setting due to use of mobile devices was a key issue. Personal experience and confidence in using mobile devices affected their use, and was guided by role modelling and expectations within a medical team.

Conclusion

Doctors use mobile devices to enhance efficiency in the workplace. In the current environment, doctors are making their own decisions based on balancing the risks and benefits of using mobile devices in the clinical setting. There is a need for guidelines around acceptable and ethical use that is patient‐centred and that respects patient privacy.