bluuebunny/crossref_metadata_2025 huggingface dataset:
“Dialysis and medical tourism. Investigating patients’ perceptions in Greece”
Authors: Traouda Vasiliki , Mpogiatzidis Panagiotis
Published: June 2021

Purpose

The purpose of this paper is to explore the possibilities and the growth prospects of medical tourism in Greece, while particularly focusing on the dialysis process. Patients with end-stage renal failure have the right to any treatment deemed necessary during their journey to another city or country away from the place where their treatment normally takes place.

Design/methodology/approach

The survey has been conducted among 193 kidney disease patients that underwent extra-renal dialysis in two public and three private artificial kidney units in Thessaloniki. The study population consists of patients with end-stage chronic renal failure (CRF) that undergo dialysis. For the purpose of this study, quantitative research was carried out via a structured and anonymous questionnaire. The design and structure of the study were based upon questionnaires from two relevant questionnaires. The questionnaires were modified appropriately to respond to the subject in question. Finally, for the analysis of the data, the SPSS software has been used.

Findings

One of the most obvious results is that patients on dialysis treatment have limited both the frequency and the duration of their vacation. The 8.3% of patients that did not use to travel increased to 37.8%, whereas only 22.3% continue to travel 2–4 times a year. Patients that keep on going on vacation frequently claim that a break from the daily routine improves their quality of life. Most of the participants (up to 36.3%) claim they feel healthier, while 34.2% stated they experience a normal life when they escape their everyday life and travel far from home. The 69.9% claim that Greece has the potentials to be a popular medical tourism destination. However, a well-structured and government-financed assistance programme is absent. The processing of data has revealed a positive correlation between age and tourism behaviour. Additionally, according to the research results, younger patients tend to be better informed regarding medical tourism in comparison with older ones.

Social implications

Considering the patients to be potential travellers facilitates the development, realization and promotion of medical tourism.

Originality/value

This study attempts to investigate, for the first time, the tourism behaviour of chronic kidney disease patients. The study highlights a sensitive issue, patients’ right to treatment without geographical or distance-related obstacles.
Determinants of adoption of organic rice production: a case of smallholder farmers in Hai Lang district of Vietnam
Authors: Hoang Hung Gia
Published: June 2021

Purpose

The purpose of this study is to investigate factors that affect smallholders' adoption of organic rice production in the Hai Lang district of Vietnam.

Design/methodology/approach

This study employed a cross-sectional survey research design. A sample size of 215 was drawn from a total of 455 smallholders. Descriptive and inferential statistics, including a binary logistic regression, were used to analyse the data.

Findings

The study concludes that younger female smallholders participating in credit/training programs and community-based organisations, who have a high level of education, a large household size and more experience in rice farming, and who grow mixed crops, have a greater tendency to adopt organic rice production.

Research limitations/implications

A combination of demographic, socio-economic and institutional characteristics of rice smallholders should be considered when promoting organic rice farming practices by smallholders and when choosing organic agricultural development strategies for smallholders in developing countries.

Originality/value

This research provides significant understanding of the determinants of organic rice adoption by smallholder farmers and highlights factors that need to be considered when designing policies to enhance the uptake of organic farming in developing countries.
Managing service innovations at online travel agencies: evidence from China
Authors: Mu Yu , Bossink Bart , Vinig Tsvi , You Suchuan
Published: June 2021

Purpose

Research on service innovation management of online travel agencies (OTAs) remains relatively scarce. This study aims to illuminate the detailed components of managing service innovations at OTAs.

Design/methodology/approach

An in-depth case study is conducted at Trip, the largest OTA in China. A coherent framework of managing service innovations at OTAs is proposed through refining an existing framework from new service development (NSD), and concerning the success factors of service innovation. Based on theoretical synthesis and empirical analysis, the NSD framework is adapted, restructured and refined for service innovation management at OTAs.

Findings

The proposed framework contains three facets and associated managerial elements: (1) resources, including stakeholders, technologies and systems; (2) contexts, including innovation strategy, structure and culture; and (3) ideation, including idea generation and idea application. Different success factors are attached to the managerial elements. The facets, managerial elements and success factors serve as the components in the framework.

Research limitations/implications

This study provides academia with an analytical framework to understand and interpret service innovation management at OTAs, which can be used as a point of departure for future research.

Practical implications

The analytical framework inspires OTA managers to adopt a structured approach in service innovation management, and policymakers to design related interventions.

Originality/value

This study offers a first step toward the investigation of service innovation management at OTAs, specifically in China. The proposed framework is potentially applicable to other industries.
Experiential examination of higher education partnerships in the UK: a knowledge management perspective
Authors: Elezi Enis , Bamber Christopher
Published: June 2021

Purpose

Higher education institutions possess a plethora of knowledge at the institutional, departmental and individual levels. Therefore, knowledge management plays a vital role in assisting partnerships to synergise knowledge and strengthen market competitiveness when working collaboratively. The purpose of this study is to identify and critically discuss the role of knowledge management concepts that support development of UK higher education partnerships. This knowledge management research was undertaken with the purpose of exploring components of behavioural constructs in assisting the development of successful partnerships between higher education institutions.

Design/methodology/approach

This research embraces a qualitative methodology and makes use of an expert panel method to gather field data and assess the relevance, robustness and applicability of a conceptual model developed in the context of higher education partnerships. Guided by two research questions, the researchers elicited knowledge from eight experts, academics and practitioners, who had initiated and led partnership development between UK higher education institutions. The experts were invited and selected to attend the panel using the criteria of “Years of Experience in the Higher Education sector”, “Job Positions and Experiences” and the “Partnership Scope and Impact”.

Findings

Depicting in a tree analogy, the conceptual model indicates that effective knowledge management will require higher education executives, managers and practitioners to centre on nurturing “tree roots” presented as behavioural knowledge management constructs and include institutional culture, trust, absorptive capacities and communication channels. The research findings elaborate on previous research and provide a categorisation of partnership outcomes between higher education institutions, explaining that partnership outcomes can be of an “Academic”, “Marketing and Finance” or “Managerial” nature. Importantly, practical use of the model could be implemented using audit methods or benchmarking methods, whereby the categorised elements of the model are used as a criterion of assessment for audit teams.

Originality/value

The conclusion extracted experiential insights to provide guidance as to how higher education executives, managers and practitioners can make use of knowledge management behavioural constructs and activities to assist collaborative undertakings in the higher education sector. This paper provided a new, modified, knowledge management higher education partnership tree, thus giving researchers and academic practitioners a holistic viewpoint of important partnership knowledge management factors.
Personal-loyalty and pricing benefits from hairstylist-client commercial friendship
Authors: Pamacheche Rukudzo , Duh Helen Inseng
Published: June 2021

Purpose

Hairstyling entrepreneurs are experiencing increasing customer demand alongside the market competition. Building commercial friendships are one of their strategies to beat the competition. However, the marketing benefits in terms of loyalty and pricing from this strategy are unknown. Following suggestions from the relationship marketing theory (RMT) that business benefits are gained from commercial friendships, this study aims to use ideas from RMT and those from models proposed by Bove and Johnson (2002) and Han et al. (2008) to examine the impact of hairstylist-client commercial friendship on four dimensions of personal loyalty to individual hairstylists and clients’ willingness to pay a premium price (WTPP).

Design/methodology/approach

Quantitative methods were used to collect and analyse data obtained from 562 hairstylists’ clients who had maintained the same hairstylist for 10 months in Johannesburg metropolis. Structural equation modelling using SmartPLS was used to test a conceptual model with eight hypotheses.

Findings

The results revealed that commercial friendship positively impacted affective, intention and behavioural personal loyalty dimensions and explained 49%, 47.9% and 46.9% of the variances, respectively. Of the four dimensions of personal loyalty, only behavioural loyalty positively influenced WTPP.

Originality/value

Unlike previous studies’ main focus on business-to-customer relationships and loyalty from a unidimensional perspective, this study contributes by revealing four dimensions of personal loyalty applicable in the haircare service sector. The findings confirm the business benefits suggested by the RMT, by showing that commercial friendship generates clients’ WTPP when they are behaviourally loyal. This guarantees profits and highlights the importance of nurturing close relationships in personal services.
Twitter content analysis of the Australian bushfires disaster 2019-2020: futures implications
Authors: Willson Gregory , Wilk Violetta , Sibson Ruth , Morgan Ashlee
Published: June 2021

Purpose

This paper aims to explore the themes and nature of sentiment of Twitter content that discussed the Australian bushfire disaster 2019–2020 and its associated wildlife devastation, with considerations for the future of Australia’s tourism industry.

Design/methodology/approach

A large, qualitative data set consisting of all publicly available Twitter posts during the period of the Australian bushfires from December 2019 to March 2020 that mentioned the bushfires and wildlife are explored.

Findings

The devastation of wildlife through the Australian bushfire disaster elicited emotionally charged Twitter content from both Australian and overseas users. Positive sentiment focused on offering support to areas impacted by wildlife devastation. Negative sentiment concentrated on linking the Australian bushfires disaster to global discussions surrounding the climate emergency, and a perceived lack of political action.

Originality/value

Despite the intensity of media attention directed towards the Australian bushfires disaster 2019–2020, there has been little scholarly research exploring social media content specifically focused on the wildlife devastation and its association with, and implications for, the tourism industry.
Optimal project portfolio selection with reinvestment strategy considering sustainability in an uncertain environment: a multi-objective optimization approach
Authors: Zarjou Mohammadali , Khalilzadeh Mohammad
Published: June 2021

Purpose

This study aims to develop a model for project portfolio selection considering organizational goals such as budgets, sustainability cash flow and reinvestment strategy under an uncertain environment.

Design/methodology/approach

A multi-objective mathematical programming model is proposed for project selection, which takes the social, environmental and financial aspects into account as the objectives of the project portfolio selection problem. The project evaluation and selection process in one of the large capitals in the Middle East with numerous urban construction projects was considered as a real case study, in which the subjects of environmental and social sustainability are of great importance. Then, the most significant criteria for project evaluation and selection based on sustainability were identified and ranked using the fuzzy best-worst method (BWM).

Findings

The criterion of “defining clear and real objectives” was ranked first, “project investment return period” was ranked second, “minimum changes in the predicted range” was ranked third, and the other ten sustainability indicators were ranked as well. Next, the presented mathematical programming model was solved using the augmented e-constraint method. The sensitivity analysis indicated that increasing the amount of investments in projects would increase their net present value. Also, increased investment had no effect on sustainability, while decreased investment caused sustainability to not being optimal.

Originality/value

This study focuses on the impact of the amount of investments on projects, and the associated costs of sustainable projects. Further to the authors' knowledge, there has been no relevant study taking uncertainty into account. Also, very few studies proposed a mathematical programming model for the project portfolio selection problem. Moreover, this research uses the brainstorming and Delphi method to identify the sustainability indicators influencing the organization and screens the evaluation indicators. Furthermore, the weights of the evaluation indicators are determined using the fuzzy BWM based on the consistency of opinions.
On facing one's students: The relevance of Emmanuel Levinas to teaching in times of Covid-19
Authors: Berenpas Martine
Published: June 2021

In this article I show the relevance of Emmanuel Levinas’ notion of primordial teaching for understanding why online teaching cannot adequately mimic face-to-face teaching. I will argue that the current Covid-19 pandemic shows us that being in the immediacy of the embodied presence of one's students is intimately intertwined with being responsive to the needs of students, which highlights that teaching is not only the transmission of intellectual knowledge and skills but first and foremost an ethical attunement to the suffering of the Other. Levinas argues that teaching is in its essence a relation between unique individuals; a uniqueness that originates in the individual's unconditional responsibility to each and every other human being. This unconditional responsibility is for Levinas the non-mediated embodied sensitivity to the needs of the Other; an openness that precedes freedom and the conscious choice of a person. In this article I claim this embodied sensitivity is jeopardised in online education, which makes it harder for the teacher to attune to the needs of every student. The risk we run is that the face of the Other remains ‘plastic’, which makes it more difficult for the teacher to attune to the specific needs of students. I will argue that online teaching should not only concentrate on enabling the transmission of knowledge but should also invest in creating an environment of intimacy that enables responsiveness and genuine contact.
Epidemiology of pregnant patients with major trauma in Victoria
Authors: Sato Nobuhiro , Cameron Peter , Thomson Benjamin NJ , Read David , McLellan Susan , Woodward Anthony , Beck Ben
Published: June 2021

Objective

Trauma is one of the most common contributors to maternal and foetal morbidity and mortality. The aim of the present study was to describe the characteristics and outcomes of major trauma in pregnant patients using a population‐based registry.

Methods

Registry‐based study using data from the Victorian State Trauma Registry (VSTR), a population‐based database of all hospitalised major trauma (death due to injury, Injury Severity Score [ISS] ≥12, admission to an intensive care unit [ICU] for more than 24 h and requiring mechanical ventilation for at least part of their ICU stay or urgent surgery) in Victoria, Australia, from 1 July 2007 to 30 June 2019. Pregnant patients with major trauma were identified on the VSTR. We summarised patient data using descriptive statistics.

Results

Over the 12‐year study period, there were 63 pregnant major trauma patients. Fifty‐two (82.5%) patients sustained injuries resulting from road transport collisions. The maternal survival rate was 98.4% and the foetal survival rate was 88.9%. Thoracic injury was the most common injury (25/63), followed by abdominal injury (23/63). Eighty‐six percent of the third trimester patients (19/22) were transported directly to a major trauma service with capacity for definitive care of the pregnancy.

Conclusion

The present study demonstrated road transport injury was the most common mechanism of injury and both maternal survival rates and foetal survival rates were high. This information is essential for trauma care system planning and public health initiatives to improve the clinical management and outcomes of pregnant women with major trauma.
Aloe‐emodin‐mediated antimicrobial photodynamic therapy against dermatophytosis caused by Trichophyton rubrum
Authors: Ma Wenpeng , Zhang Miaomiao , Cui Zixin , Wang Xiaopeng , Niu Xinwu , Zhu Yanyan , Yao Zhihong , Ye Feng , Geng Songmei , Liu Chengcheng
Published: June 2021

Trichophyton rubrum is responsible for the majority of dermatophytosis. Current systemic and topical antifungals against dermatophytosis are often tedious and sometimes unsatisfactory. Antimicrobial photodynamic therapy (aPDT) is a non‐invasive alternative suitable for the treatment of superficial fungal infections. This work investigated the photodynamic inactivation efficacy and effects of aloe‐emodin (AE), a natural photosensitizer (PS) against T. rubrum microconidia in vitro, and evaluated the treatment effects of AE‐mediated aPDT for T. rubrum‐caused tinea corporis in vivo and tinea unguium ex vivo. The photodynamic antimicrobial efficacy of AE on T. rubrum microconidia was evaluated by MTT assay. The inhibition effect of AE‐mediated aPDT on growth of T. rubrum was studied. Intracellular location of AE, damage induced by AE‐mediated aPDT on cellular structure and surface of microconidia and generation of intracellular ROS were investigated by microscopy and flow cytometry. The therapeutic effects of AE‐mediated aPDT against dermatophytosis were assessed in T. rubrum‐caused tinea corporis guinea pig model and tinea unguium ex vivo model. AE‐mediated aPDT effectively inactivated T. rubrum microconidia in a light energy dose‐dependent manner and exhibited strong inhibitory effect on growth of T. rubrum. Microscope images indicated that AE is mainly targeted to the organelles and caused damage to the cytoplasm of microconidia after irradiation through generation of abundant intracellular ROS. AE‐mediated aPDT demonstrated effective therapeutic effects for T. rubrum‐caused tinea corporis on guinea pig model and tinea unguium in ex vivo model. The results obtained suggest that AE is a potential PS for the photodynamic treatment of dermatophytosis caused by T. rubrum, but its permeability in skin and nails needs to be improved.
Development and validation of tumor‐to‐blood based nomograms for preoperative prediction of lymph node metastasis in lung cancer
Authors: Fu Yili , Xi Xiaoying , Tang Yanhua , Li Xin , Ye Xin , Hu Bin , Liu Yi
Published: June 2021

Background

To develop and validate tumor‐to‐blood based nomograms for preoperative prediction of lymph node (LN) metastasis in patients with lung cancer (LC).

Methods

A prediction model was developed in a primary cohort comprising 330 LN stations from patients with pathologically confirmed LC, these data having been gathered from January 2016 to June 2019. Tumor‐to‐blood variables of LNs were calculated from positron emission tomography‐computed tomography (PET‐CT) images of LC and the short axis diameters of LNs were measured on CT images. Tumor‐to‐blood variables, number of stations suspected of harboring LN metastasis according to PET, and independent clinicopathological risk factors were included in the final nomograms. After being internally validated, the nomograms were used to assess an independent validation cohort containing 101 consecutive LN stations accumulated from July 2019 to March 2020.

Results

Four tumor‐to‐blood variables (left atrium, inferior vena cava, liver, and aortic arch) and the maximum standardized uptake value (SUVmax) for LNs were found to be significantly associated with LN status (p < 0.001 for both primary and validation cohorts). Five predictive nomograms were built. Of these, one with LN SUVmax/left atrium SUVmax was found to be optimal for predicting LN status with AUC 0.830 (95% confidence interval [CI]: 0.774–0.886) in the primary cohort and AUC 0.865 (95% CI: 0.782–0.948) in the validation cohort. All models showed good discrimination, with a modest C‐index, and good calibration in both primary and validation cohorts.

Conclusions

We have developed tumor‐to‐blood based nomograms that incorporate identified clinicopathological risk factors and facilitate preoperative prediction of LN metastasis in LC patients.
Sleep and substance use disorder treatment: A preliminary study of subjective and objective assessment of sleep during an intensive outpatient program
Authors: Wilkerson Allison K. , Simmons Richard O. , Sahlem Gregory L. , Taylor Daniel J. , Smith Joshua P. , Book Sarah W. , McRae‐Clark Aimee L.
Published: June 2021

Background and Objectives

Characteristics of sleep concerns and their relationship to mental health in heterogeneous substance use disorder (SUD) treatment settings are not well understood. The purpose of this preliminary study was to assess sleep using subjective and objective measures at two time points during SUD treatment and compare sleep changes to changes in mental health measures.

Methods

Treatment‐seeking participants completed an assessment battery at the beginning of treatment (Time 1, N = 30) and again upon treatment completion (Time 2, approximately 4 weeks later, N = 22). The majority of participants were White (80%), male (63%), and presenting for alcohol use disorder (60.0%), though almost half reported polysubstance abuse (43%). Comorbidity was common (53%). Sleep and mental health questionnaires with 1 week of actigraphy and sleep diaries were completed at both time points.

Results

Most participants met the criteria for a sleep disorder and mean scores on questionnaires showed poor sleep quality, insomnia symptoms, and frequent nightmares, with sleep quality and insomnia improving over time but remaining clinically significant. Nightmares did not improve. Actigraphy indicated poor sleep at both time points. Improvement in insomnia was related to improvement in measures of mental health while changes in actigraphy variables were not related to these measures.

Discussion and Conclusions

Multiple types of sleep disturbance are prevalent in this population, with nightmares persisting throughout treatment and insomnia symptoms showing a relationship with mental health symptoms.

Scientific Significance

This was the first study to longitudinally assess mental health with subjective and objective measures of sleep across multiple types of SUDs in a community SUD treatment setting.
Ideological Asymmetries and the Determinants of Politically Motivated Reasoning
Authors: Guay Brian , Johnston Christopher D.
Published: June 2021

A large literature demonstrates that conservatives have greater needs for certainty than liberals. This suggests an asymmetry hypothesis: Conservatives are less open to new information that conflicts with their political identity and, in turn, political accountability will be lower on the right than the left. However, recent work suggests that liberals and conservatives are equally prone to politically motivated reasoning (PMR). The present article confronts this puzzle. First, we identify significant limitations of extant studies evaluating the asymmetry hypothesis and deploy two national survey experiments to address them. Second, we provide the first direct test of the key theoretical claim underpinning the asymmetry hypothesis: epistemic needs for certainty promote PMR. We find little evidence for the asymmetry hypothesis. Importantly, however, we also find no evidence that epistemic needs promote PMR. That is, although conservatives report greater needs for certainty than liberals, these needs are not a major source of political bias.
Systematic review with meta‐analysis: the long‐term efficacy of Barrett's endoscopic therapy—stringent selection criteria and a proposal for definitions
Authors: Desai Madhav , Rösch Thomas , Sundaram Suneha , Chandrasekar Viveksandeep Thoguluva , Kohli Divyanshoo , Spadaccini Marco , Hassan Cesare , Repici Alessandro , Sharma Prateek
Published: June 2021

Background

Barrett's endoscopic therapy (BET) is well established for neoplasia in Barrett's oesophagus using a concept of complete eradication of all Barrett's. However, long‐term efficacy is not known.

Aims

To perform a systematic review and meta‐analysis to examine long‐term efficacy of BET for Barrett's neoplasia.

Methods

Electronic databases were searched for studies meeting stringent criteria: (a) subjects with high‐grade dysplasia and/or superficial adenocarcinoma who underwent BET (ablation ± endoscopic mucosal resection); (b) BET completion by confirmation of complete eradication of neoplasia (CE‐N) and intestinal metaplasia (CE‐IM) with systematic sampling and (c) clearly defined follow‐up (endoscopy and biopsy) protocol of ≥2 years thereafter for detection of recurrence. Pooled estimates of CE‐N and CE‐IM after BET completion and follow‐up were analysed.

Results

Eight studies met the stringent criteria (n = 794, males 89%, age 64.6 years). Despite high efficacy of BET at therapy completion (CE‐N: 95.9 [91.7‐98.7]%; CE‐IM: 90.9 [83‐96.6]%), this declined (CE‐N: 89 [73.4‐98.2]%; CE‐IM: 77.8 [65.6‐88]%) over 3.4 years of follow‐up. There was considerable heterogeneity. Only two studies reported a post‐BET follow‐up of >5 years (CE‐IM 50 [41.5%‐58.5]%). Higher person years of follow‐up seem to correlate with decrease in BET efficacy.

Conclusion

Using stringent criteria for appropriate study selection with sufficient follow‐up, a lack of high‐quality controlled intervention trials becomes evident for assessment of long‐term durable remission rates of BET despite initial high success rates. We plea for a uniform documentation of study details which could be used in future trials.
Wildfire risk and response in Jasper National Park, Alberta: Application of an adaptation readiness framework
Authors: Halabut Rechelle , Birchall S. Jeff
Published: June 2021

Environmental change associated with warmer temperatures is creating unprecedented conditions in natural regions and ecosystems. In Jasper National Park, Alberta, climate change, historical fire management practices, and the mountain pine beetle infestation are combining to increase the risk of a major wildfire. The intent of this short viewpoint is to provide a primer for decision makers. The application of an adaptation readiness framework highlights areas where the Park's level of preparedness for wildfire adaptation is well developed and areas in need of further attention. Areas where adaptation is well developed include political leadership, decision making, and stakeholder engagement. Further attention is necessary around institutional organizations, funding, and public support.
The dynamic effects of preoperative intravenous iron in anaemic patients undergoing surgery for colorectal cancer
Authors: Bojesen Rasmus Dahlin , Eriksen Jens Ravn , Vogelsang Rasmus Peuliche , Grube Camilla , Forman Julie Lyng , Gogenür Ismail
Published: June 2021

Aim

The aim of this study was to describe the dynamic changes in blood work following individual adjusted dosage of intravenously administered iron(III) isomaltoside in a 4‐week period prior to surgery in patients with colorectal cancer.

Methods

This was a single‐centre, observational cohort study with prospectively collected data, including patients with colorectal cancer receiving preoperative treatment with iron(III) isomaltoside. Blood samples were taken at baseline, 1 week, 2 weeks and 4 weeks after initial treatment. Sixty‐two patients were included in the study.

Results

Sixty‐two patients were included for final analysis. The mean increase in haemoglobin was 0.77 g/dl (95% CI 0.52–1.03 g/dl, P < 0.0001) at week 1, 1.5 g/dl (95% CI 1.21–1.80 g/dl, P < 0.0001) at week 2 and 2.13 g/dl (95% CI 1.71–2.55 g/dl, P < 0.0001) at week 4. Patients with severe anaemia (<9.02 g/dl) showed the largest increase in haemoglobin during the treatment course (2.92 g/dl, 95% CI 2.27–3.58 g/dl, P < 0.0001). Patients with mild anaemia (>10.31 g/dl) did not show a significant increase (0.66 g/dl, 95% CI −0.29–1.61 g/dl, P = 0.17). The mean of transferrin saturation after 4 weeks was 8% (95% CI 6%–10%, P < 0.0001).

Conclusions

After intravenously administered iron, patients with severe anaemia had the most substantial increase in haemoglobin, and the increase was largest after 4 weeks. Patients with mild anaemia did not have an increase in haemoglobin during the treatment course. The vast majority of patients still had iron deficiency at surgery 4 weeks after the initial treatment.
Longitudinal variance of Donor‐Derived Cell‐Free DNA (dd‐cfDNA) in Stable Kidney Transplant (KTx) patients are influenced by donor/recipient variables
Authors: Anand Sanjiv , Lopez‐Verdugo Fidel , Sanchez‐Garcia Jorge , Dong Li , Fife Megan , Krong Jake , Morris Donald , Srinivas Titte R.
Published: June 2021

Background

The longitudinal time‐course of dd‐cfDNA after kidney transplant (KTx) is not well‐described. The cut off values of dd‐cfDNA in KTx derive from biopsy‐coupled single measurements. Meaningful interpretation necessitates understanding of: (1) time variance of dd‐cfDNA levels post‐KTx, (2) factors determining biologic variability, and (3) relationship to donor and recipient characteristics. We hypothesized that an understanding of the aforementioned factors would better inform clinical decision‐making using dd‐cfDNA.

Methods

One hundred and twenty five KTx patients with dd‐cfDNA obtained longitudinally were included. Univariate analyses were directed at inter‐patient variability and intra‐patient inter‐occasion variability of dd‐cfDNA. Multivariate linear regression was used in analyses accounting for repeat measures.

Results

At 1‐month post KTx median dd‐cfDNA: (1) were higher in repeat KTx (.57%, P < .001), and dual KTx (1.10%, P = ns) versus a first KTx (.31%); (2) showed a significant difference in donor after cardiac death (DCD [.45%]) versus living related (LRD [.27%]) donors (P = .036). Longitudinal (1–3 months) dd‐cfDNA measurements showed a significant downtrend for all donor types. Panel‐reactive antibodies (PRA) were positively correlated with dd‐cfDNA.

Conclusions

Repeat Tx, dual Tx, DCD, and PRA are associated with a higher dd‐cfDNA. Incorporation of donor/recipient variables and time down post transplant is material for rational interpretation of dd‐cfDNA.
Differentiating pagetoid Bowen disease from Paget disease on the nipple‐areola complex: Two unique, challenging cases
Authors: Barrutia Leire , Martínez‐García Gerardo , Santamarina‐Albertos Alba , Garabito Solovera Esther Leticia , Volo Víctor , Ruíz‐Sánchez Daniel , Manchado López Pilar
Published: June 2021

Pagetoid Bowen disease is a subtype of Bowen disease that accounts for 5% of Bowen disease. It is extremely rare for Bowen disease to appear on the nipple‐areola complex, with only seven cases described in the previous literature. Of those seven cases, only one was of the pagetoid subtype. We report two cases of pagetoid Bowen disease on this location, one of them being the first case of pagetoid Bowen disease affecting the nipple reported to date. On this location, it is crucial to perform a meticulous differential diagnosis to rule out Paget disease, because of its contrasting therapeutic and prognostic implications. In order to do this, clinical and histopathological aspects must be considered. From a clinical point of view, previous literature has stated that nipple involvement can be a clue that points to Paget disease. However, one of our cases shows that this is not always true. Regarding histopathological analysis, a complete excision of the tumor might be necessary to observe clear features of Bowen disease, such as full‐thickness atypia of the epidermis and intercellular bridges. An immunohistochemical panel comprising carcinoembryonic antigen, gross cystic disease fluid protein, epithelial membrane antigen, p63, CK34betaE12, periodic acid‐Schiff, estrogen receptor, and progesterone receptor can be decisive in complicated cases.
Exploring staff turnover, burnout, and resilience in cytology reference laboratories: A workforce qualitative study
Authors: Chiou Paul Z.
Published: June 2021

Objectives

The aims of the study were to investigate cytology laboratory staff turnover in the context of workplace stressors and burnout and to explore qualities associated with long career tenure, in order to facilitate the development of future workplace intervention programs.

Methods

Using an interpretive qualitative approach, semi‐structured interviews were conducted and analysed using a directed and conventional content analysis. Seven participants who had left large cytology reference laboratories were purposively sampled to interview about their experience of leaving their former laboratories. Conventional content analysis was used to inductively generate themes and deductive content analysis was conducted with categories from the Transactional Model of Stress and Coping (ie, stress appraisal and coping style).

Results

Three main themes were discerned from the interviews: concerns about the cytology workplace, reasons for choosing to leave, and strategies for coping with stress. Demand for productivity was the most commonly cited concern among cytotechnologists, followed by work‐life balance, and musculoskeletal strain related to microscopic screening. The top reason given for people choosing to leave the commercial laboratories was the lack of work‐life balance, and the second was the lack of professional challenges and growth opportunities. Participants with longer job tenure who experienced a promotion described coping with job stress as more optimistic and problem focused.

Conclusions

Opportunities exist within large commercial laboratories for improving the work environment to reduce workplace burnout and turnover.
Immunological features and factors associated with mucocutaneous bullous pemphigoid – a retrospective cohort study
Authors: Ständer Sascha , Schmidt Enno , Zillikens Detlef , Ludwig Ralf J. , Kridin Khalaf
Published: June 2021

Background and objectives

The features of bullous pemphigoid (BP) patients presenting with mucosal lesions are not established. We aimed to elucidate the clinical and immunological features of BP patients with mucosal involvement, and to identify factors associated with mucosal lesions.

Patients and methods

A retrospective study encompassing all consecutive patients diagnosed with BP throughout the years 2009–2019 in a tertiary referral center.

Results

The study encompassed 273 patients with BP, of whom 31 (11.4 %) presented with mucosal lesions. The oral mucosa was the most frequently affected mucosal surface (71.0 %), followed by the genital (25.8 %) and the nasal (22.6 %) mucosae. Relative to other patients with BP, patients with mucosal involvement had a more prominent palmoplantar involvement (67.7 % vs. 37.2 %;P = 0.001); lower seropositivity rate (18.2 % vs. 54.2 %;P = 0.027) and lower levels (29.3 ± 64.5 vs. 129.5 ± 304.4 U/ml;P = 0.016) of anti‐BP230 autoantibodies; and decreased peripheral eosinophil counts (760.0 ± 638.6 vs. 1296.3 ± 1013.7;P < 0.001). Absence of anti‐BP230 autoantibodies (OR, 5.32; 95 % CI, 1.07–26.32;P = 0.026) and lack of peripheral eosinophilia (OR, 4.31; 95 % CI, 1.14–16.39;P = 0.021) were associated with the presence of mucosal involvement in BP.

Conclusions

Mucosal involvement is present in a notable subgroup of patients with BP and is associated with the absence of both anti‐BP230 antibodies and peripheral eosinophilia.
Prognosis of primary teeth following intrusive luxation according to the degree of intrusion: A retrospective cohort study
Authors: e Silva Heloisa Grehs , da Costa Vanessa Polina Pereira , Goettems Marília Leão
Published: June 2021

Background/Aim

The degree of intrusion is an important aspect to be evaluated when treating children following intrusive luxation. The aim of this retrospective cohort study was to evaluate re‐eruption rates and the occurrence of sequelae in intruded primary teeth according to the degree of intrusion.

Material and methods

A total of 238 teeth from 168 patients diagnosed with and treated for intrusion over a 16‐year period at a specialized trauma center in South Brazil were included in this study. Patient details, including demographic characteristics, tooth affected, presence of sequelae of trauma during the follow up (pulp necrosis and infection, crown discoloration and abnormal mobility), and any effects on the permanent successors, were collected from their records. Photographs were analyzed to determine the degree of intrusion (Grade I, II, or III) and spontaneous re‐eruption during follow up. Re‐eruption and occurrence of sequelae according to the degree of intrusion were evaluated using the chi‐squared test. The level of significance was set at 5%.

Results

Most teeth were maxillary central incisors (87.8%) with Grade I intrusion (32.8%). In the first 30 days, 13.1% had signs of re‐eruption. After 3–6 months, the frequency of re‐eruption increased to 58.7%. Of the teeth evaluated 6 months or more after intrusion, 68% had re‐erupted. Total intrusion (Grade III) was associated with pulp necrosis and infection (p = .002), but the degree of intrusion was not associated with the presence of crown discoloration or abnormal mobility. Of the 78 permanent successors evaluated, 52.6% had developmental disturbances.

Conclusion

Most intruded primary teeth re‐erupted spontaneously, and the degree of intrusion was associated with a worse prognosis.
The private mint in economics: evidence from the American gold rushes†
Authors: White Lawrence H.
Published: June 2021

Prominent economists have supposed that the private production of full‐bodied gold or silver coins is inefficient: due to information asymmetry, private coins will be chronically low‐quality or underweight. An examination of private mints during gold rushes in the US in the years 1830–63, drawing on contemporary accounts and numismatic literature, finds otherwise. While some private gold mints produced underweight coins, from incompetence or fraudulent intent, such mints did not last long. Informed by newspapers about the findings of assays, money‐users systematically abandoned substandard coins in favour of full‐weight coins. Only competent and honest mints survived.
Was Krashen right? Forty years later
Authors: Lichtman Karen , VanPatten Bill
Published: June 2021

In the late 1970s and early 1980s, Stephen Krashen developed Monitor Theory—a group of hypotheses explaining second language acquisition with implications for language teaching. As the L2 scholarly community began considering what requirements theories should meet, Monitor Theory was widely criticized and dismissed, along with its teaching implications. What happened to these ideas? We argue that many of them have evolved and are still driving SLA research today—often unacknowledged and under new terminology. In this essay, we focus on three of Krashen's five fundamental hypotheses: The Acquisition‐Learning Distinction, The Natural Order Hypothesis, and The Input Hypothesis. We argue that these ideas persist today as the following constructs: implicit versus explicit learning, ordered development, and a central role for communicatively embedded input in all theories of second language acquisition. We conclude with implications for language teaching, including a focus on comprehensible input and communication in the classroom.
Association between social frailty as well as early physical dysfunction and exercise intolerance among older patients receiving hemodialysis
Authors: Usui Naoto , Yokoyama Minori , Nakata Junichiro , Suzuki Yusuke , Tsubaki Atsuhiro , Kojima Sho , Inatsu Akihito , Hisadome Hideki , Uehata Akimi
Published: June 2021

Background

Recently, social frailty has been increasingly recognized as a factor associated with adverse health outcomes, including physical disability and mortality. However, there are no studies about the importance of this factor among hemodialysis patients. Therefore, we investigated the relationship between social frailty and early physical dysfunction in this group of patients.

Methods

This was a two‐center cross‐sectional study. Older patients receiving hemodialysis were prospectively enrolled. Moreover, participants were evaluated for social frailty based on the definition of previous study and for physical function, peak oxygen uptake (peak VO2), ventilatory equivalent for carbon dioxide (VE/VCO2) slope and heart rate reserve. Then, they were divided into two groups based on the presence of physical frailty.

Results

Data collected from 158 individuals were statistically analyzed. The prevalence rate of social frailty was 59.5%. In the non‐physical frailty group, social frailty was found to be independently associated with reduced gait speed (P = 0.007), leg strength (P = 0.040) and peak VO2 (P = 0.023), but not with hand grip strength (P = 0.36). In the physical frailty group, there was no association between social frailty and physical function. Moreover, in patients without physical and social frailty, physical function was maintained at above accepted threshold levels, whereas peak VO2 (14.1 ± 3.3 mL/kg/min), VE/VCO2 slope (32.3 ± 5.5) and heart rate reserve (50.8% ± 21.7%) were substantially impaired.

Conclusions

Patients receiving hemodialysis can present with social frailty and exercise intolerance with cardiac dysfunction in the early phase, which may contribute to subsequent dysfunction. Geriatr Gerontol Int 2021; 21: 664–669.
No sex‐specific differences in the influence of high air temperatures during early development on nestling mass and fledgling survival in the Southern Pied Babbler (Turdoides bicolor)
Authors: Bourne Amanda R. , Cunningham Susan J. , Nupen Lisa J. , McKechnie Andrew E. , Ridley Amanda R.
Published: June 2021

Sex‐biased mortality in response to environmental adversity during early development occurs in a number of bird species. The three most prominent theories proposed to explain sex‐biased mortality in response to early‐life adversity are that (1) the heterogametic sex (e.g. females in birds), (2) the larger sex (could be male or female depending on species) or (3) the sex with the more costly and complex endocrine system (e.g. males producing higher levels of testosterone) will suffer higher mortality compared with the other sex when exposed to challenging conditions (e.g. suboptimal weather during early development). We tested for sex‐specific differences in the effects of very hot weather on nestling body mass and tarsus length, and survival of fledglings to nutritional independence in the Southern Pied Babbler Turdoides bicolor. The effect of exposure to high air temperatures did not differ by sex but had a consistently negative impact on nestling body mass, nestling tarsus length and fledgling survival, raising concerns about population replacement and the persistence of this species under rapidly advancing climate change.
A bird’s eye view of fibroblast heterogeneity: A pan‐disease, pan‐cancer perspective
Authors: Pradhan Rachana N. , Krishnamurty Akshay T. , Fletcher Anne L. , Turley Shannon J. , Müller Sören
Published: June 2021

Fibroblasts, custodians of tissue architecture and function, are no longer considered a monolithic entity across tissues and disease indications. Recent advances in single‐cell technologies provide an unrestricted, high‐resolution view of fibroblast heterogeneity that exists within and across tissues. In this review, we summarize a compendium of single‐cell transcriptomic studies and provide a comprehensive accounting of fibroblast subsets, many of which have been described to occupy specific niches in tissues at homeostatic and pathologic states. Understanding this heterogeneity is particularly important in the context of cancer, as the diverse cancer‐associated fibroblast (CAF) phenotypes in the tumor microenvironment (TME) are directly impacted by the expression phenotypes of their predecessors. Relationships between these heterogeneous populations often accompany and influence response to therapy in cancer and fibrosis. We further highlight the importance of integrating single‐cell studies to deduce common fibroblast phenotypes across disease states, which will facilitate the identification of common signaling pathways, gene regulatory programs, and cell surface markers that are going to advance drug discovery and targeting.
A Two‐level GREG Estimator for Consistent Estimation in Household Surveys
Authors: Konrad Anne , Burgard Jan Pablo , Münnich Ralf
Published: June 2021

Household surveys provide information on both person‐level and household‐level characteristics. To ensure consistent estimates between both levels, statistical offices often use integrated weights that are equal for all persons within a household and the household itself. However, these integrated weights ignore the individual patterns of the persons, and the heterogeneity within a household is no longer reflected. As an alternative to integrated weighting, we propose a two‐level generalised regression estimator that is capable of both ensuring consistent person and household estimates and allowing for different weights for persons within a household. A Monte Carlo simulation supports the superiority of our two‐level generalised regression estimator compared with integrated weighting.