bluuebunny/crossref_metadata_2025 huggingface dataset:
A scaling-up strategy supporting the expansion of integrated care: a study protocol
Authors: Grooten Liset , Alexandru Cristina-Adriana , Alhambra-Borrás Tamara , Anderson Stuart , Avolio Francesca , Valia Cotanda Elisa , Gütter Zdenek , Henderson Donna , Kassberg Ann-Charlotte , de Manuel Keenoy Esteban , Lange Marc , Lundgren Lisa , Pavlickova Andrea , Txarramendieta Suarez Jon , Whitehouse Diane , Fullaondo Zabala Ane , Zabala Rementeria Joseba Igor , Vrijhoef Hubertus Johannes Maria
Published: October 2018

Purpose

To ensure that more people will benefit from integrated care initiatives, scaling-up of successful initiatives is the way forward. However, new challenges present themselves as knowledge on how to achieve successful large-scale implementation is scarce. The EU-funded project SCIROCCO uses a step-based scaling-up strategy to explore what to scale-up, and how to scale-up integrated care initiatives by matching the complementary strengths and weaknesses of five European regions involved in integrated care. The purpose of this paper is to describe a multi-method evaluation protocol designed to understand what factors influence the implementation of the SCIROCCO strategy to support the scaling-up of integrated care.

Design/methodology/approach

The first part of the protocol focuses on the assessment of the implementation fidelity of the SCIROCCO step-based strategy. The objective is to gain insight in whether the step-based strategy is implemented as it was designed to explore what works and does not work when implementing the scaling-up strategy. The second part concerns a realist evaluation to examine what it is about the SCIROCCO’s strategy that works for whom, why, how and in which circumstances when scaling-up integrated care.

Findings

The intended study will provide valuable information on the implementation of the scaling-up strategy which will help to explain for what specific reasons the implementation succeeds and will facilitate further improvement of project outcomes.

Originality/value

The expected insights could be useful to guide the development, implementation and evaluation of future scaling-up strategies to advance the change towards more sustainable health and care systems.
The mediating role of supply chain collaboration on the relationship between information technology and innovation
Authors: Jimenez-Jimenez Daniel , Martínez-Costa Micaela , Sanchez Rodriguez Cristobal
Published: October 2018

Purpose

The high level of competition in the globalized business environment forces companies to innovate to remain competitive. Previous literature often cites information technology (IT) and supply chain collaboration as direct contributors to product innovation and IT as a direct enabler of supply chain collaboration. This suggests that IT could have an indirect effect on product innovation through supply chain collaboration, although this relationship has not been addressed yet. This paper aims to analyze empirically the direct impacts of IT and supply chain collaboration on incremental and radical product innovation and the indirect effect of IT on both types of product innovation through supply chain collaboration by using data collected from a sample of 200 manufacturing firms.

Design/methodology/approach

Structural equation modeling was used to check the research hypotheses with a sample of 200 manufacturing companies.

Findings

The results show supply chain collaboration has a positive effect on technological innovation, showing that the collaboration with external agents foster both incremental and radical innovations. Furthermore, results show that IT directly enhances both types of product innovation (incremental and radical) indirectly through supply chain collaboration.

Research limitations/implications

This article supports the pursuit of open innovation that suggests the need to acquire external knowledge to be able to develop innovation projects. The use of tools that facilitate this transmission of knowledge becomes indispensable in environments in which companies must be involved in supply chains in which different external agents intervene and in which collaboration can promote the creation of synergies and superior competitive advantages.

Practical implications

Innovation requires more and more the use of knowledge management practices that capture external information to be used in the creation of new products. In this case, collaboration within a supply chain facilitates incremental and radical innovations. However, to strengthen this transfer of information and the adoption of behaviors that stimulate innovation, the company must use ITs.

Originality/value

This paper focus on the indirect effect of IT on product innovation through the creation of the collaborations with external agents. In spite of the importance of this relation, it has been poorly studied by previous literature. The paper’s greatest interest lies in the fact that ITs not only facilitate the transmission of knowledge but also facilitate other types of behavior among supply chain agents that invite collaboration and generate innovations.
Micro enterprises, self-efficacy and knowledge acquisition: evidence from Greece and Spain
Authors: Duarte Alonso Abel , Kok Seng , Sakellarios Nikolaos , O’Brien Seamus
Published: October 2018

Purpose

The purpose of this exploratory study is to investigate the significance of self-efficacy and knowledge acquisition among micro businesses operating in challenging economic environments. The study uses social cognitive theory (SCT) and the knowledge-based theory of the firm (KBTF), and it proposes a refinement of these theoretical frameworks in the context of the study.

Design/methodology/approach

A case method was chosen, and face-to-face interviews with 14 owners of firms in island and rural regions of Greece and Spain were conducted.

Findings

Content analysis identified the importance of self-efficacy, primarily illustrated by entrepreneurs’ determination and self-motivation, propensity to take risks and ability to anticipate consequences of their actions. Acquisition and accumulation of explicit knowledge, particularly through generational or mentoring processes, and subsequent wealth of tacit knowledge, also emerged as very significant in preparing and guiding entrepreneurs. Various links between the adopted theories and findings emerged, particularly regarding forethought, vicarious learning (SCT) and specialisation in knowledge acquisition (KBTF).

Originality/value

The proposed theoretical refinement based on the SCT and KBTF paradigms allows for a more rigorous, in-depth reflection on the links between cognitive elements present in the participating micro entrepreneurs and knowledge-based attributes on their ability to increase organisational resilience. The study also contributes toward the micro business literature and addresses a knowledge gap, particularly, in that contemporary research has not explored entrepreneurial motivations among small firm entrepreneurs. Finally, the practical implications emerging from the findings provide a platform for various stakeholders (associations, government agencies) to appreciate and support entrepreneurs’ needs, notably, of acquiring, increasing and sharing knowledge.
Knowledge management strategies, intellectual capital, and innovation performance: a comparison between high- and low-tech firms
Authors: Buenechea-Elberdin Marta , Sáenz Josune , Kianto Aino
Published: October 2018

Purpose

This study aims to analyse the complementary role of structural and relational capital (as the outcomes of codification and personalisation knowledge management strategies) in renewal capital and innovation in high- and low-tech companies.

Design/methodology/approach

The primary data, which were collected through a structured questionnaire from 180 Spanish companies, are analysed using structural equation modelling based on partial least squares.

Findings

Overall, the study offers three fundamental findings. First, it demonstrates the outstanding role of renewal capital as an intellectual capital (IC) component; second, it provides a conceptual analysis of the connection between knowledge management strategies and IC; and third, it highlights the necessity of considering the technological level of the firm as a contingency variable affecting the IC–innovation relationship.

Research limitations/implications

The study has three apparent limitations: The sample of firms is restricted to Spanish companies, data concerning the main study variables were collected from only one person at each firm, and not all of the possible components of IC were included in the research model.

Practical implications

Business practitioners can find useful guidelines for making efficient use of knowledge resources when boosting innovation performance, depending on the technological level of their firms.

Originality/value

Although many studies have tried to disentangle the IC–innovation connection, this study is unique, as it considers knowledge management strategies, a novel combination of IC components and the level of technological sophistication in the same analysis.
Home sweet virtual home
Authors: Sihi Debika
Published: October 2018

Purpose

Digital technologies have made it possible for organizations to enhance service delivery and provide consumers a way to experience a product or service before even seeing it in person. Prior work has validated consumer purchase decision-making models like the Engel, Kollat and Blackwell (EKB) model in digital and multi-channel purchase environments. This research aims to explore the various impacts of digital technologies, specifically virtual reality (VR) and augmented reality (AR) features, on the different stages of the EKB model in a high involvement purchase decision context. In addition, the use of such technologies is examined as a competitive advantage for sales agents.

Design/methodology/approach

An in-depth market analysis of VR and AR technologies related to residential real estate is conducted. Then the research questions are analyzed through detailed feedback gathered from 33 prospective home-buyers and realtors in the USA.

Findings

Insights from buyers and sales agents (realtors in the context of this research) suggest that VR and AR technologies can enhance consumer information search and expedite the time consumers spend evaluating purchase alternatives. As these technologies advance in their customization features, they may also increase the conversion between alternative evaluation and purchase, but only if they are realistic and provide high quality experiences. Finally, digital technologies are viewed as becoming a necessity in high involvement sales contexts, suggesting that additional features or innovative ways to use these technologies may serve as sources of competitive advantage for sales agents.

Originality/value

This is one of the first research studies to explore the perceived impacts of VR and AR technologies on the stages of the EKB model consumer decision model. It builds on prior work and offers direction for future research.
Consumer acceptance of smart speakers: a mixed methods approach
Authors: Kowalczuk Pascal
Published: October 2018

Purpose

Voice-activated smart speakers such as Amazon Echo and Google Home were recently developed and are gaining popularity. Understanding and theorizing the underlying mechanisms that encourage or impede consumers to use smart speakers is fundamental for enhancing acceptance and future development of these new devices. Therefore, building on technology acceptance research, this study aims to develop and test an acceptance model for investigating consumers’ intention to use smart speakers.

Design/methodology/approach

First, antecedents that may significantly affect the usage intention of smart speakers were identified through an explorative approach by a netnographic analysis of customer reviews (N= 2,186) and Twitter data (N= 899). Afterward, these results and contemporary literature were used to develop and validate an acceptance model for smart speakers. Structural equation modeling (SEM) was used to test the proposed hypotheses on data collected from 293 participants of an online survey.

Findings

Besides perceived ease of use and perceived usefulness, the quality and diversity of a system, its enjoyment, consumer’s technology optimism and risk (surveillance anxiety and security/privacy risk) strongly affect the acceptance of smart speakers. Among these variables, enjoyment had the strongest effect on behavioral intention to use smart speakers.

Originality/value

This is the first study that incorporates netnography and SEM for investigating technology acceptance and applies it to the field of interactive smart devices.
Entrepreneurially oriented employees and firm performance: mediating effects
Authors: Fellnhofer Katharina
Published: October 2018

Purpose

This paper aims to contribute to the literature on entrepreneurial orientation (EO) with a focus on the interplay between the individual and firm level for embedding EO pervasively within organisations.

Design/methodology/approach

Comprising 356 individual employees from five companies collected from June to September 2015, this investigation uses structural equation modelling.

Findings

The results show significant indirect effects from individuals’ EO on firm’s performance, mediated by both individuals’ performance and firm’s EO.

Research limitations/implications

While the construct of EO is strengthened with a multi-level approach, the authors also stress the organisational homogeneity of EO.

Practical implications

Consequently, the EO instrument can be used as a strategic tool to evaluate an individual’s orientation towards entrepreneurship to facilitate firm performance.

Originality/value

Finally, the EO instrument can be used as a strategic tool to evaluate an individual’s orientation towards entrepreneurship to facilitate firm performance.
Lean management and innovation performance
Authors: Abdallah Ayman Bahjat , Dahiyat Samer Eid , Matsui Yoshiki
Published: October 2018

Purpose

The purpose of this paper is to explore the effects of innovation orientation (IO) on both the implementation levels of soft and hard lean management (LM), as well as innovation performance. It also aims at exploring the effects of soft and hard LM on innovation performance.

Design/methodology/approach

The study analyzes survey data collected as a part of a high-performance manufacturing (HPM) project from 238 international manufacturing companies in eight countries and three industries. Exploratory factor analysis and confirmatory factor analysis were applied to assess construct validity. The study hypotheses were tested using structural equation modeling.

Findings

The results demonstrated that innovation-oriented companies tend to adopt aspects of both soft and hard LM. However, the results revealed an insignificant effect of soft and hard LM on innovation performance. The study also showed that innovation performance is positively influenced by an IO. These results indicate that having an IO is vital for enhancing both LM as well as innovation performance. They also evidently suggest that LM is more related to continuous improvement (incremental innovation) rather than (radical) innovation and, as such, is not important for firm’s intent on enhancing their innovation performance.

Practical implications

The current study demonstrates that IO and LM are complementary and not contradicting strategies. The two strategies share many cultural aspects, similarities and commonalities. However, LM is not sufficient to predict innovation performance. Managers of the surveyed manufacturing firms are advised to focus on IO, as it has beneficial impacts on both LM (continuous improvement initiatives) as well as innovation performance. This clearly indicates that placing the emphasis upon radical (innovative) improvement rather than incremental improvement (LM practices) is believed to support continuous and innovative improvement alike.

Originality/value

The relationship between LM and innovation is debated in the existing literature, but the debate is characterized by a lack of empirical evidence. This is one of the first studies that empirically investigates the relationships between IO, LM and innovation performance. It identifies some new insights to direct future research, particularly regarding different innovation types as well as in service organizations.
A study on the surface quality of the 3D printed parts caused by the scanning strategy
Authors: Han Jitai , Ge Yanan , Mao Yuxin , Wu Meiping
Published: October 2018

Purpose

The purpose of this paper is to mainly focus on the relationship between the scanning strategy and surface quality. Surface quality, including surface roughness and flatness, is important for printed parts. So this paper optimizes the surface quality by changing the scanning strategy.

Design/methodology/approach

This paper is based on the phenomenon after the printed parts. A clear trend can be seen that the surface roughness on the side face shows a clear zigzag shape, so an optimized scanning strategy is used. Surface roughness in measured in macrostructure first by Mitutoyo and the flatness is measured by Hexagon Metrocogy. After that, microstructure on the side face is seen by RTEC to explain this phenomenon.

Findings

The surface quality on the side face shows a significant optimize by changing the scanning strategy. The surface quality on the positive face has some optimization to some degree.

Originality/value

This paper determines the relationship between the surface roughness on the side face and the scanning strategy. Few studies focus on the surface roughness, especially on the side face. Some studies try to optimize the surface roughness on the positive face. However, researchers always neglect the surface roughness on the side face. 2. This paper measures not only the surface roughness, but also the flatness. Surface roughness has a significant impact on the surface quality. However, it still has some limitations. Flatness is also measured to make this paper more representative. 3. This paper explains why scanning strategy can affect the surface quality. These images explain the research better and not just at the theoretical level.
A review on additive manufacturing of sand molds by binder jetting and selective laser sintering
Authors: Le Néel Tugdual Amaury , Mognol Pascal , Hascoët Jean-Yves
Published: October 2018

Purpose

The purpose of this paper is to analyze the current state of the art manufacturing techniques using sand molds for the casting industry by the means of additive manufacturing (AM). In particular, this review will cover two families of 3D printing in regards to sand mold fabrication.

Design/methodology/approach

This paper will discuss the sand casting manufacturing processes of AM by binder jetting (3D printing) and selective laser sintering. Scientific articles, patents and case studies are analyzed. Topics ranging from the technology types to the economic implications are covered.

Findings

The review investigates new factors and methods for mold design, looking at mechanical properties and cost analysis as influenced by material selection, thermal characteristics, topological optimization and manufacturing procedure. Findings in this study suggest that this topic lacks vigorous scientific research and that the case studies by manufacturers thus far are not useful.

Research limitations/implications

As demonstrated by the limited data from previous published studies, a more comprehensive and conclusive analysis is needed due to the lack of interest and resources regarding the AM of sand molds.

Practical implications

This study is a useful tool for any researchers with an interest in the field of AM of sand molds.

Social implications

Key perspectives are proposed.

Originality/value

This review highlights current gaps in this field. The review goes beyond the scientific articles by curating patents and professional case studies.
Adalimumab treatment in Japanese patients with generalized pustular psoriasis: Results of an open‐label phase 3 study
Authors: Morita Akimichi , Yamazaki Fumikazu , Matsuyama Takashi , Takahashi Kenzo , Arai Satoru , Asahina Akihiko , Imafuku Shinichi , Nakagawa Hidemi , Hasegawa Yuichi , Williams David , Matsuda Naoto , Kitamura Susumu
Published: October 2018

A phase 3, multicenter, open‐label, 52‐week study investigated the efficacy and safety of adalimumab 80 mg at week 0 followed by adalimumab 40 mg every other week (option to escalate to 80 mg when necessary) in Japanese patients with generalized pustular psoriasis (GPP). Adults (aged 15–75 years) with GPP, total skin score (overall erythema area, erythema area with pustules, and edema area) of 3 or more, and erythema with pustules (skin score, ≥1) based on the 2014 Japanese Dermatological Association severity index of GPP were enrolled. The primary efficacy end‐point was clinical response at week 16 (non‐responder imputation), defined as achieving remission (total skin score, 0) or improvement from baseline (reduction of ≥1 point from a baseline total skin score of 3 or ≥2 points from a baseline total skin score of ≥4). Of 10 enrolled patients (mean disease duration, 10.6 years), seven patients, including three with the dose escalated to 80 mg every other week before week 15, achieved clinical response at week 16, and five achieved clinical response at week 52. Mean change from baseline total GPP score was −4.6 at week 16 (n = 8) and −6.0 at week 52 (n = 5); change in total skin score was −3.1 (n = 8) and −4.2 (n = 5), respectively. Nine patients experienced one or more adverse events and three experienced serious adverse events. The most common adverse events were nasopharyngitis, pruritus and hypoalbuminemia. In conclusion, adalimumab was effective and well tolerated for up to 52 weeks in the treatment of Japanese patients with GPP.
CO2 saturation estimates at Sleipner (North Sea) from seismic tomography and rock physics inversion
Authors: Yan Hong , Dupuy Bastien , Romdhane Anouar , Arntsen Børge
Published: October 2018

CO2 saturations are estimated at Sleipner using a two‐step imaging workflow. The workflow combines seismic tomography (full‐waveform inversion) and rock physics inversion and is applied to a two‐dimensional seismic line located near the injection point at Sleipner. We use baseline data (1994 vintage, before CO2 injection) and monitor data that was acquired after 12 years of CO2 injection (2008 vintage). P‐wave velocity models are generated using the Full waveform inversion technology and then, we invert selected rock physics parameters using an rock physics inversion methodology. Full waveform inversion provides high‐resolution P‐wave velocity models both for baseline and monitor data. The physical relations between rock physics properties and acoustic wave velocities in the Utsira unconsolidated sandstone (reservoir formation) are defined using a dynamic rock physics model based on well‐known Biot–Gassmann theories. For data prior to injection, rock frame properties (porosity, bulk and shear dry moduli) are estimated using rock physics inversion that allows deriving physically consistent properties with related uncertainty. We show that the uncertainty related to limited input data (only P‐wave velocity) is not an issue because the mean values of parameters are correct. These rock frame properties are then used as a priori constraint in the monitor case. For monitor data, the Full waveform inversion results show nicely resolved thin layers of CO2–brine saturated sandstones under intra‐reservoir shale layers. The CO2 saturation estimation is carried out by plugging an effective fluid phase in the rock physics model. Calculating the effective fluid bulk modulus of the brine–CO2 mixture (using Brie equation in our study) is shown to be the key factor to link P‐wave velocity to CO2 saturation. The inversion tests are done with several values of Brie/patchiness exponent and show that the CO2 saturation estimates are varying between 0.30 and 0.90 depending on the rock physics model and the location in the reservoir. The uncertainty in CO2 saturation estimation is usually lower than 0.20. When the patchiness exponent is considered as unknown, the inversion is less constrained and we end up with values of exponent varying between 5 and 20 and up to 33 in specific reservoir areas. These estimations tend to show that the CO2–brine mixing is between uniform and patchy mixing and variable throughout the reservoir.
When can competition and dispersal lead to checkerboard distributions?
Authors: Dallas Tad , Melbourne Brett A. , Hastings Alan
Published: October 2018

Checkerboard distributions—mutually exclusive species co‐occurrences—are a common observation in community ecology and biogeography. While the underlying causes of checkerboard distributions have remained elusive, a long‐standing argument is that they are representative of strong competitive interactions and/or dispersal limitation.

We explore this using a stochastic two‐patch metacommunity model combined with an experimental two‐patch system of competing Tribolium species, quantifying checkerboard distributions using the abundance‐based index Ast.

We find that maintenance of checkerboard distributions is possible in a limited parameter space consisting of low dispersal rates, low population growth rates and high interspecific competition. Checkerboards were not maintained in experimental metacommunities.

Our model, parameterized using independent data, echoed this finding, providing a clear link between model and experiment, and suggested that only small regions of parameter space would allow for checkerboard distributions between patches with equally hospitable environments. These findings may provide insight into when interspecific competition and dispersal limitation would promote checkerboard distributions.
Asymmetric competitive effects during species range expansion: An experimental assessment of interaction strength between “equivalent” grazer species in their range overlap
Authors: Aguilera Moisés A. , Valdivia Nelson , Jenkins Stuart , Navarrete Sergio A. , Broitman Bernardo
Published: October 2018

Biotic interactions are central to the development of theory and concepts in community ecology; experimental evidence has shown their strong effects on patterns of population and community organization and dynamics over local spatial scales. The role of competition in determining range limits and preventing invasions at biogeographic scales is more controversial, partly because of the complexity of processes involved in species colonization of novel habitats and the difficulties in performing appropriate manipulations and controls.

We examined experimentally whether competition is likely to affect poleward range expansion hindering or facilitating the establishment of the limpet Scurria viridula along the south‐eastern Pacific rocky shore (30°S, Chile) in the region occupied by the congeneric S. zebrina. We also assessed whether competition with the “invader” or range‐expanding species could reduce individual performance of the “native” S. zebrina and depress local populations

Geographic field surveys were conducted to characterize the abundance and identity of limpets along the south‐eastern Pacific coast from 18°S to 41°S, and the micro‐scale (few cm) spatial distribution across the range overlap of the two species. Field‐based competition experiments were conducted at the southern leading edge of the range of S. viridula (33°S) and at the northern limit of S. zebrina (30°S).

Field surveys showed poleward range expansion of S. viridula of ca. 210 km since year 2000, with an expansion rate of 13.1 km/year. No range shift was detected for S. zebrina. The resident S. zebrina had significant negative effects on the growth rate of the invading juvenile S. viridula, while no effect of the latter was found on S. zebrina. Spatial segregation between species was found at the scale of cms.

Our results provide novel evidence of an asymmetric competitive effect of a resident species on an invader, which may hamper further range expansion. No negative effect of the invader on the resident species was detected. This study highlights the complexities of evaluating the role of species interactions in setting range limits of species, but showed how interspecific competition might slow the advance of an invader by reducing individual performance and overall population size at the advancing front.
What's driving innovation in small businesses in Australia? The case of the food industry
Authors: Soriano Franklin A. , Villano Renato A. , Fleming Euan M. , Battese George E.
Published: October 2018

There is strong evidence that innovation is a primary driver of a nation's economic growth. As Australia continues to compete in the global economy, it is imperative that businesses should be innovative to improve their performance. In this paper, we evaluate the status and main drivers of innovation in small businesses in the food sector in Australia. Discrete choice modelling and bootstrapping procedures are applied to a panel of firm‐level data collected through theABSBusiness Characteristics Survey (2006–2007 to 2010–2011 for the Australian Bureau of Statistics’ Business Longitudinal Database Confidential Unit Record File) to investigate the factors affecting the likelihood of small food businesses to innovate. Results show that businesses are more likely to innovate if they collaborate, have higher information and communication technology intensity, and use science, technology, engineering and mathematics skills. We also found that small food businesses, even at the subsector level, do combine different types of innovation when innovating. The propensity to innovate also increases for small businesses that have flexible working arrangements, face moderate‐to‐strong market competition, operate overseas and seek finance through debt and equity. The relative importance of these factors was found to vary between agricultural and nonagricultural food subsectors.
Hair cortisol and childhood trauma predict psychological therapy response in depression and anxiety disorders
Authors: Fischer S. , King S. , Papadopoulos A. , Hotopf M. , Young A. H. , Cleare A. J.
Published: October 2018

Objective

Around 30–50% of patients with depression and anxiety disorders fail to respond to standard psychological therapy. Given that cortisol affects cognition, patients with altered hypothalamic–pituitary–adrenal (HPA) axis functioning may benefit less from such treatments. To investigate this, reliable pretreatment cortisol measures are needed.

Method

N = 89 outpatients with depression and anxiety disorders were recruited before undergoing therapy within an Improving Access to Psychological Therapies (IAPT) service. Three‐month hair cortisol was determined, and the Childhood Trauma Questionnaire was administered. Patients were classified as responders if they showed significant decreases in depression (>= 6 points on the Patient Health Questionnaire) or anxiety (>= 5 points on the Generalised Anxiety Disorder Scale).

Results

Non‐responders in terms of depression (57%) had lower pretreatment hair cortisol concentrations (P = 0.041) and reported more physical abuse (P = 0.024), sexual abuse (P = 0.010) and total trauma (P = 0.039) when compared to responders. Non‐responders in terms of anxiety (48%) had lower pretreatment hair cortisol (P = 0.027), as well as higher levels of emotional abuse (P = 0.034), physical abuse (P = 0.042) and total trauma (P = 0.048).

Conclusion

If future research confirms hair cortisol to be a predictor of psychological therapy response, this may prove a useful clinical biomarker which identifies a subgroup requiring more intensive treatment.
IL8 and IL17A polymorphisms associated with multibacillary leprosy and reaction type 1 in a mixed population from southern Brazil
Authors: Aquino Julimary Suematsu , Ambrosio‐Albuquerque Eliane Papa , Alves Hugo Vicentin , Macedo Luciana Conci , Visentainer Lorena , Sell Ana Maria , Visentainer Jeane Eliete Laguila
Published: October 2018

We evaluated the influence of the IL8 T‐738A (nonidentified rs), IL8 T‐353A (rs4073), IL17A G197A (rs2275913), and IL17F T7488C (rs763780) single‐nucleotide polymorphisms on leprosy. The AA genotype of IL8 T‐353A was observed as a risk factor for multibacillary leprosy, regardless of gender and age‐of‐onset of disease, considering the recessive model (OR, 3.8; 95% CI, 1.1–13.5; P, 0.023). Furthermore, the AA genotype of IL17A G197A was associated with leprosy type 1 reaction (OR, 2.4; 95% CI, 1.1–5.1; P, 0.026) when compared to the group without reaction, which was adjusted for gender and age‐of‐onset of disease by the model log additive. These results indicate association of IL8 and IL17A polymorphisms with the progression to multibacillary leprosy and with the type 1 reaction, respectively.
Seasonally flooded, and terra firme in northern Congo: Insights on their structure, diversity and biomass
Authors: Ifo Suspense Averti , Binsangou Stoffenne , Ibocko Ngala Lypsia , Madingou Mady , Cuni‐Sanchez Aida
Published: October 2018

In the Congo basin, considerable uncertainty remains about the amount and spatial variation of carbon stocks. We studied two types of seasonally flooded forests (dominated by Guibourtia demeusei and Lophira alata) and nearby terra firme forests in northern Congo. We sampled 1.25 ha per forest type and a total of 1,400 trees ≥5 cm diameter. AGB ranged from 207–343 Mg/ha, with no significant differences between forest types. Few significant differences were observed in vegetation structure or tree diversity between forest types. Species richness and stem density of small trees were lower, and dominance was higher in Guibourtia plots, which are subject to greater flooding than Lophira plots. Guibourtia was absent from smaller diameter class in Guibourtia forests; and Uapaca spp. were more abundant in terra firme than in seasonally flooded plots. We show that both types of seasonally flooded forests store important quantities of AGB and should also be considered in forest conservation programmes. We recommend more research on seasonally flooded forests, on larger geographical extent, which assesses flood depth and duration, and measures tree height in the field, as we took a conservative approach to AGB estimates, and AGB could be even greater than we report here.
Introduction of a customised growth chart protocol increased detection of small for gestational age pregnancies in a tertiary Melbourne hospital
Authors: Jayawardena Lulusha , Sheehan Penelope
Published: October 2018

Background

Growth charts customised for maternal height, weight, ethnicity and parity have been proposed as more effective at detecting infants who are small for gestational age (SGA) than routine screening with symphysio‐fundal height measurement alone. Our non‐randomised, prospective cohort study assessed antenatal SGA detection rates in a general maternity cohort following the introduction of the Perinatal Institute's Growth Assessment Protocol (GAP) program (consisting of customised growth chart software for plotting symphysio‐fundal height, staff training and serial auditing).

Methods

The GAP program was implemented into the routine antenatal schedule of 882 women who delivered at The Royal Women's Hospital, Melbourne, during our study period. SGA detection was compared to 936 women from the same team who delivered prior to the intervention. Secondary outcomes assessed were infant gestation at birth and method of delivery, neonatal Apgar scores and admission to the Neonatal Intensive and Special Care nursery (NISC).

Results

Identification of SGA infants increased from 21% to 41% with the introduction of the GAP program (OR 2.6, 95% CI 1.3–4.9, P < 0.05). This was not associated with an increase in false‐positive rates. Following the introduction of the GAP Program, SGA babies were more likely to be born by vaginal delivery (OR 2.7; 95% CI 1.4–5.1, P < 0.005). There was no overall increase in the induction of labour or caesarean delivery rates. Overall rates of admission to NISC were reduced.

Conclusions

In our increasingly culturally heterogenous society, the use of the GAP program is a safe and potentially more sensitive tool for detecting in utero growth restriction.
Learning from history: How research evidence can inform policies to improve rural and remote medical workforce distribution
Authors: Humphreys John , Wakerman John
Published: October 2018

Objective

This article describes the rationale for, and development of, an evidence‐based rural typology as the basis for an incentive scheme to improve medical workforce retention. This case study describes the key factors associated with ensuring that research evidence is translated into rural health policy and program implementation.

Design

Case study.

Setting

Rural and remote Australia.

Results

The development and implementation of the Modified Monash Model in Australia demonstrates some of the key facilitators of knowledge exchange. These include: sound evidence based on good empirical data and rigorous methodology; transparency to peers and stakeholders; the importance of long‐term commitment to rural health research; the credibility of the researcher; multiple modes of communication of results; real world validation and amplification of results; patience and persistence underscored by the commitment of researchers to achieving more equitable outcomes for rural and remote doctors; serendipity in terms of timing; and a governmental culture that values evidence‐based outcomes.

Conclusion

The knowledge exchange process is neither easy nor simple and rarely rapid. It often requires the engagement of communities, professional associations, health care providers, researchers, policy‐makers and funders. Implementation of evidence into rural health policies and programs benefits all parties through significant improvements in efficiency, effectiveness and equity.
Grasping the Ongaonga: When will New Zealand really integrate rural clinical education?
Authors: London Martin T. , Burton John G.
Published: October 2018

Compared to Australia, substantial rural‐based clinical education in New Zealand started small and still has some way to go if it is to fulfil its potential in workforce retention and recruitment to under‐served areas. The authors share some of their experiences in rural medical education and then speculate on how it could develop. They discuss the merits of a clinical school composed of a dispersed network of rural sites, which provide and coordinate rural health education.
Higher parental education was associated with better asthma control
Authors: Strömberg Celind Frida , Wennergren Göran , Vasileiadou Styliana , Alm Bernt , Åberg Nils , Goksör Emma
Published: October 2018

Aim

Inhaled corticosteroids have resulted in the improved control of asthma and a reduced need for hospitalisation. This study aimed to examine the prevalence of uncontrolled asthma and factors that affect asthma control.

Methods

The data came from a longitudinal cohort study of children. The parents answered questionnaires from age 6 months to 12 years. The response rate at age 12 years was 76% (3637/4777) and doctor‐diagnosed asthma was reported in 6.4% (n = 233). Asthma control was examined with the Asthma Control Test (ACT), where scores below 20 denote uncontrolled asthma.

Results

Of the children with asthma at age 12 years, 15% had an ACT value below 20, that is uncontrolled asthma. Independent risk factors for uncontrolled asthma were wheeze triggered by exercise (adjusted OR, aOR 5.6; 1.9–16.6), cat at home (aOR 3.5; 1.2–10.0) and current doctor‐diagnosed rhinitis (aOR 2.8; 95% CI 1.1–7.0). A higher education in the parents reduced the risk of uncontrolled asthma (aOR 0.3; 95% CI 0.1–0.8). Only six children (i.e. 2.6%) reported hospitalisation due to asthma during the last year.

Conclusion

Of the children with asthma, 15% had uncontrolled asthma. Higher education in the parents was associated with better asthma control in the children.
A phase 1 healthy male volunteer single escalating dose study of the pharmacokinetics and pharmacodynamics of risdiplam (RG7916, RO7034067), a SMN2 splicing modifier
Authors: Sturm Stefan , Günther Andreas , Jaber Birgit , Jordan Paul , Al Kotbi Nada , Parkar Nikhat , Cleary Yumi , Frances Nicolas , Bergauer Tobias , Heinig Katja , Kletzl Heidemarie , Marquet Anne , Ratni Hasane , Poirier Agnès , Müller Lutz , Czech Christian , Khwaja Omar
Published: October 2018

Aims

Risdiplam (RG7916, RO7034067) is an orally administered, centrally and peripherally distributed, survival of motor neuron 2 (SMN2) mRNA splicing modifier for the treatment of spinal muscular atrophy (SMA). The objectives of this entry‐into‐human study were to assess the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics of risdiplam, and the effect of the strong CYP3A inhibitor itraconazole on the PK of risdiplam in healthy male volunteers.

Methods

Part 1 had a randomized, double‐blind, adaptive design with 25 subjects receiving single ascending oral doses of risdiplam (ranging from 0.6–18.0 mg, n = 18) or placebo (n = 7). A Bayesian framework was applied to estimate risdiplam's effect on SMN2 mRNA. The effect of multiple doses of itraconazole on the PK of risdiplam was also assessed using a two‐period cross‐over design (n = 8).

Results

Risdiplam in the fasted or fed state was well tolerated. Risdiplam exhibited linear PK over the dose range with a multi‐phasic decline with a mean terminal half‐life of 40–69 h. Food had no relevant effect, and itraconazole had only a minor effect on plasma PK indicating a low fraction of risdiplam metabolized by CYP3A. The highest tested dose of 18.0 mg risdiplam led to approximately 41% (95% confidence interval 27–55%) of the estimated maximum increase in SMN2 mRNA.

Conclusions

Risdiplam was well tolerated and proof of mechanism was demonstrated by the intended shift in SMN2 splicing towards full‐length SMN2 mRNA. Based on these data, Phase 2/3 studies of risdiplam in patients with SMA are now ongoing.
Use of chitosan membranes after nerve‐sparing radical prostatectomy improves early recovery of sexual potency: results of a comparative study
Authors: Porpiglia Francesco , Manfredi Matteo , Checcucci Enrico , Garrou Diletta , De Cillis Sabrina , Amparore Daniele , De Luca Stefano , Fregnan Federica , Stura Ilaria , Migliaretti Giuseppe , Fiori Cristian
Published: October 2018

Objectives

To evaluate the 1‐year efficacy of chitosan membrane (ChiMe) application on the neurovascular bundles (NVBs) after nerve‐sparing (NS) robot‐assisted radical prostatectomy (RARP) in potency recovery rate.

To compare the results with those of a contemporary cohort of patients who did not benefit from chitosan use.

Patients and Methods

Patients in the ChiMe group were enrolled at our institution from July 2015 to September 2016 in a preliminary phase II study. All of them underwent NS‐RARP with ChiMe applied on the NVBs and were followed over time to complete a 1‐year follow‐up. The control group was composed of patients who underwent NS‐RARP at our institution without the application of ChiMe from January 2015. The patients were further classified into two groups based on the amount of nerves spared: Group A, comprised patients who underwent a monolateral or bilateral full NS; Group B, comprised patients in which a full NS was not performed. The demographics, peri‐ and postoperative data, and complications were recorded and compared. Potency recovery was recorded for Group A vs Group B in both the ChiMe and the control groups.

Results

In all, 136 patients were enrolled in the ChiMe group and 334 patients in the control group. There were no differences between groups in terms of baseline variables. Based on the amount of nerves preserved, 183 patients were included in Group A and 287 in Group B. Odds ratios at different time points showed that the only two factors influencing potency recovery were the amount of nerves preserved (Group A vs Group B) and the application or not of ChiMe on the NVBs spared. Comparing the ChiMe vs control groups at different time points, we found a statistically significant improvement in the potency recovery rate in the ChiMe group at 1 month (36.76% vs 25.88%; P = 0.02) and 2 months (52.2% vs 39.22%; P = 0.01) after surgery, showing a favourable trend at every time point of the entire follow‐up period, even if not significant after the second postoperative month. In Group A, the log‐rank test showed a statistically significant difference between the ChiMe vs control groups (P = 0.02), in particular at 1 and 2 months after surgery (P = 0.02 and P = 0.01, respectively).

Conclusion

The application of ChiMe on the NVBs resulted in a higher potency recovery rate at 1 and 2 months after a bilateral or monolateral full NS‐RARP. A trend of a higher and shorter potency recovery rate showed it to be favourable to use ChiMe, even in the cohort of patients who did not undergo a full NS procedure.
Prostate cancer in 432 men aged <50 years in the prostate‐specific antigen era: a new outlook
Authors: Gielchinsky Ilan , Chang John , Cusick Thomas , Delprado Warick , Nguyen Quoc , Yuen Carlo , Savdie Richard , Böhm Maret , Haynes Anne‐Maree , Scheltema Matthijs J. , Stricker Phillip D.
Published: October 2018

Objective

To evaluate the clinical presentation and treatment outcomes of prostate cancer (PCa) in 432 consecutive patients aged < 50 years in the prostate‐specific antigen (PSA) era.

Methods

Retrospective analysis was performed on all patients with PCa (14 570) from the years 1994 to 2017. A total of 432 consecutive patients aged < 50 years were identified. The patients were stratified by D'Amico risk groups, and their clinical presentation and treatment outcomes were analysed. The rates of biochemical recurrence after surgery were compared with the D'Amico prediction model as well as with older propensity‐score‐matched patients. The surgical pathology results in patients undergoing active surveillance (AS) were compared with those of low‐risk patients who underwent immediate surgery.

Results

A total of 44%, 42% and 13% of patients harboured low‐risk, intermediate‐risk and high‐risk PCa, respectively. Their median age was 47 years and a positive family history of PCa was reported in 39.1%. Clinical stage was T1 in 65.5% and T2 in 30.0% of patients, and 2.0% of patients had metastatic disease at presentation. Radical prostatectomy (RP) was performed in 78.4% of patients (n = 339) and the biochemical recurrence rates were 7.8% (low‐risk), 15.3% (intermediate‐risk) and 23.3% (high‐risk) at 5 years post‐surgery. These rates were lower than expected according to the D'Amico prediction model or when compared with older matched patients. A total of 74 patients with low‐risk PCa underwent AS and only 17.6% (n = 13) required radical treatment after a median follow‐up of 46 months. The surgical pathology results in patients undergoing ASdid not differ significantly from patients with low‐risk PCa who underwent immediate surgery (positive surgical margins [P = 0.145], tumour volume [P = 0.257] or seminal vesicle involvement [P = 0.100]). Of the present cohort, only 0.4% died from PCa during a median follow‐up of 65 months.

Conclusions

The clinical presentation and prognosis of young patients has changed dramatically during the PSA era. Patients nowadays present with lower‐risk disease that can be treated adequately, with reassuring biochemical recurrence rates at 5 years post‐surgery. AS appears to be safe in patients with low‐risk. PCa.