bluuebunny/crossref_metadata_2025 huggingface dataset:
Need for touch and two-way communication in e-commerce
Authors: Lee Yun Jung , Yang Sujin , Johnson Zachary
Published: August 2017

Purpose

The inability to touch products online is the top reason consumers list for preferring to shop in traditional brick and mortar versus e-commerce stores (Havas Worldwide, 2013). Need for touch (NFT) comprises autotelic and instrumental motives, which, respectively, relate to enjoyment and utility. This study aimed to examine how consumers’ NFT motives affect loyalty intentions toward e-commerce websites, both directly and as mediated by consumers’ level of technology acceptance (ease of use, enjoyment and perceived usefulness [PU]). The moderating effect of synchronous versus asynchronous two-way communication with sellers on the relationships among consumers’ NFT, acceptance of technology and loyalty intention was also examined.

Design/methodology/approach

An online survey was conducted among consumers who had shopped from popular e-commerce websites chosen by this study within the 12 months prior to data collection.

Findings

Both types of NFT motives affected loyalty and technology acceptance. Specifically, autotelic NFT positively impacted perceived ease of use (PEOU) and perceived enjoyment (PE), whereas instrumental NFT negatively impacted PEOU, PE and loyalty intentions. Among the technology acceptance variables, PU had the strongest effect on loyalty intention. Tests of moderation revealed that high-quality, text-based synchronous communication (i.e. live chatting) with sellers can compensate for both autotelic and instrumental NFT.

Originality/value

This research shows how the inherent inability of e-commerce to meet consumers’ NFT stymies consumers’ e-commerce acceptance and affects their loyalty toward online retailers and examines strategies that e-commerce sites can use to compensate for this need.
Using rich media to motivate fair-trade purchase
Authors: Han Tae-Im , Stoel Leslie
Published: August 2017

Purpose

The purpose of this research is to examine the effectiveness of using social media to increase knowledge about and motivate purchase behaviors of fair-trade products, focusing specifically on the influence of information format (media richness) and characteristics (information quality and quantity).

Design/methodology/approach

One-way analysis of variance (ANOVA) was conducted to test whether consumer responses differ based on the information format. Additionally, structural equation modeling (SEM) was performed to examine the relationship among constructs of the hierarchy of effects model.

Findings

Participants exposed to the video format (rich media) had higher scores on information quality, subjective knowledge and emotion than those exposed to the text only format (lean media). SEM results showed that both objective and subjective knowledge had significant influences on emotion and emotion, in turn, had a significant influence on purchase intentions. In addition, information quantity and quality had direct and significant effects on emotion.

Originality/value

This study focused on the crucial role of knowledge related to fair-trade products by distinguishing two different types: objective and subjective knowledge. Despite the growing body of literature concerning socially responsible consumer behavior (SRCB), there are very few studies that specifically examine the differential impact of objective and subjective knowledge on consumer behaviors. Furthermore, the original hierarchy of effects model does not include antecedents of the cognitive dimension. Because developing knowledge plays a key role in motivating SRCB, this study added characteristics of information to the model to examine their influence on knowledge level.
Boards of directors: a literature review
Authors: Garner Jacqueline , Kim Taek-yul , Yong Kim Won
Published: August 2017

Purpose

The purpose of this paper is to present a literature review of research on board size, structure, and independence. The paper also reviews research on director voting, and discusses recent work on “busy” directors and board diversity.

Design/methodology/approach

The authors limited the review to a focused set of research areas.

Findings

The authors summarize the research on boards of directors and note that research on this important topic should continue.

Originality/value

This review is intended to summarize the literature on boards of directors.
Institutional ownership stability and dividend payout policy
Authors: Jory Surendranath R. , Ngo Thanh , Sakaki Hamid
Published: August 2017

Purpose

The purpose of this paper is to empirically examine the link between institutional ownership stability and dividend payout ratio.

Design/methodology/approach

First, the authors estimate the propensity of a firm to pay dividend. Next, the authors perform panel fixed-effect regressions of dividend payouts on institutional ownership stability variables. The authors also compare institutional ownership between dividend paying and non-dividend paying investee firms. The authors analyze the dividend preferences of different types of institutional owners. Finally, the authors examine the cross-sectional variation in the volatility of dividend payouts.

Findings

The authors find that stable and large institutional owners favor dividend paying companies. There also exists a positive association between ownership persistence and dividend payout. Conversely, firms that change their dividend payout frequently are associated with larger deviations in institutional ownership. Additionally, the presence of pressure-sensitive institutional investors (i.e. investors that also hold business ties with the investee firm) is significantly linked to dividend payout policy. Conversely, pressure-insensitive investors use alternative forms of monitoring instead of requiring investee firms to pay dividends, which serve to reduce agency conflicts.

Originality/value

This paper considers the preferences of long-term stable institutional investors in their selection of dividend paying firms.
Consumer social resources to co-create: evidence from Vietnam
Authors: Nguyen Tuan M.
Published: August 2017

Purpose

This study aims to validate an integrative model that investigates the structural relationships among consumer social resources (including social capital and social exchange), co-creation behaviors (as outcome of social resources) and satisfaction and positive word-of-mouth (as joint outcomes of social resources and co-creation practice).

Design/methodology/approach

A cross-sectional design was used to gather data from education services in HCM City, Vietnam. The whole of 334 consumer surveys were used to validate a research model using SEM/AMOS.

Findings

The paper, on the basis of service-dominant logic and from customer perspective, asserts the importance of consumer co-creation in service logic. The finding reinforces that social capital and social exchange, as interconnected operant resources, influence consumer co-creation that further affects consumer satisfaction and positive word-of-mouth. In addition, no gender gap of co-creation practice is found in education services of the study. Moreover, this study, with the support of structuration theory, posits that value is co-created and socially contextual through resource integration and service exchange.

Originality/value

This paper is among the first, with empirically validating the social capital-co-creation link, to reveal that social capital, as a second-order construct, is an important determinant of co-creation practice. Next, this is also one of the first studies from a consumer view, with social exchange leading social capital as empirically demonstrated, that evidently investigates both the mechanism of value co-creation and the interconnection of social resources in service systems. Last but not least, this study may be also one of the first steps toward investigating the socially contextual nature of co-creation which may assert the last updated axiom of service-dominant logic.
The relation of e-government quality on public trust and its impact on public participation
Authors: Nulhusna Rizqa , Sandhyaduhita Puspa Indahati , Hidayanto Achmad Nizar , Phusavat Kongkiti
Published: August 2017

Purpose

This paper aims to answer a major challenge in the success of electronic government (e-government) implementation, viz., public participation via continual use intention and electronic word-of-mouth (eWoM). This study tries to provide some control by examining the impact of e-government quality on public trust and with continual use intention and eWoM. This study adopts the eminent information systems (IS) success model and expands the trust dimension into a multi-dimensional trust.

Design/methodology/approach

Data were collected using questionnaires distributed among e-government service users in Indonesia. In total, 293 respondents were analysed using structural equation modelling (SEM).

Findings

Of the three IS success factors, namely, systems quality, information quality and service quality, the former two are found to have significant correlation with trust. Dispositional trust has a substantial relationship with institutional trust and interpersonal trust, whereas institutional trust has a significant correlation with interpersonal trust. Institutional trust exhibits direct relationship with continual use intention and eWoM, whereas interpersonal trust has a significantly correlation with only continual use intention.

Research limitations/implications

This study suggests that it is plausible that user satisfaction could act as an intermediary between service quality and trust or between service quality and continual use intention. Thus, further research studies to examine satisfaction factor and its correlation with public acceptance are encouraged.

Practical implications

Government agencies should focus on information quality and systems quality which have a significant relation with trust development. These should be more thorough and meticulous to provide complete, secure and easy-to-use e-government information. These should also facilitate eWoM because it plays an important role in disseminating e-government (services).

Originality/value

This research provides a deeper and more accurate grasp on how public participation of e-government can be improved via trust.
The role of loyalty programs in healthcare service ecosystems
Authors: Gambarov Vusal , Sarno Debora , Hysa Xhimi , Calabrese Mario , Bilotta Alberto
Published: August 2017

Purpose

The purpose of this paper is to investigate the role of patient loyalty programs in healthcare environment, generally considered as a way to engage patients and potentially increase the perception of service quality of healthcare systems, but not systematically analyzed at the state of the art.

Design/methodology/approach

The Service Dominant logic and, in particular, the service ecosystem construct are adopted and integrated with relevant literature references and empirical studies on a sample of patients. Loyalty programs are interpreted as institutions coordinating actors of the healthcare service ecosystem.

Findings

A conceptual model linking loyalty programs to patients and healthcare providers’ co-creation practices, engagement, satisfaction, trust, and perception of service quality is build and explained based on literature and a case study, finding that loyalty programs can strengthen the adaptability and the well-being of a healthcare service ecosystem.

Practical implications

This contribution can have a significant impact on the design of new and the evolution of current healthcare service ecosystem, providing interesting insights to practitioners on the topic of loyalty programs, both for their development and their benefits.

Originality/value

The paper revised previous healthcare service ecosystems and highlights the role of the loyalty program institution at each level and between levels of the ecosystem.
Struggling with agency problems in open innovation ecosystem: corporate policies in innovation hub
Authors: Longo Maria Cristina , Giaccone Sonia Caterina
Published: August 2017

Purpose

The purpose of this paper is to discuss the topic of agency problems in service ecosystem for innovation. It specifically explores the corporate policies aimed at encouraging collaboration, so as to prevent opportunistic behaviors within the innovation hub, where service exchange is central for innovation creation.

Design/methodology/approach

The authors apply the agency theory framework to the hub as a service ecosystem in order to understand how it would be possible to address agency problems between the firm (principal) and the other actors of the hub (agents), involved in peer-to-peer interactions. The research explores the case study of a high-tech leading company, which is a pioneer in the use of the hub for supporting its innovation process. Data are collected through semi-structured interviews to some key informants of the Hub Program regarding structure and organization; participation; incentives and monitoring.

Findings

In service ecosystems, corporate policies are based on commitment, psycho-social incentives and social control may encourage collaboration among the actors, thus contributing to align their own interests to the hub’s innovation common goals.

Research limitations/implications

Given the exploratory nature of the research, the paper is based on a single case study. Thus, it is not possible to either generalize the results or evaluate any statistical correlation.

Practical implications

The paper provides a wider awareness about the benefits and risks related to service ecosystems for innovation, and advise both managers and practitioners about appropriate corporate policies to better address the agency problems.

Originality/value

This study enhances the literature on service ecosystems, highlighting the importance of corporate policies in preventing opportunistic behavior of actors in order to ensure the value co-creation process. It also extends the agency theory application to informal and not-hierarchical contexts. Besides, it suggests practitioners a way to reconcile the different interests of the firm and the other hub’s participants.
Dream or reality? A recipe for sustainable and innovative health care ecosystems
Authors: Palumbo Rocco , Cosimato Silvia , Tommasetti Aurelio
Published: August 2017

Purpose

Service ecosystems are gaining credence among management scholars. However, there is still little agreement about the distinguishing attributes of service ecosystems in both the public and the private sectors. The purpose of this paper is to focus on the health care service system, suggesting a “recipe” for the implementation of a sustainable and innovative health care service ecosystem.

Design/methodology/approach

A mixed methodology was used. First, a critical literature review was conducted to lay the conceptual foundations of this study. Then a theory about the institutional, organizational and managerial requisites for the implementation of a health care service ecosystem was developed.

Findings

The health care sector is appropriate for the core tenets of the service ecosystem perspective. Tailored interventions aimed at improving the functioning of the health care service ecosystem should be implemented at the micro, meso, macro and mega levels. Patient empowerment, patient-centered care and integrated care are the fundamental ingredients of the recipe for effective health care service ecosystems.

Practical implications

The ecosystem approach provides health policy makers with interesting insights to help shape the health care service system of the future. The paper also contributes to the innovation of managerial practices emphasizing the role of patient involvement in the design and delivery of health care.

Originality/value

This is one of the first attempts to systematize scientific knowledge about service ecosystems in the health care sector. An agenda for further research is suggested, in order to further advance the establishment of an effective and innovative health care service ecosystem.
Evaluating the outcomes of service ecosystems
Authors: Baccarani Claudio , Cassia Fabio
Published: August 2017

Purpose

The purpose of this paper is to understand how the resource integration processes that occur within service ecosystems affect both the well-being of the entire ecosystem and the well-being of specific focal actors (i.e. customers) in the ecosystem. Specifically, this paper considered cases in which customers’ well-being results from simultaneous participation in a multiplicity of service ecosystems.

Design/methodology/approach

An illustrative example, taken from the tourism context, was used to develop a conceptual framework (of which customers were the focal actors) to evaluate service ecosystem outcomes.

Findings

The results showed that the well-being of focal actors (i.e. customers) should be evaluated by considering the outcomes that arise in the interlocking service ecosystems in which the customers simultaneously participate. Further, in relation to these interlocking service ecosystems, high levels of well-being within a single ecosystem did not necessarily cause focal actors to experience high levels of well-being.

Research limitations/implications

To ensure the creation of positive customer experiences, the co-creating actors (e.g. the service providers) must first identify each of the interlocking service ecosystems in which customers simultaneously participate and then establish interactions with other relevant actors.

Originality/value

By considering the complex relationships between the well-being of a service ecosystem as a whole and the well-being of specific focal actors (e.g. customers) in an ecosystem, this study advances knowledge about evaluations on the performance of service ecosystems.
The role of technology and institutions in tourism service ecosystems
Authors: Barile Sergio , Ciasullo Maria Vincenza , Troisi Orlando , Sarno Debora
Published: August 2017

Purpose

Given the growing attention on service ecosystem and the role played by technology and institutions in shaping of actors’ relations and interactions, the purpose of this paper is to examine a tourism environment with the lens of service ecosystem in order to derive a deeper understanding on the underlying mechanisms.

Design/methodology/approach

A mixed methodology was used. First, literature review based on service ecosystems framework was conducted to critically analyze the roles of technology and institutions to shape a tourism service ecosystem. Then a case study was conducted.

Findings

Two main findings are described: the role and the characteristics of physical and virtual engagement touchpoints in the emergence of a tourism service ecosystems; and the relationship between technology and institutions in the resource integration. In particular, the authors conclude that institutions can shape the usage of technology which, in turn, can enable and imply the emergence of new institutions, continually adjusting the system of the tourism service ecosystem.

Practical implications

The analysis contributes to deepening the knowledge about value co-creation processes and engagement expedients in tourism destination, explaining the role of institutions and technology in helping actors to integrate resources and exchange services. The study can also be useful for practitioners in search for powerful tool to increase the competitiveness of a tourism destination.

Originality/value

The study is one of the first attempts to conceptualize and operationalize a tourism destination in a service ecosystem framework. In this way it contribute to enhance scientific knowledge in a tourism management literature.
Comparing traits of native and alien plants: Can we do better?
Authors: Hulme Philip E. , Bernard‐Verdier Maud
Published: August 2017

A frequent question in invasion ecology is whether the traits of alien plant species differ from natives. This question is increasingly addressed at the plant community scale to assess the role trait differences play in community assembly. Nevertheless, there remains considerable debate as to the value of native vs. alien trait comparisons.

Recommendations are made to address seven conceptual and methodological limitations in current approaches used to assess trait differences between native and alien plants: account for spatial scale dependence, make an informed choice of traits, evaluate multiple trait dimensions, incorporate intraspecific trait variation, use appropriate null models, examine environmental gradients, and assess temporal variation in trait spectra. Tackling these limitations will dramatically improve the value of native vs. alien trait comparisons.

Traits should be selected based on expectations of abiotic and/or biotic constraints. Phylogenetic distances can provide valuable insights but are no substitute for the measurement of individual traits when contrasting alien and native species. An ideal set of traits would include one or more leaf, stem, seed and root traits as well as flowering phenology and plant height at maturity. Comparisons of intraspecific trait variation among native and alien species within the same plant community are rare but could improve predictions of interspecific competition and the response of communities to plant invasions.

The full plant community should be examined rather than selected species subsets and comparisons between native and alien species traits are better undertaken at a neighbourhood scale. The frequency distribution of alien and native species traits may change over time through competitive exclusion as well as contemporary evolution. Repeated surveys of species abundances and traits are required to understand the consequences of trait differences between aliens and natives for plant community assembly.

Analyses of the role of species traits in plant invasions need to quantify differences in a priori identified traits within communities along suitable environmental gradients and test hypothetical trait patterns against appropriate null expectations. The infrequent application of such approaches may explain the limited generalisations regarding the role of trait differences between native and alien species in the invasion of plant communities.

A plain language summary is available for this article.
Spatial mismatch between management units and movement ecology of a partially migratory ungulate
Authors: Meisingset Erling L. , Loe Leif E. , Brekkum Øystein , Bischof Richard , Rivrud Inger M. , Lande Unni S. , Zimmermann Barbara , Veiberg Vebjørn , Mysterud Atle
Published: August 2017

Population‐level management is difficult to achieve if wildlife routinely crosses administrative boundaries, as is particularly frequent for migratory populations. However, the degree of mismatch between management units and scales at which ecological processes operate has rarely been quantified. Such insight is vital for delimiting functional population units of partially migratory species common in northern forest ecosystems.

We combined an extensive dataset of 412 GPS‐marked red deer (Cervus elaphus) across Norway with information on the size and borders of two administrative levels, the governmental level (municipality) and landowner level (local management units, LMUs), to determine the timing and scale of mismatch between animal space use and management units. We analysed how landscape characteristics affected the use of management units and the timing and likelihood of crossing borders between them, in an effort to delineate more appropriate units in various landscapes.

Median municipality size could potentially cover 70% of female and 62% of male annual ranges, while only 12% and 4% of LMUs were expansive enough to accommodate migratory routes in females and males, respectively. Red deer migrate along elevational gradients and are more likely to find both suitable lowland winter habitat and higher summer habitat within management units with variable topography. Consistent with this, the likelihood of border crossing decreased with increasing diversity of elevations.

Synthesis and applications. We demonstrate a considerable mismatch between animal space use and management units. Far‐ranging movements and frequent administrative border crossings during autumn migration coincides with the period of active management (hunting season). Our study also highlights that, due to extensive movements of males, coordination of management aims may provide a more realistic avenue than increasing sizes of local management units. A more general insight is that the degree of mismatch between range use and management units depends on the season and landscape type. This needs to be accounted for when delimitating functional population units of migratory populations.
Phenology of a dipterocarp forest with seasonal drought: Insights into the origin of general flowering
Authors: Kurten Erin L. , Bunyavejchewin Sarayudh , Davies Stuart J.
Published: August 2017

Our understanding of the factors that shape reproductive phenology in Southeast Asian tropical forests comes almost exclusively from studies of everwet, general flowering (GF) forests. Therefore, we examined the phenology of an evergreen dipterocarp forest in a climate exhibiting seasonal drought in Southeast Asia, with the aim of evaluating what evidence it brings to bear on the hypothesis that reproductive phenology in contemporary dipterocarp forests is the product of evolutionarily conserved responses to seasonal drought.

We hypothesized that (1) dipterocarp forests that experience seasonal drought would exhibit annual reproduction and seasonality similar to that of forests with similar climates in other parts of the world, (2) within species, flowering frequency would be climate‐dependent, not a fixed trait, and (3) climatic events that cue flowering in everwet forests would also cue flowering in seasonally dry forests.

From 2001 to 2009, we monitored flowering and fruiting monthly for 1,344 trees (>300 spp.) in a forest in Khao Chong (KC), Thailand that experiences an annual 2–4 month dry season, assessing frequency, duration, seasonality and synchrony of reproduction. We also examined phenological records for trees in three dipterocarp‐dominated forests in everwet climates.

Reproductive phenology of the KC forest was more similar to tropical forests with similar rainfall seasonality in other parts of the world than it was to dipterocarp‐dominated forests in everwet regions of Southeast Asia. The forest exhibited annual reproduction, with peak flowering occurring at the end of the dry season and peak fruiting occurring early in the wet season. Approximately half of all species and individuals reproduced annually, including several species that are known to exhibit “general flowering” in everwet climates. Short dry spells appeared to cue flowering for early flowering species, while later flowering species may have responded to either low precipitation or temperature, consistent with data from everwet forests. GF behaviour also showed significant phylogenetic signal.

Synthesis. Our results support the hypothesis that the phenological behaviour of both seasonal and everwet dipterocarp forests may have initially evolved in response to seasonal drought and that the general flowering phenomenon is a product of evolutionary conservatism.
Curcumin ameliorates severe influenza pneumonia via attenuating lung injury and regulating macrophage cytokines production
Authors: Han Shuguang , Xu Jing , Guo Xiangjun , Huang Mao
Published: August 2017

Curcumin, an active phenolic agent extract from the Curcuma longa, exhibits excellent anti‐cancer, anti‐inflammation, and neuroprotective effects. We aimed to investigate the anti‐influenza role of curcumin in vitro and in vivo. The effect of curcumin on replication of influenza A virus (IAV) was examined in human lung cancer cell line A549, as well as in a mouse model. Curcumin could inhibit IAV in vitro and alleviate the severity of the disease in the mouse after infection with IAV. The results also indicated that curcumin could trigger expression of Heme oxygenase‐1 in vivo and attenuate IAV‐induced injury to the lung tissue. Furthermore, curcumin could regulate immune response following IAV infection through inhibiting production of local inflammatory cytokines. In addition, curcumin was found to inhibit NF‐κB signalling in macrophages, as well as the subsequent production of cytokines/chemokines responding to IAV infection, by enhancing IκBα and AMPK. Our current study supports the potential of curcumin as a promising treatment against IAV infection, whose effect may be mediated by regulating immune response to prevent injury to the lung tissue.
Blockade of 5‐HT3 receptors with granisetron does not affect trigeminothalamic nociceptive transmission in rats: Implication for migraine
Authors: Sokolov Alexey Y , Sivachenko Ivan B , Panteleev Sergey S , Lyubashina Olga A
Published: August 2017

One way to expand the existing range of anti‐migraine drugs seems to be the search for pharmacological agents with anti‐cephalalgic properties among medicines approved for clinical indications other than migraine. Numerous experimental and clinical data imply that selective serotonin 5‐HT3 receptor antagonists can be considered as potential anti‐migraine agents. Therefore, the objective of our work was to examine the impact of selective 5‐HT3 receptor blockade with granisetron on migraine‐related nociceptive transmission within the spinal trigeminal nucleus (STN) and the ventroposteromedial nucleus of the thalamus (VPM). Using an electrophysiological model of trigemino‐durovascular nociception in anaesthetised male Wistar rats, we evaluated the effects of intravenous administration of granisetron on ongoing firing and dural electrical stimulation‐evoked responses of the spinal trigeminal and thalamic cells. Granisetron did not substantially affect responses of the STN and VPM neurons to electrical stimulation of the dura mater as well as did not cause steady changes in ongoing firing of the spinal trigeminal cells. The results obtained argue against the use of 5‐HT3 receptor antagonists for treating migraine. These data also lead to the conclusion that in the absence of sustained sensitisation of neurons along the trigemino‐thalamo‐cortical pathway the role of 5‐HT3 receptor‐dependent mechanisms in serotonergic modulation of trigeminovascular nociceptive transmission can hardly be considered crucial.
DXAGE: A New Method for Age at Death Estimation Based on Femoral Bone Mineral Density and Artificial Neural Networks
Authors: Navega David , Coelho João d'Oliveira , Cunha Eugénia , Curate Francisco
Published: August 2017

Age at death estimation in adult skeletons is hampered, among others, by the unremarkable correlation of bone estimators with chronological age, implementation of inappropriate statistical techniques, observer error, and skeletal incompleteness or destruction. Therefore, it is beneficial to consider alternative methods to assess age at death in adult skeletons. The decrease in bone mineral density with age was explored to generate a method to assess age at death in human remains. A connectionist computational approach, artificial neural networks, was employed to model femur densitometry data gathered in 100 female individuals from the Coimbra Identified Skeletal Collection. Bone mineral density declines consistently with age and the method performs appropriately, with mean absolute differences between known and predicted age ranging from 9.19 to 13.49 years. The proposed method—DXAGE—was implemented online to streamline age estimation. This preliminary study highlights the value of densitometry to assess age at death in human remains.
Quantifying Macrophages and Hemosiderin in Pediatric Dura Mater,
Authors: Krywanczyk Alison , Bundock Elizabeth A.
Published: August 2017

Determining the age of a subdural hematoma at autopsy is of great interest for medicolegal purposes. The appearance of pigment‐laden macrophages is often referenced as evidence that the subdural hematoma is 3–4 days old. However, understanding the significance of macrophages and hemosiderin requires understanding the histology of infant dura. Samples of grossly unremarkable dura taken from 17 pediatric autopsies were identified and histologically confirmed to lack subdural neomembrane. CD68 immunostaining and Prussian blue staining was performed. The CD68‐positive cells per high‐power field were quantified, and the presence of iron‐containing cells was recorded. CD68‐positive cells were present in all cases, even in the dural border layer. Iron‐containing cells were identified in 59% of cases, and in the dural border layer in 29%. Therefore, CD68‐positive and iron‐containing cells can be present in pediatric dura without neomembrane or macroscopic subdural hemorrhage, and this requires consideration when estimating the age of a subdural hematoma.
Impact of systemic inflammatory response syndrome and surgical Apgar score on post‐operative acute kidney injury
Authors: Toyonaga Y. , Asayama K. , Maehara Y.
Published: August 2017

Background

Surgical Apgar Score (SAS) is relatively weakly associated with post‐operative outcomes in emergency surgery, compared with elective surgery. A combination of systemic inflammatory response syndrome (SIRS) and SAS may be useful for prediction of poor outcomes after emergency surgery.

Methods

A retrospective study was conducted in patients who underwent emergency abdominal or cerebral surgery from January 2005 to December 2010. AKI was diagnosed using Acute Kidney Injury Network criteria for 2 days after surgery. Pre‐operative SIRS was defined as SIRS score ≥ 2. Patients were divided into those with SAS ≥ 5 and < 5. Independent risk factors for post‐operative AKI were identified. Ability to predict post‐operative AKI was determined using receiver operating characteristic (ROC) curve analysis.

Results

Of 742 patients, 175 (24%) had post‐operative AKI. Pre‐operative SIRS (OR 1.9, 95% CI: 1.2–2.9, P < 0.01) and SAS < 5 (OR 2.6, 95% CI: 1.7–4.1, P < 0.01) were independent risk factors for post‐operative AKI. Patients without SIRS and SAS < 5 had an increased risk of post‐operative AKI (odds ratio (OR) 3.6, 95% confidence interval (CI) 1.9–6.7, P < 0.01) and those with SIRS and SAS < 5 had increased risks of post‐operative AKI (OR 5.9, 95% CI: 3.7–9.3, P < 0.01) and hospital mortality (OR 3.5, 95% CI: 1.9–6.3, P < 0.01). In ROC analysis, the c‐statistic using both SIRS and SAS < 5 was 0.81 (95% CI: 0.77–0.84, P < 0.01) and higher than without use of these factors (P < 0.01).

Conclusion

Pre‐operative SIRS and SAS are independently associated with post‐operative AKI. Simultaneous use of pre‐operative SIRS and SAS may improve prediction of poor post‐operative outcomes.
The 2017 Academic Emergency Medicine Consensus Conference: Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcomes
Authors: Bond William F. , Hui Joshua , Fernandez Rosemarie
Published: August 2017

Over the past decade, emergency medicine (EM) took a lead role in healthcare simulation in part due to its demands for successful interprofessional and multidisciplinary collaboration, along with educational needs in a diverse array of cognitive and procedural skills. Simulation‐based methodologies have the capacity to support training and research platforms that model micro‐, meso‐, and macrosystems of healthcare. To fully capitalize on the potential of simulation‐based research to improve emergency healthcare delivery will require the application of rigorous methods from engineering, social science, and basic science disciplines. The Academic Emergency Medicine (AEM) Consensus Conference “Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcome” was conceived to foster discussion among experts in EM, engineering, and social sciences, focusing on key barriers and opportunities in simulation‐based research. This executive summary describes the overall rationale for the conference, conference planning, and consensus‐building approaches and outlines the focus of the eight breakout sessions. The consensus outcomes from each breakout session are summarized in proceedings papers published in this issue of Academic Emergency Medicine. Each paper provides an overview of methodologic and knowledge gaps in simulation research and identifies future research targets aimed at improving the safety and quality of healthcare.
Phase III randomized trial comparing intravenous to oral iron in patients with cancer‐related iron deficiency anemia not on erythropoiesis stimulating agents
Authors: Noronha Vanita , Joshi Amit , Patil Vijay Maruti , Banavali Shripad D. , Gupta Sudeep , Parikh Purvish M. , Marfatia Shalaka , Punatar Sachin , More Sucheta , Goud Supriya , Nakti Dipti , Prabhash Kumar
Published: August 2017

Aim

We aimed to find the optimal route of iron supplementation in patients with malignancy and iron deficiency (true or functional) anemia not receiving erythropoiesis stimulating agents (ESA).

Methods

Adult patients with malignancy requiring chemotherapy, hemoglobin (Hb) <12 g/dL and serum ferritin <100 mcg/mL, transferrin saturation <20% or hypochromic red blood cells >10% were randomized to intravenous (IV) iron sucrose or oral ferrous sulfate. The primary endpoint was change in Hb from baseline to 6 weeks. Secondary endpoints included blood transfusion, quality of life (QoL), toxicity, response and overall survival.

Results

A total of 192 patients were enrolled over 5 years: 98 on IV arm and 94 on oral arm. Median age was 51 years; over 95% patients had solid tumors. The mean absolute increase in Hb at 6 weeks was 0.11 g/dL (standard deviation [SD]: 1.48) in IV arm and −0.16 g/dL (SD: 1.36) in oral arm, P = 0.23. Twenty‐three percent patients on IV iron and 18% patients on oral iron had a rise in Hb of ≥1 g/dL at 6 weeks, P = 0.45. Thirteen patients (13.3%) on the IV iron arm and 14 patients (14.9%) on the oral arm required blood transfusion, P = 1.0. Gastrointestinal toxicity (any grade) developed in 41% patients on IV iron and 44% patients on oral iron, P = 1.0. 5 patients on IV iron and none on oral iron had hypersensitivity, P = 0.06. QoL was not significantly different between the two arms.

Conclusion

IV iron was not superior to oral iron in patients with malignancy on chemotherapy and iron deficiency anemia.
Challenges in the implementation of the EAACI AIT guidelines: A situational analysis of current provision of allergen immunotherapy
Authors: Ryan D. , Gerth van Wijk R. , Angier E. , Kristiansen M. , Zaman H. , Sheikh A. , Cardona V. , Vidal C. , Warner A. , Agache I. , Arasi S. , Fernandez‐Rivas M. , Halken S. , Jutel M. , Lau S. , Pajno G. , Pfaar O. , Roberts G. , Sturm G. , Varga E. M. , Van Ree R. , Muraro A.
Published: August 2017

Purpose

The European Academy of Allergy and Clinical Immunology (EAACI) has produced Guidelines on Allergen Immunotherapy (AIT). We sought to gauge the preparedness of primary care to participate in the delivery of AIT in Europe.

Methods

We undertook a mixed‐methods, situational analysis. This involved a purposeful literature search and two surveys: one to primary care clinicians and the other to a wider group of stakeholders across Europe.

Results

The 10 papers identified all pointed out gaps or deficiencies in allergy care provision in primary care. The surveys also highlighted similar concerns, particularly in relation to concerns about lack of knowledge, skills, infrastructural weaknesses, reimbursement policies and communication with specialists as barriers to evidence‐based care. Almost all countries (92%) reported the availability of AIT. In spite of that, only 28% and 44% of the countries reported the availability of guidelines for primary care physicians and specialists, respectively. Agreed pathways between specialists and primary care physicians were reported as existing in 32%‐48% of countries. Reimbursement appeared to be an important barrier as AIT was only fully reimbursed in 32% of countries. Additionally, 44% of respondents considered accessibility to AIT and 36% stating patient costs were barriers.

Conclusions

Successful working with primary care providers is essential to scaling‐up AIT provision in Europe, but to achieve this, the identified barriers must be overcome. Development of primary care interpretation of guidelines to aid patient selection, establishment of disease management pathways and collaboration with specialist groups are required as a matter of urgency.
Family nurture intervention in preterm infants increases early development of cortical activity and independence of regional power trajectories
Authors: Welch Martha G. , Stark Raymond I. , Grieve Philip G. , Ludwig Robert J. , Isler Joseph R. , Barone Joseph L. , Myers Michael M.
Published: August 2017

Aim

Premature delivery and maternal separation during hospitalisation increase infant neurodevelopmental risk. Previously, a randomised controlled trial of Family Nurture Intervention (FNI) in the neonatal intensive care unit demonstrated improvement across multiple mother and infant domains including increased electroencephalographic (EEG) power in the frontal polar region at term age. New aims were to quantify developmental changes in EEG power in all brain regions and frequencies and correlate developmental changes in EEG power among regions.

Methods

EEG (128 electrodes) was obtained at 34‐44 weeks postmenstrual age from preterm infants born 26‐34 weeks. Forty‐four infants were treated with Standard Care and 53 with FNI. EEG power was computed in 10 frequency bands (1‐48 Hz) in 10 brain regions and in active and quiet sleep.

Results

Percent change/week in EEG power was increased in FNI in 132/200 tests (p < 0.05), 117 tests passed a 5% False Discovery Rate threshold. In addition, FNI demonstrated greater regional independence in those developmental rates of change.

Conclusion

This study strengthens the conclusion that FNI promotes cerebral cortical development of preterm infants. The findings indicate that developmental changes in EEG may provide biomarkers for risk in preterm infants as well as proximal markers of effects of FNI.
Clinical significance of CYP2C19 polymorphisms on the metabolism and pharmacokinetics of 11β‐hydroxysteroid dehydrogenase type‐1 inhibitor BMS‐823778
Authors: Cheng Yaofeng , Wang Lifei , Iacono Lisa , Zhang Donglu , Chen Weiqi , Gong Jiachang , Humphreys William Griffith , Gan Jinping
Published: August 2017

Aims

BMS‐823778 is an inhibitor of 11β‐hydroxysteroid dehydrogenase type‐1, and thus a potential candidate for Type 2 diabetes treatment. Here, we investigated the metabolism and pharmacokinetics of BMS‐823778 to understand its pharmacokinetic variations in early clinical trials.

Methods

The metabolism of BMS‐823778 was characterized in multiple in vitro assays. Pharmacokinetics were evaluated in healthy volunteers, prescreened as CYP2C19 extensive metabolizers (EM) or poor metabolizers (PM), with a single oral dose of [14C]BMS‐823778 (10 mg, 80 μCi).

Results

Three metabolites (<5%) were identified in human hepatocytes and liver microsomes (HLM) incubations, including two hydroxylated metabolites (M1 and M2) and one glucuronide conjugate (M3). As the most abundant metabolite, M1 was formed mainly through CYP2C19. M1 formation was also correlated with CYP2C19 activities in genotyped HLM. In humans, urinary excretion of dosed radioactivity was significantly higher in EM (68.8%; 95% confidence interval 61.3%, 76.3%) than in PM (47.0%; 43.5%, 50.6%); only small portions (<2%) were present in faeces or bile from both genotypes. In plasma, BMS‐823778 exposure in PM was significantly (5.3‐fold, P = 0.0097) higher than in EM. Furthermore, total radioactivity exposure was significantly higher (P < 0.01) than BMS‐823778 exposure in all groups, indicating the presence of metabolites. M1 was the only metabolite observed in plasma, and much lower in PM. In urine, the amount of M1 and its oxidative metabolite in EM was 7‐fold of that in PM, while more glucuronide conjugates of BMS‐823778 and M1 were excreted in PM.

Conclusions

CYP2C19 polymorphisms significantly impacted systemic exposure and metabolism pathways of BMS‐823778 in humans.
The complexity of school racial climate: Reliability and validity of a new measure for secondary students
Authors: Byrd Christy M.
Published: August 2017

Background

The conceptualization of the role of race and culture in students’ experience of school has been limited. This study presents a more comprehensive and multidimensional framework than previously conceptualized and includes the two domains of (1) intergroup interactions (frequency of interaction, quality of interaction, equal status, and support for positive interaction) and (2) school racial socialization (cultural socialization, mainstream socialization, promotion of cultural competence, colourblind socialization, critical consciousness socialization, and stereotyping) (Byrd, 2015, Journal of Educational Research, 108, 10).

Aims

The scale presents a measure of school racial climate for middle and high school students and tests for evidence of reliability and validity in two independent, nationwide samples.

Sample and method

Participants were 819 children aged 12–18 (M = 15.27, SD = 1.58) who completed the School Climate for Diversity – Secondary Scale and a number of validating measures: general school climate, perceived discrimination, culturally responsive teaching, grades, and academic motivation.

Results and conclusions

Confirmatory factor analyses and reliability analyses showed support for the 10‐factor structure of the scale, and the subscales were associated with the validating measures in expected ways.
A longitudinal evaluation of health‐related quality of life in patients with AL amyloidosis: associations with health outcomes over time
Authors: Sanchorawala Vaishali , McCausland Kristen L. , White Michelle K. , Bayliss Martha S. , Guthrie Spencer D. , Lo Stephen , Skinner Martha
Published: August 2017

Light chain (AL) amyloidosis is a rare disease associated with significant, irreversible organ dysfunction and high case fatality. An observational study was conducted to assess health‐related quality of life (HRQoL) in patients treated for AL amyloidosis between 1994 and 2014 with both high dose melphalan and stem cell transplantation (HDM/SCT) or non‐SCT chemotherapy regimens. The SF‐36v1® Health Survey (SF‐36) was administered to assess HRQoL during clinic visits. Analysis of variance was used to compare pre‐ and post‐treatment HRQoL within each treatment group to an age‐ and gender‐adjusted general population (GP) normative sample. Cox proportional hazard models were fit to examine associations between pre‐treatment levels of HRQoL and mortality within 1 and 5 years after initiating specific treatment regimens (HDM/SCT: n = 402; non‐SCT chemotherapy regimens: n = 172). Among patients who received HDM/SCT, there were significant improvements following treatment in vitality, social functioning, role‐emotional and mental health. Worse pre‐treatment SF‐36 physical component scores were associated with a greater risk of mortality in both treatment groups and follow‐up periods (P ≤ 0·005 for both). [Correction added on 20 October 2017, after first online publication: This P value has been corrected]. Using HRQoL assessments in every physician visit or treatment may provide valuable insights for treating rare conditions like AL amyloidosis.