bluuebunny/crossref_metadata_2025 huggingface dataset:
On the road to consensus: key soft skills required for youth employment in the service sector
Authors: Singh Anjana , Jaykumar Prashanti
Published: February 2019

Purpose

Tourism and hospitality is one of the fastest growing segments of the services industry in India, and there is tremendous need and opportunity for young, educated and qualified professionals. Academics and employers agree that there is an increasing gap between the soft skills that companies expect from their entry-level employees and the skills that these young people possess. To bridge this gap, industry leaders and researchers indicate the need for more soft skills training. The purpose of this paper is to identify soft skills competencies that are required for a diverse group of entry-level employees and then to identify gaps by exploring the hospitality programme and internships.

Design/methodology/approach

The research is analytical in nature and draws on a literature review and a questionnaire as a survey tool for stakeholders. The research had separate questionnaires for employers, students and faculty members of the Vedatya Institute, educator for the service industry. The research is focused on entry-level employees – students who had graduated from Vedatya Institute in the past five years. The employers are primarily general managers and human resource managers of five-star hotels who have recruited and been part of campus interviews.

Findings

The research analysed soft or employability skills for the hospitality industry, and it provided valuable insights from employers and perceptions of graduates in attainment of those skills during their degree programme. The study highlighted the significant role of internship in developing soft skills.

Practical implications

The paper recommends practical solutions for educators and organizations that can be applied. The research synthesized current thinking on required soft skills for young entry-level employees and explores the soft skills gap in the context of a growing soft skills training market with recommendation for stakeholders.

Originality/value

The research sought to address the real life problem impacting the hospitality industry in India using inputs from the literature, graduates and employers.
Is there evidence of insider trading in Australian water markets?
Authors: de Bonviller Simon , Zuo Alec , Wheeler Sarah Ann
Published: February 2019

Insider trading is a much studied form of market manipulation in the financial market literature. However, studies addressing the issue of insider trading in resource markets, and in particular water markets, are rare. This study investigates the occurrence of insider trading practices around important water market allocation announcements in the Goulburn temporary water market trading zone in the Murray–Darling Basin, Australia, which is one of the largest and longest operating water market districts in the world. Nine years of daily water allocation volume and price transactions between 2008 and 2017 are modelled, with some evidence found of abnormal price movements in the 3 or 5 days preceding water allocation announcements, and especially before the introduction of insider trading rules in 2014. However, although the results do suggest some very weak statistically significant evidence that insider trading may still be present in Goulburn water markets post‐2014, it is just as feasible that our results may also reflect an increased sophistication of trader behaviour over time.
The Potential for Nitrogen Abatement Trading in Agriculture: A Hypothetical Market Experiment
Authors: Hansen Line B. , Termansen Mette , Hasler Berit
Published: February 2019

The effectiveness of nitrogen abatement trading as a policy measure relies on both heterogeneity in costs and environmental effectiveness across landscapes. Cost‐efficient implementation may therefore critically depend on spatial distributions of farm and farmer characteristics in water catchments. We use a spatially specific hypothetical market experiment to analyse the likelihood of farmers’ enrolment into nitrogen abatement trading contracts, and derive demand and supply functions for farmers’ nitrogen abatement. We find that farm characteristics influence both the decision whether to supply or purchase nitrogen abatement, as well as the amounts being traded. The derived demand and supply functions for farmers’ N abatement, using hypothetical market experiment data, can be used to reveal the variability in costs of abatement within a market. This provides valuable information to test potential trading schemes ex ante, to evaluate potential economic gains from policy implementation.
Industry Concentration and U.S. REIT Returns
Authors: Zhang Ying , Hansz J. Andrew
Published: February 2019

The real estate investment trusts (REITs) industry has been omitted from industry concentration studies because REITs are unique, regulated companies. We fill this research gap and investigate the relationship between REIT industry concentration and its returns. First, we demonstrate that changes in concentration drive future REIT returns, and this causality is significant and unilateral. Second, we find that changes in concentration can significantly and negatively predict future REIT returns. Third, we reveal that this predictive power is asymmetric, with stronger power on equity‐REIT than mortgage‐REIT returns. We contend that greater REIT industry concentration implies less risk leading to lower future returns and vice versa.
Nutritional and Nutraceutical Composition of Pansies (Viola × wittrockiana) During Flowering
Authors: Fernandes Luana , Ramalhosa Elsa , Baptista Paula , Pereira José A. , Saraiva Jorge A. , Casal Susana I.P.
Published: February 2019

Edible flowers consumption and use are an increasing food trend worldwide, although information concerning their nutritional composition and nutraceutical value is still scarce. Thus, the aim of this study was to contribute to the popularization of pansies (Viola × wittrockiana), through the analysis of the nutritional and nutraceutical features of pansies with different colors (white, yellow, and red) and flowering stages. Both flower type and flowering stage influenced the flower composition. When completely open, white and yellow pansies had the highest contents of protein (>2.00 g/100 g fresh weight), while red pansies had the highest content of carbohydrates (8.0 g/100 g fresh weight). Regarding the fatty acid profiles, linoleic acid was always predominant (ranging between 18.7 and 51.0 g/100 g fatty acids), followed by the palmitic and linolenic acids. During flowering, there was an increase in protein, fat, and linolenic acid contents in white and yellow pansies, whereas in red pansies the values did not change. Red pansies were characterized by the highest contents of total carotenoids (873 to 1300 µg β‐carotene/g dry weight) and monomeric anthocyanins (303 to 402 µg Cy‐3 glu/g dry weight); however, white and yellow pansies showed an increase in the values of total reducing capacity (total phenols), hydrolysable tannins, flavonoids, monomeric anthocyanins, and antioxidant activity from the bud to completely open flower stage. Our results underline the nutritional differences between pansies with different colors at distinct stages of development and their potential health benefits, suggesting that they can be used as ingredient to improve the nutritional properties of foods.

Practical application

The market of edible flowers is increasing, although little information in nutritional view is available. So, the present study was conducted to contribute to the popularization of edible flowers as a new and prospective source for the food industry, as well as a promising product for human nutrition. The results of the present study underline the nutritional differences between pansies with different colors at distinct stages of development and their potential health benefits, suggesting that they can be used as ingredient to improve the nutritional properties of foods.
Effects of Soaking on the Functional Properties of Yellow‐Eyed Bean Flour and the Acceptability of Chocolate Brownies
Authors: English Marcia M. , Viana Lauren , McSweeney Mathew B.
Published: February 2019

Dried beans are an excellent source of protein, soluble fiber, and resistant starch. In spite of their beneficial properties, the presence of off‐flavors limits their use as alternate flour sources in food applications. Soaking and then masking with flavor compounds are effective methods to remove off‐flavors in pulses; however, these strategies are not often combined in a single‐food application. The objective of this study was to determine the effect of these combined strategies on the acceptability of brownies made with bean flour and whether soaking affected the functional properties of the flour samples. Yellow‐eyed (YE) beans were soaked for 24 hr, dried in an oven (treated), and then ground to form flour using a kitchen mill. The check‐all‐that‐apply scores revealed that brownies made with 100% YE flour had nutty and beany flavors. However, consumer liking of brownies made with 50:50 and 25:75 all‐purpose (AP):YE‐treated flour blends, respectively, were not significantly different from the control brownies made with AP flour. Starch content varied significantly among the treated (42.9 ± 3.2%, P < 0.05) and untreated YE bean flour samples (35.3 ± 1.9%). The treated YE flour showed the highest water absorption index, 3.69 ± 0.12. Overall, combining soaking and the use of chocolate were successful strategies to reduce off‐flavors in cake‐style brownies, which suggest that up to 50% treated YE flours may be used as a suitable partial replacer of AP flour in chocolate brownies.

Practical Application

Soaking yellow‐eyed (YE) beans prior to milling, combined with the use of chocolate were successful strategies to mask off‐flavors in cake‐style brownies. The significance of the findings of this study lies in the fact that treated YE flours may be used as a suitable partial replacer of AP flour in chocolate brownies. The use of these strategies has the potential to increase the consumption of pulse flours in Canada.
Genetic diversity and population structure of Pepino mosaic virus in tomato crops of Spain and Morocco
Authors: Gómez‐Aix Cristina , Alcaide Cristina , Agüero Jesús , Faize Mohamed , Juárez Miguel , Díaz‐Marrero Carlos J. , Botella‐Guillén Moises , Espino Ana I. , Aranda Miguel A. , Gómez Pedro
Published: February 2019

Pepino mosaic virus (PepMV, genus Potexvirus) is an emergent and highly infectious pathogen responsible for economically important diseases in tomato crops. An extensive survey of tomato plants showing PepMV‐like symptoms was carried out in 2017 to study the PepMV genetic diversity and populations structure in different tomato‐producing areas of Spain and Morocco. Molecular dot‐blot hybridization analysis showed that virus populations from Spain and Morocco were mainly composed of isolates belonging to the Chilean 2 (CH2) strain, although isolates of the European (EU) strain were detected in significant proportions in Spanish populations, mainly in mixed infections. A few isolates of the American (US1) strain were also detected in Tenerife (Canary Islands, Spain) crops. Eighty‐five isolates were randomly selected and sequenced in the genomic region that encodes the triple gene block and capsid protein genes. Our phylogenetic and population genetics analyses confirmed the presence of the CH2, EU and US1 PepMV strains. Despite the high genetic similarity observed within populations, variants were maintained at low frequency under purifying selection, and differentiation among more geographically distant locations was identified, with potential gene flow contributing to the shaping of the PepMV populations structure.
Neighborhood deprivation and adverse perinatal outcomes in Sweden: A population‐based register study
Authors: Hesselman Susanne , Wikström Anna‐Karin , Skalkidou Alkistis , Sundström‐Poromaa Inger , Wikman Anna
Published: February 2019

Introduction

Neighborhood deprivation has been associated with adverse perinatal outcomes but it is unclear to what extent maternal and social risk factors explain the association and how a stressful environment per se contributes.

Material and methods

A population‐based register study including 218 030 deliveries in Sweden between January 2013 and July 2017 was conducted. Exposure was living in a deprived or severely deprived area defined by the National Operations Department of the Swedish Police Authority. Adverse perinatal outcomes included preterm births, small‐for‐gestational‐age births and stillbirths. A propensity score‐based method was used to control for individual baseline characteristics. Associations were investigated with logistic regression analyses and risk estimates are presented as crude (OR) and adjusted odds ratio (aOR) with 95% confidence interval (CI).

Results

Living in a deprived neighborhood in Sweden was associated with extremely preterm births (deprived area OR 1.50, 95% CI 1.07‐2.11, severely deprived OR 1.90, 95% CI 1.40‐2.58), small‐for‐gestational‐age birth (deprived OR 1.45, 95% CI 1.31‐1.60, severely deprived OR 1.85, 95% CI 1.69‐2.03) and stillbirth (deprived OR 1.62, 95% CI 1.17‐2.26, severely deprived OR 1.56, 95% CI 1.11‐2.19). After accounting for individual maternal and social risk factors, the risk of small for gestational age in severely deprived areas remained (aOR 1.45, 95% CI, 1.19‐1.75).

Conclusions

The contextual effect of living in a deprived neighborhood on the risk of extremely preterm births, small‐for‐gestational‐age births and stillbirths was to a high extent explained by individual factors of women residing in exposed areas, yet remained for small‐for‐gestational‐age births in severely deprived areas after adjustment for maternal and social risk factors.
Strategies to improve selection of creative ideas: An experimental test of epistemic and social motivation in groups
Authors: Van Damme Michaël J.J.P.S. , Anseel Frederik , Duyck Wouter , Rietzschel Eric F.
Published: February 2019

Pre‐implementation activities like idea selection play a crucial role in the innovation process. However, groups of people seem to perform rather poorly when it comes to selecting creative ideas for implementation. The Motivated Information Processing in Groups model (MIP‐G) provides an explanation as to why some groups outperform others when it comes to making group decisions. On the basis of the MIP‐G framework, we hypothesized that groups that are both epistemically and prosocially motivated would outperform other groups in selecting creative ideas. Contrary to our hypothesis, a 2 × 2 experiment in a field sample (N = 240 or 80 three‐person groups) showed that under conditions of high epistemic motivation, proself motivated groups selected significantly more creative and original ideas than prosocial groups. Proself motivated groups did not differ significantly from the prosocial motivated groups in selecting feasible ideas under conditions of high epistemic motivation. Our results suggest that the MIP‐G framework may need refinement to increase our future understanding of group idea selection. To this end, we propose three specific avenues for future research.
Harnessing the potential of integrated systematics for conservation of taxonomically complex, megadiverse plant groups
Authors: Nic Lughadha Eimear M. , Graziele Staggemeier Vanessa , Vasconcelos Thais N. C. , Walker Barnaby E. , Canteiro Cátia , Lucas Eve J.
Published: February 2019

The value of natural history collections for conservation science research is increasingly recognized, despite their well‐documented limitations in terms of taxonomic, geographic, and temporal coverage. Specimen‐based analyses are particularly important for tropical plant groups for which field observations are scarce and potentially unreliable due to high levels of diversity‐amplifying identification challenges. Specimen databases curated by specialists are rich sources of authoritatively identified, georeferenced occurrence data, and such data are urgently needed for large genera. We compared entries in a monographic database for the large Neotropical genus Myrcia in 2007 and 2017. We classified and quantified differences in specimen records over this decade and determined the potential impact of these changes on conservation assessments. We distinguished misidentifications from changes due to taxonomic remodeling and considered the effects of adding specimens and georeferences. We calculated the potential impact of each change on estimates of extent of occurrence (EOO), the most frequently used metric in extinction‐risk assessments of tropical plants. We examined whether particular specimen changes were associated with species for which changes in EOO over the decade were large enough to change their conservation category. Corrections to specimens previously misidentified or lacking georeferences were overrepresented in such species, whereas changes associated with taxonomic remodeling (lumping and splitting) were underrepresented. Among species present in both years, transitions to less threatened status outnumbered those to more threatened (8% vs 3%, respectively). Species previously deemed data deficient transitioned to threatened status more often than to not threatened (10% vs 7%, respectively). Conservation scientists risk reaching unreliable conclusions if they use specimen databases that are not actively curated to reflect changing knowledge.
The European trade ban on wild birds reduced invasion risks
Authors: Cardador Laura , Tella José L. , Anadón José D. , Abellán Pedro , Carrete Martina
Published: February 2019

International wildlife trade is a major source of current biological invasions. However, the power of trade regulations to reduce invasion risks at large, continental scales has not been empirically assessed. The European wild bird trade ban was implemented in 2005 to counter the spread of the avian flu. We tested whether the ban reduced invasion risk in two European countries, where 398 nonnative bird species were introduced into the wild from 1912 to 2015. The number of newly introduced species per year increased exponentially until 2005 (in parallel with the volume of wild bird importations), and then sharply decreased in subsequent years. Interestingly, a rapid trade shift from wild‐caught birds to captive‐bred birds, which have lower invasive potential than wild‐caught birds, allowed the maintenance of bird availability in markets. Our results demonstrate the effectiveness of a trade ban for preventing biological invasions without impacting the ability to meet societal demands.
Measuring executive function skills in young children in Kenya: Associations with school readiness
Authors: Willoughby Michael T. , Piper Benjamin , Oyanga Arbogast , Merseth King Katherine
Published: February 2019

Most of what is known about the association between children’s executive function (EF) and school readiness skills is derived from research conducted in Western countries. We tested whether these associations were evident in a middle‐income country context. Participants were 1,480 children, aged 4–7 years old, who participated in an endline assessment of the Tayari program, an early childhood education (ECE) model that is being delivered by the Kenyan education system. High rates of task completion, low rates of floor effects, and high rates of assessor quality ratings supported the feasibility of large‐scale direct assessments of EF with young children. Assessor ratings of children’s attention‐related behaviors during testing were positively associated with their performance on EF tasks (rs = 0.12–0.27). An EF composite score was not related to demographic factors or to children’s exposure to the Tayari program. However, the EF composite score was uniquely associated with performance‐based measures of early literacy (β = 0.18, 95% confidence interval [CI] = 0.05, 0.31), early numeracy (β = 0.16, 95% CI = 0.07, 26), and social‐emotional competencies (β = 0.12, 95% CI = 0.03, 0.20), even after adjustment for multiple covariates. These results are discussed with respect to the ways in which EF skills inform ongoing efforts to invest in ECE in low‐ and middle‐income countries.
Improved set‐size labeling mediates the effect of a counting intervention on children's understanding of cardinality
Authors: O'Rear Connor D. , McNeil Nicole M.
Published: February 2019

How does improving children's ability to label set sizes without counting affect the development of understanding of the cardinality principle? It may accelerate development by facilitating subsequent alignment and comparison of the cardinal label for a given set and the last word counted when counting that set (Mix et al., 2012). Alternatively, it may delay development by decreasing the need for a comprehensive abstract principle to understand and label exact numerosities (Piantadosi et al., 2012). In this study, preschoolers (N = 106, Mage = 4;8) were randomly assigned to one of three conditions: (a) count‐and‐label, wherein children spent 6 weeks both counting and labeling sets arranged in canonical patterns like pips on a die; (b) label‐first,wherein children spent the first 3 weeks learning to label the set sizes without counting before spending 3 weeks identical to the count‐and‐label condition; (c) print referencing control. Both counting conditions improved understanding of cardinality through increases in children's ability to label set sizes without counting. In addition to this indirect effect, there was a direct effect of the count‐and‐label condition on progress toward understanding of cardinality. Results highlight the roles of set labeling and equifinality in the development of children's understanding of number concepts.
Assessment of decreased left ventricular longitudinal deformation in asymptomatic patients with organic mitral regurgitation and preserved ejection fraction using tissue‐tracking mitral annular displacement by speckle‐tracking echocardiography
Authors: Teraguchi Ikuko , Hozumi Takeshi , Takemoto Kazushi , Ota Shingo , Kashiwagi Manabu , Shimamura Kunihiro , Shiono Yasutsugu , Kuroi Akio , Yamano Takashi , Yamaguchi Tomoyuki , Matsuo Yoshiki , Ino Yasushi , Kitabata Hironori , Kubo Takashi , Tanaka Atsushi , Akasaka Takashi
Published: February 2019

Background

Application of speckle‐tracking echocardiography (STE) provides rapid assessment of tissue‐tracking mitral annular displacement (TMAD). We investigated the value of TMAD for the assessment of decreased LV longitudinal deformation in asymptomatic patients with severe or moderate‐to‐severe mitral regurgitation (MR) and preserved LV ejection fraction (LVEF).

Methods

We retrospectively studied 50 patients with severe or moderate‐to‐severe organic MR and preserved LVEF (>60%) in whom global longitudinal strain (GLS) was successfully measured by STE. TMAD was quickly assessed in the apical four‐chamber view using STE. We calculated the percentage of TMAD to LV length from the midpoint of mitral annulus to the apex at end‐diastolic (%TMAD). The study population was divided into two groups: decreased GLS patients (>−20%; Group A) and preserved GLS patients (≤−20%; Group B). We examined whether %TMAD could be used as a diagnostic factor of decreased GLS.

Results

%TMAD was significantly lower in Group A than Group B (12.5 ± 0.5 vs 16.8 ± 2.2, P < 0.0001). By univariate logistic regression analysis, %TMAD was a diagnostic factor of decreased GLS. By multiple regression analysis, %TMAD remained an independent diagnostic factor of decreased GLS (Odds ratio [OR] = 4.21, 95% confidence interval [CI] = 1.34–28.94, P < 0.0001). A cutoff value of %TMAD <14.6 had a sensitivity of 94% and specificity of 94% for the presence of decreased GLS.

Conclusions

Tissue‐tracking mitral annular displacement is useful in the assessment of decreased LV longitudinal deformation in asymptomatic patients with severe or moderate‐to‐severe MR and preserved LVEF.
Churn prediction and social neighbour influences for different types of user groups in virtual worlds
Authors: Liu Duen‐Ren , Liao Hsiu‐Yu , Chen Kuan‐Yu , Chiu Yi‐Ling
Published: February 2019

In virtual worlds (VWs), users have more VW games alternatives, whereas VW companies consequently suffer from high customer turnover rate and low customer loyalty. Therefore, building a churn prediction model to facilitate subsequent churn management and customer retention is important. The churn behaviours and the impact of social neighbour influences to customer churn may be different for different types of users. Accordingly, we segment users into stable, unstable, and solitary user groups according to their social contact behaviours in VWs. Novel segmentation‐based churn prediction approaches are proposed for churn prediction in VWs by building prediction models for each type of user groups and considering the effect of social neighbour influences for different user groups. The proposed approaches are evaluated by conducting experiments with a dataset collected from a VW platform. The experimental results show different churn prediction performances under different user groups. The segmentation‐based churn prediction approaches perform better than do general approaches without considering user groups. Moreover, the results also reveal that social neighbour influences have a positive impact on stable and unstable users. The proposed work contributes to investigating the social neighbour influences on churn prediction for different types of user groups in VWs.
Short photoperiod reduces the temperature sensitivity of leaf‐out in saplings of Fagus sylvatica but not in horse chestnut
Authors: Fu Yongshuo H. , Piao Shilong , Zhou Xuancheng , Geng Xiaojun , Hao Fanghua , Vitasse Yann , Janssens Ivan A.
Published: February 2019

Leaf phenology is one of the most reliable bioindicators of ongoing global warming in temperate and boreal zones because it is highly sensitive to temperature variation. A large number of studies have reported advanced spring leaf‐out due to global warming, yet the temperature sensitivity of leaf‐out has significantly decreased in temperate deciduous tree species over the past three decades. One of the possible mechanisms is that photoperiod is limiting further advance to protect the leaves against potential damaging frosts. However, the “photoperiod limitation” hypothesis remains poorly investigated and experimentally tested. Here, we conducted a photoperiod‐ and temperature‐manipulation experiment in climate chambers on two common deciduous species in Europe: Fagus sylvatica (European beech, a typically late flushing species) and Aesculus hippocastanum (horse chestnut, a typically early flushing species). In agreement with previous studies, we found that the warming significantly advanced the leaf‐out dates by 4.3 and 3.7 days/°C for beech and horse chestnut saplings, respectively. However, shorter photoperiod significantly reduced the temperature sensitivity of beech only (3.0 days/°C) by substantially increasing the heat requirement to avoid leafing‐out too early. Interestingly, the photoperiod limitation only occurs below a certain daylength (photoperiod threshold) when the warming increased above 4°C for beech trees. In contrast, for chestnut, no photoperiod threshold was found even when the ambient air temperature was warmed by 5°C. Given the species‐specific photoperiod effect on leaf phenology, the sequence of the leaf‐out timing among forest tree species may change under future climate warming conditions. Nonphotoperiodic species may benefit from warmer springs by starting the growing season earlier than photoperiodic sensitive species, modifying forest ecosystem structure and functions, but this photoperiod limitation needs to be further investigated experimentally in numerous species.
A possible link between polyunsaturated fatty acids and uremic toxins from the gut microbiota in hemodialysis patients: A hypothesis
Authors: Kemp Julie Ann , Esgalhado Marta , Macedo Renata Azevedo , Regis Bruna , Damasceno Nágila Raquel Teixeira , da Silva Torres Elizabeth Aparecida Ferraz , Gonçalinho Gustavo Henrique Ferreira , Borges Natália Alvarenga , Nakao Lia Sumie , Fouque Denis , Mafra Denise
Published: February 2019

Introduction: Indoxyl sulfate (IS) and p‐cresyl sulfate (p‐CS) are albumin‐bound uremic toxins that are difficult to remove by hemodialysis (HD). Human serum albumin (HSA) carries several compounds, including fatty acids that can bind to site II of HSA and represent competing ligands for uremic toxins. The aim of this study was to investigate the association between fatty acids and uremic toxin plasma levels in patients undergoing HD.

Methods: Thirty‐three HD patients (51.5% male, 54.9 ± 10.2 years old, 44.63 ± 28.4 months on HD, albumin level of 3.8 ± 0.3 g/dL) were evaluated. The erythrocyte fatty acid content (saturated fatty acid [SFA], monounsaturated fatty acid [MUFA], and polyunsaturated fatty acid [PUFA]) was measured by gas chromatography, and total IS and p‐CS plasma levels were measured by reversed‐phase high‐performance liquid chromatography.

Findings: The mean percentages of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) + DHA and gamma‐linolenic (GLA) acid in the erythrocyte membrane were 1.35% ± 0.74%, 1.85% ± 0.79%, and 0.33% ± 0.26%, respectively. The mean levels of IS and p‐CS were 19.4 ± 11.9 mg/dL and 101.5 ± 57.2 mg/dL, respectively. There was no significant association between SFA and MUFA and IS and p‐CS; however, a negative correlation was found between p‐CS and specific PUFAs, and the association between GLA and p‐CS levels was retained after adjusting for potential confounding variables (β = −0.49, P = 0.007).

Discussion: Polyunsaturated fatty acids may contribute to the decrease in p‐CS uremic toxin plasma levels in patients with chronic kidney disease undergoing HD.
Increased risk of Staphylococcus aureus bacteremia in hemodialysis—A nationwide study
Authors: Chaudry Mavish S. , Gislason Gunnar H. , Kamper Anne‐Lise , Rix Marianne , Larsen Anders R. , Petersen Andreas , Andersen Paal S. , Skov Robert L. , Fosbøl Emil L. , Westh Henrik , Schønheyder Henrik C. , Benfield Thomas L. , Fowler Vance G. , Torp‐Pedersen Christian , Bruun Niels E.
Published: February 2019

Introduction: Staphylococcus aureus bacteremia (SAB) is a high‐risk infection and feared complication related to hemodialysis. This study aimed to investigate incidence and risk factors for SAB depending on hemodialysis access type.

Methods: The Danish National Registry on Regular Dialysis and Transplantation was used to identify patients from January 1, 1996 to December 31, 2011 with end‐stage kidney disease. Patients were followed until death, the first episode of SAB, or end of study (December 31, 2011). Independent risk factors were assessed by multivariable Poisson regression with time‐updated exposure variables.

Findings: Total of 9997 patients were included. The initial modality of renal replacement therapy was hemodialysis in 6826 patients and peritoneal dialysis in 2882 patients; 289 patients had preemptive kidney transplantation. SAB occurred in 1278 patients (12.8%). The incidence rate of SAB declined after 90 days and leveled off after 270 days in hemodialysis, peritoneal dialysis, and kidney transplanted. As compared to peritoneal dialysis, the adjusted rate ratio (RR) for SAB was 7.42 (95% CI 5.63–9.79) in uncuffed central venous catheter (CVC), 5.68 (95% CI 4.39–7.36) in cuffed CVC, 4.43 (95% CI 2.10–9.53) in arteriovenous graft, and 3.40 (95% CI 2.79–4.15) in arteriovenous fistula. SAB risk did not differ between uncuffed and cuffed CVC. The risk of SAB was increased during the first three months of renal replacement therapy especially for CVC (RR 11.37 [95% CI7.09–18.22]) compared with peritoneal dialysis. Diabetes mellitus (RR 1.35 [95% CI 1.20–1.51]) and male sex (RR 1.15 [95% CI 1.03–1.29]) were also associated with SAB.

Discussion: Patients on hemodialysis had a high incidence rate of SAB, particularly those undergoing hemodialysis via CVC. SAB risk was comparable for cuffed and uncuffed CVC. Diabetes mellitus, male sex, and the first three months in renal replacement therapy were independently associated with SAB.
A prototype line clamp for venous access bleeding in hemodialysis: A prospective cohort study
Authors: Kennedy Claire , McGrath‐Chong Margaret , Arustei Daniela , d'Gama Celine , Faratro Rose , Fung Stella , Magtoto Eduardo , Wong Elizabeth , Chan Christopher T.
Published: February 2019

Introduction: Venous needle dislodgement (or venous port disconnection) during hemodialysis (HD) may lead to catastrophic blood loss, particularly during unsupervised home HD. A prototype venous line clamp was developed for use in conjunction with the Redsense blood loss sensor. We hypothesize that this prototype device will provide additional safety to dialysis without excessive burden.

Methods: This was a single‐center, prospective cohort study. Participants kept a log of bleeding, troubleshooting and clamp deployment events, and completed questionnaires before device first use and after device final use. The primary outcome was appropriate device function, evaluated by review of bleeding and clamp deployment events. The secondary outcomes were patient/nursing staff expectations and experience of the device.

Findings: Fourteen patients used the device during a combined total of 214 HD treatments. Five participants (36%) had experienced a bleeding or disconnection event prior to study recruitment. All vascular access types were represented. The device was tested during incenter HD (n = 7 patients) and home HD (n = 7 patients). There were eight clamp deployment events, three of which were in the setting of minor bleeding at the venous access site. No other bleeding events were reported. The main troubleshooting issues were related to cumbersome device connections. Participants perceived additional safety with the device (median score 4.25 out of 5; range 1–5). However, the amount of additional work created was variable, and large in some cases (median score 2 out of 5; range 0–4.5). There was no association between HD vintage and device burden (P = 0.55).

Discussion: This “proof of concept” study confirmed that a clamp on the venous line, operating in conjunction with a venous access blood detector, is feasible regardless of HD location or vascular access type. The device improved patient safety perception during HD but was burdensome. Design modifications could improve future device iterations.
Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease
Authors: Parker Krystina , Bull‐Engelstad Ingrid , Aasebø Willy , von der Lippe Nanna , Reier‐Nilsen Morten , Os Ingrid , Stavem Knut
Published: February 2019

Introduction: Elderly patients with chronic kidney disease (CKD) stage 5 with or without dialysis treatment usually have concomitant comorbidities, which often result in multiple pharmacological therapies. This study aimed to identify factors associated with medication complexity and medication adherence, as well as the association between medication complexity and medication adherence, in elderly patients with CKD.

Methods: This prospective study involved elderly patients with CKD stage 5 (estimated glomerular filtration rate < 15 ml/min/1.73m2) recruited from three Norwegian hospitals. Most of the patients were receiving either hemodialysis or peritoneal dialysis. We used the Medication Regimen Complexity Index (MRCI) to assess the complexity of medication regimens, and the eight‐item Morisky Medication Adherence Scale (MMAS‐8) to assess medication adherence. Factors associated with the MRCI and MMAS‐8 score were determined using either multivariable linear or ordinal logistic regression analysis.

Findings: In total, 157 patients aged 76 ± 7.2 years (mean ± SD) were included in the analysis. Their overall MRCI score was 22.8 ± 7.7. In multivariable linear regression analyses, female sex (P = 0.044), Charlson Comorbidity Index of 4 or 5 (P = 0.029) and using several categories of phosphate binders (P < 0.001 to 0.04) were associated with the MRCI. Moderate or high adherence (MMAS‐8 score ≥ 6) was demonstrated by 83% of the patients. The multivariable logistic regression analyses found no association of medication complexity, age or other variables with medication adherence as assessed using the MMAS‐8.

Discussion: Female sex, comorbidity and use of phosphate binders were associated with more‐complex medication regimens in this population. No association was found between medication regimen complexity, phosphate binders or age and medication adherence. These findings are based on a homogeneous elderly group, and so future studies should test if they can be generalized to patients of all ages with CKD.
Imiquimod 3.75% for field‐directed therapy of actinic keratosis: results of a prospective case‐series study in Greece
Authors: Befon Angeliki , Tzanetakou Vassiliki , Panagiotopoulos Antonios , Chasapi Vasiliki , Antoniou Christina , Stratigos Alexander J.
Published: February 2019

Background

Imiquimod 3.75% is a field‐directed treatment for actinic keratosis that can detect and treat clinical and subclinical lesions across an entire sun‐exposed field. The detection of subclinical lesions is evidenced by an increase in lesions to the maximum lesion count during treatment (Lmax). We report clinical outcomes for the first 15 patients treated with imiquimod 3.75% in daily clinical practice in Greece.

Methods

Fifteen patients with actinic keratosis lesions were treated with imiquimod 3.75% in an outpatient setting in two 2‐week treatment cycles separated by a 2‐week treatment‐free interval. Actinic keratosis lesions were counted before treatment, at the end of the first treatment cycle (Week 2; Lmax), and 2 weeks after the second treatment cycle (Week 8). Local skin reactions (LSR) were also evaluated at Weeks 2 and 8.

Results

The median baseline actinic keratosis lesion count was 25, which increased to a median Lmax of 29 at Week 2 and decreased to a median of 5 at Week 8. The median percentage and absolute reduction in actinic keratosis lesions from Lmax to Week 8 were 87% and 23%, respectively. Most of the LSR were mild‐to‐moderate in intensity at Week 2 and had resolved by Week 8.

Conclusion

Imiquimod 3.75% effectively detected and cleared both the clinical and subclinical actinic keratosis lesions across the entire sun‐exposed field in this cohort of Greek patients. Treatment was well tolerated.
Standardization of reticulocyte counts in the athlete biological passport
Authors: Naud Jean‐François , Giraud Sylvain , Robinson Neil , Desharnais Philippe , Ericsson Magnus , Saugy Martial , Kuuranne Tiia , Ayotte Christiane , Boghosian Thierry , Aikin Reid , Sottas Pierre‐Edouard
Published: February 2019

Introduction

The percentage of circulating reticulocytes (RET%) is a useful marker of blood doping in the context of the Athlete Biological Passport (ABP). The viability of the ABP depends on the comparability of sample data obtained across multiple laboratories for a given athlete. With the recent introduction of a different technology for the measurement of reticulocytes, the goal of this study was to compare currently employed Sysmex XT/XE analyzers to the recently introduced Sysmex XN analyzer.

Methods

RET% differences were searched in two independent data sets, the first consisting of 95 369 RET% values coming from 29 laboratories located in five continents as part of routine testing for the ABP, the second from a targeted study involving 510 samples analyzed on both a Sysmex XT and XN analyzers by two different laboratories.

Results

A relatively small but significant bias of 0.27 ([0.22‐0.35] 95% CI) for the first data set and 0.19% ([0.16‐0.22] 95% CI) for the second data set was observed with Sysmex XN analyzers returning higher values than Sysmex XT/XE analyzers. This bias appears constant over most of the range of RET% measured in elite athletes.

Conclusion

When RET% values are obtained for the same athlete with different technologies (XT/XE vs XN), an adjustment of RET% emanating from the XT/XE instruments through a decrease of 0.22% within the ABP calculated ranges appears to be sufficient to integrate the results from the two technologies.
Human inborn errors of the actin cytoskeleton affecting immunity: way beyond WAS and WIP
Authors: Tangye Stuart G , Bucciol Giorgia , Casas‐Martin Jose , Pillay Bethany , Ma Cindy S , Moens Leen , Meyts Isabelle
Published: February 2019

Inherited defects in genes encoding for proteins that are involved in the assembly and dynamics of the actin skeleton have increasingly been identified in patients presenting with primary immunodeficiencies. In this review, we summarize a subset of the recently described conditions, emphasizing the clinical features as well as the immunophenotype and pathophysiology.
Cognitive function during exacerbations of chronic obstructive pulmonary disease
Authors: Poot Betty , Travers Justin , Weatherall Mark , McGinty Melinda
Published: February 2019

Background

The reported prevalence of cognitive impairment in patients with stable chronic obstructive pulmonary disease (COPD) ranges 36‐77%. Few studies report the prevalence of cognitive impairment in acutely unwell COPD patients.

Aims

To determine the prevalence and time course of cognitive impairment in patients with COPD during and after an admission to hospital with an exacerbation of the disease.

Methods

Patients admitted to hospital with an exacerbation of COPD between October 2013 and November 2014 were administered the Montreal Cognitive Assessment tool, COPD assessment test and modified Borg dyspnoea scale at three points in time: within 24 h of admission, between 48 and 72 h after admission and 6 weeks post discharge.

Results

Twenty‐five patients agreed to participate. Four withdrew from the study after the initial evaluation. The mean (range) COPD assessment test score 24 h after admission was 26 (18–37). Cognitive impairment was found in 19/25 (76%) patients at the initial evaluation, 16/21 (76%) patients at the second evaluation. Overall, 22/25 (88%) showed cognitive impairment within 72 h of an exacerbation of COPD. Fourteen out of 21 (66%) patients showed cognitive impairment at the final evaluation. The mean Montreal Cognitive Assessment scores improved from admission (22.6) to the second evaluation (23.3) to the final evaluation 3 (24.4), but this change was not statistically significant.

Conclusion

Cognitive impairment is highly prevalent during hospital admissions with an exacerbation of COPD. This impairment does improve with time, but only a minority recover within a normal range. This will affect patients’ abilities to understand and remember information given to them in hospital and adhere to medication regimens.
Why go to the emergency department? Perspectives from persons with borderline personality disorder
Authors: Vandyk Amanda , Bentz Andrea , Bissonette Sarah , Cater Caitlyn
Published: February 2019

Through this qualitative study, we explored frequent emergency department use by persons with borderline personality disorder from their perspective. Interpretive description guided the study design, and data were collected through interviews with six individuals diagnosed with borderline personality disorder who had at least 12 emergency department visits for reasons related to their mental illness within a 1‐year timeframe. Using thematic data analysis, we articulate the participants’ experiences through two broad themes: cyclic nature of emergency department use and coping skills and strategies. Unstable community management that leads to self‐ or crisis presentation to the emergency department often perpetuated emergency department use by our participants and the ensuing interventions aimed at acute stabilization. The participants identified a desire for human interaction and feelings of loneliness, failure of community resources (such as crisis lines or therapy), and safety concerns following suicidal ideation, self‐harm, or substance use as the main drivers for their emergency department visits. Our participants identified several potential strategies to protect them against unnecessary emergency department use and improve their health care overall. More work is needed to explore the viability and effectiveness of these suggestions.
Carers of people from LGBTQ communities interactions with mental health service providers: Conflict and safety
Authors: Martin Jennifer , Butler Meredith , Muldowney Anne , Aleksandrs Gabriel
Published: February 2019

This exploratory study examines the experiences of informal/family carers of people from LGBTQ communities living with mental illness, or experiencing a mental health crisis, in relation to conflict and safety in their interactions with mental health service providers. Carers were surveyed to gain an understanding of their experiences of services. The data were analysed according to the six main originating domains in the Safewards model where conflict may arise as well as the nature of the activity in the domain with the addition of new categories of ‘carer characteristics’ and ‘carer modifiers’. The study findings identified the main domains where conflict occurred, as well as modifications to activities undertaken by staff, consumers, and carers that reduced tensions and misunderstandings. Carer responses revealed the interplay between the Safewards domains and activities and the location of much of what was considered conflict with staff reflecting the regulatory environment services were provided in. This study highlights distinctive carer characteristics and the important conflict modifying role of carers. The findings suggest that the expansion of the Safewards model to include carers may be beneficial.
Ejection chain moves for automatic neighborhood synthesis in constrained cardinality‐minimization problems
Authors: Adamo Tommaso , Ghiani Gianpaolo , Guerriero Emanuela , Manni Emanuele
Published: February 2019

In this paper, we deal with the problem of automatically synthesizing “good” neighborhoods for a specific class of problems, namely constrained cardinality‐minimization problems. Exploiting the peculiarity of the objective function of such problems, we develop automatic ejection chain moves that define neighborhood structures to be explored with a black‐box solver. In particular, starting from a formulation of a cardinality‐minimization problem and a feasible solution, our procedure automatically detects the “entities” involved in the problem and learns the strength of the relationships among them. This information is then used to define the characteristics of our moves that consist in ejecting one entity at a time from the solution. If one of such moves results in an infeasible solution, then feasibility is recovered by performing an additional step based on the solution of an auxiliary problem. The computational results show that, when assessed on four well‐known constrained cardinality‐minimization problems, our approach outperforms both a black‐box mixed integer programming solver and a state‐of‐the‐art model‐based neighborhood search procedure with respect to both solution quality and computing times.