bluuebunny/crossref_metadata_2025 huggingface dataset:
Extended TPB model to understand consumer “selling” behaviour
Authors: Kumar Anita
Published: August 2017

Purpose

Many academic studies on reverse supply chain management have emphasised on the development of conceptual and operational models for managing returns and extracting value, but have largely ignored the consumer selling behaviour, the starting point of a reverse supply chain. The purpose of this paper is to consider a twofold perspective to understand and analyse the reverse supply chain design of mobile phone in Delhi NCR: first, motivation and intentions of consumer selling their mobile phones and second, the returns management process through the organised and informal channels.

Design/methodology/approach

It first utilises a survey methodology and the theory of planned behaviour (TPB) model to understand and analyse the consumers’ intentions to recycle and then employs an in-depth interview methodology to derive qualitative insights needed to plot the reverse supply chain design.

Findings

In an extended TPB model, attitude, mediated by a “sense of duty” and perceived control, has a strong influence on the recycling behaviour than subjective norms and benefits. The qualitative insights draw attention to the design, configuration and management of informal and organised recycling channels that differ significantly, but remain relevant and coexist, especially in the context of emerging economies.

Research limitations/implications

It proposes an extended TPB model to understand consumer selling behaviour that can help the companies to plan and handle their demand-supply mechanisms in the reverse supply chain.

Social implications

This study calls for a proactive intervention by the Indian Government and other key stakeholders to regulate and streamline electrical and electronics waste management in India.

Originality/value

This research is positioned at the interface of logistics and marketing to understand and create a sustainable reverse supply chain design for high-value products.
Returns to search when consumers use and do not use recommendation agents
Authors: Maheswarappa Satish Sasalu , Sivakumaran Bharadhwaj , Kumar Arun G.
Published: August 2017

Purpose

The purpose of this paper is to investigate returns to search (getting a better product and/or a lower price as a result of search) when consumers use/do not use recommendation agents (RAs). Specifically, it studies the effect of RAs/no RAs on decision quality, decision confidence and decision satisfaction taking into account subjective knowledge (SK) and involvement.

Design/methodology/approach

This paper employed two between-subjects factorial experimental designs with subjects searching for digital cameras in a simulated online digital camera store. The experiment was conducted with graduate students in Chennai, Bengaluru and Mysore in India.

Findings

Results of two online experiments showed that when consumers used RAs, low search led to better decision quality, whereas when consumers did not use RAs, medium search led to optimum decision quality. When consumers use RAs, SK had a U-shaped influence on the decision quality indicating that decision quality was the lowest for those with medium SK. When consumers did not use RAs, the effect of SK on decision quality was an inverted U-shape, indicating optimum decision quality for medium SK consumers. When consumers did not use RAs, subjects with high involvement made better choices, whereas when consumers used RAs, low involvement subjects made better choices. However, subjects who searched more had higher decision confidence and decision satisfaction even if their choices were not better.

Originality/value

The effect of RA vs no RA in conjunction with relevant consumer characteristics influencing decision quality of the consumer is demonstrated in this study. The findings have important managerial, consumer and theoretical contributions to make.
Service quality of sports centers and customer loyalty
Authors: Lee Sheng Yen
Published: August 2017

Purpose

The purpose of this paper is to establish the effects of service quality of sports centers on customer loyalty and intention to adhere to exercise.

Design/methodology/approach

In total, 500 questionnaires were distributed to five sports centers located in the city of Seoul, of which 472 were returned and used in the data analysis. The collected data were subjected to frequency analysis, exploratory factor analysis, a reliability test, and structural equation model analysis using SPSS 21.0 and AMOS 18.0.

Findings

The results show that, first, service quality, comprising the two factors of the facilities of sports centers and instructors, positively influences customer loyalty. Second, the service quality of sports centers positively influences the intention to adhere to exercise, and, third, so does customer loyalty.

Practical implications

Management needs to make more efforts to strengthen service quality, comprising facilities and instructors, in order to increase customer loyalty, represented by the sense of closeness with and attachment of customers using sports centers, as well as to increase the need for exercise.

Originality/value

Previous studies on the service quality of sports centers have been limited to customer satisfaction, customer trust, reuse intention, recommendations to others, consumption behavior, and relationship commitment. Since the research on the direct relationship between service quality of sports centers and exercise adherence is still limited, this study provides data and implications relevant to the management of sports centers by investigating the relationship among service quality of sports centers, customer loyalty, and intention to adhere to exercise.
Local collaboration network in management of built heritage
Authors: Lwoga Noel Biseko
Published: August 2017

Purpose

The purpose of this paper is to apply stakeholder and network theories to explore local collaboration network, its structural features and their implications to the management of the built heritage.

Design/methodology/approach

This paper applies stakeholder and network analyses. It follows a case study approach using multiple data collection methods such as the documentary analysis, and semi-structured interviews with 22 local stakeholders in the Pangani Conservation Task Force’s (PCTF’s) in Tanzania. It subjects the data to thematic analysis through the NVivo program, and to network analysis through the UCINET and NETDRAW programs.

Findings

This paper indicates that the PCTF is composed of heterogeneous stakeholders who are networked in a less cohesive structure, whereby the collaboration system is dominated by conservation actors while marginalizing tourism and some local resident groups. This structure, despite its inherent disadvantages, was found to enhance the achievement of PCTF’s conservation goals in the short term.

Research limitations/implications

The single case study approach makes generalizing beyond the study area difficult. Nevertheless, the findings raise relevant issues for further multiple-case investigations on collaboration systems from a built heritage perspective.

Originality/value

This paper is the first insightful exploration of the stakeholder collaboration system in the local built heritage site in Tanzania, using both the stakeholder and network analyses. It presents a useful tool for organizational analysis in heritage management and makes a good argument for its use to better understand participatory management.
Using digitized objects to promote critical thinking and engagement in classrooms
Authors: Butcher Kirsten , Runburg Madlyn , Hudson Michelle
Published: August 2017

Purpose

This paper aims to examine the impact of using digitized objects for inquiry with middle-school classrooms. Research analyzed critical thinking processes and student engagement during collaborative investigations with 3D models of authentic objects.

Design/methodology/approach

Digitized objects were 3D scans of fossils from the paleontology collection at the Natural History Museum of Utah implemented as 3D prints and 3D virtual models. Verbal protocol analysis examined critical thinking processes during collaborative student learning. Engagement was assessed via student feedback and a classroom observation protocol.

Findings

The findings demonstrated that digitized objects facilitated key critical thinking processes, particularly observation, problem finding, elaboration and evaluation. Student feedback was very positive and focused on strong interest in 3D technologies and the ability to engage in authentic exploration. Observations showed very high levels of on-task engagement.

Research limitations/implications

Additional research is necessary to determine if findings generalize across varied learner populations, including broader age ranges and socioeconomic samples, to activities implemented as fully online experiences and to digitized objects from varied domains.

Originality/value

Findings demonstrate digitized objects are effective methods to engage students in critical thinking and to promote engagement with authentic objects during classroom learning. Results demonstrate strong potential of new technologies to leverage the educational impact of digitized objects from local collections, setting the stage for expanded educational outreach by museums and libraries.
Notes from the hospital bedside: reflections on researcher roles and responsibilities at the end of life in dementia
Authors: Swarbrick Caroline Margaret , Sampson Elizabeth , Keady John
Published: August 2017

Purpose

The purpose of this paper is to explore some of the ethical and practical dilemmas faced by an experienced researcher in undertaking research with a person with dementia (whom we have called Amy). Amy died shortly after a period of observation had ended and the family subsequently consented to the data being shared.

Design/methodology/approach

This individual case study presentation was nested within a larger study conducted in England and Scotland between 2013 and 2014. The overall aim of the main study was to investigate how healthcare professionals and informal carers recognised, assessed and managed pain in patients living with dementia in a range of acute settings.

Findings

The presented case study of Amy raises three critical reflection points: (i) Researcher providing care, i.e. the place and positioning of compassion in research observation; (ii) What do the stories mean? i.e. the reframing of Amy's words, gestures and behaviours as (end of) life review, potentially highlights unresolved personal conflicts and reflections on loss; and (iii) Communication is embodied, i.e. the need to move beyond the recording of words to represent lived experience and into more multi-sensory methods of data capture.

Originality/value

Researcher guidance and training about end of life observations in dementia is presently absent in the literature and this case study stimulates debate in a much overlooked area, including the role of ethics committees.
Disability status, stereotype content, and employment opportunities in sport and fitness organizations
Authors: Wright Tiffany , Cunningham George
Published: August 2017

Purpose

The purpose of this paper is to examine the influence of disability status among job applicants on stereotype attributions and personnel decisions. The authors also consider the possible moderating role of application qualifications.

Design/methodology/approach

Participants (N=247) took part in an experiment in which they evaluated job applications for a personal trainer position.

Findings

Applicants who had a disability were rated as warmer than their able-bodied peers, but ratings of competence did not vary based on the disability status. This was the case across levels of qualifications. The relationships between competence and work outcomes (person-organization fit and hiring recommendations) were stronger than those between warmth and these outcomes; however, the relationships were qualified by a significant competence-by-warmth interaction. As the competence increased, so did the ratings of the person-organization fit, but this relationship was stronger for persons rated as warm.

Originality/value

Persons with disabilities in the sport and fitness context face unique stereotypes, relative to their peers in other settings. These stereotypes influence their evaluation as job applicants.
Xeroderma pigmentosum clinical practice guidelines
Authors: Moriwaki Shinichi , Kanda Fumio , Hayashi Masaharu , Yamashita Daisuke , Sakai Yoshitada , Nishigori Chikako ,   Xeroderma pigmentosum clinical practice guidelines revision committee
Published: August 2017

Xeroderma pigmentosum (XP) is a genetic photosensitive disorder in which patients are highly susceptibe to skin cancers on the sun‐exposed body sites. In Japan, more than half of patients (30% worldwide) with XP show complications of idiopathic progressive, intractable neurological symptoms with poor prognoses. Therefore, this disease does not merely present with dermatological symptoms, such as photosensitivity, pigmentary change and skin cancers, but is “an intractable neurological and dermatological disease”. For this reason, in March 2007, the Japanese Ministry of Health, Labor and Welfare added XP to the neurocutaneous syndromes that are subject to government research initiatives for overcoming intractable diseases. XP is one of the extremely serious photosensitive disorders in which patients easily develop multiple skin cancers if they are not completely protected from ultraviolet radiation. XP patients thus need to be strictly shielded from sunlight throughout their lives, and they often experience idiopathic neurodegenerative complications that markedly reduce the quality of life for both the patients and their families. Hospitals in Japan often see cases of XP as severely photosensitive in children, and as advanced pigmentary disorders of the sun‐exposed area with multiple skin cancers in adults (aged in their 20–40s), making XP an important disease to differentiate in everyday clinical practice. It was thus decided that there was a strong need for clinical practice guidelines dedicated to XP. This process led to the creation of new clinical practice guidelines for XP.
Successful combination therapy of propranolol and prednisolone for a case with congenital Kasabach–Merritt syndrome
Authors: Mizutani Kento , Umaoka Ai , Tsuda Kenshiro , Kakeda Masato , Habe Koji , Yamanaka Keiichi , Suyama Megumi , Mizutani Hitoshi
Published: August 2017

A male fetus was delivered by cesarean section with a large hemangioma on his right chest and thrombocytopenia. Clinically, Kasabach–Merritt syndrome (KMS) was suspected, and immediately he was treated with daily prednisolone (PSL) 1 mg/kg and recombinant thrombomodulin without response. Additional propranolol (1–3 mg/kg per day) and increased PSL 2 mg/kg per day therapy successfully controlled his disseminated intravascular coagulation and decreased the tumor size without serious side‐effects. No relapse of KMS was observed after cease of PSL and propranolol. Combined use of propranolol and corticosteroid is expected as a candidate therapeutic tool for KMS.
New onset or transition of disease state of psoriatic arthritis during treatment with ustekinumab: A single‐center retrospective study
Authors: Asahina Akihiko , Umezawa Yoshinori , Momose Mami , Honda Hiromi , Yanaba Koichi , Nakagawa Hidemi
Published: August 2017

Ustekinumab (UST) is a treatment option for psoriatic arthritis (PsA), but recent observations indicate that some psoriatic patients may experience new onset of PsA or worsening of pre‐existent PsA. We retrospectively analyzed all cases of psoriasis vulgaris (PsV) and PsA treated with UST in our facility between 2011 and 2015. PsA developed in eight out of 179 PsV patients, mostly later than 8 months after initiation of UST. It was generally not severe, and none had received tumor necrosis factor (TNF)‐α inhibitors previously, indicating that the possibility of unmasking pre‐existing subclinical arthritis is minimal. The eruptions were well controlled at the time of the onset of arthritis in most cases. Interestingly, those who developed arthritis showed a significantly lower body mass index. Regarding pre‐existing PsA, nine PsA patients received UST, and at least partial improvement of PsA could be achieved in two out of three bio‐naive and three out of six bio‐switched patients from TNF‐α inhibitors. PsA was largely more refractory to UST than the eruptions. Altogether, our present study is in agreement with the notion that UST may be less efficient than TNF‐α inhibitors for PsA. While UST cannot fully prevent new development of PsA, it is unlikely that UST increases the risk of new onset of PsA as a paradoxical adverse reaction.
Case of Mycobacterium haemophilum misdiagnosed as Mycobacterium intracellulare due to one base insertion in the bacterial genome
Authors: Nishikawa Rika , Yamada Yozo , Kanki Haruhisa , Matsuoka Hiroshi , Nakamura Tatsuya , Jikimoto Takumi , Kusuki Mari , Ishii Norihisa , Ohnuma Kenichiro , Nakanaga Kazue , Nishigori Chikako
Published: August 2017

Mycobacterium haemophilum is a slow‐growing, non‐tuberculous mycobacteria that causes cutaneous infection. We describe a case of cutaneous infection in a 68‐year‐old Japanese man with polymyositis. This was caused by M. haemophilum harboring one base insertion in gene sequence. At first, the causal microorganism was misidentified as M. intracellulare by COBAS® TaqMan® MAI test. However, poor growth on Ogawa media and growth enhancement on 7H11C agar around a hemin‐containing disk prompted us to reinvestigate the causal microorganisms, which were revealed to be M. haemophilum. Amplified polymerase chain reaction products were sequenced, and the 16S rRNA gene, rpoB, hsp65 and internal transcribed spacer region sequences showed a 100%, 100%, 99.66% and 99.7% match, respectively, with the corresponding regions of M. haemophilum, but it harbored a novel gene sequence in hsp65. The sequences determined by gene analysis of the M. haemophilum strain were deposited into the International Nucleotide Sequence Database. Although numerous cases of M. haemophilum infection have been reported in other countries, only six cases have been reported in Japan to date. It could be possible that this novel mutation lead to misdiagnosis. As M. haemophilum prefers a lower growth temperature (30–32°C) and it requires iron in the culture medium, M. haemophilum could be misidentified or overlooked. Accordingly, a M. haemophilum infection should be considered in cases of cutaneous infection of the body sites, of which surface temperature is low.
Preliminary study of analyzing mucosal human papillomaviruses in cutaneous warts by restriction fragment mass polymorphism
Authors: Park So Eun , Ha Jae Won , Kim Chul Woo , Kim Sang Seok
Published: August 2017

Cutaneous human papillomavirus (HPV) types 1, 2, 4, 7 and 57 are reportedly found in cutaneous warts. However, there are few reports that have investigated the prevalence of mucosal HPV types in cutaneous warts. The aim of this study is to investigate the prevalence of mucosal HPV types in patients with cutaneous warts and to determine any association between HPV types and patient characteristics. We analyzed 62 wart samples that were taken from patients who were diagnosed with cutaneous warts, and 30 normal skin samples were used as negative control. We recorded the following characteristics: sex, age, type of warts, duration of warts, number of warts and patient's immune status. A matrix‐assisted laser desorption ionization time‐of‐flight (MALDI‐TOF) mass spectrometry (MS)‐based restriction fragment mass polymorphism (RFMP) assay was used for HPV genotyping. Of the total 62 wart samples, 50 samples (81.6%) were positive for HPV genotypes. All of the negative controls (30 samples) using normal skin showed negative reaction. Mucosal HPV types (49 samples, 84.4%) were highly detected, and high‐ or probable high‐risk HPV types (39 samples, 67.2%) were more common than lower risk HPV types (10 samples, 17.2%). A statistically significant association was observed between sex, age, duration of warts and the risk of HPV types. To the best of our knowledge, this is the first study to use the RFMP assay to analyze cutaneous wart‐associated mucosal HPV types. The high prevalence of high‐risk and probable high‐risk HPV in this study is of great significance.
From gestation to weaning: Combining robust design and multi‐event models unveils cost of lactation in a large herbivore
Authors: Richard Quentin , Toïgo Carole , Appolinaire Joël , Loison Anne , Garel Mathieu
Published: August 2017

The cost of current reproduction on survival or future reproduction is one of the most studied trade‐offs governing resource distribution between fitness components. Results have often been clouded, however, by the existence of individual heterogeneity, with high‐quality individuals able to allocate energy to several functions simultaneously, at no apparent cost.

Surprisingly, it has also rarely been assessed within a breeding season by breaking down the various reproductive efforts of females from gestation to weaning, even though resource availability and energy requirements vary greatly.

We filled this gap by using an intensively monitored population of Pyrenean chamois and by expanding a new methodological approach integrating robust design in a multi‐event framework. We distinguished females that gave birth or not, and among reproducing females whether they lost their kid or successfully raised it until weaning. We estimated spring and summer juvenile survival, investigated whether gestation, lactation or weaning incurred costs on the next reproductive occasion, and assessed how individual heterogeneity influenced the detection of such costs.

Contrary to expectations if trade‐offs occur, we found a positive relationship between gestation and adult survival suggesting that non‐breeding females are in poor condition. Costs of reproduction were expressed through negative relationships between lactation and both subsequent breeding probability and spring juvenile survival. Such costs could be detected only once individual heterogeneity (assessed as two groups contrasting good vs. poor breeders) and time variations in juvenile survival were accounted for. Early lactation decreased the probability of future reproduction, providing quantitative evidence of the fitness cost of this period recognized as the most energetically demanding in female mammals and critical for neonatal survival.

The new approach employed made it possible to estimate two components of kid survival that are often considered practically unavailable in free‐ranging populations, and also revealed that reproductive costs appeared only when contrasting the different stages of reproductive effort. From an evolutionary perspective, our findings stressed the importance of the temporal resolution at which reproductive cost is studied, and also provided insights on the reproductive period during which internal and external factors would be expected to have the greatest fitness impact.
Territory size decreases minimally with increasing food abundance in stream salmonids: Implications for population regulation
Authors: Grant James W. A. , Weir Laura K. , Steingrímsson Stefán Ó.
Published: August 2017

How the local density of territorial animals responds to changes in food abundance will depend on the flexibility of territory size. Quantitative estimates of territory size over a broad range of food abundance are relatively rare because of the difficulty of measuring food abundance in the wild.

Stream salmonids are an ideal model system for investigating flexibility in territory size, because food abundance can be quantified in the field and manipulated in the laboratory. We conducted a meta‐analysis to test whether territory size decreases with increasing food abundance, and a mixed model analysis to test among three competing predictions: with increasing food abundance, territory size will be (1) fixed—the slope of a regression of log territory size vs. log food abundance = 0; (2) flexible and decreasing, as if individuals are defending a fixed amount of food—a slope = −1; and (3) initially compressible, but with an asymptotic minimum size—a slope between 0 and −1.

We collected data from 16 studies that manipulated or measured food abundance while monitoring changes in territory size of young‐of‐the‐year salmonids; 10 were experimental laboratory studies, whereas six were observational field studies.

Overall, territory size decreased significantly with increasing food abundance; the weighted average correlation coefficient was −0.31. However, the estimated slope of the relationship between log territory size and log food abundance was only −0.23, significantly different from 0, and also significantly shallower than −1.

Our estimated slope suggests that attempts to increase the density of territorial salmonids by increasing food abundance and reducing territory size will be inefficient; a 20‐fold increase in food abundance would be required to double population density. Our analysis may also have implications for other species with a territorial mosaic social system—i.e. contiguous territories. In these social systems, social inertia will dampen any effects of changes in food abundance on the local density of settlers, compared to non‐territorial species or those with non‐contiguous territories.
The Role of Auditing, Food Safety, and Food Quality Standards in the Food Industry: A Review
Authors: Kotsanopoulos Konstantinos V. , Arvanitoyannis Ioannis S.
Published: August 2017

Food safety and quality audits are used widely in the food industry for various reasons (to evaluate management systems, obtain certifications to certain food safety and quality standards, assess the condition of premises and products, confirm legal compliance, and so on). Nowadays, the increased interest of consumers on food safety and quality matters, triggered mainly by recent food scandals, has enabled the public and private food sectors to develop a variety of food safety and quality standards. These standards have both advantages and disadvantages and their effectiveness depends on several factors such as the competency and skills of auditors and the standard used in each case. Although the industry continuously invests in developing and improving these systems, the number of foodborne outbreaks per year appears to be quite stable in both Europe and the United States. This may be an indication that additional measures and techniques or a different approach would be required to further improve the effectiveness of the food safety and quality management systems. This article examines the role of audits and food safety and quality assessment systems in the food industry, presenting the results of several studies and briefly describing the main food safety and quality standards currently used in Europe (with particular emphasis on the United Kingdom and Greece), the U.S., Australia–New Zealand, and Asia.
The contribution of bacterial genome engineering to sustainable development
Authors: Reuß Daniel R. , Commichau Fabian M. , Stülke Jörg
Published: August 2017

The United Nations’ Sustainable Development Goals define important challenges for the prosperous development of mankind. To reach several of these goals, among them the production of value‐added compounds, improved economic and ecologic balance of production processes, prevention of climate change and protection of ecosystems, the use of engineered bacteria can make valuable contributions. We discuss the strategies for genome engineering and how they can be applied to meet the United Nations’ goals for sustainable development.
Synbiotic approaches to human health and well‐being
Authors: Gurry Thomas
Published: August 2017

Synbiotics refer to combinations of probiotics and prebiotics that act synergistically to confer health benefits to the host. As a therapeutic strategy, they provide a gentle yet powerful method for modulating the composition and metabolic output of the human gut microbiota. In the context of achieving the UN Sustainable Development Goals, synbiotics have the potential to act as cost‐effective prophylactic measures against a variety of human ailments, ranging from infant diarrhoea to metabolic and inflammatory diseases in adults, by maintaining commensal microbial communities and metabolic networks that are conducive to human health.
Microbial biotechnology approaches to mitigating the deterioration of construction and heritage materials
Authors: Junier Pilar , Joseph Edith
Published: August 2017

Microorganisms are the main engines of elemental cycling in this planet and therefore have a profound impact on both organic and mineral substrates. As such, past and present human‐made structures and cultural heritage can be negatively affected by microbial activity. Processes such as bioweathering (rocks and minerals), biodeterioration (organic substrates) or biocorrosion (metals) participate to the degradation or structural damage of construction and heritage materials. This structural damage can cause major economic losses (e.g. replacement of cast‐iron pipes in water distribution networks), and in the case of heritage materials, the entire loss of invaluable objects or monuments. Even though one can regard the influence of microbial activity on construction and heritage materials as negative, remarkably, the same metabolic pathways involved in degradation can be exploited to increase the stability of these materials.
Escherichia coli surface display for the selection of nanobodies
Authors: Salema Valencio , Fernández Luis Ángel
Published: August 2017

Nanobodies (Nbs) are the smallest functional antibody fragments known in nature and have multiple applications in biomedicine or environmental monitoring. Nbs are derived from the variable segment of camelid heavy chain‐only antibodies, known as VHH. For selection, libraries of VHH gene segments from naïve, immunized animals or of synthetic origin have been traditionally cloned in E. coli phage display or yeast display systems, and clones binding the target antigen recovered, usually from plastic surfaces with the immobilized antigen (phage display) or using fluorescence‐activated cell sorting (FACS; yeast display). This review briefly describes these conventional approaches and focuses on the distinct properties of an E. coli display system developed in our laboratory, which combines the benefits of both phage display and yeast display systems. We demonstrate that E. coli display using an N‐terminal domain of intimin is an effective platform for the surface display of VHH libraries enabling selection of high‐affinity Nbs by magnetic cell sorting and direct selection on live mammalian cells displaying the target antigen on their surface. Flow cytometry analysis of E. coli bacteria displaying the Nbs on their surface allows monitoring of the selection process, facilitates screening, characterization of antigen‐binding clones, specificity, ligand competition and estimation of the equilibrium dissociation constant (KD).
Patient and Surrogate Views of Community Consultation for Emergency Research
Authors: Fehr Alexandra E. , Scicluna Victoria M. , Pentz Rebecca D. , Haggins Adrianne N. , Dickert Neal W.
Published: July 2017

Objective

Pretrial community consultation (CC) is required for emergency research conducted under an exception from informed consent (EFIC) in the United States. CC remains controversial and challenging, and minimal data exist regarding the views of individuals enrolled in EFIC trials on this process. It is important to know whether participants perceive CC to be meaningful and, if so, whom they believe should be consulted.

Methods

We conducted a secondary analysis of data from two studies interviewing patients and surrogates of two recent EFIC trials (PEER‐RAMPART and PEER‐ProTECT). These interviews included similar open‐ and closed‐ended questions regarding participants' views of the importance of CC, the rationale for their responses, and their views regarding which populations should be included in consultation efforts. A template analytic strategy was used for qualitative analysis of textual data, and descriptive statistics were tabulated to characterize demographic data and instances of major themes.

Results

Ninety percent of participants perceived CC to be valuable. Participants' reasons for finding CC valuable clustered in two categories: 1) as a method of informing the public about the trial to be conducted and 2) as a way of obtaining input and feedback from the community. Participants cited the medical community (43%) and individuals with a connection to the study condition (41%) as the most important groups to involve in consultation efforts; only 5% suggested consulting the general public in the area where the research will be conducted.

Conclusion

Participants in EFIC trials and their decision makers generally valued CC as a method of informing and seeking input from the community. Participants felt that the most appropriate groups to consult were the medical community and individuals with connections to the condition under study. Consultation efforts focused on these two groups, rather than the general public, may be more efficient and more meaningful to individuals involved in EFIC trials. These findings also reinforce the importance of the distinction between public disclosure and CC.
Performance of the Hack's Impairment Index Score: A Novel Tool to Assess Impairment from Alcohol in Emergency Department Patients
Authors: Hack Jason B. , Goldlust Eric J. , Ferrante Dennis , Zink Brian J.
Published: July 2017

Background

Over 35 million alcohol‐impaired (AI) patients are cared for in emergency departments (EDs) annually. Emergency physicians are charged with ensuring AI patients’ safety by identifying resolution of alcohol‐induced impairment. The most common standard evaluation is an extemporized clinical examination, as ethanol levels are not reliable or predictive of clinical symptoms. There is no standard assessment of ED AI patients.

Objective

The objective was to evaluate a novel standardized ED assessment of alcohol impairment, Hack's Impairment Index (HII score), in a busy urban ED.

Methods

A retrospective chart review was performed for all AI patients seen in our busy urban ED over 24 months. Trained nurses evaluated AI patients with both “usual” and HII score every 2 hours. Patients were stratified by frequency of visits for AI during this time: high (≥ 6), medium (2–5), and low (1). Within each category, comparisons were made between HII scores, measured ethanol levels, and usual nursing assessment of AI. Changes in HII scores over time were also evaluated.

Results

A total of 8,074 visits from 3,219 unique patients were eligible for study, including 7,973 (98.7%) with ethanol levels, 5,061 (62.7%) with complete HII scores, and 3,646 (45.2%) with health care provider assessments. Correlations between HII scores and ethanol levels were poor (Pearson's R2 = 0.09, 0.09, and 0.17 for high‐, medium‐, and low‐frequency strata). HII scores were excellent at discriminating nursing assessment of AI, while ethanol levels were less effective. Omitting extrema, HII scores fell consistently an average 0.062 points per hour, throughout patients’ visits.

Conclusions

The HII score applied a quantitative, objective assessment of alcohol impairment. HII scores were superior to ethanol levels as an objective clinical measure of impairment. The HII declines in a reasonably predictable manner over time, with serial evaluations corresponding well with health care provider evaluations.
Intrauterine delivery of subunit vaccines induces a systemic and mucosal immune response in rabbits
Authors: Pasternak Jonathan Alexander , Hamonic Glenn , Forsberg Nikki M. , Wheler Colette L. , Dyck Michael K. , Wilson Heather L.
Published: August 2017

Problem

Mucosal vaccines have long been sought after to improve protection though the production of both a mucosal and systemic immune response, and are thought to be particularly effective at the site of induction. Development of such vaccines has, however, been delayed by the general propensity to develop immune tolerance to antigens encountered at mucosal sites. This study aimed to determine whether an appropriately formulated subunit vaccine delivered to the uterine lumen would effectively trigger induction of immunity over tolerance.

Methods

Ovalbumin (OVA), truncated glycoprotein D (tGD) from bovine herpesvirus, and a fusion protein of porcine parvovirus VP2 and bacterial thioredoxin (rVP2‐TrX) were each formulated with a tri‐adjuvant combination of Poly(I : C) (PIC), a host defense peptide (HDP), and a polyphosphazene (PCEP). A single dose of vaccine was delivered either intramuscularly (IM) or into the uterine lumen of intact female rabbits, and the humoral response subsequently evaluated both systemically and at local and distal mucosal sites.

Results

Vaccination through either route‐induced antigen‐specific humoral responses systemically and within the local (uterus) and distal mucosa (lungs and vagina). The observed mucosal response was not compartmentalized to, or within, the upper genital tract and the degree of response appeared to be at least in part antigen dependant.

Conclusion

The results of this study provide proof of principle that the uterus can be used as an induction site for subunit vaccination and that vaccine formulation with appropriate adjuvants can trigger both systemic and mucosal immunity when administered IM or into the uterine lumen.
Vitamin D deficiency in an Italian cohort of infertile women
Authors: Triggianese Paola , Watad Abdulla , Cedola Francesca , Perricone Carlo , Amital Howard , Giambini Ilio , Perricone Roberto , Shoenfeld Yehuda , De Carolis Caterina
Published: August 2017

Problem

The purpose of this study was to explore whether vitamin D might be a marker of female primary infertility in association with the presence of autoimmune diseases (ADs).

Methods

The study was a cross‐sectional descriptive study in consecutive outpatients of the Polymedical Center for Prevention of Recurrent Spontaneous Abortion (RSA), in Rome, Italy. Women were eligible if they received a diagnosis of primary infertility or RSA. Serum vitamin D, calcium, and PTH were analyzed.

Results

Women with primary infertility (n=70) or RSA/non‐infertile (n=105) were enrolled; controls (n=250) were included. Infertile women presented lower vitamin D (P=0.03) and higher prevalence of AD (P=0.007) than non‐infertile women. In the multivariate analysis, the presence of ADs is associated with higher odds of infertility (OR=2.2), while normal vitamin D was a protective factor (OR=0.9).

Conclusion

We described that having vitamin D deficiency and suffering from an AD are independent risk factors for women primary infertility. Supplementation of vitamin D might be useful for pregnancy outcome.
Assessment of eosinophilic airway inflammation as a contribution to the diagnosis of occupational asthma
Authors: Beretta C. , Rifflart C. , Evrard G. , Jamart J. , Thimpont J. , Vandenplas O.
Published: August 2017

Background

Ascertaining the presence of asthma through the assessment of nonspecific bronchial hyperresponsiveness (NSBH) is a key step in the diagnosis of occupational asthma (OA). We aimed at investigating whether indices of airway inflammation including fractional exhaled nitric oxide (FeNO) and sputum eosinophils would be useful adjuncts to the measurement of NSBH in diagnosing OA defined as a positive specific inhalation challenge (SIC).

Methods

The study included 240 consecutive subjects with a suspicion of OA who completed a SIC, of whom 133 showed a positive response. The sensitivity, specificity, and predictive values of NSBH, and FeNO, as well as sputum eosinophil counts assessed at baseline of the SIC were determined.

Results

A concentration of histamine inducing a 20% decline in FEV1 (PC20) ≤16 mg/mL showed a sensitivity of 87% and a specificity of 36%. A FeNO level ≥25 ppb and a sputum eosinophil count ≥2% provided lower sensitivity rates (47% and 39%, respectively) than the PC20 value. Eight of the 17 subjects without baseline NSBH despite a positive SIC showed a sputum eosinophil count ≥2%, a FeNO level ≥25 ppb, or both outcomes. Combining either a PC20 value ≤16 mg/mL or a FeNO ≥25 ppb increased the sensitivity to 91%. Using either a PC20 ≤16 mg/mL or a sputum eosinophil count ≥1% increased the sensitivity to 94%.

Conclusion

Adding the assessment of FeNO level and sputum eosinophils to NSBH improves the identification of subjects who may have OA and require further objective testing before excluding the possibility of OA.
Stroke risk among adult patients with third, fourth or sixth cranial nerve palsy: a Nationwide Cohort Study
Authors: Rim Tyler Hyungtaek , Han Jinu , Choi Yoon Seong , Lee Taekjune , Kim Sung Soo
Published: August 2017

Purpose

This study sought to determine whether isolated third, fourth and sixth cranial nerve palsies (NPs) are associated with increased short‐ and long‐term risk of a subsequent stroke.

Methods

This was a nationwide retrospective propensity score‐matched cohort study. A cohort of patients with NP (n = 466) and a randomly selected, propensity‐matched control cohort (n = 2281) were extracted from the Korean national insurance claim database. Subjects were tracked for 5 years total, subdivided into periods of 0–1 years, 1–3 years and 3–5 years. We assessed the risk of stroke using hazard ratios (HRs) and confidence intervals (CIs) after adjustments using Cox regression at different time intervals.

Results

The median follow‐up was 3.1 years. Stroke developed in 18.9% of the NP cohort and 7.5% of the control cohort. Stroke risk after NP was highest in the first year [14.7 per 100 person‐year at 0–1 years (HR = 6.6), 3.1 per 100 person‐year at 1–3 years (HR = 1.6) and 4.3 per 100 person‐year at 3–5 years (HR = 2.8)]. Each type of NP was also associated with stroke risk: within 0–1 years, stroke risk was increased in third (HR = 7.6), fourth (HR = 6.0) and sixth (HR = 5. 84) NPs. In the 3‐ to 5‐year period, risk was increased in sixth (HR = 4.7) and fourth (HR = 3.3) NPs, but not third (HR = 0.6) NPs.

Conclusion

Patients in the NP cohort were more likely to have a stroke than those in the matched control cohort; the increased risk was both time‐ and cranial nerve‐dependent.
Von Helmholtz's ophthalmometer: historical review and experience with one of the last surviving original devices
Authors: Godefrooij Daniel A. , Galvis Virgilio , Tello Alejandro
Published: August 2017

Hermann von Helmholtz (1821–1894) was one of the most important scientists of the nineteenth century in optics and ophthalmology. One of his significant contributions in the field of vision sciences was the invention of the ophthalmometer in 1850, which was the precursor of the keratometers still used in clinical practice today. However, this development tends to be little recognized, and to be overshadowed by others of the achievements of this singular scientist. This review describes the historical setting behind the von Helmholtz's ophthalmometer and its mechanism. We also describe the modifications that were later made to the design. We report on our experience measuring a living human cornea with one of the last surviving devices in the world. The ophthalmometer by von Helmholtz marked the beginning of an era in the ophthalmology of the late nineteenth century, and although its original design was not broadly used in the clinical practice, and later abandoned, it opened the way for the development of practical systems very similar to the ones that we use even today.
Ultrawide field scanning laser ophthalmoscopy imaging of lipemia retinalis
Authors: Silva Paolo S. , Gupta Aditi , Ajlan Radwan S. , Schlossman Deborah K. , Tolson Ann M. , Cavallerano Jerry D. , Aiello Lloyd Paul
Published: August 2017

Objective

To describe the characteristic retinal features of lipemia retinalis when using ultrawide field scanning laser ophthalmoscopy.

Main Points

We report a case series of three subjects with ultrawide field retinal images showing cream discoloration of the fundus, light salmon‐coloured posterior retinal vessels and greyish pink peripheral vasculature. On green‐only imaging, many of the vessels appear light rather than typically dark.

Conclusion

Lipemia retinalis is readily apparent on ultrawide field imaging and illustrates the alterations that systemic diseases may induce in the posterior and peripheral retinal vasculature. Ultrawide field imaging highlights the disparate vascular appearance of the posterior pole and retinal periphery in this condition.
The effects of antioxidants on ocular blood flow in patients with glaucoma
Authors: Harris Alon , Gross Josh , Moore Nicholas , Do Thai , Huang Amelia , Gama Willy , Siesky Brent
Published: August 2017

Purpose

To investigate the effects of an antioxidant dietary supplement that includes Ginkgo biloba, on retinal and retrobulbar blood flow in patients with open‐angle glaucoma (OAG).

Methods

Forty‐five patients with confirmed OAG were enroled in a randomized, double blinded, placebo‐controlled cross‐over study. Baseline and postadministration measurements of intraocular pressure (IOP), ocular perfusion pressure (OPP), retrobulbar blood flow, and retinal capillary blood flow were non‐invasively measured (ultrasound and laser Doppler modalities, respectively) before and one month after antioxidant nutraceuticals and placebo administration. Changes in measurements between the active supplement and placebo arms were evaluated using paired t‐tests, with p < 0.05 considered statistically significant.

Results

Antioxidant supplementation produced a statistically significant increase in peak systolic and/or end diastolic blood flow velocities in all retrobulbar blood vessels compared to placebo. Vascular resistance was also reduced in central retinal and nasal short posterior ciliary arteries following antioxidant administration. Additionally, antioxidant supplementation increased superior and inferior temporal retinal capillary mean blood flow and the ratio of active to non‐active retina capillaries compared to placebo.

Conclusion

One‐month oral administration of antioxidants produced increases in biomarkers of ocular blood flow within retinal and retrobulbar vascular beds in patients with OAG.
Prophylactic intravitreal antibiotics reduce the risk of post‐traumatic endophthalmitis after repair of open globe injuries
Authors: Abouammoh Marwan A. , Al‐Mousa Abdullah , Gogandi Mohammad , Al‐Mezaine Hani , Osman Essam , Alsharidah Abdulrahman M. , Al‐Kharashi Abdullah , Abu El‐Asrar Ahmed M.
Published: August 2017

Purpose

To investigate efficacy of prophylactic intravitreal antibiotics in reducing incidence of endophthalmitis after repair of open globe injuries. At King Abdulaziz University Hospital, a standard protocol of intravenous vancomycin and ceftazidime was used in all cases.

Methods

Charts of 353 patients who presented between January 2010 and January 2014 with open globe injury were retrospectively reviewed. In addition, the standard protocol in this cohort included prophylactic intravitreal antibiotics in high‐risk cases at time of primary repair. High‐risk cases were identified based on the presence of one or more of the following risk factors: dirty wound, retained intra‐ocular foreign body (IOFB), rural setting, delayed primary repair of >24 hr and ruptured lens capsule. Rate of endophthalmitis in this recent cohort was compared with that of a previous cohort admitted for primary repair between May 1996 and May 2008 (641 patients). In the previous cohort, protocol did not include prophylactic intravitreal antibiotics.

Results

Rates of clinically suspected endophthalmitis and culture‐positive endophthalmitis were higher in previous cohort (24 of 641 eyes; 3.7% and 12 of 641 eyes; 1.9%, respectively) compared to recent cohort (six of 353 eyes; 1.7% and two of 353 eyes; 0.6%, respectively). In high‐risk groups, rates of suspected endophthalmitis and culture‐positive endophthalmitis were higher in previous cohort (19 of 345 eyes; 5.5% and 12 of 345 eyes; 3.5%, respectively) compared to the recent cohort (five of 200 eyes; 2.5% and two of 200 eyes; 1.0%, respectively).

Conclusion

Prophylactic intravitreal antibiotics reduce risk of endophthalmitis after repair of open globe injuries.