bluuebunny/crossref_metadata_2025 huggingface dataset:
Do dimensions of corporate social responsibility affect earnings management?
Authors: Ben Amar Anis , Chakroun Salma
Published: April 2018

Purpose

This paper aims to examine the impact of corporate social responsibility (CSR) on earnings management measured by discretionary accruals based on Dechow et al.’s (1995) model with cash flow from operation.

Design/methodology/approach

This study uses a sample of 119 French non-financial companies listed on the CAC All Tradable index for the 2010-2014 period. All used regressions for the analysis are estimated based on panel data with random-effects.

Findings

Based on a panel data of 595 French firm-year observations during the period 2010-2014, the authors find a negative impact of CSR on earnings management, and some CSR dimensions negatively impact earnings management.

Practical implications

The results suggest several implications for regulatory in France, as well as those in other countries that try to implement CSR activities.

Originality/value

The originality of this work lies in the division of CSR into sub-dimensions defined by the ISO 26000 standard. This division reduces the complexity of societal reality and obeys a coherent institutional logic. In addition, it enables the operationalization of CSR in a new way to determine the impact of CSR on earnings management.
A comparative study of the historical and current development of the GCC insurance and takaful industry
Authors: Alshammari Ahmad Alrazni , Syed Jaafar Alhabshi Syed Musa , Saiti Buerhan
Published: April 2018

Purpose

This paper aims to present a comparative examination of the historical and current profiles of the insurance and takaful industry in the Gulf region. Meanwhile, it will provide overview and insightful information of Gulf Cooperation Council (GCC) countries for insurance and takaful providers for their marketing strategy purpose.

Design/methodology/approach

This paper uses insurance and takaful sectors in Gulf region as an exploring area where the data are extracted from the regulators’ annual reports and other reports issued by research houses and market players, e.g. Islamic Financial Services Industry, Swiss Re and Milliman.

Findings

The comparative analysis reveals that insurance activities penetrated the Gulf region through foreign institutions. After independence and booming oil prices, local institutions established the industry in an unregulated environment. As the industry grew and matured, the sector gradually became regulated. This supported the growth of the industry, leading to the emergence of the biggest takaful market in the world, with 72 takaful operators. Almost half of the takaful operators operate in the Saudi market. Regarding business lines, general lines dominated because of compulsory motor insurance for all cars and health insurance for expatriates. Insurance penetration and insurance density recorded a low figure in GCC compared to the global market because of a lack of product development, especially in family line, which many people think the life insurance contradicts Islamic law. Furthermore, it is low due to the poor channel of distributions with depend heavily on insurance agents that fails to reach the customers.

Research limitations/implications

Interestingly, the takaful market share is considered very low, e.g. 9 per cent in Oman 9 and 9.2 per cent in UAE, where the majority of population is Muslim, indicating that takaful providers should focus in these countries to grab better market shares.

Originality/value

As takaful business is an emerging area in Islamic finance and many insurance players are interested in it, this paper provides an overview and marketing insights of insurance and takaful industries in the GCC region.
The Hijabi self: authenticity and transformation in the Hijab fashion phenomenon
Authors: El-Bassiouny Noha
Published: April 2018

Purpose

The purpose of this paper is to delve into the intricate relationships between hijab culture and consumption. The research questions whether the hijab consumption phenomenon is an icon of fashion or an authentic blend of religious and cultural tenets.

Design/methodology/approach

The research uses a netnographic approach in a qualitative manner similar to ethnography on the internet. An online forum is created on social media for Egyptian hijabista consumers, who reflect on their self-transformations with respect to the hijab phenomenon.

Findings

The findings of the study provide insights relevant to the consumer experiences of the hijab fashion phenomenon. The results are analyzed using Holt’s (1995) consumption parabola, where the insights show the consumption as experience, integration, play and classification metaphors in action. Most insights show that the hijab fashion experience combines authentic religious meanings with cultural ones.

Research limitations/implications

The study methodology used is qualitative, thereby putting limitations on generalizing the findings to other consumers and contexts.

Practical implications

The findings are relevant to fashion designers and fashion marketers who aim at understanding the hijabista culture.

Social implications

The results are relevant to consumer culture theorists as well as to macromarketing researchers looking at authenticity in the hijab fashion phenomenon. The research is also relevant in understanding the hijabista culture, which is a growing consumer culture around the globe.

Originality/value

The research combines the literatures on consumer culture theory, self-transformations and authenticity with regards to the hijab consumption phenomenon. Such relationships were not explored previously in the literature. The methodological approach is also novel.
Transnational entrepreneurship, social networks, and institutional distance
Authors: Moghaddam Kaveh , Rustambekov Elzotbek , Weber Thomas , Azarpanah Sara
Published: April 2018

Purpose

Transnational entrepreneurship can be considered a new stream of research where migrant entrepreneurship and international business research fields intersect. The purpose of this paper is to offer a theoretical framework to address the following research question: How do transnational entrepreneurs (TEs) develop their competitive advantage to succeed in a global market?

Design/methodology/approach

Based on the strategic entrepreneurship approach and dynamic capability perspective, this paper suggests a theoretical framework to extend the understanding on how TEs may develop their competitive advantage to succeed in a global market.

Findings

The suggested theoretical framework exhibits how the social ties of TEs affects their firm performance through the mediating effect of a bundle of two organizational processes (opportunity sensing and opportunity seizing) and the moderating effect of institutional distance between countries of origin and residence.

Practical implications

TEs should not solely focus on their ethnic social ties. That is why this paper suggests that ethnic ties in the country of origin and the country of residence (COR) may lead to higher firm performance only if systematically used alongside nonethnic ties in the COR. Furthermore, it is crucial for TEs to understand the importance of dynamic capabilities in developing and sustaining their competitive advantage.

Originality/value

Based on the strategic entrepreneurship approach, this paper suggests a social tie-based model of the dynamic capability to address the theoretical void in the transnational entrepreneurship literature. The linkage between social tie and performance which has been in a black box is examined in terms of how strong and weak social ties may affect different underlying processes of TEs’ dynamic capabilities differently. In contrast to the common conceptualization of institutional distance as a negative moderator in international business literature, institutional distance is theorized as a positive moderator in the suggested theoretical model of transnational entrepreneurship.
Effects of mixture ingredients on extrudability of concrete in Contour Crafting
Authors: Zareiyan Babak , Khoshnevis Behrokh
Published: April 2018

Purpose

This paper aims to investigate the extrudability (flow-ability and shape-stability) of concrete mixtures by using contour crafting (CC) as an automated construction process.

Design/methodology/approach

Several experiments have been performed for flow-ability and shape-stability of concrete mixtures. Experimental results were compared to understand significant factors and their interactions. After developing the empirical model for flow-ability, the model was validated.

Findings

The experimental investigation of varied combination of concrete components developed a mixture within constrains of the CC nozzle and improved the quality of the extruded part.

Originality/value

Several experimental samples were fabricated using CC, and the derived empirical model was validated after more than 700 h of work.
Additive manufacturing of shape memory polymers: effects of print orientation and infill percentage on mechanical properties
Authors: Villacres Jorge , Nobes David , Ayranci Cagri
Published: April 2018

Purpose

Material extrusion additive manufacturing, also known as fused deposition modeling, is a manufacturing technique in which objects are built by depositing molten materials layer-by-layer through a nozzle. The use and application of this technique has risen dramatically over the past decade. This paper aims to first, report on the production and characterization of a shape memory polymer material filament that was manufactured to print shape memory polymer objects using material extrusion additive manufacturing. Additionally, it aims to investigate and outline the effects of major printing parameters, such as print orientation and infill percentage, on the elastic and mechanical properties of printed shape memory polymer samples.

Design/methodology/approach

Infill percentage was tested at three levels, 50, 75 and 100 per cent, while print orientation was tested at four different angles with respect to the longitudinal axis of the specimens at 0°, 30°, 60° and 90°. The properties examined were elastic modulus, ultimate tensile strength and maximum strain.

Findings

Results showed that print angle and infill percentage do have a significant impact on the manufactured test samples.

Originality/value

Findings can significantly influence the tailored design and manufacturing of smart structures using shape memory polymer and material extrusion additive manufacturing.
Advanced mechanical and thermal characterization of 3D bioextruded poly(e-caprolactone)-based composites
Authors: Wang Hanxiao , Domingos Marco , Scenini Fabio
Published: April 2018

Purpose

The purpose of this paper is to study the effect of nano hydroxyapatite (HA) and graphene oxide (GO) particles on thermal and mechanical performances of 3D printed poly(ε-caprolactone) (PCL) filaments used in bone tissue engineering (BTE).

Design/methodology/approach

Raw materials were prepared by melt blending, followed by 3D printing via 3D Discovery (regenHU Ltd., CH) with all fabricating parameters kept constant. Filaments, including pure PCL, PCL/HA and PCL/GO, were tested under the same conditions. Several techniques were used to mechanically, thermally and microstructurally evaluate properties of these filaments, including differential scanning calorimetry, tensile test, nano indentation and scanning electron microscope.

Findings

Results show that both HA and GO nano particles are capable of improving mechanical performance of PCL. Enhanced mechanical properties of PCL/HA result from reinforcing effect of HA, while a different mechanism is observed in PCL/GO, where degree of crystallinity plays an important role. In addition, GO is more efficient at enhancing mechanical performance of PCL compared with HA.

Originality/value

For the first time, a systematic study about effects of nano HA and GO particles on bioactive scaffolds produced by additive manufacturing for BTE applications is conducted in this work. Mechanical and thermal behaviors of each sample, pure PCL, PCL/HA and PCL/GO, are reported, correlated and compared with literature.
Design of internal branch support structures for selective laser melting
Authors: Zhang Zhixiong , Wu Chunbing , Li Tang , Liang Keshan , Cao Yujun
Published: April 2018

Purpose

Selective laser melting (SLM) enables the fabrication of lightweight and complex metallic structures. Support structures are required in the SLM process to successfully produce parts. Supports are typically lattice structures, which cost much time and material to manufacture. Besides, the manufacturability of these supports is undesirable, which may impact the quality of parts or even fail the process. The purpose of this paper is to investigate the efficiency and mechanical properties of advanced internal branch support structures for SLM.

Design/methodology/approach

The theoretic weight of a branch support and a lattice support of the same plane were calculated and compared. A group of standard candidates of branch support structures were manufactured by SLM. The weight and scanning time of specimens with different design parameters were compared. Then, these samples were tested using an MTS Insight 30 compression testing machine to study the influence of different support parameters on mechanical strength of the support structures.

Findings

The results show that branch type supports can save material, energy and time used needed for their construction. The yield strength of the branch increases with the branch diameter and inclined branch angle in general. Furthermore, branch supports have a higher strength than traditional lattice supports.

Originality/value

To the best of the authors’ knowledge, this is the first work investigating production efficiency and mechanical properties of branch support structures for SLM. The findings in this work are valuable for development of advanced optimal designs of efficient support structures for SLM process.
Modern slavery in supply chains: a secondary data
analysis of detection, remediation and disclosure
Authors: Stevenson Mark , Cole Rosanna
Published: April 2018

Purpose

The purpose of this study is to examine how organisations report on the
detection and remediation of modern slavery in their operations and supply
chains and to understand their approaches to disclosing information in
response to modern slavery legislation.

Design/methodology/approach

An analysis of secondary data based on the statements is released in response
to the 2015 UK Modern Slavery Act by 101 firms in the clothing and textiles
sector.

Findings

Many firms use the same practices to detect and remediate modern slavery as
for other social issues. But the hidden, criminal nature of modern slavery
and the involvement of third party labour agencies mean practices need to
either be tailored or other more innovative approaches developed, including
in collaboration with traditional and non-traditional actors. Although five
broad types of disclosure are identified, there is substantial heterogeneity
in the statements. It is posited however that firms will converge on a more
homogenous set of responses over time.

Research
limitations/implications

The study is limited to one industry, responses to UK legislation and the
information disclosed by focal firms only. Future research could expand the
focus to include other industries, country contexts and stakeholders.

Practical implications

Managers must consider how their own firm’s behaviour contributes to
the modern slavery threat, regulates both their stock and non-stock supply
chains and ensures modern slavery is elevated from the procurement function
to the boardroom. In making disclosures, managers may trade-off the
potential competitive gains of transparency against the threat of
information leakage and reputational risk should their statements be
falsified. The managers should also consider what signals their statements
send back up the chain to (sub-)suppliers. Findings also have potential
policy implications.

Originality/value

The study expands the authors’ understanding of: modern slavery from a
supply chain perspective, e.g. identifying the importance of standard
setting and risk avoidance; and, supply chain information disclosure in
response to legislative demands. This is the first academic paper to examine
the statements produced by organisations in response to the UK Modern
Slavery Act.
Systematic reanalysis of genomic data improves quality of variant interpretation
Authors: Hiatt S.M. , Amaral M.D. , Bowling K.M. , Finnila C.R. , Thompson M.L. , Gray D.E. , Lawlor J.M.J. , Cochran J.N. , Bebin E.M. , Brothers K.B. , East K.M. , Kelley W.V. , Lamb N.E. , Levy S.E. , Lose E.J. , Neu M.B. , Rich C.A. , Simmons S. , Myers R.M. , Barsh G.S. , Cooper G.M.
Published: April 2018

As genomic sequencing expands, so does our knowledge of the link between genetic variation and disease. Deeper catalogs of variant frequencies improve identification of benign variants, while sequencing affected individuals reveals disease‐associated variation. Accumulation of human genetic data thus makes reanalysis a means to maximize the benefits of clinical sequencing. We implemented pipelines to systematically reassess sequencing data from 494 individuals with developmental disability. Reanalysis yielded pathogenic or likely pathogenic (P/LP) variants that were not initially reported in 23 individuals, 6 described here, comprising a 16% increase in P/LP yield. We also downgraded 3 LP and 6 variants of uncertain significance (VUS) due to updated population frequency data. The likelihood of identifying a new P/LP variant increased over time, as ~22% of individuals who did not receive a P/LP variant at their original analysis subsequently did after 3 years. We show here that reanalysis and data sharing increase the diagnostic yield and accuracy of clinical sequencing.
Developing a Dental Scrubs Ceremony to define professional identity and teach professionalism to dental undergraduates; lessons learned
Authors: Neville P. , McNally L. , Waylen A.
Published: April 2018

Introduction

The UK General Dental Council stipulates that professionalism is a key aspect of the teaching and training of dental students. However, dental educators highlight that teaching dental student's professionalism can be challenging and students often rate this teaching activity negatively. This article documents a teaching initiative at one UK Dental School that aimed to strengthen the professionalism curriculum by introducing a Dental Scrubs Ceremony for second‐year students.

Materials and method

The Dental Scrubs Ceremony is inspired by the White Coat Ceremonies that medical students have in universities in North America. It marks the students’ first step in their professional and clinical development, with the signing of a pledge of conduct and public presentation of dental scrubs to each student. We report student feedback questionnaire data over a three‐year period together with reflections on the merits and limitations of this alternative approach to teaching professionalism.

Results

Student evaluation data show that the perceived usefulness and worthwhileness of a Dental Scrubs Ceremony have grown since its inception in 2015. Most students enjoyed the symbolism of the ceremony, receiving their dental scrubs in a formal event. However, there was mixed evaluation for its effectiveness to teach professionalism.

Conclusion

A Dental Scrubs Ceremony is a useful addition to the formal curriculum of professionalism in a dental school. It provides dental students with an opportunity to be inducted into the dental profession as novice dental students starting out on their professional career.
Rapid reconstitution of CMV‐specific T‐cells after stem‐cell transplantation
Authors: Widmann Thomas , Sester Urban , Schmidt Tina , Gärtner Barbara C. , Schubert Jörg , Pfreundschuh Michael , Sester Martina
Published: April 2018

Objective

As reconstitution of virus‐specific T‐cells is critical to control cytomegalovirus (CMV)‐viremia following stem‐cell transplantation (SCT), we characterized the dynamics in CMV‐specific T‐cell reconstitution after SCT.

Methods

Cytomegalovirus‐specific T‐cells from 51 SCT‐recipients were prospectively quantified and phenotypically characterised by intracellular cytokine‐staining after specific stimulation and HLA class‐I‐specific pentamers using flow cytometry.

Results

Cytomegalovirus‐specific CD4 T‐cells reconstituted after a median of 2.3 (IQR, 2.0‐3.0) weeks following autografting, and 4.0 (IQR, 3.0‐5.6) weeks after allografting, with CMV‐specific T‐cells originating from donors and/or recipients. The time for reconstitution of CMV‐specific CD4 and CD8 T‐cells did not differ (P = .58). Factors delaying the time to initial reconstitution of CMV‐specific CD4 T‐cells included a negative recipient serostatus (P = .016) and CMV‐viremia (P = .026). Percentages of CMV‐specific CD4 T‐cells significantly increased over time and reached a plateau after 90 days (P = .043). Relative CMV‐specific CD4 T‐cell levels remained higher in long‐term transplant recipients compared with those in controls (P < .0001). However, due to persisting lymphopenia, absolute numbers of CMV‐specific T‐cells were similar as in controls.

Conclusion

Cytomegalovirus‐specific T‐cells rapidly reconstitute after SCT and their percentages remain high in the long term. In the face of persistent lymphopenia, this results in similar absolute numbers of CMV‐specific T‐cells as in controls to ensure sufficient pathogen control.
Three‐months optical coherence tomography analysis of a biodegradable polymer, sirolimus‐eluting stent
Authors: Kretov Еvgeny , Naryshkin Ivan , Baystrukov Vitaly , Grazhdankin Igor , Prokhorikhin Aleksei , Zubarev Dmitry , Biryukov Alexey , Verin Vladimir , Boykov Andrey , Malaev Dastan , Pokushalov Evgeny , Romanov Alexander , Bergmann Martin W.
Published: April 2018

Objective

We aimed to assess early neointimal healing by optical coherence tomography (OCT) 3 months after implantation of the ultrathin Orsiro® sirolimus‐eluting stent with biodegradable polymer.

Background

New generations of drug‐eluting stents with biodegradable polymer have been developed to avoid the continued vascular irritation of durable polymers.

Methods

In this prospective, open‐label study, 34 patients received an Orsiro® sirolimus‐eluting stent with biodegradable polymer. In a subgroup of patients (n = 15), the intervention was performed under OCT guidance. All patients underwent OCT‐examination at three months. The primary endpoint was 3‐month neointimal healing (NIH) score, calculated by weighing the presence of filling defects, malapposed and uncovered struts. Secondary endpoint was maturity of tissue coverage at 3 months.

Results

At 3 months, NIH score was 13.7 (5.4‐22), covered struts per lesion were 90% (84‐97%), malapposed struts were 2.7% (0.8‐5.4%) and rate of mature tissue coverage was 47% (42‐53%). No target lesion failure occurred up to 12 months. Patients with OCT‐guided stent implantation demonstrated a trend toward earlier stent healing as demonstrated by superior NIH scores (angio guided: 17.6% [8.8‐26.4]; OCT‐guided: 9.8% [4.0‐15.5]; mean difference −8, [95%CI: −18.7‐2.9], P = 0.123). This group had significantly more covered struts per lesion (angio‐guided: 86% [82‐90]; 95% [92‐99]; mean difference 9% [95%CI: 3‐15], P = 0.001).

Conclusion

The Orsiro® sirolimus‐eluting stent with biodegradable polymer shows early vascular healing with a high rate of strut coverage at 3‐month follow‐up. OCT guided stent implantation had a positive impact on early vascular healing.
A novel HLA‐C allele, HLA‐C*07:02:01:17N, with an alternative splice site
Authors: Shimizu M. , Kuroda Y. , Nakajima F. , Nagai T. , Satake M.
Published: April 2018

We describe the identification of alternatively expressed HLA allele C*07:02:01:17N.
KIR2DL1 allele sequence extensions and discovery of 2DL1*0010102 and 2DL1*0010103 alleles by DNA sequencing
Authors: Bultitude W. P. , Gymer A. W. , Robinson J. , Mayor N. P. , Marsh S. G. E.
Published: April 2018

Full‐length KIR2DL1 allele sequence extensions characterised by single molecule real‐time (SMRT) DNA sequencing.
A higher-order “figure-8” sensor and an isotropic sensor—For azimuth-elevation bivariate direction finding
Authors: Muaz Muhammad , Wu Yue Ivan , Wong Kainam Thomas , Su Da
Published: April 2018

A “p-u probe” (also known as a “p-v probe”) comprises one pressure-sensor (which is isotropic) and one uni-axial particle-velocity sensor (which has a “figure-8” bi-directional spatial directivity). This p-u probe may be generalized, by allowing the figure-8 bi-directional sensor to have a higher order of directivity. This higher-order p-u probe has not previously been investigated anywhere in the open literature (to the best knowledge of the present authors). For such a sensing system, this paper is first (1) to develop closed-form eigen-based signal-processing algorithms for azimuth-elevation direction finding; (2) to analytically derive the associated Cramér-Rao lower bounds (CRB), which are expressed explicitly in terms of the two constituent sensors' spatial geometry and in terms of the figure-8 sensor's directivity order; (3) to verify (via Monte Carlo simulations) the proposed direction-of-arrival estimators' efficacy and closeness to the respective CRB. Here, the higher-order p-u probe's two constituent sensors may be spatially displaced.
Bursting at the seams: Rippled monolayer bismuth on NbSe
2
Authors: Fang Alan , Adamo Carolina , Jia Shuang , Cava Robert J. , Wu Shu-Chun , Felser Claudia , Kapitulnik Aharon
Published: April 2018

STM studies of submonolayer bismuth on NbSe
2
reveal domain pattern of 1D ripples and anomalous density of states.
Accelerated discovery of metallic glasses through iteration of machine learning and high-throughput experiments
Authors: Ren Fang , Ward Logan , Williams Travis , Laws Kevin J. , Wolverton Christopher , Hattrick-Simpers Jason , Mehta Apurva
Published: April 2018

Coupling artificial intelligence with high-throughput experimentation accelerates discovery of amorphous alloys.
Experimental signatures of spin superfluid ground state in canted antiferromagnet Cr
2
O
3
via nonlocal spin transport
Authors: Yuan Wei , Zhu Qiong , Su Tang , Yao Yunyan , Xing Wenyu , Chen Yangyang , Ma Yang , Lin Xi , Shi Jing , Shindou Ryuichi , Xie X. C. , Han Wei
Published: April 2018

We report direct experimental signatures for the spin superfluid ground state in canted antiferromagnets via nonlocal spin transport.
Changes in the Rumen Epithelial Microbiota of Cattle and Host Gene Expression in Response to Alterations in Dietary Carbohydrate Composition
Authors: Petri R. M. , Kleefisch M. T. , Metzler-Zebeli B. U. , Zebeli Q. , Klevenhusen F.
Published: April 2018

The inclusion of high-quality hay (HQH), in place of concentrates, shifts dietary carbohydrate intake, and the extent to which these shifts effect epimural microbiota and epithelial gene expression of the rumen has not yet been evaluated. Eight ruminally cannulated nonlactating Holstein cows were used in a replicated 4 by 4 Latin square design with four dietary treatments containing HQH, with either 0% concentrate/100% HQH (100HQH), 25% concentrate/75% HQH (75HQH), or 40% concentrate/60% HQH (60HQH). The fourth group (control [CON]) was fed 60% normal fiber-rich hay and 40% concentrate. The data showed that measures of diversity for the rumen epimural population, specifically the Shannon (
P
= 0.004) and Simpson (
P
= 0.003) indices, decreased with increasing levels of HQH in the diet. The feeding of HQH shifted the epimural population from predominantly
Firmicutes
to
Proteobacteria
. Phylogenetic analysis revealed that HQH feeding markedly shifted the abundance of
Campylobacter
spp. from 7.8 up to 33.5% (
P
< 0.001), with greater ingestion of protein (
r
= 0.63) and sugars (
r
= 0.65) in HQH diet being responsible for this shift. The expression of genes targeting intracellular pH regulation, barrier function, and nutrient uptake of rumen epithelium remained stable regardless of the carbohydrate source. In conclusion, the data suggest strong alterations of the ruminal epimural microbiota in response to changes in the nutritive patterns of the diet. Further research is warranted to evaluate the long-term effects of these significant microbial changes on rumen health and food safety aspects in cattle at a transcriptional level.

IMPORTANCE
Feeding of forages versus starchy concentrates is a highly debated topic. Hay is believed to be healthier and more ecological sustainable for cattle than are concentrates, although the effects of feeding hay with enhanced sugar and protein content on epimural microbiota and host gene expression have not yet been evaluated. This research provides a report of the role of feeding hay with increased sugar and protein content in place of starchy concentrates in altering epimural microbiota and in generating a host response. Our research shows that the addition of high-quality hay to dairy rations shifted nutrient intake, resulting in strong alterations in the epimural microbiota in cattle. This work provides a background for further long-term research regarding the effects of feeding practices on the host-microbiome interaction and its role in rumen health and food safety in cattle.
Bias in patient satisfaction surveys: a threat to measuring healthcare quality
Authors: Dunsch Felipe , Evans David K , Macis Mario , Wang Qiao
Published: April 2018

Patient satisfaction surveys are an increasingly common element of efforts to evaluate the quality of healthcare. Many patient satisfaction surveys in low/middle-income countries frame statements positively and invite patients to agree or disagree, so that positive responses may reflect either true satisfaction or bias induced by the positive framing. In an experiment with more than 2200 patients in Nigeria, we distinguish between actual satisfaction and survey biases. Patients randomly assigned to receive negatively framed statements expressed significantly lower levels of satisfaction (87%) than patients receiving the standard positively framed statements (95%—p<0.001). Depending on the question, the effect is as high as a 19 percentage point drop (p<0.001). Thus, high reported patient satisfaction likely overstates the quality of health services. Providers and policymakers wishing to gauge the quality of care will need to avoid framing that induces bias and to complement patient satisfaction measures with more objective measures of quality.
Informational value of percent body fat with body mass index for the risk of abnormal blood glucose: a nationally representative cross-sectional study
Authors: Jo Ara , Mainous III Arch G
Published: April 2018

Objective

To examine the value of percent body fat (%BF) with body mass index (BMI) to assess the risk of abnormal blood glucose (ABG) among US adults who are normal weight or overweight. We hypothesised that normal-weight population with higher %BF is more likely to have ABG.

Design

A cross-sectional study.

Setting

National Health and Nutrition Examination Survey, 1999–2006, conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention.

Participants

Participants were US adults aged 40 and older who have never been diagnosed with type 2 diabetes by a doctor (unweighted n=6335, weighted n=65 705 694). The study population was classified into four groups: (1) normal weight with normal %BF, (2) normal weight with high %BF, (3) overweight with normal %BF and (4) overweight with high %BF.

Main outcome measures

ORs for ABG including pre-diabetes and undiagnosed diabetes (HbA1c ≥5.7%, ≥39 mmol/mol).

Results

64% of population with normal BMI classification had a high %BF. Prevalence of ABG in normal-weight group with high %BF (13.5%) is significantly higher than the overweight group with low %BF (10.5%, P<0.001). In an unadjusted model, the OR of ABG was significantly greater in adults at normal BMI with high %BF compared with individuals at normal weight with low %BF. In an adjusted model controlling for age, sex, race/ethnicity, first-degree-relative diabetes, vigorous-intensity activities and muscle strengthening activities, risks of ABG were greater in population with normal weight and high %BF (OR 1.55, 95% CI 1.01 to 2.38) and with overweight and low %BF (OR 1.17, 95% CI 0.69 to 1.98, P<0.05).

Conclusions

Integrating BMI with %BF can improve in classification to direct screening and prevention efforts to a group currently considered healthy and avoid penalties and stigmatisation of other groups that are classified as high risk of ABG.
Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study
Authors: McWilliams Lorna , Farrell Carole , Keady John , Swarbrick Caroline , Burgess Lorraine , Grande Gunn , Bellhouse Sarah , Yorke Janelle
Published: April 2018

Objectives

Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs.

Design

Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis.

Setting

Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre.

Participants

Purposeful sample of 10 patients with a diagnosis of cancer–dementia, informal caregivers (n=9) and oncology HCPs (n=12).

Results

Four themes were identified: (1) leading to the initial consultation—HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information—informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care—patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment—there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making.

Conclusions

Although patients with cancer–dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway.
Hip fracture incidence and mortality in chronic kidney disease: the GLOMMS-II record linkage cohort study
Authors: Robertson Lynn , Black Corrinda , Fluck Nick , Gordon Sharon , Hollick Rosemary , Nguyen Huong , Prescott Gordon , Marks Angharad
Published: April 2018

Background

Individuals on renal replacement therapy (RRT) have increased fracture risk, but risk in less advanced chronic kidney disease (CKD) is unclear.

Objective

To investigate CKD associations with hip fracture incidence and mortality.

Design

Record linkage cohort study Grampian Laboratory Outcomes Mortality and Morbidity Study II.

Setting

Single health region in Scotland.

Participants

All individuals (≥15 years) with sustained CKD stages 3–5 and those on RRT, and a 20% random sample of those with normal renal function, in the resident population in 2003.

Outcome measures

Outcomes were (1) incident hip fracture measured with (A) admissions or (B) deaths, with at least 5.5 years follow-up and (2) post-hip fracture mortality. Unadjusted and adjusted, incident rate ratios (IRRs) and mortality rate ratios were calculated using Poisson regression.

Results

Of 39 630 individuals identified in 2003 (41% males, mean age 63.3 years), 19 537 had CKD stages 3–5, 345 were on RRT and 19 748 had normal estimated glomerular filtration rate (eGFR). Hip fracture incidence, measured by admissions, was increased in CKD stages 3–5 (compared with normal eGFR), both overall (adjusted IRR 1.49 (95% CI 1.24 to 1.79)) and for individual CKD stages 3a, 3b and 4. Hip fracture incidence, measured using deaths, was increased in those with CKD stages 3b and 4. Post-hip fracture mortality was only increased in CKD stage 4. There was only a small number of individuals and events for CKD stage 5, resulting in insufficient statistical power.

Conclusion

Hip fracture incidence was higher in CKD stages 3–5 compared with normal eGFR. Post-hip fracture mortality was only increased in CKD stage 4. Reducing hip fracture incidence in CKD through regular fall and fracture risk review should reduce overall deaths after hip fracture in the population.
A UK clinical audit addressing the quality of prescribing of sodium valproate for bipolar disorder in women of childbearing age
Authors: Paton Carol , Cookson John , Ferrier I Nicol , Bhatti Sumera , Fagan Elizabeth , Barnes Thomas R E
Published: April 2018

Objectives

To review prescribing practice concerning valproate, an established human teratogen, for the management of bipolar disorder in women of childbearing age.

Design

The Prescribing Observatory for Mental Health conducted a baseline clinical audit in the UK, as part of a quality improvement programme.

Participants

Six hundred and forty-eight clinical teams from 55 mental health Trusts submitted retrospective treatment data relating to patients with a diagnosis of bipolar disorder.

Results

Of the audit sample of 6705 patients, 3854 were 50 years of age or younger. Valproate was prescribed for 24% of women and 43% men in this age group, and the mean dose of valproate was lower in women (1196 mg) than in men (1391 mg). For only half of such women was there documented evidence that information had been provided on the risks for the unborn child and the need for adequate contraception. Valproate was more often used in men to treat mania and aggression, while the most common treatment targets in women were hypomania and relapse prevention.

Conclusions

Despite explicit recommendations in national treatment guidelines and published safety alerts and warnings regarding the use of valproate in women of childbearing age, current prescribing of this medication to such women in the context of the treatment of bipolar disorder falls short of best practice, particularly with regard to provision of information regarding the risks associated with exposure to valproate during pregnancy. While women younger than 50 years of age were less likely to be prescribed valproate than men in the same age group, and at a lower dosage, it is unclear to what extent this reflects clinicians’ concerns about teratogenicity or is driven by perceptions of the indication for valproate, and the dosage required, for the treatment of different phases of the disorder in men and women.
The role of psychological factors in the perpetuation of pain intensity and disability in people with chronic shoulder pain: a systematic review
Authors: Martinez-Calderon Javier , Meeus Mira , Struyf Filip , Miguel Morales-Asencio Jose , Gijon-Nogueron Gabriel , Luque-Suarez Alejandro
Published: April 2018

Introduction

Chronic shoulder pain is a very complex syndrome, and the mechanisms involved in its perpetuation remain unclear. Psychological factors appear to play a role in the perpetuation of symptoms in people with shoulder chronicity. The purpose of this systematic review is to examine the role of psychological factors in the perpetuation of symptoms (pain intensity and disability) in people with chronic shoulder pain.

Methods and analysis

A systematic search was performed on PubMed, AMED, CINAHL, PubPsych and EMBASE from inception to July 2017. Longitudinal studies with quantitative designs analysing the role of psychological factors on pain intensity, disability or both were included. The methodological quality of the included studies was evaluated with an adapted version of the Newcastle Ottawa Scale. The level of evidence per outcome was examined using the Grading of Recommendations Assessment, Development and Evaluation approach.

Results

A total of 27 articles were included with a sample of 11 176 people with chronic shoulder pain. The risk of bias ranges from 7/21 to 13/21 across the studies. The quality of the evidence was very low. High levels of self-efficacy, resilience and expectations of recovery were significantly associated with low levels of pain intensity and disability. Inversely, high levels of emotional distress, depressive symptoms, anxiety, preoperative concerns, fear-avoidance beliefs, somatisation and pain catastrophising were significantly associated with high levels of pain intensity and disability.

Discussion

Our results suggest that psychological factors may influence the perpetuation of pain intensity and disability, with very low evidence. A meta-analysis was not carried out due to the heterogeneity of the included studies so results should be interpreted with caution.

PROSPERO trial registration number

CRD42016036366.
Sensitivity of fasting glucose for gestational diabetes mellitus screening in Mexican adolescents based on International Association of Diabetes and Pregnancy Study Groups criteria: a diagnostic accuracy study based on retrospective data analysis
Authors: Reyes-Muñoz Enrique , Sandoval-Osuna Norma Lidia , Reyes-Mayoral Christian , Ortega-González Carlos , Martínez-Cruz Nayeli , Ramírez-Torres María Aurora , Arce-Sánchez Lidia , Lira-Plascencia Josefina , Estrada-Gutiérrez Guadalupe , Montoya-Estrada Araceli
Published: April 2018

Objective

To evaluate fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) among Mexican adolescents using International Association of Diabetes and Pregnancy Study Groups criteria.

Design

Retrospective cohort study.

Setting

Level-three medical institution in Mexico City.

Participants

The study population comprised 1061 adolescent women aged 12–19 years with singleton pregnancies, who underwent a 75 g oral glucose tolerance test (OGTT) between 11 and 35 weeks of gestation.

Primary and secondary outcome measures

The sensitivity (Sn), specificity (Sp), positive and negative predictive values (PPV and NPV, respectively), and positive and negative likelihood ratios LR (+) and LR (−), respectively) with 95% CIs for selected FPG cut-off values were compared. Secondary measures were perinatal outcomes in women with and without GDM.

Results

GDM was present in 71 women (6.7%, 95% CI 5.3% to 8.4%). The performances of FPG at thresholds of ≥80 (4.5 mmol/L), 85 (4.7 mmol/L) and 90 mg/dL (5.0 mmol/L) were as follow (95% CI): Sn: 97% (89% to 99%), 94% (86% to 97%) and 91% (82% to 95%); Sp: 50% (47% to 53%), 79% (76% to 81%) and 97% (95% to 97%); PPV: 12% (9% to 15%), 23% (18% to 28%) and 64% (54% to 73%); NPV: 99% (98.5% to 99.9%) for all three cut-offs; LR (+): 1.9 (1.8 to 2.1), 4.3 (3.8 to 5.0) and 26.7 (18.8 to 37.1) and LR (−): 0.06 (0.02 to 0.23), 0.07 (0.03 to 0.19) and 0.09 (0.04 to 0.19), respectively. No significant differences in perinatal outcomes were found between adolescents with and without GDM.

Conclusions

An FPG cut-off of ≥90 mg/dL (5.0 mmol/L) is ideal for GDM screening in Mexican adolescent women. An FPG threshold of 90 mg/dL would miss 6 (8.5%) women with GDM, pick up 34 (3.4%) women without GDM and avoid 962 (90.7%) OGTTs.
56-year-old lady with transaortic gradient
Authors: Spina Roberto , Iyer Arjun , Jansz Paul
Published: April 2018

Clinical introduction

A 56-year-old lady with a background of hypertension was admitted to our institution with acute pulmonary oedema. She reported gradual and increasingly severe dyspnoea on exertion over the preceding 12 months and, prior to presentation, her exercise tolerance was restricted to one flight of stairs. On transthoracic echocardiography during the index admission, left ventricular size and systolic function were normal, and peak and mean transaortic gradients were 67 mm Hg and 33 mm Hg, respectively, with a peak velocity of 3.9 m/s. No aortic incompetence or other significant valvular abnormality was noted. A transoesophageal echocardiogram was performed. Figure 1 depicts the mid-oesophageal parasternal long-axis view. What is the explanation behind the significant transaortic gradient?

Figure 1

Transoesophageal echocardiogram, mid-oesophageal long-axis view at 135 degrees.

Question

What is the explanation behind the significant transaortic gradient?

Ventricular septal defect 

Supravalvular aortic stenosis

Aortic valvular stenosis

Subaortic membrane

Hypertrophic obstructive cardiomyopathy
Cost-effectiveness of cardiac rehabilitation: a systematic review
Authors: Shields Gemma E , Wells Adrian , Doherty Patrick , Heagerty Anthony , Buck Deborah , Davies Linda M
Published: April 2018

Patients may be offered cardiac rehabilitation (CR), a supervised programme often including exercises, education and psychological care, following a cardiac event, with the aim of reducing morbidity and mortality. Cost-constrained healthcare systems require information about the best use of budget and resources to maximise patient benefit. We aimed to systematically review and critically appraise economic studies of CR and its components. In January 2016, validated electronic searches of the National Health Service Economic Evaluation Database (NHS EED), Health Technology Assessment, PsycINFO, MEDLINE and Embase databases were run to identify full economic evaluations published since 2001. Two levels of screening were used and explicit inclusion criteria were applied. Prespecified data extraction and critical appraisal were performed using the NHS EED handbook and Drummond checklist. The majority of studies concluded that CR was cost-effective versus no CR (incremental cost-effectiveness ratios (ICERs) ranged from $1065 to $71 755 per quality-adjusted life-year (QALY)). Evidence for specific interventions within CR was varied; psychological intervention ranged from dominant (cost saving and more effective) to $226 128 per QALY, telehealth ranged from dominant to $588 734 per QALY and while exercise was cost-effective across all relevant studies, results were subject to uncertainty. Key drivers of cost-effectiveness were risk of subsequent events and hospitalisation, hospitalisation and intervention costs, and utilities. This systematic review of studies evaluates the cost-effectiveness of CR in the modern era, providing a fresh evidence base for policy-makers. Evidence suggests that CR is cost-effective, especially with exercise as a component. However, research is needed to determine the most cost-effective design of CR.