bluuebunny/crossref_metadata_2025 huggingface dataset:
NDT for bridges durability assessment on urban-industrial environment in Brazil
Authors: Esteves Ian C.A. , Medeiros-Junior Ronaldo A. , Medeiros Marcelo H.F.
Published: September 2018

Purpose

The limitation of bridges’ operation can cause serious social, environmental and economic losses. Therefore, the monitoring and maintenance actions of these structures must be efficient and periodic, especially for bridges located in aggressive environments, such as urban-industrial centres, where the higher volume of carbon dioxide emissions favours carbonation induced corrosion. The purpose of this paper is to analyse the utility of including non-destructive testing (NDTs) to bridges assessment in that regions as a way of obtaining more in-depth information on the conditions of the material composing the structure.

Design/methodology/approach

First, the main bridges’ damages were detected by visual inspection. Then, based on the observations of bridges design, environment and main damages, an NDT programme was executed including surface hardness, ultrasonic pulse velocity test, pH indicator spraying, half-cell potential measurements and concrete resistivity tests.

Findings

It was observed that, for the studied cases, the carbonation did not present harmful depths, except for the structural elements where segregation and wear of the concrete were noticed. NDTs, associated with visual inspection, indicated the regions where corrective or preventive maintenance actions were actually needed, bringing greater security to the decision maker in regions where repairs are unnecessary or could be postponed.

Originality/value

This paper highlights the contribution of NDTs application in structures in urban-industrial regions where the main mechanism of deterioration is carbonation-induced corrosion, demonstrating the importance of these methods in the rational decision making of investments for maintenance.
An analysis of the effect of carbon emission, GDP and international crude oil prices based on synthesis integration model
Authors: Zou Xiaohua
Published: September 2018

Purpose

This paper aims to analyze the impact of the relations between the US oil prices, carbon emissions and GDP through the analysis of data between 1987 and 2017.

Design/methodology/approach

ARIMA, VAR and VEC models are used to establish synthesis integration model. Furthermore, the stability test, cointegration test and Granger causality test of the model were carried out.

Findings

The results indicate that, in both short and long term, change in oil prices is the reason for change in carbon emissions, while GDP is not the reason for the growth of carbon emissions.

Originality/value

Increase of oil prices would have a negative impact on carbon emissions, and GDP growth does not lead to an increase in carbon emissions.
Measuring Lean Six Sigma and quality performance for healthcare organizations
Authors: Ahmed Selim , Abd Manaf Noor Hazilah , Islam Rafikul
Published: September 2018

Purpose

This study aims to investigate applications of Lean Six Sigma approaches and quality performance in Malaysian hospitals. It identifies five dimensions of Lean Six Sigma conformance (i.e. continuous quality improvement, Lean management initiatives, Six Sigma initiatives, patient safety and teamwork) and quality performance of the hospitals based on demographics such as gender, types of hospital and working experience.

Design/methodology/approach

This study distributed 1,007 self-administered survey questionnaires to hospital staff resulting in 438 useful responses with 43.5 per cent response rate. Research data were analysed based on reliability analysis, exploratory factor analysis (EFA), independent samples t-tests and one-way ANOVA using SPSS version 23.

Findings

Research findings indicate that there are significant differences between public and private hospital staff on Lean management initiatives, Six Sigma initiatives, patient safety and teamwork. Private hospital staff perceives Lean management initiatives, Six Sigma initiatives, patient safety and teamwork more favourably compared to public hospital staff. The present study findings also indicate that senior hospital staff (more than 10 years working experience) perceives patient safety and teamwork more favourably compared to other working experience groups.

Research limitation/implications

The research focused solely on the Malaysian health sector, and thus, the results might not be applicable to other countries.

Originality/value

This research provides theoretical, methodological and practical contributions for the Lean Six Sigma approach and the research findings are expected to provide guidelines to enhance the level of quality performance in healthcare organisations in Malaysia as well as other countries.
Service innovation, sustainability and quality meeting city challenges in the age of accelerations
Authors: Enquist Bo , Sebhatu Samuel Petros
Published: September 2018

Purpose

The aim of this article is to provide a deeper conceptual understanding of the interdependence between service innovation, sustainability and quality in the age of accelerations in the context of cities. The research question is, how can service innovation, sustainability and quality interact in cities to meet the challenges of technology, globalization and climate change?

Design/methodology/approach

The study adopts a qualitative research approach and cases study research method in the context of cities. In this article, meeting the challenges in the age of accelerations is analyzed and interpreted in an abductive process in an interaction between empirical findings of three progressive cities Freiburg, Malmö and Gothenburg and the conceptual and theoretical frame for getting a new meaning.

Findings

The article demonstrates the need for a deeper conceptual understanding of the interdependence of service innovation, sustainability and quality in the age of accelerations. Service innovation and quality improvement cannot be handled as a standalone managerial activity because these processes are part of values-based learning and developing a loop for transformation, value co-creation and sustainability practice.

Research limitations/implications

Future research in this area should focus on generalizing the present findings to securing sustainable service business embedded on social and environmental perspectives and governance issues in other empirical settings and conceptualization.

Societal implications

The article looks into the idea of an ecosystem to achieve a balance between nature and people: “Dynamic” and “complex” ecosystems can be illustrated in different contexts to ensure a strong commitment to societal and environmental perspectives to create value and develop a sustainability practice.

Originality/value

The article makes an original contribution by using insights from service research, quality movement research and from studying actual sustainability practices in the real-life contexts of cities by developing a conceptual paper.
Introducing sustainability into an architectural curriculum in East Africa
Authors: Olweny Mark
Published: September 2018

Purpose

This paper aims seeks to reflect on the transition of a school of architecture to incorporate sustainability principles as a core part of its undergraduate (Part I) programme. The paper offers a brief overview of the processes undertaken and outcomes of this to an integrated problem-based learning approach and with sustainability at its core changing both knowledge content and pedagogical approaches.

Design/methodology/approach

Reflecting on the transition to a sustainability-based curriculum, this paper makes use of a mixed methods approach incorporating a review of literature on sustainability in architectural education, pedagogical approaches and epistemology, as well as educational issues in sub-Saharan Africa. The main study made use of an ethnographic approach, including document analysis, interviews, observations and one-on-one informal interactions with students, faculty and alumni.

Findings

While the transition to a sustainability-based curriculum was achieved, with integrated studio courses at second- and third-year levels, this did not come without challenges. Divided opinions of formal education, linked to preconceived ideas of what constituted architectural education led to some resistance from students and professionals. Nevertheless, the programme serves as testament to what is achievable and provides some lessons to schools seeking to transition programmes in the future.

Practical implications

The paper contributes to discourses on sustainability in architectural education, examining the transition taken by an architectural programme to incorporate sustainability as a core part of its curriculum. The outcomes of this process provide advice that could be useful to schools of architecture seeking to integrate sustainability into their programmes.

Originality/value

As the first architecture programme in East Africa to integrate sustainability principles into its programme, this study provides an insight into the processes, experiences and outcomes of this transition. This reflective engagement highlights value of an enabling environment in any transitional process.
Factors affecting mobile shopping: a Vietnamese perspective
Authors: Phong Nguyen Dong , Khoi Nguyen Huu , Nhat-Hanh Le Angelina
Published: September 2018

Purpose

Mobile shopping is the current trend for firms to conduct business, having great advantages over electronic shopping as well as traditional shopping. The purpose of this paper is to discuss not only the driving forces of mobile shopping behaviors from the theory of reasoned action (TRA) perspective, but also the additional promotion and barrier sides of the mobile business.

Design/methodology/approach

A structural equation modeling approach with latent constructs is applied on a self-administered survey data of 208 Vietnamese consumers to test the hypotheses.

Findings

The results of this study have proved the predictive power of TRA in exploring consumer behavior in the context of mobile shopping. Also, both promotion and barrier variables have significantly strong impacts on the intention to adopt mobile shopping.

Research limitations/implications

Future studies would benefit from investigating other variables (e.g. specific aspects of trust and risk) and using actual behavior (e.g. online purchases).

Practical implications

Business managers should pay attention to both promotion and barrier factors to understand how and why Vietnamese consumers adopt mobile shopping.

Originality/value

This pioneering study adapts the TRA model with extended promotion and barrier variables to explain mobile shopping in the context of Vietnam.
Perceived underqualification and job attitudes: the role of transformational leadership
Authors: Sim Yerim , Lee Eun-Suk
Published: September 2018

Purpose

The purpose of this paper is to delve into perceived underqualification, which refers to employees’ awareness that they have deficient abilities relative to their job demands (abilitiesdemands), leaving the other type, underqualification, unexplored. To address the neglect, this study investigates how perceived underqualification relates to job attitudes (job satisfaction, organizational commitment, and turnover intention) and how transformational leadership moderates the relationships.

Design/methodology/approach

Survey data were collected from employees working at diverse organizations in South Korea over two waves; at Time 1, perceived underqualification and transformational leadership were measured and at Time 2, job attitude variables were measured. Responses from 188 employees were used for hypothesis testing.

Findings

Perceived underqualification is negatively related to job satisfaction and organizational commitment and positively related to turnover intention when transformational leadership is low. However, under high transformational leadership, such negative attitudinal implications of perceived underqualification are weakened.

Originality/value

By examining underqualification for the first time, this study corrects the current incomplete and biased understanding of P–J misfit, which is exclusively overqualification-focused. In addition, this study provides new insight into individual responses to P–J misfit by revealing that the responses are not always negative. This study specifies transformational leadership as the contingency factor that enables such responses, thus further advancing the P–J misfit literature that has hardly examined the leadership effect.
Corporate social responsibility, country reputation and corporate reputation
Authors: Kelley Keith James , Hemphill Thomas A. , Thams Yannick
Published: September 2018

Purpose

This paper aims to explore the relationship between corporate social responsibility (CSR) and corporate financial performance (CFP) from a shared value perspective. Adopting reputation as a multilevel form of value that mediates the CSR–CFP relationship, the paper explains how CSR initiatives may enhance both firm and country reputation and how the amount of shared value between the two leads to CFP.

Design/methodology/approach

The paper first establishes the theoretical foundation for the relationship between CSR and CFP. It then draws connections to a more recent stream of literature surrounding the concept of creating shared value to expand upon this relationship, adopting reputation as a multilevel form of shared value that mediates the CSR–CFP relationship. The paper further discusses moderating influences of this relationship that may vary contextually with emerging economies such as those in Latin America.

Findings

The paper argues that as markets become further developed, CSR initiatives will create a higher proportion of shared reputational value between a corporation and country. This is the result of from aligning CSR initiatives that benefit a society, with the strategic goals of the firm – the essence of creating of shared value – but is more difficult in emerging markets, especially volatile ones.

Originality/value

This paper offers insight into a complex relationship between CSR, shared reputational value and CFP by introducing the more recent concept of creating shared value. Several propositions related to this general relationship, and some related to the difference among emerging markets (such as those in Latin America), address the need for more research related to corporate and country reputation, creating shared value and in the emerging market context.
Re-testing and validating a triple bottom line dominant logic for business sustainability
Authors: Laurell Hélène , Karlsson Niklas P.E. , Lindgren John , Andersson Svante , Svensson Göran
Published: September 2018

Purpose

The triple bottom line (TBL) is still commonly explored in research without joint consideration of economic, social and environmental elements of business sustainability (BS). The purpose of this paper is to re-test and validate a BS framework based on the TBL approach.

Design/methodology/approach

This study is based on a questionnaire survey consisting of the largest firms in corporate Sweden. A total of 107 usable questionnaires were ultimately received, for a response rate of 36.5 percent.

Findings

The findings validate and extend a framework of a TBL-dominant logic for BS. A total of 19 dimensions indicating satisfactory validity and reliability of the BS framework were identified.

Research limitations/implications

The BS framework offers relevant insights to monitor and assess a TBL-dominant logic for BS. It also provides opportunities for further research.

Practical implications

Managers can use the BS framework as a tool to map firm priorities in connection with BS. Each dimension of the BS framework offers insights into how to monitor and assess firms’ efforts in the TBL.

Originality/value

This study contributes to validate and extend the TBL-dominant logic for BS. The BS framework also offers a timely and relevant contribution to both scholars and practitioners engaging in business sustainability.
Problematic and extensive YouTube use: first hand reports
Authors: Klobas Jane E. , McGill Tanya J. , Moghavvemi Sedigheh , Paramanathan Tanuosha
Published: September 2018

Purpose

The purpose of this paper is to present brief YouTube life stories to learn about how extensive users experience YouTube use and manage (or fail to manage) their use. It also explores the consequences of different types of extensive use.

Design/methodology/approach

In this paper, a biographical approach was used. Nine students who used YouTube for two or more hours every day were guided to tell life stories of their introduction to YouTube, subsequent use and critical events associated with YouTube use. Thematic analysis distinguished between non-problematic, compulsive and addicted users. Three single case life stories illustrate the experiences of users in each category.

Findings

These extensive YouTube users tell similar stories of informal learning from early interaction with the platform. For some, extensive YouTube use became problematic; for others, it remained functional. Similar to other social platforms, users unable to regulate use became compulsive users and some users can become addicted. While the symptoms of YouTube addiction are similar to other online addictions, compulsive YouTube use is driven more by algorithm-generated content chaining than overt social interaction.

Originality/value

The paper introduces life stories as a way to present case studies of social media use. The distinction between extensive, but functional, and problematic YouTube use illustrates how extensive social media use is not necessarily dysfunctional. User education for self-regulation of YouTube use is recommended.
How can the entrepreneurship ecosystem in Guyana impact the tourism industry by 2025?
Authors: Connelly Aletha
Published: September 2018

Purpose

The purpose of this conceptual paper is to discuss the entrepreneurship ecosystem in Guyana with particular emphasis on the role of cultural support and its possible impact on the tourism industry in the country by 2025.

Design/methodology/approach

The paper is based on a literature review of entrepreneurship ecosystems, document analysis of key reports on Guyana and interviews with relevant authorities.

Findings

The paper observes that Guyana can focus entrepreneurial efforts on areas of natural comparative advantage, including nature-based tourism and agriculture. However, achieving high-impact entrepreneurship in developing world economies like Guyana requires a strategic approach that is process oriented and which addresses cultural impediments to entrepreneurship.

Practical implications

Encouraging wealth creation and addressing issues of poverty and inequality are but a few of the concerns governments grapple with. Guyana is no different to its geo-political counterparts who are pushing entrepreneurship as a viable means of addressing these concerns. Driven by factors such as setbacks experienced by those with a socialist agenda, the onset of globalisation, the removal of preferential agreements, the opening of trade routes and an emphasis on local economic development, much has been made of entrepreneurship as a panacea of development issues.

Originality/value

This paper seeks to contribute to a better understanding of entrepreneurship in a developing world context with particular significance for the tourism industry.
Comprehensive exploration of the enzymes catalysing oxygen‐involved reactions and COGs relevant to bacterial oxygen utilization
Authors: Liu Shuo , Du Meng‐Ze , Wen Qing‐Feng , Kang Juanjuan , Dong Chuan , Xiong Lifeng , Huang Jian , Guo Feng‐Biao
Published: September 2018

To better understand the mechanisms of bacterial adaptation in oxygen environments, we explored the aerobic living‐associated genes in bacteria by comparing Clusters of Orthologous Groups of proteins’ (COGs) frequencies and gene expression analyses and 38 COGs were detected at significantly higher frequencies (p‐value less than 1e−6) in aerobes than in anaerobes. Differential expression analyses between two conditions further narrowed the prediction to 27 aerobe‐specific COGs. Then, we annotated the enzymes associated with these COGs. Literature review revealed that 14 COGs contained enzymes catalysing oxygen‐involved reactions or products involved in aerobic pathways, suggesting their important roles for survival in aerobic environments. Additionally, protein–protein interaction analyses and step length comparisons of metabolic networks suggested that the other 13 COGs may function relevantly with the 14 enzymes‐corresponding COGs, indicating that these genes may be highly associated with oxygen utilization. Phylogenetic and evolutionary analyses showed that the 27 COGs did not have similar trees, and all suffered purifying selection pressures. The divergent times of species containing or lacking aerobic COGs validated that the appearing time of oxygen‐utilizing gene was approximately 2.80 Gyr ago. In addition to help better understand oxygen adaption, our method may be extended to identify genes relevant to other living environments.
Effects of a Game‐Based e‐Learning Module on Undergraduate Food Science Students’ Planned Behaviors Concerning Good Manufacturing Practices
Authors: Stevenson Clinton D. , Porter Kinsey , Stevenson Kathryn T.
Published: September 2018

Understanding the role of food science education in developing undergraduate students’ intentions to implement Good Manufacturing Practices (GMPs) may be a key strategy in developing the workforce's implementation of GMPs and other food safety programs. Previous research has demonstrated the effects of educational interventions on planned food safety behaviors in various settings; however, none have studied GMPs interventions and college students. This study applied the Theory of Planned Behavior (TPB) to evaluate the effects of a game‐based e‐learning module on undergraduate students’ planned behaviors concerning GMPs. Forty‐four participants were recruited from 42 food science clubs across the United States to complete a game‐based e‐learning module and pre‐ and posttest survey instruments. We compared changes in pre‐ and posttest scores using paired Wilcoxon signed rank tests and explored the role of GMP‐related knowledge and TPB constructs (attitudes, subjective norms, and perceived behavioral controls) in predicting students’ intentions to implement GMPs using multiple linear regression. We modeled pretest scores, posttest scores, and changes in scores while controlling for student demographic factors (for example, year in college, gender, and so on). Only participants’ knowledge and perceived behavioral controls significantly increased (P < 0.05) after completing the game‐based e‐learning module. Posttest regression models explained twice as much variance than pretest models (up to 54% total). Changes in intentions to implement GMPs were predicted by changes in subjective norms, perceived behavioral controls, and knowledge, as well as previous enrollment in food safety courses and interest in working in the food industry. The only predictive variables for both pre‐ and posttest scores were subjective norms, previous enrollment in food safety courses and interest in working in the food industry (P < 0.05). A discussion of how these results provide insights for food safety educators to optimize their teaching impacts was presented.
Endophytic fungal community of Dysphania ambrosioides from two heavy metal‐contaminated sites: evaluated by culture‐dependent and culture‐independent approaches
Authors: Parmar Shobhika , Li Qiaohong , Wu Ying , Li Xinya , Yan Jinping , Sharma Vijay K. , Wei Yunlin , Li Haiyan
Published: September 2018

Endophytic fungal communities of Dysphania ambrosioides, a hyperaccumulator growing at two Pb‐Zn‐contaminated sites, were investigated through culture‐dependent and culture‐independent approaches. A total of 237 culturable endophytic fungi (EF) were isolated from 368 tissue (shoot and roots) segments, and the colonization rate (CR) ranged from 9.64% to 65.98%. The isolates were identified to 43 taxa based on morphological characteristics and rDNA ITS sequence analysis. Among them, 13 taxa (30.23%) were common in plant tissues from both sites; however, dominant EF were dissimilar. In culture‐dependent study, 1989 OTUs were obtained through Illumina Miseq sequencing, and dominant EF were almost same in plant tissues from both sites. However, some culturable EF were not observed in total endophytic communities. We suggest that combination of both culture‐dependent and culture‐independent methods will provide more chances for the precise estimation of endophytic fungal community than using either of them. The tissue had more influence on the culturable fungal community structure, whereas the location had more influence on the total fungal community structure (including culturable and unculturable). Both culture‐dependent and culture‐independent studies illustrated that endophytic fungal communities of D. ambrosioides varied across the sites, which suggested that HM concentration of the soil may have some influence on endophytic fungal diversity.
Long‐term outcomes in 1121 Australian prostate cancer patients treated with definitive radiotherapy
Authors: de Leon Jeremiah F , Kneebone Andrew , Gebski Val , Cross Shamira , Do Viet , Hayden Amy , Ngo Diana , Sidhom Mark , Turner Sandra
Published: September 2018

Introduction

Optimal definitive treatment of prostate cancer is controversial, especially in high‐risk patients. We report the largest prospective cohort of Australian patients treated with radiotherapy for localised prostate cancer.

Methods

One thousand, one hundred and twenty‐one patients with prostate cancer were prospectively registered and treated to a dose of 70–74 Gy. Patients were classified as low, intermediate or high risk based on PSA, clinical staging and Gleason score. Intermediate‐risk patients were treated with 0–6 months of hormonal therapy (ADT) and high‐risk patients were offered neoadjuvant and adjuvant ADT. Overall survival (OS) and biochemical relapse‐free survival (bNED) were calculated using the Kaplan–Meier method.

Results

Median follow‐up was 92 months. Eight‐year OS and bNED were 78.4% and 68.1% respectively in the entire cohort. OS for the low, intermediate and high‐risk groups was 84.5%, 78.4% and 68% respectively. For these risk groups, bNED was 80.3%, 65.7% and 53.7% respectively. In the intermediate and high‐risk group, OS and bNED decreased with increasing number of risk factors.

Conclusion

Definitive radiotherapy is an effective treatment for prostate cancer, including in high‐risk cases.
Matrix metalloprotease 3 is associated with sarcopenia in rheumatoid arthritis ‐ results from the CHIKARA study
Authors: Tada Masahiro , Yamada Yutaro , Mandai Koji , Hidaka Noriaki
Published: September 2018

Aim

Patients with rheumatoid arthritis (RA) show lower muscle mass and a higher prevalence of sarcopenia than healthy individuals. Correlations between sarcopenia and disease activity, physical function, laboratory data and body composition at baseline were investigated in a prospective, observational study (CHIKARA study) of RA patients.

Methods

Body composition was measured using a bioelectrical impedance analyzer. Parameters were compared between sarcopenia and non‐sarcopenia groups, and correlations between sarcopenia and Disease Activity Score of 28 joints – erythrocyte sedimentation rate (DAS28‐ESR), modified health assessment questionnaire, treatment, and laboratory data, including matrix metalloproteinase 3 (MMP3), were investigated.

Results

The participants were 100 patients with RA (women, 78%; mean age, 66.1 years). Mean disease duration was 5.5 years, DAS28‐ESR was 3.55 and the prevalence of sarcopenia was 28%. Median C‐reactive protein (CRP) and MMP3 were significantly higher in the sarcopenia group (0.21 mg/dL and 103.4 ng/mL) than in the non‐sarcopenia group (0.11 mg/dL and 70.3 ng/mL). Sarcopenia was negatively correlated with weight, body mass index (BMI), muscle mass, body fat mass, estimated bone mass and basal metabolic rate, and positively correlated with Steinbrocker stage, CRP and MMP3 on univariate analyses. BMI, body fat mass and MMP3 were independently associated with sarcopenia on multivariate logistic regression analysis. When MMP3 was ≥ 90.7 ng/mL, the odds ratio for sarcopenia was increased 3.1‐fold compared with < 90.7 ng/mL (P = 0.018).

Conclusion

The prevalence of sarcopenia was 28% in patients with RA whose disease activity was mild. Low BMI, high fat mass and high MMP3 were independently associated with sarcopenia. MMP3 might be a useful marker for sarcopenia in patients with RA.
Long‐term patient reported outcomes of elbow, wrist and hand surgery for rheumatoid arthritis
Authors: Okura Chisa , Ishikawa Hajime , Abe Asami , Yonemoto Yukio , Okamura Koichi , Suto Takahito , Oyakawa Tomo , Miyagawa Yusuke , Otani Hiroshi , Ito Satoshi , Kobayashi Daisuke , Nakazono Kiyoshi , Murasawa Akira , Takagishi Kenji , Chikuda Hirotaka
Published: September 2018

Aim

A retrospective questionnaire survey was conducted to investigate the long‐term outcomes of elbow, wrist and hand surgery for rheumatoid arthritis (RA).

Methods

One hundred and thirteen RA patients underwent primary elective elbow, wrist or hand surgery at our hospital between January 2002 and December 2003. To evaluate the outcomes at 10 years after surgery, the patient‐reported outcomes were assessed using an original questionnaire that inquired about the site of treatment; the modified Stanford Health Assessment Questionnaire (mHAQ) was also used.

Results

Responses were obtained from 67 patients (98 sites). In the 10 years after surgery, the Disease Activity Score of 28 joint – erythrocyte sedimentation rate (4) and the modified Health Assessment Questionnaire scores of the patients showed significant improvement. Nearly 85% of patients were satisfied with the outcome at the surgical site. The most frequent reason for perceived improvement was ‘pain relief’ (all surgical sites). An ‘improved appearance’ was frequently reported after finger surgery and ‘increased power’ was frequently reported after wrist and thumb surgeries. With regard to elbow surgery, 30% of the patients were satisfied with the increase in motion and power. In contrast, approximately 20% of patients complained of decreased power around the surgical site after elbow and thumb surgeries.

Conclusions

Our original patient‐reported outcome assessment tool revealed that elbow, wrist and hand surgery provided long‐lasting benefits in RA patients. While the efficacy differed in some of the surgical sites, pain relief was the most favorable effect. Altered medical therapy may also have impacted the patient‐perceived outcomes of surgery at 10 years.
A multicentre observational study comparing patient reported outcomes to assess reliability of swollen and tender joint assessments and response to certolizumab treatment as compared to clinician assessments in rheumatoid arthritis
Authors: Inderjeeth Charles A. , Inderjeeth Adrisha J. , Raymond Warren D.
Published: September 2018

Aims

The use of swollen (SJC) and tender joint counts (TJC) for rheumatoid arthritis (RA) disease activity and treatment effectiveness is well established. Patient‐reported outcomes (PRO) are important. However, it is unknown if patient scoring is as reliable as that of trained professionals.

Methods

PRO including SJC and TJC were assessed at baseline, 6 and 12 weeks by patients and clinicians. Data were collected using ePRO (electronic) and pPRO (paper). The Least Squares Method (LSM), Pearson correlation (Rs) and weighted Kappa scores were used to assess inter‐rater reliability and agreement of responses between the patient, nurse and physician for changes in TJC and SJC from 0 to 12 weeks of treatment.

Results

There was a total of 341 evaluable matched joint assessment in 52 patients with RA: 157 nurse, 106 patient and 78 physician. There were matched joint count pairs for 104 patient‐nurse, 72 physician‐nurse and 21 patient‐physician. Correlation (R) of TJC scores were as follows: patient‐nurse 0.83 (P < 0.001), physician‐nurse 0.85 (P < 0.001) and physician‐patient 0.59 (P = 0.005). The inter‐rater reliability (agreement) of the patient‐nurse pairs had a weighted Kappa of 0.59 (0.53, 0.68). Correlation (R) of SJC scores were as follows: patient‐nurse 0.69 (P < 0.001), physician‐nurse 0.66 (P < 0.001) and physician‐patient 0.42 (P = 0.058). The inter‐rater reliability (agreement) of the patient‐nurse pairs had a weighted Kappa of 0.48 (0.41, 0.55).

Conclusions

There is a moderate to high level of agreement between clinicians and patient TJC and SJC assessments that suggest it may be a useful option in assessing joints and response in RA. Further evaluation of RA activity tools such as Disease Activity Score of 28 joints, Crohn Disease Activity Index or Simple Disease Activity Index utilizing patient assessments may be worth exploring.
Can I take my normal painkillers doctor? Therapeutic management of pain following dermatological procedures
Authors: Nelson Sarah C , Nelson Toby G , Mortimer Neil J , Salmon Paul JM
Published: September 2018

Dermatological procedures performed purely under local anaesthesia can provide excellent intraoperative analgesia. However, post‐procedure patients can have significant pain. Consequences of pain include patient distress, poor compliance with dressings and subsequent delayed wound healing as well as the potential fear and avoidance of further procedures. Anecdotally the same postoperative analgesia regime is given to all dermatology patients. There is a general fear by dermatologists of nonsteroidal anti‐inflammatory drugs (NSAIDs) due to perceived risk of postoperative bleeding and of tramadol due to its sedative effects. Understanding of pharmacology within the patient population and their comorbidities is necessary in choosing the appropriate analgesic regime. We reviewed the most commonly used analgesics, giving a summary of the important pharmacology and evidence of their use in the literature in order to allow clinicians to give individual approach to managing post‐procedure analgesia.
Perioperative cardiovascular complications following urogynecological operations
Authors: Larsen Michael Due , Guldberg Rikke , Lose Gunnar
Published: September 2018

Introduction

The risk of perioperative cardiovascular complications following operations for urinary incontinence and pelvic organ prolapse (POP) must be taken into consideration during surgical planning. The literature on the cardiovascular risk following urinary incontinence and POP operations shows conflicting results. Our aims were to provide an estimate of the mortality and the risk of cardiovascular complications following urinary incontinence and POP operations considering women’s preoperative cardiovascular comorbidity.

Material and methods

This nationwide register‐based study includes a total of 13 992 operations for urinary incontinence and 35 765 for POP from 2007 to 2017. The risk was estimated as an incidence/rate ratio for women with and without former cardiovascular comorbidity adjusted for relevant confounders by using a case‐crossover study design.

Results

A total of 7677 patients were at high risk, with a cardiovascular comorbidity prior to the operation, and 42 076 patients were at low risk, with no cardiovascular comorbidity. Overall, 11 patients died within 30 days following an operation, of whom five were in the high‐risk group and six in the low‐risk group. Of the women at high risk, 0.59% had cardiovascular complications from 0 to 6 days following an operation, corresponding to an incidence/rate ratio of 3.64 (95% CI; 2.67‐4.97), compared with women at low risk where no complications were registered in the first week.

Conclusions

We found an increased risk of cardiovascular complications following urogynecological operations in women with preoperative cardiovascular comorbidity, and no increased risk in women without prior cardiovascular comorbidity. In general, the risk of cardiovascular complications was lower than that found in previous studies.
Design Effect of Metallic (Durable) and Polymeric (Resorbable) Stents on Blood Flow and Platelet Activation
Authors: Marom Gil , Eswaran Senthil K. , Rapoza Richard J. , Hossainy Syed F. A. , Slepian Marvin J. , Bluestein Danny
Published: September 2018

Bioresorbable vascular scaffolds (BVS) provide transient vessel support for occluded coronary arteries while resorbing over time, potentially allowing vessel restoration approximating the native, healthy state. Clinical trials indicate that the Absorb BVS (Abbott Vascular, Santa Clara, CA) performance was similar to that of the Xience metallic drug‐eluting stent (DES), with low long‐term complications rates. However, when under‐deployed in very small vessels (diameter < 2.25 mm), the thrombosis rate of BVS was higher, possibly due to the effect of strut thickness on the hemodynamics (157 μm BVS vs. 81 μm DES). This study aims to determine the influence of BVS design in vessels of varying diameter on the potential platelet activation. Sixteen computational fluid dynamics models of vessels of varying diameter (1.8–3.0 mm), strut thickness (81–157 μm), and BVS/DES designs were compared. Platelet stress accumulation (SA), a metric for the activation potential, was calculated along platelet flow trajectories and their probability distribution was compared. The models were consistent with clinical observations, indicating that devices deployed in very small vessels exhibited increased probability for platelet activity as compared to the same devices deployed in nominal sized vessels. Deployment, although with residual stenosis, increased probability for higher SA than in similar diameter straight vessels. Reducing BVS struts thickness while maintaining their pattern improved performance closer to that of DES. Our findings highlight the importance of appropriate vessel sizing and deployment technique for BVS, and may help designing future BVS with thinner struts, ultimately improving performance in very small vessels.
Statistics in ophthalmology revisited: the (effect) size matters
Authors: Grzybowski Andrzej , Mianowany Mariusz
Published: September 2018

The association of biomedical sciences with mathematics is inextricable and undeniable. It should be considered that gaining confidence or strong belief within the framework of a scientific experiment – in the ‘compulsory’ marriage with statistics – does not mean total and undisturbed certainty. The null hypothesis significance testing (NHST) has been the kernel of statistical data analysis for a long period. Medicine is making use of it in a very wide range. The main problem in NHST arises out of a dichotomic perception of reality. Scientific reasoning was biased in the aftermath of the uncritical, almost dogmatic, trust in a level of statistical significance, namely a p‐value, defined as ‘the dictating paradigm of p‐value’. The level of statistical significance (p‐value) is not completely plausible and objective; it cannot be equated with the nature of a phenomenon or population characteristics. The p‐value refers directly to a formulated hypothesis only, that is the probability of observing a given outcome under the condition posited by a specific null hypothesis and given a specific model of the distribution of outcomes under the null hypothesis. Experts claim that unjustified conclusions and guidelines have become the bane of many scientific journals. Investigators should be able to interpret study results in a broad context and look at them critically. Statistics indeed is a leaven to further scientific discussion, not its conclusion. It is not easy to abandon the p‐value. Lots of researchers recommended an ecumenical approach to the statistical analysis of research data, for example analyses of the same results using a variety of statistical procedures. Many of them express the view that a threshold level of statistical significance should be lower than p < 0.05. To enhance the plausibility and true scientific value of research works, investigators should also take into consideration the effect size along with its confidence limits. The effect size is a kind of added value and should be determined a priori. Account must be taken of their origin, conditioning (medical knowledge), as well as specific implications in clinical practice. The effect size makes possible to compare results of various research works. It is argued that to the rescue for modern science can come research works that bear the stamp of reproducibility, for example studies conducted in several independent centres, based on coherent and meticulous methodology, or data from various centres typed in one spotless big database and submitted to rigorous and deliberate multilevel statistical analyses.
Retinal vein occlusion and obstructive sleep apnea: a series of 114 patients
Authors: Agard Emilie , El Chehab Hussam , Vie Anne‐Laure , Voirin Nicolas , Coste Olivier , Dot Corinne
Published: September 2018

Purpose

Evaluate the prevalence of obstructive sleep apnea (OSA) in patients with retinal vein occlusion (RVO).

Methods

A prospective and controlled study including 114 patients from January to September 2016, who were divided into two groups: 69 patients with RVO (RVO+) and 45 controls (RVO−), matched for age, sex and disease. All the patients completed a simple questionnaire and the Epworth Sleepiness Scale and underwent a RUSleeping® (portable monitoring device and then continuously monitored the subject's respiration to detect respiratory events). In addition, all patients with RVO were administered OSA screening with a polysomnography (PSG) during an overnight stay in the hospital, which was analysed by a single sleep apnea specialist.

Results

Sleep apnea was suspected in 73.9% in the RVO group and 63% in the control group based on the simple questionnaire; 22% in the RVO group and 4.3% in the control group according to the Epworth Sleepiness Scale; 82.6% in the RVO group and 55.6% in the control group (p = 0.005) according to RUSleeping®. Multivariate logistic regression analysis (based on RUsleeping®) confirmed that RVO was associated with OSA (adjusted odds ratio, 5.65, [1.60–19.92], p = 0.007). All patients in the RVO group were confirmed by PSG, and finally, 91.5% were diagnosed with moderate‐to‐severe OSA. Among the RVO+ patients, the mean apnea–hypopnoea index (AHI) was 42.2 events per hour (7.7–96.5). OSA was moderate in 22% patients and severe in 69.5% patients. There was no significant relationship between RVO severity and the PSG data variables.

Conclusion

The systematic screening of OSA with the gold standard PSG found a high prevalence of OSA in patients with RVO. The OSA is probably a risk factor associated with RVO. Polysomnography remains the gold standard method; nevertheless, the RUsleeping® RTS portable monitoring device can assess the presence and severity of sleep apnea with a low failure rate and a single use, prior to PSG, which is less available in clinical practice. Further studies with larger samples are needed to clarify the association.
Contralateral eye comparison of the long‐term visual quality and stability between implantable collamer lens and laser refractive surgery for myopia
Authors: Chen Xun , Guo Lin , Han Tian , Wu Liangcheng , Wang Xiaoying , Zhou Xingtao
Published: September 2018

Purpose

To investigate the long‐term visual quality and stability of implantable collamer lens (ICL) and laser refractive surgery (LRS) for myopia.

Methods

This study comprised 52 eyes of 26 high‐myopia anisometropia patients who were suitable for surgical treatment. In each patient, the higher‐myopia eye was implanted with ICL and the lower‐myopia eye was treated with LRS. The patients were followed for 3 years. During that time period, uncorrected (UDVA) and corrected distance visual acuity (CDVA), refraction, wavefront aberration and visual quality were evaluated.

Results

The spherical equivalent refractive error changed from −14.11 ± 3.39 D preoperatively to −1.27 ± 1.05 D 3 years after ICL implantation and from −8.75 ± 2.76 D to −1.12 ± 1.30 D after LRS. The changes in refractive error from 1 month to 3 years were −0.52 and −0.77 D for the ICL and LRS groups, respectively. The safety indices (postoperative CDVA/preoperative CDVA) were 1.84 ± 1.00 and 1.32 ± 0.40, and the efficacy indices (postoperative UDVA/preoperative CDVA) were 1.40 ± 1.10 and 1.11 ± 0.44, respectively. The postoperative coma, spherical and total higher‐order aberrations in the ICL group were lower than those in the LRS group.

Conclusion

Both ICL implantation and LRS are safe and effective procedures for myopia with suitable indications, but ICL implantation is more stable. Fewer induced aberrations are gained after ICL implantation.
The impact of extent of internal limiting membrane peeling on anatomical outcomes of macular hole surgery: results of a 54‐week randomized clinical trial
Authors: Yao Yuou , Qu Jinfeng , Dong Chongya , Li Xiaoxin , Liang Jianhong , Yin Hong , Huang Lvzhen , Li Yan , Liu Peipei , Pan Chungting , Ding Xue , Song Dan , Sadda Srinivas R. , Zhao Mingwei
Published: September 2018

Purpose

To compare the anatomical outcomes of different extents of internal limiting membrane (ILM) peeling in idiopathic macular hole surgery.

Methods

Prospective, parallel‐group, randomized clinical trial. A total of 121 eyes of 121 patients with idiopathic macular hole underwent pars plana vitrectomy, and peeling of the ILM with a diameter of two disk diameters (DD) or 4DD based on randomization. The main outcome was the proportion of eyes with complete hole closure at 12 months. The second outcome was the hole closure grading stratified by macular hole closure index (MHCI) at each visit.

Results

At 12 months, there was no significant difference in anatomical outcomes with complete closure achieved in 52 (82.5%) of 63 eyes in the 2DD group and 53 (91.4%) of 58 eyes in the 4DD group (p = 0.15). For subjects with MHCI ≤0.5 (n = 24), complete closure rate was significantly lower in the 2DD group compared to the 4DD group (p = 0.012; 18.2% versus 75.9%, respectively). Average BCVA was lower in 2DD group than 4DD group (p = 0.014). By contrast, when MHCI was >0.5, the complete closure rate between the two groups showed no significant difference: 96.2% (50 patients) versus 95.6% (43 patients), respectively (p = 0.185).

Conclusion

In patients with idiopathic full‐thickness macular hole and MHCI ≤0.5, a larger ILM peel of 4DD tends to achieve better anatomical outcomes than a more limited 2DD peel.