bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergence and development of low-tech clusters: an empirical study of five Palestinian clusters
Authors: Sultan Suhail , van Dijk Meine Pieter , Omran Omar
Published: May 2020

Purpose

This study aims to analyze the nature of challenges facing five low-tech Palestinian small and medium-sized enterprise (SME) clusters and to understand their dynamics. The study proposes a number of key policies necessary to foster start-ups and the growth of the current clusters.

Design/methodology/approach

Five low-tech Palestinian clusters were selected for investigation. Using multiple sources of evidence, the research questions are answered using a case study approach. Twelve semi-structured in-depth interviews were conducted with representatives from the government, private sector and universities. Content analysis was used to analyze the data obtained from the interviews.

Findings

These five low-tech clusters in Palestine are located in a complex environment that imposes a mix of challenges which adversely affect their performance. The challenges facing Palestinian clusters are different in terms of their degree of complexity. The common challenges facing the Palestinian low-tech SME clusters are the fundamental lack of innovative stimulation policies or of incentives in the Palestinian ecosystem, lack of trust, unfair competition, limited access to finance, lack of access to promising markets and the limited collaboration between different parties. More focused policies are suggested to the Palestinian authorities.

Practical implications

Clusters represent a new and complementary way of understanding an economy, organizing economic development, enhancing competitiveness and innovation through sectoral specialization and cooperation and implementing public policies. In the overwhelming majority of Palestinian entities categorized as SMEs, clustering adds value to the firms from the point of view of productivity and by battling unemployment, which is rampant among Palestinian youth.

Originality/value

Even though the issue of clusters in SMEs has been well researched in developed countries, empirical studies are still lacking in this developing region. The attention given to policies in this article allows using the insights gained for cluster development in Palestine.
Learning method design for engineering students to be prepared for Industry 4.0: a Kaizen approach
Authors: Hasan Md. Zahid , Mallik Avijit , Tsou Jia-Chi
Published: May 2020

Purpose

Underdeveloped along with developing countries face enough crisis of human resources in high-tech industries. As a result, the amount of waste is higher along with less productivity. Highly qualified and smart employees are required as the term “Industry 4.0” introduces a lot of sophisticated and complex technologies that dominates productivity. But in those countries, to cope up with this terminology; neither the educational curriculum and method of teaching has been modified nor changed yet nor will be modified soon. So, the engineering students should be introduced with the aims and technologies of Industry 4.0 and its key technologies so that they can prepare themselves as highly skilled and qualified human resources besides academic courses.

Design/methodology/approach

This article mainly depicts the causes of poor technical skills of the engineering students of Bangladesh and a new learning process has been proposed. The model proposed is basically inspired by Kaizen philosophy consisting of initiation, sharing and implementation cycles. The key aspects of human resource quality and the possibility of gaining innovative human resources for smart industries are given equal priority here. The prime factor to evaluate any learning outcome is quality and this research is a structured guideline to achieve sustainable quality education needed for “Industry 4.0” to engineering students.

Findings

This paper provides statistical analysis on “Fitness of undergraduate engineering students for Industry 4.0”. After applying the proposed methodology on 130 students from different public engineering institutes of Bangladesh, the significant improvement of effectiveness in learning various topics of “Industry 4.0” besides academic studies has justified the method to be a successful one measuring by the criteria for fitness of human resource. This research aims to clarify the sustainable and work-based learning goals and methods for Science, Technology, Engineering and Management (STEM) students and professional courses.

Research limitations/implications

This is a research where the proposed methodology was applied upon academically enrolled engineering students and the result was very satisfactory. A sustainable learning strategy for developing professional skills from academic life can result in better productivity at the beginning of a career. However, this methodology can be applied for job holders or professionals besides their office hours thus it is the future scope of this research methodology.

Originality/value

This research represents the crucial factors related to technical education and skill development for the upcoming challenges and possible remedies needed for Industry 4.0. Therefore, students should become aware of their carrier challenges and the administration concerned for education to minimize the scarcity of skilled human resources needed for the Fourth Industrial revolution.
SDN-cloud: a power aware resource management system for efficient energy optimization
Authors: Shrabanee Swagatika , Rath Amiya Kumar
Published: May 2020

Purpose

In modern cloud services, resource provisioning and allocation are significant for assigning the available resources in efficient way. Resource management in cloud becomes challenging due to high energy consumption at data center (DC), virtual machine (VM) migration, high operational cost and overhead on DC.

Design/methodology/approach

In this paper, the authors proposed software-defined networking (SDN)-enabled cloud for resource management to reduce energy consumption in DC. SDN-cloud comprises four phases: (1) user authentication, (2) service-level agreement (SLA) constraints, (3) cloud interceder and (4) SDN-controller.

Findings

Resource management is significant for reducing power consumption in CDs that is based on scheduling, VM placement, with Quality of Service (QoS) requirements.

Research limitations/implications

The main goal is to utilize the resources energy effectively for reducing power consumption in cloud environment. This method effectively increases the user service rate and reduces the unnecessary migration process.

Originality/value

As a result, the authors show a significant reduction in energy consumption by 20 KWh as well as over 60% power consumption in the presence of 500 VMs. In future, the authors have planned to concentrate the issues on resource failure and also SLA violation rate with respect to number of resources will be decreased.
Risk-oriented approach to managing the social market economy
Authors: Krishtaleva Taisiia I. , Gureeva Elena A. , Kripakova Liliya A. , Rykova Inna N. , Krupnov Yuriy A.
Published: May 2020

Purpose

The purpose of the paper is to develop a risk-oriented approach to managing the social market economy.

Design/methodology/approach

The first task is to determine the differences in susceptibility to the risk of the social market economy as compared to “pure” market economy. The authors use comparative analysis, variation analysis and correlation analysis for determining the dependence between quality of life in 2020 and variation of quality of life in 2012–2020, as well as variation of gross domestic product per capita in 2012–2020. The second task is to determine the perspectives of risk management of the social market economy in view of the specifics of the risk component of its functioning and development. Regression analysis is used for determining the dependence of quality of life in top ten countries with the social market economy in 2020 in the key risk factors that are peculiar for market economy and that lead to its destabilization: globalization, innovations and digitization.

Findings

It is substantiated that the unique economic and social environment predetermines the specific influence of the factors that are peculiar for the modern market economy. It is proved – by the example of top ten social market economies in 2020 – that social factors are more important for provision of stability of the social market economy than economic factors.

Originality/value

A risk-oriented approach to managing the social market economy is developed; it takes into account the specifics of the risk component of its functioning and development. The offered approach showed that the social market economy requires indirect regulation of risks through correction of institutions.
Reflections on constructing time in organizational change processes: a virtuous managerial interest
Authors: Ericsson Daniel
Published: May 2020

Purpose

The purpose of the paper is to present a constructionist framework for reflection upon time in organizational change processes. The framework directs attention towards (1) institutionalized ideas on organizational change processes anchored in different theoretical epochs, (2) institutionalized norms and virtues that govern the development of specific time regimes in organizations and (3) subjective opportunistic expectations of the future.

Design/methodology/approach

The paper is essayistic in character.

Findings

The paper explores how constructions of time might be biased by managerial leaders' opportunistic enactment of specific institutionalized ideas anchored in different theoretical epochs in order to comply with culturally embedded and mediated managerial virtues such as being fast and vigorous.

Research limitations/implications

The paper opens up for a differentiated understanding of time in organizational change processes, and it pinpoints the assumptions that guide both theoretical discussions on time, as well as empirical studies.

Practical implications

The framework proffers the reflective practitioner the opportunity to develop informed expectations on time in relation to organizational change processes.

Social implications

A nuanced and differentiated understanding of how time is construed in organizational change processes might reduce the social costs of underestimating the time organizational changes take – or exaggerating the belief in managerial leaders as sovereigns of time.

Originality/value

The paper contributes with a critical understanding of how time is construed in organizational change processes.
(Re)descriptions of medical professional work: exploring accounting as a performative device within an emergency unit health-care context
Authors: Fırtın Cemil Eren , Karlsson Tom S.
Published: May 2020

Purpose

This article addresses issues of calculation and economization in contemporary public organizations. In particular, it investigates how choices of organizing emergency health-care have been affected by accounting as a performative device. Special attention has been paid to how accounting brings about performative consequences in shaping the medical profession and its context.

Design/methodology/approach

The article employs qualitative research methods and draws its analysis on empirical data from in-depth interviews at an emergency health-care unit in Sweden.

Findings

It is demonstrated how accounting, in the form of calculations of treatment time and number of patients, enables performative consequences for medical professional work. It is also demonstrated how the use of accounting engages (re)descriptions of practices and roles, creates accounts of patients, and helps to sustain such (re)descriptions. Accounting terms (such as efficiency and control) have been reframed into medical terminology (such as health-care quality and security), ensuring and retaining (re)described medical professional work in terms of practices and emerging roles.

Originality/value

This article contributes to (1) the literature on accounting practices within health-care contexts by demonstrating a case where the accounting ideas and practices of medical professionals are coexistent and interwoven and (2) the increasing body of literature focusing on accountingization by showing how emerging calculative technologies carry performative power over medical professional work through formative (re)descriptions.
The problem of the fiscal common-pool: is there an overlap effect on state and local debt?
Authors: Shi Yu , Hendrick Rebecca
Published: May 2020

Purpose

The objective of the study is to determine if an over-borrowing bias emerges when the state fiscal base is shared by multiple general-purpose and special-purpose jurisdictions serving different groups of citizens.

Design/methodology/approach

This study uses panel data from all 50 states in the US from 1997 to 2007 to estimate models of total debt levels of state governments and total debt levels of all local governments aggregated at the state level. For comparison, it also estimates total debt levels of state and local governments taken together for the same years.

Findings

This study finds that jurisdictional overlap will increase state government debt, local government debt, as well as combined state and local government debt.

Originality/value

The finding from the study suggests that the fiscal common-pool model provides a more accurate analysis and more appropriate understanding of the institutional composition at the state and local public sector, especially for the vertical dimension of the local public sector where there are more specialized and overlapping jurisdictions.
A goal programming model to study the impact of R&D expenditures on sustainability-related criteria: the case of Kazakhstan
Authors: Colapinto Cinzia , Jayaraman Raja , La Torre Davide
Published: May 2020

Purpose

Most countries face important economic, social and environmental challenges and are strongly committed to invest in research and development (R&D) activities to help support the long-run economic sustainable growth. This paper aims to extend the previous research on macro-economic growth models and introduces endogenous variables to determine the amount of investments in R&D activities.

Design/methodology/approach

The model considers four different criteria and six economic sectors and aims at finding the optimal allocation of labor across different sectors. The model also endogenously determines the amount of investments in pollution abatement activities together with energy-related R&D efforts. The paper presents an application to the case of Kazakhstan, an emerging Asian country, that aims to become one of the top 30 most developed countries in the world by 2050.

Findings

The model shows the limits of the Kazakh agenda that identified too ambitious goals as the country has to go through a sociotechnical transition that involves a range of modifications in institutional structures, together with changes in user practices and the technological dimension. Kazakhstan should invest more in R&D activities able to develop sustainable energy sources to face the current electricity consumption demand and to reduce the greenhouse gas emission in the future.

Originality/value

The paper provides valuable knowledge for researchers and policy makers interested in the impact of R&D on the long-run economic sustainable growth.
Rethinking risk management in entrepreneurial SMEs: towards the integration with the decision-making process
Authors: Crovini Chiara , Santoro Gabriele , Ossola Giovanni
Published: May 2020

Purpose

The main purpose of this study is twofold: first, to analyze how risk is considered and managed by entrepreneurial SMEs, where the original founder is still the entrepreneur running the business, and second to understand if risk management is integrated with decision making.

Design/methodology/approach

This research is based on a multiple case study. Three entrepreneurial SMEs based in the North-West of Italy were selected to obtain a heterogeneous sample. They operate in the manufacturing sector and they have different size and corporate ownership.

Findings

The risk management process cannot be always formalized but an unconscious risk analysis is always carried out. Risk is intertwined with decision and entrepreneurial orientation. Nowadays, rethinking risk management means enhancing and improving the decision-making process and integrating the phases of the two processes by introducing an alternative new model (RM-DM) that stands for “risk management-decision making”.

Research limitations/implications

Conclusions can be generalized at a theoretical level even though this multiple case study represents a contingent analysis.

Practical implications

This research enhances the understanding of the potential benefits for entrepreneurial SME owners of a risk mind-set while making decisions. RM-DM model is an alternative tool to manage risks properly in SMEs, especially when a formalized process is not implemented, as it improves the way decisions are made and introduces a more reasoned approach to manage risks.

Originality/value

This empirical study introduces a unique model (RM-DM) that helps to rethink risk management in entrepreneurial SMEs, by integrating it with the decision making and by proposing an alternative tool to manage risks with a more structured approach.
Planning a goal-oriented B2B content marketing strategy
Authors: Yaghtin Shahrzad , Safarzadeh Hossein , Karimi Zand Mehdi
Published: May 2020

Purpose

The main objective of this study is identification of the key factors in planning digital content marketing (DCM) strategy in line with the corporate's main marketing objectives in the B2B sector.

Design/methodology/approach

In order to identify the different content types and their corresponding marketing goals, content analysis method was served to analyze the content of Instagram pages of 24 top-ranked corporates from three different industries. SPSS version 22 was used to investigate the significant difference levels and the mean ranks of identified content types.

Findings

The findings uncovered the twelve content types which are commonly published by the corporates in line with their main marketing goals in the B2B sector. Furthermore, the results revealed the most valuable content types from the B2B audiences' viewpoint and the most efficient content types in persuading audiences to participate in conversations.

Research limitations/implications

This study sheds some light on the ambiguous facets of DCM in the B2B sector, and its findings is useful as the starting point for the scholars who intend to investigate the various aspects of DCM and for the practitioners who work in the related fields.

Originality/value

This research offers a novel contribution to using Instagram as a DCM platform in the B2B sector. Also it contributes to identifying the main factors in communicating to B2B audiences through DCM.
Stefan Thomke: The power of experimentation in the digital era
Authors: Leavy Brian
Published: May 2020

Purpose

In this interview with Harvard innovation expert Stefan H.Thomke about his latest book, Experimentation Works: The Surprising Power of Business Experiments, he pays tribute to the scientific method and “the engine that has powered” it over the centuries, the “humble experiment.”

Design/methodology/approach

Professor Thomke anticipates a burgeoning role for business experimentation, one that it is already playing across the value chain, particularly in leading online companies.

Findings

Digital experimentation tools have the potential to revolutionize a company’s R&D, but they can also transform entire industries by shifting experimentation–and thus product innovation–to users and customers.

Practical implications

The ability to access large customer samples, to automatically collect huge amounts of data about user interactions on websites and apps, and to run concurrent experiments gives companies an unprecedented opportunity to evaluate many ideas quickly, with great precision, and at a negligible cost per additional experiment.

Originality/value

Product development is being transformed by rapid experimentation: all aspects of software–including user interfaces, security applications and back-end changes–can now be subjected to A/B tests.
The new tools revolutionizing Vibrio science
Authors: Baker‐Austin Craig , Trinanes Joaquin , Martinez‐Urtaza Jaime
Published: May 2020

As microbiologists we live in exciting times. A variety of technical and conceptual developments, particularly in the last decade have revolutionized the field of microbiology, redrawing the landscape, and entirely redefining what is possible. Perhaps this paradigm shift is no more apparent than in the study of vibrios. The family Vibrionaceae are almost unique as a group of bacteria to study in microbiology: they are genomically, phylogenetically and functionally diverse yet a distinct group of environmental bacteria encompassing important human and animal pathogens as well as non‐pathogenic species such as ecologically critical symbionts. Sensitive to physiochemical stimuli, they are among the fasting replicating bacteria studied, capable of responding almost immediately to favourable environmental conditions such as those afforded by climate warming. Characterized by an unusual double chromosome and frequently carrying numerous cryptic plasmids – their genomes are often pockmarked with insertion elements, transposons, prophages and integrases – paying testament to past genomic promiscuity. With a strong affinity for environmental niches in freshwater and marine systems, they are among the most numerous bacteria present in our oceans, coasts and freshwater environments. As such they offer something for almost anyone interested in microbiology and represent an excellent example of field of microbiology that has benefitted hugely by advances across a gamut of disciplines – not just microbiological – but encompassing genomics, genetics, oceanography, ecological, earth observations sciences and data visualization, among others. We will briefly outline some of the most exciting, innovative and translational scientific advances that are currently being applied to these ecologically, environmentally and clinically important bacteria.
Particle therapy toxicity outcomes: A systematic review
Authors: Hwang Eun Ji , Gorayski Peter , Le Hien , Hanna Gerard G , Kenny Liz , Penniment Michael , Buck Jacqueline , Thwaites David , Ahern Verity
Published: May 2020

Owing to its physical properties, particle therapy (PT), including proton beam therapy (PBT) and carbon ion therapy (CIT), can enhance the therapeutic ratio in radiation therapy. The major factor driving PT implementation is the reduction in exit and integral dose compared to photon plans, which is expected to translate to reduced toxicity and improved quality of life. This study extends the findings from a recent systematic review by the current authors which concentrated on tumour outcomes for PT, to now examine toxicity as a separate focus. Together, these reviews provide a comprehensive collation of the evidence relating to PT outcomes in clinical practice. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and seventy‐nine studies were included. Most demonstrated acceptable and favourable toxicity results. Comparative evidence reported reduced morbidities and improvement in quality of life in head and neck, paediatrics, sarcomas, adult central nervous system, gastrointestinal, ocular and prostate cancers compared to photon radiotherapy. This suggestion for reduced morbidity must be counterbalanced by the overall low quality of evidence. A concerted effort in the design of appropriate comparative clinical trials is needed which takes into account integration of PT’s pace of technological advancements, including evolving delivery techniques, image guidance availability and sophistication of planning algorithms.
The Potential of Europe’s Sharp and Soft Power
Authors: Biersteker Thomas
Published: May 2020

While it lags behind the US and China in conventional hard power indicators, Europe is at par with and even ahead of them in some sharp and soft power indicators. Yet it consistently influences below its potential in world affairs. Its ability to leverage its sharp and soft power is hampered by questions of identity, coherence, and leadership, questions that are reflected in the scenario exercise itself. Is Europe defined as the EU, the EMU, or the Council of Europe, and will it continue to include the UK? The answer will be critical to enhancing Europe’s power. More effective use of Europe’s sharp power will require both political will and more strategic coherence in Brussels, along with some significant institutional modifications. America’s abdication from global leadership creates an opportunity for the projection of Europe’s soft power. Europe’s normative role – both through policy innovation and higher education – is its greatest strength, and its place in the world of 2030 will be determined by how it exercises its potential. It must choose whether it has the will to maintain core elements of the previous order or transform it into new, post‐hegemonic multilateral forms.
Power versus Leadership?
Authors: Fitz‐Gerald Ann , Thompson Andrew S.
Published: May 2020

European power in the 21st century is not what it was in the 20th century. The rules‐based liberal international order that Europe helped to construct after the Second World War is under threat, and arguably in decline. As this ‘order’ diminishes, so too does Europe’s ability to influence world events. While Europe will never command either the military or economic hard and ‘sharp’ power of the United States or China, it remains an important international actor with considerable soft power, even with the United Kingdom’s recent departure from the union. Although we question some of the assumptions and priorities identified by the authors of ‘Enhancing Europe’s Global Power’, we share their view that a united and strong Europe has a great deal to offer to the world, particularly in the areas of data governance and tertiary education.
The use of Bayesian priors in Ecology: The good, the bad and the not great
Authors: Banner Katharine M. , Irvine Kathryn M. , Rodhouse Thomas J.
Published: May 2020

Bayesian data analysis (BDA) is a powerful tool for making inference from ecological data, but its full potential has yet to be realized. Despite a generally positive trajectory in research surrounding model development and assessment, far too little attention has been given to prior specification.

Default priors, a sub‐class of non‐informative prior distributions that are often chosen without critical thought or evaluation, are commonly used in practice. We believe the fear of being too ‘subjective’ has prevented many researchers from using any prior information in their analyses despite the fact that defending prior choice (informative or not) promotes good statistical practice.

In this commentary, we provide an overview of how BDA is currently being used in a random sample of articles, discuss implications for inference if current bad practices continue, and highlight sub‐fields where knowledge about the system has improved inference and promoted good statistical practices through the careful and justified use of informative priors.

We hope to inspire a renewed discussion about the use of Bayesian priors in Ecology with particular attention paid to specification and justification. We also emphasize that all priors are the result of a subjective choice, and should be discussed in that way.
Epigenome signatures landscaped by histone H3K9me3 are associated with the synaptic dysfunction in Alzheimer's disease
Authors: Lee Min Young , Lee Junghee , Hyeon Seung Jae , Cho Hyesun , Hwang Yu Jin , Shin Jong‐Yeon , McKee Ann C. , Kowall Neil W. , Kim Jong‐Il , Stein Thor D. , Hwang Daehee , Ryu Hoon
Published: May 2020

The pathogenesis of Alzheimer's disease (AD) and the commonest cause of dementia in the elderly remain incompletely understood. Recently, epigenetic modifications have been shown to play a potential role in neurodegeneration, but the specific involvement of epigenetic signatures landscaped by heterochromatin has not been studied in AD. Herein, we discovered that H3K9me3‐mediated heterochromatin condensation is elevated in the cortex of sporadic AD postmortem brains. In order to identify which epigenomes are modulated by heterochromatin, we performed H3K9me3‐chromatin immunoprecipitation (ChIP)‐sequencing and mRNA‐sequencing on postmortem brains from normal subjects and AD patients. The integrated analyses of genome‐wide ChIP‐ and mRNA‐sequencing data identified epigenomes that were highly occupied by H3K9me3 and inversely correlated with their mRNA expression levels in AD. Biological network analysis further revealed H3K9me3‐landscaped epigenomes to be mainly involved in synaptic transmission, neuronal differentiation, and cell motility. Together, our data show that the abnormal heterochromatin remodeling by H3K9me3 leads to down‐regulation of synaptic function‐related genes, suggesting that the epigenetic alteration by H3K9me3 is associated with the synaptic pathology of sporadic AD.
SNP discovery and population structure analysis in Lassi and Marecha camel breeds using a genotyping by sequencing method
Authors: Sabahat S. , Brauning R. , Clarke S. M. , Nadeem A. , Thomson P.C. , Khatkar M. S.
Published: May 2020

Pakistani camels have been classified socio‐geographically into 20 breeds, but they have not yet been subjected to substantial selective pressures and the genetic basis for these breeds is not understood. However, it should be possible to distinguish them by use of molecular data. This study investigated the genetic diversity and population structure within and between two major Pakistani camel breeds, Marecha and Lassi. As no SNP array is currently available, we first identified 63 619 SNPs using a genotyping by sequencing approach. After quality control, a panel of 36 926 SNPs was used in the analysis. Population structure was investigated with a principal coordinate analysis as well as a cluster analysis using NetView, and multilocus heterozygosity analysis to explore between‐ and within‐breed genetic variation. In addition, between‐breed variation was explored using the fixation index, FST. We also compared relationship matrices computed using the VanRaden SNP‐based method and a method developed specifically for genotyping by sequencing data. Among the two camel breeds, Lassi showed a lower level of genetic diversity whereas Marecha showed a higher level. As a genotyping platform has not yet been developed for the camel, the SNPs discovered in this study will be useful in future genetic studies in camels.
Colonization rates of tracheostomy tubes associated with the frequency of tube changes
Authors: Kumarasinghe Dulitha , Wong Eugene H. , Duvnjak Marin , Smith Mark C. , Palme Carsten E. , Riffat Faruque
Published: May 2020

Background

Tracheostomy‐tube change protocols are implemented primarily due to concern regarding infections. Currently changes vary from within 4 weeks post‐insertion to 3 monthly thereafter. However, currently no evidence‐based guidelines exist to justify these protocols. This study aims to assess the colonization of tracheostomy‐tubes associated with the frequency of changes.

Methods

A prospective cohort study over 18‐months of adult tracheostomy patients at a single institution (inpatient/outpatients). Patients were grouped based on whether tubes were changed at ≤4 weeks or >4 weeks and microbiology swabs sent for microscopy, culture and sensitivities.

Results

A total of 65 patients were enrolled. No statistically significant difference in colonization in patients undergoing tube changes more than every 4 weeks to those less than every 4 weeks was found (56.2% versus 57.1%, χ2 = 0.004, P = 0.95).

Conclusion

The timing of tracheostomy‐tube changes may not affect colonization and infection rates. Routine changes for the purpose of reducing infection risk may not be needed unless clinically indicated.
Variation in ureteric re‐implantation for Australian children
Authors: Cundy Thomas P. , Barker Andrew , Borzi Peter , Khurana Sanjeev
Published: May 2020

Background

Management options for vesicoureteric reflux are numerous, increasingly diversifying and debated. There is longstanding anecdotal opinion of inexplicable regional variation in vesicoureteric reflux management in Australia. This study investigates temporal trends in ureteric re‐implantation for children, and variation between states and territories.

Methods

Ureteric re‐implantation data for children aged 0–14 years were retrieved from the Medicare Benefits Scheme item reports database for the 20‐year period from 1998–2017. Claims data were population adjusted for each state then standardized for age using Australian Bureau of Statistics records. National and regional trends were calculated using joinpoint regression. Comparison between eastern (New South Wales, Victoria, Queensland, Tasmania, Australian Capital Territory) and western or central (Western Australia, South Australia) states was performed using the Mann–Whitney U‐test.

Results

There were 4919 procedure rebate claims during the study period. A national decrease in claim rates of 6.3% per 100 000 children was identified (P < 0.001). This was derived from significant decreases observed in eastern states. There was a threefold higher claim rate in Western Australia and South Australia per annum compared to the remainder of the country (4.0 versus 12.6 per 100 000; P < 0.001). For the most recent 5 years of the study period, this difference increased to a sevenfold higher rate (1.6 versus 11.1; P < 0.001).

Conclusion

There has been a dramatic nationwide decline in the rate of ureteric re‐implantation procedure claims. Regional disparity between each side of the country is widening. Further research is required to determine if this degree of variation is warranted or unwarranted. The observed regional variation facilitates opportunity for a nationwide pragmatic clinical trial.
Minimized perfusion circuit for acute type A aortic dissection surgery
Authors: Kimura Naoyuki , Momose Naoki , Kusadokoro Sho , Yasuda Toru , Kusaura Rie , Kokubo Ryo , Hori Daijiro , Okamura Homare , Itoh Satoshi , Yuri Koichi , Yamaguchi Atsushi
Published: May 2020

A minimized perfusion circuit (MPC) may reduce transfusion requirement and inflammatory response. Its use, however, has not been standardized for complicated cardiovascular surgery. We assessed outcomes of surgery for acute type A aortic dissection (ATAAD) performed with a MPC under circulatory arrest. The study involved 706 patients treated surgically for ATAAD (by hemiarch repair [n = 571] or total arch repair [n = 135]). Total arch repair was performed using selective antegrade cerebral perfusion. Our MPC, a semi‐closed bypass system, incorporating a completely closed circuit and a level‐sensing reservoir in the venous circuit, was used. Clinical variables, transfusion volume, and outcomes were investigated in patients who underwent hemiarch repair or total arch repair. The overall incidences of shock, organ ischemia, and coagulopathy (prothrombin time–international normalized ratio >1.5) were 26%, 35%, and 8%, respectively. Mean extracorporeal circulation (ECC) time was 149 minutes for the hemiarch repair group and 241 minutes for the total arch repair group, respectively. No patient required conversion to conventional ECC, and there were no complications related to the use of the MPC. The need for transfusion (98% vs. 91%, P = .017) and median transfusion volume (1970 vs. 1680 mL, P = .002) was increased in the total arch repair group. Neither in‐hospital mortality (total arch; 12% vs. hemiarch; 7%, P = .11) nor 10‐year survival (74.4% vs. 68.4%, P = .79) differed significantly. Outcomes of surgery for ATAAD performed with the MPC were acceptable. The possibility of transfusion and transfusion volume remains high during such surgery, despite the use of the MPC.
The effect of glaucoma treatment using high‐intensity focused ultrasound on total and corneal astigmatism: a prospective multicentre study
Authors: Marques Raquel Esteves , Sousa David Cordeiro , Vandewalle Evelien , Somers Alix , Melamed Shlomo , Nardi Marco , Figus Michele , Stalmans Ingeborg , Abegao Pinto Luis
Published: May 2020

Purpose

Ultrasound cycloplasty (UCP) acts through the selective coagulation of the ciliary body using high‐intensity focused ultrasound (HIFU) technology. The aim of this study was to investigate whether the application of ultrasound beams targeting the ciliary body using an external probe influences astigmatism.

Methods

Multicentre, prospective, single‐arm, open‐label study in adult patients with primary open‐angle glaucoma and moderately uncontrolled intraocular pressure (IOP) under glaucoma medication. The primary outcome was induced corneal astigmatism, calculated from topography, and assessed statistically through vector analysis. Secondary outcomes included induced total astigmatism and mean changes from baseline in best‐corrected visual acuity (logMAR) and IOP. Subgroup analysis was performed to assess the impact of device centring on corneal and total induced astigmatism.

Results

Fifty eyes were enrolled. Mean age was 69.6 ± 11.3 years. At 1, 3 and 6 months postprocedure, HIFU‐induced corneal astigmatism was 0.88 D × 93°, 0.87 D × 106° and 1.16 D × 97°, respectively, while induced total astigmatism was 0.62 D × 103°, 0.42 × 106° and 0.39 × 107°. By the last follow‐up, the percentage of patients with <0.50, <1.00, <1.50 and <2.00 D of induced corneal versus total astigmatism was 8.3% versus 46%, 29% versus 66%, 62.5% versus 88% and 79% versus 94%. Visual acuity was statistically significantly impaired at 1 month, but no difference remained by 3 and 6 months postprocedure.

Conclusion

Ultrasound cycloplasty procedure is associated with increased corneal astigmatism. However, its impact on total refractive astigmatism is less pronounced.
Vitamin D deficiency is associated with dry eye syndrome: a systematic review and meta‐analysis
Authors: Liu Jing , Dong Yi , Wang Yan
Published: May 2020

A systematic review and meta‐analysis was conducted to determine the association between the serum vitamin D level and dry eye. A systematic literature search was performed using the PubMed, Embase, Web of Science and Cochrane Library databases to identify clinical studies evaluating the association between vitamin D levels and dry eye. The random‐effect model was used to combine the results. Possible sources of heterogeneity across studies were determined by meta‐regression and sensitivity analysis. Overall, 10 studies (n = 18 919) were included. Patients with dry eye had a mean serum vitamin D level that was lower than that in healthy controls by 3.99 ng/ml (95% CI −6.57, −1.40; p = 0.002). The mean Ocular Surface Disease Index score was higher (mean difference 10.70, 95% CI 1.55–19.86; p = 0.02) and Schirmer’s test without anaesthesia result was lower (mean difference 6.38 mm/5 min, 95% CI −10.48, −2.28; p = 0.002) in patients with vitamin D deficiency than in controls. Tear break‐up time was comparable in the vitamin D deficiency and control groups (p = 0.15). Sensitivity analyses indicated that the results obtained were robust. This meta‐analysis suggested that vitamin D deficiency is associated with worse subjective symptoms and less tear production in patients with dry eye. Vitamin D deficiency may be a risk factor for dry eye syndrome. Prospective cohort and intervention studies are warranted to determine if vitamin D has a protective role in the development of dry eye.
Changes of visual fields in treatment of proliferative diabetic retinopathy: a systematic review
Authors: Vergmann Anna Stage , Grauslund Jakob
Published: May 2020

The aim of this systematic review was to compare certain side‐effects [visual fields (VF), dark adaptation, colour vision (CV) and contrast sensitivity (CS)] of conventional panretinal photocoagulation (PRP) with those of other treatments in proliferative diabetic retinopathy (PDR). A systematic literature search was conducted on 30 November 2018 in PubMed and Embase. The search comprised the keywords ‘proliferative diabetic retinopathy’, ‘laser’, ‘treatment’ and ‘anti‐vegf’. We included prospective studies and randomized controlled trials that investigated certain side‐effects (VF, dark adaptation, CV, CS) in treatment of PDR (primary outcome). In total, 1867 articles were screened, and 10 studies were included (2176 eyes of 2086 patients examined in the VF studies and 1360 eyes of 1360 patients examined in the CV and CS studies). Visual fields (VF) were investigated in 10 studies, CV in one study and CS in one study. Treatment modalities included conventional PRP, other modalities of laser treatment and vascular endothelial growth factor (VEGF) inhibitors. Four studies demonstrated a worse VF impact of PRP than VEGF inhibitors. Seven studies reported of an overall worsening in VF after laser with no differences between different laser approaches. No differences were found in CV or CS. Overall, we found a trend, confirmed in four large studies, towards VEGF inhibitors causing less harm to VF compared to conventional PRP. Whilst VF was generally depressed after laser, it did not differ between different treatment approaches. Furthermore, it was not possible to make certain conclusions of CV or CS, with only one study in each field.
Contrasting Personal Characteristics and Psychosocial Correlates of Exercise and Eating Behavior Changes in Women Successful vs. Unsuccessful with Weight Loss and Maintenance
Authors: Annesi James J.
Published: May 2020

Background

There is great variability in individuals' responses to behavioral weight‐loss treatments. Beyond attaining meaningful weight loss in the initial several weeks, little is known of the characteristics of participants successful vs. unsuccessful with short‐ and long‐term weight loss.

Methods

Separate samples of women with obesity enrolled in cognitive‐behavioral weight‐loss treatments were assessed over 6 months (Study 1: successful weight‐loss group, n = 83; unsuccessful group, n = 158), and over 24 months (Study 2: sustained initially lost weight, n = 25; regained weight, n = 19), on personal characteristics and theory‐driven psychosocial variables.

Results

In Study 1, significantly older age and greater eating self‐regulation at baseline were found in the successful group. Significantly greater improvements in exercise‐ and eating‐related self‐regulation, mood, exercise‐ and eating‐related self‐efficacy, physical self‐concept, and body satisfaction were found in the successful group. In Study 2, the sustainer group had significantly more favorable changes over 2 years in exercise‐ and eating‐related self‐regulation, and mood. During Months 6–24, the psychosocial correlates of both exercise and eating behaviors regressed, with more pronounced reversions in the regainer group.

Conclusion

Increasing the magnitude of treatment‐associated improvement in each of the tested theory‐based psychosocial factors is warranted to increase probabilities for success with attaining and maintaining meaningful weight loss.
Sensitivity analysis for subsequent treatments in confirmatory oncology clinical trials: A two‐stage stochastic dynamic treatment regime approach
Authors: Hagiwara Yasuhiro , Shinozaki Tomohiro , Mukai Hirofumi , Matsuyama Yutaka
Published: May 2020

Subsequent treatments can result in a difficulty in interpretation of the overall survival results in confirmatory oncology clinical trials. To complement the intention‐to‐treat (ITT) analysis affected by subsequent treatment patterns unintentional in the trial protocol, several causal methods targeting the per‐protocol effect have been proposed. When two or more types of subsequent treatments are allowed in the trial protocol, however, these methods cannot answer clinical questions such as how sensitive the ITT analysis result is to higher or lower proportions of each subsequent treatment allowed in the trial protocol than observed, and to what extent ITT analysis result is generalizable to subsequent treatment patterns other than observed one. To answer these clinical questions, we propose a sensitivity analysis method for subsequent treatments using the inverse probability of treatment weighting method for stochastic dynamic treatment regimes (DTRs). We formulate oncology clinical trials with subsequent treatments as two‐stage designs in which initial treatments are randomized, but subsequent treatments are observational. In this formulation, we use stochastic DTRs to simulate specific proportions of each subsequent treatment and compare an initial experimental treatment with an initial control treatment under various proportions of each subsequent treatment. We applied our proposed method to a motivating randomized noninferiority trial for metastatic breast cancer. Simulation results are also reported to show the usefulness of the proposed method.
CD70‐silenced dendritic cells induce immune tolerance in immune thrombocytopenia patients
Authors: Zhang Xian , Wang Yunlong , Zhang Donglei , Li Huiyuan , Zhou Zeping , Yang Renchi
Published: May 2020

The hyper‐response of dendritic cell (DC) is believed to participate in the pathogenesis of immune thrombocytopenia (ITP). The CD70 expression on the surface of DCs that takes part in the CD27‐CD70 costimulation pathway is an important element of DC ‘licensing’, which may initiate a series of autoreactive immune responses. To elucidate the roles CD70 molecules play in the DCs of ITP patients, we first stimulated the CD70 molecules on the DCs of ITP patients and normal controls, and found that the stimulated DCs from ITP patients exhibited higher ability to induce CD4+CD25− T lymphocytes proliferation, while lowering the ability of the induction of regulatory T cells (Tregs) from CD4+CD25− T lymphocytes. Meanwhile, higher IFN‐γ and lower IL‐10 levels were found in the co‐culture system of stimulated DCs and CD4+CD25− T cells. We then silenced the CD70 genes on the induced DCs of ITP patients and normal controls by siRNA, and confirmed our suggestion that the silence of CD70 expression on the surface of DCs from ITP patients would decrease the CD4+CD25− T lymphocytes proliferation and Tregs differentiation, simultaneously inducing higher IL‐10 and lower IFN‐γ levels. Thus, the interference with the CD27‐CD70 costimulatory pathway might lead to the alleviation of the consequent immune reactions, polarisation of Th2, induction of immune tolerance as well as shed new light on treatment of autoimmune diseases.