bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying the criteria for corporate real estate decisions through the laddering technique: an analysis of care organisations in The Netherlands
Authors: Huisman Emelieke , Appel-Meulenbroek Rianne , Kort Helianthe , Arentze Theo
Published: September 2020

Purpose

Board members and real estate managers (decision makers) play an important role in the decision-making process in nursing home organisations. This study aims to provide an understanding of underlying attributes and benefits sought by decision makers when making nursing home real estate decisions.

Design/methodology/approach

Decision makers from seven different nursing home organisations in The Netherlands were interviewed using the laddering technique to determine the individual requirements, the considerations of the decision alternatives, the relevant attributes and benefits and their mutual relationships.

Findings

This study details the motivations behind real estate management decisions in nursing home organisations. The findings show that apart from financial considerations, decision makers strive to enhance the quality of life and satisfaction of users with their real estate decisions and seek to include residents and employees in the process. These benefits are connected to the goals of well-being and innovation in health care. Furthermore, functionality, physical and functional flexibility and technology are key considerations when undertaking corporate real estate (CRE) decisions, to ensure that real estate management aligns with the strategic goals of the nursing home organisation.

Practical implications

The insights of this study can support decision makers in healthcare facilities to create strategic value with their real estate. Understanding how to obtain certain benefits from nursing home real estate may result in a better realisation of organisational objectives and user needs.

Originality/value

This study reveals the decision-making process in a nursing home context. Moreover, the laddering technique is used as a new method to explore and gain a deep understanding of CRE decision-making processes.
Explaining the informal economy in Western Europe: beyond a rational economic actor perspective
Authors: Williams Colin , Oz-Yalaman Gamze
Published: September 2020

Purpose

The dominant theorisation of the informal economy views participants as rational economic actors operating in the informal economy when the expected benefits exceed the perceived costs of being caught and punished. Recently, an alternative theory has emerged which views participants as social actors operating in the informal economy due to their lack of vertical trust (in governments) and horizontal trust (in others). The aim of this paper is to evaluate these competing theorisations.

Design/methodology/approach

To do so, data are reported from special Eurobarometer surveys conducted in 2007, 2013 and 2019 in eight West European countries (Austria, Belgium, France, Germany, Ireland, Luxembourg, the Netherlands and the United Kingdom).

Findings

Using probit regression analysis, the finding is that increasing the expected likelihood of being caught and level of punishment had a weak significant impact on the likelihood of participating in the informal economy in 2007, and there was no significant impact in 2013 and 2019. However, greater vertical and horizontal trust is significantly associated with a lower level of participation in the informal economy in all three time periods.

Practical implications

The outcome is a call for a policy to shift away from increasing the expected level of punishment and likelihood of being caught, and towards improving vertical and horizontal trust. How this can be achieved is explored.

Originality/value

Evidence is provided in a Western European context to support a shift away from a rational economic actor to a social actor approach when explaining and tackling the informal economy.
When does an online brand community backfire? An empirical study
Authors: Liao Junyun , Wang Dianwen
Published: September 2020

Purpose

Although online brand communities (OBCs) are extensively demonstrated to be an important social media tool in building brand equity, they may have backfire effects under certain conditions. Drawing from the self–brand connection theory, the purpose of this study is to investigate the effect of group heterogeneity on brand commitment. The mediation effect of self–brand connection and moderation effect of brand symbolism has also been examined.

Design/methodology/approach

Data were collected using a survey of 498 users from a range of OBCs. Hierarchical regression and bootstrapping method were used to test the research model.

Findings

The findings indicate that group heterogeneity negatively affects brand commitment in which self–brand connection plays a role of mediation. Further, the negative effect is more pronounced for high-symbolic brands than low-symbolic ones.

Practical implications

Brand managers are advised to note the dark side of OBCs in general and alleviate the adverse effects of group heterogeneity in particular, especially for high-symbolic brands.

Originality/value

Previous research pays little attention to the adverse effect of OBCs. This study enriches the literature by revealing that the backfire effect of OBCs arises when users become heterogeneous and uncovering in what situations the negative effect is stronger.
Supply chain collaboration for sustainability: a qualitative investigation of food supply chains in Brazil
Authors: do Canto Natália Rohenkohl , Bossle Marilia Bonzanini , Vieira Luciana Marques , De Barcellos Marcia Dutra
Published: September 2020

Purpose

This paper investigates how chain members collaborate to ensure the sustainability of supply chains through the social capital perspective.

Design/methodology/approach

Following a case study design, three social capital mechanisms – reach, richness and receptivity – were used as a lens with two eco-innovative food companies and their respective supply chains in Southern Brazil. Data consisted of interviews and other sources of evidence obtained from multiple stakeholders.

Findings

Results highlight the importance of a managerial orientation for sustainability and that sustainable chains presuppose a network that is closely linked and with great affinity. Not only does the management of operations improve the green performance of companies for environmental benchmarking but it also expands to include the supply chain. Social capital mechanisms can encourage partners to develop strategic initiatives for sustainability, especially if managers share key drivers for adopting eco-innovations and overall chain sustainability.

Originality/value

The paper contributes to research on collaboration within sustainable supply chain management. Empirical data were gathered from different stakeholders in two food chains in a developing country. Through the lens of social capital mechanisms, the paper shows how different types of companies collaborate in their supply chain for sustainability.
The Risk and Potentiality of Engaging with Sustainability Problems in Education—A Pragmatist Teaching Approach
Authors: Van Poeck Katrien , Östman Leif
Published: September 2020

This article engages in the discussion about education's role in relation to sustainability problems, a debate characterised by a tension between two legitimate concerns: a concern about the instrumentalisation of education, and a concern for the urgent need of widespread engagement and mobilisation for coping with the consequences of severe socio-ecological problems. The authors argue for an approach that takes both concerns seriously. Drawing on transactional didactic theory—underpinned by a pragmatist perspective on the interplay of continuity and change through the phases of habit, crisis and creativity—they illustrate that engagement with real-world societal problems does not inevitably result in the instrumentalisation of education. It can, on the contrary, open up a space for newness, creativity, freedom and pluralism. Yet, realising this unique educative potential does not happen automatically. It requires specific didactical work, specific forms of teaching. Through a practical example, the authors illustrate how teachers can stage problematic situations and inquiries in such a way that sustainability problems are brought to the table, turned into a common matter of concern and made free by giving the students possibilities to renew the world. Thus, they turn the question whether or not to engage with real-world problems into the question how to do so.
Rethinking Environmental Education with the Help of Indigenous Ways of Knowing and Traditional Ecological Knowledge
Authors: Nesterova Yulia
Published: September 2020

In recent years, Indigenous ecological knowledge has been receiving increased attention due to its potential to help address the devastating impacts of climate change and environmental degradation. Indigenous peoples in various contexts have become engaged in collaborative research projects with scientists and other experts to build environmentally sustainable societies. Environmental education has been another site for incorporation of Indigenous knowledge systems and ways of knowing. This paper presents one such programme designed by the Bunun Indigenous group in Taiwan to support environmental learning and reconnection with the natural world of their group as well as other Indigenous and non-Indigenous individuals willing to participate. While the programme's objective is learning with and from the natural environment (the lessons that can be adopted by non-Indigenous groups), its other objectives include re-building and strengthening Indigenous identities, cultures and ways of life, and potentially contributing to decolonisation of settler societies and reconciliation between groups.
Painted Bullet Holes and Broken Promises: Understanding and Challenging Municipal Dispossession in London's Public Housing ‘Decanting’
Authors: Ferreri Mara
Published: September 2020

Low‐income municipal housing and its inhabitants have increasingly been construed as disposable within wider global dynamics of real estate speculation, leading to heightened housing insecurity, displacement and forced evictions. In Western cities urban regeneration programmes have long provided the framework for partial or wholesale demolition of public housing, drawing new frontiers of gentrification and accumulation by dispossession. Before and beyond the material loss of home, the dispossession of low‐income housing involves a deeper unmaking of the relations that constitute residents’ emplacement and political legitimacy. In this article, I present a thick ethnographic account of multiple registers of dispossession and their implications for resistance through a situated reflection on the process of ‘decanting’—as resident rehousing is colloquially known—in a South London council estate, The Heygate. Drawing on participation in an anti‐gentrification archive as a scholar‐activist, I move beyond issues of displacement and grief to analyse three key mechanisms that make becoming dispossessed possible: disowning, disavowal and the administration of differential disposability. Within a resurgent interest in municipal solutions to housing crises, there is an urgent need for understanding municipal dispossession and the role of residents and engaged scholarship in resisting and expanding imaginaries of housing justice.
Do they practise what they preach? Factors associated with teachers’ use of inclusive teaching practices among in‐service teachers
Authors: Schwab Susanne , H. Alnahdi Ghaleb
Published: September 2020

Applying the ‘theory of planned behaviour’ to teachers’ actions in the classroom, it can be assumed that teachers’ positive attitudes towards inclusive education and high self‐efficacy beliefs result in an increased use of inclusive teaching practices. However, scientific evidence for this assumption is lacking. This study aimed to investigate factors influencing teachers’ use of inclusive teaching practices. In total, 221 (188 female and 33 male) Austrian in‐service teachers participated. Participants filled out the attitudes towards inclusion scale (AIS), the Teacher Efficacy for Inclusive Practices Scale (TEIP) and the teacher version of the Inclusive Teaching Practices Scale (ITPS‐T). Results showed that teachers had high self‐perceptions towards their use of inclusive teaching practices; compared with secondary school, primary school teachers reported using more inclusive teaching practices; there was no difference between expert and novice teachers; teachers’ attitudes and self‐efficacy were associated with inclusive teaching practices; and self‐efficacy predicted teachers’ use of inclusive teaching practices.
The Effect of Managerial Litigation Risk on Earnings Warnings: Evidence from a Natural Experiment
Authors: HUANG YING , LI NINGZHONG , YU YONG , ZHOU XIAOLU
Published: September 2020

We examine the causal effect of managerial litigation risk on managers’ disclosure of earnings warnings in the face of large earnings shortfalls. Exploring the staggered adoption of universal demand (UD) laws as an exogenous decrease in litigation risk, we find that the adoption leads to a decrease in managers’ issuance of earnings warnings, especially among firms facing a higher litigation risk prior to the adoption. In contrast, we find no change in managers’ tendency to alert investors of impending large positive earnings surprises. Collectively, our results provide causal evidence that higher litigation risk incentivizes managers to issue more earnings warnings. Our results differ from Bourveau et al.’s finding of an increase in the frequency of management earnings forecasts after the adoption of UD laws. We reconcile our findings with theirs by demonstrating that the effect of adopting UD laws on management earnings forecasts depends critically on forecast horizon: The adoption increases long‐horizon forecasts, but decreases short‐horizon forecasts.
The expression of seven key genes can predict distant metastasis of colorectal cancer to the liver or lung
Authors: Tang Li , Lei Yuan Yuan , Liu Yao Jiang , Tang Bo , Yang Shi Ming
Published: September 2020

Objective

It is unclear how primary colorectal cancer (CRC) cells select to metastasize to the liver or lungs, the most frequent distant metastasis of CRC. We aimed to identify the key genes and pathways that may predict the distant metastasis of CRC to these sites.

Methods

Three gene expression array datasets from the Gene Expression Omnibus were analyzed. Protein–protein network analyses, best subsets regressions and backward stepwise regression analyses were used to screen the key genes and their expressions were used to construct a predictive logistic regression model. Expression data from local clinical samples were used as a validation dataset. The receiver operating characteristic (ROC) curve was used to test the performance of the predictive model.

Results

In total, 59 differentially expressed genes (DEG) related to liver‐metastasis, 90 related to lung metastasis and 45 related to both liver and lung metastasis were identified. The KEGG pathways and gene oncology (GO) terms that were enriched in liver and lung metastasis were identified. A predictive logistic regression model consisted of SPARC, COL1A2, MMP9, COL11A1, COL3A1, CXCL12 and THBS2 was established. The area under the ROC curve reached 0.839 in predicting liver and lung metastasis, using our clinical samples as the validation dataset.

Conclusions

Seven key genes capable of predicting liver and lung metastasis of colorectal cancer were identified, which provides clues for exploring the mechanism of selecting target organs during the metastatic process in CRC and inspires the researches for new potential targets for therapy to inhibit metastasis.
Transcriptome dynamics and metabolite analysis revealed the candidate genes and regulatory mechanism of ganoderic acid biosynthesis during liquid superficial‐static culture of Ganoderma lucidum
Authors: Wang Qiong , Xu Mengmeng , Zhao Liting , Wang Feng , Li Youran , Shi Guiyang , Ding Zhongyang
Published: September 2020

Ganoderic acid (GA), an important secondary metabolite of Ganoderma lucidum, exhibited many significant pharmacological activities. In this study, the biosynthetic mechanism of GAs was investigated by comparing metabolites and transcriptome dynamics during liquid superficial‐static culture (LSSC) and submerged culture (SC). LSSC was a better method to produce GA because thirteen GAs were identified from mycelia by UPLC‐QTOF‐MS, and the content of all GAs was higher in LSSC than in SC. Ergosterol was accumulated during the SC process in G. lucidum. Transcriptome dynamics analysis revealed CYP5150L8 was the key gene regulating lanosterol flux into GA biosynthesis. Other sixteen CYP450 genes were significantly higher expressed during the culture time in LSSC and could be potential candidate genes associated with the biosynthesis of different GAs. In addition, six of the ten expressed genes in ergosterol biosynthetic pathway shown upregulated at some time points in SC. These results not only provide a fundamental information of the key genes in ergosterol and GA biosynthetic pathway, but also provide directions for future elucidating the regulatory mechanisms of GAs in G. lucidum and enabling us to promote the development and utilization of LSSC at the industrial level.
Clostridium difficile in soil conditioners, mulches and garden mixes with evidence of a clonal relationship with historical food and clinical isolates
Authors: Lim Su‐Chen , Knight Daniel R. , Moono Peter , Foster Niki F. , Riley Thomas V.
Published: September 2020

With rates of community‐associated Clostridium difficile infection (CA‐CDI) increasing worldwide, potential reservoirs/sources of C. difficile in the community are being sought. Since C. difficile is found in animal manure and human biosolids, which are composted for agricultural purposes, composted products could be a source. In this study, the presence of C. difficile in composted products, and their genetic relatedness to other previously isolated strains from humans, root vegetables and the environment in Western Australia, was investigated. Overall, C. difficile was found in 22.5% (16/71) of composted products [29.7% (11/37) of soil conditioners, 16.7% (2/12) of mulches and 13.6% (3/22) of garden mixes]. Fifteen C. difficile PCR ribotypes (RTs) were identified, the most common toxigenic strains being RTs 020 and 056. Clostridium difficile RT 056 is commonly associated with CDI in humans and has also been isolated from cattle, root vegetables and the environment (veterinary clinics and lawn) in Australia. High‐resolution core‐genome analysis of 29 C. difficile RT 056 strains revealed clonal relationships between isolates derived from humans, vegetables, composted products and the environment. These findings provide support for an intricate transmission network between human, food and the environment, further highlighting the importance of a ‘One Health’ approach for managing CDI.
Managing Land‐based CDR: BECCS, Forests and Carbon Sequestration
Authors: Brack Duncan , King Richard
Published: September 2020

Decisions about when, where and how to achieve widespread carbon dioxide removal (CDR) are urgently required. Delays in developing the requisite policy and regulatory frameworks increase the risks of overshooting climate goals and will necessitate much larger negative emissions initiatives in the future. Yet the deployment of bioenergy with carbon capture and storage (BECCS) at the scales assumed under most Paris‐Agreement‐compliant emission‐reduction pathways is unlikely. More generally, the sustainability of large‐scale BECCS is questionable given its extensive land, water, and energy requirements for feedstocks and the competing necessity of these resources for the provision of ecosystem services and attainment of multiple Sustainable Development Goals. BECCS on a more limited scale, however, could have more benign impacts if feedstocks were restricted to wastes and residues. There is also widespread recognition that extensive afforestation, reforestation and forest restoration have critical roles in reducing greenhouse gas emissions to net zero. To date there has been little focus on the optimum strategies for integrating land‐based CDR approaches – under which circumstances forest areas are best left undisturbed, managed for conservation, and/or managed for harvested wood products, and how these options affect the availability of residual feedstocks for BECCS. This paper reviews this debate and suggests appropriate policy measures.
Enhancing the usefulness of artificial seeds in seed beetle model systems research
Authors: Holmes Leslie A. , Nelson William A. , Dyck Markus , Lougheed Stephen C.
Published: September 2020

Seed beetles are among textbook examples of experimental model systems used to better understand nature's complexities. A potential seed beetle model systems' strength is the use of artificial seeds to remove experimental confounds. This is particularly relevant for scaling life histories to population dynamics but requires many artificial seeds. Current methods of producing seeds are laborious, limiting their application.

Building on previous work, we developed efficient methods to produce artificial seeds and expand their use. We outline steps to produce artificial seeds and describe a new technique for transferring beetle eggs laid on natural seeds to artificial seeds.

Our methods yielded a 100‐fold increase in artificial seed production that is 80% more efficient than current methods. Burrowing success of beetle larvae from eggs laid on natural seeds and transferred to artificial seeds (85.4%) was comparable to rates on natural seeds.

Streamlining artificial seed production enables highly replicated life‐history and time‐series assays with large sample sizes. The ability to transfer eggs from natural to artificial seeds allows research on many phenomena including oviposition strategies, maternal provisioning and competitive strategies, broadening the usefulness of seed beetle model systems in ecological and evolutionary research.
The way bioclimatic variables are calculated has impact on potential distribution models
Authors: Bede‐Fazekas Ákos , Somodi Imelda
Published: September 2020

Bioclimatic variables (BCVs) are routinely used in potential distribution models, typically without considering their calculation options in detail. We aimed at studying the impact of a decision, yet unexamined, on the calculation of BCVs, namely whether the identity of specific months/quarters in the calculation of BCVs should be updated for the future periods (temporal context). Effects on the performance of potential distribution models and on their projections were investigated. Additionally, we also aimed at comparing the impact of month/quarter shifts to that of climate model selection and covariate selection.

Potential natural vegetation models encompassing eight habitat types and the whole territory of Hungary were created using boosted regression trees. We tested multiple initial covariate sets to compare the impact of the temporal context to that of covariate selection. The resulting models were applied to the reference and one future time period (with data from two regional climate models). The effect of the BCV calculation approach was tested by linear mixed‐effects models and model goodness‐of‐fit measures in a comprehensive framework of 192 predictions. Area under the ROC curve (AUC) and true positive rate (TPR) curves were used to evaluate the models.

Our results show that (a) temporal context of BCVs in interaction with covariate selection had a strong effect on model structure as well as on projections; (b) no evidence supporting the superiority of the widely applied calculation approach of BCVs was found. However, we found notable differences under the two approaches and examples of projection artefacts when applying the widespread way of calculation.

We conclude that (a) more attention and more transparent communication is needed when BCVs are used as covariates in distribution models; (b) not only ecophysiology but also the way covariates are calculated should be considered when preselecting covariates for potential distribution models.
Combining thermotherapy with meristem culture for improved eradication of onion yellow dwarf virus and shallot latent virus from infected in vitro‐cultured shallot shoots
Authors: Wang Min‐Rui , Hamborg Zhibo , Blystad Dag‐Ragnar , Wang Qiao‐Chun
Published: September 2020

The present study described a combining thermotherapy with meristem culture for improved eradication of onion yellow dwarf virus (OYDV) and shallot latent virus (SLV) from co‐infected in vitro‐cultured shallot shoots. In vitro‐cultured shoots infected with OYDV and SLV were thermo‐treated at a constant temperature of 36°C for 0, 2 and 4 weeks, and then meristems (0.5 mm) containing 1–2 leaf primordia were excised and cultured for shoot regrowth. Meristem culture without thermotherapy produced much higher levels of survival (100%) and shoot regrowth (55%) than those (62% survival and 32% shoot regrowth) produced by the procedure combining 4 weeks of thermotherapy with meristem culture. However, much higher virus‐free frequencies (70% for OYSV, 80% for SLV and 50% for both viruses) were obtained in the latter than those (10% for OYSV, 15% for SLV and 10% for both viruses) obtained in the former. Histological and subcellular studies showed that thermotherapy imposed stress or damage to the cells of meristems, thus resulting in reduced meristem survival and shoot regrowth. Studies on virus location revealed considerable alternations of virus distribution patterns in the thermo‐treated meristems. The results of histological and subcellular studies and analysis of virus distribution pattern added valuable experimental data in the combining thermotherapy with meristem culture for virus eradication. These data provided explanations as to why combining thermotherapy with meristem culture improved the eradication of OYDV and SLV from the virus‐infected in vitro shallot shoots.
An in‐depth examination of maize yield response to fertilizer in Central Malawi reveals low profits and too many weeds
Authors: Burke William J. , Snapp Sieglinde S. , Jayne Thom S.
Published: September 2020

We examine the productivity of fertilizer used on maize in Central Malawi using field‐level panel data from over 1,200 observations on more than 500 fields over 4 harvest years. There are several novel aspects of this analysis compared to other on‐farm fertilizer efficiency studies, including (a) precise and accurate yield measurement using crop cuts, (b) estimating the impact of timely weeding, (c) the use of data on multiple soil characteristics from a panel of soil samples, and (d) the ability to control for field‐level fixed effects by tracking the same land over time. We find critical ecological and management threshold effects on fertilizer effectiveness at 0.94% soil carbon content, 57–58% sandiness, and weeding within 4 weeks of planting. Overall, we estimate lower yield response to fertilizer than reported in earlier studies: 2.6 maize kg/N kg under ideal circumstances, and statistically nil under many other conditions. We discuss the implications of our findings for farmers, policymakers, and researchers.
Well‐being, obstetrics and gynaecology and COVID‐19: Leaving no trainee behind
Authors: Chan Grace Ming Fen , Kanneganti Abhiram , Yasin Nooraishah , Ismail‐Pratt Ida , Logan Susan Jane Sinclair
Published: September 2020

The COVID‐19 pandemic has significantly disrupted training in obstetrics and gynaecology. Past pandemics have been shown to result in significant psychological morbidity. As specialty trainees continue frontline work, they will face unprecedented work environments and may face delays in progression due to postponed examinations, case log shortfalls and inadequate clinical rotations. This contributes to burnout, anxiety and depression. We share technology‐based suggestions as well as institutional, departmental and self‐care tips on how to maintain trainees’ mental well‐being during the fight against COVID‐19.
Reflections on the T Trials
Authors: Swerdloff Ronald , Wang Christina
Published: September 2020

Background

This manuscript is a review and discussion of the published results of the T Trials.

Objective

To re‐examine the efficacy of testosterone replacement of hypogonadal men >65 years of age in the T Trials.

Materials and Methods

The T Trials were a complex collection of seven double blind, placebo‐controlled trials of the efficacy of testosterone as replacement therapy for older men with unequivocal hypogonadism. There were three main trials (sexual function; physical function; vitality) and four sub‐trials (cognition; bone; anemia; and cardiovascular). All subjects participated in the main trials while more selective inclusion/exclusion criteria existed for the sub‐trials. Subjects were excluded for perceived higher risk of prostate cancer and recent myocardial or cerebral vascular events.

Results

The previously published results are reviewed here as seen in the context of this special issue on late‐onset hypogonadism. In the T Trials, positive benefits were seen in the sexual function, bone, and anemia trials with small but significant benefits in the vitality trial. No benefit was seen in the cognition trial, partial benefit in physical function, and a negative benefit outcome seen in the cardiovascular trial. The later trial was underpowered and the results were described as exploratory. Adverse events were relatively uncommon in the 12‐month treatment phase and additional 12‐month post‐treatment phase. The most frequent adverse effect ascribed to testosterone was erythrocytosis.

Conclusions

The T Trials studied the efficacy of testosterone replacement therapy on 788 men with low testosterone and symptoms of hypogonadism. The studies demonstrated benefits in four trials (sexual function, vitality, bone, and anemia); partial benefit in the physical function trial; no effect in the cognition trial; and a negative effect in the exploratory cardiovascular trial. The T Trials were not designed to assess long‐term risks of testosterone in men.
Necrotising fasciitis deaths in Australia: patient characteristics and potential areas for improvement in clinical management
Authors: Stewart Sasha K. , Vu Janine , McCulloch Glenn A. J.
Published: September 2020

Background

Necrotising fasciitis (NF) is a life‐threatening bacterial infection with high mortality. This retrospective study aimed to investigate patient characteristics and potential areas for improvement in clinical management in NF cases in Australia.

Methods

Retrospective analysis of surgical death data from all public and private Australian hospitals in every state and territory, excluding New South Wales, collected through the Australian and New Zealand Audit of Surgical Mortality for the 9‐year period, January 2009 to February 2018.

Results

A total of 290 NF cases were identified. Among these NF cases, obesity and diabetes mellitus were two of the most common comorbidities, with a prevalence of 26% and 41%, respectively. A total of 41 clinical management issues (CMIs) were identified among 36 NF cases. A larger proportion of NF cases had CMIs compared with non‐NF surgical mortality cases. Delay in diagnosis was the leading CMI (n = 28, 68.3%), followed by delay to surgery (n = 7, 17.1%). The majority of delayed diagnoses were attributed to non‐surgical clinicians in the hospital.

Conclusion

CMIs were identified in a larger proportion of NF cases than in other non‐NF surgical mortality cases, suggesting that there are areas for improvement in NF diagnosis and management in Australia. The leading potentially avoidable issue identified in NF deaths was delay in diagnosis. This highlights the importance of awareness among non‐surgical clinicians that NF is a surgical emergency requiring urgent debridement.
Pre‐operative frailty is predictive of adverse post‐operative outcomes in colorectal cancer patients
Authors: Richards Simon J. G. , Cherry Tiffany J. , Frizelle Frank A. , Eglinton Tim W.
Published: September 2020

Background

An increasing number of elderly patients are presenting for elective surgery. Pre‐operative risk assessment in this population is inexact due to the complex interplay between age, comorbidity and functional status. Frailty assessment may provide a surrogate measure of a patient's physiological reserve and aid operative decision‐making. The aim of this study is to determine the association between pre‐operative frailty, as assessed using the Edmonton Frail Scale, and post‐operative outcomes in elderly patients undergoing elective colorectal cancer surgery.

Methods

A prospective analysis of 86 patients over the age of 65 undergoing elective colorectal cancer surgery at a tertiary centre between October 2017 and October 2018 was performed. Frailty assessment was conducted pre‐operatively using the Edmonton Frail Scale. Primary outcomes included length of stay and post‐operative complication rates. Multivariable logistic regression analyses were used to determine the influence of frailty on post‐operative outcomes including mortality, prolonged hospital admission, complication rates and quality of life.

Results

Of 86 patients, 12 (14.0%) were identified as frail. Frailty was associated with a significantly increased median length of stay (20 days versus 6 days, incidence rate ratio 2.83, P < 0.01) and a significantly increased risk of major post‐operative complications (50.0% versus 6.7%, odds ratio 13.8, P < 0.01). Frailty was not associated with a significant reduction in quality of life scores at 30 and 90 days post‐operatively.

Conclusion

Frailty is associated with adverse post‐operative outcomes in elderly patients undergoing elective colorectal cancer surgery. Frailty assessment is an important component of pre‐operative risk assessment and may identify targets for pre‐operative optimisation.
Trade misinvoicing effects on tax revenue in sub‐Saharan Africa: The role of tax holidays and regulatory quality
Authors: Asmah Emmanuel Ekow , Kwaw Andoh Francis , Titriku Edem
Published: September 2020

The first target of Goal 17 of the Sustainable Development Goal (SDG) emphasizes the need to strengthen domestic resource mobilization and improve revenue collection. However, the average tax‐to‐GDP ratio is much lower than the optimal threshold required to finance development. Meanwhile, Africa is losing a significant amount of its capital through illicit financial flows, primarily driven by trade misinvoicing, but at the same time offering fiscal incentives and improving governance to create an environment for increased domestic revenue. Using random and fixed effects models, the study examines the tax revenue effects of trade misinvoicing, and further examines the extent to which tax holidays and regulatory quality dilute or deepen the revenue effects of trade misinvoicing for 13 African countries over the period 2000 to 2015. The results suggest that trade misinvoicing reduces tax revenue. While tax holiday strengthens the effect of trade misinvoicing, regulatory quality dilutes the effect of trade misinvoicing on tax revenue. The study, therefore, recommends that the governments of SSA should promote good governance, reduce trade misinvoicing and review existing tax incentives as critical components of the ongoing efforts to increase domestic resource mobilization for development.
Impact of gene polymorphisms in drug‐metabolizing enzymes and transporters on trough concentrations of rivaroxaban in patients with atrial fibrillation
Authors: Nakagawa Junichi , Kinjo Takahiko , Iizuka Mei , Ueno Kayo , Tomita Hirofumi , Niioka Takenori
Published: September 2020

Rivaroxaban is excreted from the body via multiple pathways involving glomerular filtration, drug‐metabolizing enzymes and transporters. In this study, we aimed to examine the impact of single nucleotide polymorphisms in P‐glycoprotein, breast cancer resistance protein, cytochrome P450 (CYP) 3A5 and CYP2J2 on the pharmacokinetics of rivaroxaban. Eighty‐six patients with non‐valvular atrial fibrillation (NVAF) undergoing AF catheter ablation were enrolled in this study. In these analyses, the dose‐adjusted plasma trough concentration ratio (C0h/D) of rivaroxaban was used as the pharmacokinetic index. The median (quartile range) rivaroxaban C0h/D was 3.39 (2.08‐5.21) ng/mL/mg (coefficient of variation: 80.5%). The C0h/D did not differ significantly among ABCB1 c.3435C>T, c.2677G>A/T, c.1236C>T, ABCG2 c.421C>A, CYP3A5*3 and CYP2J2*7 genotypes. Stepwise selection multiple linear regression analysis showed that the estimated glomerular filtration rate was the only independent factor influencing the C0h/D of rivaroxaban (R2 = 0.152, P < 0.001). There was a significant correlation between the C0h of rivaroxaban and prothrombin time (PT) (rho = 0.357, P = 0.001). In patients with NVAF, pharmacokinetic genotype tests are unlikely to be useful for prediction of the C0h of rivaroxaban.
‘Like a rug had been pulled from under you’: The impact of COVID‐19 on teachers in England during the first six weeks of the UK lockdown
Authors: Kim Lisa E. , Asbury Kathryn
Published: September 2020

Background

On 20 March 2020, in response to COVID‐19, UK schools were closed to most pupils. Teachers were required to put remote teaching and learning in place with only two days’ notice from the government.

Aims

The current study explores teachers’ experiences of this abrupt change to their working practices, and during the 5–6 weeks that followed.

Sample

Twenty‐four teachers from English state schools were interviewed, representing mainstream primary and secondary schools and a range of years of experience and seniority.

Methods

Participants were asked to tell stories of three key scenes during the first 5–6 weeks of lockdown: a low point, a high point, and a turning point. A reflexive thematic analysis of their narratives was conducted.

Results and Conclusions

Six themes were identified: uncertainty, finding a way, worry for the vulnerable, importance of relationships, teacher identity, and reflections. Teachers’ narratives suggest that, after an initial period of uncertainty they settled into the situation and found a way forward, supported by strong relationships. However, they remain extremely worried about the most vulnerable pupils and want more joined‐up thinking from the government on how to support them effectively, along with clarity from policymakers to enable planning ahead. Teachers reflected on how to use their learning during this period to improve pupils’ experiences of education post‐COVID‐19, and on how aspects of shared teacher identity have worked as stressors and coping mechanisms. These initial interviews form the baseline for a longitudinal interview study of teachers’ experiences of COVID‐19 in England.
Usability and experience testing to refine an online intervention to prevent weight gain in new kidney transplant recipients
Authors: Castle Ellen M. , Greenwood James , Chilcot Joseph , Greenwood Sharlene A.
Published: September 2020

Objectives

Weight gain in the first year following kidney transplantation increases the risk of adverse health outcomes. Currently, there is no recognized intervention available to prevent weight gain after kidney transplantation. An online kidney transplant‐specific resource, entitled Exercise in Renal Transplant Online (ExeRTiOn), has been co‐created by a multi‐professional team, including patients, to assist with weight prevention. This study aimed to evaluate patient and health care professional usability and experience of the ExeRTiOn online resource.

Design

Qualitative study utilizing ‘Think‐Aloud’ and semi‐structured interviews.

Methods

Participants (n = 17) were purposively sampled to include new kidney transplant recipients (n = 11) and transplant health care professionals (n = 6). Kidney transplant recipient participants were from a spread of physical activity levels based on scores from the General Practice Physical Activity Questionnaire (GPPAQ). ‘Think‐Aloud’ interviews assessed the usability of ExeRTiOn. Semi‐structured interviews explored participants’ experience of ExeRTiOn, weight gain, and physical activity. The data set were analysed thematically. Participant characteristics, including login data and self‐reported body weight, were collected.

Results

Data analyses identified valued intervention content and usability aspects which were summarized by two themes. The first theme ‘You need to know how to manage yourself’ included subthemes: (1) the resource filled a guidance gap, (2) expert patient content resonated, and (3) the importance of goal setting and monitoring progress. The second theme ‘room for improvement’ included subthemes: (2) web support and (2) content and operational change suggestions.

Conclusions

Results have allowed for identification of potential areas for resource refinement. This has facilitated iterative enhancement of ExeRTiOn in preparation for a randomized controlled feasibility trial.
Three‐dimensional echocardiography to identify right ventricular dilatation in patients with corrected Fallot anomaly or pulmonary stenosis
Authors: Trzebiatowska‐Krzynska Aleksandra , Swahn Eva , Wallby Lars , Nielsen Niels Erik , Carlhäll Carl Johan , Engvall Jan
Published: September 2020

Background

3‐Dimensional Echocardiography allows measuring volumes and parameters of myocardial deformation (strain). Myocardial strain has been suggested to be superior to conventional echo parameters in the assessment of right ventricular (RV) function. Myocardial strain can be assessed by cardiac magnetic resonance (CMR) or two‐ and three‐dimensional echocardiography (2D and 3DEcho). We performed a comprehensive assessment of the RV based on 3DEcho and compared the results with those based on CMR and 2DEcho.

Methods

36 patients with corrected heart defects underwent CMR and 3DEcho to assess RV volume, strain and cardio pulmonary exercise testing with peak VO2 measurement. 2DEcho was used for reference.

Results

There was a moderate correlation between 3DEcho and CMR for measuring RV end‐diastolic and end‐systolic volumes (r = .82 and .72). 3DEcho tended to underestimate the RV volumes, mean difference EDV 8.5 ± 33 ml (CI −2.8; 19.7 ml) and ESV 13.2 ± 29 ml (CI 3.3; 23 ml). According to method‐specific reference values for RVEDV, 34/35 (3DEcho) and 29/36 (CMR) were dilated. Among those dilated according to CMR, all were identified by 3DEcho. The coefficient of correlation between RV atrioventricular plane displacement measured by CMR and tricuspid annular plane systolic excursion measured by 3D and 2DEcho was r = .6 for both. 2DEcho measured lower LV volumes than CMR. LVEF and GLS were similar in 2DEcho, 3DEcho and CMR. Patients with CMR‐determined RV free wall strain ≤ −14% tended to have lower peak VO2.

Conclusions

Although 3DEcho underestimated RV volumes, it successfully identified all patients with RV dilatation based on method‐specific reference values.
Transcriptional repression of p21 by EIF1AX promotes the proliferation of breast cancer cells
Authors: Li Yuhuan , Guo Lu , Ying Sunyang , Feng Gui‐Hai , Zhang Ying
Published: September 2020

Objective

Dysregulation of the cell cycle is associated with the progression of malignant cancer, but its precise functional contribution is unknown.

Materials and Methods

The expression of EIF1AX in breast cancer tissues was detected by qRT‐PCR and immunohistochemistry staining. Colony formation and tumour xenograft assays were used to examine the tumorigenesis‐associated function of EIF1AX in vitro and in vivo. RNA‐Seq analysis was used to select the downstream target genes of EIF1AX. Flow cytometry, ChIP and luciferase assays were used to investigate the molecular mechanisms by which EIF1AX regulates p21 in breast cancer cells.

Results

EIF1AX promoted breast cancer cell proliferation by promoting the G1/S cell cycle transition. A mechanistic investigation showed that EIF1AX inhibited the expression of p21, which is an essential cell cycle regulator. We identified that the transcriptional regulation of p21 by EIF1AX was p53‐independent. Clinically, EIF1AX levels were significantly elevated in breast cancer tissues, and the high level of EIF1AX was associated with lower survival rates in breast cancer patients.

Conclusions

Our results imply that EIF1AX may play a key role in the incidence and promotion of breast cancer and may, thus, serve as a valuable target for breast cancer therapy.
Clinical characteristics and aetiological analysis of 133 patients for pulmonary embolism combined with haemoptysis
Authors: Zou Yong Wei , Duan Jun , Wang Xiao‐Hui , Yang Huan Huan , Chi Jing , Chen Hong
Published: September 2020

Background

In the patients with pulmonary embolism (PE), PE itself can cause haemoptysis and other reasons can also cause haemoptysis. Therefore, the clinical characteristics and the causes of haemoptysis are lacking.

Methods

A retrospective analysis was performed that involved screening 583 PE patients and determining that haemoptysis occurred in 141 cases. Of these, eight cases were omitted due to anticoagulation‐related haemoptysis or unavailable data, leaving 133 cases that were enrolled in final analysis (127 acute and 6 chronic case of PE). We classified the acute PE patients who combined with diseases which can cause haemoptysis to non‐simple group (n = 61) and those without these diseases to simple group (n = 66).

Results

The incidence of haemoptysis in PE patients was 23.75%. In the simple group, the amount of haemoptysis ≤ 5 mL was 80.30% (53/66) and ≤ 20 mL was 90.91% (60/66). In the non‐simple group who combined with lung cancer, the amount of haemoptysis ≤ 5 mL was 68.4% (26/38) and ≤ 20 mL was 86.8% (33/38). Further analyses revealed that the amount of haemoptysis in the non‐simple group was larger than that in the simple group (median 5 [5‐125] vs. 5 [5‐5], p < 0.001; volume ≥ 100 mL: 29.5% vs. 6.1%, p< 0.001). Among all the PE patients, chronic thromboembolic pulmonary hypertension (CTEPH), PE combined with tuberculosis (TB) and PE combined with bronchiectasis were independent risk factors for the amount of haemoptysis ≥ 100 mL (OR = 15.00, (95% CI: 2.235‐100.652); 12.00, (3.101‐46.437); 60.00, (6.552‐549.441), respectively).

Conclusions

The haemoptysis caused by acute PE or PE combined with lung cancer was mild and was characterised by blood in sputum. PE combined with TB, bronchiectasis and CTEPH are associated with moderate to massive haemoptysis, with a greater risk of haemoptysis ≥ 100 mL.