bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a three-tier assessment model: a case study
Authors: Lau Henry C. , Ip Andrew , Lee CKM , Ho GTS
Published: August 2018

Purpose

The purpose of this paper is to propose a three-tier assessment model (TAM), aiming to identify and evaluate the competitiveness level of companies. The existing problem is that companies find it difficult to choose a proper model which can be deployed to benchmark with competitors in terms of their competiveness level in the marketplace. Most of the available models are not appropriate or easy to use. The proposed assessment model is able to provide an insight for better planning and preparation so as to gain a better chance of success comparing with their competitors. Most importantly, the proposal model adopts a pragmatic approach and can be implemented without going through tedious mathematical calculations and analysis.

Design/methodology/approach

TAM embraces three different approaches deployed in various stages of the application process. The first stage is to identify the relevant criteria using hierarchical holographic modeling and the second stage is to assess the associated weightings of these criteria used to rate the potential competitiveness of related companies. The technique used in stage two is known as fuzzy analytic hierarchy process (FAHP) which is a combination of two well-established methods including fuzzy logic and analytical hierarchical programming. In stage three, a technique known as technique for order preference by similarity to the ideal solution (TOPSIS) is adopted to benchmark the level of competitiveness covering several companies in the same industry.

Findings

In this paper, a case study is conducted in order to validate the feasibility and practicality of the proposed model. Results indicate that TAM can be easily applied in various industrial settings by practitioners in the field for supporting operations management practices.

Research limitations/implications

Significant amount of work is needed to ensure that the proposed model can be practically deployed in real industrial settings.

Practical implications

This proposed model is able to capitalize on the benefits of the HMM, FAHP and TOPSIS methods and offset their deficiencies. Most importantly, it can be applied to various industries without complex modification.

Originality/value

This paper suggests a hybrid model to assess competitiveness level embracing three different techniques with the unique feature which is able to provide an insight for better planning and preparation in order to excel competitors. Companies may be able to follow the procedures and steps suggested in the paper to implement the model which is proven to be pragmatic and can be applied in real situations.
Is organizational evolution Darwinian and/or Lamarckian?
Authors: Grandinetti Roberto
Published: August 2018

Purpose

Recently, some biologists have argued that the time has come to replace separation between Lamarckism and Darwinism with their connection. The aim of this paper is to understand whether this paradigm shift in the interpretation of biological evolution offers useful insights for dealing with the unresolved issue of how industries and their organizational populations evolve.

Design/methodology/approach

Lamarckism and Darwinism are two approaches that have contrasted or interwoven with each other in the study of biological evolution, just as they have in the study of organizational evolution. This paper provides a critical analysis of the long history of the debate through to the recent, revolutionary discoveries in evolutionary microbiology obtained in the wake of the genomic revolution.

Findings

From this new research frontier emerge three important findings: adaptive variations are no longer an anomaly that is peculiar to human organizations, but rather correspond to a widely observed phenomenon in the biological world; the same can be said for the process of horizontal replication; Lamarckism and Darwinism are not two mutually exclusive interpretations of evolution but two dimensions of evolution that coexist in various ways. Lamarckian dimension of evolution and the Darwinian one, handled in the light of these results, may help to understand the evolutionary logic that underpins specific stages of the history of industries.

Originality/value

The paper presents a new way of looking at industries and their firms from an evolutionary perspective.
Health information systems in Namibia
Authors: Nengomasha Cathrine Tambudzai , Abankwah Ruth , Uutoni Wilhelm , Pazvakawambwa Lilian
Published: August 2018

Purpose

This paper aims to report some findings of a study that investigated health information systems (HISs) in Namibia with a view of establishing the nature of these systems and coming up with recommendations on how these could be enhanced.

Design/methodology/approach

This study applied a mixed methods research approach, using interviews and survey questionnaire to collect data. Survey data were analysed for descriptive statistics using SPSS and data from interviews were analysed applying content analysis for data analysis.

Findings

The findings of this study indicate fragmented HISs resulting in duplication of diagnosis, tests and treatment. The findings show that there were errors in capturing data into the systems, which could compromise the reliability of the data and compromise service delivery.

Research limitations/implications

This study was limited to two (Khomas and Oshana) of the fourteen regions in Namibia; therefore, further studies could look at other regions, as the study findings cannot be generalised to the entire country.

Practical implications

The findings and recommendations, particularly those relating to the public health sector, could inform policies and procedures, especially those relating to the patient health passport (card), and the way health information is shared within and across health sectors.

Originality/value

This study focused on health information sharing, whereas a previous study on HISs concentrated on quality of healthcare.
Beyond disgorgement: the impact of Kokesh on the SEC’s pursuit of equitable remedies
Authors: Karp Brad , Ehrlich Andrew , Reisner Lorin , Soloway Audra , Tarlowe Richard , Lichtenstein Maia , Vizcarrondo Peter
Published: August 2018

Purpose

This paper aims to explain the US Supreme Court’s ruling in Kokesh v. SEC, which limited the U.S. Securities and Exchange Commission’s (SEC) ability to seek the remedy of disgorgement and to examine how lower courts have applied the ruling to other types of equitable relief that that the SEC commonly pursues.

Design/methodology/approach

This study explains why the Supreme Court in Kokesh ruled that disgorgement is a “penalty” and that the five-year limitations period therefore was applicable to actions seeking disgorgement; discusses a footnote in Kokesh that left open the question of whether the SEC has the power to pursue disgorgement at all; and reviews four recent cases that grapple with the application of Kokesh to injunctions and lifetime bars.

Findings

Lower courts and the SEC have not settled on how Kokesh might impact equitable remedies commonly pursued by the SEC, but recent cases indicate that the effect of Kokesh may be broader than its narrow holding suggests.

Originality/value

Practical guidance from experienced white collar and regulatory defense lawyers that consolidates several recent developments in one piece.
Disease severity and economic burden in Japanese patients with systemic lupus erythematosus: A retrospective, observational study
Authors: Tanaka Yoshiya , Mizukami Akiko , Kobayashi Akihiro , Ito Chie , Matsuki Taizo
Published: August 2018

Aim

To describe the healthcare resource utilization (HRU), direct medical costs and clinical characteristics for Japanese patients with mild, moderate or severe systemic lupus erythematosus (SLE). The primary objectives were to describe HRU and examine the direct medical costs for Japanese patients with mild, moderate, or severe SLE over the 3‐year study period. Secondary objectives included recording patient demographics, clinical characteristics and frequency and cost of mild, moderate or severe flares. Exploratory objectives included a description of treatment patterns, and to explore which factors affect medical costs.

Methods

This retrospective, observational cohort study identified patients with SLE (diagnosed April 2010 to March 2012), from the Japan Medical Data Center claims database.

Result

The study cohort comprised 295 patients with mild (28, 9.5%), moderate (134, 45.4%), or severe (133, 45.1%) SLE. Outpatient visits, hospitalizations and emergency room stays were experienced by 295 (100%), 116 (39.3%) and 31 (10.5%) patients, respectively, over the 3‐year study period. Over the 3‐year period, the mean total direct medical cost was US$27 004, and cost increased with SLE severity: mild, $5549 moderate, $15 290; and severe, $43 322 (analysis of variance, P < 0.0001). During this period, the majority of patients (282, 95.6%) experienced at least one flare episode and the mean (standard deviation) frequency was 5.5 (3.3) flares. The mean total direct medical cost per flare increased with SLE severity.

Conclusion

This descriptive study provides information on the economic burden and clinical characteristics of Japanese patients with SLE based on claims data; high levels of HRU and direct medical costs were exhibited, particularly in patients with moderate or severe disease.
Evidence‐based guidelines for intra‐articular injection in knee osteoarthritis: Formulating and evaluating research questions
Authors: Xing Dan , Wang Qi , Yang Ziyi , Hou Yunfei , Zhang Wei , Chen Yaolong , Lin Jianhao
Published: August 2018

Objective

To formulate and evaluate clinical questions about intra‐articular injection for knee osteoarthritis in developing clinical practice guidelines and to introduce a new methodology for framing relevant questions.

Methods

We framed the clinical questions and evaluated the importance of these questions according to the following four steps: (a) first round questionnaire survey intended to get the clinical questions from doctors; (b) evaluating importance of questions via second round questionnaire survey intended to summarize and rank the clinical questions; (c) consensus conference was conducted by clinical and methodological experts; and (d) confirm the important clinical questions according to PICO (Patients, Intervention, Comparison and Outcomes) principles.

Results

After the first round questionnaire survey, the number of clinical questions was 26. Thirteen of these 26 questions were regarded as important questions by the second questionnaire survey. Ultimately, the 13 important clinical questions were determined in a consensus conference. All included questions were deconstructed by clinical experts and methodologists based on the PICO principles.

Conclusion

The present study describes an approach about the selection of clinical questions and importance evaluation. Relevant important clinical questions about intra‐articular injection for knee osteoarthritis are determined according to the methodology. It could help other guideline developers to utilize this method to frame clinical questions.
Effect of a single pre‐operative 125 mg dose of methylprednisolone on postoperative delirium in hip fracture patients; a randomised, double‐blind, placebo‐controlled trial
Authors: Clemmesen C. G. , Lunn T. H. , Kristensen M. T. , Palm H. , Foss N. B.
Published: August 2018

Postoperative delirium is common after hip fracture surgery, and may have a neuro‐inflammatory cause. We conducted a single‐centre, randomised, double‐blind, placebo‐controlled trial of 117 older hip fracture patients to see if a single, pre‐operative intravenous dose of 125 mg methylprednisolone could reduce the severity and/or incidence of postoperative delirium, assessed using the Confusion Assessment Method delirium severity score. Modified intention‐to‐treat analysis found no significant difference in our primary outcome, median (IQR [range]) cumulative Confusion Assessment Method delirium severity score over the first three postoperative days between the methylprednisolone and placebo groups (1 (0–6 [0–39]) vs. 2 (0–10 [0–32]), p = 0.294). Both the prevalence of postoperative delirium (Confusion Assessment Method delirium severity score ≥ 5, 10/59 vs. 19/58, p = 0.048) and the median (IQR [range]) cumulated postoperative (by day 3) fatigue scores (5 (2–6 [0–11]) vs. 6 (4–8 [0–16]), p = 0.008) were significantly lower in the methylprednisolone compared with the placebo group. There were no significant between‐group differences in the rate of completing physiotherapy, postoperative pain, the administration of antipsychotic drugs, infection, length of inpatient stay or 30‐ and 90‐day mortality. No major adverse reactions related to methylprednisolone were recorded. We conclude that a single, pre‐operative dose of 125 mg methylprednisolone does not reduce the severity of postoperative delirium, but may reduce both the prevalence of delirium and the severity of fatigue after hip fracture surgery in older patients, enabling remobilisation and recovery.
Traumatic shaking: The role of the triad in medical investigations of suspected traumatic shaking
Authors: Elinder Göran , Eriksson Anders , Hallberg Boubou , Lynøe Niels , Sundgren Pia Maly , Rosén Måns , Engström Ingemar , Erlandsson Björn‐Erik
Published: August 2018

The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects.

The language in SBU's reports are adjusted to a wide audience.

SBU's Board of Directors has approved the conclusions in this report.

The systematic review showed the following graded results:

There is limited scientific evidence that the triad (Three components of a whole. The triad associated with SBS usually comprises subdural haematoma, retinal haemorrhages and encephalopathy.) and therefore, its components can be associated with traumatic shaking (low‐quality evidence).

There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low‐quality evidence).

Limited scientific evidence (low‐quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support.

Insufficient scientific evidence (very low‐quality evidence) represents either a lack of studies or situations when available studies are of low quality or show contradictory results. Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.
Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain: An Update on Current Evidence and Cannabis Science
Authors: Baron Eric P.
Published: August 2018

Background

Comprehensive literature reviews of historical perspectives and evidence supporting cannabis/cannabinoids in the treatment of pain, including migraine and headache, with associated neurobiological mechanisms of pain modulation have been well described. Most of the existing literature reports on the cannabinoids Δ9‐tetrahydrocannabinol (THC) and cannabidiol (CBD), or cannabis in general. There are many cannabis strains that vary widely in the composition of cannabinoids, terpenes, flavonoids, and other compounds. These components work synergistically to produce wide variations in benefits, side effects, and strain characteristics. Knowledge of the individual medicinal properties of the cannabinoids, terpenes, and flavonoids is necessary to cross‐breed strains to obtain optimal standardized synergistic compositions. This will enable targeting individual symptoms and/or diseases, including migraine, headache, and pain.

Objective

Review the medical literature for the use of cannabis/cannabinoids in the treatment of migraine, headache, facial pain, and other chronic pain syndromes, and for supporting evidence of a potential role in combatting the opioid epidemic. Review the medical literature involving major and minor cannabinoids, primary and secondary terpenes, and flavonoids that underlie the synergistic entourage effects of cannabis. Summarize the individual medicinal benefits of these substances, including analgesic and anti‐inflammatory properties.

Conclusion

There is accumulating evidence for various therapeutic benefits of cannabis/cannabinoids, especially in the treatment of pain, which may also apply to the treatment of migraine and headache. There is also supporting evidence that cannabis may assist in opioid detoxification and weaning, thus making it a potential weapon in battling the opioid epidemic. Cannabis science is a rapidly evolving medical sector and industry with increasingly regulated production standards. Further research is anticipated to optimize breeding of strain‐specific synergistic ratios of cannabinoids, terpenes, and other phytochemicals for predictable user effects, characteristics, and improved symptom and disease‐targeted therapies.
Hybrid Cognitive‐Behavioral Therapy Intervention for Adolescents With Co‐Occurring Migraine and Insomnia: A Single‐Arm Pilot Trial
Authors: Law Emily F. , Wan Tham See , Aaron Rachel V. , Dudeney Joanne , Palermo Tonya M.
Published: August 2018

Objective

This study aimed to evaluate feasibility and acceptability of a hybrid cognitive‐behavioral therapy intervention for adolescents with co‐occurring migraine and insomnia.

Background

Many youth with chronic migraine have co‐occurring insomnia. Little research has been conducted to evaluate behavioral treatments for insomnia in youth with migraine.

Design and Methods

We conducted a single‐arm pilot trial to evaluate the feasibility and acceptability of delivering cognitive‐behavioral therapy for insomnia to 21 youth (mean age 15.5, standard deviation 1.6) with co‐occurring chronic migraine and insomnia. Adolescents completed up to 6 individual treatment sessions over 6 to 12 weeks, and 1 booster session 1 month later. Assessments included a prospective 7‐day headache and sleep diary, and self‐report measures of insomnia, sleep quality, sleep habits, and activity limitations at pre‐treatment, immediate post‐treatment, and 3‐month follow‐up.

Results

Adolescents demonstrated good treatment adherence and families rated the intervention as highly acceptable. Preliminary analyses indicated improvements from pre‐treatment to post‐treatment in primary outcomes of headache days (M = 4.7, SD = 2.1 vs M = 2.8, SD = 2.7) and insomnia symptoms (M = 16.9, SD = 5.2 vs M = 9.5, SD = 6.2), which were maintained at 3‐month follow‐up (M = 2.7, SD = 2.8; M = 9.3, SD = 5.0, respectively). We also found improvements in secondary outcomes of pain‐related activity limitations as well as sleep quality, sleep hygiene, and sleep patterns.

Conclusions

These preliminary data indicate that hybrid cognitive‐behavioral therapy is feasible and acceptable for youth with co‐occurring chronic migraine and insomnia. Future randomized controlled trials are needed to test treatment efficacy on migraine, sleep, and functional outcomes. ClinicalTrials.gov Identifier: NCT03137147.
The complex role of bone morphogenetic protein 9 in liver damage and regeneration: New evidence from in vivo and in vitro studies
Authors: Pascale Rosa M. , Feo Francesco , Calvisi Diego F.
Published: August 2018

See Article on Page 1664
Data for Peace: The League of Nations and Disarmament 1920–40
Authors: Lincove David
Published: August 2018

Based on Article 8 of the League of Nations Covenant, the League pursued a program to reduce and regulate national armaments to promote peace and security among nations. An integral part of the program was compiling and disseminating data on national armaments holdings, arms trade, and natural resources used to make war. The League anticipated that publishing and sharing arms data would contribute to an environment of greater transparency, international trust, and cooperation. There was a genuine belief among many disarmament supporters that data could be used as a tool to influence public opinion and national leaders, and contribute to the League's negotiations for a disarmament agreement. This philosophy of armaments data led to the publication and use of Armaments Year‐Book and Statistical Year‐Book of the Trade in Arms, Ammunition, and Implements of War, representing an approach to disarmament that set a precedent for the United Nations.
The association between malnutrition and childhood disability in low‐ and middle‐ income countries: systematic review and meta‐analysis of observational studies
Authors: Hume‐Nixon Maeve , Kuper Hannah
Published: August 2018

Objective

The aim of this study was to evaluate the association between childhood disability and malnutrition in low‐ and middle‐ income countries (LMICs).

Methods

Articles were identified from 1990 to August 2017 by searching nine electronic databases. Epidemiological studies, undertaken in LMICs that compared the prevalence of malnutrition in children with disabilities to children without disabilities were eligible for inclusion. Titles, abstracts, and full texts were screened by two reviewers, and data were extracted using a structured table for eligible papers. Meta‐analyses for the association between childhood disability and undernutrition were performed.

Results

The search generated 4678 results, from which 17 articles were eligible. Fifty‐three per cent of these studies showed a positive association between childhood disability and undernutrition. Results varied when disaggregated by type of disability, with positive associations identified for 44% of studies focussed on neurodevelopmental disability, 60% of general disability studies and 67% of studies on hearing impairment. Only four studies were identified that considered overnutrition outcomes, and these showed variable results. Eighteen per cent of eligible studies were considered at low risk of bias, 53% had a medium risk, and 29% had a high risk of bias. Pooled ORs showed that children with disabilities were almost three times more likely to be underweight (OR 2.97, 95% CI 2.33, 3.79), and nearly twice as likely to experience stunting and wasting (Stunting: 1.82, 1.40, 2.36; Wasting: 1.90, 1.32–2.75), compared to controls.

Conclusions

Children with disabilities may be a vulnerable group for undernutrition in LMICs, which should be reflected in disability and nutritional programming and policy‐making.
Prospective Social Studies Teachers’ Evaluations of Their Own Oral History Experiences Related to Turkey’s Recent History
Authors: Çelik Hülya
Published: August 2018

This study examined how prospective social studies teachers evaluate their experiences conducting oral histories regarding Turkey’s recent history. The research was completed in a course called History of the Republic of Turkey in the Faculty of Education at Sakarya University. Thirty-four social studies teacher candidates participated in the study. Based on a phenomenological research design (a qualitative research method), the data were obtained via semi-structured interviews consisting of 5 questions developed for this study. Content analysis was used to analyze the data. The prospective social studies teachers reported that their experiences completing oral histories related to recent Turkish history positively affected their views of the study of history and that their oral history experiences exposed them to diverse perspectives. The primary difficulties they encountered conducting their oral histories concerned the source persons they did oral histories. They also reported that they would like to practice oral history in their future social studies classes.
Integration of microwave-annealed oxidation on germanium metal-oxide-semiconductor devices
Authors: Hsu Chung-Chun , Chi Wei-Chun , Tsai Yi-He , Tsai Ming-Li , Wang Shin-Yuan , Chou Chen-Han , Zhang Jun Lin , Luo Guang-Li , Chien Chao-Hsin
Published: August 2018

In this paper, a method that entails using microwave thermal oxidation to form a high-quality gate dielectric on Ge through surface passivation at considerably low temperatures (<400 °C) is presented. Formation of the GeOx layer was confirmed by x-ray photoelectron spectroscopy. To reduce the bulk trap density and interface trap density (Dit), microwave thermal oxidation was employed for postdeposition microwave thermal oxidation after the deposition of Al2O3 through atomic layer deposition. Tiny frequency dispersion in capacitance measurement and a low Dit value of 5.9 × 1011 cm−2 eV−1 near the midgap confirmed a desirable passivation effect, which was favorable in mitigating the formation of dangling bonds on the Ge surface. A small hysteresis in capacitance was also observed, suggesting that the bulk dielectric was of high quality. On the basis of these characteristics, microwave-activated GeOx is a promising passivation layer material for aggressively scaled Ge-related metal oxide semiconductor devices.
The potential of agricultural land management to contribute to lower global surface temperatures
Authors: Mayer Allegra , Hausfather Zeke , Jones Andrew D. , Silver Whendee L.
Published: August 2018

Warming reduction can be achieved globally through improved agricultural land management using existing knowledge and technology.
Lake Tauca highstand (Heinrich Stadial 1a) driven by a southward shift of the Bolivian High
Authors: Martin Léo C. P. , Blard Pierre-Henri , Lavé Jérôme , Condom Thomas , Prémaillon Mélody , Jomelli Vincent , Brunstein Daniel , Lupker Maarten , Charreau Julien , Mariotti Véronique , Tibari Bouchaïb ,   ASTER Team, Davy Emmanuel
Published: August 2018

Our paleoprecipitation map of the Altiplano reveals the atmospheric processes underlying a major hydroclimatic change 16 ka ago.
PA5339, a RidA Homolog, Is Required for Full Growth in Pseudomonas aeruginosa
Authors: Irons Jessica , Hodge-Hanson Kelsey M. , Downs Diana M.
Published: August 2018

RidA is a widely conserved protein that prevents endogenous metabolic stress caused by 2-aminoacrylate (2AA) damage to pyridoxal 5′-phosphate (PLP)-dependent enzymes in prokaryotes and eukaryotes. The framework for understanding the accumulation of 2AA and its consequences have largely been defined in
Salmonella enterica
. We show here that in
P. aeruginosa
(PAO1), 2AA accumulation leads to reduced growth, compromised motility, and defective biofilm formation. This study expands our knowledge how the metabolic architecture of an organism contributes to the consequences of 2AA inactivation of PLP-dependent enzymes and identifies a key RidA protein in
P. aeruginosa
.
Genome Sequences of Three Isolates of Fusarium verticillioides
Authors: Gardiner Donald M.
Published: August 2018

Fusarium verticillioides
is an important pathogen of maize worldwide. Here, three Australian isolates of
F. verticillioides
, originally obtained from maize or sorghum, were sequenced using Illumina technology to expand the available genomic resources for this important pathogen.
Complete Genome Sequence of the Marine Carbazole-Degrading Bacterium Erythrobacter sp. Strain KY5
Authors: Vejarano Felipe , Suzuki-Minakuchi Chiho , Ohtsubo Yoshiyuki , Tsuda Masataka , Okada Kazunori , Nojiri Hideaki
Published: August 2018

We determined the complete genome sequence of
Erythrobacter
sp. strain KY5, a bacterium isolated from Tokyo Bay and capable of degrading carbazole.
Complete Genome Sequence of Moraxella bovis Strain Epp-63 (300), an Etiologic Agent of Infectious Bovine Keratoconjunctivitis
Authors: Loy John Dustin , Dickey Aaron M. , Clawson Michael L.
Published: August 2018

We report here the complete closed genome sequence of
Moraxella bovis
strain Epp-63 (300) (Epp63). This strain was isolated from an infectious bovine keratoconjunctivitis (IBK) case in 1963.
Modifying maternal sleep position in the third trimester of pregnancy with positional therapy: a randomised pilot trial
Authors: Kember Allan J , Scott Heather M , O’Brien Louise M , Borazjani Ali , Butler Michael B , Wells Jesse H , Isaac Andre , Chu Kaishin , Coleman Jerry , Morrison Debra L
Published: August 2018

Objective

To evaluate whether the percentage of time spent supine during sleep in the third trimester of pregnancy could be reduced using a positional therapy device (PrenaBelt) compared with a sham device.

Design

A double-blind, randomised, sham-controlled, cross-over pilot trial.

Setting

Conducted between March 2016 and January 2017, at a single, tertiary-level centre in Canada.

Participants

23 participants entered the study. 20 participants completed the study. Participants were low-risk, singleton, third-trimester pregnant women aged 18 years and older with body mass index <35 kg/m2at the first antenatal appointment for the index pregnancy and without known fetal abnormalities, pregnancy complications or medical conditions complicating sleep.

Interventions

A two-night, polysomnography study in a sleep laboratory. Participants were randomised by computer-generated, one-to-one, simple randomisation to receive either a PrenaBelt or a sham-PrenaBelt on the first night and were crossed over to the alternate device on the second night. Allocation concealment was by unmarked, security-tinted, sealed envelopes. Participants, the recruiter and personnel involved in setting up, conducting, scoring and interpreting the polysomnogram were blinded to allocation.

Primary and secondary outcome measures

The primary outcome was the percentage of time spent supine during sleep. Secondary outcomes included maternal sleep architecture, respiration, self-reported sleep position and feedback.

Results

The median percentage of sleep time supine was reduced from 16.4% on the sham night to 3.5% on the PrenaBelt night (pseudomedian=5.8, p=0.03). We were unable to demonstrate differences in sleep architecture or respiration. Participants underestimated the time they spent sleeping supine by 7.0%, and six (30%) participants indicated they would make changes to the PrenaBelt. There were no harms in this study.

Conclusions

This study demonstrates that the percentage of sleep time supine during late pregnancy can be significantly reduced via positional therapy.

Trial registration number

NCT02377817; Results.
Excess costs of alcohol-dependent patients in German psychiatric care compared with matched non-alcohol-dependent individuals from the general population: a secondary analysis of two datasets
Authors: Dams Judith , Buchholz Angela , Kraus Ludwig , Reimer Jens , Scherbaum Norbert , Konnopka Alexander , König Hans-Helmut
Published: August 2018

Objectives

Heavy alcohol use can cause somatic and mental diseases, affects patients’ social life and is associated with social isolation, unemployment and reduced quality of life. Therefore, societal costs of alcohol dependence are expected to be high. The aim of this study was to estimate excess costs of patients with alcohol dependence diagnosed using theDiagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria compared with individuals without alcohol dependence in Germany.

Design

In a secondary analysis, baseline data of patients with alcohol dependence enrolled in a randomised controlled trial (German Clinical Trials Register DRS00005035) were compared with data collected via a telephone survey from individuals without alcohol dependence and that had been matched by entropy balancing. Health service use was evaluated retrospectively for a 6-month period.

Settings

Four German psychiatric university clinics (patients with alcohol dependence) and the German general adult population (individuals without alcohol dependence).

Participants

n=236 adult patients with alcohol dependence and n=4687 adult individuals without alcohol dependence.

Primary and secondary outcome measures

The excess costs of health service use, absenteeism and unemployment of patients with alcohol dependence were calculated and compared with individuals without alcohol dependence. In subgroup analyses, the associations between excess cost and gender, comorbidities and the duration of disease were investigated.

Results

Total 6-month excess costs of €11 839 (95% CI €11 529 to €12 147) were caused by direct excess costs of €4349 (95% CI €4129 to €4566) and indirect costs of €7490 (95% CI €5124 to €9856). In particular, costs of inpatient treatment, formal long-term care, absenteeism and unemployment were high.

Conclusions

Alcohol dependence causes substantial direct and indirect excess costs. Cost-effective interventions to prevent and treat alcohol dependence are urgently needed.

Trial registration number

DRKS00005035.
Differential intervention effectiveness of a universal school-based resilience intervention in reducing adolescent substance use within student subgroups: exploratory assessment within a cluster-randomised controlled trial
Authors: Hodder Rebecca Kate , Freund Megan , Bowman Jenny , Wolfenden Luke , Campbell Elizabeth , Dray Julia , Lecathelinais Christophe , Oldmeadow Christopher , Attia John , Wiggers John
Published: August 2018

Objectives

Interventions addressing the individual and environmental protective factors of adolescents are suggested to have potential for reducing adolescent substance use. While universally delivered school-based substance use prevention interventions are common, previous studies have suggested variable effectiveness by subgroups of students. An exploratory study was undertaken to examine the differential effectiveness of a universal school-based resilience intervention on adolescent substance use and protective factors according to their sociodemographic and previous substance use.

Design

Secondary analysis of data from a cluster-randomised controlled trial.

Setting

32 Australian secondary schools.

Participants

Cohort of grade 7 students (n=3155) followed up in grade 10 (aged 15–16 years; 2014; n=2105).

Intervention

Three-year universal school-based intervention implemented by school staff that targeted a range of student resilience protective factors (2012–2014).

Measurements

Primary outcomes included: tobacco (recent, number of cigarettes) and alcohol (recent, ‘risk’ and number of drinks) use, and secondary outcomes included: marijuana (recent) and other illicit substance (recent) use, and aggregate individual and environmental protective factor scores. Generalised and linear mixed models examined interactions between treatment and student subgroups (gender; socioeconomic disadvantage (low/high); geographic location (major city/inner regional/outer regional-remote); and previous substance use (non-user/user)) at follow-up (36 models).

Results

Analysis of student follow-up data showed no differential intervention effect for any substance use or protective factor outcome for any subgroup, with the exception of one differential effect found by socioeconomic status for the outcome of mean number of cigarettes smoked by recent smokers (p=0.003). There was no evidence of an intervention effect within the low (mean difference (MD) −12.89, 95% CI −26.00 to 0.23) or high (MD 16.36, 95% CI −1.03 to 33.76) socioeconomic subgroups.

Conclusions

No evidence of an intervention effect on substance use and protective factors was found according to student subgroups defined by sociodemographic characteristics or previous substance use.

Trial registration number

ACTRN12611000606987.
Knowledge mobilisation: an ethnographic study of the influence of lay mindlines on eczema self-management in primary care in the UK
Authors: Cowdell Fiona
Published: August 2018

Objective

To investigate the way in which mindlines, ‘collectively reinforced, internalised tacit guidelines’, are constructed among lay people with eczema in primary care.

Design

Ethnographic study.

Setting

Observation in one general practice in the UK and interviews across central England.

Participants

In observation, patients in the participating general practice regardless of presenting complaint and in interviews, people with eczema or parents of children with eczema (n=16).

Results

Observation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Four themes were identified: doctor knows best; not worth bothering the doctor; I need to manage this myself; and how I know what to do. Themes were set within the context of four broad typologies of lay people’s approach to self-management: content to self-manage; content to accept practitioner management; self-managing by default; and those referred to secondary care.

Conclusions

This study is the first to examine how lay eczema mindlines are developed and to recognise typologies of people with different need for, and receptiveness to, information. Lay eczema mindlines are constructed in many ways. The outstanding challenge is to find strategies to revise or modify these mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information.
Acute poisoning in Shenyang, China: a retrospective and descriptive study from 2012 to 2016
Authors: Zhang Yajie , Yu Boxin , Wang Nana , Li Tiegang
Published: August 2018

Objectives

Up-to-date information on the patterns of acute poisoning is crucial for the proper management of poisoning events. The objectives of this study were to analyse the characteristics of patients suffering from acute poisoning admitted to the emergency department (ED) in a tertiary medical centre in Northeast China and to compare these characteristics with those of a previous comparable study.

Design

Retrospective and descriptive study.

Setting

Data were collected from the hospital information system in Shengjing Hospital, China, from January 2012 to December 2016.

Participants

All cases aged ≥11 years old with a diagnosis of acute poisoning.

Results

In total, 5009 patients aged ≥11 years presented to the ED with acute poisoning during the study period. The average age of the patients was 36.0±15.1 years and over half (52.7%) were in the 20–39age group. The female to male ratio was 1.2:1. Patients with acute poisoning mainly lived in rural areas rather than in urban areas. The majority of patients consumed poison as suicide attempts (56.7%). Men were more commonly poisoned by drug abuse than women, but women outnumbered men in suicidal poisoning. The most common form of poison intake was ingestion (oral intake; 86.2%). The five most common toxic agent groups, in descending order, were therapeutic drugs (32.6%), pesticides (26.9%), alcohol (20.7%), fumes/gases/vapours (11.4%) and chemicals (3.6%). Sedatives/hypnotics in the therapeutic drugs group and paraquat in the pesticides group were the most common toxic agents, respectively. The mortality rate of study participants was 1.3%, with 64 deaths.

Conclusions

The results of this study indicate the need to strengthen education on the rational and safe use of drugs in Shenyang.
Sunbed use 2007–2015 and skin cancer projections of campaign results 2007–2040 in the Danish population: repeated cross-sectional surveys
Authors: Køster Brian , Meyer Maria KH , Andersson Therese M-L , Engholm Gerda , Dalum Peter
Published: August 2018

Objective

To evaluate the effect of the Danish Sun Safety Campaign 2007–2015 on the prevalence of sunbed use and to model future effects on the skin cancer incidences 2007–2040.

Design

The study has a repeated, cross-sectional design.

Setting

Exposure to ultraviolet radiation is the main risk factor for skin cancer. Denmark has the highest prevalence of sunbed use reported and one of the highest incidences of skin cancer worldwide.

Participants

During 2007–2015, survey data were collected for 37 766 Danes, representative of the Danish population with regards to age, gender and region.

Interventions

In 2007, an ongoing long-term antisunbed campaign was launched in Denmark.

Primary and secondary outcome measures

Sunbed use was evaluated by annual cross-sectional surveys. Skin cancer incidence was modelled in the Prevent programme, using population projections, historic cancer incidence, sunbed use exposure and relative risk of sunbed use on melanoma.

Results

The prevalence of recent sunbed use in Denmark was reduced from 32% and 18% to 13% and 8% for women and men, respectively. The campaigns results during 2007–2015 are estimated to reduce the number of skin cancer cases from more than 5000 (746malignant melanoma, 1562 SCC, 2673 BCC) totally during 2007–2040. Keeping the 2015 level of sunbed use constant by continued campaign pressure or introduction of structural interventions would potentially prevent more than 750 skin cancer cases annually in 2040 and 16 000 skin cancer cases in total during 2007–2040.

Conclusion

We have shown the value of prevention and of long-term planning in prevention campaigning. Sunbed use was reduced significantly during 2007–2015 and further reductions are possible by structural interventions. Consequently, significantly fewer skin cancer cases are anticipated during 2007–2040. The Danish Parliament has population support to enforce structural interventions to avoid a large burden of this disease.
Attitude towards active surveillance: a cross-sectional survey among patients with uroandrological disorders
Authors: Capogrosso Paolo , Boeri Luca , Ventimiglia Eugenio , Camozzi Ilenya , Cazzaniga Walter , Chierigo Francesco , Scano Roberta , Briganti Alberto , Montorsi Francesco , Salonia Andrea
Published: August 2018

Objectives

We looked at subjective attitude towards active surveillance (AS) as the first option for cancer management in a cohort of patients seeking first medical help for uroandrological disorders prior to a formal discussion with a caregiver.

Design

Cross-sectional observational study.

Setting

Uroandrological outpatient clinic of a European academic centre.

Participants

Data of 1059 patients at their first access for uroandrological purposes from January 2014 to December 2016 were analysed.

Intervention

Patients were invited to complete a survey with closed questions investigating their attitude towards AS, prior to any clinical evaluation. Likewise, patients were invited to score the importance given to different aspects of personal life in the case of a cancer diagnosis, using a 10-point Likert scale.

Primary and secondary outcomes measures

The reported opinion towards AS management for cancer was assessed. Logistic regression analyses tested participants’ sociodemographic characteristics associated with a positive opinion on AS.

Results

Positive, negative and doubtful attitudes towards AS were observed in 347 (33%), 331 (31%) and 381 (36%) patients, respectively. Female patients were more likely to report a negative attitude towards AS (38.7% vs 29.6%, p=0.04) while patients with previous parenthood more frequently reported a positive opinion on AS (37.2% vs 29.9%, p=0.005). Patient age emerged as the only predictor of a positive attitude towards AS (OR 1.03; 95% CI 1.01 to 1.04, p<0.001), with a 46% and 33% probability of being pro-AS for a patient aged 65 and 45 years, respectively.

Conclusions

One out of three patients would express positive feedbacks on AS in the unfortunate case of tumour diagnosis, only according to his/her baseline personal opinion and prior to any discussion with a cancer caregiver. The older the patient, the higher the probability of being compliant with a conservative management for cancer.
Minor flow disruptions, traffic-related factors and their effect on major flow disruptions in the operating room
Authors: Joseph Anjali , Khoshkenar Amin , Taaffe Kevin M , Catchpole Ken , Machry Herminia , Bayramzadeh Sara
Published: August 2018

Background

Studies in operating rooms (OR) show that minor disruptions tend to group together to result in serious adverse events such as surgical errors. Understanding the characteristics of these minor flow disruptions (FD) that impact major events is important in order to proactively design safer systems

Objective

The purpose of this study is to use a systems approach to investigate the aetiology of minor and major FDs in ORs in terms of the people involved, tasks performed and OR traffic, as well as the location of FDs and other environmental characteristics of the OR that may contribute to these disruptions.

Methods

Using direct observation and classification of FDs via video recordings of 28 surgical procedures, this study modelled the impact of a range of system factors—location of minor FDs, roles of staff members involved in FDs, type of staff activities as well as OR traffic-related factors—on major FDs in the OR.

Results

The rate of major FDs increases as the rate of minor FDs increases, especially in the context of equipment-related FDs, and specific physical locations in the OR. Circulating nurse-related minor FDs and minor FDs that took place in the transitional zone 2, near the foot of the surgical table, were also related to an increase in the rate of major FDs. This study also found that more major and minor FDs took place in the anaesthesia zone compared with all other OR zones. Layout-related disruptions comprised more than half of all observed FDs.

Conclusion

Room design and layout issues may create barriers to task performance, potentially contributing to the escalation of FDs in the OR.
Colonic lymphoma causing colo-colonic intussusception and chronic intestinal obstruction in a four-year-old German shepherd dog
Authors: DiGiovanni Lisa , Selmic Laura E , Cray Megan , Zamprogno Helia
Published: August 2018

Gastrointestinal lymphoma accounts for approximately 7 per cent of all canine lymphomas. It is typically associated with a poor prognosis when localised to the gastrointestinal tract. This case report describes a four-year 10-month-old, male intact German shepherd dog that experienced complications relating to the presence of colonic lymphoma lesion with colo-colonic intussusception and chronic gastrointestinal obstruction, leading to severe distention and enlargement of the proximal small intestine. Surgery was performed and this dog recovered well from surgery. The colonic mass was completely excised along with a grossly abnormal appearing colonic lymph node. Postoperatively, a multidrug chemotherapy protocol was administered with success. This case demonstrates a good outcome with surgery to remove a colonic lymphoma lesion that was causing obstruction followed by adjuvant multidrug chemotherapy.
Prevalence of gastrointestinal parasites in a yak herd in Nepal
Authors: Angell Joseph William , Graham-Brown John , Singh Upendra Man , Joshi Bhoj Raj
Published: August 2018

Current information on the domestic yak (Poephagus grunniens or Bos grunniens) in the Himalayan agroecological zone in Nepal is limited. Despite their isolation, yak may contact other domestic livestock particularly during the winter when they are at lower altitudes and as such they may be exposed to infectious disease. Faeces from 50 adult yak from a herd of 123 adults and 27 calves in the Kaski region of the Nepali Himalaya were analysed for the presence of gastrointestinal parasites using standard flotation and sedimentation methods. In this herd, 18 per cent (95% CI 9% to 31%) of the samples showed evidence of nematode infection, with trichostrongyle and Nematodirus/Marshallagia species eggs being detected. No trematode eggs were detected in any samples, and no Galba species or other snails were found in the environment. The herd appeared healthy with low intestinal parasitic burdens. Our findings may indicate Nematodirus/Marshallagia species infection to be exclusive to yak in this region.