bluuebunny/crossref_metadata_2025 huggingface dataset:
Supporting participation of Asia-Pacific SMEs in global value chains
Authors: Abe Masato , Proksch Marc
Published: April 2017

Purpose

Global value chains (GVCs) have become increasingly influential in determining the patterns of international trade and foreign direct investment (FDI) and in providing growth opportunities in Asia and the Pacific while small- and medium-sized enterprises (SMEs) have been an engine of economic development. The purpose of this paper is to provide effective development strategies and relevant policy approaches to facilitate dynamic insertion of SMEs into GVCs.

Design/methodology/approach

This paper was developed based on various Economic and Social Commission for Asia and the Pacific works in the fields of the development of SMEs and GVCs in Asia and the Pacific. Sectoral case studies on agribusiness, garment/apparel, automotive and electronics illustrate SMEs’ effective integration into GVCs.

Findings

SMEs face multiple obstacles and challenges which may limit the benefits derived from the development of GVCs in Asia and the Pacific. Policymakers are suggested to design and implement appropriate strategies and polices in order to facilitate the development of SMEs under the ongoing globalization.

Research limitations/implications

This paper is mainly based on existing policy papers which were developed by the United Nations Secretariat, its specialized agencies and others. Further empirical and policy studies are expected to be conducted in order to deepen the understanding of the present topics and to come up with practical policy options.

Practical implications

Policymakers are suggested to consider strategies and policy options recommended by this paper for their works on SME development and trade and investment promotion.

Originality/value

This is the first policy paper which proposes a comprehensive framework for SMEs’ effective participation in GVCs, specifically suggesting seven approaches, namely, SME development; trade policy; behind-the-border and cross-border trade facilitation; regional integration frameworks; FDI promotion; SME clusters; and national innovation system.
Acceptance and usage of social media as a platform among student entrepreneurs
Authors: Nawi Noorshella Binti Che , Mamun Abdullah Al , Nasir Noorul Azwin Binti Md , Shokery Noorlisa Maria bt A. Hamid , Raston Nursalihah Binti Ahmad , Fazal Syed Ali
Published: April 2017

Purpose

While it is perceived that adoption reflects acceptance, the purpose of this paper is to argue that individual usage is critical and cannot be guaranteed by mere adoption. This study, therefore, focuses on the factors (i.e. performance expectancy, perceived trust, perceived risk, facilitating condition, and perceived enjoyment) contributing to the adoption and ultimately usage of social media as a business platform among student entrepreneurs in Malaysia under the premise of the unified theory of acceptance and use of technology (UTAUT).

Design/methodology/approach

This study adopts a cross-sectional design and quantitative data are collected from 300 selected respondents listed as student entrepreneurs in the entrepreneurship centers of all public universities within Peninsular Malaysia.

Findings

Performance expectancy, perceived risk, perceived trust, and perceived enjoyment have a significant effect on the adoption of social media leading to its usage as a business platform. Findings also report a significant mediating effect of adoption of social media on the relationship between performance expectancy, perceived trust, perceived risk, and perceived enjoyment with the depth of social media usage.

Research limitations/implications

In order to promote entrepreneurial activities among student entrepreneurs using social media as a business platform, programs and policies should focus on improving cyber security and value-added services.

Originality/value

This study puts forward and tests the original UTAUT model to assess the adoption and depth of social media usage as a business platform among young student entrepreneurs in Peninsular Malaysia, which provides a foundation for the design and implementation of programs and policies that promote entrepreneurial activities using social media among student entrepreneurs in Malaysia.
Entrepreneurial intention: a study of individual, situational and gender differences
Authors: Yukongdi Vimolwan , Lopa Nusrat Zahan
Published: April 2017

Purpose

The purpose of this paper is to examine the determinants of entrepreneurial intention. Specifically, the study investigated the extent to which personality traits or situational factors influenced entrepreneurial intention and whether the relationship among the predictor variables and the intention to become entrepreneurs differed between men and women.

Design/methodology/approach

Data were collected using a questionnaire-based survey of 393 students at a reputable international educational institution in Thailand. Hierarchical multiple regression analysis and analysis of variance were employed to test the hypotheses.

Findings

A total of eight independent variables were tested for their effect on entrepreneurial intention. Three of the personality traits, including need for achievement, risk-taking tendency, job security, were found to have a significant effect on intention for entrepreneurship. However, environment for starting a business and educational programme were found to be suppressor variables. Personality factors had a greater degree of effect on entrepreneurial intention than situational factors. With respect to gender differences, for women, job autonomy and job security were significant predictors while for men, need for achievement and risk-taking tendency contributed to entrepreneurial intention.

Originality/value

The study investigated whether personality factors or situational factors were the main drivers of entrepreneurial intention and to what extent gender differences exist in the determinants of entrepreneurial intention. Few studies have been based on a sample of respondents of such diversity in terms of nationality. The present study included respondents from 12 different nationalities in Asia.
The impact of external financing on firm value and a corporate governance index: SME evidence
Authors: Al-Najjar Basil , Al-Najjar Dana
Published: April 2017

Purpose

The purpose of this paper is to investigate the effect of external financing needs on both firm value and corporate governance mechanisms within the UK SME context. This framework is of importance because of the limited external financial resources SMEs might face.

Design/methodology/approach

The authors consider the endogeneity problem between corporate governance mechanisms and firm value, and hence, the three stages least squares and the instrumental variables based on two stages least squares estimation methods are employed.

Findings

The authors find a positive relationship between external financing needs and firm value. In addition, the authors detect that size and profitability are positively associated with firm value in the sample. Concerning the corporate governance index (CGI), the authors detect that big SMEs and those with low-debt levels have better corporate governance structures.

Originality/value

The authors employ a CGI for the sample which is constructed using ten corporate governance variables. The authors also examine different factors that affect SMEs 2019 governance by applying different models including logistic analysis.
Making collaboration work – developing boundary work and boundary awareness in emergency exercises
Authors: Andersson Annika , Lindström Berner
Published: April 2017

Purpose

This study aims to investigate how boundary work is carried out at the incident site during exercises with police, ambulance and rescue services, and how boundary awareness is developed based on this boundary work. Collaboration in emergency work is challenging on many levels. The unforeseen and temporary nature of incidents presents basic challenges. Another important challenge is boundaries between specialised and autonomous emergency service organisations. Knowledge on how exercises are performed to increase the individuals' and organisations' preparedness for future joint-response work is relatively limited.

Design/methodology/approach

Empirically, full-scale exercises involving police, ambulance and rescue services and with repetition of practical scenarios and joint-reflection seminars are studied. Interview data with 26 exercise participants were analysed using thematic analysis. The analytic focus is on how boundaries are identified, negotiated and managed in the participants’ work.

Findings

Much of the work in the exercises was performed within distinct areas of expertise, in accordance with concrete routines, skills and responsibilities. Boundary work was often organised in the form of distribution of labour or creating chains of actions. The exercises shed light on challenges related to other aspects of emergency response, such as a lack of resources, diverging primary responsibilities, time-criticality and hazardous environments. The design allowed participants to explicate boundaries, to test and discuss alternative solutions and to visualise the effects of different solutions, as the scenarios were repeated.

Originality/value

The study found that the boundaries that were identified were often of institutional character, and were also related to the specific scenarios and to the actions taken in the activities. By integrating real-life experiences of collaborative work in the exercise, the exercise gained a certain meaning that was essential for the participants to develop boundary awareness.
Sampling roots to capture plant and soil functions
Authors: Freschet Grégoire T. , Roumet Catherine
Published: April 2017

Roots vary in anatomy, morphology and physiology, both spatially (different parts of the same root system) and temporally (plastic changes, root ageing), suggesting that root trait measurements are strongly affected by root sampling categories.

In this context, it is urgent to clarify the functional significance of current root sampling categories (e.g. fine roots of the first order, the first three orders, ≤1 mm or ≤2 mm), establish guidelines for choosing between sampling methods and revise root ontology to account for functional differences between traits measured on distinct root categories.

Here, we used a worldwide database of fine‐root traits to test the hypothesis that distinct fine‐root trait values – with link to fine‐root functions – were generally affected by different root sampling categories. We observed indeed a clear functional break between first‐order roots and roots of all three other sampling categories, and a smaller but substantial break between roots of the three first orders and the ≤2 mm category, demonstrating globally that different sampling methodologies capture different functional parts of roots.

Our synthesis suggests that all current root sampling categories present both advantages and pitfalls and that no single method can appropriately tackle the main current challenge of root functional ecology: i.e. linking fine roots to plant and ecosystem functions in a truly comparable way across all plants. We argue instead that a small set of complementary standardized sampling methods is necessary to capture the linkages between root forms and functions.

To assist experimenters selecting adequate sampling we developed a decision table following three logical questions: (i) what plant or ecosystem function must be addressed; (ii) what root categories are involved in this function and (iii) what traits should be measured on these root categories. Challenging, strengthening and expending such common reference framework would be a substantial step towards wider comparability of future functional trait datasets.

A lay summary is available for this article.
Root and shoot glucosinolate allocation patterns follow optimal defence allocation theory
Authors: Tsunoda Tomonori , Krosse Sebastian , van Dam Nicole M.
Published: April 2017

Optimal defence allocation theory (ODT) is one of the most prominent theoretical frameworks to explain the allocation of defence compounds within plants. It predicts that the most valuable and vulnerable plant organs have the highest levels of chemical defence. TheODThas been well worked out and experimentally tested for shoot defences, but not for root defences. To assess ifODTprinciples apply similarly to roots and shoots, we examined glucosinolates in above‐ground and below‐ground organs of nine plant species belonging to two families.

In order to evaluate whetherODTequally applies to shoot and root organs, we designed a conceptual model in which above‐ground and below‐ground organs were assigned to orders of importance to plant performance. We hypothesized that organs constituting the plant's core structure are better protected than more distal organs.

The nine plant species were cultivated, and their roots and shoots were harvested and divided into three orders for glucosinolate analysis. Using a specialist (Delia radicum) and a generalist (Amphimallon solstitiale) root herbivore, we also experimentally tested the hypothesis that the generalist herbivore prefers to feed on fine roots (FRs) with a low glucosinolate concentration, while the specialist prefers taproots (TRs) with a high glucosinolate concentration.

We found that both in roots and shoots, the higher ordered core structural organs (TRs and stems) had the highest levels of glucosinolates. Below‐ground, TRs and lateral roots were better protected than the more distal, and less costly, FRs in seven out of nine species tested. The specialist root herbivore preferred feeding on the highly defended TRs, which is in line with what has been found for above‐ground specialist herbivores. Moreover, the glucosinolate concentration in roots overall was significantly higher than that in shoots.

Synthesis. These results support the hypothesis thatOptimal defence allocation theory (ODT)generally applies to glucosinolate allocation in above‐ground and below‐ground organs and may mainly serve to maintain the integrity of the main plant structure. Moreover, it suggests that above‐ground and below‐ground insect herbivores independently exert similar selection pressures on defence allocation patterns in roots and shoots.
Effectiveness of vildagliptin as add‐on to metformin monotherapy among uncontrolled type 2 diabetes mellitus patients in a real‐world setting
Authors: Melzer Cohen Cheli , Davis Carla , Shalev Varda , Chodick Gabriel
Published: April 2017

Background

Vildagliptin is a dipeptidyl peptidase‐4 inhibitor commonly used as a dual oral agent with metformin, thiazolidinediones, or sulfonylurea for the treatment of type 2 diabetes mellitus (T2DM). The efficacy of dual therapy with vildagliptin and metformin has been established in randomized controlled trials, but there is little evidence from observational studies. The aims of the present study were to evaluate the effectiveness of vildagliptin as an add‐on therapy to metformin in reducing HbA1c and its affects on body weight and blood lipids in a real‐life setting.

Methods

Included in the present retrospective cohort were T2DM patients (n = 345) who were uncontrolled on metformin monotherapy and intensified treatment with vildagliptin. The efficacy of at least 90 days of dual therapy with vildagliptin and metformin in reducing HbA1c levels, as well as changes in blood lipids and body weight, were evaluated.

Results

After 180 days (range 90–365 days) from the index date with a mean daily dose of 92 mg vildagliptin, HbA1c was significantly (P < 0.001) reduced by an average of 0.9% (95% confidence interval −1.0%, −0.7%). The absolute reduction in HbA1c was positively associated with baseline HbA1c levels. In addition to HbA1c, a modest but significant (P < 0.05) decrement was also calculated in the patients' body weight and blood lipids.

Conclusions

The present analysis of real‐world data corroborates the results of previous randomized controlled trials indicating that add‐on therapy with vildagliptin in uncontrolled patients on metformin monotherapy is associated with a significant improvement in the control of HbA1c.
The coping function of mental disorder symptoms: is it to be considered when developing diagnostic criteria for behavioural addictions?
Authors: Konkolÿ Thege Barna
Published: April 2017

Commentary to: How can we conceptualize behavioural addiction without pathologizing common behaviours?
The roles of prostate‐specific antigen (PSA) density, prostate volume, and their zone‐adjusted derivatives in predicting prostate cancer in patients with PSA less than 20.0 ng/mL
Authors: Shen P. , Zhao J. , Sun G. , Chen N. , Zhang X. , Gui H. , Yang Y. , Liu J. , Shu K. , Wang Z. , Zeng H.
Published: April 2017

The aim of this study was to develop nomograms for predicting prostate cancer and its zonal location using prostate‐specific antigen density, prostate volume, and their zone‐adjusted derivatives. A total of 928 consecutive patients with prostate‐specific antigen (PSA) less than 20.0 ng/mL, who underwent transrectal ultrasound‐guided transperineal 12‐core prostate biopsy at West China Hospital between 2011 and 2014, were retrospectively enrolled. The patients were randomly split into training cohort (70%, n = 650) and validation cohort (30%, n = 278). Predicting models and the associated nomograms were built using the training cohort, while the validations of the models were conducted using the validation cohort. Univariate and multivariate logistic regression was performed. Then, new nomograms were generated based on multivariate regression coefficients. The discrimination power and calibration of these nomograms were validated using the area under the ROC curve (AUC) and the calibration curve. The potential clinical effects of these models were also tested using decision curve analysis. In total, 285 (30.7%) patients were diagnosed with prostate cancer. Among them, 131 (14.1%) and 269 (29.0%) had transition zone prostate cancer and peripheral zone prostate cancer. Each of zone‐adjusted derivatives‐based nomogram had an AUC more than 0.75. All nomograms had higher calibration and much better net benefit than the scenarios in predicting patients with or without different zones prostate cancer. Prostate‐specific antigen density, prostate volume, and their zone‐adjusted derivatives have important roles in detecting prostate cancer and its zonal location for patients with PSA 2.5–20.0 ng/mL. To the best of our knowledge, this is the first nomogram using these parameters to predict outcomes of 12‐core prostate biopsy. These instruments can help clinicians to increase the accuracy of prostate cancer screening and to avoid unnecessary prostate biopsy.
Expression of toll‐like receptors in T lymphocytes stimulated with N‐(3‐oxododecanoyl)‐L‐homoserine lactone from Pseudomonas aeruginosa
Authors: Bao Lei , Yu Jialin , Zhong Haiying , Huang Daochao , Lu Qi
Published: April 2017

The establishment of chronic Pseudomonas aeruginosa infections is correlated with the disturbance of the host immune system. The P. aeruginosa quorum‐sensing molecule N‐3‐(oxododecanoyl)‐L‐homoserine lactone (3‐O‐C12‐HSL) has the potential to modulate the host immune system. The immune system recognizes pathogens via toll‐like receptors (TLRs). We found that 3‐O‐C12‐HSL induced TLR changes in monocytes. However, the role of T cells in P. aeruginosa infection has not been delineated. In order to understand this activity, we examined whether 3‐O‐C12‐HSL has an effect on the immune function and the expression of TLRs in T lymphocytes. Human peripheral blood mononuclear cells (PBMCs) cells were cultured with 0, 1, 10, 50, or 100 μM 3‐O‐C12‐HSL for 12 h. TLR2/TLR4 expression and T‐lymphocyte proliferation were increased in a dose‐dependent manner, and 100 μM 3‐O‐C12‐HSL significantly increased TLR2 expression. Moreover, tumor necrosis factor‐α production of these PBMCs was inhibited. To conclude, 3‐O‐C12‐HSL can induce lymphocyte cell proliferation. These findings provide a new perspective on our understanding of the persistence of the chronic inflammation that accompanies P. aeruginosa infection.
Assessment of biofilm removal capacity of a broad host range bacteriophage JHP against Pseudomonas aeruginosa
Authors: Shafique Muafia , Alvi Iqbal Ahmad , Abbas Zaigham , ur Rehman Shafiq
Published: April 2017

Pseudomonas aeruginosa is an efficient biofilm‐dwelling microbial pathogen, associated with nosocomial infections. These biofilm‐associated infections are resistant to antibiotics and immune defenses, therefore pose major problem against their treatment. This scenario demands alternative therapeutic regimens, and bacteriophage therapy is one among potential strategies for clinical management of multiple drug resistance. In this investigation, the efficacy of a bacteriophage, JHP, is evaluated to eradicate P. aeruginosa biofilms. Growth kinetics of P. aeruginosa biofilm revealed that the highest cell density biofilm (1.5 × 1016 CFU/mL) was established within the polystyrene microtiter plate at 72 h post inoculation. Pseudomonas aeruginosa biofilms of different ages, treated with JHP (0.6 MOI) for different post‐infection durations, reduced biomass from 2 to 4.5 logs (60–90%). JHP treatment before biofilm development reduced the bacterial load up to 9 logs (>95% bacterial load reduction) as compared with untreated control, which highlights its potential to prevent biofilm formation in indwelling medical devices. Combinations of JHP with other phages or antibiotics could be an efficient alternative for P. aeruginosa biofilm removal in clinical and industrial settings.
Evaluation of gender‐based disparities in time from initial haematuria presentation to upper tract urothelial carcinoma diagnosis: analysis of a nationwide insurance claims database
Authors: Chappidi Meera R. , Kates Max , Tosoian Jeffrey J. , Johnson Michael H. , Hahn Noah M. , Bivalacqua Trinity J. , Pierorazio Phillip M.
Published: April 2017

Objective

To investigate the length of time from initial haematuria presentation to upper tract urothelial carcinoma (UTUC) diagnosis and the effect of gender on this duration.

Patients and Methods

Patients with haematuria claims in the year prior to UTUC diagnosis were identified from the MarketScan database (2010–2014). Delayed diagnosis was defined as >90 days from haematuria presentation to UTUC diagnosis. Multivariable Poisson regression models were used to determine factors associated with delayed UTUC diagnosis.

Results

Among 1 326 patients with UTUC, 469 (35.4%) experienced delayed diagnosis. Men (n = 866) had a longer median interval from haematuria to diagnosis than women (60 vs 49 days; P = 0.04). In the multivariable model, male gender (relative risk [RR] 1.13, 95% confidence interval [CI] 0.95–1.34) was not associated with delayed diagnosis, while urinary tract infection (UTI; RR 1.52, 95% CI 1.32–1.76), nephrolithiasis (RR 1.23, 95% CI 1.06–1.44), new (RR 1.37, 95% CI 1.12–1.66) and recurrent prostate‐related diagnoses (RR 1.61, 95% CI 1.23–2.10) were. For men presenting to non‐urologists, UTI (RR 1.44, 95% CI 1.22–1.71), nephrolithiasis (RR 1.25 95% CI 1.05–1.49), new (RR 1.41, 95% CI 1.12–1.78) and recurrent prostate‐related diagnoses (RR 1.94, 95% CI 1.45–2.58) were associated with delayed diagnosis; however, for men presenting to urologists, nephrolithiasis (RR 1.08 95% CI 0.78–1.49), new (RR 1.15, 95% CI 0.79–1.68) and recurrent prostate‐related diagnoses (RR 1.17, 95% CI 0.69–1.97) were not associated with delayed diagnosis, while UTI diagnosis (RR 1.74, 95% CI 1.31–2.31) was still associated with delayed diagnosis.

Conclusion

A UTUC diagnosis was made >90 days after haematuria presentation in approximately one‐third of patients. Men experienced a longer median interval from haematuria to UTUC diagnosis compared with women, but male gender was not an independent predictor of delayed diagnosis. Benign diagnoses during haematuria evaluation were strongly associated with delayed diagnosis, especially among patients initially seen by non‐urologists. Future interventions should focus on development of non‐invasive techniques to improve clinical risk stratification of patients presenting with haematuria and to educate practitioners, especially non‐urologists, with regard to the importance of a thoughtful haematuria evaluation and the common mimickers of UTUC, to help reduce delays in diagnosis.
Genetically engineered mouse models of craniopharyngioma: an opportunity for therapy development and understanding of tumor biology
Authors: Apps John Richard , Martinez‐Barbera Juan Pedro
Published: April 2017

Adamantinomatous craniopharyngioma (ACP) is the commonest tumor of the sellar region in childhood. Two genetically engineered mouse models have been developed and are giving valuable insights into ACP biology. These models have identified novel pathways activated in tumors, revealed an important function of paracrine signalling and extended conventional theories about the role of organ‐specific stem cells in tumorigenesis. In this review, we summarize these mouse models, what has been learnt, their limitations and open questions for future research. We then discussed how these mouse models may be used to test novel therapeutics against potentially targetable pathways recently identified in human ACP.
Real‐time measurement of needle forces and acute pressure changes during intravitreal injections
Authors: Christensen Logan , Cerda Ashlee , Olson Jeffrey L
Published: April 2017

Background

The purpose of this study was to use a physiological pressure transducer to measure real‐time, continuous pressure changes in an ex vivo study model of porcine eyes to record the amount of force needed for scleral penetration and to measure acute intraocular pressure rise during intravitreal injections.

Methods

A pressure transducer was inserted into the anterior chamber of 30 fresh porcine eyes, and intraocular pressure was measured 2 s prior to intravitreal injection until 2 s after. A force transducer plate was used to insert various gauge needles into the vitreous cavity and the amount of force in Newtons (N) required for scleral penetration was recorded.

Results

For scleral perforation, 32‐ and 30‐gauge needles required 0.44 N and 0.45 N, significantly less than larger gauge needles (P < 0.05). Similarly, 27‐ and 25‐gauge needles required more force than smaller gauge needles but less than 19 gauge (P < 0.05). Intraocular pressure increased an average of 64.5 mmHg during intravitreal injection. Two seconds postinjection intraocular pressure readings showed a residual intraocular pressure increase of 11.1 mmHg from pre‐injection baseline.

Conclusion

Real‐time continuous recordings of pressure reveal that an instantaneous intraocular pressure spike occurs during intravitreal injection and appears to be separate from the intraocular pressure spike that occurs during needle insertion. This pressure spike is transient and has not been captured by previous methods of intraocular pressure measurement, which rely on single time point measurements. The clinical significance of this brief intraocular pressure spike is unclear and warrants further investigation.
MULTIPLE THRESHOLDS IN THE NEXUS BETWEEN WORKING HOURS AND PRODUCTIVITY
Authors: Lee Dongyeol , Lim Hyunjoon
Published: April 2017

Changes in working hours may have two contrasting effects on productivity: a “fatigue effect” and a “learning effect.” An increase in working hours may lead to the accumulation of workers' proficiency and skill in his or her job, while it may cause the level of workers' fatigue to increase. Our estimation results find multiple thresholds in the linkage between working time and productivity, supporting the existence of learning effect as well as fatigue effect from working time extension. The results of our study provide some implications for the recent discussion on reform of the working time system: for example, (i) the overall effects of changes in working time depend upon a variety of factors, such as the initial level of working hours and the features of the industry concerned; and (ii) job sharing may induce employers to substitute part‐timers for full‐time workers, thereby hindering workers' accumulation of skills. (JELJ24, D24, D92, O47)
Cash Transfers and Child Nutrition: Pathways and Impacts
Authors: de Groot Richard , Palermo Tia , Handa Sudhanshu , Ragno Luigi Peter , Peterman Amber
Published: April 2017

Childhood malnutrition remains a significant global problem, with an estimated 162 million children under the age of five suffering from stunted growth. This article examines the extent to which cash transfer programmes can improve child nutrition. It adopts a framework that captures and explains the pathways and determinants of child nutrition. The framework is then used to organize and discuss relevant evidence from the impact evaluation literature, focusing on impact pathways and new and emerging findings from sub‐Saharan Africa to identify critical elements that determine child nutrition outcomes as well as knowledge gaps requiring further research, such as children's dietary diversity, caregiver behaviours and stress.
A ‘new’ economic history of the Middle East and North Africa (MENA) region
Authors: Saleh Mohamed
Published: April 2017

This article argues that there is a need to develop a ‘new’ economic and social history of the Middle East and North Africa (MENA) region that is based on exploiting novel sources of data, including (a) primary papyrological sources from the medieval period, (b) primary sources at the region's local archives and European (colonial) archives, and (c) primary sources from the ancient (pre‐Islamic) period. The proposed ‘new’ history of the MENA region must be inter‐disciplinary for two reasons: (a) digitizing and employing these novel data sources in research requires the collaboration of social scientists, historians, archaeologists, anthropologists, demographers and papyrologists, as well as the co‐operation of MENA‐based scholars who have better access to MENA's local archives, and (b) even if these novel sources are digitized, data limitations are likely to impose a constraint on the reach of quantitative analysis and thus necessitate an inter‐disciplinary methodology that combines quantitative evidence with historical analysis.
“What is the point of life?”: An interpretative phenomenological analysis of suicide in young menwith first‐episode psychosis
Authors: Gajwani Ruchika , Larkin Michael , Jackson Chris
Published: April 2017

Background

Lifetime risk of suicide in first‐episode psychosis far exceeds the general population, with the risk of suicide persisting long after first presentation. There is strong evidence to suggest that women more frequently attempt suicide, while men are at a greater risk of completing suicide. First‐hand experiential evidence is needed in order to better understand men's motives for, and struggles with, suicidality in early psychosis.

Methods

Semi‐structured interviews were conducted with 7 participants. The interviews explored each respondent's account of their suicide attempt within the broader context of their life, in relation to their past, present and future. In line with the exploratory, inductive nature of the study, an Interpretative Phenomenological Analysis was used to explore the meaning of suicide attempts in these accounts.

Results

Three super‐ordinate themes emerged: Self‐as‐vulnerable (intra‐ and inter‐personal relationships), appraisal of cumulative life events as unbearable and meaning of recovery marked by shared sense of hope and imagery for the future.

Conclusions

Young men in the early stages of their treatment are seeking to find meaning for frightening, intrusive experiences with origins which often precede psychosis. These experiences permeate personal identity, relationships and recovery. Suicide was perceived as an escape from this conundrum, and was pursued angrily and impulsively. By contrast, the attainment of hope was marked by sharing one's burden and finding a sense of belonging. Specialized assertive outreach programmes may be beneficial in improving the social inclusion of young men who may be particularly marginalized.
The impact of OECD‐PISA results on Japanese educational policy
Authors: Tasaki Noritomo
Published: April 2017

The author describes the results of PISA, including those of 2015 and Japan's reaction, as well as their impact. Highly‐ranked in PISA, Japan has always tried to improve its education system. The promotion of reading comprehension remains an important issue and low interest and motivation to learn subjects are crucial problems. The author discusses these questions and reform policies from a Japanese point of view. He explains the latest reform plan which will be implemented in 2020. The Japanese peculiarity in education is referred to in the conclusion.
Clinical frailty is independently associated with non‐prescription of anticoagulants in older patients with atrial fibrillation
Authors: Induruwa Isuru , Evans Nicholas R. , Aziz Ayesha , Reddy Snigdha , Khadjooi Kayvan , Romero‐Ortuno Roman
Published: April 2017

Aim

Anticoagulants are underused in older patients with atrial fibrillation (AF). Scoring systems, such as CHA2DS2‐VASc and HAS‐BLED, are recommended to guide clinicians in anticoagulation decisions, but patients’ frailty might be an underrecognized factor. We investigated the association between the Clinical Frailty Scale (CFS) and community anticoagulant prescribing habits in patients aged ≥75 years with AF admitted acutely to hospital.

Methods

Data were gathered retrospectively over 3 months on individuals admitted under a medical team to a tertiary teaching hospital in the UK. Demographics, AF history, CHA2DS2−VASc, HAS‐BLED and CFS were collected. Bivariable analysis compared anticoagulated and non‐anticoagulated groups. Each component of the CHA2DS2‐VASc and HAS‐BLED scores, as well as frailty, age and sex, were entered in a multivariable analysis.

Results

A total of 419 patients with known AF were included. Of these, 215 were not anticoagulated (51.3%) on admission. Non‐anticoagulated individuals were older (median age 87 years, [interquartile range (IQR) 7] vs 83 years [IQR 6], P < 0.001), more likely to be frail (81.4% vs 52.5%, P < 0.001) and had lower CHA2DS2‐VASc scores (median 4, [IQR 2] vs 5 [IQR 2], P = 0.01). In the multivariable analysis, frailty had the strongest effect against anticoagulant prescription (OR 0.77, 95% CI 0.70–0.85, P < 0.001) compared with other significant risk factors, such as age (OR 0.98, 95% CI 0.97–0.98, P < 0.001) and bleeding risk (OR 0.85, 95% CI 0.74–0.97, P = 0.02).

Conclusions

Frailty is associated with non‐prescription of anticoagulants, independently of CHA2DS2‐VASc and HAS‐BLED. It could be an important unmeasured factor in anticoagulation decisions. The utility of explicit frailty measurements in anticoagulation decisions and patient outcomes requires further research. Geriatr Gerontol Int 2017; 17: 2178–2183.
Genetic analysis of a morphologically heterogeneous ovarian endometrioid carcinoma
Authors: Geyer Felipe C , Pareja Fresia , Burke Kathleen A , Schultheis Anne M , Hussein Yaser R , Ye Jiqing , De Filippo Maria R , Marchio Caterina , Macedo Gabriel S , Piscuoglio Salvatore , Lim Raymond S , Toy Eugene , Murali Rajmohan , Jungbluth Achim A , Reis‐Filho Jorge S , Soslow Robert A , Weigelt Britta
Published: April 2017

Aims

Low‐grade ovarian endometrioid carcinomas may be associated with high‐grade components. Whether the latter are clonally related to and originate from the low‐grade endometrioid carcinoma remains unclear. The aim of this study was to use massively parallel sequencing to characterize the genomic landscape and clonal relatedness of an ovarian endometrioid carcinoma containing low‐grade and high‐grade components.

Methods and results

DNA samples extracted from each tumour component (low‐grade endometrioid, high‐grade anaplastic and high‐grade squamous) and matched normal tissue were subjected to targeted massively parallel sequencing with the 410‐gene Memorial Sloan Kettering‐Integrated Mutation Profiling of Actionable Cancer Targets (MSK‐IMPACT) sequencing assay. Somatic single nucleotide variants, small insertions and deletions, and copy number alterations were detected with state‐of‐the‐art bioinformatics algorithms, and validated with orthogonal methods. The endometrioid carcinoma and the associated high‐grade components shared copy number alterations and four clonal mutations, including SMARCA4 mutations, which resulted in loss of BRG1 protein expression. Subclonal mutations and mutations restricted to single components were also identified, such as distinct TP53 mutations restricted to each histological component.

Conclusions

Histologically distinct components of ovarian endometrioid carcinomas may show intratumour genetic heterogeneity but be clonally related, harbouring a complex clonal composition. In the present case, SMARCA4 mutations were probably early events, whereas TP53 somatic mutations were acquired later in evolution.
Editorial Perspective: Longitudinal research in autism – introducing the concept of ‘chronogeneity’
Authors: Georgiades Stelios , Bishop Somer L. , Frazier Thomas
Published: April 2017

Autism Spectrum Disorder (ASD or autism) is a heterogeneous neurodevelopmental disorder. We are now at a critical juncture in autism research where we have the knowledge base and expertise to begin to think about studies that view heterogeneity, not as ‘statistical noise’ that can be ‘accounted for’ using data‐reduction techniques (such as group trajectories), but rather as ‘informative variance’ that can help form a more precise and dynamic picture of autism. In this Editorial we coin a new term and introduce the concept of ‘chronogeneity’ for the study of autism heterogeneity in relation to the dimension of time (chrono). Using examples of ongoing research and analytical advances we build the case for the potential utility of the concept of ‘chronogeneity’ and argue that a refined approach to the longitudinal investigation of autism (and other neurodevelopmental disorders) may move us closer to more precise and adaptive models of care for the children and youth affected by these disorders.
A National Survey on the Effect of the Geriatric Academic Career Award in Advancing Academic Geriatric Medicine
Authors: Foley Kevin T. , Luz Clare C. , Hanson Katherine V. , Hao Yuning , Ray Elisia M.
Published: April 2017

A workforce that understands principles of geriatric medicine is critical to addressing the care needs of the growing elderly population. This will be impossible without a substantial increase in academicians engaged in education and aging research. Limited support of early‐career clinician–educators is a major barrier to attaining this goal. The Geriatric Academic Career Award (GACA) was a vital resource that benefitted 222 junior faculty members. GACA availability was interrupted in 2006, followed by permanent discontinuation after the Geriatrics Workforce Education Program (GWEP) subsumed it in 2015, leaving aspiring clinician–educators with no similar alternatives. GACA recipients were surveyed in this cross‐sectional, multimethod study to assess the effect of the award on career development, creation and dissemination of educational products, funding discontinuation consequences, and implications of program closure for the future of geriatric health care. Uninterrupted funding resulted in fulfillment of GACA goals (94%) and overall career success (96%). Collectively, awardees reached more than 40,700 learners. Funding interruption led to 55% working additional hours over and above an increased clinical workload to continue their GACA‐related research and scholarship. Others terminated GACA projects (36%) or abandoned academic medicine altogether. Of respondents currently at GWEP sites (43%), only 13% report a GWEP budget including GACA‐like support. Those with GWEP roles attributed their current standing to experience gained through GACA funding. These consequences are alarming and represent a major setback to academic geriatrics. GACA's singular contribution to the mission of geriatric medicine must prompt vigorous efforts to restore it as a distinct funding opportunity.
Algal supplementation of vegetarian eating patterns improves plasma and serum docosahexaenoic acid concentrations and omega‐3 indices: a systematic literature review
Authors: Craddock J. C. , Neale E. P. , Probst Y. C. , Peoples G. E.
Published: April 2017

Background

Vegetarians are likely to have lower intakes of preformed docosahexaenoic acid (DHA) than omnivorous populations who consume fish and animal products. As such, vegetarian populations have omega‐3 indices up to 60% lower than those who consume marine products. Algae, the primary producer of DHA in the marine food chain, offer an alternative source of DHA for those who do not consume marine or animal products. This systematic review aims to examine the evidence for the relationship between supplementation with algal forms of DHA and increased DHA concentrations in vegetarian populations.

Methods

The SCOPUS, Science Direct and Web of Science scientific databases were searched to identify relevant studies assessing the effect of algal DHA consumption by vegetarian (including vegan) populations.

Results

Four randomised controlled trials and two prospective cohort studies met the inclusion criteria. All included studies reported algal sources of DHA significantly improve DHA concentrations (including plasma, serum, platelet and red blood cell fractions), as well as omega‐3 indices, in vegetarian populations. An evident time or dose response was not apparent given the small number of studies to date.

Conclusions

Future studies should address long chain n‐3 polyunsaturated fatty acid deficiencies in vegetarian populations using algal DHA and explore the potential physiological and health improvements in these individuals.
Bilateral cataract surgery with intraocular lens implant in a captive western lowland gorilla
Authors: Warwick Alasdair , Redrobe Sharon , Lotery Andrew , Watts Jenny
Published: April 2017

We report a case of bilateral cataract surgery performed in a 21‐year‐old western lowland gorilla. Phacoemulsification with intraocular lens insertion was performed using standard human surgical equipment. Visual function significantly improved. She subsequently mated and gave birth. Ultimately, cataract surgery enabled the birth of a baby gorilla.
Acupressure as adjuvant treatment for the inpatient management of nausea and vomiting in early pregnancy: A double‐blind randomized controlled trial
Authors: Adlan Aizura‐Syafinaz , Chooi Kar Yoke , Mat Adenan Noor Azmi
Published: April 2017

Aim

To evaluate the efficacy of acupressure at the Neiguan point (Pericardium [P]6) as adjuvant treatment during inpatient management of severe nausea and vomiting in pregnancy.

Methods

Low risk, spontaneously conceived singleton pregnancies were randomly assigned to a treatment group, who received an acupressure band placed at the Neiguan point (P6) or a placebo group who received an otherwise identical non‐stimulating wristband. Participants wore the band for 12 h daily for the first three days of admission. The primary outcome measure was the severity of symptoms of nausea, vomiting and retching, recorded according to Pregnancy‐Unique Quantification of Emesis and Nausea score.

Results

There was a statistically significant improvement in Pregnancy‐Unique Quantification of Emesis and Nausea scores from day 1 until day 3 of admission in the treatment group compared with the placebo. Patients who received Neiguan point acupressure also showed a significant improvement in their ketonuria scores. The treatment group required a shorter hospital stay compared with the placebo. The only reported side effect of the acupressure band was redness on the wrist.

Conclusions

The use of the acupressure band at the Neiguan point (P6) for 12 h daily for three days for inpatients with hyperemesis gravidarum significantly reduced the symptoms of nausea, vomiting and retching and ketonuria and led to a reduction in hospital stay. We recommend the use of the acupressure band at the Neiguan point (P6) as an adjunct/supplementary therapy to co‐exist with the standard care of management for hyperemesis gravidarum, particularly in low‐risk pregnant women.
Pyoderma gangrenosum in a pregnant patient: A case report and literature review
Authors: Takeshita Naoki , Takashima Akiko , Ishida Hiroaki , Manrai Megumi , Kinoshita Toshihiko
Published: April 2017

Pyoderma gangrenosum (PG) is a rare ulcerative skin disease that usually starts as a pustular lesion and rapidly progresses to a painful ulcer with undermined violaceous borders. The occurrence of PG during pregnancy is uncommon. We describe a case of a pregnant patient with PG who was diagnosed as having ulcerative colitis after delivery. Obstetricians need to understand the pathogenesis of PG and its associated conditions because it is important to make a proper diagnosis and provide targeted therapy.
Nutritional parameters as mortality predictors in haemodialysis: Differences between genders
Authors: Oliveira Telma Sobral , Valente Ana Tentúgal , Caetano Cristina Guerreiro , Garagarza Cristina Antunes
Published: April 2017

Background

Malnutrition is common in patients undergoing haemodialysis (HD). Several studies have described different nutritional parameters as mortality predictors but few have studied whether there are differences between genders. This study aimed to evaluate which nutrition parameters may be associated with mortality in patients undergoing long‐term HD depending on their gender.

Methods

Longitudinal prospective multicentre study with 12 months of follow‐up. Anthropometric and laboratory measures were obtained from 697 patients.

Results

Men who died were older, had lower dry weight, body mass index, potassium, phosphorus and albumin, compared with male patients who survived. Female patients who died had lower albumin and nPCR compared with survivors. Kaplan–Meier analysis displayed a significantly worse survival in patients with albumin <3.5 g/dl in both genders and with body mass index <23 kg/m2 in men. In the Cox regression analysis patients overall mortality was related to body mass index <23 kg/m2, potassium ≤5.5 mEq/l and phosphorus <3.0 mg/dl for male patients and albumin <3.5 g/dl and normalised protein catabolic rate (nPCR) <0.8 g/kg/day for both genders. Associations between albumin, body mass index and mortality risk continued to be significant after adjustments for age, length of time on dialysis and diabetes for males. However, in women, only albumin persisted as an independent predictor of death.

Conclusion

Depending on the gender, different parameters such as protein intake, potassium, phosphorus, body mass index and albumin are associated with mortality in patients undergoing HD. Albumin <3.5 g/dl is an independent mortality predictor in both genders, whereas a body mass index <23 kg/m2 is an independent predictor of death, but only in men.